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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 22, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 21, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 84, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 350, 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)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 240, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 135, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 6)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 41, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 50, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
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)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 61)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 353, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
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: 325, 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: 39, 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: 54, 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: 10, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
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)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 8, 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: 6)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 39, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 8, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, 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: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 237, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 57, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5)
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: 25, 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: 22, 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: 57, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 11)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 166, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 160, 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)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Cardiology
  [SJR: 2.063]   [H-I: 186]   [47 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]
  • Comparison of Left Ventricular Function and Myocardial Infarct Size
           Determined by 2-Dimensional Speckle Tracking Echocardiography in Patients
           With and Without Chronic Obstructive Pulmonary Disease After ST-Segment
           Elevation Myocardial Infarction
    • Authors: Laurien Goedemans; Rachid Abou; Georgette E. Hoogslag; Nina Ajmone Marsan; Christian Taube; Victoria Delgado; Jeroen J. Bax
      Pages: 734 - 739
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Laurien Goedemans, Rachid Abou, Georgette E. Hoogslag, Nina Ajmone Marsan, Christian Taube, Victoria Delgado, Jeroen J. Bax
      Patients with chronic obstructive pulmonary disease (COPD) have a high risk of mortality after acute ST-segment elevation myocardial infarction (STEMI). We compared STEMI patients with versus without COPD in terms of infarct size and left ventricular (LV) systolic function using advanced 2-dimensional speckle tracking echocardiography. Of 1,750 patients with STEMI (mean age 61 ± 12 years, 76% male), 133 (7.6%) had COPD. With transthoracic echocardiography, left ventricular ejection fraction (LVEF) and wall motion score index were measured. Infarct size was assessed using biomarkers (creatine kinase and troponin T). LV global longitudinal strain (GLS), reflecting active LV myocardial deformation, was measured with 2-dimensional speckle tracking echocardiography to estimate LV systolic function and infarct size. STEMI patients with COPD were significantly older, more likely to be former smokers, and had worse renal function compared with patients without COPD. There were no differences in infarct size based on peak levels of creatine kinase (1315 [613 to 2181] vs 1477 [682 to 3047] U/l, p = 0.106) and troponin T (3.3 [1.4 to 7.3] vs 3.9 [1.5 to 7.8] µg/l, p = 0.489). Left ventricular ejection fraction (46% vs 47%, p = 0.591) and wall motion score index (1.38 [1.25 to 1.66] vs 1.38 [1.19 to 1.69], p = 0.690) were comparable. In contrast, LV GLS was significantly more impaired in patients with COPD compared with patients without COPD (−13.9 ± 3.0% vs −14.7 ± 3.9%, p = 0.034). In conclusion, despite comparable myocardial infarct size and LV systolic function as assessed with biomarkers and conventional echocardiography, patients with COPD exhibit more impaired LV GLS on advanced echocardiography than patients without COPD, suggesting a greater functional impairment at an early stage after STEMI.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.06.006
  • Characteristics and Long-Term Prognosis of Patients ≤35 Years of Age
           with ST Segment Elevation Myocardial Infarction and “Normal or Near
           Normal” Coronary Arteries
    • Authors: Loukianos S. Rallidis; Argyri Gialeraki; Andreas S. Triantafyllis; Georgios Tsirebolos; Georgios Liakos; Paraskevi Moutsatsou; Efstathios Iliodromitis
      Pages: 740 - 746
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Loukianos S. Rallidis, Argyri Gialeraki, Andreas S. Triantafyllis, Georgios Tsirebolos, Georgios Liakos, Paraskevi Moutsatsou, Efstathios Iliodromitis
      There are scarce data regarding risk factors and prognosis of patients with premature ST segment elevation myocardial infarction (STEMI) and “normal or near normal” coronary arteries (N/NNCAs). We compared the characteristics and long-term prognosis of patients with premature STEMI and N/NNCAs with their counterparts with significant coronary artery disease (CAD). We recruited 330 patients who had STEMI ≤35 years of age and 167 age- and gender-matched controls. All patients underwent coronary angiography. Coronary arteries with no lesions or lesions causing <30% reduction in lumen diameter were defined as N/NNCAs, whereas narrowings causing ≥50% diameter reduction formed the significant CAD group. Lipid profile, homocysteine levels, and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism were determined. Sixty patients (18%) had N/NNCAs. Patients with N/NNCAs had lower low-density lipoprotein-cholesterol and higher high-density lipoprotein-cholesterol levels, higher homocysteine levels, and higher prevalence of MTHFR TT genotype (34.6 vs 18%, p = 0.008) compared with patients with significant CAD. After a median follow-up of 8 years, cardiovascular events occurred in 105 (36%) of 291 patients with available follow-up data. Significant CAD was associated with higher risk for recurrent cardiovascular events after adjustment for traditional risk factors (hazard ratio 2.095, 95% confidence interval 1.088 to 3.664, p = 0.022) and additional adjustment for the left ventricular ejection fraction, reperfusion therapy, and persistent smoking (hazard ratio 1.869, 95% confidence interval 1.007 to 3.468, p = 0.041). In conclusion, patients with premature STEMI and N/NNCAs have fewer lipid abnormalities, higher homocysteine levels and prevalence of MTHFR TT genotype, and better long-term prognosis compared with their counterparts with significant CAD.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.06.002
  • Usefulness of Elevated Levels of Growth Differentiation Factor-15 to
           Classify Patients With Acute Coronary Syndrome Having Percutaneous
           Coronary Intervention Who Would Benefit from High-Dose Statin Therapy
    • Authors: Ioannis Tentzeris; Serdar Farhan; Matthias Karl Freynhofer; Miklos Rohla; Rudolf Jarai; Birgit Vogel; Sabina Baumgartner-Parzer; Michael Nürnberg; Alexander Geppert; Emil Wessely; Johann Wojta; Kurt Huber; Alexandra Kautzky-Willer
      Pages: 747 - 752
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Ioannis Tentzeris, Serdar Farhan, Matthias Karl Freynhofer, Miklos Rohla, Rudolf Jarai, Birgit Vogel, Sabina Baumgartner-Parzer, Michael Nürnberg, Alexander Geppert, Emil Wessely, Johann Wojta, Kurt Huber, Alexandra Kautzky-Willer
      The aim of this study was to evaluate whether growth differentiation factor-15 (GDF-15) plasma concentration at the time of percutaneous coronary intervention (PCI) might help identify those patients with acute coronary syndrome (ACS), who benefit most from high-dose statin treatment. Two hundred eighty-four consecutive patients, who underwent percutaneous coronary intervention (PCI) for ACS, were included in a prospective registry. The combined end point at 3 months after PCI consisted of cardiovascular death, nonfatal myocardial infarction, and unstable angina. Patients were divided into those with elevated levels of GDF-15 and those with lower levels in relation to the median plasma concentration. Results were compared between patients receiving high-dose, highly efficient statins and patients receiving low-dose statins or no statins. The median GDF-15 plasma concentration was 3.31 ng/ml. One hundred six patients (74.6%) of the high GDF-15 group and 122 patients (85.9%) of the low GDF-15 group received high-dose statins. The combined end point was statistically lower in patients with high levels of GDF-15 treated with high-dose statins compared with patients treated with low-dose statins or without statin treatment (3.8% vs 22.2%, hazard ratio [HR] = 0.156; 95% confidence interval [CI], 0.047 to 0.519; p = 0.002). After propensity score adjustment, the results remained significant (adjusted HR for high-dose statins = 0.148; 95% CI, 0.045 to 0.494; p = 0.002). In contrast, in patients with lower levels of GDF-15, there was no significant reduction in combined end point rates associated with high-dose statin treatment (1.6% vs 5.0%, HR = 0.320; 95% CI 0.029 to 3.534; p = 0.353). In conclusion, increased GDF-15 plasma concentrations at the time of PCI and stent implantation might classify high-risk patients with ACS who benefit from high-dose, highly efficient statins.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.05.045
  • Impact of Cardiorespiratory Fitness and Risk of Systemic Hypertension in
           Nonobese Versus Obese Men Who Are Metabolically Healthy or Unhealthy
    • Authors: Sae Young Jae; Abraham Samuel Babu; Eun Sun Yoon; Sudhir Kurl; Jari A. Laukkanen; Yoon-Ho Choi; Barry A. Franklin
      Pages: 765 - 768
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Sae Young Jae, Abraham Samuel Babu, Eun Sun Yoon, Sudhir Kurl, Jari A. Laukkanen, Yoon-Ho Choi, Barry A. Franklin
      Few data are available regarding the influence of body phenotype on systemic hypertension (SH) and whether cardiorespiratory fitness (CRF) attenuates this relation. We tested the hypothesis that obesity phenotypes and CRF would predict incident hypertension, evaluating 3,800 Korean men who participated in 2 health examinations in1998 to 2009. All participants were normotensive at baseline and were divided into 4 groups based on body mass index using the Asia-Pacific descriptors for obesity and metabolic health status and the National Cholesterol Education Program's adult treatment panel III (ATP-III) criteria. A metabolically healthy obese (MHO) phenotype was defined as a body mass index of ≥25 kg/m2 with <2 metabolic abnormalities. CRF was directly measured by peak oxygen uptake, and the participants were divided into unfit and fit categories based on age-specific peak oxygen uptake percentiles. Compared with the metabolically healthy nonobese phenotype, MHO and metabolically unhealthy nonobese (MUNO) phenotypes were at increased risk of SH (relative risk [RR] = 1.47; 95% confidence interval [CI], 1.07 to 2.02 and 1.62, 1.21 to 2.16) after adjusting for potential confounders. Joint analysis showed that MHO or MUNO unfit men had 1.91 and 2.27 greater risk of incident SH, respectively. However, MHO fit men had no significant RR of incident SH (RR 1.37; 95% CI, 0.93 to 2.03), whereas MUNO fit men remained at increased risk (RR 1.48; 95% CI, 1.04 to 2.11) compared with their metabolically healthy nonobese fit counterparts. In conclusion, MHO and MUNO men were at increased risk of SH, but these risks were attenuated by fitness.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.05.054
  • Relation of Exercise Capacity to Risk of Development of Diabetes in
           Patients on Statin Therapy (the Henry Ford Exercise Testing Project)
    • Authors: Gabriel E. Shaya; Stephen P. Juraschek; David I. Feldman; Clinton A. Brawner; Jonathan K. Ehrman; Steven J. Keteyian; Mouaz H. Al-Mallah; Michael J. Blaha
      Pages: 769 - 773
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Gabriel E. Shaya, Stephen P. Juraschek, David I. Feldman, Clinton A. Brawner, Jonathan K. Ehrman, Steven J. Keteyian, Mouaz H. Al-Mallah, Michael J. Blaha
      High exercise capacity (EC) has been associated with a lower risk of incident diabetes, whereas statin therapy has been associated with a higher risk. We sought to investigate whether the association between EC and diabetes risk is modified by statin therapy. This retrospective cohort study included 47,337 patients without diabetes or coronary artery disease at baseline (age 53 ± 13 years, 48% women, 66% white) who underwent clinical treadmill stress testing within the Henry Ford Health System from January 1, 1991, to May 31, 2009. The patients were stratified by baseline statin use and estimated peak METs achieved during exercise testing. Hazard ratios for incident diabetes were calculated using Cox proportional hazards models adjusted for demographic characteristics, co-morbidities, pertinent medications, and stress test indication. We observed 6,921 new diabetes cases (14.6%) over a median follow-up period of 5.1 years (interquartile interval of 2.6 to 8.2 years). Compared with the statin group, the no-statin group achieved higher mean METs (8.9 ± 2.7 vs 9.6 ± 3.0, respectively; p <0.001). After adjustment for covariates, a higher EC was associated with a lower risk of incident diabetes, irrespective of statin use (p-interaction = 0.15). Each 1-MET increment was associated with an 8%, 8%, and 6% relative risk reduction in the total cohort, the no-statin, and the statin groups, respectively (95% confidence interval, 0.91 to 0.93, 0.91 to 0.93, and 0.91 to 0.96, respectively; p <0.001 for all). We conclude that a higher EC is associated with a lower risk of incident diabetes regardless of statin use.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.05.048
  • Meta-analysis of Placebo-Controlled Randomized Controlled Trials on the
           Prevalence of Statin Intolerance
    • Authors: Haris Riaz; Abdur Rahman Khan; Muhammad Shahzeb Khan; Karim Abdur Rehman; Shehab Ahmad Redha Alansari; Bashaer Gheyath; Sajjad Raza; Amr Barakat; Faraz Khan Luni; Haitham Ahmed; Richard A. Krasuski
      Pages: 774 - 781
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Haris Riaz, Abdur Rahman Khan, Muhammad Shahzeb Khan, Karim Abdur Rehman, Shehab Ahmad Redha Alansari, Bashaer Gheyath, Sajjad Raza, Amr Barakat, Faraz Khan Luni, Haitham Ahmed, Richard A. Krasuski
      The prevalence of intolerance varies widely. Stopping statin therapy is associated with worse outcomes in patients with cardiovascular disease. Despite extensive studies, the benefits and risks of statins continue to be debated by clinicians and the lay public. We searched the PubMed, Medline, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for all randomized controlled trials of statins compared with placebo. Studies were included if they had ≥1,000 participants, had patients who were followed up for ≥1 year, and reported rates of drug discontinuation. Studies were pooled as per the random effects model. A total of 22 studies (statins = 66,024, placebo = 63,656) met the inclusion criteria. The pooled analysis showed that, over a mean follow-up of 4.1 years, the rates of discontinuation were 13.3% (8,872 patients) for statin-treated patients and 13.9% (8,898 patients) for placebo-treated patients. The random effects model showed no significant difference between the placebo and statin arms (odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.93 to 1.06). The results were similar for both primary prevention (OR = 0.98, 95% CI = 0.92 to 1.05, p = 0.39) and secondary prevention (OR = 0.92, 95% CI = 0.83 to 1.05, p = 0.43) studies. The pooled analysis suggested that the rates of myopathy were also similar between the statins and placebos (OR = 1.2, 95% CI = 0.88 to 1.62, p = 0.25). In conclusion, this meta-analysis of >125,000 patients suggests that the rate of drug discontinuation and myopathy does not significantly differ between statin- and placebo-treated patients in randomized controlled trials. These findings are limited by the heterogeneity of results, the variable duration of follow-up, and the lower doses of statins compared with contemporary clinical practice.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.05.046
  • Usefulness of Atrial Premature Complexes on Routine Electrocardiogram to
           Determine the Risk of Atrial Fibrillation (from the REGARDS Study)
    • Authors: Wesley T. O'Neal; Hooman Kamel; Suzanne E. Judd; Monika M. Safford; Viola Vaccarino; Virginia J. Howard; George Howard; Elsayed Z. Soliman
      Pages: 782 - 785
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Wesley T. O'Neal, Hooman Kamel, Suzanne E. Judd, Monika M. Safford, Viola Vaccarino, Virginia J. Howard, George Howard, Elsayed Z. Soliman
      Atrial premature complexes (APCs) serve as acute triggers for atrial fibrillation (AF), but it is currently unknown whether the association between APCs and AF varies by race or sex. We examined the association between APCs and AF in 13,840 (mean age = 63 ± 8.4 years; 56% women; 37% black) participants from the REasons for Geographic And Racial Differences in Stroke study. APCs were detected on baseline electrocardiograms (2003 to 2007). Incident AF was identified by study-scheduled electrocardiograms and self-reported history at a follow-up examination. Logistic regression was used to compute odds ratios (OR) and 95% confidence intervals for the association between APCs and incident AF. A total of 950 participants (6.9%) had APCs at the baseline visit. After a median follow-up of 9.4 years, 1015 incident AF cases (7.3%) were detected. APCs were associated with an increased risk of AF (odds ratios = 1.92, 95% confidence intervals = 1.57, 2.35). The relation between APCs and AF did not vary by race (interaction p value = 0.56) or sex (interaction p value = 0.66). In conclusion, APCs detected on a routine electrocardiogram are associated with an increased risk of AF development, and this association does not vary by race or sex. The findings of this analysis suggest that the risk of AF associated with atrial ectopy does not account for the differential risk of AF that is observed in whites compared with blacks, and in men compared with women.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.06.007
  • Anticoagulation Control in Warfarin-Treated Patients Undergoing
           Cardioversion of Atrial Fibrillation (from the Edoxaban Versus
           Enoxaparin–Warfarin in Patients Undergoing Cardioversion of Atrial
           Fibrillation Trial)
    • Authors: Gregory Y.H. Lip; Naab Al-Saady; James Jin; Ming Sun; Michael Melino; Shannon M. Winters; Dmitry Zamoryakhin; Andreas Goette
      Pages: 792 - 796
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Gregory Y.H. Lip, Naab Al-Saady, James Jin, Ming Sun, Michael Melino, Shannon M. Winters, Dmitry Zamoryakhin, Andreas Goette
      In the Edoxaban Versus Enoxaparin–Warfarin in Patients Undergoing Cardioversion of Atrial Fibrillation (ENSURE-AF) study (NCT 02072434), edoxaban was compared with enoxaparin–warfarin in 2,199 patients undergoing electrical cardioversion of nonvalvular atrial fibrillation (AF). In this multicenter prospective randomized open blinded end-point trial, we analyzed patients randomized to enoxaparin–warfarin. We determined time to achieve therapeutic range (TtTR); time in therapeutic range (TiTR); their clinical determinants; relation to sex, age, medical history, treatment, tobacco use, race risk (SAMe-TT2R2) score; and impact on primary end points (composite of stroke, systemic embolic event[SEE], myocardial infarction [MI], and cardiovascular death [CVD] and composite of major + clinically relevant nonmajor bleeding). Among 1,104 patients randomized to enoxaparin–warfarin, 27% were naïve to oral anticoagulants. Mean age was 64.2 ± 11 years and mean congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65–74, female (CHA2DS2-VASc) score was 2.6. Mean TtTR was 7.7 days (median 7 days) and mean TiTR after reaching an international normalized ratio of 2.0 to 3.0 was 71%. In 695 patients who had an INR <2.0 before the first dose and who reached an INR ≥2.0, 436 had a SAMe-TT2R2 score ≤2 and 259 had a score >2. On multivariate regression, an independent predictor of extended TtTR was creatinine clearance (p = 0.02). TtTR was marginally related to stroke/SEE/MI/CVD (p = 0.06; odds ratio  0.23, 95% confidence interval 0.02 to 1.17) but not to any bleeding. Independent predictors of TiTR were previous vitamin K antagonist experience (p <0.01) and low hypertension, abnormal renal or liver function, stroke, bleeding, labile INRs, age >65, concomitant drugs or alcohol (HAS-BLED) score (p = 0.02). TiTR was related to any bleeding (p = 0.02; odds ratio  0.39, 95% confidence interval 0.16 to 0.88), but not stroke/SEE/MI/CVD. In this cohort of warfarin users with a high TiTR no difference was seen between TtTR and TiTR in relation to SAMe-TT2R2 score. In conclusion, even in this short-term study, TiTR was significantly related to bleeding events.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.06.005
  • A Clinical Score Model to Predict Lethal Events in Young Patients (≤19
           Years) With the Brugada Syndrome
    • Authors: M. Cecilia Gonzalez Corcia; Juan Sieira; Gudrun Pappaert; Carlo de Asmundis; Gian Battista Chierchia; Andrea Sarkozy; Pedro Brugada
      Pages: 797 - 802
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): M. Cecilia Gonzalez Corcia, Juan Sieira, Gudrun Pappaert, Carlo de Asmundis, Gian Battista Chierchia, Andrea Sarkozy, Pedro Brugada
      Risk stratification in Brugada syndrome in young patients remains challenging. We investigated the clinical characteristics, prognosis, and risk in young patients with the Brugada syndrome. We studied 95 patients with the Brugada syndrome aged ≤19 years. The median age at diagnosis was 12.9 years. The clinical presentation was sudden cardiac death in 7% and syncope in 21%. The remaining 72% were asymptomatic at diagnosis. Electrical abnormalities were present in 36%, including spontaneous type I electrocardiogram (12%), sinus node dysfunction (9%), atrioventricular block (17%), intraventricular conduction delay (16%), and atrial arrhythmias (8%). An electrophysiologic study was performed in 75%; ventricular arrhythmias were induced in 3%. An implantable cardioverter-defibrillator was placed in 25%. During a mean follow-up of 59 months, 9 patients presented with arrhythmic events (event rate: 1.9% per year). Variables significantly associated with events were: presentation with sudden cardiac death or syncope, spontaneous type I electrocardiogram, sinus node dysfunction and/or atrial tachycardia, conduction abnormality, and induction of ventricular arrhythmias during programmed ventricular stimulation. A model including the previous 4 main clinical variables (1, sudden cardiac death or syncope; 2, spontaneous type I electrocardiogram; 3, sinus node dysfunction and/or atrial tachycardia; and 4, conduction abnormality) had a high predictive power (C: 0.93) for the risk of lethal events. A score of ≥4 conferred a 5-year event probability of 30% that increased to 53% if the score was ≥6. In conclusion, our study validated a model to predict risk in young patients with the Brugada syndrome, which takes into account 4 clinical measures.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.05.056
  • Serial Heart Rates, Guideline-Directed Beta Blocker Use, and Outcomes in
           Patients With Chronic Heart Failure With Reduced Ejection Fraction
    • Authors: Nasrien E. Ibrahim; James L. Januzzi; Dustin J. Rabideau; Parul U. Gandhi; Hanna K. Gaggin
      Pages: 803 - 808
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Nasrien E. Ibrahim, James L. Januzzi, Dustin J. Rabideau, Parul U. Gandhi, Hanna K. Gaggin
      A single heart rate (HR) measurement may inform future prognosis in chronic heart failure with reduced ejection fraction (HFrEF). The importance of elevated HR across serial assessment is uncertain, particularly with well-applied guideline-directed medical therapy (GDMT) with beta blockers (BBs). In this post hoc analysis of 129 patients with chronic HFrEF in sinus rhythm, who had aggressive medication titration over 10.6 months, HR and BB use were assessed at each visit (average of 6 visits per patient). All-cause mortality was assessed. At baseline, 81 subjects (62.8%) had HR ≥70 beats/min; 40 subjects (31.0%) had high HR despite being on ≥50% of GDMT BB dose. At final visit, 30.4% of the subjects still had high HR despite achieving ≥50% target BB dose. There were no significant baseline differences in demographics or BB doses in patients with HR <70 vs HR ≥70 beats/min. In adjusted model in which HR was treated as time-dependent covariate, an increase in HR of 10  beats/min was associated with an increased hazard of all-cause mortality during follow-up (adjusted hazard ratio per 10 beats/min = 2.46; 95% confidence interval 1.46–4.16, p <0.001). In conclusion, in well-managed patients with HFrEF, high HR was frequent even after aggressive medication titration, and often despite being on at least 50% of GDMT BB dose. An increase in HR was associated with worse clinical outcomes ( NCT#00351390).

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.05.052
  • Long-Term Survival of Patients With Left Bundle Branch Block Who Are
           Hypo-Responders to Cardiac Resynchronization Therapy
    • Authors: Himabindu Vidula; Valentina Kutyifa; Scott McNitt; Ilan Goldenberg; Scott D. Solomon; Arthur J. Moss; Wojciech Zareba
      Pages: 825 - 830
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Himabindu Vidula, Valentina Kutyifa, Scott McNitt, Ilan Goldenberg, Scott D. Solomon, Arthur J. Moss, Wojciech Zareba
      Guidelines support cardiac resynchronization therapy with a defibrillator (CRT-D) in mild heart failure (HF) patients with left bundle branch block (LBBB). However, not all patients demonstrate echocardiographic or clinical response to CRT-D. We aimed to evaluate the long-term outcomes of echocardiographic hypo-responders and clinical hypo-responders to CRT-D with LBBB in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy. Five-hundred thirty-four patients with LBBB in the CRT-D arm were followed for 5.6 years (median). Clinical hypo-response was defined as HF event in the first year after CRT-D implantation. Echocardiographic hypo-response was defined as ≤35% reduction (median) in left ventricular end-systolic volume 1 year after CRT-D implantation without evidence of clinical hypo-response. Echocardiographic and clinical response was observed in 257 patients (48%). Two-hundred fifty patients (47%) were echocardiographic hypo-responders and 27 patients (5%) were clinical hypo-responders. Echocardiographic hypo-responders had increased risk of all-cause mortality compared with echocardiographic + clinical responders (hazard ratio [HR] 2.85, 95% confidence interval [CI]: 1.37 to 5.94, p = 0.005). Clinical hypo-responders had increased risk of mortality compared with echocardiographic + clinical responders (HR 7.49, 95% CI: 2.88 to 19.48, p <0.0001) and compared with echocardiographic hypo-responders (HR 2.63, 95% CI: 1.17 to 5.92, p = 0.020). In conclusion, during long-term follow-up, patients with mild HF and LBBB who have echocardiographic hypo-response to CRT, with or without clinical signs of worsening HF, have increased risk of mortality. This study emphasizes the prognostic significance of echocardiographic assessment of left ventricular volume after CRT implantation in LBBB patients with mild HF.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.06.001
  • Prognostic Usefulness of Cardiopulmonary Exercise Testing for Managing
           Patients With Severe Aortic Stenosis
    • Authors: Van D. Le; Gunnar V. Jensen; Lars Kjøller-Hansen
      Pages: 844 - 849
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Van D. Le, Gunnar V. Jensen, Lars Kjøller-Hansen
      The approach to managing asymptomatic or questionably symptomatic patients for aortic stenosis is difficult. We aimed to determine whether cardiopulmonary exercise testing (CPET) is prognostically useful in such patients. Patients judged asymptomatic or questionably symptomatic for aortic stenosis with aortic valve area index <0.6 cm2/m2 and left ventricular ejection fraction ≥0.50 were managed conservatively provided they had either (group 1) normal peak oxygen consumption and peak oxygen pulse (>83% and >95% of the predicted values, respectively) or (group 2) subnormal peak oxygen consumption or peak oxygen pulse but with CPET data pointing to pathologies other than hemodynamic compromise from aortic stenosis. Increase in systolic blood pressure <20 mm Hg, ST depression ≥2 mm, or symptoms during the exercise test were allowed. Unexpected events included cardiac death or hospitalization with heart failure in patients who had not been recommended valve replacement. The median age of the study population (n = 101) was 75 years (interquartile range 65 to 79 years), and 67% were judged questionably symptomatic. During a follow-up at 24 ± 6 months, the rate of unexpected cardiac death and unexpected hospitalization with heart failure was 0% and 6.0%, respectively. All-cause mortality was 4.0% compared with 8.0% in the age- and gender-matched population. For group 1, 26 of 70 (37.1%) succumbed to cardiac death, or were hospitalized because of heart failure, or underwent valve replacement, and for group 2 this was 12 of 31 (38.7%). In conclusion, if CPET does not indicate a significant hemodynamic compromise because of aortic stenosis, an initially conservative strategy results in a good prognosis and an acceptable event rate.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.05.047
  • Correlates and Significance of Elevation of Cardiac Biomarkers Elevation
           Following Transcatheter Aortic Valve Implantation
    • Authors: Edward Koifman; Hector M. Garcia-Garcia; M. Chadi Alraies; Kyle Buchanan; Alex Hideo-Kajita; Arie Steinvil; Toby Rogers; Itsik Ben-Dor; Augusto D. Pichard; Rebecca Torguson; Jiaxiang Gai; Lowell F. Satler; Ron Waksman
      Pages: 850 - 856
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Edward Koifman, Hector M. Garcia-Garcia, M. Chadi Alraies, Kyle Buchanan, Alex Hideo-Kajita, Arie Steinvil, Toby Rogers, Itsik Ben-Dor, Augusto D. Pichard, Rebecca Torguson, Jiaxiang Gai, Lowell F. Satler, Ron Waksman
      The Valve Academic Research Consortium-2 recommends cutoff levels of cardiac troponin of >15 and of creatine kinase MB (CKMB) of >5 of the upper limit of normal (ULN) as markers of periprocedural myocardial infarction. We aimed to evaluate the correlation of these cutoffs with the survival rate in patients who underwent transcatheter aortic valve implantation (TAVI) through the femoral access. Patients who underwent TAVI were classified according to the postprocedural peak marker level of >15 and >5 ULN for troponin and CKMB, respectively. Baseline characteristics were compared, and the impact of these markers on a 1-year survival rate was assessed. Of 474 patients who underwent TAVI, 77% had a peak troponin level of >15 ULN, whereas only 8% had a CKMB level of >5 ULN. Factors associated with troponin and CKMB elevations differed except for the preserved ejection fraction, which was associated with the elevation of both markers. Patients with troponin elevations had higher rates of postprocedure conduction defects (p = 0.001), whereas patients with CKMB had higher rates of bleeding (p <0.001) and stroke (p = 0.03). A troponin elevation of >15 ULN had no impact on the 1-year survival rate (p = 0.52); however, patients with a CKMB level of >5 ULN had increased mortality (p = 0.008), which remained significant in the multivariate analysis (hazard ratio = 2.02, p = 0.035). Troponin level and CKMB had a good correlation (r = 0.7), and a troponin level of 75 ULN was linked with a CKMB level of >5 ULN. In conclusion, cardiac markers differ in their peak levels above the ULN after TAVI. Careful attention should be taken for patients who underwent TAVI with a CKMB level of >5 ULN, as this is the only biomarker independently associated with survival rate.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.05.059
  • Postprocedural Changes of Tricuspid Regurgitation After MitraClip Therapy
           for Mitral Regurgitation
    • Authors: Kentaro Toyama; Kengo Ayabe; Saibal Kar; Shunsuke Kubo; Toshinori Minamishima; Florian Rader; Takahiro Shiota; Toshihiko Nishioka; Robert J. Siegel
      Pages: 857 - 861
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Kentaro Toyama, Kengo Ayabe, Saibal Kar, Shunsuke Kubo, Toshinori Minamishima, Florian Rader, Takahiro Shiota, Toshihiko Nishioka, Robert J. Siegel
      The effect of percutaneous mitral valve repair using the MitraClip system on tricuspid regurgitation (TR) has not been well investigated. We retrospectively analyzed 102 consecutive patients who underwent the successful MitraClip procedure, and who also had a preprocedural and 1-year follow-up transthoracic echocardiography. TR severity was graded by standard guideline-recommended criteria. At 1 year after the MitraClip procedure, the degree of TR regressed (at least 1 grade) in 23% of the patients, was unchanged in 62% of the patients, and progressed in 16% of the patients. Compared with patients in the other groups, the patients with TR regression had a greater severity of TR at baseline. The TR regression group showed a significant reduction in the systolic pulmonary artery pressure (sPAP) (49 ± 13 to 37 ± 11 mm Hg, p <0.05), a right-sided cardiac reverse remodeling (right ventricular diameter: 41 ± 7 to 39 ± 7 mm, tricuspid annular diameter: 48 ± 8 to 46 ± 9 mm, both p <0.05), and an increase in the right ventricular fractional area change (38 ± 7 to 40 ± 7%, p <0.05). In the multivariate analysis, the decrease in sPAP was the only independent parameter change associated with TR regression. In conclusion, TR regression was observed in 23% of the patients after the successful MitraClip procedures, and favorable echocardiographic parameter changes were detected in this group. Only a reduction in sPAP was independently associated with TR regression.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.05.044
  • Risk Factors for Mortality Among Individuals With Peripheral Arterial
    • Authors: Stephen M. Amrock; Cherrie Z. Abraham; Enjae Jung; Pamela B. Morris; Michael D. Shapiro
      Pages: 862 - 867
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Stephen M. Amrock, Cherrie Z. Abraham, Enjae Jung, Pamela B. Morris, Michael D. Shapiro
      Morbidity and mortality from peripheral arterial disease (PAD) continues to increase. Traditional cardiovascular risk factors are implicated in the development of PAD, yet the extent to which those risk factors correlate with mortality in such patients remains insufficiently assessed. Using data from the 1999 to 2004 National Health and Nutrition Examination Survey, Cox proportional hazards models were used to examine the association of cardiovascular risk factors and all-cause and cardiovascular mortality. A total of 647 individuals ≥40 years old with PAD (i.e., ankle-brachial index [ABI] ≤ 0.9) were followed for a median of 7.8 years. There were 336 deaths, of which 98 were attributable to cardiovascular disease. Compared with never smokers, current (hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.62 to 3.71) and former (HR 1.62, 95% CI 1.14 to 2.29) smokers with PAD had higher rates of death. Moderate or vigorous physical activity of ≥10 minutes monthly was associated with lower death rates (HR 0.63, 95% CI 0.44 to 0.91). Also associated with increased rates of cardiovascular death were an ABI of <0.5 (HR 2.56, 95% CI 1.28 to 5.15, compared with those with an ABI of 0.7 to 0.9) and diabetes mellitus (HR 2.50, 95% CI 1.33 to 4.73). Neither C-reactive protein nor body mass index was associated with mortality. In conclusion, tobacco use increased the risk of all-cause and cardiovascular death, whereas physical activity was associated with a decreased mortality risk. A low ABI and diabetes were also predictive of cardiovascular death.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.05.057
  • Load Adaptability in Patients With Pulmonary Arterial Hypertension
    • Authors: Myriam Amsallem; David Boulate; Marie Aymami; Julien Guihaire; Mona Selej; Jennie Huo; Andre Y. Denault; Michael V. McConnell; Ingela Schnittger; Elie Fadel; Olaf Mercier; Roham T. Zamanian; Francois Haddad
      Pages: 874 - 882
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Myriam Amsallem, David Boulate, Marie Aymami, Julien Guihaire, Mona Selej, Jennie Huo, Andre Y. Denault, Michael V. McConnell, Ingela Schnittger, Elie Fadel, Olaf Mercier, Roham T. Zamanian, Francois Haddad
      Right ventricular (RV) adaptation to pressure overload is a major prognostic factor in patients with pulmonary arterial hypertension (PAH). The objectives were first to define the relation between RV adaptation and load using allometric modeling, then to compare the prognostic value of different indices of load adaptability in PAH. Both a derivation (n = 85) and a validation cohort (n = 200) were included. Load adaptability was assessed using 3 approaches: (1) surrogates of ventriculo-arterial coupling (e.g., RV area change/end-systolic area), (2) simple ratio of function and load (e.g., tricuspid annular plane systolic excursion/right ventricular systolic pressure), and (3) indices assessing the proportionality of adaptation using allometric pressure-function or size modeling. Proportional hazard modeling was used to compare the hazard ratio for the outcome of death or lung transplantation. The mean age of the derivation cohort was 44 ± 11 years, with 80% female and 74% in New York Heart Association class III or IV. Mean pulmonary vascular resistance index (PVRI) was 24 ± 11 with a wide distribution (1.6 to 57.5 WU/m2). Allometric relations were observed between PVRI and RV fractional area change (R2 = 0.53, p < 0.001) and RV end-systolic area indexed to body surface area right ventricular end-systolic area index (RVESAI) (R2 = 0.29, p < 0.001), allowing the derivation of simple ratiometric load-specific indices of RV adaptation. In right heart parameters, RVESAI was the strongest predictor of outcomes (hazard ratio per SD = 1.93, 95% confidence interval 1.37 to 2.75, p < 0.001). Although RVESAI/PVRI0.35 provided small incremental discrimination on multivariate modeling, none of the load-adaptability indices provided stronger discrimination of outcome than simple RV adaptation metrics in either the derivation or the validation cohort. In conclusion, allometric modeling enables quantification of the proportionality of RV load adaptation but offers small incremental prognostic value to RV end-systolic dimension in PAH.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.05.053
  • Comparison of Outcomes of Pericardiocentesis Versus Surgical Pericardial
           Window in Patients Requiring Drainage of Pericardial Effusions
    • Authors: Samuel E. Horr; Amgad Mentias; Penny L. Houghtaling; Andrew J. Toth; Eugene H. Blackstone; Douglas R. Johnston; Allan L. Klein
      Pages: 883 - 890
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Samuel E. Horr, Amgad Mentias, Penny L. Houghtaling, Andrew J. Toth, Eugene H. Blackstone, Douglas R. Johnston, Allan L. Klein
      Comparative outcomes of patients undergoing pericardiocentesis or pericardial window are limited. Development of pericardial effusion after cardiac surgery is common but no data exist to guide best management. Procedural billing codes and Cleveland Clinic surgical registries were used to identify 1,281 patients who underwent either pericardiocentesis or surgical pericardial window between January 2000 and December 2012. The 656 patients undergoing an intervention for a pericardial effusion secondary to cardiac surgery were also compared. Propensity scoring was used to identify well-matched patients in each group. In the overall cohort, in-hospital mortality was similar between the group undergoing pericardiocentesis and surgical drainage (5.3% vs 4.4%, p = 0.49). Similar outcomes were found in the propensity-matched group (4.9% vs 6.1%, p = 0.55). Re-accumulation was more common after pericardiocentesis (24% vs 10%, p <0.0001) and remained in the matched cohorts (23% vs 9%, p <0.0001). The secondary outcome of hemodynamic instability after the procedure was more common in the pericardial window group in both the unmatched (5.2% vs 2.9%, p = 0.036) and matched cohorts (6.1% vs 2.0%, p = 0.022). In the subgroup of patients with a pericardial effusion secondary to cardiac surgery, there was a lower mortality after pericardiocentesis in the unmatched group (1.5% vs 4.6%, p = 0.024); however, after adjustment, this difference in mortality was no longer present (2.6% vs 4.5%, p = 0.36). In conclusion, both pericardiocentesis and surgical pericardial window are safe and effective treatment strategies for the patient with a pericardial effusion. In our study there were no significant differences in mortality in patients undergoing either procedure. Observed differences in outcomes with regard to recurrence rates, hemodynamic instability, and in those with postcardiac surgery effusions may help to guide the clinician in management of the patient requiring therapeutic or diagnostic drainage of a pericardial effusion.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.06.003
  • Prolongation of the QT Interval and Myocardial Ischemia Are More Pieces of
           the “Metabolically Unhealthy Obesity” Puzzle
    • Authors: Andrea De Lorenzo
      First page: 891
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Andrea De Lorenzo

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.06.008
  • Ischemic or Nonischemic Functional Mitral Regurgitation and Outcomes in
           Patients With Acute Decompensated Heart Failure With Preserved or Reduced
           Ejection Fraction
    • Authors: Katsuya Kajimoto; Yuichiro Minami; Naoki Sato; Shigeru Otsubo; Hiroshi Kasanuki
      Pages: 1623 - 1630
      Abstract: Publication date: 1 September 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 5
      Author(s): Katsuya Kajimoto, Yuichiro Minami, Shigeru Otsubo, Naoki Sato
      The aim of this study was to evaluate the association of functional mitral regurgitation (FMR), preserved or reduced ejection fraction (EF), and ischemic or nonischemic origin with outcomes in patients discharged alive after hospitalization for acute decompensated heart failure (HF). Of the 4,842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 3,357 patients were evaluated to assess the association of FMR, preserved or reduced EF, and ischemic or nonischemic origin with the primary end point (all-cause death and readmission for HF after discharge). At the time of discharge, FMR was assessed semiquantitatively (classified as none, mild, or moderate to severe) by color Doppler analysis of the regurgitant jet area. According to multivariable analysis, in the ischemic group, either mild or moderate to severe FMR in patients with a preserved EF had a significantly higher risk of the primary end point than patients without FMR (hazard ratio [HR] 1.60; 95% confidence interval [CI] 1.12 to 2.29; p = 0.010 and HR 1.98; 95% CI 1.30 to 3.01; p = 0.001, respectively). In patients with reduced EF with an ischemic origin, only moderate to severe FMR was associated with a significantly higher risk of the primary end point (HR 1.67; 95% CI 1.11 to 2.50; p = 0.014). In the nonischemic group, there was no significant association between FMR and the primary end point in patients with either a preserved or reduced EF. In conclusion, among patients with acute decompensated HF with a preserved or reduced EF, the association of FMR with adverse outcomes may differ between patients who had an ischemic or nonischemic origin of HF.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.02.012
  • Painless Mini-Wellens Sign 5 Minutes after Exercise in a Man with
           Previously Undiagnosed Total Occlusion of the Left Anterior Descending and
           Right Coronary Arteries
    • Authors: Mazen M. Kawji; David Luke Glancy
      Abstract: Publication date: Available online 5 September 2017
      Source:The American Journal of Cardiology
      Author(s): Mazen M. Kawji, David Luke Glancy
      A 60-year-old man with no coronary artery history and a normal resting electrocardiogram came to the hospital with his second stroke and underwent a treadmill exercise test before carotid endarterectomy. He had no chest pain and stopped because of leg pain. Five minutes after exercise he developed terminal T-wave inversion in leads V3 and V4 that lasted 7 minutes. The T-wave pattern resembled the Wellens pattern that has usually been seen after intense preinfarction rest pain and has usually lasted hours, days, or even weeks. Coronary arteriography showed complete occlusion of the left anterior descending and right coronary arteries.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.032
  • Effect of Hemodialysis on Levels of High-Sensitivity Cardiac Troponin T
    • Authors: Michael Chen; Howard Gerson; Shaun Eintracht; Sharon J. Nessim; Elizabeth MacNamara
      Abstract: Publication date: Available online 4 September 2017
      Source:The American Journal of Cardiology
      Author(s): Michael Chen, Howard Gerson, Shaun Eintracht, Sharon J. Nessim, Elizabeth MacNamara
      Cardiac troponin (cTn) is essential for the diagnosis of an acute coronary syndrome (ACS). However, in end-stage renal disease (ESRD) baseline cTn levels are often elevated, and it is unknown whether the hemodialysis (HD) procedure affects cTn levels. This leaves clinicians unsure of how to interpret cTn in HD patients with cardiac ischemia. We therefore sought to determine if plasma levels of high-sensitivity cardiac troponin T (hs-cTnT) vary during or after HD treatment. We prospectively enrolled 10 chronic HD patients who were admitted to our institution. All participants were receiving thrice weekly HD prior to admission and were medically stable. Those admitted for ACS or to critical care units were excluded. Baseline hs-cTnT was measured immediately prior to HD. For the subsequent 6 hours, hs-cTnT was measured every 2 hours and every 3 hours thereafter for a total collection period of 24 hours. A significant decline in mean hs-cTnT was noted with HD. During HD (2 hours post HD initiation), hs-cTnT decreased 10.7% (Confidence Interval 5% to 17%). Immediately following HD (4 hours post HD initiation), a decline of 12% (Confidence Interval 5% to 19%) was observed. Thereafter hs-cTnT began to rise. Hs-cTnT levels returned to baseline by 11 hours after HD completion, and remained stable for the reminder of the study. In conclusion, HD induces a short-lived negative bias in hs-cTnT. When measured for investigation of ACS, hs-cTnT concentration should be interpreted with respect to time of dialysis and specimen collection.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.026
  • Correlation of Fractional Flow Reserve with Ischemic Burden Measured by
           Cardiovascular Magnetic Resonance Perfusion Imaging
    • Authors: Shazia T. Hussain; Matthias Paul; Geraint Morton; Andreas Schuster; Amedeo Chiribiri; Divaka Perera; Eike Nagel
      Abstract: Publication date: Available online 4 September 2017
      Source:The American Journal of Cardiology
      Author(s): Shazia T. Hussain, Matthias Paul, Geraint Morton, Andreas Schuster, Amedeo Chiribiri, Divaka Perera, Eike Nagel
      Cardiovascular Magnetic Resonance (CMR) perfusion imaging and Fractional Flow Reserve (FFR) assess myocardial ischemia. FFR measures the pressure loss across a stenosis determining hemodynamic significance but does not assess the area subtended by the stenotic vessel. CMR perfusion imaging measures the extent of myocardial blood flow reduction (= ischemic burden). Both techniques allow for continuous rather than categorical evaluation but their relationship is poorly understood. This study investigates the relationship between the FFR value and the extent of myocardial ischemia. 49 patients with angina underwent CMR perfusion imaging. FFR was measured in vessels with a visual diameter stenosis >40%. The extent of ischemia for each coronary artery was measured by delineating the perfusion defect on the CMR images and expressing as a percentage of the LV myocardium. The correlation between the extent of ischemia measured by CMR and FFR was good (r = -0.85, p<0.0005). The mean FFR value was 0.67 ± 0.17 and the mean perfusion defect was 8.9 ± 9.3%. An FFR value of ≥0.75 was not associated with ischemia on CMR. The maximum amount of ischemia (23.0±1.5%) was found at FFR values between 0.4 - 0.5. In patients with one vessel disease (49%) the mean ischemic burden was 15.3±8.3%. In patients with 2 vessel disease (18%) the mean ischemic burden was 26.0±12%. Reproducibility for measurement of ischemic burden was very good with a Kappa coefficient (k=0.826, p=0.048). In conclusion, there is good correlation between the FFR value and the amount of myocardial ischemia in the subtended myocardium.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.002
  • Predictors of 1-Year Mortality after Transcatheter Aortic Valve
    • Authors: Amos Levi; Pablo Codner; Amer Masalha; Giuseppe Gargiulo; Fabien Praz; Kentaro Hayashida; Yusuke Watanabe; Darren Mylotte; Nicolas Debry; Marco Barbanti; Thierry Lefèvre; Thomas Modine; Johan Bosmans; Stephan Windecker; Israel Barbash; Jan-Malte Sinning; Georg Nickenig; Alon Barsheshet; Ran Kornowski
      Abstract: Publication date: Available online 4 September 2017
      Source:The American Journal of Cardiology
      Author(s): Amos Levi, Pablo Codner, Amer Masalha, Giuseppe Gargiulo, Fabien Praz, Kentaro Hayashida, Yusuke Watanabe, Darren Mylotte, Nicolas Debry, Marco Barbanti, Thierry Lefèvre, Thomas Modine, Johan Bosmans, Stephan Windecker, Israel Barbash, Jan-Malte Sinning, Georg Nickenig, Alon Barsheshet, Ran Kornowski
      Advanced chronic kidney disease (CKD) is an independent predictor of mortality in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). We aimed to identify predictors of 1-year mortality in post-TAVI patients stratified by the presence or absence of advanced CKD (defined as eGFR ≤30 ml/min/1.73m2 or permanent renal replacement therapy). Patients (n=1204) from 10 centers in Europe, Japan and Israel were included: 464 with and 740 without advanced CKD. Advanced CKD was associated with a 2-fold increase in the adjusted risk of 1-year all-cause death (p<0,001), and a 1.9-fold increase in cardiovascular death (p=0.016). Interaction-term analysis was utilized to identify and compare independent predictors of 1-year mortality in both groups. Impaired Left Ventricular Ejection Fraction (LVEF) and poor functional class (FC) were predictive of death in the advanced CKD group (OR 2.27, p=0.002 and OR 3.87, p=0.003, respectively) but not in patients without advanced CKD (p for interaction = 0.035 and 0.039, respectively), whereas bleeding was a predictor of mortality in the non-advanced CKD group (OR 3.2, p=0.005) but not in advanced CKD (p for interaction = 0.006). Atrial fibrillation was associated with a 2.2-fold increase (p=0.032) in the risk of cardiovascular death in the advanced CKD group but not in the absence of advanced CKD (p for interaction = 0.022). In conclusion, the coexistence of advanced CKD and either reduced LVEF or poor FC has an incremental effect on the risk of death after TAVI. In contrast, bleeding had a greater effect on risk of death in patients without advanced CKD.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.020
  • Impact of Tachyarrhythmia Detection Rate and Time From Detection to Shock
           on Outcomes in Nationwide U.S. Practice
    • Authors: Jonathan P. Piccini; Prashanthan Sanders; Riddhi Shah; Greg Roberts; Edward Karst; Mintu P. Turakhia
      Abstract: Publication date: Available online 1 September 2017
      Source:The American Journal of Cardiology
      Author(s): Jonathan P. Piccini, Prashanthan Sanders, Riddhi Shah, Greg Roberts, Edward Karst, Mintu P. Turakhia
      Although higher detection rates and delayed detection improve survival in ICD clinical trials, their effectiveness in clinical practice has limited validation. In order to evaluate the effectiveness of programming strategies for reducing shocks and mortality we conducted a nationwide assessment of ICD/CRT-D patients with linked remote monitoring data. We categorized patients based upon the presence or absence of high rate detection and delayed detection: higher rate delayed detection (HRDD), higher rate early detection (HRED), lower rate delayed detection (LRDD), and lower rate early detection (LRED). Cox-regression was used to compare mortality and shock-free survival. There were 64,769 patients (age 68±12 years; 27% female; 46% CRT-D; follow-up 1.7±1.1 years). In the first year, 13% of HRDD, 14% of HRED, 18% of LRDD, and 20% in the LRED group experienced a shock. After adjustment, HRDD was associated with lower risk of shock than HRED (HR 0.93 [95% CI 0.89-0.98], p=0.002), LRDD (HR 0.63 [95% CI 0.60-0.66], p<0.001), and LRED (HR 0.58 [95% CI 0.55-0.61], p<0.001). HRDD was also associated with lower risk of mortality than HRED (adjusted HR 0.80 [95% CI 0.75-0.86], p<0.001), LRDD (HR 0.76 [95% CI 0.70-0.83], p<0.001), and LRED (HR 0.68 [95% CI 0.62-0.73], p<0.001). Similar results were observed in patients with or without a shock in the first 6 months after implant. In conclusion, rate programming is associated with lower risk of shocks or death compared with delayed detection. Optimal outcomes are observed in patients programmed with both high rate and delayed detection.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.07.015
  • Frequency of Cholesterol Crystals in Culprit Coronary Artery Aspirate
           During Acute Myocardial Infarction and Their Relation to Inflammation and
           Myocardial Injury
    • Authors: George S. Abela; Jagadeesh K. Kalavakunta; Abed Janoudi; Dale Leffler; Gaurav Dhar; Negar Salehi; Joel Cohn; Ibrahim Shah; Milind Karve; Veera Pavan K. Kotaru; Vishal Gupta; Shukri David; Keerthy K. Narisetty; Michael Rich; Abigail Vanderberg; Dorothy R. Pathak; Fadi E. Shamoun
      Abstract: Publication date: Available online 31 August 2017
      Source:The American Journal of Cardiology
      Author(s): George S. Abela, Jagadeesh K. Kalavakunta, Abed Janoudi, Dale Leffler, Gaurav Dhar, Negar Salehi, Joel Cohn, Ibrahim Shah, Milind Karve, Veera Pavan K. Kotaru, Vishal Gupta, Shukri David, Keerthy K. Narisetty, Michael Rich, Abigail Vanderberg, Dorothy R. Pathak, Fadi E. Shamoun
      Cholesterol crystals (CCs) have been associated with plaque rupture through mechanical injury and inflammation. This study evaluated the presence of CCs during acute myocardial infarction (AMI) and associated myocardial injury, inflammation, and arterial blood flow before and after percutaneous coronary intervention. Patients presenting with AMI (n = 286) had aspiration of culprit coronary artery obstruction. Aspirates were evaluated for crystal content, size, composition, and morphology by scanning electron microscopy, crystallography, and infrared spectroscopy. These were correlated with inflammatory biomarkers, cardiac enzymes, % coronary stenosis, and Thrombolysis in Myocardial Infarction (TIMI) blush and flow grades. Crystals were detected in 254 patients (89%) and confirmed to be cholesterol by spectroscopy. Of 286 patients 240 (84%) had CCs compacted into clusters that were large enough to be measured and analyzed. Moderate to extensive CC content was present in 172 cases (60%). Totally occluded arteries had significantly larger CC clusters than partially occluded arteries (p <0.05). Patients with CC cluster area >12,000 µm2 had significantly elevated interleukin-1 beta (IL-1β) levels (p <0.01), were less likely to have TIMI blush grade of 3 (p <0.01), and more likely to have TIMI flow grade of 1 (p <0.01). Patients with recurrent AMI had smaller CC cluster area (p <0.04), lower troponin (p <0.02), and IL-1β levels (p <0.04). Women had smaller CC clusters (p <0.04). Macrophages in the aspirates were found to be attached to CCs. Coronary artery aspirates had extensive deposits of CCs during AMI. In conclusion, presence of large CC clusters was associated with increased inflammation (IL-1β), increased arterial narrowing, and diminished reflow following percutaneous coronary intervention.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.07.075
  • Predictors of Prognosis in Light-Chain Amyloidosis and Chronological
           Changes in Cardiac Morphology and Function
    • Authors: Masashi Amano; Chisato Izumi; Shunsuke Nishimura; Maiko Kuroda; Jiro Sakamoto; Yodo Tamaki; Soichiro Enomoto; Makoto Miyake; Toshihiro Tamura; Hirokazu Kondo; Yoshihisa Nakagawa
      Abstract: Publication date: Available online 31 August 2017
      Source:The American Journal of Cardiology
      Author(s): Masashi Amano, Chisato Izumi, Shunsuke Nishimura, Maiko Kuroda, Jiro Sakamoto, Yodo Tamaki, Soichiro Enomoto, Makoto Miyake, Toshihiro Tamura, Hirokazu Kondo, Yoshihisa Nakagawa
      Immune light-chain (AL) amyloidosis with cardiac involvement is associated with a high mortality despite improved therapeutic regimens, but there are few reports on prognostic predictors and chronological changes in cardiac morphology and function. Prognosis and its predictors were evaluated in 36 consecutive patients with cardiac AL amyloidosis. Chronological changes in cardiac morphology and function were also evaluated. Median follow-up period was 0.95 years. Median survival time and 3-year death-free rate after diagnosis in all-cause and cardiac death were 0.85 and 1.06 years and 26 and 36%, respectively. Differences in median survival time due to left ventricular (LV) wall thickness at diagnosis were not evident. Being female and diastolic wall strain (DWS), as a measure of diastolic stiffness, were independent predictors of all-cause death in multivariable analysis. ROC analysis revealed that a DWS cutoff value of 0.189 had a sensitivity of 78% and a specificity of 72% for predicting all-cause death within 1 year after diagnosis (AUC=0.726). LV size and stroke volume decreased and DWS worsened during the short-term follow-up period in patients who died within 1 year compared with patients who were alive after 1 year. The prognosis for patients with cardiac AL amyloidosis was poor, and DWS may be a significant predictor of prognosis. Narrowing of the LV cavity and progressive diastolic dysfunction were evident in patients with a poor prognosis.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.024
  • Characteristics of Highly Cited Articles in Interventional Cardiology.
    • Authors: Muhammad Shahzeb Khan; Muhammad Shariq Usman; Kaneez Fatima; Nauman Hashmani; Tariq Jamal Siddiqi; Haris Riaz; Abdur Rahman Khan; Faisal Khosa
      Abstract: Publication date: Available online 31 August 2017
      Source:The American Journal of Cardiology
      Author(s): Muhammad Shahzeb Khan, Muhammad Shariq Usman, Kaneez Fatima, Nauman Hashmani, Tariq Jamal Siddiqi, Haris Riaz, Abdur Rahman Khan, Faisal Khosa
      Citation classics have been published in many fields of medicine; however, none have focused on interventional cardiology. The goal of this study was to identify the top 100 articles in the field of interventional cardiology and highlight their important trends and characteristics. The Scopus database was used by two independent reviewers to extract the top 100 articles using a variety of keywords. We found articles published between 1953 and 2012. Majority (n=78) of the top 100 articles were published between 1996 and 2010 while USA was affiliated with the highest number of articles in our list (n=68). Over half (n=54) the articles were funded. Private funding was correlated with higher citations (p=0.036). A third (n=33) of the papers had authors with conflicts of interest; however, conflict of interest had no effect on citations (p=0.837). Majority (n=57) of the articles studied coronary angioplasty and stenting; followed by coronary angiography (n=14). Women were underrepresented, with only 11 female first authors in the top 100 papers, and only one female in the list of top authors who had 5 or more publications. In conclusion, the following features define the typical highly cited article in interventional cardiology – a clinical trial conducted in the USA, which studies angioplasty, and has been published relatively recently in a high impact journal by a male first author.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.030
  • Cardiorespiratory Fitness is a Function of Fat-Free Mass.
    • Authors: Benno Krachler; Steven D. Stovitz
      Abstract: Publication date: Available online 31 August 2017
      Source:The American Journal of Cardiology
      Author(s): Benno Krachler, Steven D. Stovitz

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.031
  • Iron Laboratory Studies in Pediatric Patients with Heart Failure From
           Dilated Cardiomyopathy
    • Authors: David Higgins; Jessica Otero; Christa Jefferis Kirk; Jennifer Pak; Neal Jorgensen; Mariska Kemna; Erin Albers; Borah Hong; Joshua Friedland-Little; Yuk Law
      Abstract: Publication date: Available online 30 August 2017
      Source:The American Journal of Cardiology
      Author(s): David Higgins, Jessica Otero, Christa Jefferis Kirk, Jennifer Pak, Neal Jorgensen, Mariska Kemna, Erin Albers, Borah Hong, Joshua Friedland-Little, Yuk Law
      Iron deficiency (FeD), with or without anemia, in adults with heart failure (HF) is associated with poor outcomes, which can be improved with replacement therapy. A similar therapeutic opportunity may exist for children; however, iron laboratory measurements and FeD have not been described in pediatric patients with HF. A single-center, retrospective study was conducted on 28 patients <21 years old with a diagnosis of dilated cardiomyopathy and HF who had iron labs (serum iron, iron saturation (Tsat), and ferritin) performed. The mean (SD) age at time of lab collection was 10.3 (5.5) years. Twenty-seven patients (96.4%) met the criteria for FeD. Serum iron and Tsat were significantly associated with inpatient hospitalization, being on inotropic medications or having stage D HF. Low serum iron was associated with a higher Left Ventricular End Diastolic Dimension (LVEDD) and Left Ventricular End Systolic Dimension (LVESD) Z-score by echocardiography ((β, -2.58; 95% CI, -4.76,-0.40, p=0.02) and (β, -2.43; 95% CI -4.70,-0.17, p=0.04)), respectively. Low ferritin was associated with higher mortality (RR, 0.29; 95% CI, 0.12,0.70, p=0.006). In conclusion, FeD was common in this pediatric cohort with more advanced HF. Iron profile abnormalities were associated with worse HF severity and outcomes including mortality.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.023
  • Influence of Aging on Level and Layer Specific Left Ventricular
           Longitudinal Strain in Individuals Without Structural Heart Disease
    • Authors: Rachid Abou; Melissa Leung; Mand J.H. Khidir; Ron Wolterbeek; Martin J. Schalij; Nina Ajmone Marsan; Jeroen J. Bax; Victoria Delgado
      Abstract: Publication date: Available online 30 August 2017
      Source:The American Journal of Cardiology
      Author(s): Rachid Abou, Melissa Leung, Mand J.H. Khidir, Ron Wolterbeek, Martin J. Schalij, Nina Ajmone Marsan, Jeroen J. Bax, Victoria Delgado
      Values for level- (apical, mid and basal) and layer-based (endocardial, mid-myocardial and epicardial) left ventricular (LV) longitudinal strain across age are scarce. The present study evaluates the effect of aging on level- and layer-specific LV longitudinal strain in individuals without structural heart disease. A total of 408 individuals (mean age 58 (range 16-91) years; 49% men) were evaluated retrospectively. Patients were divided into equal groups based on age and gender. Individuals with evidence of structural heart disease or arrhythmias were excluded. Mean LV ejection fraction was 62±6.2%. A gradual increase in magnitude of level LV longitudinal strain was observed from basal to mid and apical levels (-16.7±2.1%, -18.8±2.0%, -22.6±3.8%; p<0.001, respectively). Across age groups, there was a borderline significant decrease in magnitude of basal longitudinal strain in older individuals while the magnitude in the apical level significantly increased. On layer-based analysis, the magnitude of longitudinal strain increased from epi- to endocardium across all age groups. On multivariable analysis, only diabetes mellitus was associated with more impaired longitudinal strain in the endocardium. Whereas, male gender was associated with more impaired longitudinal strain at the epicardium layer. In conclusion, with increasing age, the magnitude of LV longitudinal strain at the basal level declines while the apical LV longitudinal strain increases. In contrast, layer-specific LV longitudinal strain remains unchanged with aging. The presence of diabetes mellitus modulated the effect of age on the LV endocardial layer whereas male gender was associated with more impaired longitudinal strain at the epicardial layer.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.027
  • Wilson's Disease and Cardiac Myopathy
    • Authors: Donald J. Grandis; Gregory Nah; Isaac R. Whitman; Eric Vittinghoff; Thomas A. Dewland; Jeffrey E. Olgin; Gregory M. Marcus
      Abstract: Publication date: Available online 30 August 2017
      Source:The American Journal of Cardiology
      Author(s): Donald J. Grandis, Gregory Nah, Isaac R. Whitman, Eric Vittinghoff, Thomas A. Dewland, Jeffrey E. Olgin, Gregory M. Marcus
      Wilson's disease is a well-characterized disorder known to cause liver and brain disease due to abnormal copper deposition. Data regarding copper infiltration of the heart is conflicting, and the risk of heart disease has not been well described. We aimed to determine whether Wilson's disease is associated with cardiac myopathy, clinically evident in the atria as atrial fibrillation (AF) and in the ventricles as heart failure (HF). We longitudinally assessed 14.3 million patients in the California Healthcare Cost and Utilization Project database from 2005 through 2009 for diagnoses of Wilson's disease, AF, HF, and covariates using ICD-9 codes. Cirrhosis and appendicitis diagnoses were assessed for positive and negative validation, respectively. We identified 464 patients with Wilson's disease. As expected in validation analyses, Wilson's disease patients had a three-fold greater risk of cirrhosis (HR 2.85, 95% CI 2.81–2.90, p<0.0001) and no increased risk of appendicitis (HR 0.24, 95% CI 0.04–1.71, p=0.16). Wilson's disease patients exhibited a 29% higher risk of AF after adjusting for age, sex, race, income, hypertension, diabetes, renal disease, hyperlipidemia, obesity, coronary disease, and obstructive sleep apnea (HR 1.29, 95% CI 1.15–1.45, p<0.0001). After adjusting for the same covariates, Wilson's disease patients had a 55% higher risk of incident HF (HR 1.55, 95% CI 1.41–1.71, p<0.0001). Wilson's disease patients have an increased risk of AF and HF, supporting the need for careful surveillance for heart disease. These findings also suggest that the role of copper metabolism in heart disease should be more broadly investigated.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.025
  • Refining Prediction of Atrial Fibrillation Risk in the General Population
           with Analysis of P-Wave Axis (From the Atherosclerosis Risk in Communities
    • Authors: Ankit Maheshwari; Faye L. Norby; Elsayed Z. Soliman; Ryan Koene; Mary Rooney; Wesley T O'neal; Alvaro Alonso; Lin Y. Chen
      Abstract: Publication date: Available online 30 August 2017
      Source:The American Journal of Cardiology
      Author(s): Ankit Maheshwari, Faye L. Norby, Elsayed Z. Soliman, Ryan Koene, Mary Rooney, Wesley T O'neal, Alvaro Alonso, Lin Y. Chen
      Adverse atrial remodeling is associated with increased risk of atrial fibrillation (AF) and can be detected by a shift in P-wave axis. We aimed to determine whether analysis of P-wave axis can be used to improve risk prediction of AF. We used data from the Atherosclerosis Risk In Communities study, a community-based prospective cohort study. We included 15,102 participants (age 54.2 ± 5.7 years, 55.2% women, 26.5% blacks) who attended the baseline exam (1987-89) and without AF. Abnormal P-wave axis (aPWA) was defined as any value outside 0-75 degrees on study visit 12-lead electrocardiograms (ECGs). AF was determined using study visit ECGs, death certificates, and hospital discharge records. Multivariable Cox regression was used to estimate hazard ratios and 95% confidence intervals (95% CIs) for the association of aPWA with AF. The Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE)-AF risk prediction model variables served as our benchmark. Improvement in 10-year AF prediction was assessed by C-statistic, category-based net reclassification improvement (NRI), and relative integrated discrimination improvement (IDI). During a mean follow-up of 20.2 years, there were 2618 incident AF cases. aPWA was independently associated with a 2.34-fold (95% CI, 2.12-2.58) increased risk of AF after adjusting for CHARGE-AF risk score variables. Use of aPWA improved the C-statistic from 0.719 (95% CI, 0.702-0.736) to 0.722 (95% CI, 0.705-0.739), which corresponded to NRI of 0.021 (95% CI, 0.001, 0.040) and IDI of 0.043 (95% CI, 0.018, 0.069). In conclusion, aPWA is independently associated with incident AF in the general population. Use of this maker modestly improves AF prediction.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.015
  • Usefulness of the CRT-SCORE for Shared Decision-Making in Cardiac
           Resynchronization Therapy in Patients with Left Ventricular Ejection
           Fraction ≤ 35%.
    • Authors: Ulas Höke; Bart Mertens; Mand J.H. Khidir; Martin J. Schalij; Jeroen J. Bax; Victoria Delgado; Nina Ajmone Marsan
      Abstract: Publication date: Available online 30 August 2017
      Source:The American Journal of Cardiology
      Author(s): Ulas Höke, Bart Mertens, Mand J.H. Khidir, Martin J. Schalij, Jeroen J. Bax, Victoria Delgado, Nina Ajmone Marsan
      Individualized estimation of prognosis after cardiac resynchronization therapy (CRT) remains challenging. Our aim was to develop a multi-parametric prognostic risk score (CRT-SCORE) that could be used for patient-specific clinical shared decision-making about CRT implantation. The CRT-SCORE was derived from an ongoing CRT registry, including 1053 consecutive patients (age 67±10 years, 76% male). Using pre-implantation variables, 100 multiple-imputed datasets were generated for model calibration. Based on multivariate Cox-regression models, cross-validated linear prognostic-scores were calculated, as well as survival fractions at 1 and 5 years. Specifically, the CRT-SCORE was calculated using atrioventricular junction ablation, age, gender, etiology, New York Heart Association class, diabetes, hemoglobin level, renal function, left bundle branch block, QRS duration, atrial fibrillation, left ventricular systolic and diastolic function and mitral regurgitation, and showed a good discriminative ability (AUC 0.773 at 1 year and 0.748 at 5 years). During long-term follow-up (median 60-months, IQR 31-85), all-cause mortality was observed in 494 (47%) patients. Based on distribution of CRT-SCORE, lower and higher risk patient groups were identified. An estimated mean survival of 98% at 1 year and 92% at 5 years were observed in the lowest 5% risk group (L5 CRT-SCORE:-4.42 to -1.60), while the highest 5% risk group (H5 CRT-SCORE: 1.44 to 2.89) showed poor survival: 78% at 1 year and 22% at 5 years. In conclusion, the CRT-SCORE allows accurate prediction of 1 and 5 year survival after CRT using readily available and CRT-specific clinical, electrocardiographic and echocardiographic parameters. The model may assist clinicians in counseling patients and in decision-making.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.019
  • Using Machine Learning to Define the Association between Cardiorespiratory
           Fitness and All-Cause Mortality (From the FIT [Henry Ford Exercise
           Testing] Project)
    • Authors: Mouaz H. Al-Mallah; Radwa Elshawi; Amjad M. Ahmed; Waqas T. Qureshi; Clinton A. Brawner; Michael J. Blaha; Haitham M. Ahmed; Jonathan K. Ehrman; Steven J. Keteyian; Sherif Sakr
      Abstract: Publication date: Available online 30 August 2017
      Source:The American Journal of Cardiology
      Author(s): Mouaz H. Al-Mallah, Radwa Elshawi, Amjad M. Ahmed, Waqas T. Qureshi, Clinton A. Brawner, Michael J. Blaha, Haitham M. Ahmed, Jonathan K. Ehrman, Steven J. Keteyian, Sherif Sakr
      Prior studies have demonstrated that cardiorespiratory fitness (CRF) is a strong marker of cardiovascular health. Machine learning (ML) can enhance the prediction of outcomes through classification techniques that classify the data into predetermined categories. The aim of the analysis is to compare the prediction of 10 years all-cause mortality (ACM) using statistical logistic regression (LR) and ML approaches in a cohort of patients who underwent exercise stress testing. We included 34,212 patients (55% males, mean age 54±13 years) free of coronary artery disease or heart failure who underwent exercise treadmill stress testing between 1991 and 2009 and had complete 10-years follow-up. The primary outcome of this analysis was ACM at 10 years. The probability of 10-years ACM was calculated using statistical LR and ML and the accuracy of these methods was calculated and compared. A total of 3,921 patients died at ten years. Using statistical LR, the sensitivity to predict ACM was 44.9% (95%CI 43.3%-46.5%) while the specificity was 93.4% (95%CI 93.1%-93.7%). The sensitivity of ML to predict ACM was 87.4% (95%CI 86.3%- 88.4%) while the specificity was 97.2% (95%CI 97.0%-97.4%). ML approach was associated with improved model discrimination, (area under the curve for ML (0.923 (95% CI 0.917 - 0.928)) compared to statistical LR (0.836 (95% CI 0.829 - 0.846)), p<0.0001). In conclusion, our analysis demonstrates that ML provides better accuracy and discrimination of the prediction of ACM among patients undergoing stress testing.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.029
  • Six-Year Outcome of Subjects Without Overt Heart Disease with an Early
           Repolarization/J Wave Electrocardiographic Pattern
    • Authors: Gaetano Antonio Lanza; Alessia Argirò; Roberto Mollo; Antonio De Vita; Francesco Spera; Michele Golino; Elisabetta Rota; Monica Filice; Filippo Crea
      Abstract: Publication date: Available online 30 August 2017
      Source:The American Journal of Cardiology
      Author(s): Gaetano Antonio Lanza, Alessia Argirò, Roberto Mollo, Antonio De Vita, Francesco Spera, Michele Golino, Elisabetta Rota, Monica Filice, Filippo Crea
      “Early repolarization” (ER) is a frequent finding at standard electrocardiogram (ECG). In this study we assessed whether ER is associated with an increased risk of events, as recently suggested by some studies. We prospectively enrolled 4176 consecutive individuals without any heart disease, undergoing routine ECG recording. ER was diagnosed in case of typical concave ST-segment elevation ≥0.1 mV; a J wave was diagnosed when the QRS showed a notch or a slur in its terminal part. In this study we compared the 6-year outcome of all 687 subjects with ER/J wave and 687 matched subjects without ER/J wave (controls). Both groups included 335 males and 352 females, and age was 48.8±18 years. Overall, 145 deaths occurred (11%), only 11 of which attributed to cardiac causes. No sudden death was reported. Cardiac deaths occurred in 5 (0.8%) and 6 (0.9%) ER/J wave subjects and controls, respectively (OR, 0.85; 95% CI, 0.26-2.80; p=0.79). Both ER (OR, 1.68; 95% CI, 0.21-13.3; p=0.62) and J wave (OR, 0.91; 95% CI, 0.28-3.00; p=0.88) showed no association with cardiac death. Total mortality was 11.5% in the ER/J wave group and 10.6% in the control group (OR, 1.10; 95% CI, 0.78-1.56; p=0.58). Both ER (OR, 0.44; 95% CI, 0.16-1.24; p=0.12) and J wave (OR, 1.20; 95% CI, 0.85-1.70; p=0.30) showed also no association with all-cause death. In individuals without any evidence of heart disease, we found no significant association of ER/J wave with the risk of cardiac, as well as all-cause, death at medium-term follow-up.

      PubDate: 2017-09-05T11:43:13Z
      DOI: 10.1016/j.amjcard.2017.08.028
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