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Publisher: Elsevier   (Total: 3158 journals)

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Showing 1 - 200 of 3157 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 36, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 24, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 97, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 27, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 37, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 422, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 283, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 14, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 17, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 168, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 32, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
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: 28, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 11)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 25)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 47, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 60, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 19, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 24, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 18, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 7, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
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: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
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: 17, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 25, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 12)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
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: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 65)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 408, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 12, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 34, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 19)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 48, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 358, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 471, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 57, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 11)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 10, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 10, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 52, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 57, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 60, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 11)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 13, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 48)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 229, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 29, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 29, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 38, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 19, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 43, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 194, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 205, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
American Journal of Cardiology
Journal Prestige (SJR): 1.93
Citation Impact (citeScore): 3
Number of Followers: 60  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9149 - ISSN (Online) 0002-9149
Published by Elsevier Homepage  [3158 journals]
  • Proceedings of the Editorial Board Meeting of The American Journal of
           Cardiology on March 17, 2019, in New Orleans, Louisiana
    • Abstract: Publication date: Available online 18 April 2019Source: The American Journal of CardiologyAuthor(s): William C. Roberts
       
  • Temporal Pattern of Growth Differentiation Factor-15 Protein After Acute
           Coronary Syndrome (From the BIOMArCS Study)
    • Abstract: Publication date: Available online 18 April 2019Source: The American Journal of CardiologyAuthor(s): Nermina Buljubasic, Maxime M. Vroegindewey, Rohit M. Oemrawsingh, Folkert W. Asselbergs, Etienne Cramer, Anho Liem, Pim van der Harst, Arthur Maas, Eelko Ronner, Carl Schotborgh, Alexander J. Wardeh, K. Martijn Akkerhuis, Eric Boersma, for the BIOMArCS investigatorsABSTRACTGrowth differentiation factor-15 (GDF-15) has appeared as a promising biomarker with strong predictive abilities in acute coronary syndrome (ACS). However, studies are solely based on single measurements in the acute phase of an ACS event. The way GDF-15 patterns in post ACS patients behave on the long term is largely unknown. We conducted a nested case-control study within our multicenter, prospective, observational biomarker study (BIOMArCS) of 844 ACS patients. Following an index ACS event, high-frequency blood sampling was performed during 1-year of follow-up. GDF-15 was determined batchwise by electrochemiluminescence immunoessays in 37 cases with a recurrent event during 1-year follow-up, and in 74 event-free controls. Cases and controls had a mean ± standard deviation age of 66.9 ± 11.3 years and 81% were men. From 30 days onwards, patients showed stable levels, which were on average 333 (95% confidence interval 68-647) pg/mL higher in cases than controls (1704 vs. 1371 pg/mL; p-value 0.013). Additionally, in the post 30-day period, GDF-15 showed low within-individual variability in both cases and controls. In conclusion, post ACS patients experiencing a recurrent event had stable and systematically higher GDF-15 levels during 30-day to 1-year follow-up than their event-free counterparts with otherwise similar clinical characteristics. Thus, post-discharge blood sampling might be used throughout the course of 1 year to improve prognostication, whereas, in view of the low within-individual variation, the number of repeated sampling moments might be limited.
       
  • Heterogeneity of periodic limb movements associated with central sleep
           apnea in Heart Failure patients
    • Abstract: Publication date: Available online 10 April 2019Source: The American Journal of CardiologyAuthor(s): Doctor Maher Abouda
       
  • “Some Math All Investors Should Know”
    • Abstract: Publication date: Available online 10 April 2019Source: The American Journal of CardiologyAuthor(s): Robert M. Doroghazi
       
  • Effect of Transcatheter Aortic Valve Implantation on Renal Function in
           Patients with Previous Renal Dysfunction
    • Abstract: Publication date: Available online 10 April 2019Source: The American Journal of CardiologyAuthor(s): Alexis K Okoh, Kamrani Kambiz, Dileep Unnikrishnan, Setri Fugar, Christoph Sossou, Mohammed Thawabi, Amer Hawatmeh, Bruce Haik, Chunguang Chen, Marc Cohen, Mark J RussoABSTRACTThe study aims to investigate the incidence of immediate renal function improvement among renal dysfunction patients who had transcatheter aortic valve implantation (TAVI). TAVI patients with ≥ moderate reduced renal function [estimated GFR ≤ 60ml/min/1.73m2] at baseline were identified from a prospectively maintained database. Patients were divided into 3 groups based on percent change [(discharge eGFR- baseline eGFR/baseline GFR) X 100] in eGFR post-TAVR. Improvement ≥ 10%, No change, Decline ≥ 10%. Multivariable logistic regression was performed to identify factors that predicted improvement/decline in GFR post-procedure. Out of 677 patients, 359 (53%) had eGFR ≤ 60ml/min/1.73m2. Of these, 188 (52%) had an improvement in eGFR ≥ 10%, 125 (34%) had no change and 48 (14%) observed decline ≥ 10%. All groups had similar proportions of females and age was comparable among patient groups. Patients in whom a decline in eGFR was observed had significantly higher STS scores (10.7 vs. 8.2 vs. 8.2; p = 0.007) and incidence of liver disease (6% vs, 0% vs. 2%; p = 0.014) than the no-change or improved groups respectively. On multivariable analysis, independent predictors of decline/improvement in eGFR were being female, low left ventricular ejection fraction and baseline liver dysfunction. In conclusion, over half of patients with compromised renal function undergoing TAVI experience an immediate improvement in kidney function post-TAVI. Being female, baseline liver dysfunction and a low left ventricular ejection fraction is associated with an immediate decline in eGFR.
       
  • Meta-analysis of Acetylsalicylic Acid Desensitization in Patients with
           Acute Coronary Syndrome
    • Abstract: Publication date: Available online 10 April 2019Source: The American Journal of CardiologyAuthor(s): Amitabh Madhukumar Chopra, Pablo Díez-Villanueva, Juan Gabriel Córdoba-Soriano, Joe KT Lee, Mona Al-Ahmad, Victor A Ferraris, Monik Mehta, Marek L. Kowalski Acetylsalicylic acid (ASA) hypersensitivity represents a clinical challenge in acute coronary syndrome (ACS) patients urgently requiring ASA for antiplatelet therapy. ASA desensitization has been reported with successful outcomes among cardiac patients. The aim of this review is to determine the safety and efficacy of ASA desensitization therapy in ACS patients. A PubMed database search was conducted for articles containing combinations of keywords, “aspirin desensitization” or “aspirin hypersensitivity” and “acute coronary syndrome” between January 1, 1990 and August 1, 2018. The primary endpoint was desensitization protocol success. Secondary endpoints included hypersensitivity adverse events and ASA discontinuation due to hypersensitivity adverse events at follow-up. Fifteen reports consisting of 480 ACS patients with prior hypersensitivity to ASA were included. The pooled desensitization success rate was 98.3%(95%CI:97.2% – 99.5%). There was no statistical difference in outcomes between protocols ≤ 2 hours and> 2 hours in duration (96.3[92.3 – 100.3]% vs 97.2[94.6 – 99.8]%; P=0.71). Protocols with> 6 dose escalations were associated with higher success rates compared to those with ≤ 6 doses (99.2[97.9 – 100.4]% vs 95.4[93 – 97.8]%; P=0.007). At follow-up between 1 and 46 months (mode 12 months), zero hypersensitivity adverse events were reported. Consequently, no ASA discontinuations were related to hypersensitivity adverse events. In conclusion, ASA desensitization therapy is safe and effective in patients with ACS. Protocols with> 6 dose escalations may be optimal for ASA desensitization in ACS patients.
       
  • Impact of Hemodynamic Support on Outcome in Patients Undergoing High-Risk
           Percutaneous Coronary Intervention
    • Abstract: Publication date: Available online 10 April 2019Source: The American Journal of CardiologyAuthor(s): Jasmin Shamekhi, Andrea Pütz, Sebastian Zimmer, Vedat Tiyerili, Fritz Mellert, Armin Welz, Rolf Fimmers, Eberhard Grube, Georg Nickenig, Nikos Werner, Jan-Malte Sinning The use of left-ventricular (LV) hemodynamic support might facilitate high-risk percutaneous coronary interventions (PCI) in patients with complex coronary artery disease. The impact on outcome is a matter of ongoing debate. We assessed the outcome of high-risk patients undergoing protected PCI in comparison to patients undergoing unprotected high-risk PCI. 139 patients underwent non-emergent high-risk PCI; 24 (17%) patients underwent protected PCI. To address selection bias, we performed a propensity score matched subanalysis. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) during the first year. Patients with protected PCI had a higher logistic EuroSCORE (logES) (protected PCI: 19% vs. unprotected PCI: 12%; p=0.01), a higher SYNTAX score (SS) (45 vs. 36, p=0.07), and significantly more often reduced LV function (40% vs. 55%; p
       
  • Propensity Matched Analysis Comparing Conscious Sedation Versus General
           Anesthesia in Transcatheter Aortic Valve Implantation
    • Abstract: Publication date: Available online 10 April 2019Source: The American Journal of CardiologyAuthor(s): Wassim Mosleh, Jeffrey F. Mather, Mostafa R. Amer, Brett Hiendlmayr, Francis J. Kiernan, Raymond G. McKay Conscious sedation (CS) has been increasingly utilized in transcatheter aortic valve implantation (TAVI). We aim to compare safety, efficacy, efficiency and direct cost outcomes of patients who underwent TAVI with general anesthesia (GA) to those with CS. Records for all adult patients undergoing transfemoral TAVI at our institution between February 2012 to September 2018 were retrospectively screened. Patients were grouped by anesthesia treatment (GA or CS) and propensity matched. Safety (in-hospital and 30-day mortality, in-hospital and 30-day stroke, cardiac arrest, need for permanent pacemaker, composite bleed/vascular adverse events), efficacy (follow-up echocardiographic findings), efficiency (procedure duration, fluoroscopy time, radiation dose, intensive care unit (ICU) stay, hospital length-of–stay (LOS), discharge to home), and direct cost outcomes were compared. 589 patients met our inclusion criteria. Propensity matching yielded 154 GA patients and 154 CS patients. There were no differences in the safety outcomes of in-hospital or 30-day mortality, in-hospital or 30-day stroke, cardiac arrest, and need for permanent pacemaker between GA and CS groups. There was a significant reduction in composite bleeding/vascular events in the CS group (8.4% vs 19.5%, p
       
  • Surveillance of Congenital Heart Defects among Adolescents at Three U.S.
           Sites
    • Abstract: Publication date: Available online 10 April 2019Source: The American Journal of CardiologyAuthor(s): George K. Lui, Claire McGarry, Ami Bhatt, Wendy Book, Tiffany J. Riehle-Colarusso, Julie E. Dunn, Jill Glidewell, Michelle Gurvitz, Trenton Hoffman, Carol J. Hogue, Daphne Hsu, Stan Obenhaus, Cheryl Raskind-Hood, Fred H. Rodriguez, Ali Zaidi, Alissa R. Van Zutphen The prevalence, comorbidities, and healthcare utilization among adolescents with congenital heart defects (CHDs) is not well understood. Adolescents (11-19 years old) with a healthcare encounter between 1/1/2008 (1/1/2009 for MA) and 12/31/2010 with a CHD diagnosis code were identified from multiple administrative data sources compiled at three U.S. sites: Emory University, Atlanta, Georgia (EU); Massachusetts Department of Public Health (MA); and New York State Department of Health (NY). The estimated prevalence for any CHD was 4.77 (EU), 17.29 (MA), and 4.22 (NY) and for severe CHDs was 1.34 (EU), 3.04 (MA), and 0.88 (NY) per 1,000 adolescents. Private or commercial insurance was the most common insurance type for EU and NY, and Medicaid for MA. Inpatient encounters were more frequent in severe CHDs. Cardiac comorbidities included rhythm and conduction disorders at 20% (EU), 46% (MA), and 9% (NY) as well as heart failure at 3% (EU), 15% (MA), and 2% (NY). Leading noncardiac comorbidities were respiratory/pulmonary (22% EU, 34% MA, 16% NY), infectious disease (17% EU, 22% MA, 20% NY), non-CHD birth defects (12% EU, 23% MA, 14% NY), gastrointestinal (10% EU, 28% MA, 13% NY), musculoskeletal (10% EU, 32% MA, 11% NY), and mental health (9% EU, 30% MA, 11% NY). In conclusion, this study used a novel approach of uniform CHD definition and variable selection across administrative data sources in three sites for the first population-based CHD surveillance of adolescents in the U.S. High resource utilization and comorbidities illustrate ongoing significant burden of disease in this vulnerable population.
       
  • Perceived Health Mediates Effects of Physical Activity on Quality of Life
           in Patients with a Fontan Circulation
    • Abstract: Publication date: Available online 10 April 2019Source: The American Journal of CardiologyAuthor(s): Christina E. Holbein, Gruschen R. Veldtman, Philip Moons, Adrienne H. Kovacs, Koen Luyckx, Silke Apers, Shanti Chidambarathanu, Alexandra Soufi, Katrine Eriksen, Jamie L. Jackson, Junko Enomoto, Susan M. Fernandes, Bengt Johansson, Luis Alday, Mikael Dellborg, Malin Berghammer, Samuel Menahem, Maryanne Caruana, Shelby Kutty, Andrew S. MackieABSTRACTPatients with Fontan circulations are at risk of a sedentary lifestyle. Given the direct relationship between physical activity and health, promotion of physical activity has the potential to improve outcomes, including quality of life (QOL). This study aimed to describe self-reported physical activity in adult Fontan patients and examine associations between physical activity, perceived health status and QOL. The sample consisted of 177 Fontan patients (Mage=27.5 ± 7.6 years, 52% male) who reported their physical activity, perceived health status, and QOL as part of the cross-sectional Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease – International Study (APPROACH-IS). Descriptive statistics and univariate analyses of variance with planned contrasts were computed to describe physical activity characteristics. Mediation analyses tested whether perceived health status variables mediated the association between physical activity and QOL. Forty-six percent of patients were sedentary and 40% met international physical activity guidelines. Higher physical activity was associated with younger age, lower NYHA class, higher perceived general health, and greater QOL. Patients who commuted by walking and engaged in sports reported better perceived health and QOL. Mediation analyses revealed that perceived general health but not NYHA functional class mediated the association between physical activity and QOL (αβ=.22, 95% CI=.04-.49). In conclusion, Fontan patients likely benefit from regular physical activity, having both higher perceived general health and functional capacity; greater perceived health status may contribute to enhanced QOL. In conclusion, these data support the pivotal role of regular physical activity for Fontan patients.
       
  • Prognosis and Risk Stratification of Patients with Advanced Heart Failure
           (From PROBE)
    • Abstract: Publication date: Available online 9 April 2019Source: The American Journal of CardiologyAuthor(s): Matteo Cameli, M. Concetta Pastore, Giulia E. Mandoli, Dan Nistor, Edoardo Lisi, Özge Ö. Tok, Luna Cavigli, Andrea Romano, Sergio MondilloIn recent years, many prognostic scores have been developed for advanced chronic heart failure (CHF), but none of them is comprised of first and second level echocardiographic indexes. The aim was to create a new prognostic echocardiographic score for patients with advanced CHF. Patients with advanced CHF were analyzed by standard, 3D and speckle tracking echocardiography and followed prospectively for 2±0.7 years recording major adverse cardiac events (MACE): cardiovascular death, hospitalization for HF, emergency heart transplantation and left ventricular assist device or intra-aortic balloon pump implantation. 110 patients were enrolled. The best predictors of MACE were selected on the basis of area under the curve (AUC) by receiver operating characteristic (ROC) analysis> 0.70: left atrial volume index (LAVI, no MACE vs MACE groups, 51.3±20mL/m2 vs 67±20mL/m2, p=0.0003), right ventricular sphericity index (RVSI, 0.53±0.09 vs 0.61±0.10, p=0.0002), right ventricular fractional area change (RVFAC, 41±9% vs 33±9.5, p65ml/m2)+1(if RVSI>0.53)+0.5(if RVFAC-14%). It presented an AUC by ROC analysis of 0.90 and classified patients at low (PROBE≤1), intermediate (PROBE=1-2) or high (PROBE>2) risk of MACE. The Kaplan-Meier analysis revealed a strong correlation between the event-free survival rate and the 3 groups. In conclusion, the PROBE score, with first and second level echocardiographic parameters, demonstrated a good predictive value for MACE. It represents a useful tool for a non-invasive, individualized and accurate evaluation and stratification of prognosis in patients with advanced CHF.
       
  • Meta-Analysis of the Effect of Preoperative Atrial Fibrillation on
           Outcomes After Left Ventricular Assist Device Implantation
    • Abstract: Publication date: Available online 9 April 2019Source: The American Journal of CardiologyAuthor(s): Muhammad Shariq Usman, Saba Ahmed, Naser Yamani, Tauseef Akhtar, Nisar Asmi, Tariq Jamal Siddiqi, Safi U. Khan, Rami Doukky, Muhammad Shahzeb Khan The effect of preoperative atrial fibrillation (AF) on clinical outcomes after left ventricular assist device (LVAD) implantation remains uncertain. We sought to conduct a meta-analysis to assess the safety and efficacy of LVAD implantation in AF patients. Medline and Scopus were searched for studies that assessed the effect of pre-operative AF on clinical outcomes in patients undergoing LVAD implantation. Outcomes of interest included all-cause mortality, thromboembolic events and bleeding. Estimates were combined using random effects model to calculate risk ratios (RRs) with 95% confidence intervals (CIs). In this meta-analysis of 7 studies including 5,658 patients, preoperative AF was not associated with increased risk of all-cause mortality at 30 days (RR=0.84 [0.51, 1.37]; p=0.49; I2=0%), 6 months (RR=1.17 [0.96, 1.14]; p=0.11; I2=21%), 1 year (RR=1.16 [0.84, 1.60]; p=0.37; I2=53%) and 2 years (RR=1.14 [0.96, 1.36]; p=0.12; I2=23%). Preoperative AF did not increase the risk of thromboembolism (RR=0.86 [0.38, 1.92]; p=0.71; I2=26%), pump thrombosis (RR=1.22 [0.88, 1.68]; p=0.23; I2=49%), stroke (RR=1.02 [0.87, 1.19]; p=0.79; I2=11%) or major bleeding (RR=0.86 [0.38, 1.92]; p=0.71; I2=26%) after LVAD implantation. However, AF was associated with significantly increased risk of gastro-intestinal bleeding in patients receiving LVADs (RR=1.27 [1.05, 1.55]; p=0.014; I2=0%). In conclusion, this meta-analysis reports a significantly increased risk of gastrointestinal bleeding in LVADs recipients having concomitant AF. However, AF had no significant effect on all-cause mortality, stroke, or thromboembolic events in these patients. Further well conducted studies are needed to validate these results.
       
  • Effect of Left Ventricular Reverse Remodeling on Long-term Outcomes after
           Aortic Valve Replacement
    • Abstract: Publication date: Available online 9 April 2019Source: The American Journal of CardiologyAuthor(s): Chisato Izumi, Takeshi Kitai, Teruyoshi Kume, Toshinari Onishi, Satoshi Yuda, Kumiko Hirata, Eiji Yamashita, Takayuki Kawata, Kunihiro Nishimura, Masaaki Takeuchi, Satoshi Nakatani There have been few studies with a large number of patients on the effect of left ventricular (LV) reverse remodeling and long-term outcomes after aortic valve replacement (AVR). This study aimed to investigate long-term outcomes and the prognostic impact of follow-up echocardiographic parameters after AVR. We evaluated 456 consecutive patients from a retrospective multicenter registry in Japan (J-PROVE-Retro) who underwent AVR for aortic valve diseases (predominantly aortic stenosis [AS]; 326 patients and aortic regurgitation [AR]; 130 patients). Preoperative and follow-up echocardiography at 1 year after AVR was evaluated. The primary outcome measure was a composite of cardiac death or hospitalization due to heart failure. The median follow-up period was 9.2 years in AS group and 9.7 years in AR group. The freedom rate from the primary outcome was 92% at 5-years and 79% at 10-years in AS, and 97% at 5-years and 93% at 10-years in AR. LV end-diastolic and end-systolic diameters, and the LV mass index (LVMI) decreased and LV ejection fraction increased after AVR in both AS and AR, and LVMI was normalized in more than half of the patients. In the Cox proportional hazard model, echocardiographic parameters at 1 year after AVR were more strongly related to long-term outcomes than preoperative echocardiographic parameters. In conclusion, echocardiographic parameters at 1 year after AVR are more important as predictors of long-term outcomes than preoperative parameters in both AS and AR. More attention should be paid on early postoperative remodeling for long-term follow-up of patients after AVR.
       
  • Effect of Aortic Regurgitation by Cardiovascular Magnetic Resonance After
           Transcatheter Aortic Valve Implantation
    • Abstract: Publication date: Available online 9 April 2019Source: The American Journal of CardiologyAuthor(s): Alfredo Nunes Ferreira-Neto, Constanze Merten, Hans-Wilko Beurich, Dirk Zachow, Gert Richardt, Eric Larose, Leonardo Guimaraes, Philippe Pibarot, Emilie Pelletier-Beaumont, Josep Rodés-Cabau, Mohamed Abdel-WahabABSTRACTCardiovascular magnetic resonance (CMR) has demonstrated a high accuracy for evaluating the severity of aortic regurgitation (AR). However, scarce data exist on the impact of AR as evaluated by CMR on clinical outcomes following transcatheter aortic valve implantation (TAVI). The objective of this study was to evaluate the impact of AR as determined by CMR on clinical outcomes (mortality, heart failure [HF] hospitalization) post-TAVI. A total of 448 TAVI recipients from 2 centers (mean age: 80±7 years, mean STS: 5.8±5.4%) who survived the periprocedural period with no pacemaker implantation were included. A newer generation transcatheter valve system was used in 213 patients (47.5%). The CMR examination was performed at a median of 12 (IQR: 7-21) days post-TAVI. After a mean follow-up of 24±19 months, a total of 94 patients (21%) had died and 72 patients (16%) had at least one hospitalization because of decompensated HF. The aortic regurgitation fraction (RF) as determined by CMR was an independent predictor of mortality (HR:1.06 for each increase of 10%, 95% CI: 1.01-1.12, p=0.03) and HF hospitalization (HR:1.15 for each increase of 10%, 95% CI:1.02-1.30, p=0.02). The rate of moderate-severe CMR-AR defined as a RF ≥30% was 3%, and this was associated with an increased risk of mortality (HR: 2.63, 95% CI: 2.30-2.99, p
       
  • Beyond Atrial Fibrillation Patterns as Contributors to Risk of
           Thromboembolism
    • Abstract: Publication date: Available online 9 April 2019Source: The American Journal of CardiologyAuthor(s): James A. Reiffel
       
  • Relation of Fontan Baffle Stroke Volume to Fontan Failure and Lower
           Exercise Capacity in Patients With an Atriopulmonary Fontan
    • Abstract: Publication date: Available online 9 April 2019Source: The American Journal of CardiologyAuthor(s): Tarek Alsaied, Jelle P.G. van der Ven, Saeed Juggan, Lynn A. Sleeper, Nina Azcue, Lucia J Kroft, Andrew J. Powell, Willem A. Helbing, Rahul H. Rathod Fontan failure remains a significant problem, especially in patients with an atriopulmonary Fontan. Fontan baffle volume change during the cardiac cycle (Fontan baffle stroke volume) may affect outcomes in Fontan circulation. Assuming that increased Fontan baffle stroke volume is associated with increased energy loss in the baffle, we hypothesized that higher baffle stroke volume is associated with worse exercise capacity and increased incidence of Fontan failure. Patients from 6 centers with an atriopulmonary or lateral tunnel Fontan operation were included if they had a cardiac magnetic resonance (CMR) study and an adequate cardiopulmonary exercise test. Fontan baffle stroke volume was defined as the difference between maximum and minimum Fontan baffle volumes. Fontan failure was defined as death, listing for transplantation, heart failure symptoms requiring medications, or peak VO2 below 16 ml/kg/min. The study group consisted of 107 patients (median age 19 years, interquartile range (IQR), 14-29 years). Most patients (84%) had lateral tunnel procedure. During a median follow-up period of 6.8 [IQR: 3.2-8.8] years after the CMR, 25 (23%) patients had Fontan failure (7 deaths, 3 listed for transplantation, 15 with heart failure symptoms). Predictors of Fontan failure on multivariable analysis were ventricular tachycardia, protein losing enteropathy, and additionally in atriopulmonary Fontan only, larger Fontan baffle stroke volume. Predictors of lower peak VO2 on multivariable analysis were older age at CMR and additionally in atriopulmonary Fontan only, larger Fontan baffle stroke volume. In conclusion, larger Fontan baffle stroke volume was independently associated with lower peak VO2 and Fontan failure in atriopulmonary Fontan.
       
  • Comparison of Coronary Culprit Lesion Morphology Determined by Optical
           Coherence Tomography and Relation to Outcomes in Patients Diagnosed with
           Acute Coronary Syndrome During Winter –vs– Other Seasons
    • Abstract: Publication date: Available online 8 April 2019Source: The American Journal of CardiologyAuthor(s): Junsuke Shibuya, Nobuaki Kobayashi, Kuniya Asai, Masafumi Tsurumi, Yusaku Shibata, Saori Uchiyama, Hirotake Okazaki, Goda Hiroki, Kenichi Tani, Akihiro Shirakabe, Masamichi Takano, Wataru Shimizu Patients diagnosed with acute coronary syndrome (ACS) during winter have worse outcomes; however, mechanisms driving this trend are unclear. We examined coronary culprit lesion morphologies using optical coherence tomography (OCT). Features and outcomes were retrospectively compared between patients admitted with ACS in winter (W-ACS; n=390) and in other seasons (O-ACS; n=1027). Angiography and OCT results were analyzed in patients who underwent OCT examination (173 patients in W-ACS and 450 in O-ACS). On initial angiography, minimum lumen diameter was smaller (median; 0.12 mm vs. 0.25 mm, p=0.021) and Thrombolysis in Myocardial Infarction (TIMI) flow grade was worse (TIMI 0/1; 57% vs. 44%, p=0.005) in W-ACS. OCT performed before coronary interventions or just after intracoronary thrombectomy showed that plaque rupture (56% vs. 46%) and calcified nodules (8% vs. 5%) were more prevalent, and plaque erosion (37% vs. 49%) was less prevalent in W-ACS (p=0.039 for all three variables). At 2-year follow-up for all admitted ACS patients, Kaplan–Meier estimates showed higher cardiac mortality in W-ACS (11.8% vs. 8.3%, p=0.043). Multivariate Cox proportional hazard analysis showed that patients in W-ACS group had a 1.5-fold increased risk of cardiac death within two years after adjusting for traditional cardiovascular risk factors (hazard ratio, 1.54 [95% confidence interval, 1.06–2.23]; p=0.024). In conclusion, patients diagnosed with ACS during winter had worse angiographic results and OCT revealed less plaque erosion (more plaque rupture or calcified nodules) at the culprit lesions, which may be partly associated with worse cardiac mortality within two years.
       
  • Electrocardiograms Recorded After Asystolic Cardiac Arrest
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Solomon A. Seifu, Pramilla N. Subramaniam, David Luke GlancyA man with a history of drug abuse was found down at home and was asystolic. Following restoration of sinus rhythm, a hypothermia protocol brought his temperature to 32.5°C (90.5°F), and large Osborn waves appeared on his electrocardiogram. With rewarming the electrocardiographic signs of hypothermia diminished. Due to hypoxic brain injury during the arrest, the patient remained unresponsive and died on the fourth hospital day.
       
  • Implications of Faint Heart Sounds After Acute Myocardial Infarction
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Paul D. SteinABSTRACTCardiologists have known for many years that heart sounds are diminished after acute myocardial infarction (AMI). It is now recognized that the diminished mitral component of the first heart sound is due to impaired left ventricular isovolumic rate of change of pressure (dp/dt). The decreased aortic component of the second heart sound is due to impaired left ventricular isovolumic relaxation (negative dp/dt). A pathophysiological interpretation of the low intensity mitral component of the first heart sound is impaired ventricular contraction and the pathophysiological interpretation of the low intensity aortic component of the second heart sound is impaired diastolic suction. Simple auscultation, therefore, can identify impaired systolic and diastolic function, which otherwise require imaging modalities which have their own strengths and weaknesses.
       
  • Impact of Discontinuation of Antithrombotic Therapy Following Closure of
           Patent Foramen Ovale in Patients With Cryptogenic Embolism
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Jérôme Wintzer-Wehekind, Alberto Alperi, Christine Houde, Jean-Marc Côté, Leonardo de Freitas Campos Guimaraes, Melanie Côté, Josep Rodés-CabauNo data exist on the optimal duration of antithrombotic therapy (AT) following patent foramen ovale (PFO) closure. We sought to assess the safety of AT discontinuation following PFO closure in patients with a cryptogenic ischemic event. A total of 453 consecutive patients (mean age: 48 ± 13years, men: 51%) who underwent PFO closure due to a cryptogenic ischemic event were included. All patients were on AT following PFO closure (antiplatelet therapy: 92.7%, anticoagulation: 7.3%). Ischemic and bleeding events, and AT were assessed at a median follow-up of 8 (IQR: 4 to 11) years, and follow-up was complete in 96% of patients. Stroke and transient ischemic attack occurred in 4 (0.9%) and 12 (2.6%) patients, respectively, and 27 (6.0%) patients had bleeding events (major in 6 [1.3%] patients, including 4 episodes of intracranial hemorrhage). All major bleeding events occurred under aspirin therapy. A total of 82 patients (18%) stopped the AT at a median of 7 (IQR: 5 to 34) months post-PFO closure (due to a bleeding event or gastrointestinal symptoms: 13 patients, no specific reason: 69 patients), and none of them had any ischemic event after a median time of 7 (IQR 3 to 10) years without any AT. A propensity score matched analysis including 46 patients who discontinued the AT within 1-year post-PFO closure and 120 patients with an ongoing AT showed the lack of differences in ischemic events between groups (0 vs 0.2 stroke/transient ischemic attack per 100 patient-years in the no-AT and AT groups, respectively). In conclusion, in young patients who underwent PFO closure, bleeding events occurred in ∼6% of patients after a median follow-up of 8years. AT was discontinued in about one fifth of patients (most of them within the year following PFO closure), and this was not associated with any increase in ischemic events at long-term follow-up. These results suggest that, in patients without other co-morbidities increasing the risk of stroke, temporary AT following PFO closure may be a reasonable strategy.
       
  • Role of Preoperative Cardiovascular Magnetic Resonance in Planning
           Ventricular Septal Myectomy in Patients With Obstructive Hypertrophic
           Cardiomyopathy
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Paolo Spirito, Irene Binaco, Daniele Poggio, Aleksei Zyrianov, Massimiliano Grillo, Laura Pezzoli, Jessica Rossi, Dmitri Malanin, Giuseppe Vaccari, Lucian Dorobantu, Maria Iascone, Andrea Mortara, Toufic Khouri, Paolo Bruzzi, Paolo FerrazziIn obstructive hypertrophic cardiomyopathy (HC), extreme heterogeneity of septal morphology makes septal myectomy particularly challenging. Although cardiovascular magnetic resonance (CMR) reconstructs ventricular anatomy with high spatial resolution, CMR is not used systematically to plan preoperatively septal myectomy. In this study, we report our results with using CMR to plan the extent of septal excision in 112 consecutive HC patients who subsequently underwent myectomy. Depth and length of the myectomy planned at CMR were compared with those of the septal muscle excised in a single piece in all patients. Anterior septum maximal thickness at CMR was 22 ± 5 mm and excised muscle thickness 9 ± 3 mm. Planned myectomy length was 35 ± 11 mm (range 17 to 65) and excised muscle length 38 ± 10 mm (range 10 to 70), indicating extension of septal resection to mid-cavity. Thickness and length of the planned myectomy showed a significant correlation with the excised muscle (R2 = 0.345; p
       
  • Usefulness of Clopidogrel Loading in Patients Who Underwent Transcatheter
           Aortic Valve Implantation (from the BRAVO-3 Randomized Trial)
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Vincent Johan Nijenhuis, Jurrien Maria ten Berg, Christian Hengstenberg, Thierry Lefèvre, Stephan Windecker, David Hildick-Smith, Christian Kupatt, Eric Van Belle, Christophe Tron, Hans Ulrich Hink, Antonio Colombo, Bimmer Claessen, Samantha Sartori, Jaya Chandrasekhar, Roxana Mehran, Prodromos Anthopoulos, Efthymios N. Deliargyris, George DangasP2Y12-inhibitor initiation with clopidogrel using a loading dose (LD) versus no LD (NLD) provides more rapid inhibition of platelet activation and reduced risk of ischemic events after coronary stenting. Whether a similar beneficial effect is achieved in the setting of transcatheter aortic valve implantation (TAVI) is unknown. We evaluate the effects of preprocedural clopidogrel LD versus no NLD on 48-hour and 30-day clinical outcomes after TAVI. In the BRAVO-3 trial, 802 patients with severe aortic stenosis who underwent transfemoral TAVI were randomized to intraprocedural anticoagulation with bivalirudin or unfractionated heparin. Administration of clopidogrel LD was left to the discretion of the treating physician. For this analysis, patients were stratified according to receiving clopidogrel LD (n = 294, 36.6%) or NLD (n = 508, 63.4%) before TAVI. LD patients more often received a self-expandable prosthesis using larger sheaths. P2Y12-inhibitor maintenance therapy pre-TAVI was similar in patients with LD versus NLD (28.2% vs 33.1%, p = 0.16). LD versus NLD was associated with similar incidences of major adverse cardiovascular events (i e., death, myocardial infarction, or stroke) (4.1% vs 4.1%, p = 0.97) and major bleeding (8.5% vs 7.7%, p = 0.68), but a higher rate of major vascular complications (11.9% vs 7.1%, p = 0.02). Multivariable adjustment showed that clopidogrel LD did not affect any of the studied clinical events, including major vascular complications (odds ratio 0.91, 95% confidence interval 0.60 to 1.39, p = 0.67). Also patients on clopidogrel maintenance therapy and thus considered in steady state were not at reduced risk of major adverse cardiovascular events compared with patients not on clopidogrel (3.7% vs 5.2%, p = 0.36). In conclusion, in patients who underwent TAVI, use of clopidogrel LD was associated with higher vascular complications and otherwise similar clinical events compared to NLD patients.
       
  • The Added Value of Exercise Stress Echocardiography in Patients With Heart
           Failure
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Iacopo Fabiani, Nicola Riccardo Pugliese, Gian Giacomo Galeotti, Andreina D'Agostino, Matteo Mazzola, Roberto Pedrinelli, Frank L. DiniDoppler echocardiography can provide reliable and repeatable measures of cardiac index (CI), whereas lung ultrasound (LUS) represents a quantitative approach to assess pulmonary congestion. We tested the hypothesis that simultaneous assessment of CI and LUS during exercise stress echocardiography (ESE) may define heart failure (HF) outpatients with different risk of adverse outcome. Standard transthoracic echocardiography and LUS (B-lines) evaluation were assessed during semisupine ESE. CI and B-lines were measured at baseline and peak exercise. Resting plasma B-type natriuretic peptide levels were also evaluated. We enrolled 105 HF patients (87 males; age 62 ± 11 years; New York Heart Association class I to III) with reduced left ventricular ejection fraction (30 ± 7%). Patients were classified into 4 profiles: (1) peak CI ≥4.0 l/min/m2 and peak B-lines
       
  • Clinical Usefulness of an Echo-Doppler Model in Predicting Elevated
           Pulmonary Capillary Wedge Pressure in Patients With Heart Failure
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Daigo Chinen, Toshiyuki Nagai, Kazunori Uemura, Yukio Aikawa, Tetsufumi Motokawa, Yasuhide Asaumi, Takeshi Ogo, Hideaki Kanzaki, Teruo Noguchi, Toshihisa Anzai, Wataru Shimizu, Hisao Ogawa, Masaru Sugimachi, Satoshi YasudaAlthough several tissue-Doppler imaging (TDI) models for pulmonary capillary wedge pressure (PCWP) estimation have been reported, their reliability remains uncertain. Our previous theoretical and experimental analyses suggest that right atrial pressure (RAP) corrected by tissue-Doppler imaging tricuspid/mitral annular peak systolic velocities (ST/SM) (RAP × ST/SM) reliably predicts elevated PCWP. We sought to investigate its clinical usefulness for predicting elevated PCWP in heart failure (HF) patients. Ninety-eight patients admitted with HF who underwent right heart catheterization were prospectively studied. RAP and PCWP were measured by right heart catheterization. Simultaneously, ST/SM, early diastolic transmitral flow velocity to mitral annular velocity ratio (E/Ea), and diameter of inferior vena cava at inspiration (IVCDi), a noninvasive surrogate for RAP, were measured by echocardiography. RAP correlated with IVCDi (R2 = 0.57). A significantly stronger correlation was observed between IVCDi corrected by ST/SM (IVCDi × ST/SM) and PCWP than between E/Ea and PCWP (R2 = 0.47 vs 0.18). Receiver-operating characteristic analyses indicated that IVCDi × ST/SM>16 mm predicted PCWP>18 mm Hg with 90% sensitivity and 77% specificity, and the area under the curve was 0.86, which was significantly larger than that of E/Ea (area under the curve=0.72). In conclusions, IVCDi × ST/SM is a new useful noninvasive model to predict elevated PCWP in HF patients.
       
  • Sex Differences in Risk Factors for Incident Atrial Fibrillation (from the
           Reasons for Geographic and Racial Differences in Stroke [REGARDS] Study)
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Abhishek Bose, Wesley T. O'Neal, Chengyi Wu, Leslie A. McClure, Suzanne E. Judd, Virginia J. Howard, George Howard, Elsayed Z. SolimanWe examined whether the sex differences in atrial fibrillation (AF) is related to difference in risk factors leading to AF or due to a differential impact of the same risk factors in 11,806 participants (55.2 % women) from the REGARDS study. Incident AF was ascertained by electrocardiograms and medical history at a follow-up examination. Backwards elimination logistic regression was used to identify AF risk factors in men and women, separately. Over a median follow-up of 9.0years, 588 (11.1%) men and 428 (6.6%) women (p value
       
  • Relation of Minor Electrocardiographic Abnormalities to Cardiovascular
           Mortality
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Krupal J. Hari, Matthew J. Singleton, Muhammad Imtiaz Ahmad, Elsayed Z. SolimanAlthough minor electrocardiographic (ECG) abnormalities are common findings in clinical practice, their prognostic significance remains unclear due to inconsistent reports. We hypothesized that this inconsistency is due to the traditional focus on examining their prognostic significance as a binary variable (i.e., presence vs absence of any abnormality) ignoring the number of abnormalities. We tested this hypothesis in 6,467 participants (mean age 59 years, 53% women) from the Third National Health and Nutrition Examination Survey who were free of baseline cardiovascular disease (CVD) and major ECG abnormalities. ECG abnormalities were defined from digitally recorded and centrally processed standard electrocardiograms using the Minnesota ECG Classification. CVD mortality was ascertained using National Death Index. About 38% of participants (n = 2,438) had at least 1 minor ECG abnormality at baseline. During a median follow-up of 13.9 years, 755 CVD deaths occurred. In a multivariable Cox model, presence of at least 1 minor ECG abnormality was marginally associated with increased risk of CVD mortality (hazard ratio (95% confidence interval):1.15(1.00,1.34), p-value = 0.04)). However, as the number of ECG abnormalities increases, the association with CVD mortality showed a dose-response relation (event rate per 1,000 person-year of 7.3, 10.1, and 16.7 in participants with 0, 1, and ≥2 ECG abnormalities, respectively; p-value for trend
       
  • The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse
           Cardiac Events According to Renal Function (from the Coronary Computed
           Tomography Angiography Evaluation for Clinical Outcomes: An International
           Multicenter [CONFIRM] Registry)
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Ji Hyun Lee, Asim Rizvi, Bríain Ó. Hartaigh, Donghee Han, Mahn Won Park, Hadi Mirhedayati Roudsari, Wijnand J. Stuijfzand, Heidi Gransar, Yao Lu, Tracy Q. Callister, Daniel S. Berman, Augustin DeLago, Martin Hadamitzky, Joerg Hausleiter, Mouaz H. Al-Mallah, Matthew J. Budoff, Philipp A. Kaufmann, Gilbert L. Raff, Kavitha Chinnaiyan, Filippo CademartiriThe prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m2) was ascertained using the modified Modification of Diet in Renal Disease formula, and was categorized as: ≥90, 60 to 89, and 400. Multivariable Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days). Mean age was 55.8 ± 11.5 years (52.8% male). In total, 261 (2.7%) patients experienced MACE over a median follow-up of 24.5 months (interquartile range: 16.9 to 41.1). Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS>400 and eGFR 400 increased MACE risk with HR 4.46 (95% CI 1.68 to 11.85), 6.63 (95% CI 4.03 to 10.92), and 6.14 (95% CI 2.85 to 13.21) for eGFR ≥90, 60 to 89, and
       
  • Relation of Isolated Low High-Density Lipoprotein Cholesterol to Mortality
           and Cardiorespiratory Fitness (from the Henry Ford Exercise Testing
           Project [FIT Project])
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Seamus P. Whelton, Zeina Dardari, Cathy Handy Marshall, Haitham Ahmed, Clinton A. Brawner, Jonathan K. Ehrman, Steven J. Keteyian, Mouaz Al Mallah, Michael J. BlahaIsolated low high-density lipoprotein cholesterol (HDL-C) is associated with lower fitness and increased mortality. Whether the association between isolated low HDL-C and mortality differs by fitness is uncertain. Patients in the Henry Ford ExercIse Testing Project (FIT Project) completed a physician-referred treadmill stress test and those prescribed lipid-lowering medications or with known cardiovascular disease were excluded. Isolated low HDL-C was defined as HDL-C
       
  • Usefulness of Atherectomy in Chronic Total Occlusion Interventions (from
           the PROGRESS-CTO Registry)
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Iosif Xenogiannis, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, James W. Choi, M. Nicholas Burke, Anthony H. Doing, Phil Dattilo, Catalin Toma, A.J. Conrad Smith, Barry Uretsky, Oleg Krestyaninov, Dmitrii Khelimskii, Elizabeth Holper, Srinivas Potluri, R. Michael Wyman, David E. KandzariThere is limited data on the use of atherectomy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared the clinical and procedural characteristics and outcomes of CTO PCIs performed with or without atherectomy in a contemporary multicenter CTO PCI registry. Between 2012 and 2018, 3,607 CTO PCIs were performed at 21 participating centers. Atherectomy was used in 117 (3.2%) cases: rotational atherectomy in 105 cases, orbital atherectomy in 8, and both in 4 cases. Patients in whom atherectomy was used, were older (68 ± 8 vs 64 ± 10 years, p
       
  • Relationship Between Optimism and Outcomes in Patients With Chronic Angina
           Pectoris
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Alexander C. Fanaroff, Kristi Prather, Amanda Brucker, Daniel Wojdyla, Linda Davidson-Ray, Daniel B. Mark, Redford B. Williams, John Barefoot, Giora Weisz, Ori Ben-Yehuda, Gregg W. Stone, Erik Magnus Ohman, Karen P. AlexanderGreater optimism regarding recovery from chronic illness is associated with improved quality of life and clinical outcomes. We performed a post-hoc analysis on the association between optimism and outcomes in Ranolazine in Patients with Incomplete Revascularization after Percutaneous Coronary Intervention (RIVER-PCI), a randomized trial in patients with chronic angina pectoris who had incomplete revascularization following percutaneous coronary intervention. At baseline, patients answered how much they agreed with the phrase, “I am optimistic about my future and returning to a normal lifestyle.” We evaluated the association between baseline optimism and time to ischemia-driven hospitalization or revascularization using a Cox model, and the association between baseline optimism and change in frequency of angina pectoris using a mixed measures model. Of 2,389 patients, 782 (33.2%) were very optimistic (“strongly agree”), 1,000 (42.4%) were optimistic (“agree”), 451 (19.1%) were neutral (“undecided”), and 123 (5.2%) were not optimistic (“disagree” or “strongly disagree”). Very optimistic patients had a lower prevalence of co-morbidities and less severe angina at baseline than less optimistic patients. The rate of ischemia-driven revascularization or hospitalization was higher in neutral and not optimistic patients compared with very optimistic patients; this finding persisted after adjustment for co-morbidities and baseline angina frequency (hazard ratio 1.42, 95% confidence interval 1.14 to 1.77 for neutral vs very optimistic; hazard ratio 1.38, 95% confidence interval 0.98 to 1.94 for not optimistic vs very optimistic). Neutral and not optimistic patients also had less improvement in angina than very optimistic patients. In conclusion, in patients with angina, those with more self-reported optimism had better health status outcomes. Whether structured interventions targeting optimism improve outcomes in these patients warrants further study.
       
  • Mechanisms of ST Elevation Myocardial Infarction in Patients Hospitalized
           for Noncardiac Conditions
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Khola Tahir, Eric Pauley, Xuming Dai, Sidney C. Smith, Craig Sweeney, George A. StoufferST elevation myocardial infarction (STEMI) occurring in patients hospitalized for a noncardiac condition is associated with a high mortality rate and thus we sought to determine the mechanisms underlying STEMI in this patient population. This is a single center retrospective study of 70 patients who had STEMI while hospitalized on a noncardiac service and underwent coronary angiography. Thrombotic in-hospital STEMI was defined by angiographic or intravascular imaging evidence of intracoronary thrombus, plaque rupture, or stent thrombosis. Thirty-six (51%) inpatient STEMIs developed in the operating room or various postoperative stages and 6 (9%) after endoscopy or a percutaneous procedure. Thrombotic etiologies were found in 39 (56%) patients. Nonthrombotic etiologies included vasospasm, supply-demand mismatch, and takotsubo cardiomyopathy. Patients in the thrombotic group were more likely to have antiplatelet medications discontinued on admission, had higher peak troponin levels and were more likely to undergo percutaneous coronary intervention than patients in the nonthrombotic group. Exposure to vasopressors, time from ECG to angiography, post-STEMI ejection fraction, length of stay, and in-hospital mortality were similar in both groups. There was no difference in the use of percutaneous coronary intervention in patients but longer ECG to coronary angiography times and fivefold higher in-hospital mortality in thrombotic inpatient STEMI compared with 643 patients who presented with an out-of-hospital STEMI during the same time period. In conclusion, thrombotic and nonthrombotic mechanisms cause STEMI in hospitalized patients and are associated with a high mortality.
       
  • Normal Values for Left Ventricular Strain and Synchrony in Children Based
           on Speckle Tracking Echocardiography
    • Abstract: Publication date: 1 May 2019Source: The American Journal of Cardiology, Volume 123, Issue 9Author(s): Adi Adar, Sunil J. Ghelani, Lynn A. Sleeper, Minmin Lu, Edward Marcus, Alessandra M. Ferraro, Steven D. Colan, Puja Banka, Andrew J. Powell, David M. HarrildStrain and synchrony are associated with clinical outcomes in children with heart diseases. Robust normative data for these values, measured by 2-dimensional speckle tracking echocardiography (2DSTE), are limited. Therefore, we aimed to derive normal ranges and z-scores of 2DSTE strain and synchrony parameters in children. Subjects were
       
  • Thoracoscopic Left Atrial Appendage Occlusion for Stroke Prevention
           Compared With Long-Term Warfarin Therapy in Patients With Nonvalvular
           Atrial Fibrillation
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Sophie Weiwei Gao, Emilie Prudence Belley-Côté, Kevin John Um, Richard Paul Whitlock
       
  • Mycoplasma Pneumoniae Pericarditis
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Aishwarya Vijay, John C. Stendahl, Lynda E. RosenfeldMycoplasma pneumoniae is an atypical bacterium that is frequently implicated in respiratory infections, but uncommonly identified as a cause of pericarditis. We report 2 cases of pericarditis attributed to M. pneumoniae that were characterized by prolonged respiratory prodromes, pericardial, and pleural effusions, elevated inflammatory markers, and relapsing clinical courses. In conclusion, our experience suggests that M. pneumoniae should be considered as a potential cause in cases of pericarditis associated with upper respiratory symptoms, pneumonia, pleural effusions, arthralgia, and/or a recurrent/refractory clinical course. The availability of effective antibiotic treatment makes this an important diagnosis to make.
       
  • Benefits and Risks of High-Intensity Interval Training in Patients With
           Coronary Artery Disease
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): John C. Quindry, Barry A. Franklin, Matthew Chapman, Reed Humphrey, Susan MathisExercise-based cardiac rehabilitation is integral to secondary prevention in patients with coronary artery disease. Recently, the effectiveness and “superiority” of high-intensity interval training (HIIT) is a purported time-saving alternative to “traditional” moderate-intensity continuous training (MICT) in cardiac rehabilitation. The rationale for HIIT adoption is, however, not fully substantiated in the scientific literature. Established guidelines for exercise testing and training, when carefully adhered to, reduce the likelihood of triggering a cardiac event or inducing musculoskeletal injury. Clinicians should likewise consider patient risk stratification and introduce HIIT as an alternative to MICT only after patients exhibit stable and asymptomatic responses to vigorous exercise training. Although HIIT adherence appears comparable with MICT during outpatient rehabilitation, compliance drops dramatically for unsupervised exercise. Despite the enthusiasm surrounding HIIT, its main advantage over MICT appears to be short-term exercise performance outcomes and indices of vascular function. Regarding benefits to cardiovascular disease risk factor modification, management of vital signs, and measures of cardiac performance, current evidence indicates that HIIT does not outperform MICT. Long-term outcomes to HIIT are currently uncertain and logistical constraints to HIIT incorporation need additional clarification. Based on these limited findings, derived from facilities and clinicians at the forefront of cardiac rehabilitation, the routine adoption of HIIT should be viewed cautiously. In conclusion, the current review highlights numerous specific research directives that are needed before the safety and effectiveness of HIIT can be confirmed and widely adopted in patients with known or suspected coronary artery disease, especially in unsupervised, nonmedical settings.
       
  • A Prothrombotic State in Patients With a History of Left Ventricular
           Thrombus
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Michał Ząbczyk, Rafal Meus, Krzysztof Piotr Malinowski, Joanna Natorska, Anetta UndasLeft ventricular thrombus (LVT) is associated with a hypercoagulable state and occurs most frequently after myocardial infarction (MI). Blood prothrombotic alterations might predispose to LVT formation, its recurrence, and subsequent cerebrovascular events. We investigated 58 patients with a history of LVT unrelated to recent MI or LV ejection fraction
       
  • Feasibility of Cardiac Magnetic Resonance Wideband Protocol in Patients
           With Implantable Cardioverter Defibrillators and Its Utility for Defining
           Scar
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Amita Singh, Keigo Kawaji, Neha Goyal, Noreen T. Nazir, Andrew Beaser, Virginia O'Keefe-Baker, Karima Addetia, Roderick Tung, Peng Hu, Victor Mor-Avi, Amit R. PatelImplantable cardioverter defibrillators (ICDs) have been a relative contraindication to cardiovascular magnetic resonance imaging. Although cardiovascular magnetic resonance provides valuable information regarding scar in patients with ventricular arrhythmias or cardiomyopathy, ICDs in these patients frequently cause artifacts hindering accurate interpretation of both cine and late gadolinium enhancement (LGE) images. We sought to quantify the frequency and severity of artifact on LGE images and assess whether a modified wideband LGE protocol could improve the diagnostic yield of scar identification in agreement with invasive electroanatomic mapping (EAM). Forty-nine patients with ICDs and ventricular tachycardia (VT) or cardiomyopathy underwent CMR (Philips 1.5T), including standard and wideband LGE imaging. A safety algorithm was followed throughout the protocol. Standard and wideband LGE short-axis images were graded using an artifact score on a per-slice basis. LGE on wideband images was compared with EAM in 27 of 49 patients who underwent VT ablation. There were no adverse patient- or device-related events. With standard LGE imaging, 84% of patients demonstrated some degree of hyperenhancement artifact, which persisted in 22% on wideband LGE but with much less extent. Wideband LGE imaging resulted in an increase from 48% to 94% diagnostic-quality slices, with a significant reduction in artifact score, and correlated with EAM in 21 of 27 patients (78%). In conclusion, assessment of standard LGE is markedly limited by artifact in patients with ICD. The use of wideband LGE significantly improves image quality and can accurately localize myocardial scar before VT ablation.
       
  • Predictive Factors for Progression of Mitral Regurgitation in Asymptomatic
           Patients With Mitral Valve Prolapse
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Janet I. Ma, Sachiyo Igata, Monet Strachan, Marin Nishimura, Darrin J. Wong, Ajit Raisinghani, Anthony N. DeMariaRisk factors predicting progression from low grade to severe mitral regurgitation (MR), which is a guideline criterion for surgical intervention, remain unknown. We hypothesized that abnormalities of cardiac structure and function may predict progression in MR severity. We followed 82 asymptomatic mitral valve prolapse (MVP) patients (65 ± 12 years, 51% men) with mild or moderate MR (36 mild, 46 moderate, mean LVEF: 62%), without significant co-morbidities. We examined clinical findings and 13 echo measurements. The primary end point was progression to severe MR. In a mean follow-up period of 4.5 ± 2.7 years, mortality and heart failure development were similar for mild and moderate MR. No mild MR patient progressed to severe, but 23 moderate MR patients (50.0%) progressed to severe with 9 patients (39.1%) who underwent surgery. No clinical variables were predictive for progression. Only mean mitral annulus diameter (apical 4 and 2 chamber) was predictive for progression to severe MR (hazards ratio 1.14, 95% confidence interval 1.03 to 1.26, p = 0.01). A cut-off annulus diameter of 39.6 mm had a good accuracy (area under the curve 0.78, sensitivity 100%, and specificity 63.8%) for progression to severe. In conclusion, over a 4.5-year period, 50% of asymptomatic MVP patients with moderate MR, but none with mild, progressed to severe MR. Only mitral annular dimension predicted progression of moderate to severe MR, and values>39.6 mm predicted progression accurately. Mitral annulus diameter may be of value in identifying asymptomatic MVP patients at risk of developing severe MR.
       
  • Usefulness of Left Ventricular Strain by Cardiac Magnetic Resonance
           Feature-Tracking to Predict Cardiovascular Events in Patients With and
           Without Heart Failure
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Mayank Sardana, Prasad Konda, Zeba Hashmath, Garrett Oldland, Swetha Gaddam, Rachana Miller, Vaibhav Satija, Bilal Ansari, Jonathan Lee, Anique Mustafa, Scott R. Akers, Julio A. ChirinosThere is controversy regarding the utility of left ventricular (LV) mechanics assessed by feature-tracking steady-state free-precession (FT-SSFP), a readily implementable technique in clinical practice. In particular, whether LV mechanics assessed by FT-SSFP predicts outcomes in subjects with heart failure (HF) with reduced ejection fraction (HFrEF), with preserved ejection fraction (HFpEF), or without HF is unknown. We aimed to assess whether LV mechanics measured with FT-SSFP cine magnetic resonance imaging (MRI) predicts adverse outcomes. We prospectively enrolled 612 adults without HF (n = 402), with HF with reduced ejection fraction (HFrEF; n = 113), or HFpEF (n = 97) and assessed LV strain using FT-SSFP cine MRI. Over a median follow-up of 39.5 months, 75 participants had an HF admission, and 85 died. In Cox proportional hazards models, lower global longitudinal (Standardized hazard ratio 1.56, 95% confidence interval [CI] 1.22 to 2.00, p = 0.0004), circumferential (Standardized HR 1.46, 95% CI 1.08 to 1.95, p = 0.0123), and radial strain (Standardized HR 0.59, 95% CI 0.43 to 0.83, p = 0.0019) were independently associated with the composite endpoint, after adjustment for HF status, LV ejection fraction (LVEF), age, sex, ethnicity, body mass index, systolic and diastolic blood pressure, hypertension, diabetes, coronary artery disease, and glomerular filtration rate. Furthermore, global longitudinal strain stratified the risk of adverse outcomes across tertiles better than LVEF. In analyses that included only participants with a preserved LVEF, systolic radial, circumferential and longitudinal strain were independently predictive of adverse outcomes. We conclude that LV longitudinal, circumferential and radial strain measured using FT-SSFP cine MRI (a readily implementable technique in clinical practice) predict the risk of adverse events, independently of LVEF.
       
  • Thromboembolic Risk of Imaging-Confirmed Coronary Artery Disease Without
           Myocardial Infarction in Patients With Nonvalvular Atrial Fibrillation
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Min Soo Cho, Kyusup Lee, Kee-Joon Choi, Jung-bok Lee, Ungjung Do, Yu Na Kim, Jun Kim, Gi-Byoung Nam, You-Ho KimThe implication of coronary artery disease (CAD) without the clinical manifestation of myocardial infarction (non-MI-CAD) on thromboembolic events in patients with nonvalvular atrial fibrillation (NVAF) is not well evaluated. We hypothesized that non-MI-CAD would have a similar risk of future thromboembolism as MI-CAD. Clinical data for 17,073 consecutive patients (mean age, 64.3 years; males, 64.9%) diagnosed with NVAF at our center were analyzed. CAD was defined as stenosis of ≥50% stenosis of major coronary arteries identified using coronary artery angiography or coronary computed tomographic angiography. The main outcome of the present study was the rate of thromboembolic events (ischemic stroke and systemic embolism) during the follow-up period (3.1 ± 2.4 years). A total of 1,011 patients (5.9%) were diagnosed with CAD without clinical manifestation of MI (non-MI-CAD) and 708 (4.1%) had a history or diagnosis of MI-CAD. Thromboembolic events occurred in 1,007 patients (5.9%) during follow-up. The groups were at high risk of future thromboembolic events determined using univariate (hazard ratio [HR] 1.55; 95% confidence interval [CI] 1.25 to 1.91; p
       
  • Relation of Left Atrial Appendage Morphology Determined by Computed
           Tomography to Prior Stroke or to Increased Risk of Stroke in Patients With
           Atrial Fibrillation
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Lingmin Wu, Erpeng Liang, Siyang Fan, Lihui Zheng, Zhongpeng Du, Shangyu Liu, Feng Hu, Xiaohan Fan, Gang Chen, Ligang Ding, Yan YaoLeft atrial appendage (LAA) morphology is considered to be associated with ischemic stroke, non-Chicken Wing LAA morphology increases the risk of thromboembolic events. However, existing classification of LAA morphology remains not well quantifiable and therefore may leave room for substantial subjective interpretation. This study aimed to assess interobserver and intraobserver agreements in LAA morphology and its real value in stroke prediction. A total of 2,264 atrial fibrillation patients who underwent computed tomography to explore the LAA anatomy were enrolled. All computed tomography images were given to 3 reviewers to judge the LAA morphology independently. A consensus between all 3 reviewers was only reached in 655 cases (28.9%). In which, 86 patients had previous stroke. Poor intraobserver consistency was observed between 2 times of reading in all the 3 reviewers (Kappa = 0.368, p = 0.014; Kappa = 0.350, p = 0.014; Kappa = 0.333, p = 0.015). Multivariate analysis showed that persistent atrial fibrillation (odds ratio [OR] 1.679; 95% confidence interval [CI] 1.031 to 2.736; p = 0.037), female gender (OR 1.761; 95% CI 1.037 to 2.994; p = 0.036) and age (OR 1.029; 95% CI 1.004 to 1.056; p = 0.025) were associated with previous stroke. LAA morphology was not associated with previous stroke and non-Chicken Wing LAA morphology did not increase the risk of stroke (OR 1.392; 95% CI 0.847 to 2.288; p = 0.192). In conclusion, high interobserver and intraobserver variabilities suggested that existing classification of LAA morphology was unreliable, the interpretation of the relation between LAA morphology and stroke needs caution.
       
  • Occurrence of Atrial Fibrillation During Dobutamine Stress
           Echocardiography
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Nicolas Mansencal, Hazrije Mustafic, Marie Hauguel-Moreau, Simon Lannou, Catherine Szymanski, Olivier DubourgDobutamine stress echocardiography (DSE) is a widely used examination for assessment of coronary ischemia, but several complications have been reported. The aim of this study was to assess the incidence of atrial fibrillation (AF) during DSE, and a systematic review and meta-analysis were also performed to determine an accurate estimate of the AF incidence. Over a 16-year period, we reviewed all patients referred for DSE. We systematically analyzed all ECG performed during DSE to detect AF during the examination. DSE was completely performed in 4,818 patients (mean age: 62.1 ± 11.7 years). AF was observed in 40 patients (31 men, mean age: 79.7 ± 8.9 years). Incidence of AF during DSE was 0.83%. Regarding the meta-analysis, the combined AF incidence was 0.86%. In our study, patients with AF occurrence had more frequent previous history of paroxysmal AF (p = 0.02) were also older (p < 0.0001) and incidence of AF during DSE increased with age: 0% below 60 years, 0.45% in patients 60 to 69 years, 1.3% in patients 70 to 79 years, and 4% in patients>80 years (p < 0.0001). In multivariate analysis, the factors significantly associated with an increased risk of AF were age (adjusted odds ratio (aOR) = 2.4, 95% confidence interval: 1.5 to 3.3, p = 0.003) and previous history of paroxysmal AF (aOR = 1.5, 95% confidence interval: 1.1 to 1.9; p = 0.04). In conclusion, AF is uncommon during DSE, and elderly patients and patients with previous history of paroxysmal AF are at risk of AF during DSE.
       
  • Usefulness of Ezetimibe Versus Evolocumab as Add-On Therapy for Secondary
           Prevention of Cardiovascular Events in Patients With Type 2 Diabetes
           Mellitus
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Ronen Arbel, Ariel Hammerman, Joseph AzuriEvolocumab and ezetimibe, were both proven to significantly reduce the incidence of major adverse cardiovascular events (MACE), in type 2 diabetes patients with atherosclerotic cardiovascular disease and low-density lipoprotein (LDL) cholesterol>70 mg/dl despite statin therapy. Providing evolocumab for all such patients may be a significant burden on healthcare systems. Therefore, we analyzed the treatment cost of ezetimibe versus evolocumab to prevent 1 MACE. We extracted the number needed to treat (NNT) with evolocumab or with ezetimibe for avoiding MACE from the published FOURIER and IMPROVE-IT trials respectively. Drug costs were based on 2018 US prices. Sensitivity and scenario analyses were performed to overcome variances in terms of population risk, efficacy of therapies, and costs. In FOURIER, the 1-year NNT for avoiding MACE with evolocumab was 104 (95% confidence intervals [CI] 66 to 235). In IMPROVE-IT, the 1-year NNT with ezetimibe was 124 (95% CI 73 to 288). The annual cost of evolocumab and ezetimibe is $6,540 and $88, respectively. Therefore, the cost to prevent 1 MACE in the FOURIER and IMPROVE-IT trials would have been $678,981 (95% CI $429,810 to $1,537,910,149) and $10,870 (95% CI $6,384 to $25,322), respectively. Ezetimibe was consistently a cost-saving strategy compared with evolocumab, in all analyses performed, except for the case where evolocumab price is significantly reduced and the branded ezetimibe is used. In conclusion, treatment with ezetimibe seems to be a major cost-saving strategy for preventing MACE in this patient population.
       
  • Conduction Delay-Induced J-Wave Augmentation in Patients With Coronary
           Heart Disease
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Masafumi Nakayama, Kazuhiro Satomi, Mikio Yuhara, Takashi Uchiyama, Yoshiyasu Aizawa, Yoshifusa AizawaElectrocardiogram records were surveyed for the presence of an atrial premature beat (APB) and J waves in patients with coronary heart disease and patients with noncardiac diseases. The prevalence and response of J waves to sudden shortening of the RR interval on the conducted APB were determined and compared between the 2 patients groups. The change in the QRS complexes on the APB was also determined. Among 17,013 patients, 243 patients who underwent percutaneous coronary intervention for acute myocardial infarction or angina pectoris had an APB, and J waves were observed in 16 patients (6.6%). In an additional 729 patients with noncardiac diseases and APB, 19 patients showed J waves (2.6%; p = 0.010). The clinical features were almost similar between the ischemic and nonischemic groups. J waves were located more often in inferior and high lateral leads in the ischemic group. When the RR interval shortened from 942 ± 228 to 621 ± 175 ms and 869 ± 158 to 570 ± 118 ms at baseline and in the conducted APB (p
       
  • Sudden Cardiac Death Risk Distribution in the United States Population
           (from NHANES, 2005 to 2012)
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Kristoff A. Olson, Ravi B. Patel, Faraz S. Ahmad, Hongyan Ning, Brittany M. Bogle, Jeffrey J. Goldberger, Donald M. Lloyd-JonesSudden cardiac death (SCD) accounts for more than half of all deaths from cardiovascular disease and is the first manifestation of heart disease in 50% of these subjects. We aimed to describe the distribution of predicted SCD risk in the general US population using a recently developed risk score. We previously developed a population-based, 10-year risk score for SCD using data from the multiracial Atherosclerosis Risk in Communities cohort, validated in the Framingham Study. We now estimate 10-year predicted SCD risk in National Health and Nutrition Examination Survey participants (pooled from cycles in 2005 to 2012) and evaluate the clinical profile of participants in lower risk (0 to 80th percentile of risk) or high risk (81st to 100th percentile of risk) strata. A total of 10,811 participants were included; the mean age of participants was 48 years, and 50% were women. The average predicted 10-year risk of SCD was 3.6% in high-risk participants (81st to 100th percentile), and 0.37% in low-risk participants (0 to 80th percentile). High-risk participants were older, had higher blood pressure, total cholesterol and body mass index, lower high-density lipoprotein, and were more likely to be men, black, smokers, and diabetic. In US adults free of cardiovascular disease, the majority of SCD risk appears confined to 10% to 20% of the population. This risk score, comprised of readily available clinical variables, identifies a subset of individuals in the population who are at an appreciably higher risk of SCD. This enriched cohort represents candidates for additional nuanced and selective screening techniques to further quantify SCD risk.
       
  • Relation of Direct, Indirect, and Total bilirubin to Adverse Long-term
           Outcomes Among Patients With Acute Coronary Syndrome
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Chenbo Xu, Mengya Dong, Yangyang Deng, Lisha Zhang, Fuxue Deng, Juan Zhou, Zuyi YuanBilirubin is known as an antioxidant. However, there have been controversies over whether bilirubin is protective against cardiovascular disease or not. In addition, no study has examined the association between subtypes of total bilirubin (direct bilirubin [DB] and indirect bilirubin [IDB]) and long-term outcomes of acute coronary syndrome (ACS) patients. We included 533 consecutive patients with ACS. All the patients were followed up for the composite end point of cardiac death, revascularization, and acute heart failure. At a median follow-up of 2.4 years, Kaplan-Meier curve demonstrated that higher serum DB levels were significantly associated with major adverse cardiac events (MACE) (p
       
  • Effects of Cangrelor as Adjunct Therapy to Percutaneous Coronary
           Intervention
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Alexandre Hideo-Kajita, Toby Rogers, Kyle Buchanan, Micaela Iantorno, Deepakraj Gajanana, Yuichi Ozaki, Kazuhiro Dan, Paul Kolm, Echo Brathwaite, Solomon Beyene, Gebremedhin Melaku, Yael Meirovich, Aaphtaab Dheendsa, Hector M. Garcia-Garcia, Rebecca Torguson, Ron WaksmanPercutaneous coronary intervention (PCI) in patients with angiographic evidence of intracoronary thrombus is associated with in-hospital and 30-day adverse clinical outcomes. Cangrelor, a direct, rapid-onset acting intravenous P2Y12 receptor inhibitor, has been proved to be effective by reducing peri-PCI ischemic complications in subjects who underwent PCI. This study aimed to assess the angiographic and in-hospital clinical outcomes in all-comer patients receiving cangrelor immediately before PCI at a tertiary care center. The study analyzed consecutive unselected subjects treated with cangrelor at the time the decision was made to proceed with PCI. At the end of the procedure, all patients were transitioned to oral antiplatelet therapy. The target lesion angiographic assessment of Thrombolysis in myocardial infarction flow grade (TIMI-Flow), TIMI-thrombus grade (TIMI-Thrombus), myocardial blush grade, and TIMI-myocardial perfusion grade (TMPG) was performed before and post-PCI. Clinical events were recorded during the procedure and at discharge. In total, 223 patients (244 lesions) were included in the analysis (106, 97, and 20 patientswith TIMI-Flow 0/1, TIMI-Flow 2/3, and cardiogenic shock, respectively). The overall mean age was 63 ± 12 years, 70% men and 38% with diabetes mellitus. Acute myocardial infarction was the main presentation (72%). The use of cangrelor improved TIMI-Flow, MGB, TMPG, and TIMI-Thrombus in patients with initial TIMI-Flow 0 to 2. Major bleeding rate was 2.0%. In conclusion, cangrelor was effective and safe in restoring TIMI-Flow 3, reducing thrombus burden and improving myocardial blush grade and TMPG when administered to unselected subjects who underwent PCI. Therefore, cangrelor should be considered in patients presenting with intracoronary thrombus before intervention.
       
  • Outcomes Among Patients Transferred for Revascularization With Impella for
           
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Brian P. O'Neill, Mauricio G. Cohen, Mir Babar Basir, Theodore Schreiber, Navin K. Kapur, Simon Dixon, Akshay K. Khandelwal, Cindy Grines, Erik Magnus Ohman, William W. O'NeillThe outcomes for patients transferred with cardiogenic shock and later treated with revascularization and Impella support have not previously been studied. To evaluate these outcomes, patients in cardiogenic shock were recruited from the catheter-based ventricular assist device registry, a prospective registry enrolling patients who underwent percutaneous coronary intervention with hemodynamic support using Impella 2.5 or CP. Analysis was performed on subgroups of patients who were characterized as those directly admitted to a tertiary care hospital (direct), or those transferred from an outside hospital (transfer). Patients who were transferred with acute myocardial infarction with cardiogenic shock (AMICS) more often presented in shock were in shock longer than 24 hours, and were more likely to be on intra-aortic balloon pump but were less likely to sustain cardiac arrest. The number of pressors, EF, diseased, and treated vessels were similar between the 2 groups. Despite baseline differences, the mortality was similar in the transfer versus direct patients (47.0% vs 53.5% p = 0.19). In a multivariate model, the factors independently associated with 30-day mortality in AMICS treated with revascularization and Impella support were cardiopulmonary resuscitation (CPR) (p
       
  • The Simulation Training in Coronary Angiography and Its Impact on Real
           Life Conduct in the Catheterization Laboratory
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Batric Popovic, Samuel Pinelli, Eliane Albuisson, Pierre Adrien Metzdorf, Brice Mourer, Nguyen Tran, Edoardo CamenzindOur study aimed to evaluate the effectiveness of mentored simulation training (ST) in coronary angiography and to assess the transferability of acquired skills from virtual reality to the real world. Twenty cardiology residents were randomized to ST or control before performing real-life cases in the catheterization laboratory. The control group underwent secondary ST and reperformed real-life cases in the catheterization laboratory. Skill metrics were compared between the ST and the control group, and within the control group between before and after ST. In real-life cases, the procedure time was shorter (p = 0.002), the radiation dose lower (p = 0.001), and the global procedure skill score was higher (p = 0.0001) in the ST group as compared with the control (before ST) group. During virtual ST procedural time (p
       
  • Simulation of the Impact of Statin Intolerance on the Need for Ezetimibe
           and/or Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor for Meeting
           Low-Density Lipoprotein Cholesterol Goals in a Population With
           Atherosclerotic Cardiovascular Disease
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Christopher P. Cannon, Robert J. Sanchez, Alexa C. Klimchak, Irfan Khan, William J. Sasiela, Matthew R. Reynolds, Robert S. RosensonIn a population with atherosclerotic cardiovascular disease, previous research indicated that approximately 86% can achieve low-density lipoprotein cholesterol (LDL-C) of
       
  • Patient Phenotypes, Cardiovascular Risk, and Ezetimibe Treatment in
           Patients After Acute Coronary Syndromes (from IMPROVE-IT)
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Abhinav Sharma, Jie-Lena Sun, Yuliya Lokhnygina, Matthew T. Roe, Tariq Ahmad, Nihar R. Desai, Michael A. BlazingRisk prediction following acute coronary syndrome (ACS) remains challenging. Data-driven machine-learning algorithms can potentially identify patients at high risk of clinical events. The Improved Reduction of Outcomes: Vytorin Efficacy International Trial randomized 18,144 post-ACS patients to ezetimibe + simvastatin or placebo + simvastatin. We performed hierarchical cluster analysis to identify patients at high risk of adverse events. Associations between clusters and outcomes were assessed using Cox proportional hazards models. The primary outcome was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, unstable angina hospitalization, or coronary revascularization ≥30 days after randomization. We evaluated ezetimibe's impact on outcomes across clusters and the ability of the cluster analysis to discriminate for outcomes compared with the Global Registry of Acute Coronary Events (GRACE) score. Five clusters were identified. In cluster 1 (n = 13,252), most patients experienced a non-STEMI (54.8%). Cluster 2 patients (n = 2,719) had the highest incidence of unstable angina (n = 83.3%). Cluster 3 patients (n = 782) all identified as Spanish descent, whereas cluster 4 patients (n = 803) were primarily from South America (56.2%). In cluster 5 (n = 587), all patients had ST elevation. Cluster analysis identified patients at high risk of adverse outcomes (log-rank p
       
  • American and European Hypertension Guidelines: Finding Common Ground
    • Abstract: Publication date: 15 April 2019Source: The American Journal of Cardiology, Volume 123, Issue 8Author(s): Eugene Yang, Garima Sharma, Venkata Ram
       
  • Neutrophil to lymphocyte ratio and risk of atrial fibrillation
    • Abstract: Publication date: Available online 21 March 2019Source: The American Journal of CardiologyAuthor(s): Dr. Shuli Silberman
       
  • Outcomes and Resource Utilization for Non-Elective Versus Elective
           Transcatheter Mitral Valve Repair
    • Abstract: Publication date: Available online 20 March 2019Source: The American Journal of CardiologyAuthor(s): Mohamad Alkhouli, Fahad Alqahtani, Deepak L. Bhatt, Verghese Mathew
       
  • Differences in Echocardiographic Measures of Aortic Dimensions by Race
    • Abstract: Publication date: Available online 19 March 2019Source: The American Journal of CardiologyAuthor(s): Troy M. LaBounty, Theodore J. Kolias, Eduardo Bossone, David S. Bach It is not clear whether there are differences in aortic dimensions by race. Our hypothesis was that race-specific differences in aortic size exist. We compared the relationship between race and aortic dimensions among 15,295 adults without known risk factors for cardiovascular disease or aortic dilatation, who underwent clinically indicated transthoracic echocardiography. We compared inner edge-to-inner edge measurements between whites (n=12,932), blacks (n=958), Asians (n=827), Hispanics (n=366), Native Americans (n=38), and others (n=174). Multivariate analysis compared measurements indexed to body surface area (BSA) between races and adjusted for variables including age, gender, and mean blood pressure. Mean age was 49.9±17.6 years, and 58.7% were female. On gender-specific comparisons, there were significant differences in aortic size between races (p
       
  • Sex differences in 1-year rehospitalization for heart failure and
           myocardial infarction after primary percutaneous coronary intervention
    • Abstract: Publication date: Available online 19 March 2019Source: The American Journal of CardiologyAuthor(s): Huili Zheng, Ling Li Foo, Huay Cheem Tan, A. Mark Richards, Siew Pang Chan, Ronald C.H. Lee, Adrian F.H. Low, Derek J. Hausenloy, Jack W.C. Tan, Anders O. Sahlen, Hee Hwa Ho, Siang Chew Chai, Khim Leng Tong, Doreen S.Y. Tan, Khung Keong Yeo, Terrance S.J. Chua, Carolyn S.P. Lam, Mark Y. Chan It is unclear whether universal access to primary percutaneous coronary intervention (pPCI) may reduce sex differences in 1-year rehospitalization for heart failure (HF) and myocardial infarction (MI) after ST-elevation myocardial infarction (STEMI). We studied 7,597 consecutive STEMI patients (13.8% women, N=1,045) who underwent pPCI from January 2007 to December 2013. Cox regression models adjusted for competing risk from death were used to assess sex differences in rehospitalization for HF and MI within 1 year from discharge. Compared with men, women were older (median age 67.6 vs 56.0 years, P
       
  • Diagnostic Yield of Customized Exercise Provocation Following Routine
           Testing
    • Abstract: Publication date: Available online 19 March 2019Source: The American Journal of CardiologyAuthor(s): Timothy W Churchill, Michael Disanto, Tamanna K Singh, Erich Groezinger, Garrett Loomer, Miranda Contursi, Milena DiCarli, Jennifer Michaud-Finch, Katie Morganti Stewart, Adolph M Hutter, Gregory D Lewis, Rory B Weiner, Aaron L Baggish, Meagan M Wasfy Clinical guidelines advocate for customization of exercise testing to address patient-specific diagnostic goals, including reproduction of presenting exertional symptoms. However, the diagnostic yield of adding customized exercise testing to graded exercise among patients presenting with exertional complaints has not been rigorously examined and is the focus of this study. Using prospectively collected data, we analyzed the diagnostic yield of customized additional exercise provocation following inconclusive graded exercise test with measurement of gas exchange. Additional testing was defined as ‘positive’ if it revealed a clinically-actionable diagnosis related to the chief complaint or reproduced symptoms in the absence of an explanatory diagnosis or pathology. Of 1,110 patients who completed a graded test, 122 (11%) symptomatic patients underwent additional customized exercise testing (e.g. sprint intervals, race simulations). Compared to those who did not undergo additional testing, this group was younger (29 [IQR 19-45] vs. 46 [25-58] y.o.) and disproportionately female (43% vs. 27%). Presenting symptoms included palpitations (46%), lightheadedness / syncope (25%), chest pain (14%), dyspnea (11%), and exertional intolerance (3%). Additional testing was ‘positive’ in 48/122 (39%) of patients by revealing a clinically actionable diagnosis in 26/48 (54%) or reproducing symptoms without an explanatory diagnosis in 22/48 (46%). In conclusion, while patient-centered customization of exercise testing is suggested by clinical guidelines, these data are the first to demonstrate that the selective addition of customized exercise provocation following inconclusive graded exercise testing improves the diagnostic yield of exercise assessment.
       
  • What is Your Spare Time Worth'
    • Abstract: Publication date: Available online 19 March 2019Source: The American Journal of CardiologyAuthor(s): Robert M. Doroghazi
       
  • ST-Elevation Myocardial Infarction Associated With Infective Endocarditis
    • Abstract: Publication date: Available online 17 March 2019Source: The American Journal of CardiologyAuthor(s): Salik Nazir, Eric Elgin, Richard Loynd, Mumtaz Zaman, Anthony DonatoST-elevation myocardial infarction (STEMI) as a complication of infective endocarditis (IE) is a rarely reported entity. No clear guidelines exist with regards to the management of this medical emergency. We sought to systematically review the clinical presentation and management of this condition. We searched relevant articles on STEMI associated with IE and extracted data on demographic variables, key clinical characteristics upon presentation, treatment strategies, and clinical outcomes. We identified 100 patients from 95 articles. The mean age at presentation was 53 ± 17 years with male preponderance (n = 63, 63%, p = 0.01). Most patients (63 of 100, 63%) presented with STEMI as their first manifestation of IE, with others occurring at 15 ± 17 days after diagnosis of IE. Findings that suggested possible septic emboli were not consistently present, including history of prosthetic valve placement (15%), presence of other embolic disease (27%), fever (42%) increased leukocyte count (80%), and presence of murmur (88%). Atherosclerotic disease was absent in 95% on cardiac catheterization. Eleven patients receiving tissue plasminogen activator fared poorly, with 9 major bleeds; balloon angioplasty was successful in 56% (9 of 16 cases), aspiration thombectomy in 68% (21 of 31 cases), and coronary stenting in 81% (14 of 16 cases). The 30-day mortality was 43%. In conclusion, patients with STEMI in the face of recent IE, new precordial murmur, fever, increased leukocyte count or other embolic events, septic emboli should be considered as a cause for STEMI. Best practices for management are not known, but thrombolytics appear to carry significant bleeding and embolic risks.
       
 
 
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