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Publisher: Elsevier   (Total: 3123 journals)

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Showing 1 - 200 of 3120 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 26, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 378, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 237, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
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Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 5)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 140, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 4)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 9, SJR: 1.054, h-index: 35)
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Advances in Applied Microbiology     Full-text available via subscription   (Followers: 23, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 6, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 47, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 17, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 27)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 10)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 371, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 338, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 433, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 49, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 207, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 61, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 60, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
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Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 173, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 176, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)

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Journal Cover American Journal of Cardiology
  [SJR: 2.063]   [H-I: 186]   [48 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9149 - ISSN (Online) 0002-9149
   Published by Elsevier Homepage  [3123 journals]
  • Meta-Analysis of Culprit-Only Versus Multivessel Percutaneous Coronary
           Intervention in Patients With ST-Segment Elevation Myocardial Infarction
           and Multivessel Coronary Disease
    • Authors: Sripal Bangalore; Bora Toklu; Gregg W. Stone
      Pages: 529 - 536
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Sripal Bangalore, Bora Toklu, Gregg W. Stone
      Recently, several randomized controlled trials (RCT) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) have compared a strategy of routine multivessel percutaneous coronary intervention (PCI) performed either as a single procedure or as staged procedures to culprit-only PCI. All of these trials have been underpowered for clinical end points. We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for RCT comparing multivessel PCI with culprit-only PCI in patients with STEMI and MVD. The primary efficacy outcome was the composite rate of death or MI. Other efficacy outcomes included death, MI, and repeat revascularization. Safety outcomes were contrast-associated acute kidney injury, stroke, and major bleeding. Pairwise direct comparison and mixed-treatment comparison network meta-analyses were performed. Eleven trials that enrolled 3,150 patients with a total of 5,296 patient-years of follow-up were included. In direct comparison meta-analysis, single-procedure multivessel PCI was associated with a reduction in the risk of death or MI (rate ratio [RR] = 0.52; 95% confidence interval [CI] 0.37 to 0.73; p <0.001), due to less death (RR = 0.64; 95% CI 0.40 to 1.02; p = 0.06) and MI (RR = 0.42; 95% CI 0.25 to 0.69; p <0.0001) compared with culprit-only PCI. No heterogeneity (I2 = 0) was present between studies. In contrast, staged multivessel PCI did not significantly reduce death or MI compared with culprit-only PCI. Both multivessel PCI strategies reduced the risk of repeat revascularization without significant differences in safety outcomes. Results were consistent in the mixed-treatment comparison meta-analysis. In conclusion, the present meta-analysis suggests that single-procedure multivessel PCI may be the preferred strategy in patients with STEMI and MVD.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.022
       
  • Gender-Specific Differences in All-Cause Mortality Between Incomplete and
           Complete Revascularization in Patients With ST-Elevation Myocardial
           Infarction and Multi-Vessel Coronary Artery Disease
    • Authors: Aukelien C. Dimitriu-Leen; Maaike P.J. Hermans; Alexander R. van Rosendael; Erik W. van Zwet; Bas L. van der Hoeven; Jeroen J. Bax; Arthur J.H.A. Scholte
      Pages: 537 - 543
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Aukelien C. Dimitriu-Leen, Maaike P.J. Hermans, Alexander R. van Rosendael, Erik W. van Zwet, Bas L. van der Hoeven, Jeroen J. Bax, Arthur J.H.A. Scholte
      The best revascularization strategy (complete vs incomplete revascularization) in patients with ST-elevation myocardial infarction (STEMI) is still debated. The interaction between gender and revascularization strategy in patients with STEMI on all-cause mortality is uncertain. The aim of the present study was to evaluate gender-specific difference in all-cause mortality between incomplete and complete revascularization in patients with STEMI and multi-vessel coronary artery disease. The study population consisted of 375 men and 115 women with a first STEMI and multi-vessel coronary artery disease without cardiogenic shock at admission or left main stenosis. The 30-day and 5-year all-cause mortality was examined in patients categorized according to gender and revascularization strategy (incomplete and complete revascularization). Within the first 30 days, men and women with incomplete revascularization were associated with higher mortality rates compared with men with complete revascularization. However, the gender-strategy interaction variable was not independently associated with 30-day mortality after STEMI when corrected for baseline characteristics and angiographic features. Within the survivors of the first 30 days, men with incomplete revascularization (compared with men with complete revascularization) were independently associated with all-cause mortality during 5 years of follow-up (hazard ratios 3.07, 95% confidence interval 1.24;7.61, p = 0.016). In contrast, women with incomplete revascularization were not independently associated with 5-year all-cause mortality (hazard ratios 0.60, 95% confidence interval 0.14;2.51, p = 0.48). In conclusion, no gender-strategy differences occurred in all-cause mortality within 30 days after STEMI. However, in the survivors of the first 30 days, incomplete revascularization in men was independently associated with all-cause mortality during 5-year follow-up, but this was not the case in women.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.026
       
  • Impact of Complete Revascularization on Six-Year Clinical Outcomes and
           Incidence of Acute Decompensated Heart Failure in Patients With ST-Segment
           Elevation Myocardial Infarction and Multivessel Coronary Artery Disease
    • Authors: Min Joo Ahn; Min Chul Kim; Youngkeun Ahn; Doo Sun Sim; Young Joon Hong; Ju Han Kim; Myung Ho Jeong; Jeong Gwan Cho; Jong Chun Park
      Pages: 544 - 551
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Min Joo Ahn, Min Chul Kim, Youngkeun Ahn, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park
      It remains unclear whether complete revascularization (CR) reduces the incidences of acute decompensated heart failure (ADHF) and adverse cardiac outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD). A total of 453 hemodynamically stable patients with STEMI and MVD were retrospectively evaluated; the patients were divided into 2 groups according to interventional strategy: CR (n = 240) and incomplete revascularization (IR) (n = 213). We analyzed the incidences of ADHF and major adverse cardiac events (MACE; a composite of all-cause mortality, myocardial infarction, and any revascularization) over a long follow-up period (median 6.3 years). MACE developed in 158 patients (34.9%), and 40 patients (8.8%) were re-admitted because of ADHF developing during follow-up. Results after propensity matching showed that CR did not reduce the incidence of ADHF (hazard ratio [HR] for IR 1.63, 95% confidence interval [CI] 0.63 to 4.22, p = 0.311). However, IR increased the risk of MACE (HR 1.73, 95% CI 1.09 to 2.74, p = 0.021), attributable principally to an increased risk of nontarget vessel revascularization (HR 3.12, 95% CI 1.23 to 7.92, p = 0.039). Although CR did not reduce the incidence of ADHF, CR might reduce repeat revascularization to treat non–infarct-related arteries in hemodynamically stable patients with STEMI and MVD.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.025
       
  • Comparison of Outcomes for Off-Pump Versus On-Pump Coronary Artery Bypass
           Grafting in Low-Volume and High-Volume Centers and by Low-Volume and
           High-Volume Surgeons
    • Authors: Umberto Benedetto; Christopher Lau; Massimo Caputo; Luke Kim; Dmitriy N. Feldman; Lucas B. Ohmes; Antonino Di Franco; Giovanni Soletti; Gianni D. Angelini; Leonard N. Girardi; Mario Gaudino
      Pages: 552 - 557
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Umberto Benedetto, Christopher Lau, Massimo Caputo, Luke Kim, Dmitriy N. Feldman, Lucas B. Ohmes, Antonino Di Franco, Giovanni Soletti, Gianni D. Angelini, Leonard N. Girardi, Mario Gaudino
      In terms of in-hospital outcomes, controversy still remains whether off-pump coronary artery bypass grafting is superior to on-pump coronary artery bypass surgery. We investigated whether the volume of off-pump coronary artery bypass procedures by hospital and individual surgeon influences patient outcomes when compared with on-pump coronary artery bypass surgery. Discharge records from the Nationwide Inpatient Sample were retrospectively reviewed for in-hospital admissions from 2003 to 2011, including 999 hospitals in 44 states. A total of 2,094,094 patients undergoing on- and off-pump coronary artery bypass surgery were included. In patients requiring 2 or more grafts, off-pump coronary artery bypass compared with on-pump coronary artery bypass was associated with increased risk-adjusted mortality when performed in low-volume centers (<29 cases per year) (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.06 to 1.57) or by low-volume surgeons (<19 cases per year) (OR 1.26, 95% CI 1.02 to 1.56). In high-volume off-pump coronary artery bypass centers (≥164 cases per year) and surgeons (≥48 cases per year), off-pump coronary artery bypass reduced mortality compared with on-pump coronary artery bypass in cases requiring a single graft (OR 0.66, 95% CI 0.49 to 0.89 and OR 0.33, 95% CI 0.22 to 0.47, respectively) or 2 or more grafts (OR 0.82, 95% CI 0.66 to 0.99 and OR 0.63, 95% CI 0.49 to 0.81, respectively). In conclusion, the outcome of off-pump coronary artery bypass grafting procedures is dependent on volume at both the institution and the individual surgeon level. Off-pump coronary artery bypass should not be performed at low-volume centers and by low-volume surgeons.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.035
       
  • Association of Stress Test Risk Classification With Health Status After
           Chronic Total Occlusion Angioplasty (from the Outcomes, Patient Health
           Status and Efficiency in Chronic Total Occlusion Hybrid Procedures
           [OPEN-CTO] Study)
    • Authors: Adam C. Salisbury; James Sapontis; John T. Saxon; Kensey L. Gosch; William L. Lombardi; Dimitri Karmpaliotis; Jeffery W. Moses; Mohammed Qintar; Ajay J. Kirtane; John A. Spertus; David J. Cohen; J. Aaron Grantham
      Pages: 558 - 563
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Adam C. Salisbury, James Sapontis, John T. Saxon, Kensey L. Gosch, William L. Lombardi, Dimitri Karmpaliotis, Jeffery W. Moses, Mohammed Qintar, Ajay J. Kirtane, John A. Spertus, David J. Cohen, J. Aaron Grantham
      Stress testing is endorsed by the American College of Cardiology/American Heart Association Appropriate Use Criteria to identify appropriate candidates for Chronic Total Occlusion (CTO) Percutaneous Coronary Intervention (PCI). However, the relation between stress test risk classification and health status after CTO PCI is not known. We studied 449 patients in the 12-center OPEN CTO registry who underwent stress testing before successful CTO PCI, comparing outcomes of patients with low-risk (LR) versus intermediate to high-risk (IHR) findings. Health status was assessed using the Seattle Angina Questionnaire Angina Frequency (SAQ AF), Quality of Life (SAQ QoL), and Summary Scores (SAQ SS). Stress tests were LR in 40 (8.9%) and IHR in 409 (91.1%) patients. There were greater improvements on the SAQ AF (LR vs IHR 14.2 ± 2.7 vs 23.3 ± 1.3 points, p <0.001) and SAQ SS (LR vs IHR 20.8 ± 2.3 vs 25.4 ± 1.1 points, p = 0.03) in patients with IHR findings, but there was no difference between groups on the SAQ QoL domain (LR vs IHR 24.8 ± 3.4 vs 27.3 ± 1.6 points, p = 0.42). We observed large health status improvements after CTO PCI in both the LR and IHR groups, with the greatest reduction in angina among those with IHR stress tests. Although patients with higher risk studies may experience greater reduction in angina symptoms, on average, patients with LR stress tests also experienced large improvements in symptoms after CTO PCI, suggesting patients with refractory symptoms should be considered appropriate candidates for CTO PCI regardless of stress test findings.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.024
       
  • Comparisons of the Framingham and Pooled Cohort Equation Risk Scores for
           Detecting Subclinical Vascular Disease in Blacks Versus Whites
    • Authors: Matthew L. Topel; Jia Shen; Alanna A. Morris; Ibhar Al Mheid; Salman Sher; Sandra B. Dunbar; Viola Vaccarino; Laurence S. Sperling; Gary H. Gibbons; Greg S. Martin; Arshed A. Quyyumi
      Pages: 564 - 569
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Matthew L. Topel, Jia Shen, Alanna A. Morris, Ibhar Al Mheid, Salman Sher, Sandra B. Dunbar, Viola Vaccarino, Laurence S. Sperling, Gary H. Gibbons, Greg S. Martin, Arshed A. Quyyumi
      The pooled cohort Atherosclerotic Cardiovascular Disease (ASCVD) risk calculator is designed to improve cardiovascular risk estimation compared with the Framingham Risk Score, particularly in blacks. Although the ASCVD risk score better predicts mortality and incident cardiovascular disease in blacks, less is known about its performance for subclinical vascular disease measures, including arterial stiffness and carotid intima-media thickness. We sought to determine if the ASCVD risk score better identifies subclinical vascular disease in blacks compared with the Framingham risk score. We calculated both the Framingham and ASCVD cohort risk scores in 1,231 subjects (mean age 53 years, 59% female, 37% black) without known cardiovascular disease and measured the extent of arterial stiffness, as determined by pulse wave velocity (PWV), central pulse pressure (CPP), and central augmentation index (CAIx), and subclinical atherosclerosis, as determined by carotid-IMT (C-IMT). Compared with whites, blacks had higher CAIx (23.9 ± 10.2 vs 22.1 ± 9.6%, p = 0.004), CPP (36.4 ± 10.5 vs 34.9 ± 9.8 mmHg, p = 0.014), PWV (7.6 ± 1.5 vs 7.3 ± 1.3 m/s, p = 0.004), and C-IMT (0.67 ± 0.10 vs 0.65 ± 0.10 mm, p = 0.005). In a multivariable analysis including race and Framingham risk score, race remained an independent predictor of all measures of subclinical vascular disease; however, models with race and the ASCVD risk score showed that race was not an independent predictor of subclinical vascular disease. In conclusion, greater subclinical vascular disease in blacks was not estimated by the Framingham risk score. The new ASCVD risk score provided a better estimate of racial differences in vascular function and structure.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.031
       
  • Relation of Overall and Abdominal Adiposity With Electrocardiogram
           Parameters of Subclinical Cardiovascular Disease in Individuals Aged 45 to
           65 Years (from the Netherlands Epidemiology of Obesity Study)
    • Authors: Theodora W. Elffers; Renée de Mutsert; Hildo J. Lamb; Arie C. Maan; Peter W. Macfarlane; Ko Willems van Dijk; Frits R. Rosendaal; J. Wouter Jukema; Stella Trompet
      Pages: 570 - 578
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Theodora W. Elffers, Renée de Mutsert, Hildo J. Lamb, Arie C. Maan, Peter W. Macfarlane, Ko Willems van Dijk, Frits R. Rosendaal, J. Wouter Jukema, Stella Trompet
      Overall and abdominal obesity are well-established risk factors for cardiometabolic disease. However, associations of overall and abdominal adiposity with electrocardiographic (ECG) markers of subclinical cardiovascular disease (CVD) have not yet been fully elucidated. Therefore, we investigated these associations in a population without preexisting CVD. We performed cross-sectional analyses in the Netherlands Epidemiology of Obesity Study. Body mass index (BMI), total body fat, and waist circumference were assessed in all participants, and abdominal subcutaneous adipose tissue and visceral adipose tissue (by magnetic resonance imaging) were assessed in a random subgroup. ECG parameters were determined using 12-lead electrocardiograms. We performed linear regression analyses, adjusting for potential confounding factors and, when investigating abdominal adiposity, additionally for total body fat. After exclusion of participants with preexisting CVD (n = 654), 5,939 individuals (42% men) were analyzed, with a mean (SD) age of 55 (6) years and BMI of 26.3 (4.4) kg/m2. Measures of both overall and abdominal adiposity were associated with ECG parameters but none of these measures was more strongly associated than the others. For example, heart rate (beats/min) increased per SD higher BMI (2.2; 95% confidence interval 1.9,2.5), total body fat (2.9; 2.4,3.4), subcutaneous adipose tissue (2.3;1.7,2.9), waist circumference (2.1; 1.4,2.8), and visceral adipose tissue (1.7; 0.8,2.5). In subgroup analyses based on gender and cardiovascular risk factors, no consistent interactions were observed. In conclusion, in a middle-aged population without preexisting CVD, measures of both overall and abdominal adiposity were associated with ECG parameters. Future studies should evaluate the added value of adiposity measures in electrocardiography-based diagnoses and the prognostic value of adding adiposity measures to risk prediction tools.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.030
       
  • Effect of Serum Adiponectin Levels on the Association Between Childhood
           Body Mass Index and Adulthood Carotid Intima-Media Thickness
    • Authors: Yang Du; Tao Zhang; Dianjianyi Sun; Changwei Li; Lydia Bazzano; Lu Qi; Marie Krousel-Wood; Jiang He; Paul K. Whelton; Wei Chen; Shengxu Li
      Pages: 579 - 583
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Yang Du, Tao Zhang, Dianjianyi Sun, Changwei Li, Lydia Bazzano, Lu Qi, Marie Krousel-Wood, Jiang He, Paul K. Whelton, Wei Chen, Shengxu Li
      Childhood obesity predicts adult cardiovascular risk. We hypothesized that the association between childhood body mass index (BMI) and adult carotid intima-media thickness (CIMT) may be modified by levels of adiponectin, an adipocytokine that connects body fatness with cardiovascular risk. The study sample included 1,052 adults (71% white and 29% black, 57% female) aged 23.8 to 43.5 years who were previously examined as children in the Bogalusa Heart Study cohort, with an average follow-up period of 26.5 (range 14.1 to 29.6) years. Childhood BMI, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and systolic blood pressure were standardized to age-specific z-scores. General linear models were used for data analyses. Childhood BMI (p = 0.034), low-density lipoprotein cholesterol (p <0.001), and systolic blood pressure (p = 0.005), along with adult adiponectin levels (p = 0.002) were associated with adult CIMT, adjusted for race, sex, adult age, and cigarette smoking. Further, adult adiponectin levels significantly modified the association between childhood BMI and adult CIMT (P for interaction = 0.0003) such that a significant association between childhood BMI and adult CIMT (p <0.0001) was only observed in those with adiponectin levels below the median. In conclusion, these results suggest that serum adiponectin levels modify the association between childhood obesity and adult atherosclerosis, which has implications for risk stratification and targeted intervention for obese children with low levels of adiponectin.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.029
       
  • Predictors of Mortality in Patients With Atrial Fibrillation (from the
           Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of
           Vascular Events [ACTIVE A])
    • Authors: Kanjana S. Perera; Lesly A. Pearce; Mukul Sharma; Oscar Benavente; Stuart J. Connolly; Robert G. Hart
      Pages: 584 - 589
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Kanjana S. Perera, Lesly A. Pearce, Mukul Sharma, Oscar Benavente, Stuart J. Connolly, Robert G. Hart
      The mortality rate of most patients with atrial fibrillation (AF) exceeds the stroke rate, but predictors of mortality have not been well defined. The Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE A) recruited patients with AF who were unsuitable to receive vitamin K-antagonists and were randomized to aspirin alone versus aspirin plus clopidogrel. We investigated independent predictors of all-cause mortality by multivariable Cox regression analysis and explored interactions with assigned antiplatelet therapy. Of the 7,554 patients enrolled with a mean age of 71 years, 1,687 (22%) patients died during the median follow-up of 3.7 years (annualized mortality rate 6.4%/year). Assignment to dual antiplatelet therapy had no effect on mortality (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.90 to 1.1) or on vascular and nonvascular death. Independent predictors of all-cause mortality were advancing age, lower body mass index (HR 1.4 < 25 kg/m2, 95% CI 1.3 to 1.6), diabetes mellitus, Latin American ethnicity (HR 1.4, 95% CI 1.1 to 1.6), previous stroke or transient ischemic attack, peripheral artery disease, increased resting heart rate (HR 1.3, 95% CI 1.1 to 1.4 per 30 bpm), lower diastolic blood pressure, coronary artery disease, heart failure, left ventricular systolic dysfunction, hemoglobin level of <13 mg/dl, and reduced estimated glomerular filtration rate. In conclusion, in this large clinical trial cohort of patients with AF, treatment with clopidogrel plus aspirin versus aspirin monotherapy did not affect all-cause mortality, vascular death, or nonvascular death. Novel independent predictors of increased mortality included lower diastolic blood pressure and Latin American ethnicity.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.028
       
  • In-Hospital Cerebrovascular Outcomes of Patients With Atrial Fibrillation
           and Cancer (from the National Inpatient Sample Database)
    • Authors: Ayman Elbadawi; Islam Y. Elgendy; Le Dung Ha; Basarat Baig; Marwan Saad; Hussain Adly; Gbolahan O. Ogunbayo; Odunayo Olorunfemi; Matthew S. Mckillop; Scott A. Maffett
      Pages: 590 - 595
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Ayman Elbadawi, Islam Y. Elgendy, Le Dung Ha, Basarat Baig, Marwan Saad, Hussain Adly, Gbolahan O. Ogunbayo, Odunayo Olorunfemi, Matthew S. Mckillop, Scott A. Maffett
      Limited data are available regarding the impact of cancer on cerebrovascular accidents in patients with atrial fibrillation (AF). We queried the Nationwide Inpatient Survey Database to identify patients who have diagnostic code for AF. We performed a 1:1 propensity matching based on the CHA2DS2VASc score and other risk factors between patients with AF who had lung, breast, colon, and esophageal cancer, and those who did not (control). The final cohort included a total of 31,604 patients. The primary outcome of in-hospital cerebrovascular accidents (CVA) was lower in the cancer group than in the control group (4% vs 7%, p < 0.001), but with only a weak association (ф = −0.067). In-hospital mortality was higher in the cancer group than in the control group (18% vs 11%, p < 0.001; ф = −0.099). A subgroup analysis according to cancer type showed similar results with a weak association with lower CVA in breast cancer (4% vs 7%; ф = −0.066, p < 0.001), lung cancer (4% vs 6%; ф = −0.062, p < 0.001), colon cancer (4% vs 6%; ф = −0.062, p < 0.001), and esophageal cancer (3% vs 7%; ф = −0.095, p < 0.001) compared with the control groups. A weak association with higher in-hospital mortality was demonstrated in lung cancer (20% vs 11%; ф = −0.127, p < 0.001), colon cancer (16% vs 11%; ф = −0.076, p < 0.001), and esophageal cancer (20% vs 12%; ф = −0.111, p < 0.001) compared with the control groups, but no significant difference between breast cancer and control groups in mortality (11% vs 11%; ф = −0.002, p = 0.888). In conclusion, in patients with AF, cancer diagnosis may not add a predictive role for in-hospital CVA beyond the CHADS2VASc score.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.027
       
  • Relation of Orthostatic Hypotension With New-Onset Atrial Fibrillation
           (From the Framingham Heart Study)
    • Authors: Darae Ko; Sarah R. Preis; Steven A. Lubitz; David D. McManus; Ramachandran S. Vasan; Naomi M. Hamburg; Emelia J. Benjamin; Gary F. Mitchell
      Pages: 596 - 601
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Darae Ko, Sarah R. Preis, Steven A. Lubitz, David D. McManus, Ramachandran S. Vasan, Naomi M. Hamburg, Emelia J. Benjamin, Gary F. Mitchell
      Previous studies have reported that orthostatic hypotension (OH) is associated with increased risk of atrial fibrillation (AF). We sought to determine whether the association persists after adjusting for hypertension and other cardiovascular risk factors. We studied the Framingham Heart Study Original cohort participants evaluated between 1981 and 1984 without baseline AF. OH was defined as drop in standing systolic blood pressure (BP) of at least 20 mm Hg or standing diastolic BP of at least 10 mm Hg from their supine values after standing for 2 minutes. We estimated Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HR) for association between OH and risk of incident AF, adjusting for age, sex, seated systolic BP and diastolic BP, resting heart rate, height, weight, current tobacco use, hypertension treatment, diabetes, and history of myocardial infarction and heart failure. Of 1,736 participants (mean age, 71.7 ± 6.5 years, 60% women), 256 (14.8%) had OH at baseline. During 10 years of follow-up, 224 participants developed new AF. In our multivariable-adjusted model, OH (HR 1.61, 95% confidence interval 1.17 to 2.20) and greater orthostatic decrease in mean arterial pressure (MAP) (HR 1.11, 95% confidence interval 1.02 to 1.22 per 8.6 mm Hg change in MAP) were both associated with higher risk of new AF. In conclusion, in our longitudinal community-based sample, OH and orthostatic decline in MAP were significantly associated with increased risk of incident AF after adjustment for systolic BP, diastolic BP, and hypertension treatment.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.036
       
  • Left Ventricular Volume-Time Relation in Patients With Heart Failure With
           Preserved Ejection Fraction
    • Authors: Michinari Hieda; Joshua Parker; Tanya Rajabi; Naoki Fujimoto; Paul S. Bhella; Anand Prasad; Jeffrey L. Hastings; Satyam Sarma; Benjamin D. Levine
      Pages: 609 - 614
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Michinari Hieda, Joshua Parker, Tanya Rajabi, Naoki Fujimoto, Paul S. Bhella, Anand Prasad, Jeffrey L. Hastings, Satyam Sarma, Benjamin D. Levine
      Elevated left ventricular (LV) filling pressures are commonly reported in patients with heart failure with preserved ejection fraction (HFpEF) and are associated with impaired relaxation in diastole. Relaxation has been assessed by Doppler, but the methods for doing so are indirect and heavily influenced by loading conditions. The aim of this study is to assess LV volume-time relation in patients with HFpEF, when correcting for left atrial driving pressure and chamber size, using cardiac magnetic resonance imaging (cMRI). Cine short-axis views by cMRI (1.5T-magnet) at 26 Hz were used for measurement of LV volume. We compared the following diastolic parameters: peak filling rate/end-diastolic volume (PFR/EDV); PFR/EDV/pulmonary capillary wedge pressure (PFR/EDV/PCWP); time to PFR (TPFR); and %TPFR for cardiac cycle calculated by cMRI between patients with HFpEF (n = 10, 73 ± 7 years) and age-matched controls (n = 12, 70 ± 3 years). PCWP was significantly greater in the HFpEF group than in controls (HFpEF vs controls: 15.6 ± 5.2 vs 11.2 ± 1.3 mmHg, p = 0.0092). PFR/EDV was significantly slower in the HFpEF group than in controls (2.68 ± 0.85 vs 3.59 ± 0.87/s, p = 0.03), and was nearly 50% slower when corrected for left atrial driving pressure: PFR/EDV/PCWP (0.18 ± 0.07 vs 0.33 ± 0.10/s/mmHg, p = 0.002). In addition, TPFR (246 ± 17.2 vs 188 ± 15.7 ms, p = 0.04) and %TPFR of cardiac cycle (36.4 ± 10.4 vs 25.6 ± 5.9%, p = 0.012) were significantly longer in the HFpEF group than in controls. Patients with HFpEF have an abnormal volume-time relation, including lower PFR/EDV (PFR/EDV/PCWP) and prolonged TPFR, due to the impairment of active relaxation during early diastole.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.033
       
  • Long-Term Survival With Implantable Cardioverter-Defibrillator in
           Different Symptomatic Functional Classes of Heart Failure
    • Authors: Yitschak Biton; Spencer Rosero; Arthur Moss; Wojciech Zareba; Valentina Kutyifa; Jayson Baman; Alon Barsheshet; Scott McNitt; Bronislava Polonsky; Ilan Goldenberg
      Pages: 615 - 620
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Yitschak Biton, Spencer Rosero, Arthur Moss, Wojciech Zareba, Valentina Kutyifa, Jayson Baman, Alon Barsheshet, Scott McNitt, Bronislava Polonsky, Ilan Goldenberg
      The ACC/AHA/HRS (American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society) guidelines recommend implantable cardioverter-defibrillator (ICD) therapy primary prevention in all patients with severely reduced left ventricular ejection fraction (≤30%) regardless of New York Heart Association (NYHA) functional class, whereas recent European guidelines limit the indication to those with symptomatic heart failure (NYHA ≥ II). We therefore aimed to evaluate the long-term survival benefit of primary ICD therapy among postmyocardial infarction patients with and without heart failure (HF) symptoms who were enrolled in MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II). We classified 1,164 MADIT-II patient groups according to the baseline NYHA class (NYHA I [n = 442], NYHA II [n = 425], and NYHA III [n = 297]); patients with NYHA IV were excluded. Multivariate Cox proportional hazards regression modeling was performed to compare the mortality reduction with ICD versus non-ICD therapy during 8 years of follow-up between the 3 NYHA groups. The median (interquartile range) follow-up time was 7.6 (3.5 to 9) years. At 8 years of follow-up, the cumulative probability of mortality in the non-ICD treatment arm was 57% for NYHA I, 57% for NYHA II, and 76% for NYHA III (p <0.001). Multivariate models demonstrated similar long-term mortality risk reduction with ICD compared with the non-ICD treatment arm regardless of HF symptoms: NYHA I (HR = 0.63, 0.46 to 0.85, p = 0.003), NYHA II (HR = 0.68, 0.50 to 0.93, p = 0.017), and NYHA III (HR = 0.68, 0.50 to 0.94, p = 0.018); p for NYHA class by treatment arm interaction >0.10. In conclusion, primary ICD therapy provides consistent long-term survival benefit among patients with previous myocardial infarction and severe left ventricular dysfunction, regardless of HF symptoms.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.032
       
  • Diabetes Mellitus and Right Ventricular Dysfunction in Heart Failure With
           Preserved Ejection Fraction
    • Authors: Thomas M. Gorter; Koen W. Streng; Joost P. van Melle; Michiel Rienstra; Michael G. Dickinson; Carolyn S.P. Lam; Yoran M. Hummel; Adriaan A. Voors; Elke S. Hoendermis; Dirk J. van Veldhuisen
      Pages: 621 - 627
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Thomas M. Gorter, Koen W. Streng, Joost P. van Melle, Michiel Rienstra, Michael G. Dickinson, Carolyn S.P. Lam, Yoran M. Hummel, Adriaan A. Voors, Elke S. Hoendermis, Dirk J. van Veldhuisen
      Diabetes mellitus is associated with left-sided myocardial remodeling in heart failure with preserved ejection fraction (HFpEF). Little is known about the impact of diabetes mellitus on right ventricular (RV) function in HFpEF. We therefore studied the relation between diabetes mellitus and RV dysfunction in HFpEF. We have examined patients with HFpEF who underwent simultaneous right-sided cardiac catheterization and echocardiography. RV systolic function was assessed using multiple established echocardiographic parameters, and systolic dysfunction was present if ≥2 parameters were outside the normal range. RV diastolic function was assessed using the peak diastolic tissue velocity of the lateral tricuspid annulus (RV e') and was present if <8.0 cm/s. Diabetes mellitus was defined as a documented history of diabetes, a fasting glucose level of ≥7.0 mmol/L, a positive glucose intolerance test result, or a glycated hemoglobin level of ≥6.5%. A total of 91 patients were studied (mean age 74 ± 9 years, 69% women). A total of 37% had RV systolic dysfunction and 23% RV diastolic dysfunction. Thirty-seven percent of the patients had type 2 diabetes mellitus. These patients had higher pulmonary artery pressure (34 mm Hg vs 29 mm Hg, p = 0.004), more RV systolic dysfunction (57% vs 29%, p = 0.009), more RV diastolic dysfunction (46% vs 12%, p = 0.001), and lower RV e' (8.7 cm/s vs 11.5 cm/s, p = 0.006). The presence of diabetes mellitus was independently associated with RV systolic dysfunction (odds ratio 2.84, 95% confidence interval 1.09 to 7.40, p = 0.03) and with RV diastolic dysfunction (odds ratio 4.33, 95% confidence interval 1.25 to 15.07, p = 0.02), after adjustment for age, gender, and pulmonary pressures. In conclusion, diabetes mellitus is strongly associated with RV systolic and diastolic dysfunctions in patients with HFpEF, independent of RV afterload.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.040
       
  • Frequency and Prognostic Significance of Acute Kidney Recovery in Patients
           Who Underwent Transcatheter Aortic Valve Implantation
    • Authors: Amir Azarbal; Kevin L. Leadholm; Takamaru Ashikaga; Richard J. Solomon; Harold L. Dauerman
      Pages: 634 - 641
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Amir Azarbal, Kevin L. Leadholm, Takamaru Ashikaga, Richard J. Solomon, Harold L. Dauerman
      Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is associated with increased mortality. As significant hemodynamic improvement may occur with relief of aortic stenosis, we hypothesized that TAVI patients may demonstrate the opposite phenomena: acute kidney recovery (AKR). We studied the incidence and predictors of AKR in post-TAVI patients. A total of 366 consecutive patients underwent TAVI (January 2012 to January 2017) at a single center. We defined AKR as a 25% improvement in glomerular filtration rate (GFR) at 48 hours after TAVI. AKI-creatinine (Cr) was defined as an increase in Cr of ≥0.3 mg/dl at 48 hours. Patients were categorized in 3 groups: AKR (≥25% increase in GFR), unchanged GFR, and AKI-GFR (inverse definition of AKR, ≥25% decrease in GFR). Multivariable logistic regression defined independent predictors of AKR. AKR occurred in 1/3 of patients. AKI-Cr occurred in 13% of patients, whereas AKI-GFR occurred similarly in 15%. AKR and AKI occurred most frequently in patients with chronic kidney disease (CKD: GFR ≤ 60 ml/min/1.73 m2). Independent predictors of AKR-GFR by multivariable analysis were male gender, lack of chronic β-blocker utilization, and presence of CKD. Notably, left ventricular dysfunction and contrast volume were not predictive of AKR. Transfusion occurred less frequently among patients with AKR compared with patients with AKI-GFR (11% vs 26%, p = 0.03). Death occurred in 0% of AKR patients versus 9.3% of AKI-GFR patients (p <0.01). In conclusion, this is the first report of AKR after TAVI. Patients with CKD, male gender, and lack of pre-TAVI beta blockade were more likely to demonstrate AKR.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.043
       
  • Effectiveness and Safety of Transcatheter Aortic Valve Implantation in
           Patients With Pure Aortic Regurgitation and Advanced Heart Failure
    • Authors: Gabriele Pesarini; Mattia Lunardi; Anna Piccoli; Leonardo Gottin; Daniele Prati; Valeria Ferrero; Roberto Scarsini; Aldo Milano; Alberto Forni; Giuseppe Faggian; Flavio Ribichini
      Pages: 642 - 648
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Gabriele Pesarini, Mattia Lunardi, Anna Piccoli, Leonardo Gottin, Daniele Prati, Valeria Ferrero, Roberto Scarsini, Aldo Milano, Alberto Forni, Giuseppe Faggian, Flavio Ribichini
      Results of transcatheter aortic valve implantation (TAVI) for treatment of severe noncalcific isolated aortic regurgitation (AR) complicated by advanced heart failure or cardiogenic shock has been previously reported only in isolated case reports. Current self-expanding transcatheter aortic valves are designed to treat aortic valve stenosis, and have also been implanted in cases of severe AR due to degenerated bioprosthesis and in very few cases of native aortic valves. We report 13 consecutive inoperable patients with noncalcific, pure AR, and advanced heart failure treated with emergency percutaneous transfemoral implantation with self-expandable CoreValves at our institution between July 2012 and September 2017. The immediate and long-term clinical outcome was prospectively assessed according to the Valve Academic Research Consortium-2 criteria for device success and safety. All but 3 patients had previous surgery of the aortic root, including 2 implants of Heart Mate-II left ventricle assist device; none had surgical aortic bioprosthesis at the time of the TAVI. Valve implantation was successful in 12 of 13 patients (92%) and 1 patient required a second unplanned valve procedure within 18 hours. Oversizing the prosthesis by approximately 15% yielded better results with 1 valve. Two patients with left ventricle assist device died within 30 days of TAVI. All patients who survived to hospital discharge had none or just mild residual AR, improved their cardiac function, and survived at long-term without recurrence of clinical events. In conclusion, implanting self-expandable transcatheter valves in patients pure AR in this small study was safe and effective, and represented an important option for inoperable patients with noncalcific severe AR.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.042
       
  • Meta-Analysis Comparing Patent Foramen Ovale Closure Versus Medical
           Therapy to Prevent Recurrent Cryptogenic Stroke
    • Authors: Tomo Ando; Anthony A. Holmes; Mohit Pahuja; Arshad Javed; Alenxandros Briasoulis; Tesfaye Telila; Hisato Takagi; Theodore Schreiber; Luis Afonso; Cindy L. Grines; Sripal Bangalore
      Pages: 649 - 655
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Tomo Ando, Anthony A. Holmes, Mohit Pahuja, Arshad Javed, Alenxandros Briasoulis, Tesfaye Telila, Hisato Takagi, Theodore Schreiber, Luis Afonso, Cindy L. Grines, Sripal Bangalore
      New evidence suggests that closure of a patent foramen ovale (PFO) plus medical therapy (MT; antiplatelet or anticoagulation) is superior to MT alone to prevent recurrent cryptogenic stroke. We performed a meta-analysis of randomized controlled trials that compared PFO closure plus MT with MT alone in patients with cryptogenic stroke. The efficacy end points were recurrent stroke, transient ischemia attack, and death. The safety end points were major bleeding and newly detected atrial fibrillation. Trials were pooled using random effects and fixed effects models. A trial sequential analysis was performed to assess if the current evidence is sufficient. Risk ratios (RR) were calculated for pooled estimates of risk. Five randomized controlled trials (3,440 patients) were included. Mean follow-up was 4.1 years. PFO closure reduced the risk of recurrent stroke by 58% (RR 0.42, 95% CI 0.20 to 0.91, p = 0.03). The number needed to treat was 38. The cumulative Z-line crossed the trial sequential boundary, suggesting there is adequate evidence to conclude that PFO closure reduces the risk of recurrent stroke by 60%. PFO closure did not reduce the risk of transient ischemia attack (RR 0.78, 95% CI 0.53 to 1.15, p = 0.21), mortality (RR 0.74, 95% CI 0.35 to 1.60, p = 0.45), or major bleeding (RR 0.96, 95% CI 0.42 to 2.20, p = 0.93); it did increase the risk of atrial fibrillation (RR 4.69, 95% CI 2.17 to 10.12, p <0.0001).

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.037
       
  • Diffuse Myocardial Interstitial Fibrosis and Dysfunction in Early Chronic
           Kidney Disease
    • Authors: Manvir Kaur Hayer; Anna Marie Price; Boyang Liu; Shanat Baig; Charles Joseph Ferro; Jonathan Nicholas Townend; Richard Paul Steeds; Nicola Catherine Edwards
      Pages: 656 - 660
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Manvir Kaur Hayer, Anna Marie Price, Boyang Liu, Shanat Baig, Charles Joseph Ferro, Jonathan Nicholas Townend, Richard Paul Steeds, Nicola Catherine Edwards
      Patients with chronic kidney disease (CKD) have a disproportionately high risk of cardiovascular (CV) morbidity and mortality from the very early stages of CKD. This excess risk is believed to be the result of myocardial disease commonly termed uremic cardiomyopathy (UC). It has been suggested that interstitial myocardial fibrosis progresses with advancing kidney disease and may be the key mediator of UC. This longitudinal study reports data on the myocardial structure and function of 30 patients with CKD with no known cardiovascular disease and healthy controls. All patients underwent cardiac magnetic resonance imaging including T1 mapping and late gadolinium enhancement (if estimated glomerular filtration rate > 30 ml/min/1.73 m2). Over a mean follow-up period of 2.7 ± 0.8 years, there was no change in left ventricular mass, volumes, ejection fraction, native myocardial T1 times, or extracellular volume with CKD or in healthy controls. Global longitudinal strain (20.6 ± 2.9 s−1 vs 19.8 ± 2.9 s−1, p = 0.03) and mitral annular planar systolic excursion (13 ± 2 mm vs 12 ± 2 mm, p = 0.009) decreased in CKD but were clinically insignificant. Midwall late gadolinium enhancement was present in 4 patients at baseline and was unchanged at follow-up. Renal function was stable in this cohort over follow-up (change in estimated glomerular filtration rate was −3 ml/min/1.73 m2) with no adverse clinical CV events. In conclusion, this study demonstrates that in a cohort of patients with stable CKD, left ventricular mass, native T1 times, and extracellular volume do not increase over a period of 2.7 years.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.041
       
  • Asymptomatic Ascending Aorta Aneurysm With Severe Aortic Regurgitation
           Caused by Multiple Intimal-Medial Tears Unassociated With Aortic
           Dissection
    • Authors: Carlos E. Velasco; Helen Hashemi; Christina P. Roullard; Juan Machannaford; William C. Roberts
      Pages: 668 - 669
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Carlos E. Velasco, Helen Hashemi, Christina P. Roullard, Juan Machannaford, William C. Roberts
      A 62-year-old man was found to have an asymptomatic ascending aortic aneurysm (6.6 cm) associated with severe aortic regurgitation. Operative resection of the wall of the aneurysm disclosed its cause to be multiple healed intimal-medial tears without dissection involving a previously normal aorta. The concept of an intimal-medial tear unassociated with aortic dissection is a poorly recognized entity and these tears appear to be asymptomatic and after the aortic tearing lead to aneurysmal formation.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.12.001
       
  • Residual Confounding Prohibits Interpretation of Results After Propensity
           Score Matching
    • Authors: Barret Rush; Clark Fruhstorfer
      First page: 670
      Abstract: Publication date: 1 March 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 5
      Author(s): Barret Rush, Clark Fruhstorfer


      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.11.044
       
  • Usefulness of Achieving ≥10 METs With a Negative Stress
           Electrocardiogram to Screen for High-Risk Obstructive Coronary Artery
           Disease in Patients Referred for Coronary Angiography After Exercise
           Stress Testing
    • Authors: Adrián I. Löffler; Margarita V. Perez; Emmanuel O. Nketiah; Jamieson M. Bourque; Ellen C. Keeley
      Pages: 289 - 293
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Adrián I. Löffler, Margarita V. Perez, Emmanuel O. Nketiah, Jamieson M. Bourque, Ellen C. Keeley
      Functional capacity in exercise stress testing is an independent predictor of cardiac events. Routine use of nuclear perfusion imaging increases radiation burden and cost. Our goal was to assess the clinical utility of exercise functional capacity with stress electrocardiogram (ECG) as an adjunct in predicting the presence of high-risk obstructive coronary artery disease (CAD) on diagnostic coronary angiography. We performed a retrospective study of patients who underwent exercise stress testing for the evaluation of chest pain and underwent diagnostic coronary angiography within the subsequent 3 months. High-risk CAD was defined as coronary artery diameter stenosis of ≥70% in the proximal left anterior descending artery, ≥70% diameter stenosis in 3 major epicardial arteries, or ≥50% diameter stenosis in the left main artery. Univariable and multivariable analyses were performed to identify predictors of high-risk CAD. Of the 412 patients, 105 (25%) had high-risk CAD on coronary angiography. On multivariate logistic regression, we found that positive stress ECG, abnormal stress imaging, left ventricular ejection fraction, and male gender were independent predictors of high-risk CAD. The strongest predictor was positive stress ECG (hazard ratio 3.16, 95% confidence interval 1.90 to 5.27, p <0.001). Functional capacity measures alone were not independent predictors of high-risk CAD. Achieving ≥10 METs with a negative stress ECG resulted in 94% sensitivity and 97% negative predictive value in identifying high-risk CAD. This supports the strategy for provisional use of myocardial perfusion imaging in patients with low functional capacity and/or abnormal stress ECG to minimize cost and radiation exposure.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.032
       
  • Electrocardiographic Findings in Patients With Acute Coronary Syndrome
           Presenting With Out-of-Hospital Cardiac Arrest
    • Authors: Bradley Sarak; Shaun G. Goodman; David Brieger; Chris P. Gale; Nigel S. Tan; Andrzej Budaj; Graham C. Wong; Thao Huynh; Mary K. Tan; Jacob A. Udell; Akshay Bagai; Keith A.A. Fox; Andrew T. Yan
      Pages: 294 - 300
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Bradley Sarak, Shaun G. Goodman, David Brieger, Chris P. Gale, Nigel S. Tan, Andrzej Budaj, Graham C. Wong, Thao Huynh, Mary K. Tan, Jacob A. Udell, Akshay Bagai, Keith A.A. Fox, Andrew T. Yan
      We sought to characterize presenting electrocardiographic findings in patients with acute coronary syndromes (ACSs) and out-of-hospital cardiac arrest (OHCA). In the Global Registry of Acute Coronary Events and Canadian ACS Registry I, we examined presenting and 24- to 48-hour follow-up ECGs (electrocardiogram) of ACS patients who survived to hospital admission, stratified by presentation with OHCA. We assessed the prevalence of ST-segment deviation and bundle branch blocks (assessed by an independent ECG core laboratory) and their association with in-hospital and 6-month mortality among those with OHCA. Of the 12,040 ACS patients, 215 (1.8%) survived to hospital admission after OHCA. Those with OHCA had higher presenting rates of ST-segment elevation, ST-segment depression, T-wave inversion, precordial Q-waves, left bundle branch block (LBBB), and right bundle branch block (RBBB) than those without. Among patients with OHCA, those with ST-segment elevation had significantly lower in-hospital mortality (20.9% vs 33.0%, p = 0.044) and a trend toward lower 6-month mortality (27% vs 39%, p = 0.060) compared with those without ST-segment elevation. Conversely, among OCHA patients, LBBB was associated with significantly higher in-hospital and 6-month mortality rates (58% vs 22%, p <0.001, and 65% vs 28%, p <0.001, respectively). ST-segment depression and RBBB were not associated with either outcome. Sixty-three percent of bundle branch blocks (RBBB or LBBB) on the presenting ECG resolved by 24 to 48 hours. In conclusion, compared with ACS patients without cardiac arrest, those with OHCA had higher rates of ST-segment elevation, LBBB, and RBBB on admission. Among OHCA patients, ST-segment elevation was associated with lower in-hospital mortality, whereas LBBB was associated with higher in-hospital and 6-month mortality.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.030
       
  • Meta-Analysis of the Safety and Efficacy of the Oral Anticoagulant Agents
           (Apixaban, Rivaroxaban, Dabigatran) in Patients With Acute Coronary
           Syndrome
    • Authors: Safi U. Khan; Adeel Arshad; Irbaz Bin Riaz; Swapna Talluri; Fahad Nasir; Edo Kaluski
      Pages: 301 - 307
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Safi U. Khan, Adeel Arshad, Irbaz Bin Riaz, Swapna Talluri, Fahad Nasir, Edo Kaluski
      The significance of adding new oral anticoagulants (NOACs) to antiplatelet therapy in patients with acute coronary syndrome (ACS) is unclear. We conducted a meta-analysis to assess the safety and efficacy of adding NOACs (apixaban, rivaroxaban, and dabigatran) to single antiplatelet agent (SAP) or dual antiplatelet therapy (DAPT) in patients with ACS. Seven randomized controlled trials were selected using PubMed or MEDLINE, Scopus, and Cochrane library (inception to August 2017). The summary measure was random effects hazard ratio (HR) with 95% confidence interval (CI). The primary safety outcome was clinically significant bleeding. The secondary efficacy outcome was major adverse cardiovascular events (MACE; composite of myocardial infarction, stroke, and all-cause mortality). In 31,574 patients, addition of NOAC to SAP did not increase the risk of clinically significant bleeding (HR 0.82, 95% CI 0.56 to 1.20, p = 0.31); however, the risk of clinically significant bleeding was significantly increased with NOAC plus DAPT (HR 2.24, 95% CI 1.75 to 2.87, p < 0.001). NOACs had no statistically beneficial effect on MACE when used with SAP (HR 0.82, 95% CI 0.66 to 1.04, p = 0.10); however, a modest reduction in MACE was observed when NOACs were combined with DAPT (HR 0.86, 95% CI 0.78 to 0.93, p < 0.001). In conclusion, in patients with ACS, the addition of NOAC to DAPT resulted in increased risk of clinically significant bleeding, whereas only a modest reduction in MACE was achieved. The addition of NOACs to SAP did not result in significant reduction of MACE or increase in clinically significant bleeding.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.035
       
  • Effect of Evolocumab on Lipoprotein Particles
    • Authors: Peter P. Toth; Naveed Sattar; Dirk J. Blom; Seth S. Martin; Steven R. Jones; Maria Laura Monsalvo; Mary Elliott; Mike Davis; Ransi Somaratne; David Preiss
      Pages: 308 - 314
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Peter P. Toth, Naveed Sattar, Dirk J. Blom, Seth S. Martin, Steven R. Jones, Maria Laura Monsalvo, Mary Elliott, Mike Davis, Ransi Somaratne, David Preiss
      The level of low-density lipoprotein cholesterol (LDL-C) reflects the cholesterol carried mainly by low-density lipoprotein particles (LDL-P). LDL-C, however, does not always correlate with LDL-P because of the variable amounts of cholesterol per particle. Consideration of LDL-P concentrations in addition to LDL-C may help guide therapeutic decisions in a select number of patients. Evolocumab is a fully human monoclonal antibody directed against proprotein convertase subtilisin-kexin type 9 that lowers both LDL-C and cardiovascular events. To evaluate the effect of evolocumab on serum levels and size of lipoprotein particles, we conducted a post hoc subanalysis of 619 patients from the Durable Effect of PCSK9 Antibody Compared with Placebo Study or DESCARTES trial, a 52-week, randomized, double-blind, placebo-controlled, global study of patients with hyperlipidemia. At baseline, mean LDL-P concentration was 1077 nmol/L for the placebo group and 1100 nmol/L for the evolocumab group. In patients receiving evolocumab, week 52 total LDL-P concentration decreased to 610 nmol/L, a treatment difference of 50% versus placebo. Evolocumab also reduced concentrations of medium very low-density lipoprotein particles (VLDL-P), small VLDL-P, and intermediate-density lipoprotein particle: median (Q1, Q3) changes were −15.2% (−48, 48), −29% (−54, 18), and −36% (−70, 22), respectively. Mean (95% confidence interval) % changes in total LDL particle size in the evolocumab group was −1.7 (−2.0, −1.4); % changes in HDL and VLDL particle sizes were 1.1 (0.7, 1.5) and 8.7 (7.0, 10.5), respectively. Changes in total LDL, HDL, and VLDL particle sizes (vs placebo) were all significant (p <0.001). In conclusion, evolocumab significantly lowers atherogenic lipoprotein particles including low-density and remnant lipoproteins.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.028
       
  • Relation of Ectopic Fat with Atherosclerotic Cardiovascular Disease Risk
           Score in South Asians Living in the United States (from the Mediators of
           Atherosclerosis in South Asians Living in America [MASALA] Study)
    • Authors: Morgana Mongraw-Chaffin; Unjali P. Gujral; Alka M. Kanaya; Namratha R. Kandula; John Jeffrey Carr; Cheryl A.M. Anderson
      Pages: 315 - 321
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Morgana Mongraw-Chaffin, Unjali P. Gujral, Alka M. Kanaya, Namratha R. Kandula, John Jeffrey Carr, Cheryl A.M. Anderson
      Few studies have investigated the association between ectopic fat from different depots and cardiovascular risk scores and their components in the same population, and none have investigated these relations in South Asians. In a cross-sectional analysis of 796 participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study who had measurements of visceral, subcutaneous, pericardial, hepatic, and intermuscular fat from abdominal and cardiac computed tomography scans, we used linear regression to determine the associations of 1 standard deviation difference in each ectopic fat depot with pooled cohort risk score and its components. Pericardial and visceral fat were more strongly associated with the pooled cohort risk score (3.1%, 95% confidence interval [CI] 2.5 to 3.7, and 2.7%, 95% CI 2.1 to 3.3, respectively) and components than intermuscular fat (2.3%, 95% CI 1.7 to 3.0); subcutaneous fat was inversely associated with the pooled cohort risk score (−2.6%, 95% CI −3.2 to 1.9) and hepatic fat attenuation was not linearly associated with the pooled cohort risk score when mutually adjusted (−0.3%, 95% CI −0.9 to 0.4). Associations for risk factor components differed by fat depot. In conclusion, subcutaneous and hepatic fat may have different functions than fat stored in other depots in South Asians. Determining whether these relations are heterogeneous by race may help elucidate the mechanisms underlying CVD disparities.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.026
       
  • Validation of Predictive Score of 30-Day Hospital Readmission or Death in
           Patients With Heart Failure
    • Authors: Quan Huynh; Kazuaki Negishi; Carmine G. De Pasquale; James L. Hare; Dominic Leung; Tony Stanton; Thomas H. Marwick
      Pages: 322 - 329
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Quan Huynh, Kazuaki Negishi, Carmine G. De Pasquale, James L. Hare, Dominic Leung, Tony Stanton, Thomas H. Marwick
      Existing prediction algorithms for the identification of patients with heart failure (HF) at high risk of readmission or death after hospital discharge are only modestly effective. We sought to validate a recently developed predictive model of 30-day readmission or death in HF using an Australia-wide sample of patients. This study used data from 1,046 patients with HF at teaching hospitals in 5 Australian capital cities to validate a predictive model of 30-day readmission or death in HF. Besides standard clinical and administrative data, we collected data on individual sociodemographic and socioeconomic status, mental health (Patient Health Questionnaire [PHQ]-9 and Generalized Anxiety Disorder [GAD]-7 scale score), cognitive function (Montreal Cognitive Assessment [MoCA] score), and 2-dimensional echocardiograms. The original sample used to develop the predictive model and the validation sample had similar proportions of patients with an adverse event within 30 days (30% vs 29%, p = 0.35) and 90 days (52% vs 49%, p = 0.36). Applying the predicted risk score to the validation sample provided very good discriminatory power (C-statistic = 0.77) in the prediction of 30-day readmission or death. This discrimination was greater for predicting 30-day death (C-statistic = 0.85) than for predicting 30-day readmission (C-statistic = 0.73). There was a small difference in the performance of the predictive model among patients with either a left ventricular ejection fraction of <40% or a left ventricular ejection fraction of ≥40%, but an attenuation in discrimination when used to predict longer-term adverse outcomes. In conclusion, our findings confirm the generalizability of the predictive model that may be a powerful tool for targeting high-risk patients with HF for intensive management.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.031
       
  • Prevalence and Prognostic Significance of Nonsustained Ventricular
           Tachycardia in Patients With a Left Ventricular Ejection Fraction from 35%
           to 50%
    • Authors: Sorcha M. Allen; Victor A. Abrich; Paul S. Bibby; Daniel Fishman; Win-Kuang Shen; Dan Sorajja
      Pages: 330 - 335
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Sorcha M. Allen, Victor A. Abrich, Paul S. Bibby, Daniel Fishman, Win-Kuang Shen, Dan Sorajja
      The risk of life-threatening ventricular arrhythmias in patients with mild-to-moderately reduced left ventricular ejection fraction (LVEF) is unknown. This retrospective case-control study aims to identify the prevalence, risk factors, and outcomes associated with the development of nonsustained ventricular tachycardia (NSVT) as documented on permanent pacemakers or implantable loop recorders in tertiary care center patients with an LVEF of 35% to 50%. Data pertaining to patient demographics, previous medical history, heart failure functional class, echocardiographic parameters, and survival were compared between the groups. Of the 326 patients with an LVEF within the target range, 90 patients (27.6%) had NSVT recorded on their device and 236 patients (72.4%) did not. Compared with patients without NSVT, patients with NSVT had a higher body mass index (28.4 kg/m2 vs 26.8 kg/m2, p = 0.02), more ischemic heart disease (57.8% vs 32.8%, p < 0.0001), higher left atrial volume index (45.8 ml/m2 vs 42.0 ml/m2, p = 0.04), and lower use of antiarrhythmic medications (4.4% vs 11.9%, p = 0.04). The presence of NSVT and the duration of NSVT had no relation to survival, supporting the notion that NSVT is a benign finding in patients with an LVEF of 35% to 50%.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.023
       
  • Frequency and Consequences of Right-Sided Heart Failure After
           Continuous-Flow Left Ventricular Assist Device Implantation
    • Authors: Chitaru Kurihara; Andre C. Critsinelis; Masashi Kawabori; Tadahisa Sugiura; Gabriel Loor; Andrew B. Civitello; Jeffrey A. Morgan
      Pages: 336 - 342
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Chitaru Kurihara, Andre C. Critsinelis, Masashi Kawabori, Tadahisa Sugiura, Gabriel Loor, Andrew B. Civitello, Jeffrey A. Morgan
      Postoperative right-sided heart failure (RHF) is a common complication after continuous-flow left ventricular assist device implantation. Studies have examined RHF in the perioperative period, but few have assessed late-onset RHF. We analyzed the incidence of early and late RHF in patients with HeartMate II and HeartWare left ventricular assist devices and associated morbidity, mortality, and independent predictors of RHF. We retrospectively analyzed records of 526 patients with chronic heart failure who underwent continuous-flow left ventricular assist device implantation; 147 (27.9%) developed RHF (early RHF, n = 87, 16.5%; late RHF, n = 74, 14.4%). We examined demographics, postoperative complications, and long-term survival rate. Patients with RHF or late RHF had higher mortality (p <0.001) than those without RHF. Patients with RHF had a higher incidence of acute kidney injury (20.4% vs 11.9%, p = 0.01). Device type did not affect the incidence of early, late, or overall RHF. Patients with severe RHF requiring right ventricular assist device support had a low success of bridge to transplantation (11.1% vs 33.3%, p = 0.02). In Cox regression models, RHF was an independent predictor of mortality (hazard ratio = 1.69, 95% confidence interval = 1.28 to 2.22, p <0.001), but no predictive variables of RHF were identified. RHF was significantly associated with increased mortality and a higher incidence of postoperative acute kidney injury. RHF decreased the success rate of bridging patients to transplantation when a right ventricular assist device was required.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.022
       
  • Comparison of the Prognostic Usefulness of the European Society of
           Cardiology and American Heart Association/American College of Cardiology
           Foundation Risk Stratification Systems for Patients With Hypertrophic
           Cardiomyopathy
    • Authors: Kevin M.W. Leong; Ji-Jian Chow; Fu Siong Ng; Emanuela Falaschetti; Norman Qureshi; Michael Koa-Wing; Nicholas W.F. Linton; Zachary I. Whinnett; David C. Lefroy; D. Wyn Davies; Phang Boon Lim; Nicholas S. Peters; Prapa Kanagaratnam; Amanda M. Varnava
      Pages: 349 - 355
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Kevin M.W. Leong, Ji-Jian Chow, Fu Siong Ng, Emanuela Falaschetti, Norman Qureshi, Michael Koa-Wing, Nicholas W.F. Linton, Zachary I. Whinnett, David C. Lefroy, D. Wyn Davies, Phang Boon Lim, Nicholas S. Peters, Prapa Kanagaratnam, Amanda M. Varnava
      Implantable cardiodefibrillators (ICDs) have proven benefit in preventing sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HC), making risk stratification essential. Data on the predictive accuracy on the European Society of Cardiology (ESC) risk scoring system have been conflicting. We independently evaluated the ESC risk scoring system in our cohort of patients with HC from a large tertiary center and compared this with previous guidance by the American College of Cardiology Foundation and Heart Association (ACCF/AHA). Risk factor profiles, 5-year SCD risk estimates, and ICD recommendations, as defined by the ACCF/AHA and ESC guidelines, were retrospectively ascertained for 288 HC patients with and without SCD or equivalent events at our center. In the SCD group (n = 14), a significantly higher proportion of patients would not have met the criteria for an ICD implant using the ESC scoring algorithm compared with ACCF/AHA guidance (43% vs 7%, p = 0.029). In those without SCD events (n = 274), a larger proportion of individuals not requiring an ICD was identified using the ESC risk score model compared with the ACCF/AHA model (82% vs 57%; p < 0.0001). Based on risk stratification criteria alone, 5 more individuals with a previously aborted SCD event would not have received an ICD with the ESC risk model compared with the ACCF/AHA risk model. In conclusion, we found that the current ESC scoring system potentially leaves more high-risk patients unprotected from sudden death in our cohort of patients.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.027
       
  • Value of the Electrocardiographic (P Wave, T Wave, QRS) Axis as a
           Predictor of Mortality in 14 Years in a Population With a High Prevalence
           of Chagas Disease from the Bambuí Cohort Study of Aging
    • Authors: Diego N. Moraes; Bruno R. Nascimento; Andrea Z. Beaton; Elsayed Z. Soliman; Maria Fernanda Lima-Costa; Rodrigo C.P. dos Reis; Antonio Luiz P. Ribeiro
      Pages: 364 - 369
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Diego N. Moraes, Bruno R. Nascimento, Andrea Z. Beaton, Elsayed Z. Soliman, Maria Fernanda Lima-Costa, Rodrigo C.P. dos Reis, Antonio Luiz P. Ribeiro
      We sought to investigate the prognostic value of the electrocardiogram (ECG) electrical axes (P wave, T wave and QRS) as predictors of mortality in the 14-year follow-up of the prospective cohort of all residents ≥60 years living in the southeastern Brazilian city of Bambuí, a population with high prevalence of Chagas disease (ChD). Baseline ECG axes were automatically measured with normal values defined as follows: P-wave axis 0° to 75°, QRS axis −30° to 90°, and T axis 15° to 75°. Participants underwent annual follow-up visits and death was verified using death certificates. Cox proportional hazards regression was used to assess the prognostic value of ECG axes for all-cause mortality, after adjustment for potential confounders. From 1,742 qualifying residents, 1,462 were enrolled, of whom 557 (38.1%) had ChD. Mortality rate was 51.9%. In multivariable adjusted models, abnormal P-wave axis was associated with a 48% (hazard ratio [HR] = 1.48 [95% confidence interval (CI) 1.16–1.88]) increased mortality risk in patients with ChD and 43% (HR = 1.43 [CI 1.13–1.81]) in patients without ChD. Abnormal QRS axis was associated with a 34% (HR = 1.34 [CI 1.04–1.73]) increased mortality risk in patients with ChD, but not in individuals without ChD. Similarly, in the ChD group, abnormal T-wave axis was associated with a 35% (HR = 1.35 [CI 1.07–1.71]) increased mortality, but not in patients without ChD. In conclusion, abnormal P-wave, QRS, and T-wave axes were associated with increased all-cause mortality in patients with ChD. Abnormal P-wave axis was associated with mortality also among those without ChD, being the strongest predictor among ECG variables.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.020
       
  • Magnetic Resonance Imaging Correlates of Left Bundle Branch Disease in
           Patients With Nonischemic Cardiomyopathy
    • Authors: Chrysanthos Grigoratos; Riccardo Liga; Elena Bennati; Andrea Barison; Giancarlo Todiere; Giovanni Donato Aquaro; Matteo Dell'Omodarme; Michele Emdin; Pier Giorgio Masci
      Pages: 370 - 376
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Chrysanthos Grigoratos, Riccardo Liga, Elena Bennati, Andrea Barison, Giancarlo Todiere, Giovanni Donato Aquaro, Matteo Dell'Omodarme, Michele Emdin, Pier Giorgio Masci
      The pathologic correlates of intraventricular conduction delays in patients with nonischemic cardiomyopathy (NIC) have been scarcely investigated. We assessed left ventricular (LV) structural, functional, and tissue abnormalities associated with intraventricular conduction left bundle disease (LBD), including left anterior hemiblock or complete left bundle branch block, in a cohort of patients with NIC submitted to cardiovascular magnetic resonance. Twelve-lead electrocardiogram and cardiovascular magnetic resonance were performed in 196 consecutive patients with NIC. The presence and extent of myocardial fibrosis was evaluated with late gadolinium enhancement (LGE) technique. Compared with normal intraventricular conduction patients, those with LBD were older (66 vs 59 years, p = 0.001), had greater LV volumes (p = 0.035 for end-diastolic and p = 0.009 for end-systolic volume) and mass (p = 0.034), and showed lower LV ejection fraction (33% vs 40%, p = 0.008). LGE was observed more commonly in LBD than in normal intraventricular conduction patients and was more often located in the ventricular septum (p < 0.001). On multivariate analysis, septal LGE was independently associated with a higher likelihood of LBD (odds ratio 6.1, 95% confidence interval 2.9 to 12.7, p < 0.001), even after correction for LV volumes, mass, and ejection fraction. In conclusion, in NIC, the presence of LBD is associated with worse LV remodeling and dysfunction than normal intraventricular conduction. Septal fibrosis yielded a 6-fold greater likelihood of LBD, independently of the degree of LV dilatation and systolic dysfunction.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.024
       
  • Clinical and Psychological Drivers of Perceived Health Status in Adults
           With Congenital Heart Disease
    • Authors: Jong Mi Ko; Kristen M. Tecson; Vanessa al Rashida; Sandeep Sodhi; Josh Saef; Mehwish Mufti; Kamila S. White; Philip A. Ludbrook; Ari M. Cedars
      Pages: 377 - 381
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Jong Mi Ko, Kristen M. Tecson, Vanessa al Rashida, Sandeep Sodhi, Josh Saef, Mehwish Mufti, Kamila S. White, Philip A. Ludbrook, Ari M. Cedars
      The factors having the greatest impact on self-reported health status in adults with congenital heart disease (ACHD) remain incompletely studied. We conducted a single-site, cross-sectional study of ACHD patients followed at the Center for ACHD at Washington University School of Medicine, including retrospectively gathered clinical data and psychometric and health status assessments completed at the time of enrollment. To identify primary drivers of perceived health status, we investigated the impact of the demographic, clinical, and psychological variables on self-reported health status as assessed using the Rand 36-Item Short Form Health Survey. Variables with significant associations within each domain were considered jointly in multivariable models constructed via stepwise selection. There was domain-specific heterogeneity in the variables having the greatest effect on self-reported health status. Depression was responsible for the greatest amount of variability in health status in all domains except physical functioning. In the physical functioning domain, depression remained responsible for 5% of total variability, the third most significant variable in the model. In every domain, depression more strongly influenced health status than did any cardiac-specific variable. In conclusion, depression was responsible for a significant amount of heterogeneity in all domains of self-perceived health status. Psychological variables were better predictors of health status than clinical variables.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.038
       
  • Using Metabolic Equivalents in Clinical Practice
    • Authors: Barry A. Franklin; Jenna Brinks; Kathy Berra; Carl J. Lavie; Neil F. Gordon; Laurence S. Sperling
      Pages: 382 - 387
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Barry A. Franklin, Jenna Brinks, Kathy Berra, Carl J. Lavie, Neil F. Gordon, Laurence S. Sperling
      Metabolic equivalents, or METs, are routinely employed as a guide to exercise training and activity prescription and to categorize cardiorespiratory fitness (CRF). There are, however, inherent limitations to the concept, as well as common misapplications. CRF and the patient's capacity for physical activity are often overestimated and underestimated, respectively. Moreover, frequently cited fitness thresholds associated with the highest and lowest mortality rates may be misleading, as these are influenced by several factors, including age and gender. The conventional assumption that 1 MET = 3.5 mL O2/kg/min has been challenged in numerous studies that indicate a significant overestimation of actual resting energy expenditure in some populations, including coronary patients, the morbidly obese, and individuals taking β-blockers. These data have implications for classifying relative energy expenditure at submaximal and peak exercise. Heart rate may be used to approximate activity METs, resulting in a promising new fitness metric termed the “personal activity intelligence” or PAI score. Despite some limitations, the MET concept provides a useful method to quantitate CRF and define a repertoire of physical activities that are likely to be safe and therapeutic. In conclusion, for previously inactive adults, moderate-to-vigorous physical activity, which corresponds to ≥3 METs, may increase MET capacity and decrease the risk of future cardiac events.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.033
       
  • Some Cardiologists' Perspective on Past, Current, and Future of Sleep
           Medicine
    • Authors: Younghoon Kwon; Lee A. Surkin; Chi-Hang Lee
      Pages: 388 - 389
      Abstract: Publication date: 1 February 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 3
      Author(s): Younghoon Kwon, Lee A. Surkin, Chi-Hang Lee
      An accumulating body of evidence has highlighted the importance of sleep in cardiovascular health. Sleep apnea (SA) is a highly common condition in patients with cardiovascular comorbidities. Although awareness about the importance of diagnosis and treatment of SA among cardiologists has increased, incorporating it into daily practice has been challenging. We briefly review the current state of sleep medicine in the United States and provide views on how the cardiology community can more actively participate in SA care to deliver higher quality of care. We propose a cardiology-led patient-centered SA collaborative care model to effectively achieve this.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.10.034
       
  • Long-Term Change in Cardiorespiratory Fitness in Relation to Atrial
           Fibrillation and Heart Failure (From the Kuopio Ischemic Heart Disease
           Risk Factor Study)
    • Authors: Hassan Khan; Setor K. Kunutsor; Rainer Rauramaa; Faisal Merchant; Jari A. Laukkanen
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of Cardiology
      Author(s): Hassan Khan, Setor K. Kunutsor, Rainer Rauramaa, Faisal Merchant, Jari A. Laukkanen
      The benefits of aerobic fitness in relation to all-cause and cardiovascular mortality is well established; however, the associations of long term change in cardiorespiratory fitness with incident heart failure (HF) and atrial fibrillation (AF) have not been studied before. The Kuopio Ischaemic Heart Disease Risk Factor Study is a prospective cohort comprising men aged 42 to 60 years from the city of Kuopio and its surroundings with a baseline examination between 1984 and 1989 (V1), a re-examination at 11 years (V2), and up to 15 years of follow-up from V2. Cardiorespiratory fitness (CRF), as assessed by VO2max, was measured at both visits using respiratory gas exchange during maximal exercise tolerance test. The difference (ΔVO2max) was estimated as VO2max (V2) - VO2max (V1). Participants with no missing data on both baseline and 11-year exercise test were included (N=481). The mean ΔVO2max was -5.4(SD 5.4) ml/min*kg. During a median follow-up of 14.3 (interquartile range: 13.3–15.1) years, 46 (9.6%) incident HF and 73 (15.2%) incident AF events were recorded. In a multivariate analysis adjusted for baseline age, baseline VO2max, systolic blood pressure, smoking, type 2 diabetes and cardiovascular disease, per 1 ml/min*kg higher ΔVO2max was log linearly associated with incident HF with a 10% relative risk reduction of HF (HR 0.90; 95% CI: 0.83 to 0.97). No significant relationship of ΔVO2max with incident AF was observed. In Conclusion, overall long-term improvement in CRF is associated with reduced risk of HF, indicating the importance of maintaining good CRF over time.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2018.01.003
       
  • Efficacy and Safety of Alirocumab in High-Risk Patients with Clinical
           Atherosclerotic Cardiovascular Disease and/or Heterozygous Familial
           Hypercholesterolemia (From 5 Placebo-Controlled ODYSSEY Trials)
    • Authors: Peter A. McCullough; Christie M. Ballantyne; Santosh K. Sanganalmath; Gisle Langslet; Seth J. Baum; Prediman K. Shah; Andrew Koren; Jonas Mandel; Michael H. Davidson
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of Cardiology
      Author(s): Peter A. McCullough, Christie M. Ballantyne, Santosh K. Sanganalmath, Gisle Langslet, Seth J. Baum, Prediman K. Shah, Andrew Koren, Jonas Mandel, Michael H. Davidson
      Patients with prior atherosclerotic cardiovascular disease (ASCVD) and/or heterozygous familial hypercholesterolemia (HeFH) are at high risk of future cardiovascular events. Despite maximally tolerated doses of statins, many still have elevated low-density lipoprotein cholesterol (LDL-C) levels. We evaluated the efficacy and safety of alirocumab in ASCVD and/or HeFH patients on a maximally tolerated dose of statin (rosuvastatin 20 or 40 mg, atorvastatin 40 or 80 mg, or simvastatin 80 mg, or lower doses with an investigator-approved reason) ± other lipid-lowering therapies from 5 placebo-controlled Phase 3 trials (52–78 weeks). Patients with (n=2449) and without (n=1050) ASCVD were pooled from the FH I, FH II, HIGH FH, LONG TERM, and COMBO I trials. HeFH patients with (n=575) and without ASCVD (n=682) were pooled from all trials except COMBO I. High-intensity statins were utilized in 55.7–59.0% and 72.4–87.6% of ASCVD and HeFH groups, respectively. Efficacy endpoints included LDL-C % change from baseline to week 24 stratified by alirocumab dose. Mean baseline demographics and lipid levels were comparable in alirocumab- and placebo-treated patients. LDL-C reductions from baseline at week 24 ranged from 46.6–51.3% for alirocumab 75/150 mg and 54.1–61.9% for alirocumab 150 mg in ASCVD and HeFH groups and were sustained for up to 78 weeks. LDL-C reductions with alirocumab were independent of ASCVD and/or HeFH status (interaction P-value >0.05). Concordant results were observed for other lipids analyzed. Overall safety in subgroups analyzed was similar in both treatment arms. Injection-site reactions were observed more frequently with alirocumab versus placebo.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.12.040
       
  • Relation of Waist-Hip Ratio to Long-Term Cardiovascular Events in Patients
           with Coronary Artery Disease
    • Authors: Jose R. Medina-Inojosa; John A. Batsis; Marta Supervia; Virend K. Somers; Randal Thomas; Sarah Jenkins; Chassidy Grimes; Francisco Lopez-Jimenez
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of Cardiology
      Author(s): Jose R. Medina-Inojosa, John A. Batsis, Marta Supervia, Virend K. Somers, Randal Thomas, Sarah Jenkins, Chassidy Grimes, Francisco Lopez-Jimenez
      Aiming to assess the association between measures of obesity and outcomes in coronary artery disease (CAD) patients. We included consecutive patients referred to cardiac rehabilitation because of prior CAD events, who were classified using BMI groups and sex-specific tertiles of waist-to-hip ratio (WHR). Follow-up was ascertained using a population-based, record linkage system that consists of complete data on all residents. A major cardiovascular event (MACE) was defined as the composite outcome including acute coronary syndromes, coronary revascularization, ventricular arrhythmias, stroke or death from any cause. The association between obesity measures and MACE was assessed using cox proportional hazards models adjusted for potential confounders. The cohort included 1529 patients (74% men) mean age ± SD 63.1±12.5 years, 40% were obese by BMI. Eighty-eight percent of men and 57% of women were classified as having central obesity by WHR. Median follow-up was 5.7 years and 415 patients had a MACE event. After adjustment, a high WHR tertile was a significant predictor for MACE in women (HR=1.85 [95% CI: 1.16, 2.94]; p=0.01), but not in men (HR=0.92 [95%CI: 0.69, 1.22]; p=0.54). This relationship in women persisted after further adjustment for BMI (HR=1.75 [95%CI: 1.07, 2.87]; p=0.03). Obesity by BMI was not associated with MACE in either men (HR=1.07 [95%CI: 0.76, 1.51]; p=0.69) or women (HR=0.98 [95%CI: 0.62, 1.56]; p=0.95). In conclusion WHR is associated with a higher risk of MACE among women with CAD but not in men. There was no obesity paradox when assessing obesity by BMI and MACE in CAD patients when including non-fatal events.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2017.12.038
       
  • Measurements of Lumen Areas and Diameters of Proximal and Middle Coronary
           Artery Segments in Subjects Without Coronary Atherosclerosis
    • Authors: Jaroslaw Skowronski; Jerzy Pregowski; Gary S. Mintz; Mariusz Kruk; Cezary Kepka; Pawel Tyczynski; Ilona Michalowska; Lukasz Kalinczuk; Maksymilian Opolski; Michal Ciszewski; Rafal Wolny; Zbigniew Chmielak; Adam Witkowski
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of Cardiology
      Author(s): Jaroslaw Skowronski, Jerzy Pregowski, Gary S. Mintz, Mariusz Kruk, Cezary Kepka, Pawel Tyczynski, Ilona Michalowska, Lukasz Kalinczuk, Maksymilian Opolski, Michal Ciszewski, Rafal Wolny, Zbigniew Chmielak, Adam Witkowski
      There are plenty of data on morphology and lumen dimensions of diseased coronary arteries. However, information on normal coronary vessel anatomy is scarce. We provided computed tomography angiography (CTA)-derived reference values of lumen dimensions in proximal and middle coronary segments in a healthy population with respect to gender and vessel dominance. Consecutive 2849 CTA examinations were reviewed to identify 201 subjects (77 males, patient age 50±13 years) whose coronary arteries were free from any sign of atherosclerosis (calcium score 0, no detectable plaque). For all proximal and middle coronary segments, lumen areas and diameters were measured. Coronary vessel segmentation and dominance pattern were defined using the Syntax Score. Normal values of lumen areas and diameters were significantly smaller for women compared to men except for the proximal right coronary artery (RCA) and the left main coronary artery (LMCA) 20.2±6.6mm2 vs 23.0±6.1mm2, p=0.0003, and 5.0±0.8mm vs 5.4±0.7mm, p=0.0001. The lower limit of normal for the LMCA (defined as mean lumen area – 2 SDs) equaled 7.0mm2 and 10.8mm2, for women and men, respectively. Subjects with left (vs right) coronary dominance had significantly larger areas and diameters of the LMCA (26.2±9.2mm2 vs 20.7±6.0mm2, p=0.0017, and 5.7±1.0mm vs 5.1±0.7 mm, p=0.0017, respectively) and proximal left circumflex (13.8±2.7mm2 vs 10.4±3.8mm2, p=0.0001, and 4.2±0.4mm vs 3.6±0.7mm, p=0.0001, respectively) and smaller areas and diameters of the proximal RCA (7.1±2.0mm2 vs 13.3±3.6mm2, p<0.0001, and 3.0±0.4mm vs 4.1±0.6mm, p<0.0001, respectively). In conclusion, gender and coronary artery dominance pattern significantly impact normal lumen areas and dimensions in subjects without coronary atherosclerosis.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2018.01.002
       
  • Relative Prognostic Value of Cardiac Troponin I and C-Reactive Protein in
           the General Population (From the HUNT Study)
    • Authors: Fjola D. Sigurdardottir; Magnus N. Lyngbakken; Oddgeir L. Holmen; Håvard Dalen; Kristian Hveem; Helge Røsjø; Torbjørn Omland
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of Cardiology
      Author(s): Fjola D. Sigurdardottir, Magnus N. Lyngbakken, Oddgeir L. Holmen, Håvard Dalen, Kristian Hveem, Helge Røsjø, Torbjørn Omland
      C-reactive protein and cardiac troponin I measured with high-sensitivity assays (hs-CRP and hs-TnI) have been associated with risk of fatal and nonfatal cardiovascular events in the general population. The relative prognostic merit of hs-CRP and hs-TnI, and whether these markers of inflammation and subclinical myocardial injury provide incremental information to established cardiovascular risk prediction models, remain unclear. hs-CRP and hs-TnI were measured in 9005 participants from the prospective observational HUNT study. All study subjects were free from known cardiovascular disease at baseline. During a median follow up period of 13.9 years, 733 participants reached the composite endpoint of hospitalization for acute myocardial infarction or heart failure, or cardiovascular death. In adjusted models, increased hs-TnI concentrations (>10 ng/L for women and >12 ng/L for men) were associated with the incidence of the composite endpoint (hazard ratio [HR] 3.61 [95% confidence interval (CI) 2.89-4.51]), while the risk associated with increased hs-CRP concentrations (>3 mg/L for both sexes) appeared to be weaker (HR 1.71 [1.40-2.10]). The addition of hs-TnI to established cardiovascular risk prediction models led to a net reclassification improvement (NRI) of 0.35 (95% CI 0.27-0.42), superior to that of hs-CRP (0.21 [0.13-0.28]). The prognostic accuracy of hs-TnI, assessed by C-statistics, was significantly greater than that of hs-CRP (0.753 (0.735-0.772) vs. 0.644 [0.625-0.663]). In conclusion, in subjects from the general population without a history of cardiovascular disease, hs-TnI provides prognostic information superior to that provided by hs-CRP and may therefore be a preferred marker for targeted prevention.

      PubDate: 2018-02-05T08:38:42Z
      DOI: 10.1016/j.amjcard.2018.01.004
       
 
 
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