Search Results for: Circulation

Stroke, Ahead of Print. BACKGROUND:Deep learning–based synthetic super-resolution magnetic resonance imaging (SynthMRI) may improve the quantitative lesion performance of portable low–field strength magnetic resonance imaging (LF-MRI). The aim of this study is to evaluate whether SynthMRI improves the diagnostic performance of LF-MRI in assessing ischemic lesions.METHODS:We retrospectively included 178 stroke patients and 104 healthy controls with both LF-MRI and high–field strength magnetic resonance imaging (HF-MRI) examinations. Using HF-MRI as the ground truth, the deep learning–based super-resolution framework (SCUNet) was pretrained using large-scale open-source data sets to generate SynthMRI images from LF-MRI images. Participants were split into a training set (64.2%) to fine-tune the pretrained SCUNet, and a testing set (35.8%) to evaluate the performance of SynthMRI. Sensitivity and specificity of LF-MRI and SynthMRI were assessed. Agreement with HF-MRI for Alberta Stroke Program Early Computed Tomography Score in the anterior and posterior circulation (diffusion-weighted imaging–Alberta Stroke Program Early Computed Tomography Score and diffusion-weighted imaging–posterior circulation Alberta Stroke Program Early Computed Tomography Score) was evaluated using intraclass correlation coefficients (ICCs). Agreement with HF-MRI for lesion volume and mean apparent diffusion coefficient (ADC) within lesions was assessed using both ICCs and Pearson correlation coefficients.RESULTS:SynthMRI demonstrated significantly higher sensitivity and specificity than LF-MRI (89.0% [83.3%–94.6%] versus 77.1% [69.5%–84.7%];P0.35). Furthermore, for lesions during various poststroke phases, SynthMRI exhibited significantly higher agreement with HF-MRI than LF-MRI during the early hyperacute and subacute phases.CONCLUSIONS:SynthMRI demonstrates high agreement with HF-MRI in detecting and quantifying ischemic lesions and is better than LF-MRI, particularly for lesions during the early hyperacute and subacute phases.

Circulation, Ahead of Print. The growing morbidity, mortality, and health care costs related to heart failure (HF) underscore the urgent need to prioritize its primary prevention. Whereas a risk-based approach for HF prevention remains in its infancy, several key opportunities exist to actualize this paradigm in clinical practice. First, the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guidelines provided recommendations, for the first time, on the clinical utility of multivariable risk equations to estimate risk of incident HF. Second, the American Heart Association recently developed the PREVENT (Predicting Risk of Cardiovascular Disease Events) equations, which not only enable prediction of incident HF separately, but also include HF in the prediction of total cardiovascular disease. Third, the predominant phenotype of HF risk has emerged as the cardiovascular-kidney-metabolic syndrome. Fourth, the emergence of novel therapies that prevent incident HF (eg, sodium-glucose cotransporter-2 inhibitors) and target multiple cardiovascular-kidney-metabolic axes demonstrate growing potential for risk-based interventions. Whereas the concept of risk-based prevention has been established for decades, it has only been operationalized for atherosclerotic cardiovascular disease prevention to date. Translating these opportunities into a conceptual framework of risk-based primary prevention of HF requires implementation of PREVENT-HF (Predicting Risk of Cardiovascular Disease Events–Heart Failure) equations, targeted use of cardiac biomarkers (eg, natriuretic peptides) and echocardiography for risk reclassification and earlier detection of pre-HF, and definition of therapy-specific risk thresholds that incorporate net benefit and cost-effectiveness. This scientific statement reviews the current evidence for accurate risk prediction, defines strategies for equitable prevention, and proposes potential strategies for the successful implementation of risk-based primary prevention of HF.

Circulation, Volume 151, Issue 15, Page e923-e924, April 15, 2025.

Circulation, Volume 151, Issue 15, Page 1063-1075, April 15, 2025. BACKGROUND:Few middle-aged and older adults engage in regular leisure-time exercise. Incidental physical activity (IPA) encompasses activities of daily living outside the leisure-time domain. No dose-response study is available to guide IPA-focused interventions and guidelines. We examined the associations of device-assessed IPA intensities (vigorous [VIPA], moderate [MIPA], light [LIPA]) with major adverse cardiovascular events (MACE) and mortality, and we estimated the “health equivalence” of LIPA and MIPA against 1 minute of VIPA.METHODS:A total of 24 139 nonexercisers from the 2013 to 2015 UK Biobank accelerometry substudy (56.2% women) with a mean±SD age of 61.9±7.6 years were analyzed using a prospective cohort design. IPA energy expenditure and daily durations of VIPA, MIPA, and LIPA were calculated with a validated machine learning-based intensity classifier. MACE included incident stroke, myocardial infarction, and heart failure; CVD death; CVD mortality; and all-cause mortality.RESULTS:Analyses included 22 107 (MACE), 22 174 (CVD mortality), and 24 139 (all-cause mortality) participants, corresponding to 908/223/1071 events over 7.9 years of follow-up. IPA volume exhibited an L-shaped association with a nadir at ≈35 to 38 kJ·kg−1·d−1, corresponding to hazard ratios of 0.49 (95% CI, 0.39–0.61) for MACE, 0.33 (95% CI, 0.22–0.52) for CVD mortality, and 0.31 (95% CI, 0.25–0.38) for all-cause mortality. Any amounts of VIPA or MIPA were associated with lower risk, with a plateau of ≈14 minutes per day (VIPA) and 34 to 50 minutes per day (MIPA). The median VIPA (4.6 min/d) and MIPA (23.8 min/d) durations were associated with CVD mortality hazard ratio of 0.62 (95% CI, 0.46–0.83) and 0.50 (95% CI, 0.31–0.80), respectively. LIPA showed a subtle inverse gradient which was statistically significant only for CVD mortality at levels >130 minutes per day. One minute of VIPA was equivalent to 2.8 (MACE) to 3.4 (CVD mortality) minutes of MIPA and 34.7 (CVD mortality) to 48.5 (MACE) minutes of LIPA.CONCLUSIONS:Any daily IPA amount of vigorous or moderate intensity was associated with lower CVD risk in a dose-response manner. LIPA had weak associations with all outcomes. One minute of vigorous or ≈3.0 to 3.5 minutes of moderate IPA was associated with a similar degree of lower CVD risk. Our findings highlight the potential cardiovascular health value of incidental physical activity, especially for people who struggle to do structured exercise.

Circulation, Volume 151, Issue 15, Page 1060-1062, April 15, 2025.

Circulation, Volume 151, Issue 15, Page 1095-1097, April 15, 2025.

Circulation, Volume 151, Issue 15, Page 1126-1129, April 15, 2025.

Circulation, Volume 151, Issue 15, Page e925-e925, April 15, 2025.

Circulation, Volume 151, Issue 15, Page 1111-1125, April 15, 2025. Heart failure is a growing health-care concern affecting tens of millions of individuals globally. Although traditional therapeutic strategies have focused on reducing the risk for hospitalization and mortality, the importance of patient-reported outcomes (PROs) in patients with heart failure is increasingly being recognized. Regulatory agencies consider PROs part of their evaluation of drugs and devices, and professional society guidelines may recommend interventions that improve PROs. However, for several reasons, the effect of interventions on PROs reported in heart failure trials currently is difficult to interpret. There is no consensus on the timing and frequency of PRO assessments. Moreover, it has been difficult to establish a minimal clinically important difference, that is, the minimal change in a PRO score that is meaningful to a patient. In addition, traditional methods of analyzing and reporting PROs such as comparison of mean differences across groups or responder analysis are prone to statistical artifacts and misinterpretation. This article presents an in-depth discussion of these issues, with the Kansas City Cardiomyopathy Questionnaire used as an example, to facilitate the use of PROs in heart failure research, regulatory, and clinical settings.

Circulation, Volume 151, Issue 15, Page e956-e956, April 15, 2025.

Circulation, Ahead of Print. BACKGROUND:Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart disease characterized by irregular rhythms and right ventricular dysplasia. Sequence variations in desmosomal protein-encoding genes are linked to ARVC development. Effective treatments for ARVC are lacking. Whereas mRNA-based therapies have shown efficacy in humans, their therapeutic potential for inherited cardiomyopathies remains unclear.METHODS:Whole-exome sequencing identified a novelDSC2sequence variation causing autosomal recessive ARVC in a Chinese family with consanguineous marriage. Mouse models withDsc2sequence variation knock-in and constitutive knock-out were generated and analyzed using echocardiography and histology. Transcriptomic and biochemical analyses were conducted to explore ARVC mechanisms.Dsc2mRNA delivered by intracardiac or transcoronary injection was assessed as a treatment for ARVC inDsc2knock-out mice. In addition, effects ofDsc2mRNA were examined in a transverse aortic constriction mouse model with noninherited right ventricular systolic dysfunction.RESULTS:Dsc2-deficient mice exhibited right ventricular dilation and dysfunction, mimicking human disease. Transcriptomic analysis identifiedMyl7as the most downregulated gene in the right ventricles ofDsc2-deficient mice, and its restoration by adeno-associated virus 9 rescued heart function.Dsc2mRNA delivery, with or without lipid nanoparticle encapsulation, normalized heart size and function inDsc2-deficient mice. ReducedDSC2andMLC2aexpression was also noted in patients with noninherited dilated cardiomyopathy and in mice with transverse aortic constriction. A single dose of mRNA provided therapeutic effects lasting 2 to 3 months before declining.CONCLUSIONS:Our study reveals novel mechanisms of ARVC caused byDSC2loss of function, supported by human and mouse data. Loss ofMyl7contributes to reduced cardiac contractility in ARVC and dilated cardiomyopathy with right ventricular systolic dysfunction.Dsc2mRNA treatment demonstrated significant therapeutic potential in ARVC and transverse aortic constriction models, providing a basis for future clinical applications.

Circulation, Ahead of Print. The Physical Activity Guidelines for Americans supports sitting less and moving more. Growing evidence suggests that a waking behavior profile with less sedentary behavior and more light-intensity physical activity is associated with more favorable cardiovascular health. Remarkably, little is known about how these behaviors relate to cardiovascular health during pregnancy. The purpose of this American Heart Association science advisory is to describe the existing evidence on device-measured sedentary behavior and light-intensity physical activity in relation to cardiovascular health during pregnancy and to make specific calls to action for future research to improve health outcomes and to promote health equity. Outcomes included adverse pregnancy outcomes associated with increased risk of cardiovascular disease and the American Heart Association’s Life’s Essential 8 health factor components (blood pressure, lipids, glucose, and gestational weight gain). Findings from observational studies are mixed, with preliminary evidence demonstrating an association between high sedentary behavior and increased risk of hypertensive disorders of pregnancy, shorter gestational age at delivery, low or high birth weight, and elevated maternal blood pressure, lipids, glucose, and gestational weight gain. Findings for light-intensity physical activity are limited by fewer studies and are less compelling. Experimental evidence evaluating the impact of decreasing sedentary behavior or increasing light-intensity physical activity on pregnancy cardiovascular health is weak. Future observational studies with rigorous longitudinal designs and larger, diverse samples are needed to characterize associations and to inform the design of adequately powered randomized controlled trials testing the impact of decreasing sedentary behavior and increasing light-intensity physical activity on cardiovascular health during pregnancy.

In 2024, cases of the mosquito-borne viral disease dengue hit historic highs throughout the Americas. The virus remains a threat in 2025, with more than 477 000 suspected cases already reported in the region as of February 20. The Pan American Health Organization (PAHO) also has issued an epidemiological alert based on growing circulation of 1 of dengue’s 4 distinct serotypes, DENV-3, in the region.

Circulation, Ahead of Print. BACKGROUND:Despite reported racial disparities between Black and White adults in short-term outcomes after abdominal aortic aneurysmal intervention, there is a paucity of literature aimed at understanding long-term disparities. The present study aims to characterize racial disparities in long-term outcomes, perioperative outcomes, and health care use after endovascular aortic aneurysm repair.METHODS:We conducted a retrospective cohort study from 2011 to 2019 with outcome assessment through 2020. Using a 100% sample of national Medicare data, we identified beneficiaries ≥66 years of age who underwent intact infrarenal endovascular aortic aneurysm repair. The primary outcome was a composite of endovascular or open aortic reintervention, late aneurysm rupture, and all-cause mortality. Secondary outcomes included other reinterventions, perioperative outcomes, and annual rates of health care use.RESULTS:A cohort of 107 636 Black (3.9%) and White (96.1%) beneficiaries was identified. The cumulative incidence of the primary outcome was 72.9% (95% CI, 71.8%–73.9%) in White patients versus 80.0% (95% CI, 76.4–83.0) in Black patients (P

Circulation, Ahead of Print. Populations most affected by cardiovascular health disparities, including underrepresented populations with lower socioeconomic status, people with disabilities, and those living in underserved rural communities, are disproportionately exposed to adverse social determinants of health. Specifically, economic instability and suboptimal living conditions within the neighborhood and built environment directly determine access to resources and opportunities for healthful behaviors. In this scientific statement, we examined the technology-enabled interventions that address cardiovascular health behaviors from adolescence to adulthood in populations most affected by health disparities. We used a broad definition of technology, including wearables, applications, and telehealth, for behavior tracking. Aligning with Life’s Essential 8, we focused on interventions targeting behavior change related to physical activity, sedentary time, dietary intake, tobacco cessation, and sleep health to improve cardiovascular health. The digital determinants of health are important adjuncts to the social determinants and operate at the individual, interpersonal, community, and societal levels. The digital determinants of health include the impact of digital technologies (eg, wearables, telemedicine) across health outcomes. Evidence of effective interventions using technology to improve cardiovascular health through positive behavior change is critical for preventing cardiovascular disease events. Stronger evidence is needed to inform and implement effective approaches that are scalable and cost-effective across communities and health care institutions to advance digital equity in cardiovascular health. Dissemination of digital solutions to improve cardiovascular health in communities or across health care systems must ensure effective, feasible, available, and affordable solutions for populations most in need.

Circulation, Volume 151, Issue 14, Page e922-e922, April 8, 2025.