Pub Date : 2025-11-22DOI: 10.1016/j.ahj.2025.107310
Balimkiz Senman MD , Shashank S. Sinha MD, MSc , Alexander G. Truesdell MD , Israel Safiriyu MD , Stavros Drakos MD, PhD , Allison G. Dupont MD , Mir Babar Basir DO , P. Elliott Miller MD, MHS , Aniket S. Rali MD , Courtney Bennett DO , Behnam Tehrani MD , Jennifer Cowger MD, MS , Shelley A. Hall MD , Carolyn Rosner RN, BSN, MSN, NP-C, MBA , Amy E. Hackmann MD , David E. Wang MD , Alexander I. Papolos MD , Bernard S. Kadosh MD , Saraschandra Vallabhajosyula MD, MSc , Michelle Ferri MS, ACNP-BC , Jason N. Katz MD, MHS
Cardiogenic shock (CS) remains a high-mortality condition that demands rapid diagnosis, coordinated multidisciplinary management, and timely initiation of mechanical circulatory support. As more institutions implement dedicated CS teams, substantial heterogeneity has emerged in how these teams are structured, activated, and sustained. To better characterize this variability and begin defining the components of an optimal CS team, the Society of Critical Care Cardiology (SoCCC), in partnership with the Society for Cardiovascular Angiography and Interventions (SCAI), convened the Inaugural Cardiogenic Shock Teams Think Tank. Held on October 17, 2024, as a preconference program to SCAI SHOCK 2024 in Washington, DC, the meeting brought together national leaders in CS care, mechanical circulatory support, and resuscitation to identify shared challenges and propose practical solutions.
This manuscript summarizes key insights from this inaugural Think Tank, which represents the first in an ongoing series of collaborative efforts aimed at informing the standardization and optimization of CS teams nationwide. Specifically, we review the ideal composition and core competencies of a CS team; the rationale and emerging evidence supporting dedicated team-based CS care; activation algorithms and operational workflows; and common barriers to establishing and sustaining such teams. We also outline future directions and opportunities to strengthen collaborative infrastructure, refine clinical pathways, and enhance the reliability, responsiveness, and effectiveness of cardiogenic shock teams across diverse healthcare settings.
{"title":"Towards an understanding of best practice: The good, the bad and the future of cardiogenic shock teams","authors":"Balimkiz Senman MD , Shashank S. Sinha MD, MSc , Alexander G. Truesdell MD , Israel Safiriyu MD , Stavros Drakos MD, PhD , Allison G. Dupont MD , Mir Babar Basir DO , P. Elliott Miller MD, MHS , Aniket S. Rali MD , Courtney Bennett DO , Behnam Tehrani MD , Jennifer Cowger MD, MS , Shelley A. Hall MD , Carolyn Rosner RN, BSN, MSN, NP-C, MBA , Amy E. Hackmann MD , David E. Wang MD , Alexander I. Papolos MD , Bernard S. Kadosh MD , Saraschandra Vallabhajosyula MD, MSc , Michelle Ferri MS, ACNP-BC , Jason N. Katz MD, MHS","doi":"10.1016/j.ahj.2025.107310","DOIUrl":"10.1016/j.ahj.2025.107310","url":null,"abstract":"<div><div>Cardiogenic shock (CS) remains a high-mortality condition that demands rapid diagnosis, coordinated multidisciplinary management, and timely initiation of mechanical circulatory support. As more institutions implement dedicated CS teams, substantial heterogeneity has emerged in how these teams are structured, activated, and sustained. To better characterize this variability and begin defining the components of an optimal CS team, the Society of Critical Care Cardiology (SoCCC), in partnership with the Society for Cardiovascular Angiography and Interventions (SCAI), convened the Inaugural Cardiogenic Shock Teams Think Tank. Held on October 17, 2024, as a preconference program to SCAI SHOCK 2024 in Washington, DC, the meeting brought together national leaders in CS care, mechanical circulatory support, and resuscitation to identify shared challenges and propose practical solutions.</div><div>This manuscript summarizes key insights from this inaugural Think Tank, which represents the first in an ongoing series of collaborative efforts aimed at informing the standardization and optimization of CS teams nationwide. Specifically, we review the ideal composition and core competencies of a CS team; the rationale and emerging evidence supporting dedicated team-based CS care; activation algorithms and operational workflows; and common barriers to establishing and sustaining such teams. We also outline future directions and opportunities to strengthen collaborative infrastructure, refine clinical pathways, and enhance the reliability, responsiveness, and effectiveness of cardiogenic shock teams across diverse healthcare settings.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107310"},"PeriodicalIF":3.5,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1016/j.ahj.2025.107308
Benjamin L. Magod MD , Zachary H. Hughes MD , Anusha Manjunath MD , Tingqing Wu , Rebecca Harrap , Benjamin Bryner MD , Sabra Lewsey MD, MPH , Kambiz Ghafourian MD, MPH , Olise Oputa , Duc Pham MD , Kiersten Rasberry , Anjan Tibrewala MD, MS , Jane Wilcox MD, MSc , Quentin R. Youmans MDMSc , Ike S. Okwuosa MD
Background
Malignancy threatens to limit survival in heart transplant recipients. Improved understanding of cancer risk is needed to direct prevention and screening strategies following heart transplantation. This study aims to describe the incidence, demographics, and risk factors associated with de novo malignancy, lymphoproliferative disorders, and solid-organ malignancy subtypes.
Methods
We analyzed the incidence, types, and predictors of malignancy in 50,370 heart transplant recipients from the United Network for Organ Sharing registry.
Results
The incidence of de novo post-transplant malignancy at 10 years was 20.6%. The incidence at 10 years by malignancy type was: nonmelanoma skin cancer (9.0%), solid-organ cancer (6.2%), and lymphoproliferative disorder (1.2%). Older age (OR, 1.05; 95%CI, 1.049-1.060), male gender (female vs male; OR, 0.63; 95%CI, 0.58-0.68), induction immunosuppression with OKT3 (OR, 1.47; 95%CI, 1.23-1.76) or >1 induction agent (OR, 1.44; 95%CI, 1.14-1.82), history of cigarette use (OR, 1.19; 95%CI, 1.11-1.28) and hospitalization for infection (OR, 1.26; 95% CI, 1.18-1.34) were associated with increased incidence of de novo malignancy.
Conclusions
De novo malignancy is common, occurring in one-fifth of recipients after heart transplant. Risk factors for de novo malignancy included older age, male gender, induction immunosuppression, and history of cigarette use. Hospitalization for infection is a risk factor that has not been previously described. Improved prevention and personalized screening strategies are needed to reduce the adverse outcome of post-transplant malignancy.
{"title":"Incidence and risk factors for malignancy after heart transplantation- Analysis of the UNOS Registry","authors":"Benjamin L. Magod MD , Zachary H. Hughes MD , Anusha Manjunath MD , Tingqing Wu , Rebecca Harrap , Benjamin Bryner MD , Sabra Lewsey MD, MPH , Kambiz Ghafourian MD, MPH , Olise Oputa , Duc Pham MD , Kiersten Rasberry , Anjan Tibrewala MD, MS , Jane Wilcox MD, MSc , Quentin R. Youmans MDMSc , Ike S. Okwuosa MD","doi":"10.1016/j.ahj.2025.107308","DOIUrl":"10.1016/j.ahj.2025.107308","url":null,"abstract":"<div><h3>Background</h3><div>Malignancy threatens to limit survival in heart transplant recipients. Improved understanding of cancer risk is needed to direct prevention and screening strategies following heart transplantation. This study aims to describe the incidence, demographics, and risk factors associated with de novo malignancy, lymphoproliferative disorders, and solid-organ malignancy subtypes.</div></div><div><h3>Methods</h3><div>We analyzed the incidence, types, and predictors of malignancy in 50,370 heart transplant recipients from the United Network for Organ Sharing registry.</div></div><div><h3>Results</h3><div>The incidence of de novo post-transplant malignancy at 10 years was 20.6%. The incidence at 10 years by malignancy type was: nonmelanoma skin cancer (9.0%), solid-organ cancer (6.2%), and lymphoproliferative disorder (1.2%). Older age (OR, 1.05; 95%CI, 1.049-1.060), male gender (female vs male; OR, 0.63; 95%CI, 0.58-0.68), induction immunosuppression with OKT3 (OR, 1.47; 95%CI, 1.23-1.76) or >1 induction agent (OR, 1.44; 95%CI, 1.14-1.82), history of cigarette use (OR, 1.19; 95%CI, 1.11-1.28) and hospitalization for infection (OR, 1.26; 95% CI, 1.18-1.34) were associated with increased incidence of de novo malignancy.</div></div><div><h3>Conclusions</h3><div>De novo malignancy is common, occurring in one-fifth of recipients after heart transplant. Risk factors for de novo malignancy included older age, male gender, induction immunosuppression, and history of cigarette use. Hospitalization for infection is a risk factor that has not been previously described. Improved prevention and personalized screening strategies are needed to reduce the adverse outcome of post-transplant malignancy.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107308"},"PeriodicalIF":3.5,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/j.ahj.2025.107307
Jing Li MD , Zhen-Yu Wang MD , Ju Yan MD , Wen-Hao Li MD , Feng-Chao Wu MD , Ji-Zhao Deng MD , Li Yan MD , Hao-Yu Wu MD , Lei Liang MD
Background
The effectiveness and safety of drug-coated balloon (DCB) have been extensively studied in the treatment of de novo small-vessel coronary lesions. Proper lesion preparation is essential prior to performing DCB angioplasty; however, the optimal approach for intravascular ultrasound (IVUS)-guided lesion preparation remains unclear. The safety and efficacy of IVUS-guided DCB treatment for de novo small-vessel coronary lesions continue to be uncertain. To address these gaps, this trial has been designed to evaluate the efficacy and safety of IVUS-guided DCB angioplasty for de novo small-vessel coronary lesions. Additionally, the trial seeks to establish optimal critical values for IVUS-derived lumen parameters (such as minimum lumen area, plaque burden, and the length and thickness of dissection) prior to the use of DCB for de novo small-vessel coronary lesions.
Methods and Design
This trial is designed to test the hypothesis that IVUS-guided DCB results in a lower rate of major adverse cardiac events (MACE) for de novo small-vessel coronary lesions. It is a prospective, multicenter, randomized controlled study involving 998 patients indicated for PCI with de novo coronary lesions suitable for DCB treatment. Participants will be randomly allocated in a 1:1 ratio to either the research group (IVUS-guided group) or the control group (angiography-guided group). The primary endpoint is defined as the incidence of MACE (comprising cardiac death, target vessel-related myocardial infarction, or ischemia-driven target lesion revascularization) at the 12-month follow-up. Secondary endpoints include clinical outcomes such as all-cause mortality, any myocardial infarction, or ischemia-driven target vessel revascularization at the 12-month follow-up. Additionally, periprocedural outcomes, including the angiographic success rate, clinical procedural success rate, and target vessel drug-eluting stent implantation rate, will also be assessed.
Conclusions
This clinical trial aims to provide evidence on whether IVUS-guided DCB reduces the incidence of MACE in de novo small-vessel coronary lesions.
{"title":"Prospective, multicenter, randomized controlled study on the efficacy and safety of intravascular ultrasound-guided drug-coated balloon for de novo small-vessel coronary lesions: Design and rationale of the DCB-IVUS trial","authors":"Jing Li MD , Zhen-Yu Wang MD , Ju Yan MD , Wen-Hao Li MD , Feng-Chao Wu MD , Ji-Zhao Deng MD , Li Yan MD , Hao-Yu Wu MD , Lei Liang MD","doi":"10.1016/j.ahj.2025.107307","DOIUrl":"10.1016/j.ahj.2025.107307","url":null,"abstract":"<div><h3>Background</h3><div>The effectiveness and safety of drug-coated balloon (DCB) have been extensively studied in the treatment of de novo small-vessel coronary lesions. Proper lesion preparation is essential prior to performing DCB angioplasty; however, the optimal approach for intravascular ultrasound (IVUS)-guided lesion preparation remains unclear. The safety and efficacy of IVUS-guided DCB treatment for de novo small-vessel coronary lesions continue to be uncertain. To address these gaps, this trial has been designed to evaluate the efficacy and safety of IVUS-guided DCB angioplasty for de novo small-vessel coronary lesions. Additionally, the trial seeks to establish optimal critical values for IVUS-derived lumen parameters (such as minimum lumen area, plaque burden, and the length and thickness of dissection) prior to the use of DCB for de novo small-vessel coronary lesions.</div></div><div><h3>Methods and Design</h3><div>This trial is designed to test the hypothesis that IVUS-guided DCB results in a lower rate of major adverse cardiac events (MACE) for de novo small-vessel coronary lesions. It is a prospective, multicenter, randomized controlled study involving 998 patients indicated for PCI with de novo coronary lesions suitable for DCB treatment. Participants will be randomly allocated in a 1:1 ratio to either the research group (IVUS-guided group) or the control group (angiography-guided group). The primary endpoint is defined as the incidence of MACE (comprising cardiac death, target vessel-related myocardial infarction, or ischemia-driven target lesion revascularization) at the 12-month follow-up. Secondary endpoints include clinical outcomes such as all-cause mortality, any myocardial infarction, or ischemia-driven target vessel revascularization at the 12-month follow-up. Additionally, periprocedural outcomes, including the angiographic success rate, clinical procedural success rate, and target vessel drug-eluting stent implantation rate, will also be assessed.</div></div><div><h3>Conclusions</h3><div>This clinical trial aims to provide evidence on whether IVUS-guided DCB reduces the incidence of MACE in de novo small-vessel coronary lesions.</div></div><div><h3>Trial Registration</h3><div>ChiCTR2300073877, URL: <span><span>https://www.chictr.org.cn/indexEN.html</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107307"},"PeriodicalIF":3.5,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In high-bleeding-risk (HBR) patients undergoing percutaneous coronary intervention (PCI), shortening dual antiplatelet therapy (DAPT) is essential, but the optimal approach in those requiring oral anticoagulation (OAC) is uncertain. We evaluated a 1-month dual antithrombotic regimen in HBR patients with and without OAC indication in a prespecified sub-analysis of the POEM trial.
Method
POEM enrolled HBR patients treated with a bioresorbable polymer everolimus-eluting stent. Patients were stratified by OAC indication: the non-OAC group (n = 281) received 1-month DAPT followed by single antiplatelet therapy; the OAC group (n = 158) received 1-month OAC plus a P2Y12 inhibitor followed by OAC monotherapy. Time-to-event outcomes were analyzed using the log-rank test, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox regression models. The primary analysis was conducted according to the intention-to-treat principle. A per-protocol analysis, excluding patients with DAPT duration >1 month, was performed as a sensitivity analysis.
Results
At 1 year, the primary endpoint, a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis, occurred in 6.1% of the non-OAC group versus 2.6% of the OAC group (HR 0.41, 95% CI 0.14–1.22; P = .097). Secondary ischemic outcomes were similar. BARC type 3–5 bleeding was infrequent (2.6% vs 1.3%; P = .369). The per-protocol analysis showed consistent results.
Conclusions
In HBR patients after PCI, transition to OAC monotherapy at 1 month was associated with low ischemic and bleeding risks, comparable to single antiplatelet therapy. These findings support early OAC monotherapy as a feasible strategy warranting randomized investigation.
背景：在接受经皮冠状动脉介入治疗（PCI）的高风险（HBR）患者中，缩短双重抗血小板治疗（DAPT）是必不可少的，但对于需要口服抗凝（OAC）的患者，最佳方法尚不确定。我们在预先指定的POEM试验亚分析中评估了有和没有OAC适应症的HBR患者1个月的双重抗血栓治疗方案。方法：POEM纳入了接受生物可吸收聚合物依维莫司洗脱支架治疗的HBR患者。根据OAC适应症对患者进行分层：非OAC组（n=281）接受1个月DAPT治疗，随后接受单次抗血小板治疗；OAC组（n=158）接受1个月的OAC + P2Y12抑制剂治疗，然后接受OAC单药治疗。使用log-rank检验分析事件发生时间结局，使用Cox回归模型计算95%置信区间的风险比（hr）。根据意向治疗原则进行初步分析。每个方案分析，排除DAPT持续时间为bb10 - 1个月的患者，进行敏感性分析。结果：1年后，主要终点为心源性死亡、心肌梗死或明确/可能的支架血栓形成，非OAC组为6.1%，OAC组为2.6% （HR 0.41, 95% CI 0.14-1.22; p=0.097）。继发性缺血结果相似。BARC 3-5型出血不常见（2.6% vs. 1.3%; p=0.369）。每个方案分析显示一致的结果。结论：在接受PCI治疗的HBR患者中，在1个月时过渡到OAC单药治疗与低缺血和出血风险相关，与单一抗血小板治疗相当。这些发现支持早期OAC单药治疗是可行的策略，需要随机调查。试验注册：稿号：2016-004510-99；clinicaltrials.gov: NCT03112707。
{"title":"Early oral anticoagulation monotherapy after PCI: Insights from the POEM trial","authors":"Carlo A. Pivato MD, PhD , Gianluca Mincione MD , Leon Gramss MD , Andrea Pacchioni MD , Raffaele Piccolo MD, PhD , Carmine Musto MD, PhD , Gennaro Sardella MD , Ciro Indolfi MD , Giulia Antonelli MD , Damiano Regazzoli MD , Valeria Paradies MD, PhD , Bernhard Reimers MD , Gianluigi Condorelli MD, PhD , Luca Testa MD, PhD , Carlo Briguori MD, PhD , Giulio Stefanini MD, MSc, PhD","doi":"10.1016/j.ahj.2025.107309","DOIUrl":"10.1016/j.ahj.2025.107309","url":null,"abstract":"<div><h3>Background</h3><div>In high-bleeding-risk (HBR) patients undergoing percutaneous coronary intervention (PCI), shortening dual antiplatelet therapy (DAPT) is essential, but the optimal approach in those requiring oral anticoagulation (OAC) is uncertain. We evaluated a 1-month dual antithrombotic regimen in HBR patients with and without OAC indication in a prespecified sub-analysis of the POEM trial.</div></div><div><h3>Method</h3><div>POEM enrolled HBR patients treated with a bioresorbable polymer everolimus-eluting stent. Patients were stratified by OAC indication: the non-OAC group (<em>n</em> = 281) received 1-month DAPT followed by single antiplatelet therapy; the OAC group (<em>n</em> = 158) received 1-month OAC plus a P2Y12 inhibitor followed by OAC monotherapy. Time-to-event outcomes were analyzed using the log-rank test, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox regression models. The primary analysis was conducted according to the intention-to-treat principle. A per-protocol analysis, excluding patients with DAPT duration >1 month, was performed as a sensitivity analysis.</div></div><div><h3>Results</h3><div>At 1 year, the primary endpoint, a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis, occurred in 6.1% of the non-OAC group versus 2.6% of the OAC group (HR 0.41, 95% CI 0.14–1.22; <em>P</em> = .097). Secondary ischemic outcomes were similar. BARC type 3–5 bleeding was infrequent (2.6% vs 1.3%; <em>P</em> = .369). The per-protocol analysis showed consistent results.</div></div><div><h3>Conclusions</h3><div>In HBR patients after PCI, transition to OAC monotherapy at 1 month was associated with low ischemic and bleeding risks, comparable to single antiplatelet therapy. These findings support early OAC monotherapy as a feasible strategy warranting randomized investigation.</div></div><div><h3>Trial Registration</h3><div>EudraCT Number: 2016‐004510‐99; <span><span>clinicaltrials.gov</span><svg><path></path></svg></span>: NCT03112707.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107309"},"PeriodicalIF":3.5,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145572642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Occlusion vs subocclusion of the left main. The ECG pattern has the word","authors":"Miquel Fiol MD, PhD , Alberto Rodríguez MD , Andrés Carrillo MD, PhD","doi":"10.1016/j.ahj.2025.107303","DOIUrl":"10.1016/j.ahj.2025.107303","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107303"},"PeriodicalIF":3.5,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-15DOI: 10.1016/j.ahj.2025.107304
Scott W. Sharkey MD , Frank Aguirre MD , Balaj Rai MD , Timothy D Henry MD
{"title":"Re. response to “Occlusion vs subocclusion of the left main, the ECG pattern has the word”","authors":"Scott W. Sharkey MD , Frank Aguirre MD , Balaj Rai MD , Timothy D Henry MD","doi":"10.1016/j.ahj.2025.107304","DOIUrl":"10.1016/j.ahj.2025.107304","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107304"},"PeriodicalIF":3.5,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-14DOI: 10.1016/j.ahj.2025.107302
Antoon J.M. van den Enden MD , Mark M.P. van den Dorpel MD , Giulio M. Mondellini MD , Antonio M. Mattace-Raso BSc , Rik Adrichem MD , Marcello B. Bastos MD , Jan J. Schreuder MD, PhD , Mattie J. Lenzen PhD , Isabella Kardys MD, PhD , Marcel L. Geleijnse MD, PhD , Rutger J. Nuis MD, PhD , Joost Daemen MD, PhD , Daniel Burkhoff MD, PhD , Nicolas M. Van Mieghem MD, PhD
Background
Severe aortic stenosis (AS) induces a disproportional pressure gradient across the aortic valve causing increased left ventricular (LV) afterload. Transcatheter Aortic Valve Replacement (TAVR) aims to immediately alleviate the aortic pressure gradient and thereby changing LV cardiac mechanics. The aim was to describe by in-vivo assessment of LV pressure-volume (PV) relationships how TAVR acutely affects LV cardiac mechanics.
Methods
In this prospective observational study in patients with severe AS, LV cardiac mechanics were evaluated with an LV conductance catheter before and after TAVR. The effects of transcatheter valve design, pre and postdilatation, use of rapid pacing (≥180 bpm) and LV ejection fraction (EF) were specifically addressed.
Results
In-vivo LV PV reconstructions were obtained in 61 patients. Stroke work (SW) and pressure volume area (PVA) were significantly lower following TAVR (decrease from median [25th-75th percentile] of 10,935.6 [6877.5-13490.8] to 6,878.0 [4,870.8-8,613.8] mmHg/mL, P < .001 and from 17,831.5 [12,414.9-22,416.8] to 11,024.9 [8364.7-14705.0] mmHg/mL, P < .001, respectively) with stable SW/PVA ratios. Overall, end-systolic and end-diastolic pressures and volumes were significantly lower after TAVR. Arterial Elastance, as an index for LV afterload also decreased (2.66 [2.01-3.87]-1.96 [1.25-2.72] mmHg/mL, P < .001). LV contractility declined as illustrated by a reduction in End-systolic Elastance (2.22 [1.50-3.10]-1.58 [1.08-2.43] mmHg/mL, P < .001). The trends in changing LV cardiac mechanics were similar for balloon- and self-expanding valves and were not affected by pre/post dilatation, rapid pacing or LV EF.
Conclusions
TAVR for severe AS resulted in immediate LV unloading, lower myocardial metabolic demand and impaired contractility.
Trial Registration
This observational study was registered at URL: https://www.clinicaltrials.gov with unique identifier: NCT06204783.
{"title":"Immediate changes in left ventricular cardiac mechanics following transcatheter aortic valve replacement for severe aortic stenosis – an in-vivo pressure-volume analysis study","authors":"Antoon J.M. van den Enden MD , Mark M.P. van den Dorpel MD , Giulio M. Mondellini MD , Antonio M. Mattace-Raso BSc , Rik Adrichem MD , Marcello B. Bastos MD , Jan J. Schreuder MD, PhD , Mattie J. Lenzen PhD , Isabella Kardys MD, PhD , Marcel L. Geleijnse MD, PhD , Rutger J. Nuis MD, PhD , Joost Daemen MD, PhD , Daniel Burkhoff MD, PhD , Nicolas M. Van Mieghem MD, PhD","doi":"10.1016/j.ahj.2025.107302","DOIUrl":"10.1016/j.ahj.2025.107302","url":null,"abstract":"<div><h3>Background</h3><div>Severe aortic stenosis (AS) induces a disproportional pressure gradient across the aortic valve causing increased left ventricular (LV) afterload. Transcatheter Aortic Valve Replacement (TAVR) aims to immediately alleviate the aortic pressure gradient and thereby changing LV cardiac mechanics. The aim was to describe by in-vivo assessment of LV pressure-volume (PV) relationships how TAVR acutely affects LV cardiac mechanics.</div></div><div><h3>Methods</h3><div>In this prospective observational study in patients with severe AS, LV cardiac mechanics were evaluated with an LV conductance catheter before and after TAVR. The effects of transcatheter valve design, pre and postdilatation, use of rapid pacing (≥180 bpm) and LV ejection fraction (EF) were specifically addressed.</div></div><div><h3>Results</h3><div>In-vivo LV PV reconstructions were obtained in 61 patients. Stroke work (SW) and pressure volume area (PVA) were significantly lower following TAVR (decrease from median [25th-75th percentile] of 10,935.6 [6877.5-13490.8] to 6,878.0 [4,870.8-8,613.8] mmHg/mL, <em>P</em> < .001 and from 17,831.5 [12,414.9-22,416.8] to 11,024.9 [8364.7-14705.0] mmHg/mL, <em>P</em> < .001, respectively) with stable SW/PVA ratios. Overall, end-systolic and end-diastolic pressures and volumes were significantly lower after TAVR. Arterial Elastance, as an index for LV afterload also decreased (2.66 [2.01-3.87]-1.96 [1.25-2.72] mmHg/mL, <em>P</em> < .001). LV contractility declined as illustrated by a reduction in End-systolic Elastance (2.22 [1.50-3.10]-1.58 [1.08-2.43] mmHg/mL, <em>P</em> < .001). The trends in changing LV cardiac mechanics were similar for balloon- and self-expanding valves and were not affected by pre/post dilatation, rapid pacing or LV EF.</div></div><div><h3>Conclusions</h3><div>TAVR for severe AS resulted in immediate LV unloading, lower myocardial metabolic demand and impaired contractility.</div></div><div><h3>Trial Registration</h3><div>This observational study was registered at URL: <span><span>https://www.clinicaltrials.gov</span><svg><path></path></svg></span> with unique identifier: NCT06204783.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107302"},"PeriodicalIF":3.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-14DOI: 10.1016/j.ahj.2025.107306
Yilin Yoshida PhD, MPH, FAHA
{"title":"Response to letter to the editor, titled: Beyond cumulative exposure: The roles of glycemic variability and metabolic memory in cardiac dysfunction","authors":"Yilin Yoshida PhD, MPH, FAHA","doi":"10.1016/j.ahj.2025.107306","DOIUrl":"10.1016/j.ahj.2025.107306","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107306"},"PeriodicalIF":3.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-14DOI: 10.1016/j.ahj.2025.107305
Mohammed Ahmed Taha Aly ElDabour (محمد أحمد طه علي الدبور) , Israa Yasser Salah Ahmed (إسراء ياسر صلاح احمد)
{"title":"Beyond cumulative exposure: The roles of glycemic variability and metabolic memory in cardiac dysfunction","authors":"Mohammed Ahmed Taha Aly ElDabour (محمد أحمد طه علي الدبور) , Israa Yasser Salah Ahmed (إسراء ياسر صلاح احمد)","doi":"10.1016/j.ahj.2025.107305","DOIUrl":"10.1016/j.ahj.2025.107305","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107305"},"PeriodicalIF":3.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1016/j.ahj.2025.107301
Graham S. Hillis MBChB, PhD , Jarryd S.K. Walker MBChB , Thomas Gilbert BSc(Hons) , Charley A. Budgeon PhD , John K. French MBChB, PhD , Joseph B. Selvanayagam MBBS, DPhil , Vijay A. Dhakshinamurthy MBBS , Richard W. Troughton MBChB, PhD , Jorge Moragues MD , Abdul R. Ihdayhid MBBS, PhD , Thomas J. Ford MBChB, PhD , Sarah Zaman MBBS, PhD , Johanne Neill MBBCh, MD , Philip D. Adamson MBChB, PhD , James Pemberton MD , Erin Doherty MD , Gillian A. Whalley PhD , Kiran Sarathy MBBS , David B. Brieger MBBS, PhD , Chiew Wong MBBS , Ralph A.H. Stewart MBChB, MD
Rationale
Left ventricular (LV) thrombus is a consequence of systolic dysfunction and is associated with an increased risk of stroke and systemic embolism. Anticoagulation with warfarin has been the standard of care. However, following the widespread adoption of direct oral anticoagulants (DOACs) in other settings, these are increasingly used to treat LV thrombus, despite limited randomized data to support equivalent outcomes and safety.
Primary Hypothesis
We hypothesize that DOACs will be noninferior to warfarin in the resolution of LV thrombus, without the occurrence of cardiovascular death, stroke, systemic embolism or major bleeding at 3-months.
Design
The REsolution of LEft VENTricular thrombus (RELEVENT) trial (ACTRN12618001254280) will test the noninferiority of DOACs compared to warfarin. This prospective trial will randomize 216 patients with best-available imaging confirmed LV thrombus, at a 1:1 ratio to either warfarin or a DOAC, for a duration of 12 to 14 weeks. Any DOAC approved for stroke prevention in atrial fibrillation may be used, according to local preference. The primary endpoint will be the resolution of the thrombus, without the occurrence of cardiovascular death, stroke, systemic embolism or major bleeding at 3-month follow-up. Secondary and other endpoints of interest include components of the primary outcome, changes to thrombus diameter, days alive and out of hospital, disability free survival and quality of life. Patients will be followed up for 3 years to obtain data on long-term management and outcomes.
Sites
Recruitment to the RELEVENT trial is underway in 16 centers in New Zealand and Australia.
Conclusions
The RELEVENT trial will help clarify whether DOACs are noninferior to warfarin in the early treatment of LV thrombus. It will also generate important insights into the long-term management and outcomes for patients.
{"title":"Rationale for and design of the REsolution of LEft VENTricular thrombus (RELEVENT) Trial","authors":"Graham S. Hillis MBChB, PhD , Jarryd S.K. Walker MBChB , Thomas Gilbert BSc(Hons) , Charley A. Budgeon PhD , John K. French MBChB, PhD , Joseph B. Selvanayagam MBBS, DPhil , Vijay A. Dhakshinamurthy MBBS , Richard W. Troughton MBChB, PhD , Jorge Moragues MD , Abdul R. Ihdayhid MBBS, PhD , Thomas J. Ford MBChB, PhD , Sarah Zaman MBBS, PhD , Johanne Neill MBBCh, MD , Philip D. Adamson MBChB, PhD , James Pemberton MD , Erin Doherty MD , Gillian A. Whalley PhD , Kiran Sarathy MBBS , David B. Brieger MBBS, PhD , Chiew Wong MBBS , Ralph A.H. Stewart MBChB, MD","doi":"10.1016/j.ahj.2025.107301","DOIUrl":"10.1016/j.ahj.2025.107301","url":null,"abstract":"<div><h3>Rationale</h3><div>Left ventricular (LV) thrombus is a consequence of systolic dysfunction and is associated with an increased risk of stroke and systemic embolism. Anticoagulation with warfarin has been the standard of care. However, following the widespread adoption of direct oral anticoagulants (DOACs) in other settings, these are increasingly used to treat LV thrombus, despite limited randomized data to support equivalent outcomes and safety.</div></div><div><h3>Primary Hypothesis</h3><div>We hypothesize that DOACs will be noninferior to warfarin in the resolution of LV thrombus, without the occurrence of cardiovascular death, stroke, systemic embolism or major bleeding at 3-months.</div></div><div><h3>Design</h3><div>The REsolution of LEft VENTricular thrombus (RELEVENT) trial (ACTRN12618001254280) will test the noninferiority of DOACs compared to warfarin. This prospective trial will randomize 216 patients with best-available imaging confirmed LV thrombus, at a 1:1 ratio to either warfarin or a DOAC, for a duration of 12 to 14 weeks. Any DOAC approved for stroke prevention in atrial fibrillation may be used, according to local preference. The primary endpoint will be the resolution of the thrombus, without the occurrence of cardiovascular death, stroke, systemic embolism or major bleeding at 3-month follow-up. Secondary and other endpoints of interest include components of the primary outcome, changes to thrombus diameter, days alive and out of hospital, disability free survival and quality of life. Patients will be followed up for 3 years to obtain data on long-term management and outcomes.</div></div><div><h3>Sites</h3><div>Recruitment to the RELEVENT trial is underway in 16 centers in New Zealand and Australia.</div></div><div><h3>Conclusions</h3><div>The RELEVENT trial will help clarify whether DOACs are noninferior to warfarin in the early treatment of LV thrombus. It will also generate important insights into the long-term management and outcomes for patients.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107301"},"PeriodicalIF":3.5,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145522511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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