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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 331, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
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Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
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Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
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Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
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Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
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Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 128, SJR: 5.2, h-index: 222)
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Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
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Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 5)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
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Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
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Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
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Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
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Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
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Advances in Psychology     Full-text available via subscription   (Followers: 60)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
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Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 307, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 191, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 10)
Anales de Cirugia Vascular     Full-text available via subscription  
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Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 162, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
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Animal Behaviour     Hybrid Journal   (Followers: 157, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
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Journal Cover American Journal of Cardiology
  [SJR: 2.063]   [H-I: 186]   [45 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9149 - ISSN (Online) 0002-9149
   Published by Elsevier Homepage  [3043 journals]
  • Introduction
    • Authors: Robert Chilton
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1, Supplement
      Author(s): Robert J. Chilton

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjmed.2017.04.003
  • Pharmacologic Management of Type 2 Diabetes Mellitus: Available Therapies
    • Authors: James Thrasher
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1, Supplement
      Author(s): James Thrasher
      Choices for the treatment of type 2 diabetes mellitus (T2DM) have multiplied as our understanding of the underlying pathophysiologic defects has evolved. Treatment should target multiple defects in T2DM and follow a patient-centered approach that considers factors beyond glycemic control, including cardiovascular risk reduction. The American Association of Clinical Endocrinologists/American College of Endocrinology and the American Diabetes Association recommend an initial approach consisting of lifestyle changes and monotherapy, preferably with metformin. Therapy choices are guided by glycemic efficacy, safety profiles, particularly effects on weight and hypoglycemia risk, tolerability, patient comorbidities, route of administration, patient preference, and cost. Balancing management of hyperglycemia with the risk of hypoglycemia and consideration of the effects of pharmacotherapy on weight figure prominently in US-based T2DM recommendations, whereas less emphasis has been placed on the ability of specific medications to affect cardiovascular outcomes. This is likely because, until recently, specific glucose-lowering agents have not been shown to affect cardiorenal outcomes. The Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose (EMPA-REG OUTCOME), the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial, and the Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes 6 (SUSTAIN-6) recently showed a reduction in overall cardiovascular risk with empagliflozin, liraglutide, and semaglutide treatment, respectively. Moreover, empagliflozin has become the first glucose-lowering agent indicated to reduce the risk of cardiovascular death in adults with T2DM and established cardiovascular disease. Results from cardiovascular outcomes trials have prompted an update to the 2017 American Diabetes Association standards of care, which now recommend consideration of empagliflozin or liraglutide for patients with suboptimally controlled long-standing T2DM and established atherosclerotic cardiovascular disease because these agents have been shown to reduce cardiovascular and all-cause mortality when added to standard care.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjmed.2017.04.004
  • Cardiovascular Protection in the Treatment of Type 2 Diabetes: A Review
           of Clinical Trial Results Across Drug Classes
    • Authors: Francesco Paneni; Thomas F. Lüscher
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1, Supplement
      Author(s): Francesco Paneni, Thomas F. Lüscher
      Patients with type 2 diabetes (T2DM) have a significantly higher risk of developing cardiovascular disease (CVD)—namely myocardial infarction, heart failure, and stroke. Despite clear advances in the prevention and treatment of CVD, the impact of T2DM on CVD outcome remains high and continues to escalate. Available evidence indicates that the risk of macrovascular complications increases with the severity of hyperglycemia, thus suggesting that the relation between metabolic disturbances and vascular damage is approximately linear. Although current antidiabetic drugs are highly effective for the management of hyperglycemia, most T2DM patients remain exposed to a substantial and concrete risk of CVD. Over the last decade many glucose-lowering agents have been tested for their safety and efficacy in T2DM with CVD. Noteworthy, most of these studies failed to show a significant benefit in terms of CV morbidity and mortality, despite intensive glycemic control. The recent trials Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose (EMPA-REG OUTCOME); Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN-6); Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER); and Insulin Resistance Intervention After Stroke (IRIS) have shed some light on this important clinical issue, thus showing a convincing effect of empagliflozin, liraglutide, and pioglitazone on CVD outcomes. Here we provide a critical and updated overview of the main glucose-lowering agents and their risk/benefit ratio for the prevention of CVD in patients with T2DM.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjmed.2017.04.008
  • Cardiovascular Protection by Sodium Glucose Cotransporter 2 Inhibitors:
           Potential Mechanisms
    • Authors: Bart Staels
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1, Supplement
      Author(s): Bart Staels
      The mechanism of action of empagliflozin in reducing the risk of adverse cardiovascular outcomes vs placebo in patients with type 2 diabetes mellitus and a high risk of cardiovascular disease in the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose (EMPA-REG OUTCOME) trial is currently unknown. An antiatherosclerotic effect is considered unlikely given the speed of the observed decrease in cardiovascular mortality. Hemodynamic effects, such as reductions in blood pressure and intravascular volume, and involving osmotic diuresis, may provide a more plausible explanation. Metabolic effects, such as cardiac fuel energetics, and hormonal effects, such as increased glucagon release, may also contribute to the results observed during EMPA-REG OUTCOME. This review discusses the main hypotheses suggested to date.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjmed.2017.04.009
  • Diabetes Mellitus and Heart Failure
    • Authors: Michael Lehrke; Nikolaus Marx
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1, Supplement
      Author(s): Michael Lehrke, Nikolaus Marx
      Epidemiologic and clinical data from the last 2 decades have shown that the prevalence of heart failure in diabetes is very high, and the prognosis for patients with heart failure is worse in those with diabetes than in those without diabetes. Experimental data suggest that various mechanisms contribute to the impairment in systolic and diastolic function in patients with diabetes, and there is an increased recognition that these patients develop heart failure independent of the presence of coronary artery disease or its associated risk factors. In addition, current clinical data demonstrated that treatment with the sodium glucose cotransporter 2 inhibitor empagliflozin reduced hospitalization for heart failure in patients with type 2 diabetes mellitus and high cardiovascular risk. This review article summarizes recent data on the prevalence, prognosis, pathophysiology, and therapeutic strategies to treat patients with diabetes and heart failure.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjmed.2017.04.010
  • EMPA-REG OUTCOME: The Endocrinologist's Point of View
    • Authors: Leigh Perreault
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1, Supplement
      Author(s): Leigh Perreault
      For many years, it was widely accepted that control of plasma lipids and blood pressure could lower macrovascular risk in patients with type 2 diabetes mellitus (T2DM), whereas the benefits of lowering plasma glucose were largely limited to improvements in microvascular complications. The Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose (EMPA-REG OUTCOME) study demonstrated for the first time that a glucose-lowering agent, the sodium glucose cotransporter 2 (SGLT2) inhibitor empagliflozin, could reduce major adverse cardiovascular events, cardiovascular mortality, hospitalization for heart failure, and overall mortality when given in addition to standard care in patients with T2DM at high cardiovascular risk. These results were entirely unexpected and have led to much speculation regarding the potential mechanisms underlying cardiovascular benefits. In this review, the results of EMPA-REG OUTCOME are summarized and put into perspective for the endocrinologist who is treating patients with T2DM and cardiovascular disease.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjmed.2017.04.005
  • EMPA-REG OUTCOME: The Cardiologist's Point of View
    • Authors: Son V. Pham; Robert Chilton
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1, Supplement
      Author(s): Son V. Pham, Robert J. Chilton
      Cardiologists could view empagliflozin as a cardiovascular drug that also has a beneficial effect on reducing hyperglycemia in patients with type 2 diabetes mellitus (T2DM). The effects of empagliflozin in lowering the risk of cardiovascular death and hospitalization for heart failure in T2DM patients with high cardiovascular risk during the recent Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose (EMPA-REG OUTCOME) trial may be explained principally in terms of changes to cardiovascular physiology; namely, by the potential ability of empagliflozin to reduce cardiac workload and myocardial oxygen consumption by lowering blood pressure, improving aortic compliance, and improving ventricular arterial coupling. These concepts and hypotheses are discussed in this report.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjmed.2017.04.006
  • EMPA-REG OUTCOME: The Nephrologist's Point of View
    • Authors: Christoph Wanner
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1, Supplement
      Author(s): Christoph Wanner
      There is increasing evidence that sodium glucose cotransporter 2 (SGLT2) inhibitors have renoprotective effects, as demonstrated by the renal analyses from clinical trials including Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose (EMPA-REG OUTCOME), CANagliflozin Treatment And Trial Analysis versus SUlphonylurea (CANTATA-SU), and the dapagliflozin renal study. The potential mechanisms responsible are likely multifactorial, and direct renovascular and hemodynamic effects are postulated to play a central role. This report reviews the renal outcomes data from key SGLT2 inhibitor clinical trials, discusses the hypotheses for SGLT2 inhibitor-associated renoprotection, and considers the main renal safety issues associated with SGLT2 inhibitor treatment.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjmed.2017.04.007
  • Usefulness of Plasma Tissue Inhibitor of Matrix Metalloproteinase-4 to
           Predict Death and Myocardial Infarction in Patients With Diabetes Mellitus
           Referred for Coronary Angiography
    • Authors: Erdal Cavusoglu; John T. Kassotis; Jonathan D. Marmur; Mary Ann Banerji; Sunitha Yanamadala; Vineet Chopra; Ayesha Anwar; Calvin Eng
      Pages: 1 - 7
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Erdal Cavusoglu, John T. Kassotis, Jonathan D. Marmur, Mary Ann Banerji, Sunitha Yanamadala, Vineet Chopra, Ayesha Anwar, Calvin Eng
      TIMP-4 is the newest member of a family of secreted proteins known as the tissue inhibitors of metalloproteases that selectively inhibit matrix metalloproteases. TIMP-4 is abundantly expressed in human cardiovascular structures and has been implicated in cardiovascular disease. Furthermore, it has also been shown to be a novel target of peroxisome proliferator-activated receptor gamma in rat smooth muscle cells, suggesting a potential role in diabetes mellitus as well. However, there have been no studies that have specifically examined the utility of baseline plasma TIMP-4 levels for the prediction of long-term adverse cardiovascular outcomes. In this study, baseline plasma TIMP-4 levels were measured in 162 male patients with diabetes mellitus who were referred for coronary angiography and followed prospectively for the development of all-cause mortality and enzymatically confirmed myocardial infarction (MI) out to 5 years. After adjustment for a variety of baseline clinical, angiographic and laboratory parameters, plasma TIMP-4 levels were an independent predictor of all-cause mortality (hazard ratio 1.60, 95% CI 1.13 to 2.26; p = 0.0082) and MI (hazard ratio 1.61, 95% CI 1.19 to 2.18; p = 0.0021) at 5 years. Furthermore, in additional multivariate models that adjusted for a variety of biomarkers with established prognostic efficacy, TIMP-4 remained an independent predictor of adverse outcomes. In conclusion, elevated levels of TIMP-4 are associated with an increased risk of long-term all-cause mortality and MI in patients with diabetes mellitus referred for coronary angiography. Moreover, this association is independent of a variety of clinical, angiographic, and laboratory variables, including biomarkers with established prognostic efficacy in the prediction of adverse cardiovascular outcomes.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.267
  • Validation of the CHA2DS2-VASc Score in Predicting Coronary
           Atherosclerotic Burden and In-Hospital Mortality in Patients With Acute
           Coronary Syndrome
    • Authors: Alparslan Kurtul; Sadik Kadri Acikgoz
      Pages: 8 - 14
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Alparslan Kurtul, Sadik Kadri Acikgoz
      Although the CHA2DS2-VASc score has been initially recommended for the assessment of the risk of thromboembolic event in patients with atrial fibrillation, in recent years, it is used to predict adverse outcomes in various cardiovascular diseases. However, little is known about its predictive value for coronary atherosclerotic burden in patients with acute coronary syndrome (ACS). The aim of the present study is to investigate whether the CHA2DS2-VASc score could predict higher coronary atherosclerotic burden assessed by SYNTAX score (SS) in ACS. A total of 2,222 ACS patients (mean age 59.8 ± 12.7 years) who underwent coronary angiography were divided into 3 SS tertiles stratified by SS: low (≤22) (n = 1,445); intermediate (23 to 32) (n = 556); and high (≥33) (n = 221). The mean CHA2DS2-VASc score was 2.71 ± 1.51 (range 1 to 9) and CHA2DS2-VASc score was higher in patients with high SS than in those with intermediate and low SS (4.24 ± 1.49, 2.89 ± 1.49, and 2.40 ± 1.36, respectively, p <0.001). In multivariate analysis, CHA2DS2-VASc score ≥4 (odds ratio [OR] 3.048, 95% confidence interval 1.658 to 5.617, p <0.001) was an independent predictor of high SS, as well as body mass index (OR 0.929, p = 0.015), chronic total occlusion (OR 11.363, p <0.001), current smoking (OR 0.476, p = 0.026), and chronic renal disease (OR 1.828, p = 0.033). The CHA2DS2-VASc score was also an independent predictor for in-hospital mortality in multivariate Cox regression analysis. In conclusion, CHA2DS2-VASc, as a simply calculated and reliable score, is independently associated with high SS and in-hospital mortality in patients with ACS. Thus, this score provides an additional level of risk stratification regarding coronary atherosclerotic burden and prognosis beyond that provided by traditional risk factors.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.266
  • Transcoronary Concentration Gradient of microRNA-133a and Outcome in
           Patients With Coronary Artery Disease
    • Authors: Roberta De Rosa; Salvatore De Rosa; David Leistner; Jes-Niels Boeckel; Till Keller; Stephan Fichtlscherer; Stefanie Dimmeler; Andreas M. Zeiher
      Pages: 15 - 24
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Roberta De Rosa, Salvatore De Rosa, David Leistner, Jes-Niels Boeckel, Till Keller, Stephan Fichtlscherer, Stefanie Dimmeler, Andreas M. Zeiher
      Circulating levels of microRNA (miR)-133a are increased in patients with coronary atherosclerotic disease (CAD). Whether the cardiac release of this miR provides any prognostic information in patients with CAD is currently unknown. We aimed to investigate if changes in concentration of miR-133a trough the coronary circulation may be associated with patients' cardiovascular outcome. We enrolled 111 patients (82 with stable CAD and 29 with acute coronary syndromes [ACS]) who underwent coronary angiography. Circulating levels of miR-133a were measured across the transcoronary circulation. Major adverse cardiac events (MACE: death, nonfatal myocardial infarction, and need for revascularization) were recorded through a median follow-up of 32 months. An increased transcoronary concentration gradient of miR133a showed a significant association with overall rate of MACE at follow-up in patients with both stable CAD and ACS (p = 0.011 and p = 0.002, respectively). At the single end point-analysis, increased transcoronary concentration gradients of miR133a were significantly associated with increased rate of death in patients with ACS (p = 0.017) and with increased incidence of new revascularization because of in-stent restenosis in patients with stable CAD (p = 0.026). Kaplan-Meier curves showed a significantly worse event-free survival in patients with greater transcoronary gradients of miR133a (p = 0.026 in stable CAD group and p = 0.007 for ACS group). Nevertheless, these findings lost their significance after adjustment for common cardiovascular risk factor and high-sensitivity troponin-T. In conclusions, the release of miR133a, as measured by its transcoronary concentration gradient, is associated with a higher incidence of MACE in patients with CAD, but it does not add significant prognostic information compared with traditional prognostic biomarkers, therefore limiting its potential usefulness in the clinical practice. Nevertheless, the differential modulation of miR-133a release in the coronary circulation may reflect pathophysiological mechanism involved in CAD progression and complications and suggest a novel potential role for this miR in the development of in-stent restenosis.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.264
  • Radial Versus Femoral Access for the Treatment of Left Main Lesion in the
           Era of Second-Generation Drug-Eluting Stents
    • Authors: Sebastiano Gili; Fabrizio D'Ascenzo; Roberto Di Summa; Federico Conrotto; Enrico Cerrato; Alaide Chieffo; Giacomo Boccuzzi; Antonio Montefusco; Fabrizio Ugo; Pierluigi Omedé; Hiroyoshi Kawamoto; Francesco Tomassini; Marco Pavani; Ferdinando Varbella; Roberto Garbo; Maurizio D'Amico; Giuseppe Biondi Zoccai; Claudio Moretti; Javier Escaned; Antonio Colombo; Fiorenzo Gaita
      Pages: 33 - 39
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Sebastiano Gili, Fabrizio D'Ascenzo, Roberto Di Summa, Federico Conrotto, Enrico Cerrato, Alaide Chieffo, Giacomo Boccuzzi, Antonio Montefusco, Fabrizio Ugo, Pierluigi Omedé, Hiroyoshi Kawamoto, Francesco Tomassini, Marco Pavani, Ferdinando Varbella, Roberto Garbo, Maurizio D'Amico, Giuseppe Biondi Zoccai, Claudio Moretti, Javier Escaned, Antonio Colombo, Fiorenzo Gaita
      Transradial access (TRA) is often avoided in favor of the transfemoral access (TFA) during percutaneous coronary interventions of the unprotected left main coronary artery (ULM), due to technical and safety concerns. The aim of this study was to compare the performance of TRA and TFA in the treatment of ULM with second-generation drug-eluting stents. Consecutive patients who underwent percutaneous coronary intervention on ULM with second-generation drug-eluting stents were retrospectively enrolled in the multicenter Failure in Left Main Study With 2nd Generation Stents (FAILS 2) registry. Patients were stratified according to the arterial access. The choice between TRA and TFA was left to each operator's preferences. Bleedings during index hospitalization were the primary end point. Secondary end points were major adverse cardiovascular events (a composite of death, reinfarction, and target lesion revascularization), the single components of major adverse cardiovascular events at follow-up and stent thrombosis. Propensity score matching was executed to account for possible confounding. Overall, 1,247 patients were enrolled (23.2% [289] of female gender, mean age 70.2 ± 10.2 years). Diagnosis at presentation was stable angina in 603 (48.7%) cases, non–ST-segment elevation acute coronary syndrome in 465 (37.3%), ST-segment elevation myocardial infarction in 117 (9.5%). Mean follow-up was 726 ± 654 days. After propensity score with matching, 354 patients were included. The primary end point was significantly reduced in patients treated with TRA (2.0% vs 4.0%, p = 0.042), whereas no differences emerged pertaining the secondary end points, including target lesion revascularization and reinfarction. In conclusion, TRA may reduce in-hospital bleedings in patients undergoing percutaneous treatment of the ULM, without increasing the rate of adverse cardiovascular events at follow-up, and may therefore be safely used in the treatment of the ULM.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.262
  • Impact of Calcium on Chronic Total Occlusion Percutaneous Coronary
    • Authors: Judit Karacsonyi; Dimitri Karmpaliotis; Khaldoon Alaswad; Farouc A. Jaffer; Robert W. Yeh; Mitul Patel; Ehtisham Mahmud; William Lombardi; Michael R. Wyman; Anthony Doing; Jeffrey W. Moses; Ajay Kirtane; Manish Parikh; Ziad Ali; David Kandzari; Nicholas Lembo; Santiago Garcia; Barbara A. Danek; Aris Karatasakis; Erica Resendes; Pratik Kalsaria; Bavana V. Rangan; Imre Ungi; Craig A. Thompson; Subhash Banerjee; Emmanouil S. Brilakis
      Pages: 40 - 46
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Judit Karacsonyi, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, William Lombardi, Michael R. Wyman, Anthony Doing, Jeffrey W. Moses, Ajay Kirtane, Manish Parikh, Ziad Ali, David Kandzari, Nicholas Lembo, Santiago Garcia, Barbara A. Danek, Aris Karatasakis, Erica Resendes, Pratik Kalsaria, Bavana V. Rangan, Imre Ungi, Craig A. Thompson, Subhash Banerjee, Emmanouil S. Brilakis
      We sought to examine the impact of calcific deposits on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The outcomes of 1,476 consecutive CTO PCIs performed in 1,453 patients (65.5 ± 10 years, 85% male) between 2012 and 2016 at 11 US centers were evaluated. Moderate or severe quantity of calcium was present in 58% of target lesions. Calcified lesions were more tortuous and more likely to have proximal cap ambiguity and interventional collaterals. PCI of moderately/severely calcified CTOs more often required use of the retrograde approach (54% vs 30%, p <0.001) and was associated with longer procedure and fluoroscopy time and higher air kerma radiation dose and contrast volume. Moderate/severe quantity of calcium was associated with lower technical (86.6% vs 93.8%, p <0.001) and procedural (84.4% vs 92.7%, p <0.001) success rates and higher incidence of major adverse cardiac events (3.7% vs 1.8%, p = 0.033). On multivariate analysis, the presence of moderate/severe quantity of calcium was not independently associated with technical success. Balloon angioplasty was the most common lesion preparation technique for calcified lesions, followed by rotational atherectomy and laser. To conclude, in a contemporary, multicenter registry, moderate/severe calcific deposits were present in 58% of attempted CTO lesions and were associated with higher use of the retrograde approach, lower success, and higher complication rates. However, on multivariable analysis, the amount of calcium was not independently associated with technical success.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.263
  • Evolution of Australian Percutaneous Coronary Intervention (from the
           Melbourne Interventional Group [MIG] Registry)
    • Authors: Julian Yeoh; Matias B. Yudi; Nick Andrianopoulos; Bryan P. Yan; David J. Clark; Stephen J. Duffy; Angela Brennan; Gishel New; Melanie Freeman; David Eccleston; Martin Sebastian; Christopher M. Reid; William Wilson; Andrew E. Ajani; Chris Reid; Andrew E. Ajani; Stephen Duffy; David Clark; Melanie Freeman; Chin Hiew; Nick Andrianopoulos; Ernesto Oqueli; Angela Brennan; S.J. Duffy; J.A. Shaw; A. Walton; A. Dart; A. Broughton; J. Federman; C. Keighley; C. Hengel; K.H. Peter; D. Stub; W. Chan; S. Nanayakkara; J. O'Brien; L. Selkrig; K. Rankin; R. Huntington; S. Pally; D.J. Clark; O. Farouque; M. Horrigan; J. Johns; L. Oliver; J. Brennan; R. Chan; G. Proimos; T. Dortimer; B. Chan; R. Huq; D. Fernando; M. Yudi; K. Charter; L. Brown; A. AlFiadh; J. Ramchand; S. Picardo; E. Oqueli; A. Sharma; C. Hengel; N. Ryan; T. Harrison; C. Barry; M. Freeman; L. Roberts; A. Teh; M. Rowe; G. Proimos; Y. Cheong; C. Goods; D. Fernando; A. Baradi; D. Jackson; J. Sajeev; C. Hiew; M. Sebastian; T. Yip; M. Mok; C. Jaworski; A. Hutchison; M. Turner; B. Khialani; J. Dyson; B. McDonald; L. Duff; C. Reid; N. Andrianopoulos; A.L. Brennan; V. Chand; D. Dinh; B.P. Yan; A.E. Ajani; R. Warren; D. Eccleston; J. Lefkovits; R. Iyer; R. Gurvitch; W. Wilson; M. Brooks; S. Biswas; J. Yeoh
      Pages: 47 - 54
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Julian Yeoh, Matias B. Yudi, Nick Andrianopoulos, Bryan P. Yan, David J. Clark, Stephen J. Duffy, Angela Brennan, Gishel New, Melanie Freeman, David Eccleston, Martin Sebastian, Christopher M. Reid, William Wilson, Andrew E. Ajani
      Percutaneous coronary intervention (PCI) continues to evolve with shifting patient demographics, treatments, and outcomes. We sought to document the specific changes observed over a 9-year period in a contemporary Australian PCI cohort. The Melbourne Interventional Group is an established multicenter PCI registry in Melbourne, Australia. Data were collected prospectively with 30-day and 12-month follow-ups. Demographic, procedural, and outcome data for all consecutive patients were analyzed with a year-to-year comparison from 2005 to 2013. National Death Index linkage was performed for long-term mortality analysis; 19,858 procedures were captured over 9 years. Patient complexity and acuity increased with a higher proportion of traditional risk factors and more elderly patients who underwent PCI. Angiographic lesion complexity increased with more multivessel coronary artery disease and more American College of Cardiology/American Heart Association type B2/C lesions proceeding to PCI. The 30-day rate of death, myocardial infarction, or target vessel revascularization has not changed nor has 12-month mortality, myocardial infarction, or major adverse cardiovascular event rates. The strongest independent predictor of long-term mortality was cardiogenic shock at presentation (hazard ratio [HR] 2.95, p <0.01). Drug-eluting stent use (HR 0.83, p <0.01) and a history of dyslipidemia (HR 0.81, p <0.01) were associated with long-term survival. In conclusion, from 2005 to 2013, we observed a cohort of higher risk clinical and angiographic characteristics, with stable long-term mortality.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.258
  • Incidence and Long-Term Clinical Impact of Late-Acquired Stent Fracture
           After Sirolimus-Eluting Stent Implantation in Narrowed Coronary Arteries
    • Authors: Shoichi Kuramitsu; Hiroyuki Jinnouchi; Tomohiro Shinozaki; Takashi Hiromasa; Yukiko Matsumura; Yuhei Yamaji; Mizuki Miura; Hiroaki Matsuda; Hisaki Masuda; Takenori Domei; Yoshimitsu Soga; Makoto Hyodo; Shinichi Shirai; Kenji Ando
      Pages: 55 - 62
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Shoichi Kuramitsu, Hiroyuki Jinnouchi, Tomohiro Shinozaki, Takashi Hiromasa, Yukiko Matsumura, Yuhei Yamaji, Mizuki Miura, Hiroaki Matsuda, Hisaki Masuda, Takenori Domei, Yoshimitsu Soga, Makoto Hyodo, Shinichi Shirai, Kenji Ando
      The incidence and long-term clinical impact of stent fracture (SF) occurred beyond 1 year after sirolimus-eluting stent (SES) implantation remains unclear. From April 2004 to March 2008, 985 consecutive patients with 1,307 lesions were treated only with SES. Of these, 868 patients (88.1%) with 1,140 lesions underwent follow-up angiography within 1 year after the index procedure, and 646 patients (65.6%) with 872 lesions underwent it both within and beyond 1 year after the index procedure. According to the diagnosed timing of SF, we divided the patients into the 2 groups: early SF (<1 year after the index procedure) and late-acquired SF (>1 year after the index procedure). Early- and late-acquired SFs were observed in 64 of 868 patients (7.4%) and 66 of 1,140 lesions (5.8%); 12 of 646 patients (1.9%) and 12 of 872 lesions (1.4%), respectively. Cumulative 10-year incidence of clinically driven target lesion revascularization and definite stent thrombosis were numerically higher in the early- and late-acquired SF groups than in the non-SF group (41.6% vs 45.5% vs 19.0%; 8.0% vs 8.3% vs 2.0%, respectively). In conclusion, late-acquired SF after SES implantation occurred in 1.4% of lesions, which was lower than that of early SF. However, both early- and late-acquired SFs appeared to be associated with clinically driven target lesion revascularization and stent thrombosis during the long-term follow-up.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.259
  • Meta-Analysis Comparing Coronary Artery Bypass Grafting to Drug-Eluting
    • Authors: Rahman Shah; Mohamed S. Morsy; Darryl S. Weiman; George W. Vetrovec
      Pages: 63 - 68
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Rahman Shah, Mohamed S. Morsy, Darryl S. Weiman, George W. Vetrovec
      Historically, coronary artery bypass graft (CABG) surgery has been the standard revascularization method for unprotected left main coronary artery (LMCA) disease. Over the last decade, several randomized controlled trials (RCTs) have shown favorable results for percutaneous coronary intervention (PCI) with drug-eluting stent (DES) compared with CABG; however, no RCT has been conducted directly comparing DESs with medical therapy alone (MTA). Furthermore, the 2 most recently reported larger RCTs, using new-generation DESs reached somewhat conflicting conclusions comparing the 2 revascularization strategies. Therefore, we performed a traditional pairwise meta-analysis and Bayesian network meta-analysis to compare the efficacies of the 3 currently available treatment strategies (MTA, CABG, and DES) for unprotected LMCA disease. Scientific databases and websites were searched to find RCTs. Data from 8 trials including 4,850 patients were analyzed. Overall PCI increased the risk of major adverse cardiac and cerebrovascular events (MACCEs) driven by increased rate of revascularization compared with CABG, but no differences in all-cause mortality, cardiac mortality, and recurrent myocardial infarction were found. However, early (i.e., within 30 days) PCI decreased the risk of MACCEs and stroke compared with CABG. In the mixed-treatment comparison models, both CABG and DESs were associated with better survival compared with MTA, but no difference was found between them. In conclusion, in patients with unprotected LMCA disease, PCI with DESs yields similar all-cause and cardiac mortalities compared with CABG. Furthermore, CABG increases early (i.e., within 30 days) MACCE rates, driven by an increased risk of stroke. Over longer durations, PCI increases MACCE rates because of increased recurrent revascularization.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.260
  • Comparison of Outcomes of Coronary Artery Bypass Grafting Versus
           Drug-Eluting Stent Implantation in Patients With Severe Left Ventricular
    • Authors: Se Hun Kang; Cheol Whan Lee; Seunghee Baek; Pil Hyung Lee; Jung-Min Ahn; Duk-Woo Park; Soo-Jin Kang; Seung-Whan Lee; Young-Hak Kim; Seong-Wook Park; Seung-Jung Park
      Pages: 69 - 74
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Se Hun Kang, Cheol Whan Lee, Seunghee Baek, Pil Hyung Lee, Jung-Min Ahn, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Seong-Wook Park, Seung-Jung Park
      The optimal revascularization strategy for patients with significant coronary artery disease (CAD) and severe left ventricular (LV) dysfunction (ejection fraction ≤35%) remains unclear. We compared the effects of coronary artery bypass surgery (CABG, n = 442) versus percutaneous coronary intervention (PCI) with drug-eluting stents (n = 469) on long-term mortality in 911 patients with significant CAD and severe LV dysfunction using large real-world registry data. Databases of 3 real-world registries were merged for a patient-level meta-analysis. Primary outcome was death from any cause; secondary outcomes were death from cardiac causes, myocardial infarction, stroke, or repeat revascularization. At a median follow-up of 37.3 months, the risk of all-cause death (adjusted hazard ratio [HR] 0.43; 95% confidence interval [CI] 0.31 to 0.61; p <0.001) was significantly lower in the CABG group than in the PCI group after adjustment. Similar findings were observed with regard to the risks of death from cardiac cause (adjusted HR 0.49; 95% CI 0.33 to 0.73; p <0.001) and repeat revascularization (adjusted HR 0.08; 95% CI 0.03 to 0.20; p <0.001). However, there were no significant differences in the risks of myocardial infarction and stroke between the 2 groups. The superiority of CABG over PCI was particularly pronounced in patients receiving β blockers and angiotensin-converting enzyme inhibitor or angiotensin receptor blockers than those who are not. In conclusion, among patients with significant CAD and severe LV dysfunction, CABG showed a lower risk of all-cause death, cardiac-cause death, and repeat revascularization compared with PCI with drug-eluting stents.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.261
  • The Population-Based Long-Term Impact of Anticoagulant and Antiplatelet
           Therapies in Low-Risk Patients With Atrial Fibrillation
    • Authors: Anjani Golive; Heidi T. May; Tami L. Bair; Victoria Jacobs; Brian G. Crandall; Michael J. Cutler; John D. Day; Charles Mallender; Jeffrey S. Osborn; Scott M. Stevens; J. Peter Weiss; Scott C. Woller; T. Jared Bunch
      Pages: 75 - 82
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Anjani Golive, Heidi T. May, Tami L. Bair, Victoria Jacobs, Brian G. Crandall, Michael J. Cutler, John D. Day, Charles Mallender, Jeffrey S. Osborn, Scott M. Stevens, J. Peter Weiss, Scott C. Woller, T. Jared Bunch
      Among patients with atrial fibrillation (AF), the risk of stroke risk is a significant concern. CHADS2 and CHA2DS2-VASc ≤2 scoring have been used to stratify patients into categories of risk. Without randomized, prospective data, the need and type of long-term antithrombotic medications for thromboembolism prevention in lower risk AF patients remains controversial. We sought to define the long-term impact of anticoagulant and antiplatelet therapy use in AF patients at low risk of stroke. A total of 56,764 patients diagnosed with AF and a CHADS2 score of 0 or 1, or CHA2DS2-VASc score of 0, 1, or 2 were studied. Antithrombotic therapy was defined as aspirin, clopidogrel (antiplatelet therapy), or warfarin monotherapy (anticoagulation) initiated within 6 months of AF diagnosis. End points included all-cause mortality, cerebrovascular accident, transient ischemic attack (TIA), and major bleed. The average age of the population was 67.0 ± 14.1 years and 56.6% were male. In total, 9,682 received aspirin, 1,802 received clopidogrel, 1,164 received warfarin, and 46,042 did not receive any antithrombotic therapy. Event rates differed between patients with a CHADS2 score of 0 and 1; 18.5% and 37.8% had died, 1.7% and 3.4% had a stroke, 2.2% and 3.2% had a TIA, and 14% and 12.5% had a major bleed, respectively (p <0.0001 for all). The rates of stroke, TIA, and major bleeding increased as antithrombotic therapy intensity increased from no therapy, to aspirin, to clopidogrel, and to warfarin (all p <0.0001). Similar outcomes were observed in low-risk CHA2DS2-VASc scores (0 to 2). In low-risk AF patients with a CHADS2 score of 0 to 1 or CHA2DS2-VASc score of 0 to 2, the use of aspirin, clopidogrel, and warfarin was not associated with lower stroke rates at 5 years compared with no therapy. However, the use of antithrombotic agents was associated with a significant risk of bleed.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.256
  • Usefulness of the CHA2DS2-VASc Score to Predict Mortality in Defibrillator
    • Authors: Christopher Hong; Krishna Alluri; Nasir Shariff; Furqan Khattak; Evan Adelstein; Sandeep Jain; Samir Saba
      Pages: 83 - 86
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Christopher Hong, Krishna Alluri, Nasir Shariff, Furqan Khattak, Evan Adelstein, Sandeep Jain, Samir Saba
      The CHA2DS2-VASC score is a well-validated stratification tool that predicts the risk of thromboembolism and stroke in patients with nonvalvular atrial fibrillation. Several studies have examined its application as a predictor of mortality in clinical applications other than atrial fibrillation. However, there are current no studies examining its use as an outcome prediction tool in a population of patients with implantable cardiac defibrillators (ICDs). In this study, we examined data from 2,258 patients who underwent ICD device implantation at the hospitals of the University of Pittsburgh Medical Center from February 2002 to April 2014 (median follow-up 5.1 years) and examined the impact of their CHA2DS2-VASC score at the time of device implantation on all-cause mortality. Survival curves based on CHA2DS2-VASC scores were generated using the Kaplan-Meier method and were adjusted for unbalanced covariates using the Cox proportional hazards model. The mean CHA2DS2-VASC score was 3.15 ± 1.52 (range 1 to 8, mode 3). The CHA2DS2-VASC score predicted all-cause mortality in a significant and dose-dependent fashion. Analyzing the population by quartiles revealed increasing all-cause mortality from Q1 to Q4 (p <0.001). Using a Cox multivariate model adjusting for ejection fraction, BMI, serum creatinine, hemoglobin level, and QRS width, the CHA2DS2-VASC score remained a strong predictor of all-cause mortality (hazard ratio 1.26 per 1-point increase, 95% confidence interval 1.20 to 1.32). In conclusion, the CHA2DS2-VASC score is a simple tool that highly predicts all-cause mortality in patients with ICD.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.257
  • Changes in Coagulation and Platelet Activation Markers Following
           Transcatheter Left Atrial Appendage Closure
    • Authors: Josep Rodés-Cabau; Gilles O'Hara; Jean-Michel Paradis; Mathieu Bernier; Tania Rodriguez-Gabella; Ander Regueiro; Kim O'Connor; Jonathan Beaudoin; Rishi Puri; Mélanie Côté; Jean Champagne
      Pages: 87 - 91
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Josep Rodés-Cabau, Gilles O'Hara, Jean-Michel Paradis, Mathieu Bernier, Tania Rodriguez-Gabella, Ander Regueiro, Kim O'Connor, Jonathan Beaudoin, Rishi Puri, Mélanie Côté, Jean Champagne
      The recommendations for antithrombotic treatment after left atrial appendage closure (LAAC) remain empirical, and no data exist on the changes in hemostatic markers associated with LACC. The objective of the present study is to determine the presence, degree, and timing of changes in the markers of platelet and coagulation activation after LAAC. Forty-three patients (mean age 76 ± 9 years, 23 men) with atrial fibrillation who underwent successful LACC with the Watchman (n = 27) or Amplatzer Cardiac Plug (n = 16) devices were included in the study. Patients received antiplatelet therapy after LAAC (aspirin + clopidogrel: 27 patients; single antiplatelet therapy with aspirin or clopidogrel: 16 patients). Prothrombin fragment 1+2 and thrombin-antithrombin III were used as markers of coagulation activation, and soluble P-selectin and soluble CD40 ligand were used as markers of platelet activation. Measurements of all hemostatic markers were performed at baseline just before the procedure, followed by days 7, 30, and 180 after LAAC. Prothrombin fragment 1+2 and thrombin-antithrombin levels increased from 0.27 nmol/L and 4.68 ng/ml, respectively, at baseline to peak values of 0.43 nmol/L and 9.76 ng/ml, respectively, at 7 days, partially returning to baseline levels at days 30 and 180 after LAAC (p <0.001 for both markers). No clinical or procedural factors were associated with a greater increase in the markers of coagulation activation after LAAC. Levels of soluble P-selectin and soluble CD40 ligand did not change at any time after LAAC. In conclusion, transcatheter LAAC is associated with significant activation of the coagulation system, yet without evidence of significant platelet activation.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.253
  • Ventricular and Supraventricular Ectopy in Subjects With Early
    • Authors: Teresa Trenkwalder; Ryan King; Bernhard M. Kaess; Christian Hengstenberg; Heribert Schunkert; Till Ittermann; Stephan B. Felix; Mathias Busch; Marcus Dörr; Wibke Reinhard
      Pages: 92 - 97
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Teresa Trenkwalder, Ryan King, Bernhard M. Kaess, Christian Hengstenberg, Heribert Schunkert, Till Ittermann, Stephan B. Felix, Mathias Busch, Marcus Dörr, Wibke Reinhard
      Early repolarization (ER) is a common electrocardiographic (ECG) finding that is associated with an increased risk of idiopathic ventricular fibrillation and sudden cardiac death. This study investigated whether the presence of ER is a predictor of ventricular and supraventricular ectopy as a marker for electrical instability. Standard 12-lead electrocardiograms of the first follow-up in the population-based Study of Health in Pomerania (SHIP-1) (n = 3,300, age 20 to 79 years) were analyzed to identify subjects with an ER pattern. Ventricular and supraventricular ectopy was assessed via portable tele-ECG cards recording 2 electrocardiograms daily over the course of 4 weeks. Data of 1,630 subjects (n = 83,833 ECG card recordings, average 51.4 per subject) were analyzed for ventricular and supraventricular ectopy using a standardized automated algorithm. Associations of ER and several forms of arrhythmias were assessed using a 2-sided Fisher's exact test or t test, where appropriate. Overall, prevalence of ER in the SHIP-1 population was 4.8%. Presence of ER was not associated with the occurrence of ventricular and supraventricular arrhythmias (p ≥0.05 for all analyses). Furthermore, subgroup analyzes for ER localization (inferior) and ST-segment morphology (horizontal/descending) did not show any association with arrhythmic events. In conclusion, presence of the ER pattern is not associated with an increased occurrence of ventricular or supraventricular arrhythmias as assessed by serial ECG card recordings in this large population-based sample.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.254
  • Trajectory of Congestion Metrics by Ejection Fraction in Patients With
           Acute Heart Failure (from the Heart Failure Network)
    • Authors: Andrew P. Ambrosy; Ankeet S. Bhatt; Dianne Gallup; Kevin J. Anstrom; Javed Butler; Adam D. DeVore; G. Michael Felker; Marat Fudim; Stephen J. Greene; Adrian F. Hernandez; Jacob P. Kelly; Marc D. Samsky; Robert J. Mentz
      Pages: 98 - 105
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Andrew P. Ambrosy, Ankeet S. Bhatt, Dianne Gallup, Kevin J. Anstrom, Javed Butler, Adam D. DeVore, G. Michael Felker, Marat Fudim, Stephen J. Greene, Adrian F. Hernandez, Jacob P. Kelly, Marc D. Samsky, Robert J. Mentz
      Differences in the clinical course of congestion by underlying ejection fraction (EF) have not been well-characterized in acute heart failure (AHF). A post hoc analysis was performed using pooled data from the Diuretic Optimization Strategies Evaluation in Acute Heart Failure, Cardiorenal Rescue Study in Acute Decompensated Heart Failure, and Renal Optimization Strategies Evaluation in Acute Heart Failure trials. All patients were admitted for a primary diagnosis of AHF. Patients were grouped as reduced EF ≤40%, borderline 40% < EF < 50%, or preserved EF ≥50%. Multivariable Cox regression analysis was used to assess the association among measures of congestion and the composite of unscheduled outpatient visits, rehospitalization, or death. Mean age was 68 ± 13 years and 74% were male. Patients with a preserved EF were older, more likely to be female, less likely to have an ischemic etiology of HF, and had a higher prevalence of atrial fibrillation/flutter and chronic obstructive pulmonary disease. Compared with patients with a reduced EF, preserved EF patients had lower amino-terminal pro-b-type natriuretic peptide levels at baseline (i.e., reduced: 5,998 pg/ml [3,009 to 11,414] vs borderline: 4,420 pg/ml [1,740 to 8,057] vs preserved: 3,272 pg/ml [1,687 to 6,536]) and experienced smaller changes during hospitalization. In general, there were few differences between EF groups in the clinical course of congestion as measured by signs and symptoms of HF, body weight change, and net fluid loss. After adjusting for potential confounders, a greater improvement in global visual analog scale was associated with lower risk of unscheduled outpatient visits, rehospitalization, or death at day 60 (hazard ratio 0.94 per 10 mm increase, 95% confidence interval 0.89 to 0.995). This relation did not differ by EF (p = 0.54). In conclusion, among patients hospitalized for AHF, there were few differences in the in-hospital trajectory or prognostic value of routine markers of congestion by EF.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.249
  • Correlation between Angiographic and Physiologic Evaluation of Coronary
           Artery Narrowings in Patients With Aortic Valve Stenosis
    • Authors: Giuseppe Di Gioia; Roberto Scarsini; Teresa Strisciuglio; Chiara De Biase; Carlo Zivelonghi; Danilo Franco; Bernard De Bruyne; Flavio Ribichini; Emanuele Barbato
      Pages: 106 - 110
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Giuseppe Di Gioia, Roberto Scarsini, Teresa Strisciuglio, Chiara De Biase, Carlo Zivelonghi, Danilo Franco, Bernard De Bruyne, Flavio Ribichini, Emanuele Barbato
      We aimed to assess the correlation between angiographic and physiologic evaluation of coronary lesions in aortic stenosis (AS) patients presenting with intermediate coronary stenoses at the angiography. From 2002 to 2010, we included 163 patients from 2 centers with both AS and coronary artery disease (CAD), matched by age and gender with 163 contemporary patients with CAD alone. With both quantitative coronary angiography and fractional flow reserve (FFR), we assessed 259 coronary stenoses in the AS + CAD group, and 256 in the CAD alone group. A significant correlation was found between diameter stenosis (DS) and FFR in both groups, although this was significantly stronger in the AS + CAD than in the CAD alone group (R = −0.63 vs −0.44, p <0.01). Likewise, the correlation between minimum lumen diameter and FFR was stronger in the AS + CAD than in the CAD alone group (R = −0.54 vs −0.41, p = 0.05). Receiver operator characteristic curves analysis showed that DS was a better predictor of hemodynamically significant coronary stenoses (FFR ≤0.8) in the AS + CAD rather than in the CAD alone group (area under the curve = 0.83 vs 0.67, p <0.01). With 50% DS cut-off value, the sensitivity, specificity, and accuracy was 77%, 66%, and 70% in the AS + CAD group versus 59%, 63%, and 61% in the CAD alone group. In both groups, the diagnostic accuracy of DS in predicting FFR was higher in the right and circumflex coronary artery compared with the left anterior descending artery (LAD), although this was only statistically significant in the AS + CAD group (area under the curve 0.88 in the right and circumflex coronary artery vs 0.76 in LAD, p = 0.03). In conclusion, the correlation between the angiographic and hemodynamic significance of coronary stenoses is modest in AS patients. The assessment of CAD severity solely based on angiography poorly predicts the hemodynamic significance of the coronary stenosis especially when these are located in the LAD.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.250
  • Comparison of Features of Fatal Versus Nonfatal Cardiac Arrest in Patients
           With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
    • Authors: Richa Gupta; Crystal Tichnell; Brittney Murray; Stefania Rizzo; Anneline Te Riele; Harikrishna Tandri; Daniel P. Judge; Gaetano Thiene; Cristina Basso; Hugh Calkins; Cynthia A. James
      Pages: 111 - 117
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Richa Gupta, Crystal Tichnell, Brittney Murray, Stefania Rizzo, Anneline Te Riele, Harikrishna Tandri, Daniel P. Judge, Gaetano Thiene, Cristina Basso, Hugh Calkins, Cynthia A. James
      Once arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is diagnosed, the incidence of sudden cardiac death (SCD) is rare and prognosis is favorable, highlighting the value of early disease recognition. To inform strategies to diagnose ARVD/C before SCD, we sought to characterize clinical, genetic, and family history features of ARVD/C cases first recognized after SCD or resuscitated SCD (sudden cardiac arrest [SCA]). We identified 66 ARVD/C cases submitted to the Johns Hopkins ARVD/C Registry in whom disease was first recognized after SCD (n = 45) or SCA (n = 21) and compared their clinical, genetic, and demographic features with 352 patients (227 probands) diagnosed with ARVD/C by 2010 Task Force Criteria before any arrest. SCD/SCA cases were 65% men and experienced their arrest at 29.3 ± 13.8 years. Exertion precipitated 72% of arrests. Family history was recognized before arrest in 11 cases (17%), and 24 cases (41%) had reported cardiac symptoms before arrest. The SCD/SCA cohort was disproportionately men (65% SCD/SCA vs 50% living, p = 0.03) and younger at both first reported symptom (27.7 ± 13.5 years SCD/SCA vs 33.0 ± 13.6 years living, p = 0.01) and first sustained ventricular arrhythmia (VA) (29.3 ± 13.8 years SCD/SCA vs 35.6 ± 12.9 years living, p <0.001). In addition, survival from first symptom to VA was significantly shorter in SCD/SCA cases (p <0.001). These results suggest that the natural history of ARVD/C may be accelerated in SCD/SCA cases. In conclusion, although symptoms or family history provide a window of opportunity for diagnosis before death, time to intervene after symptom onset is limited.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.251
  • Usefulness of Preoperative Transforming Growth Factor-Beta to Predict New
           Onset Atrial Fibrillation After Surgical Ventricular Septal Myectomy in
           Patients With Obstructive Hypertrophic Cardiomyopathy
    • Authors: Ying Guo; Xi Wu; Xinxin Zheng; Jie Lu; Shuiyun Wang; Xiaohong Huang
      Pages: 118 - 123
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Ying Guo, Xi Wu, Xinxin Zheng, Jie Lu, Shuiyun Wang, Xiaohong Huang
      Postoperative atrial fibrillation (AF) occurs frequently after cardiac surgery and contributes significantly to mortality. Transforming growth factor-beta (TGF-β) is associated with postoperative AF after coronary artery bypass grafting and valve surgery. We performed a prospective study to evaluate the role of TGF-β as a predictor of AF after myectomy. A total of 109 consecutive obstructive hypertrophic cardiomyopathy patients without previous AF who underwent myectomy were identified. We measured plasma TGF-β levels before surgery, monitored heart rhythm until discharge, and followed patients for a mean of 36 ± 10 months. AF was documented in 19 patients (17%). AF patients were older (50 ± 10 vs 43 ± 15 years, p = 0.037). Patients who developed AF had higher plasma TGF-β levels (1,695 ± 2,011 vs 1,099 ± 2,494 pg/ml, p = 0.011), more major adverse cardiac events (32% vs 7%, p = 0.006), and more strokes (16% vs 0%, p = 0.005) than patients who did not. TGF-β level ≥358 pg/ml predicted AF with sensitivity and specificity of 58% and 77% (p = 0.011), respectively. Higher TGF-β levels were associated with pulmonary hypertension (25% vs 8%, p = 0.033). In multivariable regression analysis, age (odds ratio 1.05, 95% confidence interval 1.00 to 1.11, p = 0.041) and TGF-β levels (odds ratio 2.42, 95% confidence interval 1.30 to 4.50, p = 0.005) predicted AF independently. In conclusion, elevated preoperative TGF-β value is an independent predictor of postoperative AF in hypertrophic cardiomyopathy patients after surgical ventricular septal myectomy.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.252
  • Usefulness of Non–Anteroseptal Region Left Ventricular Hypertrophy Using
           Cardiac Magnetic Resonance to Predict Repeat Alcohol Septal Ablation for
           Refractory Obstructive Hypertrophic Cardiomyopathy
    • Authors: Mitsunobu Kitamura; Yasuo Amano; Morimasa Takayama; Junsuke Shibuya; Junya Matsuda; Hideto Sangen; Shunichi Nakamura; Hitoshi Takano; Kuniya Asai; Shinichiro Kumita; Wataru Shimizu
      Pages: 124 - 130
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Mitsunobu Kitamura, Yasuo Amano, Morimasa Takayama, Junsuke Shibuya, Junya Matsuda, Hideto Sangen, Shunichi Nakamura, Hitoshi Takano, Kuniya Asai, Shinichiro Kumita, Wataru Shimizu
      We evaluated a cohort of patients treated with alcohol septal ablation (ASA) to identify predictive factors for repeat ASA. We compared 15 patients who underwent repeat ASA procedures (group R) with 69 patients not requiring repeat procedures (group S) in terms of clinical parameters and morphologic cardiac magnetic resonance. Group R showed higher number of hypertrophic segments (thickness ≥15 mm) in the basal left ventricular level (2.8 ± 1.7 vs 1.7 ± 0.8, p = 0.009) than group S. In the multivariate analysis, diuretics use (adjusted odds ratio 5.8, 95% confidential interval [CI] 1.04 to 32.2, p = 0.045) and the number of non–anteroseptal extended hypertrophy segments at the basal level were independent predictors of a repeat ASA procedure (adjusted odds ratio 3.64/segment, 95% CI 1.40 to 9.4, p = 0.008). One repeat ASA among 21 patients without non–anteroseptal hypertrophy and 1 repeat ASA among 29 patients without posteroseptal hypertrophy were observed; however, 7 of the 14 patients with ≥2 segments of non–anteroseptal hypertrophy received repeat ASA. In conclusion, cardiac magnetic resonance–based cross-sectional investigation elucidated non–anteroseptal hypertrophy (≥2 segments) to be a crucial predictor of repeat ASA. ASA is useful for patients with regional hypertrophy in the basal anteroseptal, but not posteroseptal region, and without heart failure requiring diuretics.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.248
  • Aortic Diameter Growth in Children With a Bicuspid Aortic Valve
    • Authors: Remy Merkx; Anthonie L. Duijnhouwer; Evelien Vink; Jolien W. Roos-Hesselink; Michiel Schokking
      Pages: 131 - 136
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Remy Merkx, Anthonie L. Duijnhouwer, Evelien Vink, Jolien W. Roos-Hesselink, Michiel Schokking
      Knowledge of aortic growth in patients with bicuspid aortic valve (BAV) is essential to identify patients at risk for dissection, but data on children remain unclear. We retrospectively evaluated the aortic diameters of all pediatric BAV patients, identified through an echocardiographic database (2005 to 2013). Medical records were reviewed and aortic diameters re-measured on echocardiographic images at diagnosis and if available on variable mid- and endpoints follow-up. Dilatation (z-score >2) was based on 2 different z-score equation methods (Gautier/Campens). In 234 of the total 250 BAV patients, aortic diameters were analyzed; median age was 6.1 years (interquartile range 1.7 to 10), of which 63% were male. Aortic coarctation was present in 81 (36%) patients, 23% had a ventricular septal defect. BAV morphology according to Sievers was as follows: type 0 in 128 patients (55%), type 1 in 96 (41%), and type 2 in 10 (4%). Ascending aortic (AA) dilatation was present in 24% (Gautier) and 36% (Campens) at inclusion. Median follow-up was 4.7 years. The AA was the only location where mean z-scores progressed significantly with age: 0.06 (Gautier) and 0.09 (Campens) units per year between ages 5 and 15 years. Associations for higher AA z-scores at older age were an initial z-score >2 (p <0.001) and aortic valve stenosis (p <0.05). Neither dissection nor preventive aortic surgery occurred. In conclusion, only the AA seems at risk for complication, although no aortic complications occurred in this pediatric BAV cohort. BAV morphology seems associated with larger AA z-scores and valvular dysfunction.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.245
  • Effectiveness and Safety of the Femoral Venous Approach for Coronary Sinus
           Catheterization in Children
    • Authors: Marica Baleilevuka-Hart; Trevor Feldman; Seshadri Balaji
      Pages: 137 - 139
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Marica Baleilevuka-Hart, Trevor Feldman, Seshadri Balaji
      Coronary sinus (CS) catheterization is widely used during electrophysiological studies (EPS) and catheter ablation. The femoral venous (FV) approach to CS catheterization for EPS has been reported in adults but not in children. We report our experience with CS catheter placement through the FV approach in children. The charts of children with normal hearts who underwent EPS with CS cannulation were reviewed. The FV approach was attempted followed by right internal jugular (IJ) vein approach, if unsuccessful. Between 2010 and 2015, 250 patients were studied with an average of 13 ± 3 years. The FV approach to CS catheterization was attempted in 249 patients and was successful in all but 13 (95% successful). The right IJ was used as the primary approach in 1 infant aged 6 weeks and as the backup approach in 11 of the 13 in whom the FV approach failed. There was no appreciable difference between ages of patients in whom FV versus IJ approaches were successful (13 years ± 3 vs 13 years ± 3, respectively). There were no complications from FV sheath placement or from placement of the CS catheter from the FV approach. The right IJ approach was complicated by carotid artery puncture without hematoma in 2 patients (18% of attempts). In conclusion, the FV approach is a safe and effective option for CS cannulation for EPS procedures in children. The IJ and other approaches could be used as back up when the FV approach fails.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.246
  • Effect of Aging on Left Atrial Compliance and Electromechanical Properties
           in Subjects Without Structural Heart Disease
    • Authors: Rachid Abou; Melissa Leung; Anthony M. Tonsbeek; Tomaz Podlesnikar; Arie C. Maan; Martin J. Schalij; Nina Ajmone Marsan; Victoria Delgado; Jeroen J. Bax
      Pages: 140 - 147
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Rachid Abou, Melissa Leung, Anthony M. Tonsbeek, Tomaz Podlesnikar, Arie C. Maan, Martin J. Schalij, Nina Ajmone Marsan, Victoria Delgado, Jeroen J. Bax
      Aging is associated with changes in left atrial (LA) structure and function. The present study aimed at describing the effect of aging on LA properties in a large cohort of subjects without structural heart disease. We divided 386 subjects (mean age 58 years [range 16 to 91]; 188 men [49%]) clinically referred for echocardiography according to age groups. The P-wave dispersion (PWD), reflecting total atrial conduction time, was measured on a 12-lead surface electrocardiogram as the difference between maximum and minimum P-wave duration. The PA-TDI duration reflecting the total atrial conduction time was measured on tissue Doppler imaging (TDI) as the time between onset of P wave on surface electrocardiogram to peak A′-wave velocity. Two-dimensional speckle-tracking echocardiography was used to assess LA reservoir function, reflecting LA compliance. In the overall population, mean PWD, PA-TDI, and LA reservoir strain were 43 ± 12 ms, 129 ± 27 ms, and 36 ± 13%, respectively. Increasing age was independently associated with prolonged PWD (β = 0.161; p <0.001), PA-TDI (β = 0.476; p <0.001), and reduced LA reservoir strain (β = −0.259; <0.001), suggesting age-related fibrotic changes of the LA myocardium. The association between age and LA reservoir strain was modulated by body mass index (β = −0.582; p <0.001) and LA volume index (β = −0.117; p = 0.014). In conclusion, aging is associated with longer PWD and PA-TDI duration along with a decrease in LA reservoir function. Obesity and larger LA volumes are independently associated with reduced LA compliance.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.243
  • Meta-Analysis of Effects of Voluntary Slow Breathing Exercises for Control
    • Authors: Yan Zou; Xin Zhao; Yun-Ying Hou; Ting Liu; Qing Wu; Yu-Hui Huang; Xiao-Hua Wang
      Pages: 148 - 153
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Yan Zou, Xin Zhao, Yun-Ying Hou, Ting Liu, Qing Wu, Yu-Hui Huang, Xiao-Hua Wang
      Rising heart rate (HR) and elevated blood pressure (BP) cause a greater frequency of cardiovascular events. Many patients cannot maintain target HR and BP using pharmacological therapies. To evaluate the effectiveness of voluntary slow breathing exercises in reducing resting HR and BP, we searched Embase (1974 to April 2016), PubMed (1966 to April 2016), the Cochrane Central Register of Controlled Trials (issue 4, April 2016), and PEDro ( ; 1999 to April 2016). The primary outcome was the mean change in HR at rest. Secondary outcomes included changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as compliance with the breathing training. Finally, we included 6 studies consisting of 269 subjects. Practice of the breathing exercises resulted in statistically significant HR reduction (mean difference: −1.72 beats/min, 95% CI −2.70 to −0.75). Reductions were seen in SBP (mean difference: −6.36 mm Hg, 95% CI −10.32 to −2.39) and DBP (mean difference: −6.39 mm Hg, 95% CI −7.30 to −5.49) compared with the controls. Trial durations ranged from 2 weeks to 6 months. In conclusion, the existing evidence from randomized controlled trails demonstrates that short-term voluntary slow breathing exercises can reduce resting HR, SBP, and DBP for patients with cardiovascular diseases.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.247
  • Relation of the Number of Parity to Left Ventricular Diastolic Function in
    • Authors: Muhammed Keskin; Şahin Avşar; Mert İlker Hayıroğlu; Taha Keskin; Edibe Betül Börklü; Adnan Kaya; Ahmet Okan Uzun; Burcu Akyol; Tolga Sinan Güvenç; Ömer Kozan
      Pages: 154 - 159
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Muhammed Keskin, Şahin Avşar, Mert İlker Hayıroğlu, Taha Keskin, Edibe Betül Börklü, Adnan Kaya, Ahmet Okan Uzun, Burcu Akyol, Tolga Sinan Güvenç, Ömer Kozan
      Left ventricular diastolic dysfunction (LVDD) has been relatively less studied than other cardiac changes during pregnancy. Previous studies revealed a mild diastolic deterioration during pregnancy. However, these studies did not evaluate the long-term effect of parity on left ventricular diastolic function. A comprehensive study evaluating the long-term effect of parity on diastolic function is required. A total of 710 women with various number of parity were evaluated through echocardiography to reveal the status of diastolic function. Echocardiographic parameters were compared among the women by parity number and categorized accordingly: none, 0 to 4 and 4< parity (grand multiparous). In nulliparous group, 19 women (23.2%) had grade 1 LVDD, and only 2 women (2.4%) had grade 2 LVDD. In women with a parity number of 0 to 4, 209 women (38.3%) had grade 1 LVDD, and only 17 women (3.1%) had grade 2 LVDD. In grand multiparous group, only 2 women (2.4%) did not have LVDD, and 12 women (14.6%) had grade 2 LVDD. None of the subjects had grade 3 or grade 4 LVDD. According to hierarchical logistic regression analysis, any grade of LVDD and grade 2 LVDD had the highest rates at parity category of > 4 parity and that had 21 and 5.8 times higher than nulliparous group, respectively. In conclusion, according to the present study, grand multiparity but not multiparity, severely deteriorates left ventricular diastolic function. Further studies are warranted to evaluate the risk of gradual diastolic dysfunction after each pregnancy.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.244
  • Mitral Valve Repair for Pure Mitral Regurgitation Followed Years Later by
           Mitral Valve Replacement for Mitral Stenosis
    • Authors: Tiffany M. Becker; Paul A. Grayburn; William C. Roberts
      Pages: 160 - 166
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Tiffany M. Becker, Paul A. Grayburn, William C. Roberts
      We describe herein 2 patients who developed severe mitral stenosis (MS) approximately two decades after a mitral valve repair operation for pure mitral regurgitation (MR) secondary to mitral valve prolapse. This report's purpose is to point out that use of a circumferential mitral annular ring during the repair has the potential to produce a transmitral pressure gradient just like that occurring after mitral valve replacement utilizing a mechanical prosthesis or a bioprosthesis in the mitral position.

      PubDate: 2017-06-12T12:41:24Z
      DOI: 10.1016/j.amjcard.2017.03.242
  • Comparison of 30-Day and Long-Term Outcomes and Hospital Complications
           Among Patients Aged <75 Versus ≥75 Years With ST-Elevation
           Myocardial Infarction Undergoing Percutaneous Coronary Intervention
    • Authors: Guy Topaz; Ariel Finkelstein; Nir Flint; Yacov Shacham; Shmuel Banai; Arie Steinvil; Yaron Arbel; Gad Keren; Lior Yankelson
      Pages: 1897 - 1901
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Guy Topaz, Ariel Finkelstein, Nir Flint, Yacov Shacham, Shmuel Banai, Arie Steinvil, Yaron Arbel, Gad Keren, Lior Yankelson
      Our aim was to evaluate the mortality rate and occurrence of complications in patients aged <75 versus ≥75 years with ST-elevation myocardial infarction (STEMI). We studied 1,657 consecutive patients with STEMI hospitalized in the cardiac intensive care unit during 2008 to 2014. All patients underwent primary percutaneous intervention, of which 292 (18%) were aged ≥75 years. Patient records were evaluated for in-hospital complications, 30-day mortality, and long-term mortality over a mean period of 3.4 ± 2.1 years. Compared with younger patients, patients aged ≥75 years had a significantly higher rate of coronary disease risk factors, prolonged symptom duration (512 ± 640 vs 333 ± 545 minutes, p <0.01) and door-to-balloon time (51.1 ± 24 vs 45.6 ± 38, p = 0.02). Patients aged ≥75 years had more in-hospital noncardiac and cardiac complications, including cardiogenic shock and arrhythmia, and had higher 30-day and long-term mortalities. Cardiogenic shock was associated with increased short- and long-term mortality in the older group but was not incremental over the noncardiogenic shock cohort. In conclusion, in patients aged ≥75 years who underwent primary percutaneous intervention for STEMI, the short- and long-term mortality rate was greater than fourfold higher compared with younger patients.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.014
  • Interactions Between Reciprocal ST-Segment Downsloping During ST-Elevated
           Myocardial Infarction and Global Cardiac Perfusion and Functional
    • Authors: Riccardo Liga; Enrico Orsini; Paolo Caravelli; Marco De Carlo; Anna Sonia Petronio; Mario Marzilli
      Pages: 1902 - 1908
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Riccardo Liga, Enrico Orsini, Paolo Caravelli, Marco De Carlo, Anna Sonia Petronio, Mario Marzilli
      Reciprocal ST-segment downsloping on electrocardiogram is a frequent finding during ST-elevated myocardial infarction (STEMI), but its etiology is still disputed. We sought to evaluate the relation between reciprocal ST-segment downsloping during STEMI and major cardiac perfusion and functional parameters. One hundred eighty-five patients with STEMI underwent emergency coronary angiography. The presence of reciprocal ST-segment downsloping was assessed. At coronary angiography, the corrected TIMI frame count (cTFC) was computed both on culprit and remote vessels and the occurrence of “no/slow reflow” phenomenon after percutaneous coronary intervention (PCI) identified. The left ventricular wall motion score index ratio (discharge/admission values) at echocardiography and the slope of high-sensitivity troponin elimination were computed as measures of effective myocardial reperfusion. Reciprocal ST-segment downsloping was revealed in 91 patients (49%). They presented higher cTFC values on remote vessels than patients without reciprocal electrocardiographic abnormalities (44 ± 18 vs 37 ± 15 cineframes × second−1, p = 0.004). The presence of remote ST-segment downsloping was also associated with a higher prevalence of “no/slow reflow” phenomenon (59% vs 40%, p = 0.013) as well as more abnormal values of wall motion score index ratio (p = 0.042) and high-sensitivity troponin slope (p = 0.012). At multivariate analyses, a higher cTFC on remote vessels predicted the occurrence of reciprocal ST-segment changes (p = 0.018) and the development of “no/slow reflow” phenomenon after PCI (p = 0.005). In conclusion, the presence of reciprocal ST-segment downsloping during STEMI clusters with significant perfusion and cardiac functional abnormalities, predicting the development of “no reflow” phenomenon after PCI.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.015
  • Prognostic Impact of Age and Hemoglobin in Acute ST-Segment Elevation
           Myocardial Infarction Treated With Reperfusion Therapy
    • Authors: Jesús Velásquez-Rodríguez; Felipe Diez-Delhoyo; María Jesús Valero-Masa; Lourdes Vicent; Carolina Devesa; Iago Sousa-Casasnovas; Miriam Juárez; Rocío Angulo-Llanos; Francisco Fernández-Avilés; Manuel Martínez-Sellés
      Pages: 1909 - 1916
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Jesús Velásquez-Rodríguez, Felipe Diez-Delhoyo, María Jesús Valero-Masa, Lourdes Vicent, Carolina Devesa, Iago Sousa-Casasnovas, Miriam Juárez, Rocío Angulo-Llanos, Francisco Fernández-Avilés, Manuel Martínez-Sellés
      Advanced age and low hemoglobin levels have been associated with a poor prognosis in ST-segment elevation myocardial infarction (STEMI). We studied 1,111 patients with STEMI who received reperfusion treatment (1,032 [92.9%] primary angioplasty and 79 [7.1%] fibrinolysis without rescue percutaneous coronary intervention). Mean age was 64.1 ± 14.0 years, and 23.2% were women. Patients in the last age quartile (>76 years) were more frequently women, presented more risk factors (except smoking), received thrombolysis less frequently, had less complete revascularization, and presented more complications and higher mortality. Hemoglobin level at admission was associated with age and ranged from 14.8 ± 1.5 g/dl in the first quartile to 13.2 ± 1.8 g/dl in the last, p <0.001. Multivariate analysis identified age as a predictor of in-hospital and long-term mortality (odds ratio 1.04, 95% confidence interval [CI] 1.00 to 1.07, hazard ratio 1.06, 95% CI 1.04 to 1.08). Hemoglobin levels were associated with better survival (odds ratio 0.8, 95% CI 0.6 to 0.9, hazard ratio 0.85, 95% CI 0.78 to 0.92). The other predictors of inhospital mortality were Killip class, chronic kidney disease, left ventricular ejection fraction, significant pericardial effusion, and ventricular arrhythmias. The association of hemoglobin with hospital mortality was seen in men and in women ≥65 years. In men ≥65 years, this association was also present in those with hemoglobin levels in the normal range. In conclusion, in patients with STEMI, hemoglobin is an independent predictor of inhospital and long-term mortality, especially in those aged ≥65 years. This association is also present in men ≥65 years with normal hemoglobin levels.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.018
  • Comparison of Outcomes and Prognosis of Patients With Versus Without Newly
           Diagnosed Diabetes Mellitus After Primary Percutaneous Coronary
           Intervention for ST-Elevation Myocardial Infarction (the HORIZONS-AMI
    • Authors: Konstanze Ertelt; Sorin J. Brener; Roxana Mehran; Ori Ben-Yehuda; Thomas McAndrew; Gregg W. Stone
      Pages: 1917 - 1923
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Konstanze Ertelt, Sorin J. Brener, Roxana Mehran, Ori Ben-Yehuda, Thomas McAndrew, Gregg W. Stone
      A history of diabetes mellitus (DM) is an independent predictor for adverse events in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Outcomes of patients with STEMI and newly diagnosed DM (NDM) are less well described. We used the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial database to identify the outcomes at 30 days and 3 years according to no, known, and NDM in patients with STEMI. In HORIZONS-AMI, 3,602 patients with STEMI were randomized to bivalirudin versus heparin and a glycoprotein IIb/IIIa inhibitor, and eligible patients were randomized again to a paclitaxel-eluting stent or a bare-metal stent. DM was defined as a history of hyperglycemia managed by insulin, oral hypoglycemic agents, or diet. NDM was defined as the absence of previous diagnosis or treatment for DM at baseline and its addition at discharge. DM was present in 593/3,599 patients (16.5%), and NDM was diagnosed in 130 cases (3.6%). Compared with nondiabetics, those with DM and NDM had higher 3-year rates of death (11.4% and 12.0% vs 5.6%, respectively, p <0.0001) and major adverse cardiac events (29.6% and 30.2% vs 19.9%, respectively, p <0.0001). There were no significant differences in adverse events between new and known diabetic patients. DM and NDM were independent predictors of 3-year mortality and 3-year major adverse cardiac events. In conclusion, patients with NDM have a similarly poor prognosis after primary percutaneous coronary intervention in STEMI as those with previously established DM.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.016
  • Thirty-Day Outcomes After Unrestricted Implantation of Bioresorbable
           Vascular Scaffold (from the Prospective RAI Registry)
    • Authors: Bernardo Cortese; Alfonso Ielasi; Elisabetta Moscarella; Bruno Loi; Giuseppe Tarantini; Francesco Pisano; Alessandro Durante; Giampaolo Pasquetto; Alessandro Colombo; Gabriele Tumminello; Luciano Moretti; Paolo Calabrò; Pietro Mazzarotto; Attilio Varricchio; Maurizio Tespili; Roberto A. Latini; Gianfranco Defilippi; Donatella Corrado; Giuseppe Steffenino
      Pages: 1924 - 1930
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Bernardo Cortese, Alfonso Ielasi, Elisabetta Moscarella, Bruno Loi, Giuseppe Tarantini, Francesco Pisano, Alessandro Durante, Giampaolo Pasquetto, Alessandro Colombo, Gabriele Tumminello, Luciano Moretti, Paolo Calabrò, Pietro Mazzarotto, Attilio Varricchio, Maurizio Tespili, Roberto A. Latini, Gianfranco Defilippi, Donatella Corrado, Giuseppe Steffenino
      The Absorb biovascular scaffold (BVS) is a bioresorbable, everolimus-eluting scaffold whose data on real-world patients with complex lesions are limited. Short-term follow-up from recent studies point to a higher rate of 30-day thrombosis than observed with drug-eluting stents. We aimed to understand the short-term safety and efficacy of BVS. Registro Absorb Italiano (RAI, is an Italian, prospective, multicenter registry not funded, whose aim is to investigate BVS performance through a 5-year follow-up of all consecutive patients who have undergone successful implantation of ≥1 BVS in different clinical/lesion subsets. Co-primary end points were target lesion revascularization and definite/probable thrombosis. Secondary end point was the occurrence of device-oriented cardiac events. The registry involved 23 centers, with patient enrollment from October 2012 to December 2015. We here report the 30-day outcomes of the whole population of the registry. We enrolled 1,505 consecutive patients, of which 82% were men and 22.4% diabetic. At presentation, 59.6% of the patients had an acute coronary syndrome, including 21% ST-elevation myocardial infarction. All lesions were pre-dilated and in 96.8% of the cases BVS was post-dilated. At 30 days, the co-primary study end point target lesion revascularization occurred in 0.6% of patients and definite/probable BVS thrombosis in 0.8%. There were 2 cases of cardiac and overall death (0.13%). Device-oriented cardiac events occurred in 1% of the patients. In conclusion, our data of consecutive patients suggest that current use of BVS in a wide spectrum of coronary narrowings and clinical settings is associated with good outcome at 30 days.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.017
  • Comparison of Outcomes in Men Versus Women After Percutaneous Coronary
           Intervention for Chronic Total Occlusion
    • Authors: Barbara Elisabeth Stähli; Cathérine Gebhard; Michael Gick; Miroslaw Ferenc; Kambis Mashayekhi; Heinz Joachim Buettner; Franz-Josef Neumann; Aurel Toma
      Pages: 1931 - 1936
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Barbara Elisabeth Stähli, Cathérine Gebhard, Michael Gick, Miroslaw Ferenc, Kambis Mashayekhi, Heinz Joachim Buettner, Franz-Josef Neumann, Aurel Toma
      Conflicting evidence exists on gender differences in outcomes after coronary stenting, and gender-based data in patients with chronic total occlusions (CTO) who underwent percutaneous coronary intervention (PCI) are scarce. Consecutive patients who underwent CTO PCI from January 2005 to December 2013 were included in the analysis and stratified according to gender. The primary outcome measure was all-cause mortality. Median follow-up was 2.6 years (interquartile range 1.1 to 3.1). Of 2002 patients, 332 (17%) were women. Procedural success was achieved in 82% and 83% of women and men (p = 0.31). All-cause mortality was 15% and 11% in women and men (log-rank p = 0.17) with an adjusted hazard ratio of 0.85 (95% confidence interval [CI] 0.61 to 1.17, p = 0.31). All-cause mortality was significantly reduced in patients with procedural success, both in women (12% vs 32%, adjusted hazard ratio 0.44, 95% CI 0.24 to 0.79, p = 0.006) and men (9% vs 21%, adjusted hazard ratio 0.64, 95% CI 0.47 to 0.88, p = 0.006), with similar mortality benefits associated with successful revascularization in both groups (interaction p = 0.35). In conclusion, recanalization of coronary arterial CTO is equally successful in both women and men.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.021
  • Patient Versus Physician Variation in Use of Transradial Percutaneous
           Coronary Intervention
    • Authors: Shariq Shamim; Fengming Tang; David Safley; Philip Jones; John A. Spertus; Dmitri Baklanov
      Pages: 1937 - 1941
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Shariq Shamim, Fengming Tang, David Safley, Philip Jones, John A. Spertus, Dmitri Baklanov
      The prevalence of radial access for transradial catheterization remains low in the United States, occurring in only 28% of cases in the National Cardiovascular Data Registry (NCDR) CathPCI. It is unknown whether the low adoption rate has been influenced by patient characteristics or is more operator dependent. In a 10-center study, we compared clinical and demographic characteristics among 323 radial and 1,506 femoral access percutaneous coronary intervention (PCIs) performed by 65 interventionists capable of radial PCI. We created a hierarchical logistic regression model to identify operator and patient characteristics associated with radial PCI and the median rate ratio to quantify the variation across operators. A subset was interviewed to assess health literacy and preferences in shared medical decision making. Radial access was used in 17.7% of patients. Patient factors associated with lower rate of radial PCI were previous PCI (33.4% vs 41.4%, p = 0.008), history of coronary artery bypass graft (8.4% vs 23.0%, p <0.001), and chronic total occlusion PCI (10.2% vs 17.9%, p <0.001). Operator characteristics associated with lower rate of radial PCI are being older, being longer in practice, lower number of publications, and Southern practice location. The range of radial use across operators was 1% to 99% and the median rate ratio was 1.97. Patients with radial access had lower health literacy, as assessed by the Rapid Estimate of Adult Literacy in Medicine Revised (REALM) score (6.6 ± 2.6 vs 7.1 ± 2.0, p = 0.03) but did not differ in their preferences for shared decision making. In conclusion, our study demonstrates a high degree of variability of radial access for PCI among different operators, with few differences in patient characteristics, suggesting that improvement efforts should focus on operators.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.020
  • Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary
           Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass
           Grafting in Left Main Coronary Artery Disease
    • Authors: Aakash Garg; Sunil V. Rao; Sahil Agrawal; Kleanthis Theodoropoulos; Marco Mennuni; Abhishek Sharma; Lohit Garg; Giuseppe Ferrante; Omar A. Meelu; Davit Sargsyan; Bernhard Reimers; Marc Cohen; John B. Kostis; Giulio G. Stefanini
      Pages: 1942 - 1948
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Aakash Garg, Sunil V. Rao, Sahil Agrawal, Kleanthis Theodoropoulos, Marco Mennuni, Abhishek Sharma, Lohit Garg, Giuseppe Ferrante, Omar A. Meelu, Davit Sargsyan, Bernhard Reimers, Marc Cohen, John B. Kostis, Giulio G. Stefanini
      Few randomized controlled trials (RCTs) and observational studies had shown acceptable short-term efficacy and safety of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) in selected patients with left main coronary artery disease (LMCAD). We aimed to evaluate long-term outcomes of PCI using DES compared with CABG in patients with LMCAD. On November 1, 2016, we searched available databases for published RCTs directly comparing DES PCI with CABG in patients with LMCAD. Odds ratios (ORs) were used as the metric of choice for treatment effects using a random-effects model. I-squared index was used to assess heterogeneity across trials. Prespecified end points were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, and repeat revascularization at maximal available follow-up. We identified 5 RCTs including a total of 4,595 patients, with a median follow-up of 60 months. The risk of all-cause mortality (OR 1.01; 95% confidence interval [CI] 0.76 to 1.34) and cardiovascular mortality (OR 1.02; 95% CI 0.73 to 1.42) were comparable between PCI with DES and CABG. Similarly, there were no statistically significant differences between PCI with DES and CABG for MI (OR 1.45; 95% CI 0.87 to 2.40) and stroke (OR 0.87; 95% CI 0.38 to 1.98). Conversely, repeat revascularization was significantly higher with PCI compared with CABG (OR 1.82; 95% CI 1.51 to 2.21). In conclusion, in patients with LMCAD, PCI with DES appears to be a viable alternative to CABG at long-term follow-up, with similar risks of ischemic adverse events (mortality, MI, and stroke) but a higher risk of repeat revascularization.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.019
  • Meta-analysis of Percutaneous Coronary Intervention Versus Coronary Artery
           Bypass Grafting in Left Main Coronary Artery Disease
    • Authors: Abdur R. Khan; Harsh Golwala; Avnish Tripathi; Haris Riaz; Arnav Kumar; Michael P. Flaherty; Deepak L. Bhatt
      Pages: 1949 - 1956
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Abdur R. Khan, Harsh Golwala, Avnish Tripathi, Haris Riaz, Arnav Kumar, Michael P. Flaherty, Deepak L. Bhatt
      Despite the increase in use of percutaneous coronary intervention (PCI) in left main coronary disease, its efficacy compared with coronary artery bypass grafting (CABG) is unclear. We performed a meta-analysis of randomized controlled trials to assess the optimal revascularization strategy. Our search yielded 8 studies reporting relevant outcomes that were pooled using the inverse variance method, and the hazard ratio (HR) was calculated. The primary outcome was all-cause mortality, myocardial infarction (MI), or stroke (major adverse cardiac events [MACE]), and the secondary outcome was death/MI/stroke/repeat revascularization (expanded MACE). Differences in outcomes classified by follow-up duration (early: 0 to 1 year; late: 3 to 5 years) or anatomical complexity of coronary artery disease (SYNTAX score) were investigated. Our results suggest no difference in either early or late MACE (early: HR 0.81; 95% confidence interval [CI] 0.63 to 1.05; late: HR 1.12; 95% CI 0.80 to 1.56) or expanded MACE (early: HR 1.03; 95% CI 0.69 to 1.52; late: HR 1.16; 95% CI 0.95 to 1.43) between the 2 groups. There was an increased risk of expanded MACE with a high SYNTAX score for PCI (HR 1.47; 95% CI 1.13 to 1.92) at late follow-up. There were comparable rates of all-cause mortality and nonprocedural MI between the 2 groups with increased rates of repeat revascularization with PCI throughout the follow-up and higher rates of stroke with coronary artery bypass grafting early in the follow-up period. In conclusion, our analysis suggests that CABG may be preferable in patients with left main disease and high SYNTAX scores, assuming they are at low surgical risk, and PCI may be an acceptable alternative in patients with low-intermediate SYNTAX scores.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.022
  • Long-Term Prognostic Value of Appropriate Myocardial Perfusion Imaging
    • Authors: Angela S. Koh; Weng Kit Lye; Shaw Yang Chia; Jennifer Salunat-Flores; Ling L. Sim; Felix Y.J. Keng; Ru San Tan; Terrance S.J. Chua
      Pages: 1957 - 1962
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Angela S. Koh, Weng Kit Lye, Shaw Yang Chia, Jennifer Salunat-Flores, Ling L. Sim, Felix Y.J. Keng, Ru San Tan, Terrance S.J. Chua
      Appropriate use criteria (AUC) for single-photon emission computed tomography myocardial perfusion images (SPECT-MPIs) were developed to address the growth of cardiac imaging studies. Long-term prognostic value of AUC in SPECT-MPI has not been tested in existing cohorts. We sought to determine the long-term prognostic value of MPI classified as appropriate. AUC was evaluated in a prospectively designed cohort of patients who underwent clinically indicated MPI. MPI studies were classified based on 2009 AUC for SPECT-MPI. Data regarding downstream coronary angiography (cath), revascularization and all-cause mortality, cardiac death, and nonfatal myocardial infarction (MI) were collected from national registries. Among n = 1,129 MPI scans that received an appropriate grading, 148 all-cause deaths, 109 MIs, 58 cardiac deaths, 152 caths, 113 revascularization procedures occurred over a mean follow-up period of 5.4 ± 1.2 years (0.9% cardiac death rate per year, 1.8% MI rate per year). Most of the scans were low-risk normal MPI scans (summed stress score ≤3; 74.1%). An abnormal scan was associated with higher rates of MI (19.5% vs 6.2%, hazard ratio 1.72, p = 0.017) and cardiac death (13.4% vs 2.3%, hazard ratio 2.12, p = 0.016). In conclusion, MPI scans classified as appropriate have long-term prognostic value, despite a high proportion of low-risk scans. This provides support for clinicians to consider the use of appropriate grading in addition to MPI scan results in patient management.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.026
  • Relation of Stress Hormones (Urinary Catecholamines/Cortisol) to Coronary
           Artery Calcium in Men Versus Women (from the Multi-Ethnic Study of
           Atherosclerosis [MESA])
    • Authors: Rachel T. Zipursky; Marcella Calfon Press; Preethi Srikanthan; Jeff Gornbein; Robyn McClelland; Karol Watson; Tamara B. Horwich
      Pages: 1963 - 1971
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Rachel T. Zipursky, Marcella Calfon Press, Preethi Srikanthan, Jeff Gornbein, Robyn McClelland, Karol Watson, Tamara B. Horwich
      The relation between high levels of psychosocial stress and the development of coronary artery disease (CAD) has been increasingly recognized, especially in women. We hypothesized that simple biomarkers of stress, urinary catecholamines/cortisol levels, are associated with more coronary artery calcium (CAC), an indicator of CAD, and that this relation is stronger in women compared with men. Using data from the Multi-Ethnic Study of Atherosclerosis Stress study, we examined the relation between urinary catecholamines/cortisol and CAC. The study cohort (n = 654) was 53% women, and 56.4% of the cohort had detectable CAC. Multivariable regression analyses assessed the relation between urinary catecholamines/cortisol and CAC (odds CAC >0 through logistic and ln CAC through Tobit model). There was an association between increased cortisol and increased CAC and an inverse association between dopamine and CAC. These relations were seen in men and women, with no difference between the genders. In conclusion, higher cortisol and lower dopamine levels are independently associated with higher CAC to a similar degree in men and women. These simple urinary biomarkers contribute to our understanding of the role of stress in the pathogenesis of CAD and may be incorporated into future strategies to prevent and treat CAD.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.025
  • Relation of Quantity of Subepicardial Adipose Tissue to Infarct Size in
           Patients With ST-Elevation Myocardial Infarction
    • Authors: Loïc Bière; Vianney Behaghel; Victor Mateus; Antonildes Assunção; Christoph Gräni; Kais Ouerghi; Sylvain Grall; Serge Willoteaux; Fabrice Prunier; Raymond Kwong; Alain Furber
      Pages: 1972 - 1978
      Abstract: Publication date: 15 June 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 12
      Author(s): Loïc Bière, Vianney Behaghel, Victor Mateus, Antonildes Assunção, Christoph Gräni, Kais Ouerghi, Sylvain Grall, Serge Willoteaux, Fabrice Prunier, Raymond Kwong, Alain Furber
      According to the so-called obesity paradox, obesity might present a protective role in patients with myocardial infarction. We aimed to assess the influence of the epicardial adipose tissue (EAT) volume on cardiac healing and remodeling in patients with acute ST-elevation myocardial infarction. We prospectively included 193 consecutive patients presenting a first STEMI without known coronary artery disease. Cardiac magnetic resonance imaging was performed at baseline and after a 3-month follow-up. EAT volume was computed, and the population was divided into quartiles: the highest quartile of EAT defining the high EAT group (h-EAT). h-EAT was associated with increased body mass index, higher rate of history of hypertension, and smaller infarct size at initial CMR assessment (18.3 ± 11.9% vs 23 ± 13.7% of total left ventricular [LV] mass, p = 0.041). Moreover, microvascular obstruction was less frequent in the h-EAT group (36.2% vs 59.3%, p = 0.006). There were no differences in LV ejection fraction (LVEF), LV volumes, systolic wall stress, coronary artery burden, and clinical events during the index hospitalization between the EAT groups at baseline and at follow-up. Linear regression analysis showed h-EAT to be associated with smaller infarct size at baseline (β coefficient = −3.25 [95% CI −5.89 to −0.61], p = 0.016). h-EAT also modified positively the effect of infarct size on LV remodeling, as assessed by the change in LVEF (p = 0.046). In conclusion, h-EAT was paradoxically related to smaller infarct size and acted as an effect modifier in the relation between the extent of infarct size and LVEF changes. Patients with higher extent of EAT presented better cardiac healing.

      PubDate: 2017-05-28T14:41:23Z
      DOI: 10.1016/j.amjcard.2017.03.024
  • Usefulness of Multiple Biomarkers for Predicting Incident Major Adverse
           Cardiac Events in Patients Who Underwent Diagnostic Coronary Angiography
           (from the Catheter Sampled Blood Archive in Cardiovascular Diseases
           [CASABLANCA] Study)
    • Authors: Cian McCarthy; Roland R.J. van Kimmenade Hanna Gaggin Mandy Simon
      Abstract: Publication date: 1 July 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 1
      Author(s): Cian P. McCarthy, Roland R.J. van Kimmenade, Hanna K. Gaggin, Mandy L. Simon, Nasrien E. Ibrahim, Parul Gandhi, Noreen Kelly, Shweta R. Motiwala, Arianna M. Belcher, Jamie Harisiades, Craig A. Magaret, Rhonda F. Rhyne, James L. Januzzi
      We sought to develop a multiple biomarker approach for prediction of incident major adverse cardiac events (MACE; composite of cardiovascular death, myocardial infarction, and stroke) in patients referred for coronary angiography. In a 649-participant training cohort, predictors of MACE within 1 year were identified using least-angle regression; over 50 clinical variables and 109 biomarkers were analyzed. Predictive models were generated using least absolute shrinkage and selection operator with logistic regression. A score derived from the final model was developed and evaluated with a 278-patient validation set during a median of 3.6 years follow-up. The scoring system consisted of N-terminal pro B-type natriuretic peptide (NT-proBNP), kidney injury molecule-1, osteopontin, and tissue inhibitor of metalloproteinase-1; no clinical variables were retained in the predictive model. In the validation cohort, each biomarker improved model discrimination or calibration for MACE; the final model had an area under the curve (AUC) of 0.79 (p <0.001), higher than AUC for clinical variables alone (0.75). In net reclassification improvement analyses, addition of other markers to NT-proBNP resulted in significant improvement (net reclassification improvement 0.45; p = 0.008). At the optimal score cutoff, we found 64% sensitivity, 76% specificity, 28% positive predictive value, and 93% negative predictive value for 1-year MACE. Time-to-first MACE was shorter in those with an elevated score (p <0.001); such risk extended to at least to 4 years. In conclusion, in a cohort of patients who underwent coronary angiography, we describe a novel multiple biomarker score for incident MACE within 1 year (NCT00842868).

      PubDate: 2017-06-12T12:41:24Z
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