for Journals by Title or ISSN
for Articles by Keywords
help

Publisher: Elsevier   (Total: 3185 journals)

 A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Showing 1 - 200 of 3185 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 100, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 40, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 6)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 434, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 307, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 184, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 29, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 11, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 33, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 51, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 66, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 24)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 12, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 24)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 18)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 66)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 420, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 37, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 53, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 382, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 472, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 45, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 7, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 11)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 10, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 54, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 63, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 46, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 12)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 250, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 66, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 24, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 210, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 218, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 6, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Similar Journals
Journal Cover
American Journal of Cardiology
Journal Prestige (SJR): 1.93
Citation Impact (citeScore): 3
Number of Followers: 63  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9149 - ISSN (Online) 0002-9149
Published by Elsevier Homepage  [3185 journals]
  • Usefulness of 3-Tesla Cardiac Magnetic Resonance to Detect Mitral Annular
           Dysfunction in Patients with Mitral Valve Prolapse
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of CardiologyAuthor(s): Benjamin Essayagh, Laura Iacuzio, Filippo Civaia, Jean-Francois Avierinos, Christophe Tribouilloy, Franck Levy Mitral annulus disjunction (MAD) is characterized by a separation between the atrial wall mitral junction and the left ventricular (LV) free wall. Little is known regarding cardiac magnetic resonance (CMR) performance to detect MAD and its prevalence in mitral valve prolapse (MVP). Based on 89 MVP patients (63 women; mean age 64 ±13) referred for CMR assessment of MR, either from Myxomatous Mitral Valve Disease (MMVP) (n=40; 45%) or fibroelastic disease (FED) (n=49; 55%), we sought to assess the frequency of MAD and its consequences on LV morphology. Patients were classified in 2 groups according to MAD presence (MAD+) or absence (MAD-). MAD (measuring 8±4mm) was diagnosed in 35% (31/89) of MVP patients, more frequently in MMVP than FED (60% vs 14%). MAD+ was associated with MMVP; bileaflet MVP and non-sustain ventricular tachycardia (NSVT) but not with the severity of MR. Diagnostic accuracy of TTE for the detection of MAD was fair (65% sensitivity, 96% specificity) with CMR as reference. MAD+ showed significantly enlarged basal and mid LV diameters and enlarged mitral-annulus diameter. Among patients with late gadolinium enhancement, presence of LV fibrosis at level of papillary muscle was more frequent in MAD+. After adjustment on age and MR severity, MMVP and enlarged end-systolic mitral annulus diameter were independently associated with MAD+. In conclusion, MAD was present in about 1/3 of MVP patients, mostly in MMVP and independent of MR severity. Enlarged mitral-annulus and basal LV diameters, NSVT and papillary muscle fibrosis were associated with MAD presence.
       
  • When You Reach Your Goal: Stop
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of CardiologyAuthor(s): Robert M. Doroghazi
       
  • New Onset Palpitations, Chest Pain, Dyspnea, and Diaphoresis in a
           65-Year-Old Woman
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Mazen M. Kawji, David Luke GlancyA woman with the new onset of cardiac symptoms was in atrial fibrillation with a wide QRS complex that was not typical of bundle branch block. After electrical cardioversion, a short PR interval and delta waves indicated the presence of an accessory atrioventricular pathway. This left lateral atrioventricular bypass tract was subsequently ablated.
       
  • Leasing a Car
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Robert M. Doroghazi
       
  • Usefulness of Trends in Continuous Electrocardiographic Telemetry
           Monitoring to Predict In-Hospital Cardiac Arrest
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Duc H. Do, Alan Kuo, Edward S. Lee, David Mortara, David Elashoff, Xiao Hu, Noel G. BoyleSurvival from in-hospital cardiac arrest (IHCA) due to pulseless electrical activity/asystole remains poor. We aimed to evaluate whether electrocardiographic changes provide predictive information for risk of IHCA from pulseless electrical activity/asystole. We conducted a retrospective case-control study, utilizing continuous electrocardiographic data from case and control patients. We selected 3 consecutive 3-hour blocks (block 3, 2, and 1 in that order); block 1 immediately preceded cardiac arrest in cases, whereas block 1 was chosen at random in controls. In each block, we measured dominant positive and negative trends in electrocardiographic parameters, evaluated for arrhythmias, and compared these between consecutive blocks. We created random forest and logistic regression models, and tested them on differentiating case versus control patients (case block 1 vs control block 1), and temporal relation to cardiac arrest (case block 2 vs case block 1). Ninety-one cases (age 63.0 ± 17.6, 58% male) and 1,783 control patients (age 63.5 ± 14.8, 67% male) were evaluated. We found significant differences in electrocardiographic trends between case and control block 1, particularly in QRS duration, QTc, RR, and ST. New episodes of atrial fibrillation and bradyarrhythmias were more common before IHCA. The optimal model was the random forest, achieving an area under the curve of 0.829, 63.2% sensitivity, 94.6% specificity at differentiating case versus control block 1 on a validation set, and area under the curve 0.954, 91.2% sensitivity, 83.5% specificity at differentiating case block 1 versus case block 2. In conclusion, trends in electrocardiographic parameters during the 3-hour window immediately preceding IHCA differ significantly from other time periods, and provide robust predictive information.
       
  • Regadenoson Stress Perfusion Cardiac Magnetic Resonance Imaging in
           Children With Kawasaki Disease and Coronary Artery Disease
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Tam T. Doan, James C. Wilkinson, Robert W. Loar, Amol S. Pednekar, Prakash M. Masand, Cory V. NoelCoronary artery (CA) stenosis and occlusion in convalescent Kawasaki disease (KD) is progressive and may result in myocardial infarction. The use of regadenoson, a strong selective CA vasodilator with low side effect profile, for stress cardiac magnetic resonance (CMR) imaging has not been studied in children with KD. The safety, feasibility, and diagnostic utility of regadenoson stress CMR was assessed in children with KD and CA abnormalities. A retrospective review of regadenoson stress CMR in children with convalescent KD was performed. Hemodynamics changes after regadenoson administration and adverse effects were recorded. First-pass perfusion was evaluated at rest and during pharmacologic stress. The results were compared with anatomic CA imaging. Forty-one stress CMR (18 sedated examinations, 44%) were performed successfully in 32 patients. Median age was 11.2 years (range 2.2 to 18.6) and weight 41 kg (range 13 to 93.4). Heart rate increased 66 ± 25% (p 90% negative and overall agreement with moderate-to-severe CA stenoses. Four patients with hypoperfusion underwent revascularization for severe CA stenoses. In conclusion, regadenoson stress CMR is hemodynamically safe and feasible in children with KD and CA disease. It has excellent agreement with CA angiography and aided decision-making to proceed with revascularization.
       
  • Atrial Septal Defect and the Risk of Ischemic Stroke in the Perioperative
           Period of Noncardiac Surgery
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Nathaniel R. Smilowitz, Varun Subashchandran, Jeffrey S. BergerStroke is a serious complication of noncardiac surgery. Congenital defects of the interatrial septum may be a potent risk factor for perioperative stroke. The aim of the present study was to determine the association between atrial septal defect (ASD) or patent foramen ovale (PFO) and in-hospital perioperative ischemic stroke after non-cardiac surgery in a large nationwide cohort of patients hospitalized in the United States. Patients undergoing noncardiac surgery between 2004 and 2014 were identified using the Healthcare Cost and Utilization Project's National Inpatient Sample. Patients without an in-hospital echocardiogram were excluded. The presence of an ostium secundum-type ASD or PFO was identified by ICD-9 diagnosis code 745.5. The primary study outcome was perioperative acute ischemic stroke. Between 2004 and 2014, there were 639,985 admissions for noncardiac surgery with an in-hospital echocardiogram. An ASD or PFO was documented in 9,041 (1.4%) hospitalizations. Perioperative ischemic stroke occurred more frequently in patients with an ASD or PFO compared with those without an ASD or PFO (35.1% vs 6.0%, p
       
  • In-Hospital Outcomes After Transcatheter Aortic Valve Implantation in
           Patients With Versus Without Chronic Thrombocytopenia
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Marwan Saad, Ahmed N. Mahmoud, Amr F. Barakat, Amgad Mentias, Ayman Elbadawi, Islam Y. Elgendy, Ahmed Abuzaid, Akram Y. Elgendy, Hani JneidPatients with chronic thrombocytopenia (cTCP) were excluded from the pivotal transcatheter aortic valve implantation (TAVI) trials. The National Inpatient Sample was queried and propensity score matching was performed to evaluate the prevalence and impact of cTCP on in-hospital clinical outcomes after TAVI. The main outcome was in-hospital mortality in patients with versus without cTCP. Among 38,855 TAVI hospitalizations, 7,105 had a diagnosis of cTCP (18.3%). In-hospital mortality was similar in both groups (ORadjusted 0.79; 95% confidence interval [CI] 0.57 to 1.09); however, cTCP was associated with higher risk of acute kidney injury (ORadjusted 1.29; 95% CI 1.08 to 1.54), vascular complications (ORadjusted 1.99; 95% CI 1.22 to 3.25), perioperative blood product transfusion (ORadjusted 1.69; 95% CI 1.42 to 2.01), cardiac tamponade (ORadjusted 4.04; 95% CI 1.51 to 10.82), cardiogenic shock (ORadjusted 1.52; 95% CI 1.07 to 2.15), and use of extracorporeal membrane oxygenation (ORadjusted 2.32; 95% CI 1.1 to 4.9). In conclusion, cTCP is common in patients who underwent TAVI and is associated with worse postprocedure clinical outcomes, however, with similar in-hospital mortality.
       
  • Trends in the Management of Acute Heart Failure Requiring Intensive Care
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Akihiro Shirakabe, Nobuaki Kobayashi, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Hiroki Goda, Syouta Shigihara, Kazuhiro Asano, Kazutaka Kiuchi, Noritake Hata, Kuniya Asai, Wataru ShimizuThe aim of the present study was to elucidate trends in managing acute heart failure (AHF) patients who require intensive care over a 19-year period. We evaluated a total of 1,475 AHF patients, comparing patient backgrounds, in-hospital management, and prognosis according to the year of admission (2000s group, n = 608 and 2010s group, n = 867). A multivariate logistic regression analysis revealed that age (≥75 years; odds ratio [OR] 1.334, 95% confidence interval [CI] 1.048 to 1.700), systolic blood pressure (40%; OR 1.441, 95% CI 1.125 to 1.847), and prognostic nutritional index (severe; OR 1.865, 95% CI 1.224 to 2.841) were independently associated with admission in the 2010s group. The use of intra-aortic balloon pumping and noninvasive positive pressure ventilation increased significantly, whereas the need for endotracheal intubation and administration of furosemide and carperitide in the 2010s group decreased significantly compared with the 2000s group. Tolvaptan therapy was introduced from 2010. The duration of intensive care unit admission and total hospitalization in the 2010s group (4 [3 to 6] and 23 [15 to 40] days, respectively) were significantly shorter than in the 2000s group (5 [4 to 8] and 30 [20 to 54] days, respectively). A Kaplan-Meier survival curve analysis showed the survival rate of the 2010s group was significantly poorer compared with the 2000s group (hazards ratio 1.435, 95% CI 1.113 to 1.851). After propensity score matching, the 365-day mortality rates of the 2 groups did not significantly differ. In conclusion, the condition of AHF patients became more critical year by year, leading to poorer long-term prognosis despite improved treatment strategy. These findings will be useful for managing AHF in the next pandemic era.
       
  • Effects of a Higher Heart Rate on Quality of Life and Functional Capacity
           in Patients With Left Ventricular Diastolic Dysfunction
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Kramer Wahlberg, Maren E. Arnold, Daniel Lustgarten, Markus MeyerThere is no evidence-based treatment for heart failure with preserved ejection fraction. Although lower heart rates (HRs) provide an unequivocal benefit for patients with HF with reduced ejection fraction, higher HR might convey important hemodynamic and substrate-modifying benefits in patients with diastolic dysfunction. In a prospective study of 20 stable outpatients with diastolic dysfunction and pacemakers, we evaluated the effects of a 4-week increase in the lower pacemaker rate to 80 beats/min followed by reversal to the previous lower HR setting from weeks 4 to 6. We assessed quality of life (Minnesota Living with Heart Failure Questionnaire), 6-minute walk test and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Pacing at 80 beats/min significantly improved quality of life and the 6-minute walk test (p ≤0.05). There was a strong positive correlation between the pacing-induced changes in NT-proBNP and baseline QRS intervals (r2 = 0.31, p 150 ms was associated with a 26 ± 35% increase in NT-proBNP (p
       
  • Usefulness of CHA2DS2-VASc Score to Predict Stroke Risk Independent of
           Atrial Fibrillation
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Anne Gulbech Ording, Erzsébet Horváth-Puhó, Paolo Prandoni, Michelle Zippora Leisner, Dóra Körmendiné Farkas, Flemming Hald Steffensen, Morten Olsen, Henrik Toft Sørensen, Morten SchmidtThe CHA2DS2-VASc score is used to predict stroke risk among patients with atrial fibrillation (AF). We examined whether a CHA2DS2-VASc score predicts stroke risk among individuals without hospital-diagnosed AF and quantified the magnitude of the association in comparison to AF patients. We used data from population-based medical registries (1995 to 2005) covering all Danish hospitals to identify patients diagnosed with AF (n = 122,980). We matched ≤5 non-AF individuals (n = 612,723) to each AF patient on the individual risk factors included in the CHA2DS2-VASc score. We calculated 10-year absolute risk of ischemic and all-cause stroke in AF and non-AF individuals and compared the stroke risk between cohorts within strata of CHA2DS2-VASc scores using Cox regression. The 10-year risk of ischemic/all-cause stroke was 4.4%/8.8% among non-AF individuals and 6.2%/12% in AF patients, corresponding to a risk difference of 1.8% for ischemic stroke and 3.3% for all-cause stroke. In both cohorts, the stroke risk correlated with increasing CHA2DS2-VASc scores. However, in individuals with CHA2DS2-VASc scores ≥5 who were
       
  • Comparison of In-Hospital Outcomes of Patients With-Versus-Without Atrial
           Fibrillation and Alcohol Withdrawal Syndrome
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Vivek Reddy, Oluwole Adegbala, Tomo Ando, Mohamed Shokr, Kartik Kumar, Anirudh Penumetcha, Mazhar KhanAlcohol withdrawal syndrome (AWS) has been associated with significant medical complications and length of stay. Cardiovascular effects from AWS include a physiologic tachycardia and hypertensive response. Although atrial fibrillation (AF) is one of the most common arrhythmias, the impact of a known history of AF on AWS is unclear. The purpose of our study is to assess the impact of history of AF on clinical outcomes, cost, and length of stay on AWS. The Nationwide Inpatient Sample was used to identify patients aged 18 years or older who underwent AWS with or without AF using the International Classification of Disease 9 Clinical Modification codes from January 2010 to December 2014. Outcomes were compared between those with or without AF using propensity score method-stratified morbidity ratio weighing- to adjust for baseline patient and hospital characteristics. A total of 280,451 patients with AWS of which 14,459 (5.2%) had history of AF. Patients with AF was older, less likely female, and more had higher burden of co-morbidities. In an adjusted model, in-hospital mortality (odds ratio [OR] 1.98 95% confidence interval [CI] 1.61 to 2.45), ischemic stroke (OR 1.67 95% CI 1.42 to 1.95), acute kidney injury (OR 1.36 95% CI 1.24 to 1.49), acute kidney injury requiring dialysis (OR 1.89 95% CI 1.39 to 2.50), and cost (mean ratio 1.27 95% CI 1.21 to 1.33) were higher in the AF cohort. Length of stay was shorter in patients with AF (mean ratio 0.85 95% CI 0.81 to 0.90). In conclusion, a known history of AF increased the risk of in-hospital mortality, morbidity, and hospital expense in AWS.
       
  • Effect of Left Ventricular Conduction Delay on All-Cause and
           Cardiovascular Mortality (from the PRECISION Trial)
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Erich L. Kiehl, Venu Menon, Kyle T. Mandsager, Katherine E. Wolski, Lisa Wisniewski, Steven E. Nissen, A. Michael Lincoff, Jeffrey S. Borer, Thomas F. Lüscher, Daniel J. CantillonThe prognosis associated with prolonged intraventricular conduction on electrocardiogram (ECG) remains uncertain. We aimed to compare clinical outcomes of narrow versus prolonged intraventricular conduction on ECG stratified by QRS morphology and cardiovascular disease (CVD) status. A post-hoc analysis was performed of the randomized-control PRECISION trial. Patients with centrally adjudicated, nonpaced baseline ECGs were included. QRS duration was classified narrow (≤100 ms) versus prolonged (>100 ms) with additional categorization into left (LBBB) or right (RBBB) bundle branch block or nonspecific intraventricular conduction delay (IVCD). IVCD was subclassified if left ventricular conduction delay (LVCD) was present (L-IVCD) or absent (O-IVCD). The primary outcome was adjudicated all-cause and cardiovascular (CV) mortality. Of 24,081 patients randomized, 22,067 (92%) were included with follow-up 34 ± 13 months. Study patients were 63 ± 9 years, 64% female, 75% Caucasian, 23% with established CVD. The prevalence of QRS prolongation was 5.6% (1,240): 760 right bundle branch block (3.4%), 313 LBBB (1.4%), and 161 IVCD (0.7%), 95 subclassified L-IVCD (0.4%). After adjustment, LBBB and L-IVCD were similarly associated with increased all-cause (LBBB: 2.3 [1.4 to 3.8], p = 0.001; L-IVCD: 4.0 [2.1 to 7.9], p
       
  • External Validation of the ORBIT Bleeding Score and the HAS-BLED Score in
           Nonvalvular Atrial Fibrillation Patients Using Direct Oral Anticoagulants
           (Asian Data from the DIRECT Registry)
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Naoki Mori, Yohei Sotomi, Akio Hirata, Atsushi Hirayama, Yasushi Sakata, Yoshiharu HiguchiFor Asian patients with nonvalvular atrial fibrillation (NVAF) using direct oral anticoagulants (DOACs), performance of contemporary various bleeding risk scores in a real-world setting is unknown. The objective of this study was to externally validate the ORBIT bleeding score and the HAS-BLED score in a large pooled real-world Asian population with NVAF using DOACs. We conducted a single-center prospective observational registry of NVAF patients treated with DOACs: the DIRECT registry (UMIN000033283). We assessed predictive and discriminative performance of the ORBIT bleeding and the HAS-BLED scores for major bleeding in 2,216 patients with NVAF using DOACs (63.6% male, median age 73 years, median CHADS2 score 2). The overall incidence of major bleeding was 4.2% after a median follow-up of 315 days (interquartile range: 76 to 621). The ORBIT bleeding and the HAS-BLED scores both had modest discrimination ability to identify those who had bled versus who had not (C index = 0.64 [95% confidence interval {CI} 0.59, 0.70] and 0.62 [95% CI 0.57, 0.68], respectively). Calibration plots of the ORBIT bleeding score showed similar predictive performance compared with the HAS-BLED score (slope: 0.91 [95% CI 0.40, 1.43] vs 0.72 [95% CI 0.03, 1.40], intercept: 0.24 [95% CI −2.13, 2.61] vs 0.71 [95% CI −2.35, 3.76], respectively). In conclusion, the ORBIT bleeding score and the HAS-BLED score in a real-world of NVAF population with DOACs showed a modest discriminative performance and a similar predictive performance for major bleeding.
       
  • Consensus Clinical Decision-Making Factors Driving Anticoagulation in
           Atrial Fibrillation
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Philip K. King, Susan M. Fosnight, Jeffrey R. BishopGuideline-recommended anticoagulation is frequently omitted in high-risk patients with atrial fibrillation (AF) for reasons not fully understood, which may result in suboptimal care. A nationally representative, expert group of physicians (cardiology, neurology, and general medicine), and clinical pharmacists participated in a consensus-seeking, modified Delphi method to identify key clinical decision-making factors driving anticoagulant prescribing in real-world AF patients. Representing>2,500 anticoagulation-related patient encounters per month, 27 of 30 participants completed the study (90% overall response rate). In Round-1, experts rated their level of agreement with factors and suggested modifications or additional factors. Of 66 factors entering Round-1, 21 met and 4 partially met consensus, 41 did not meet consensus, and 7 were newly suggested. Of 32 factors advanced for scoring in Round-2, 16 met consensus criteria. In Round-3, experts were given the option to rescue up to 2 of the 16 nonconsensus factors from Round-2. Including a concomitant need for dual antiplatelet therapy, no factor was successfully rescued into consensus. The most important factors related to risk of infarction rather than bleeding risk or other patient-specific considerations. Among factors not independently addressed in current guidelines, these included baseline hematologic indicators of potential bleeding risk, previous bleeding episodes by specific type, other risk factors for bleeding, and adherence. In conclusion, when determining anticoagulation strategies in AF, there is a need for further research on the clinical implications of these emerging factors as well as the reasons behind divergent opinions toward nonconsensus factors.
       
  • Effect of ApoE4 Genotype on the Association Between Metabolic Phenotype
           and Subclinical Atherosclerosis in Postmenopausal Women
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Intira Sriprasert, Wendy Jean Mack, Howard Neil Hodis, Hooman Allayee, Roberta Diaz Brinton, Roksana KarimMetabolic profile and ApoE4 genotype have effects on coronary heart disease. We examined the interaction between these factors on subclinical atherosclerosis in postmenopausal women from the Early versus Late Intervention Trial with Estradiol (n = 497). Based on nine metabolic biomarkers (fasting blood glucose, insulin sensitivity, ketones, triglycerides, high-density lipoprotein, low-density lipoprotein, hemoglobin A1c, and blood pressure), K-means clustering categorized women into three distinct phenotypes: healthy, high blood pressure, and poor metabolic. ApoE4 genotype was classified as either ApoE4+ or ApoE4−. General linear models tested whether the cross-sectional association between metabolic phenotypes and common carotid intima media thickness (CIMT) differed by ApoE4 genotype. Mixed effects linear models evaluated the modifying role of ApoE4 genotype on the association of metabolic phenotype with CIMT progression over a median follow-up of 4.8 years. In cross-sectional analysis, ApoE4+ women with poor metabolic phenotype had the highest CIMT compared with all other groups. In ApoE4− women, CIMT was significantly lower in those classified as healthy compared with high blood pressure phenotype (p = 0.004). In ApoE4+ women, CIMT was significantly higher in those with poor metabolic phenotype compared with healthy (p = 0.0003) and high blood pressure (p = 0.001) phenotypes. These results indicate that metabolic phenotype had a negative effect on CIMT in women with ApoE4+ but not ApoE4− (interaction p = 0.001). These effects were not observed on CIMT progression in longitudinal analysis. In conclusion, ApoE4+ women are more likely to have higher levels of subclinical atherosclerosis if their metabolic phenotype is poor compared with ApoE4+ women without poor metabolic profile and ApoE4− women.
       
  • Efficacy and Safety of Ultrathin, Bioresorbable-Polymer Sirolimus-Eluting
           Stents Versus Thin, Durable-Polymer Everolimus-Eluting Stents for Coronary
           Revascularization of Patients With Diabetes Mellitus
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Ron Waksman, Evan Shlofmitz, Stephan Windecker, Jacques J. Koolen, Shigeru Saito, David Kandzari, Paul Kolm, Michael J. Lipinski, Rebecca TorgusonPatients with diabetes mellitus are prone to increased adverse outcomes after percutaneous coronary intervention, even with contemporary drug-eluting stents. Randomized controlled trials have demonstrated comparable clinical outcomes between an ultrathin bioresorbable-polymer sirolimus-eluting stent (BP-SES) and a thin-strut durable-polymer everolimus-eluting stent (DP-EES) that has specific labeling for patients with diabetes. We aimed to evaluate the safety and efficacy of the BP-SES in patients with diabetes mellitus. To determine the performance of the BP-SES in diabetic patients, patient-level data from the BIOFLOW II, IV, and V randomized controlled trials were pooled. The primary end point was target lesion failure (TLF), defined as the composite of cardiovascular death, target-vessel myocardial infarction, ischemia-driven target lesion revascularization, and definite or probable stent thrombosis, at 1 year. Among 1,553 BP-SES and 791 DP-EES patients, 757 diabetic patients were identified. Of the diabetic patients included in this analysis (494 BP-SES vs 263 DP-EES), the proportion of insulin- and noninsulin-treated patients was similar between groups. The 1-year TLF rate in the diabetic population was 6.3% in the BP-SES group and 8.7% in the DP-EES group (hazard ratio 0.82, 95% confidence interval 0.047 to 1.43, p = 0.493). There were no significant differences, based on stent type or diabetes treatment regimen, in TLF hazards. In a patient-level pooled analysis of the diabetic population from randomized trials, 1-year clinical safety and efficacy outcomes were similar in patients treated with ultrathin BP-SES and thin-strut DP-EES.
       
  • Comparison of Coronary Atherosclerotic Plaque Burden and Composition as
           Assessed on Coronary Computed Tomography Angiography in East Asian and
           European-Origin Caucasians
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Abdul Rahman Ihdayhid, Markus Goeller, Damini Dey, Nitesh Nerlekar, Grace Yap, Udit Thakur, Daniel Adams, James Cameron, Sujith Seneviratne, Stephan Achenbach, Brian KoRecent evidence suggests plaque morphology evaluated on coronary computed tomography angiography has prognostic implications. East Asians have a lower prevalence of myocardial infarction and cardiovascular mortality compared with European-origin Caucasians. We aimed to compare coronary atherosclerotic burden and plaque composition in a matched cohort of Caucasian and East Asians patients with stable chest pain who underwent computed tomography angiography. Two-hundred symptomatic patients (age 58.8 ± 7.9, male 51%) were matched for age, gender, body mass index, and diabetes (100 each ethnic group). A blinded core-laboratory quantified calcified and noncalcified plaque (NCP) volume and burden. Components of NCP were differentiated by plaque hounsfield unit (HU) thresholds which defined high-risk necrotic core (−30 to 30HU), fibrofatty plaque (31 to 130HU); and low-risk fibrous plaque (131 to 350HU). Composition of NCP components was derived as (NCP component volume/total NCP volume) × 100%. Segment Involvement Score, percent diameter and area stenosis were comparable in both groups. Similarly, there was no difference in the volume and burden of total, calcified and NCP. Compared with Caucasians, East Asians demonstrated lower composition of plaque attenuation corresponding to necrotic core (3.5 vs 5.1%; p = 0.004) and fibrofatty plaque (29.6 vs 37.3%; p = 0.005), and higher fibrous plaque (65.7 vs 57.6%; p = 0.004). On multivariable analysis East Asian ethnicity was independently associated with lower composition of high-risk plaque after adjustment for risk factors and scan parameters. These findings were consistent in a propensity-matched sensitivity-analysis. In conclusion, based on this matched cohort, East Asian ethnicity is associated with significantly less composition of high-risk NCP (necrotic core and fibrofatty plaque) and a higher composition of low-risk fibrous plaque compared with Caucasians; which may confer a lower risk of cardiovascular events.
       
  • Relation of Frailty to Outcomes in Patients With Acute Coronary Syndromes
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Chun Shing Kwok, Gina Lundberg, Hussam Al-Faleh, Alex Sirker, Harriette G.C. Van Spall, Erin D. Michos, Muhammad Rashid, Mohamed Mohamed, Rodrigo Bagur, Mamas A. MamasThis study examines a national cohort of patients with a diagnosis of acute coronary syndrome (ACS) for the prevalence of frailty, temporal changes over time, and its association with treatments and clinical outcomes. The National Inpatient Sample database was used to identify US adults with a diagnosis of ACS between 2004 and 2014. Frailty risk was determined using a validated Hospital Frailty Risk Score based on ICD-9 codes using the cutoffs 15 for low- (LRS), intermediate- (IRS), and high-risk (HRS) frailty scores, respectively. Logistic regression assessed associations of frailty with clinical outcomes, adjusted for patient co-morbidities and hospital characteristics. From 7,398,572 hospital admissions with ACS between 2004 and 2014, 86.5% of patients had LRS, 13.4% had an IRS, and 0.1% had an HRS. From 2004 to 2014, the prevalence of IRS and HRS patients increased from 8.1% to 18.2% and 0.03% to 0.18%, respectively (p
       
  • Lipid-Lowering Prescription Patterns in Patients With Diabetes Mellitus or
           Cardiovascular Disease
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Alanna M. Chamberlain, Sarah S. Cohen, Jill M. Killian, Keri L. Monda, Susan A. Weston, Ted OkersonThe purpose of this study is to describe lipid-lowering therapy (LLT) prescriptions and low-density lipoprotein cholesterol (LDL-C) monitoring in patients with diabetes mellitus (DM) with or without concomitant cardiovascular disease (CVD). Olmsted County, Minnesota residents with a first-ever diagnosis of DM or CVD (ischemic stroke/transient ischemic attack, myocardial infarction, unstable angina pectoris, or revascularization procedure) between 2005 and 2012 were classified as having DM only, CVD only, or CVD + DM. All LLT prescriptions and LDL-C measurements were obtained for 2 years after diagnosis. A total of 4,186, 2,368, and 724 patients had DM, CVD, and CVD + DM, respectively. Rates of LDL-C measurement were 1.31, 1.66, and 1.88 per person-year and 14%, 32%, and 42% of LDL-C measurements were
       
  • David H. Spodick, MD (1927 to 2019)
    • Abstract: Publication date: 1 October 2019Source: The American Journal of Cardiology, Volume 124, Issue 7Author(s): Lovely Chhabra
       
  • Increasing Rate of Hospital Admissions in Patients with Amyloidosis (From
           the National Inpatient Sample)
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of CardiologyAuthor(s): Brett W. Sperry, Ibrahim M. Saeed, Shahzad Raza, Kevin F. Kennedy, Mazen Hanna, John A. SpertusABSTRACTCardiac amyloidosis is an increasingly recognized cause of heart failure with preserved or mildly reduced ejection fraction with emerging treatment options. We sought to analyze the temporal trends and impact of hospital admissions in patients with amyloidosis. The National Inpatient Sample was queried to identify patients from 2005-2014 who were hospitalized with a diagnosis of amyloidosis using ICD9 codes. Trends over time of prevalence, demographics, comorbidities, and outcomes were described. Propensity-matching was used to assess the impact of amyloidosis on in-hospital outcomes, including mortality. A total of 156,914 admissions in patients with amyloidosis (age 69.86 +/- 12.33 years, 45.7% female, 68.5% Caucasian) were identified. Hospitalizations more than doubled with a peak of 21,740 per year and 62 per 100,000 admissions in 2014. Over time, patients admitted with amyloidosis were older and more likely to have comorbid medical conditions. A diagnosis of heart failure was present in 34.7% of patients, increased over time (p=0.001), and was associated with further morbidity and mortality. In a propensity-matched analysis, patients admitted with amyloidosis had a longer length of stay (7.5 vs 6.2 days), were less likely to be discharged home (43.6% vs 48.7%), and were more likely to die during the hospitalization (7.4% vs 4.9%, p
       
  • Sodium Glucose Co-transporter 2 Inhibitors and Heart Failure
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of CardiologyAuthor(s): Raktim K Ghosh, Gopal Chandra Ghosh, Manasvi Gupta, Dhrubajyoti Bandyopadhyay, Tauseef Akhtar, Prakash Deedwania, Carl J Lavie, Gregg C Fonarow, Ashish Aneja Sodium-glucose co-transporter 2 (SGLT2) receptors are primarily located in the proximal convoluted tubule of the nephron. These receptors are responsible for almost 90-95% of tubular reabsorption of the glucose in the nephron. In patients with diabetes mellitus (DM), due to upregulation of SGLT2 receptors, glucose reabsorption is further increased. The Food and Drug Administration (FDA) approved SGLT2 inhibitors, such as canagliflozin, empagliflozin, dapagliflozin, and ertugliflozin, for the treatment of type 2 diabetes. In addition to their positive effect on blood glucose, additional cardioprotective and renoprotective functions have been demonstrated in major trials such as EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI-58 and CREDENCE. Unlike other antihyperglycemic drugs, reduction in hospitalization for heart failure was also seen as a class effect with this group, mechanisms of which are probably multifactorial. Subgroup analysis from these major trials indicated a reduction in progression of nephropathy and HF readmission with SGLT2 inhibitors. While this unique property of canagliflozin was further analyzed in the CREDENCE trial, similar trials for empagliflozin (EMPERIAL-Reduced and EMPERIAL-Preserved) and dapagliflozin (DAPA-HF) are currently underway. Recently released phase III results from DAPA-HF trial indicate that dapagliflozin shows significant reduction in death due to cardiovascular causes and hospitalization in heart failure (HF) compared to the placebo, in both diabetics and non-diabetics. In this review article, the authors attempt to explore the possible underlying molecular mechanisms and data from existing trials pertaining to the heart failure related outcomes associated with SGLT2 inhibitors.
       
  • Utility of Pacemaker with Sleep Apnea Monitor to Predict Left Ventricular
           Overload and Acute Decompensated Heart Failure
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of CardiologyAuthor(s): João Bicho Augusto, Susana Antunes, João Baltazar Ferreira, Daniel Faria, David Roque, Marco Beringuilho, Hilaryano Ferreira, Inês Fialho, Mariana Faustino, Nuno Cabanelas, Ana Rita Ferreira, Hugo Vasconcelos, Miguel Borges Santos, António Freitas, Francisco Madeira, Victor Gil, Carlos Morais Pacemakers with sleep apnea monitor (SAM) provide an easy tool to assess obstructive sleep apnea over long periods of time. The link between respiratory disturbances at night and the incidence of acute decompensated heart failure (ADHF) is not well established. We aimed at (i) determining the ability of SAM pacemakers to evaluate the extent of left ventricular overload and (ii) assess the impact of respiratory disturbances at night on the occurrence of ADHF over 1-year of follow-up. We conducted a single-center prospective study. Consecutive patients with SAM pacemakers were comprehensively assessed. SAM automatically computes a respiratory disturbance index (RDI, apneas/hyponoeas per hour - AH/h) in the previous night and the percentage of nights with RDI>20AH/h in the previous 6 months. 37 patients were included (79.3±11.2 years, 46% males). A high RDI in the previous night and a higher %nights with increased RDI were associated with increased NT-proBNP values (p=0.008 and p=0.013, respectively) and were the sole predictors of increased non-invasive pulmonary capillary wedge pressures (PCWP) in the morning of assessment (p=0.031 and p=0.044, respectively). ROC curve analysis revealed an area under the curve of 0.804 (CI95% 0.656–0.953, p=0.002) for %nights with RDI>20AH/h in the prediction of high PCWP. Patients with>12.5% of nights with RDI>20AH/h tended to have more ADHF during follow-up (log-rank p=0.067). In conclusion, a high burden of apneas/hypopneas at night is associated with elevated NT-proBNP and PCWP values and an increased risk of ADHF over 1 year. These patients might benefit from early tailored clinical management.
       
  • Long-Term Functional and Structural Durability of Bioprosthetic Valves
           Placed in the Aortic Valve Position via Percutaneous Rout in Israel
    • Abstract: Publication date: Available online 9 September 2019Source: The American Journal of CardiologyAuthor(s): Katia Orvin, Sagit Ben Zekry, Olga Morelli, Israel M. Barabash, Amit Segev, Haim Danenberg, Abid Assali, Victor Guetta, Hana Vaknin Assa, Vicki Zeniou, Chaim Lotan, Alexander Sagie, Dan Gilon, Micha S. Feinberg, Yaron Shapira, Kornowski Ran There is limited organized 'real life' data regarding the long-term structural and functional durability of transcatheter aortic valve implants, a topic of major importance. We assessed the 5-year structural and functional integrity outcomes following trans-catheter aortic valve implantation (TAVI) with both self-expandable and balloon-expandable prosthetic valve devices.This study included 450 consecutive patients who underwent TAVI for severe symptomatic aortic stenosis (AS) between 9/2008 and 12/2011. Data were acquired from a multi-center Israeli registry and the median follow up time was 5.6 years. In 184 patients (40.9%) who survived 5 years, prostheses displayed sustained hemodynamic performance, with average peak and mean aortic valve gradients of 16.2 ± 8.9 and 9.2 ± 6.6 mmHg, respectively. Late structural valve deterioration was found in 22 (12.3%) patients. Of these, 16 (8.9%) experienced valve deterioration and 6 (3.3%) experienced valve failure. Among the 6 patients with bio-prosthetic valve failure, only 3 underwent re-interventions. Bioprosthetic valve dysfunction occurred more frequently in patients with small valves (23 mm) and high peak and mean transvalvular gradients at baseline. In conclusion, a relatively low rate of valve deterioration or failure was noted in our long-term follow-up study after TAVI procedures with both the catheter-based self-expandable and balloon-expandable prosthetic valves.
       
  • Usefulness of Aspirin for Primary Prevention of Atherosclerotic
           Cardiovascular Disease
    • Abstract: Publication date: Available online 9 September 2019Source: The American Journal of CardiologyAuthor(s): Aneesha Thobani, Devinder S. Dhindsa, Benjamin D. DeMoss, Mohamad Raad, Pratik B. Sandesara, Laurence S. Sperling, Jefferson T. Baer Aspirin use in the prevention of cardiovascular events has been a mainstay of treatment for decades. However, the use of aspirin in primary prevention of atherosclerotic cardiovascular disease (ASCVD) has recently come under scrutiny. Several recent studies have evaluated the use of aspirin in primary prevention and the results suggest that in many individuals the risks may outweigh the benefits. Closer examination of these trials suggests that the use of aspirin therapy for primary prevention may have a role but likely needs a more tailored approach and that caution is needed in prescribing aspirin for primary prevention. In conclusion, in this article we review the evolving evidence for aspirin in the primary prevention of ASCVD.
       
  • Wide-QRS Tachycardia in an 89-Year-Old Woman with an ICD
    • Abstract: Publication date: Available online 9 September 2019Source: The American Journal of CardiologyAuthor(s): Mazen M. Kawji, D. Luke Glancy An elderly woman had ventricular tachycardia, and her defibrillator failed to discharge. Intravenously administered amiodarone returned her to sinus rhythm.
       
  • Pure Aortic Regurgitation in Paediatric Patients
    • Abstract: Publication date: Available online 9 September 2019Source: The American Journal of CardiologyAuthor(s): Aladino Ibrahim, Nunzia Borrelli, Sylvia Krupickova, Jolanda Sabatino, Martina Avesani, Josefa Paredes, Manjit Josen, Flavio D'Ascenzi, Sergio Mondillo, Giovanni Di Salvo Aortic regurgitation (AR) continues to be an important cause of morbidity and mortality in paediatric patients. While echocardiographic parameters are well established for the adults, there are no clear cut-off values for AR severity in children. Cardiac magnetic resonance (CMR) imaging is considered a “gold standard” for a quantitative evaluation of the AR, but it is not widely available. This study assesses which echo parameter can accurately define AR severity as assessed by CMR in paediatric patients. A total of 27 paediatric patients (12 ± 3 years, range 6-18 years) with different degree of AR underwent echo assessment within an average of 35 days from CMR. CMR included phase-contrast velocity-encoded imaging for the measurement of regurgitant fraction (RF). Severe AR was defined as RF>33%. Echo evaluation included vena contracta (VC), pressure half time (PHT), the ratio between the AR jet and the LVOT diameter (jet/LVOT), presence of holodiastolic reversal flow in abdominal aorta (abdAo), the ratio between the velocity-time integral of the reversal flow over the forward flow in descending aorta (echoRF). Among the studied parameters, the strongest predictor of severe AR, as assessed by CMR, was echoRF. ROC curve showed, for a cut-off>0.38, an AUC of 0.886 (p
       
  • Comparison of Usefulness of Cardiac Resynchronization Therapy in Patients
           with Type 1 Myotonic Dystrophy with –vs- without Left Bundle Branch
           Block
    • Abstract: Publication date: Available online 9 September 2019Source: The American Journal of CardiologyAuthor(s): Anish Nikhanj, Soori Sivakumaran, Haran Yogasundaram, Harald Becher, Shane Kimber, Zaeem A. Siddiqi, Gavin Y. Oudit Patients with type 1 myotonic dystrophy (MD1) show reduced LV systolic function in the presence of left bundle branch block (LBBB) due to electromechanical dyssynchrony. Our prospective study tracked a cohort of 64 MD1 patients that demonstrated a high burden of atrial and ventricular arrhythmias and conduction delays. Of these patients, 12 (19%) patients had LBBB, which was associated with reduced left ventricular systolic function. Eight of these patients received cardiac resynchronization therapy (CRT) devices resulting in reduction of median QRS complex duration from 173 ms to 166 ms (p = 0.04), and improvement in median left ventricular ejection fraction from 37% to 46% (p = 0.007). In conclusion, CRT device therapy is both feasible and effective in treating advanced cardiac disease in this vulnerable group of patients by improving left ventricular function.
       
  • Effect of Atrial Septal Defect in Adults on Work Participation (From a
           Nation Wide Register Based Follow-up Study Regarding Work Participation
           and Use of Permanent Social Security Benefits)
    • Abstract: Publication date: Available online 9 September 2019Source: The American Journal of CardiologyAuthor(s): Camilla Nyboe, Kirsten Fonager, Mogens Lytken Larsen, Jan Jesper Andreasen, Søren Lundbye-Christensen, Vibeke Hjortdal Low work participation is well known in patients with chronic disease but has not been described in patients with atrial septal defect (ASD). In this nation-wide cohort study we report the first long-term follow-up of use of permanent social security benefits and work participation in adults with ASD. All Danes born before 1994 and diagnosed with ASD between 1959-2013 (n=2,277) were identified from the Danish medical registries. We used Cox proportional hazards regression to compare the risk of receiving permanent social security benefits in the ASD patients compared with an age and gender matched general population cohort. Using the DREAM database we calculated work participation score and proportion of patients working or not working at the age of 30 years. Median follow-up from ASD diagnosis was 23.4 years (range 0.2-59.3). ASD patients had a higher risk of receiving permanent social security benefits (hazard ratio 2.3 (95% confidence interval 2.1-2.6)) compared with the comparison cohort with 24% of the ASD patients receiving permanent social security benefits at the end of follow up compared with 12% of the comparison cohort. At the age of 30 years, the proportion not working was 28% in the ASD cohort and 18% in the comparison cohort. In patients with ASD, 23% of those without a job had a psychiatric diagnosis. In conclusion, the risk of receiving permanent social security benefits was twice as high in patients with ASD and the work participation score was reduced compared with the background population.
       
  • Effect on Mortality of Systemic Thrombo-Inflammatory Response after
           Transcatheter Aortic Valve Implantation
    • Abstract: Publication date: Available online 9 September 2019Source: The American Journal of CardiologyAuthor(s): Łukasz Kalińczuk, Kamil Zieliński, Zbigniew Chmielak, Gary S. Mintz, Maciej Dąbrowski, Jerzy Pręgowski, Michał Proczka, Ilona Michałowska, Katarzyna Czerwińska-Jelonkiewicz, Hubert Łazarczyk, Marcin Demkow, Tomasz Hryniewiecki, Adam Witkowski After transcatheter aortic valve implantation (TAVI) there is consistently identified fall in platelets accompanied by a leucocyte (WBC) increase. We aimed to analyze the prognostic value of early platelet and WBC count changes (thrombo-inflammatory response) after successful TAVI. Among 432 consecutive patients [median 83.0 years of age, 63.4% female], platelets and WBCs were measured prior to and for 7 days post-TAVI. Follow-up was 36.9 (21.4-48.0) months. Platelet drop (∆%Platelet-max) and parallel WBC rise (∆%WBC-max) were seen at days 1-3. Both ∆%Platelet-max≤-37.6% and ∆%WBC-max>72.5% predicted mortality (AUC=0.569 and AUC=0.626). The 30-day and 1-year mortality (13.1% and 26.2%) were highest among 28% patients with a greater drop in platelets and a greater increase in WBCs; intermediate (0.9% and 12.3%) among 52.5% patients with either a greater drop in platelets or a greater increase in WBCs, but not both; and lowest (0% and 6.6%) among 19.5% patients with a lesser drop in platelets and a lesser increase in WBCs (p
       
  • Prediction and Prevention of Sudden Death in the Brugada Syndrome
    • Abstract: Publication date: Available online 9 September 2019Source: The American Journal of CardiologyAuthor(s): Shayna McEnteggart, N.A. Mark Estes Sudden cardiac death (SCD) secondary to sudden cardiac arrest (SCA) is a leading cause of death in the United States, claiming over a quarter million lives annually, and is directly responsible for 50% of all cardiovascular mortality. Brugada Syndrome (BrS) is an arrhythmogenic cardiovascular channelopathy that predisposes asymptomatic individuals who have no identified disease to a high-risk of SCD/SCA as their first cardiac event/disease manifestation. Limited progress has been made in risk prediction of SCA and SCD, with the greatest challenge being the ability to identify the small high-risk subgroups concealed within the larger general population. In conclusion, accurate identification of high-risk asymptomatic BrS individuals (via multiparametric risk scores composed of reliable and validated unambiguous clinical variables and biomarkers) may hold utility in improving current SCD prediction algorithms, and the appropriate primary prevention therapy may prove valuable in reducing risk of sudden death for this patient population. This systematic review aims to comprehensively summarize qualitative evidence that explore proposed clinical, electrocardiographic, electrophysiological, and genetic markers for risk stratification of individuals with BrS phenotype, and to discuss the best available contemporary evidence regarding therapeutic approach.
       
  • Relation of Lipid-lowering Therapy to Need for Aortic Valve Replacement in
           Patients with Asymptomatic Mild to Moderate Aortic Stenosis
    • Abstract: Publication date: Available online 7 September 2019Source: The American Journal of CardiologyAuthor(s): Anders M. Greve, Casper N. Bang, Kurt Boman, Kenneth Egstrup, Y. Antero Kesäniemi, Simon Ray, Terje R. Pedersen, Kristian Wachtell In this study, we aimed to determine if pretreatment low-density lipoprotein (LDL) levels and aortic stenosis (AS) severity alter the efficacy of lipid-lowering therapy on reducing aortic valve replacement (AVR). We used 1,687 patients with asymptomatic mild-to-moderate AS, who were randomly assigned (1:1) to 40/10 mg simvastatin/ezetimibe combination vs. placebo in the simvastatin and ezetimibe in Aortic Stenosis (SEAS) trial. Pretreatment LDL levels (>4mmol/L) and peak aortic jet velocity (3m/s) were used to partition study participants into 4 groups, which were followed for a primary endpoint of AVR. Cox regression with tests for interaction was used to study the effect of randomized treatment in each subgroup. During a median follow-up of 4.3 years (IQR 4.2-4.7 years; total 7,396 patient-years of follow-up), 478 (28%) patients underwent AVR and 146 (9%) died. A significant risk dependency was detected between simvastatin/ezetimibe combination, LDL levels and mild vs. moderate AS on rates of AVR (p=0.01 for interaction). In stratified analyses, randomized treatment, therefore, reduced the rate of AVR among patients with LDL levels>4mmol and mild AS at baseline (HR 0.4; 95%CI: 0.2-0.9). There was no detectable effect of randomized treatment on the need for AVR in the 3 other participants subgroups. We conclude, that in a secondary analysis from a prospective randomized clinical trial, treatment with simvastatin/ezetimibe combination reduced the need for AVR in a subset of patients with mild AS and high pretreatment LDL levels (Unique identifier on clinicaltrials.gov: NCT00092677).
       
  • Meta-analysis of the Relation of Television-Viewing Time and
           Cardiovascular Disease
    • Abstract: Publication date: Available online 6 September 2019Source: The American Journal of CardiologyAuthor(s): Hisato Takagi, Yosuke Hari, Kouki Nakashima, Toshiki Kuno, Tomo Ando, for the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group To determine whether television (TV) viewing is associated with cardiovascular disease (CVD) risk, we performed a meta-analysis of currently available prospective cohort studies. We systematically searched PubMed and Web of Science through April 2019. Eligible for inclusion in the present meta-analysis was a prospective cohort study investigating the association of TV viewing time with CVD risk (CVD prevalence, CVD incidence, cardiovascular events, and cardiovascular mortality). From each study, adjusted hazard ratios (HRs) of CVD risk were extracted. We separately combined study-specific estimates for dichotomous, tertile, quartile, and continuous values of TV viewing time in the random-effects model. The pooled analysis for dichotomous time demonstrated that CVD risk was significantly higher in the longer than shorter viewing (HR, 1.28; p = 0.02). In the meta-analysis for tertile time, CVD risk was significantly higher in the longest than shortest tertile (T1) (HR, 1.26; p = 0.0006), but there was no significant difference between the middle tertile and T1 (p = 0.51). The meta-analysis for quartile time indicated that CVD risk was significantly higher in the longest than shortest quartile (Q1) (HR, 1.32; p = 0.0007), but there were no significant differences between the second longest quartile and Q1 (p = 0.12) and between the second shortest quartile and Q1 (p = 0.60). In the meta-analysis for continuous time, longer viewing was significantly associated with higher CVD risk (HR per 1-h/day increment; 1.06; p = 0.005). In conclusion, longer TV viewing time is significantly associated with higher CVD risk.
       
  • National Trends in Incidence and Outcomes of Patients with Heart Failure
           Requiring Respiratory Support
    • Abstract: Publication date: Available online 6 September 2019Source: The American Journal of CardiologyAuthor(s): P. Elliott Miller, Shanti Patel, Aparna Saha, Avirup Guha, Sumeet Pawar, Priti Poojary, Parita Ratnani, Lili Chan, Stephan L. Kamholz, Carlos L. Alviar, Sean van Diepen, Khurram Nasir, Tariq Ahmad, Girish N. Nadkarni, Nihar R. Desai Despite increasing medical complexity in patients with heart failure (HF), there are limited data on incidence and outcomes for patients with HF needing respiratory support. This study sought to examine contemporary trends of respiratory support strategies among patients with HF. Using the National Inpatient Sample, we identified adults aged greater than 18 years hospitalized with a primary diagnosis of HF. We assessed for trends in the use of invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV), length of stay (LOS), hospital costs, and in-hospital mortality. From 2002-2014, we identified 9,508,768 HF hospitalizations, which included 202,340 (2.13%) and 257,549 (2.71%) patients that required IMV and NIV, respectively. Over the study period, the proportion of HF patients requiring IMV significantly decreased (3.25% in 2002 to 1.56% in 2014) while the use of NIV significantly increased from 0.95% to 7.25% (ptrend
       
  • Predictors and Incidence of Atrial Flutter After Catheter Ablation of
           Atrial Fibrillation
    • Abstract: Publication date: Available online 6 September 2019Source: The American Journal of CardiologyAuthor(s): Esra Gucuk Ipek, Joseph Marine, Eunice Yang, Mohammadali Habibi, Jonathan Chrispin, David Spragg, Ronald D Berger, Hugh Calkins, Saman Nazarian Atrial flutter (AFL) is a common form of arrhythmia recurrence after atrial fibrillation (AF) ablation. We aimed to define a) the incidence of AFL and b) the clinical factors associated with cavo-tricuspid isthmus dependent (typical) and atypical AFL, after AF ablation. The retrospective cohort consisted of 1029 patients that underwent initial radiofrequency AF ablation between May 2005 and December 2013 at a single academic center. Patients with missing follow-up data, history of AFL ablation, and those with undocumented AFL were excluded. Atrial volumes were measured using three-dimensional cardiac computed tomography or magnetic resonance imaging. A total of 607 patients were included in the final cohort (age 59.2±10.6 years, 76.0% male, 58.7% paroxysmal AF). During a median follow-up of 845 days (IQR 389-1597 days), 122 (20.1%) patients developed AFL. Of these, 17 had typical AFL, 98 had atypical AFL, and 7 patients had both circuits. In the multivariable Cox regression analysis, only right atrial volume index (HR 1.25 per 10 ml/m2, CI 95% 1.10-1.42) was associated with incident typical AFL; while persistent AF (HR 1.59, CI 95% 1.06-2.40), linear lesions (HR 1.58, CI 95% 1.02-2.46) and left atrial volume index (HR 1.17 per 10 ml/m2, CI 95% 1.07-1.27) were associated with incident atypical AFL. In conclusion, non-invasive measures of right and left atrial remodeling are strongly associated with incident AFL following AF ablation. Strategies to prevent incident AFL using these measures following index ablation warrant further investigation.
       
  • Effect of Body Mass Index on Ischemic and Bleeding Events in Patients
           Presenting with Acute Coronary Syndromes (From the START-ANTIPLATELET
           Registry)
    • Abstract: Publication date: Available online 6 September 2019Source: The American Journal of CardiologyAuthor(s): Paolo Calabrò, Elisabetta Moscarella, Felice Gragnano, Arturo Cesaro, Pia Clara Pafundi, Giuseppe Patti, Ilaria Cavallari, Emilia Antonucci, Plinio Cirillo, Pasquale Pignatelli, Gualtiero Palareti, Ferdinando Carlo Sasso, Vittorio Pengo, Paolo Gresele, Rossella Marcucci, the START-ANTIPLATELET collaboratorsABSTRACTThe protective effect of obesity on mortality in acute coronary syndromes (ACS) patients remains debated. We aimed at evaluating the impact of obesity on ischemic and bleeding events as possible explanations to the obesity paradox in ACS patients. For the purpose of this sub-study, patients enrolled in the START-ANTIPLATELET registry were stratified according to Body Mass Index (BMI) into three groups: normal,BMI
       
  • Resting Heart Rate, Short-Term Heart Rate Variability and Incident Atrial
           Fibrillation (from the Multi-Ethnic Study of Atherosclerosis (MESA))
    • Abstract: Publication date: Available online 6 September 2019Source: The American Journal of CardiologyAuthor(s): Mohammadali Habibi, Harjit Chahal, Philip Greenland, Eliseo Guallar, João A.C. Lima, Elsayed Z Soliman, Alvaro Alonso, Susan R. Heckbert, Saman Nazarian Evidence suggests an association between autonomic nervous system (ANS) function and atrial fibrillation (AF) development. We sought to examine the association of baseline resting heart rate (RHR) and short-term heart rate variability (HRV) as surrogates of (ANS) with incident AF in individuals without prior cardiovascular disease. A total of 6261 participants of the Multi Ethnic Study of Atherosclerosis (MESA) who were free of AF and diagnosed cardiovascular disease were enrolled. Three standard 10-second, 12-lead electrocardiograms were used to measure RHR, the standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive differences in RR intervals (RMSSD). Cox proportional hazards models adjusted for demographics, atrioventricular nodal agents, and known cardiovascular risk factors were used to examine the association of baseline RHR, and log transformed SDNN and RMSDD with incident AF. Over a mean follow-up of 11.3 ± 3.7 years, 754 (12%) participants developed AF. Spline curve analysis revealed a non-linear association between RHR, HRV and incident AF. In fully adjusted models higher (but not lower) baseline resting heart rate (RHR>76 beats/min) was associated with incident AF (HR: 1.48 95% CI: 1.18-1.86). Additionally, lower values of RMSDD and SDNN and higher values of RMSDD were independently associated with incident AF. In conclusion, cardiac ANS dysregulation indicated as higher RHR and lower HRV is associated with incident AF independent of known cardiovascular risk factors.
       
  • Relations Between Physical Activity, Subclinical Myocardial Injury, and
           Cardiovascular Mortality in the General Population
    • Abstract: Publication date: Available online 6 September 2019Source: The American Journal of CardiologyAuthor(s): Charles German, Muhammad Imtiaz Ahmad, Yabing Li, Elsayed Z. Soliman We examined the association between poor physical activity (PA) and subclinical myocardial injury (SC-MI), and how concomitant exposure to poor PA and SC-MI modifies their association with cardiovascular disease (CVD) mortality. This analysis included 6,044 participants free of CVD from the NHANES-III survey. Leisure time PA was defined as: ideal (3-5.99 METs and ≥5 times/week or any PA with ≥6METs and ≥3times/week), intermediate (any activity other than ideal), or poor (no activity at all). SC-MI was defined as an electrocardiographic cardiac infarction/injury score ≥10units. CVD mortality was ascertained from the National Death Index. In multivariable logistic regression analysis, poor PA (OR (95%CI): 1.30 (1.10-1.54)) and intermediate PA (OR (95%CI): 1.19 (1.02-1.38), compared to ideal PA, were associated with an increased odds of SC-MI. During a median follow-up of 14 years, 589 CVD deaths occurred. In multivariable Cox-proportional hazard analysis, the presence (vs. absence) of SC-MI was associated with a 33% increased risk of CVD mortality while poor (vs. ideal) PA was associated with a 67% increased risk of CVD mortality (HR (95%CI): 1.33 (1.11-1.58) and 1.67 (1.37-2.05), respectively). Additionally, the concomitant presence of both poor PA and SC-MI were associated with a higher risk of CVD mortality (HR (95%CI): 2.25(1.68-3.00)) compared to ideal PA and the absence of SC-MI. In conclusion, poor PA is associated with an increased risk of SC-MI and their concomitant presence is associated with a marked increase in CVD mortality, underscoring the potential role of PA in preventing clinical and subclinical CVD outcomes.
       
  • Circulating Levels of Biomarkers of Cerebral Injury in Patients with
           Atrial Fibrillation
    • Abstract: Publication date: Available online 6 September 2019Source: The American Journal of CardiologyAuthor(s): Oxana Galenko, Victoria Jacobs, Stacey Knight, Daniel Bride, Michael J. Cutler, Joseph B. Muhlestein, John L. Carlquist, Jeffrey L Anderson, Kirk U. Knowlton, T. Jared Bunch Atrial fibrillation (AF) is a source of altered brain perfusion and ischemia, potentially leading to cerebral injury and blood brain barrier (BBB) disruption, which may result in the permeation of neuro-specific molecules into the bloodstream. We retrospectively analyzed circulating levels of biomarkers of cerebral injury: astrocyte-specific glial acidic fibrillary protein (GFAP), calcium-binding protein B (S100 b), stress response marker growth differential factor 15 (GDF15), and microtubule associated Tau protein, in patients with AF and non-AF controls. A total of 196 AF cases and 47 non-AF controls were enrolled in this study all without prior clinical stroke or cerebral injury.  Plasma samples were obtained from the Intermountain INSPIRE biobank registry. AF status was determined at the time of the sample draw using clinical diagnosis. Assessment of circulating biomarkers was conducted with EIA. Multivariate linear modeling, using natural log and square root transformation of the biomarkers, was done adjusting for 1) CHA2DS2-VASc and anticoagulation, and 2) age, gender, coronary artery disease and anticoagulation. Circulating Tau, GDF15 and GFAP were elevated in AF cases. After multivariate adjustment, GFAP and Tau remained significantly elevated in the AF, while the signal for GDF15 was confounded by age. In conclusion, circulating biomarkers of neuronal and glial injury Tau and GFAP are elevated in patients with AF that are consistent with subclinical cerebral injury and disruption of the BBB, which can predispose these patients to the development of cognitive dysfunction and/or dementia later in life.
       
  • Effect on Survival of Concurrent Hemoconcentration and Increase in
           Creatinine During Treatment of Acute Decompensated Heart Failure
    • Abstract: Publication date: Available online 6 September 2019Source: The American Journal of CardiologyAuthor(s): Matthew Griffin, Veena S. Rao, James Fleming, Parinita Raghavendra, Jeffrey Turner, Devin Mahoney, Nicholas Wettersten, Alan Maisel, Juan B Ivey-Miranda, Lesley Inker, W.H. Wilson Tang, F. Perry Wilson, Jeffrey M. Testani Hemoconcentration during the treatment of acute decompensated heart failure (ADHF) is a surrogate for plasma volume reduction and is associated with improved survival, but most definitions only allow for hemoconcentration to be determined retrospectively. An increase in serum creatinine can also be a marker of aggressive decongestion, but in isolation is not specific. Our objective was to determine if combined hemoconcentration and worsening creatinine could better identify patients that were aggressively treated and, as such, may have improved post-discharge outcomes. A total of 4181 patients hospitalized with ADHF were evaluated. Those who experienced both hemoconcentration and worsening creatinine at any point had a profile consistent with aggressive in-hospital treatment and longer length of stay (p
       
  • Comparison of Frequency of Atherosclerotic Cardiovascular Disease Events
           Among Primary and Secondary Prevention Subgroups of the Systolic Blood
           Pressure Intervention Trial
    • Abstract: Publication date: Available online 6 September 2019Source: The American Journal of CardiologyAuthor(s): Timothy B Plante, Stephen P. Juraschek, Neil A Zakai, Russell P. Tracy, Mary Cushman The Pooled Cohort Equation (PCE) predicts 10-year risk of first-time atherosclerotic cardiovascular disease (ASCVD) events and was incorporated in analyses of a primary and secondary prevention population in the Systolic Blood Pressure Intervention Trial (SPRINT). Whether PCE enhances risk prediction among secondary prevention populations is unknown. We sought to compare ASCVD events by level of PCE-predicted risk among primary and secondary prevention SPRINT populations. SPRINT randomized adults with hypertension and ≥1 CVD risk factor or prior CVD events to systolic blood pressure (BP) control targeting
       
  • Meta-analysis Comparing Multivessel versus Culprit Coronary Arterial
           Revascularization for Patients with Non-ST-Segment Elevation Acute
           Coronary Syndromes
    • Abstract: Publication date: Available online 29 August 2019Source: The American Journal of CardiologyAuthor(s): Vincent R. Siebert, Sanket Borgaonkar, Xiaoming Jia, Hong Loan Nguyen, Yochai Birnbaum, Nasser M. Lakkis, Mahboob Alam We present a systematic review and meta-analysis comparing efficacy and safety outcomes between single procedure multivessel revascularization (MVR) and culprit vessel only revascularization (CVR) in patients presenting with non-ST-segment- elevation acute coronary syndrome (NSTE-ACS). NSTE-ACS is the most common form of acute coronary syndrome (ACS), and multivessel disease is common. There is no consensus on the most efficacious single procedure revascularization strategy for patients undergoing percutaneous coronary intervention (PCI) not meeting coronary artery bypass grafting (CABG) criteria. Studies in PubMed and EMBASE databases were systematically reviewed, and 15 studies met criteria for inclusion in the meta-analysis. Baseline characteristics between the groups were similar. A random effects model was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity of studies was assessed using Cochrane's Q and Higgins I2 tests. For short-term outcomes, patients undergoing MVR had higher rates of major adverse cardiac events (MACE) (OR: 1.14; 95% CI: 1.01 – 1.29; p=0.03); and stroke (OR: 1.94; 95% CI: 1.01-3.72; p=0.05), but lower rates of urgent or emergent CABG (OR: 0.35; 95% CI: 0.29 – 0.43; p
       
  • Outcomes with intravascular ultrasound-guided drug eluting stent
           implantation for unprotected left main coronary lesions: A meta-analysis
    • Abstract: Publication date: Available online 29 August 2019Source: The American Journal of CardiologyAuthor(s): Islam Y. Elgendy, Mohamed Gad, Ankur Jain, Ahmed N. Mahmoud, Gary S. Mintz
       
  • Corrigendum to “Cocaine, Amphetamine, and Cannabis Use Increases the
           Risk of Acute Myocardial Infarction in Teenagers” * [The American
           Journal of Cardiology 123/2 (2019) 354]
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Kamleshun Ramphul, Stephanie G. Mejias, Jyotsnav Joynauth
       
  • Noninvasive Mechanical Ventilation in Combination With Propofol Deep
           Sedation in Left Atrial Ablation Procedures: Yes, But Should Be Cautious
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Antonio M. Esquinas, Habib Md Reazaul Karim
       
  • Underlying Differences in the Treatment of Left Ventricular Thrombus With
           Non-Vitamin K Antagonist Oral Anticoagulants
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Aloysius Sheng-Ting Leow, Ching-Hui Sia, Benjamin Yong-Qiang Tan, Mark Yan-Yee Chan, Joshua Ping-Yun Loh
       
  • Readers' Comments An Explanation for the Effect of Different Storage
           Conditions on Sublingual Nitroglycerin Tablet Stability
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Linda A. Felton, David A. Lauber, Jason Koury, James J. Nawarskas
       
  • Chest Pain and Electrocardiographic Changes
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Mazen M. Kawji, D. Luke GlancyA 58-year-old man with his first episode of chest pain had an acute anterior myocardial infarct. After balloon angioplasty and stenting of a completely occluded left anterior descending coronary artery, the anterolateral ST-T changes had largely resolved.
       
  • “Embezzlement”
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Robert M. Doroghazi
       
  • Meta-Analysis of Relation of Skipping Breakfast With Heart Disease
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Hisato Takagi, Yosuke Hari, Kouki Nakashima, Toshiki Kuno, Tomo Ando, for the ALICE (All-Literature Investigation of Cardiovascular Evidence) GroupTo determine whether skipping breakfast is associated with heart disease, the first meta-analysis of currently available epidemiological studies was performed. To identify case-control, cross-sectional, longitudinal, or cohort studies investigating the association of skipping breakfast with prevalence, incidence, or mortality of heart disease in adults, PubMed, and Web of Science were searched through April 2019. Adjusted (if unavailable, unadjusted) hazard ratios (HRs) or odds ratios (ORs) with their confidence interval (CIs) of prevalence, incidence, or mortality for skipping breakfast were extracted from each study. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic HRs/ORs in the random-effects model. Eight eligible studies with a total of 284,484 participants were identified and included in the present meta-analysis. The primary meta-analysis combining HRs for Q1 (first quartile, most skipping breakfast) versus Q4 (fourth quartile, least skipping breakfast) from 3 studies together with other HRs/ORs demonstrated that skipping breakfast was associated with the significantly increased risk of heart disease (pooled HR/OR 1.24; 95% CI 1.09 to 1.40; p = 0.001). In sensitivity analyses combining HRs for Q2 (second quartile, second most skipping breakfast) versus Q4 or HRs for Q3 (third quartile, second least skipping breakfast) versus Q4 from 3 studies together with other HRs/ORs, the association of skipping breakfast with the increased risk of heart disease in the primary meta-analysis was confirmed. In conclusion, skipping breakfast is associated with the increased risk of heart disease.
       
  • Usefulness of Blunted Heart Rate Reserve as an Imaging-Independent
           Prognostic Predictor During Dipyridamole Stress Echocardiography
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Lauro Cortigiani, Clara Carpeggiani, Patrizia Landi, Mauro Raciti, Francesco Bovenzi, Eugenio PicanoA blunted heart rate (HR) response during dipyridamole myocardial perfusion imaging has been associated with a poor outcome. To assess the value of HR response in patients who underwent high-dose dipyridamole stress echocardiography (SE), we retrospectively selected a sample of 3,059 patients (none with pacemakers or atrial fibrillation; mean age 66 ± 11 years). All underwent high-dose (0.84 mg/kg) dipyridamole SE for evaluation of known or suspected coronary artery disease and/or heart failure in 2 laboratories of Pisa-IFC and Lucca. HR (with 12-lead ECG) was obtained each minute and recorded at rest and peak stress. HR reserve (HRR) was calculated as the peak/rest HR ratio. All patients were followed up. Patients were randomly divided into the modeling and validation group of equal size. During a median follow-up time of 1,004 days, 321 hard events occurred: 231 deaths and 90 nonfatal myocardial infarctions. HRR ≤ 1.22 identified by receiver operating characteristic analysis in the modeling group was an independent predictor of infarction-free survival in the modeling (hazard ratio 1.83, 95% confidence interval [CI] 1.30 to 2.60, p = 0.001), in the validation (hazard ratio 1.47, 95% CI 1.08 to 2.01, p = 0.02), and in the overall group (hazard ratio 1.60, 95% CI 1.27 to 2.02, p
       
  • Global Longitudinal Strain and Immune Status in Patients Living With Human
           Immunodeficiency Virus
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Fawaz Alenezi, Gerald S. Bloomfield, Nwora Lance Okeke, Poonam Velagapudi, Loai Abudaqa, Nkechinyere Ijioma, Allison Dunning, Hasan Alajmi, Meredith E. Clement, Svati H. Shah, Susanna Naggie, Eric J. VelazquezImprovement in survival in patients living with human immunodeficiency virus (PLHIV) has led to increased prevalence of cardiovascular disease. Whether HIV-associated immune dysfunction is associated with preclinical left ventricular (LV) dysfunction despite normal LV ejection fraction (LVEF) is unclear. Accordingly, we investigated the relation of immune status and LV function in PLHIV. Global longitudinal strain (GLS) analyses were performed retrospectively on all echocardiograms for PLHIV who had available HIV-1 RNA viral load, nadir, and proximal CD4 cell count data at Duke University Medical Center between 2001 and 2012. The relation between HIV-1 RNA viral load, nadir, and proximal CD4 count and GLS as a continuous dependent variable was assessed with unadjusted and adjusted linear regression. GLS was calculated for 253 PLHIV. Median GLS in our cohort was – 15.1% with interquartile range from (−16.7 to −13.6). All participants had an LVEF ≥50%. In adjusted analyses, proximal CD4
       
  • Trends of Inpatient Venous Thromboembolism in United States Before and
           After the Surgeon General's Call to Action
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Kathan D. Mehta, Sudeep K. Siddappa Malleshappa, Smit Patel, Smith Giri, Hong Wang, Roy Smith, Rahul A. ParikhVenous thromboembolism (VTE) is an important cause of morbidity and mortality in the United States (US). The increasing rates of VTE in the US resulted in the surgeon general issuing a call to action to reduce VTE in 2008. The objective of our study was to analyze the national trends of inpatient VTE in the US from 2004 to 2013 (5 years before and after 2008). We used the dataset National Inpatient Sample, Healthcare Cost and Utilization Project and measured trends of inpatient VTE by annual % change using joinpoint regression software. From 2004 to 2013 the National Inpatient Sample contained data on 78 million hospitalizations (weighted n = 385 million). In these 1.6 million had a diagnosis of VTE (2.0%, weighted n = 7.7 million) including 1.2 million with deep venous thrombosis (DVT) (1.53%, weighted n = 5.9 million) and 588,878 with pulmonary embolism (PE) (0.74%, weighted n = 2.8 million). Joinpoint regression analysis showed that rates of DVT and PE are increasing consistently from 2004 to 2013(1.27% to 1.80% for DVT and 0.52% to 0.92% for PE). The increasing rates of DVT and PE were consistent in all subgroups except few exceptions. In conclusion inpatient VTE rates continue to rise even after 5 years from the surgeon general's a call to action except in certain high-risk patients. Further research is needed to curb the VTE in patients especially among those perceived to be at lower risk of VTE.
       
  • Differentiating Constriction from Restriction (from the Mayo Clinic
           Echocardiographic Criteria)
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Salima Qamruddin, Saqer Khaled Alkharabsheh, Kimi Sato, Arnav Kumar, Paul C. Cremer, Michael Chetrit, Douglas R. Johnston, Allan L. KleinConstrictive Pericarditis (CP) is a curable and reversible form of severe diastolic heart failure. We aimed to investigate the diagnostic accuracy of published echocardiographic Mayo Clinic Criteria in differentiating 107 patients with surgically proven CP from 30 patients with restrictive cardiomyopathy due to cardiac Amyloidosis. Five principal echocardiographic and Doppler variables were remeasured on preoperative transthoracic echocardiogram namely (1) respiration-related ventricular septal shift; (2) respiratory variation in mitral inflow E pulsed Doppler velocity; 3) tissue Doppler medial mitral annular e’ velocity; (4) ratio of medial mitral annular e’ to lateral mitral annular e’ velocity; and 5) hepatic vein (HV) pulsed Doppler diastolic flow reversal ratio. Etiology of CP included viral/idiopathic or autoimmune (75%), postcardiac surgery (13%) and postradiation (7%). Univariate logistic regression analysis showed that (1) respiration related ventricular septal shift, (2) percentage change in Mitral E velocity, (3) medial e’ velocity ≥9 cm/sec, (4) medial e’/lateral e’ ratio ≥0.91, (5) HV diastolic reversal ratio ≥0.79 were associated with the diagnosis of CP. Multivariable logistic regression analyses showed that medial e’ velocity ≥9 cm/s was independently associated with the diagnosis of CP. Respiration related ventricular septal shift had the highest sensitivity, whereas medial e’ velocity ≥9 cm/s has the highest specificity to diagnose CP (Areas under curves 0.99, p 0.001). Combining respiration related ventricular septal shift with medial e’ velocity ≥9 cm/s gave a desirable sensitivity (80%) and specificity (92%). Adding reversal ratio to this combination further increased the specificity (97%) but dropped the sensitivity (70%) to diagnose CP.
       
  • Impact of Tricuspid Regurgitation in Patients With Heart Failure and
           Mitral Valve Disease from a Nationwide Cohort Study
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Amer N. Kadri, Rama D. Gajulapalli, Yasser M. Sammour, Johnny Chahine, Leen Nusairat, Mohamed M. Gad, Yasser Al-khadra, Adrian V. Hernandez, Florian Rader, Serge C. Harb, Samir KapadiaConcomitant heart failure (HF) and mitral valve disease (MVD) portend significant morbidity and mortality. Although associated Tricuspid regurgitation (TR) is a common occurrence in this scenario, it is not well known whether there are additional prognostic implications. We sought to assess whether coexistent TR is associated with higher readmission rates or increased mortality in patients with HF and MVD. We identified 1,520,871 encounters with a primary diagnosis of HF in the 2013 to 2014 Nationwide Readmission Database. We excluded patients without MVD, patients
       
  • Meta-Analysis for Impact of Statin on Mortality After Transcatheter Aortic
           Valve Implantation
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Hisato Takagi, Yosuke Hari, Kouki Nakashima, Toshiki Kuno, Tomo Ando, for the ALICE (All-Literature Investigation of Cardiovascular Evidence) GroupTo determine whether statin (hydroxymethylglutaryl-CoA reductase inhibitor) therapy is associated with better midterm survival after transcatheter aortic valve implantation (TAVI), the first meta-analysis of currently available studies was performed. To identify all observational comparative studies and randomized controlled trials (RCTs) of statin versus control (no statin) therapy or cohort studies investigating statin treatment as one of covariates in patients undergoing TAVI, PubMed, Web of Science, and Google Scholar were searched through March 2019. Adjusted (if unavailable, unadjusted) hazard ratios (HRs) with their confidence interval (CIs) of midterm (≥1 year) all-cause mortality after TAVI for statin therapy were extracted from each study. Study-specific estimates were combined by means of inverse variance-weighted averages of logarithmic HRs in the random-effects model. Eight eligible studies with a total of 5,170 TAVI patients were identified and included in the present meta-analysis. The primary meta-analysis (including HRs for high intensity statin from 3 studies together with other HRs) demonstrated that statin treatment was associated with significantly lower midterm mortality (HR, 0.74; 95% CI, 0.60 to 0.91; p = 0.005). The secondary meta-analysis (including HRs for low/moderate intensity statin from 3 studies together with other HRs) also indicated an association of statin therapy with significantly lower midterm mortality (HR, 0.80; 95% CI, 0.69 to 0.93; p = 0.005). No funnel plot asymmetry for the primary meta-analysis (p = 0.64) was identified, which suggested probably no publication bias. In conclusion, statin therapy is associated with better midterm survival after TAVI.
       
  • Defining Subclinical Myocardial Dysfunction and Implications for Patients
           With Diabetes Mellitus and Preserved Ejection Fraction
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Arnold C.T. Ng, Matteo Bertini, See Hooi Ewe, Enno T. van der Velde, Dominic Y. Leung, Victoria Delgado, Jeroen J. BaxLeft ventricular (LV) global longitudinal strain (GLS) can detect subclinical myocardial systolic dysfunction in individuals with diabetes. The present study investigates the clinical usefulness and incremental net benefit of identifying subclinical myocardial systolic dysfunction in individuals with diabetes. A cohort of 397 type 2 diabetic individuals was followed up for the occurrence of all-cause mortality. Clinical and echocardiographic data of diabetic patients were assessed retrospectively. LV GLS was evaluated on transthoracic echocardiography using speckle tracking imaging. Subclinical LV systolic dysfunction was defined as LV GLS> −17.0% from 104 healthy volunteers recruited from the community. A total of 178 (44.8%) diabetic individuals had evidence of subclinical LV systolic dysfunction and 46 (11.6%) died during follow-up. The presence of subclinical LV systolic dysfunction was independently associated with all-cause mortality on follow-up (hazard ratio [HR] 2.83, 95% confidence interval [CI] 1.40 to 5.71, p = 0.004). Diabetic individuals without subclinical LV systolic dysfunction had similar survival as the general population (standardized mortality ratio 0.94, 95% CI 0.52 to 1.58). Decision curve analysis showed identification of subclinical LV systolic dysfunction and quantification of LV GLS provided an incremental net clinical benefit at risk stratifying patients for risk of death at 5 years. In conclusion, subclinical LV systolic dysfunction is independently associated with all-cause mortality in diabetic patients. Decision curve analyses suggest use of LV GLS and identification of subclinical LV systolic dysfunction is clinically useful, and provided incremental net clinical benefit for diabetic individuals.
       
  • Interrelation Between Electrocardiographic Left Atrial Abnormality, Left
           Ventricular Hypertrophy, and Mortality in Participants With Hypertension
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Muhammad Imtiaz Ahmad, Mohammadtokir Mujtaba, Muhammad Ali Anees, Yabing Li, Elsayed Z. SolimanLeft ventricular hypertrophy (LVH) and left atrial abnormality (LAA) are common correlated complications of hypertension. It is unclear how common for electrocardiographic markers of LAA (ECG-LAA) to coexist with ECG-LVH and how their coexistence impacts their prognostic significance. This analysis included 4,077 participants (61.2 ± 13.0 years, 51.2% women, 48.6% whites) with hypertension from the Third National Health and Nutrition Examination Survey. ECG-LVH was defined by Cornell voltage criteria. ECG-LAA was defined as deep terminal negativity of P wave in V1>100 µV. Cox proportional hazard analysis was used to examine the associations between various combinations of ECG-LAA and ECG-LVH with all-cause mortality over a median follow-up of 14 years. The baseline prevalence of ECG-LVH, ECG-LAA, and the concomitant presence of both was 3.6%, 2.7%, and 0.34%, respectively. In a multivariable-adjusted model, mortality risk was highest in the group with concomitant ECG-LAA and ECG-LVH (hazard ratio [HR; 95% confidence interval {CI}] 2.69 [1.51, 4.80]), followed by isolated ECG-LAA (HR [95% CI] 1.63 [1.26, 2.12]), and then isolated ECG-LVH (HR [95% CI] 1.40 [1.08, 1.81]), compared with the group without ECG-LAA or ECG-LVH. Effect modification of these results by age and diabetes but not by gender or race was observed. In models with similar adjustment where ECG-LVH and ECG-LAA were entered as 2 separate variables and subsequently additionally adjusted for each other, the mortality risk was essentially unchanged for both variables. In conclusion, in participants with hypertension, ECG-LAA and ECG-LVH are independent markers of poor outcomes, and their concomitant presence carries a higher risk than either marker alone.
       
  • Meta-Analysis of Oral Anticoagulant Monotherapy as an Antithrombotic
           Strategy in Patients With Stable Coronary Artery Disease and Nonvalvular
           Atrial Fibrillation
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): So-Ryoung Lee, Tae-Min Rhee, Do-Yoon Kang, Eue-Keun Choi, Seil Oh, Gregory Y.H. LipGuidelines recommend oral anticoagulant (OAC) monotherapy without antiplatelet therapy (APT) in patients with nonvalvular atrial fibrillation (AF) with stable coronary artery disease (CAD) of>1 year after myocardial infarction or percutaneous coronary intervention. More evidences are required for the safety and efficacy of OAC monotherapy compared with OAC plus APT. PubMed, EMBASE, and Cochrane Database of Systematic Reviews were systematically searched up to February 2019. Nonrandomized studies and randomized clinical trials comparing OAC monotherapy with OAC plus single APT (SAPT) for patients with stable CAD and nonvalvular AF. The primary end point was major adverse cardiovascular events (composite of ischemic or thrombotic events) and secondary outcomes included major bleeding, stroke, all-cause death, and net adverse events (composite of ischemic, thrombotic, or bleeding events). From 6 trials, 8,855 patients were included. There was no significant difference in major adverse cardiovascular event in patients with AF treated using OAC plus SAPT compared with those treated with OAC monotherapy (hazard ratio [HR] 1.09; 95% confidence interval [CI] 0.92 to 1.29). OAC plus SAPT was associated with a significantly higher risk of major bleeding compared with OAC monotherapy (HR 1.61; 95% CI 1.38 to 1.87), as well as in terms of net adverse event (HR 1.21; 95% CI 1.02 to 1.43). There were no significant differences in rates of stroke and all-cause death. In conclusion, in this meta-analysis, OAC monotherapy and OAC plus SAPT treatment showed similar effectiveness, but OAC monotherapy was significantly associated with a lower risk of bleeding compared with OAC plus SAPT in patients with nonvalvular AF and stable CAD.
       
  • A Cluster Analysis of the Japanese Multicenter Outpatient Registry of
           Patients With Atrial Fibrillation
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Taku Inohara, Jonathan P. Piccini, Kenneth W. Mahaffey, Takehiro Kimura, Yoshinori Katsumata, Kojiro Tanimoto, Kohei Inagawa, Nobuhiro Ikemura, Ikuko Ueda, Keiichi Fukuda, Seiji Takatsuki, Shun KohsakaRecently, cluster analysis was used to identify unique clinically relevant phenotypes of atrial fibrillation (AF) in a cohort from the United States (US) and classified clusters according to the presence of comorbid behavioral disorders, those with conduction disorders, or atherosclerotic comorbidities. Whether these phenotypes are consistent in AF cohorts outside the US remains unknown. Thus, we sought to conduct a cluster analysis in a cohort of Japanese AF patients. We conducted a cluster analysis of phenotypic data (46 variables) in an AF patient cohort recruited from 11 Japanese sites participating in the KiCS-AF Registry. Overall, 2,458 AF patients (median [IQR] age, 68.0 [60.0 to 76.0]; 30.3% female; median [IQR] CHA2DS2-Vasc, 2 [1, 3]) were analyzed. Similar to the US cohort, atherosclerotic comorbidities were identified as distinguishing factors to characterize clusters. Distribution of AF type and left atrial (LA) size substantially varied and was the key feature for cluster formation. CHA2DS2-Vasc score also contributed to cluster formation, although behavioral disorders and/or conduction disorders did not readily characterize clusters. Subsequently, the cohort was classified into 3 clusters: (1) Younger paroxysmal AF (n = 1,190); (2) Persistent/permanent AF with LA enlargement (n = 1,143); and (3) Atherosclerotic comorbid AF in elderly patients (N = 125). In conclusion, conventional classifications, such as atherosclerotic risk factors and CHA2DS2-Vasc score contributed to cluster formation in mutually, whereas in nonatherosclerotic clusters, AF type or LA size rather than the presence or absence of behavior risk factors or sinus node dysfunction (tachy-brady syndrome) seemed to contribute to cluster formation in the Japanese cohort.
       
  • Changes in Management Following Detection of Previously Unknown Atrial
           Fibrillation by an Insertable Cardiac Monitor (from the REVEAL AF Study)
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Atul Verma, Rolf Wachter, Peter R. Kowey, Jonathan L. Halperin, Bernard J. Gersh, Mitchell S.V. Elkind, Rachelle E. Kaplon, Paul D. Ziegler, Lou Sherfesee, James A. ReiffelThe REVEAL AF study demonstrated a high incidence of previously undetected atrial fibrillation (AF) using insertable cardiac monitors (ICMs) in patients with risk factors for AF and stroke. This analysis evaluated whether ICM monitoring led to changes in clinical management after AF detection. Patients with CHADS2 scores ≥3 (or =2 with ≥1 additional AF risk factor) but no history of AF received an ICM and were followed 18 to 30 months. Physicians recorded changes in clinical management in response to AF detection at scheduled (every 6 months) and unscheduled follow-up visits. Changes in clinical management included oral anticoagulation, rhythm or rate control pharmacotherapy, cardioversion, ablation, and cardiac subspecialist referral. In 387 patients who met inclusion criteria and received an ICM, AF was found in 115. A change in clinical management was taken in 87 patients with AF (76%). In 80 of these 87, a change was taken at the first visit after AF detection. In total, 31 patients (27%) with AF had ≥2 visits at which changes in clinical management were taken. The most common change was initiation of oral anticoagulation (n = 73, 63% of patients with AF). Patients with a change in clinical management at the first visit after AF detection tended to have longer AF episodes and a higher maximal daily AF burden compared with AF patients for whom no change was taken (longest episode: 52 vs 28 minutes; maximal daily AF burden:112 vs 23 minutes). Changes in management more frequently occurred at visits where patients reported AF-compatible symptoms (65% vs 46% of visits, p = 0.01). In conclusion, ICM monitoring to identify AF guides both immediate and long-term patient management in a population at high risk for stroke.
       
  • Meta-Analysis Comparing the Risk of Myocardial Infarction Following
           Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention
           in Patients With Multivessel or Left Main Coronary Artery Disease
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Pil Hyung Lee, Hanbit Park, Ji Sung Lee, Seung-Whan Lee, Cheol Whan LeeThere is insufficient data regarding the comparative efficacy of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) regarding myocardial infarction (MI). Our systematic review included randomized controlled trials that compared CABG versus PCI with stents in patients with multivessel or left main coronary artery disease (CAD). Included trials should have had reported event number of MI and a clinical follow-up of one or more years. Data were pooled using a random-effects model. The primary end point was MI at the longest available follow-up in the intention-to-treat population. Fifteen trials with a total of 13,592 patients treated with either CABG (n = 6,596) or PCI (n = 6,996) were included. After a weighted follow-up of 4.5 years, patients treated with CABG had a significantly lower risk of MI than those treated with PCI (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.58 to 0.96, p = 0.024). The lower risk of MI with CABG as compared with PCI was more evident during a longer duration of follow-up (≥3 years, RR 0.69, 95% CI 0.52 to 0.91, p = 0.008; ≥5 years, RR 0.64, 95% CI 0.48 to 0.86, p = 0.003) and in the diabetic population (RR 0.55, 95% CI 0.44 to 0.70, p
       
  • Comparison of Acute Versus Subacute Coronary Angiography in Patients With
           NON-ST-Elevation Myocardial Infarction (from the NONSTEMI Trial)
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Martin B Rasmussen, Carsten Stengaard, Jacob T Sørensen, Ingunn S Riddervold, Hanne M Søndergaard, Troels Niemann, Karen Kaae Dodt, Lars Frost, Tage Jensen, Bent Raungaard, Troels M Hansen, Matthias Giebner, Claus-Henrik Rasmussen, Hans Erik Bøtker, Steen D Kristensen, Michael Maeng, Evald H Christiansen, Christian J TerkelsenThe optimal timing of coronary angiography (CAG) in high-risk patients with acute coronary syndrome without persisting ST-segment elevation (NST-ACS) remains undetermined. The NON-ST-Elevation Myocardial Infarction trial aimed to compare outcomes in NSTE-ACS patients randomized to acute CAG (STEMI-like approach) with patients randomized to medical therapy and subacute CAG. We randomized 496 patients with suspected NST-ACS based on symptoms and significant regional ST depressions and/or elevated point-of-care troponin T (POC-cTnT) (≥50 ng/l) to either acute CAG (
       
  • On the QT
    • Abstract: Publication date: 15 September 2019Source: The American Journal of Cardiology, Volume 124, Issue 6Author(s): Basil M. RuDusky
       
  • Temporal Trends in the Use of Intravascular Imaging Among Patients
           Undergoing Percutaneous Coronary Intervention for ST Elevation Myocardial
           Infarction in the United States.
    • Abstract: Publication date: Available online 27 August 2019Source: The American Journal of CardiologyAuthor(s): Gbolahan O Ogunbayo, Rachel P Goodwin, Ayman Elbadawi, Mohamed Omar, Dustin Hillerson, Elliott M Goodwin, Robert Pecha, Ahmed Abdel-Latif, Claude S Elayi, Adrian W Messerli
       
  • Author Reply to “Underlying Differences in the Treatment of Left
           Ventricular Thrombus with Non-Vitamin K Antagonist Oral Anticoagulants
    • Abstract: Publication date: Available online 24 August 2019Source: The American Journal of CardiologyAuthor(s): Adam Fleddermann, Charles Hayes, Anthony Magalski, Michael L. Main
       
  • Prevalence and Incidence of Atrial Fibrillation in Ambulatory Patients
           with Heart Failure
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of CardiologyAuthor(s): Pierpaolo Pellicori, Alessia Urbinati, Kuldeep Kaur, Jufen Zhang, Parin Shah, Syed Kazmi, Alessandro Capucci, John GF Cleland, Andrew L. Clark Heart failure (HF) and atrial fibrillation (AF) commonly co-exist. We aimed to determine the prevalence and incidence of AF in ambulatory patients with HF. HF was defined by the presence of symptoms or signs supported by objective evidence of cardiac dysfunction: either a left ventricular ejection fraction (LVEF) ≤45% (HFrEF), or LVEF>45% and a raised plasma concentration of amino-terminal pro-B type natriuretic peptide (NT-proBNP>220ng/L; HFpEF). Of 3,570 patients with HF, 1,164 were in AF at baseline (33%), with a higher prevalence among patients with HFpEF compared to HFrEF (40% vs 26%, respectively, p
       
  • Extracorporeal Membrane Oxygenation (ECMO): A Promising Option for
           Treating Adult Down Syndrome Patients'
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of CardiologyAuthor(s): Mohammad Uddin Faisal, Pulwasha Maria Iftikhar, Roopam Bansal, Azeem Hussain Arastu, Javiadullah Khan
       
  • Comparison of Two-year Outcomes of Acute Myocardial Infarction Caused by
           Coronary Artery Spasm Versus that Caused by Coronary Atherosclerosis
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of CardiologyAuthor(s): Ju Yeol Baek, Byoung Geol Choi, Seung-Woon Rha, Cheol Ung Choi, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh, Tae Hoon Ahn, Kiyuk Chang, Shung-Chull Chae, Seung Ho Hur, Kwang-Soo Cha, In-Ho Choi, Hyo-Soo Kim, Hyeon Cheol Gwon, Young Jo Kim, Seok Kyu Oh, Jei Keon Chae, In Whan Seong, Kyung-Kook Hwang The study compared the two-year outcomes of patients diagnosed with acute myocardial infarction (AMI) triggered by coronary artery atherosclerosis and AMI caused by coronary artery spasm. A total of 36,797 patients in the Korea AMI Registry were grouped into two categories: 1) AMI due to coronary artery spasm without stenotic lesion (CAS-AMI, N = 484); and 2) AMI induced by coronary artery atherosclerosis (CAA-AMI, N = 36,313). The major clinical outcomes of the two groups were compared over a two-year clinical follow-up period. Major adverse cardiac events (MACE) were defined as the composite of total death, non-fatal myocardial infarction, and repeat revascularization. The incidence of MACE (7.1% vs. 11.1%; p = 0.007) and repeat revascularization (0.4% vs. 4.2%; p < 0.001) in the CAS-AMI group were significantly lower than in the CAA-AMI group at two years. However, the incidence of total death and non-fatal myocardial infarction was similar in both the groups. Aborted cardiac arrest was strongly associated with two-year mortality in the CAS-AMI group (HR 13.5, 95% CI 5.34 to 34.15, p < 0.001) The incidence of MACE in CAS-AMI patients was significantly lower than in the CAA-AMI group of patients up to two years due to the relatively lower rate of repeat revascularization in CAS-AMI patients. However, the incidence of total death or non-fatal myocardial infarction in CAS-AMI patients was not different from that of patients with CAA-AMI.
       
  • Comparison of In-hospital Outcomes in Patients Having
           Limb-Revascularization with vs without Atrial Fibrillation
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of CardiologyAuthor(s): Homam Moussa Pacha, Yasser Al-khadra, Fahed Darmoch, Mohamad Soud, Anwar Zaitoun, Chun Shing Kwok, Mamas A. Mamas, Amir Kaki, Santiago Garcia, Subhash Banerjee, Salman A. Arain, George W. Vetrovec, James J. Glazier, M Chadi Alraies The impact of atrial fibrillation (AF) on clinical outcomes among patients with peripheral artery disease (PAD) who undergo limb revascularization procedures is not well understood. We aim to compare in-hospital outcomes for patients with and without AF who underwent limb revascularization. We identified patients with PAD aged ≥18 years that underwent limb revascularization using endovascular or surgical approaches in the National Inpatient Sample between 2002 and 2014. Multivariate logistic regression analysis was performed to examine in-hospital outcomes. A total of 2,283,568 patients underwent limb revascularization during the study duration and 294,469 (12.9%) had AF. Patients with AF were older (mean age 76.1 ± 10.0 years), more likely to be women and white, compared with non-AF group. Among patients who had surgical revascularization, AF was associated with a higher rates of in-hospital mortality (6.4% vs 2.5%, adjusted odds ratio[aOR]: 1.09 [95% CI: 1.05-1.12]) and major amputation (5.2% vs 3.8%, aOR: 1.05 [95% CI: 1.02 – 1.08]), compared with non-AF group. Among patients who had endovascular intervention (EVI), AF was associated with a higher rates of in-hospital mortality (3.8% vs 1.6%, aOR: 1.29 [95% CI: 1.24-1.33]) and major amputation (5.2% vs 3.9%, aOR: 1.07 [95% CI: 1.04 – 1.10]), compared with non-AF group. Within study period, EVI utilization increased in patients with and without AF (Ptrend < 0.001); whereas, surgical revascularization utilization decreased in patients with and without AF (Ptrend < 0.001). In conclusion, among patients with PAD who undergo limb revascularization, AF appears to be associated with poor in-hospital outcomes.
       
  • Impact of Insulin-Treated and Noninsulin-Treated Diabetes Mellitus in
           All-Comer Patients Undergoing Percutaneous Coronary Interventions with
           Polymer-Free Biolimus-Eluting Stent (from The RUDI-FREE Registry)
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of CardiologyAuthor(s): Martino Pepe, Gennaro Sardella, Giulio G. Stefanini, Nicola Corcione, Palma Luisa Nestola, Alberto Morello, Carlo Briguori, Corrado Tamburino, Franco Fabbiocchi, Francesco Luigi Rotolo, Fabrizio Tomai, Anita Paggi, Mario Lombardi, Gaetano Gioffrè, Rocco Sclafani, Andrea Rolandi, Alessandro Sciahbasi, Francesco Scardaci, Nicola Signore, Massimo ManconeABSTRACTPatients with diabetes mellitus (DM) have worse outcomes after PCI. Recent evidences suggest a differential impact of insulin-treated and noninsulin-treated DM on prognosis. We evaluated the clinical outcome of diabetic patients after PCI with polymer-free biolimus-eluting stent (PF-BES) from the RUDI-FREE Registry, investigating a possible different prognostic impact of insulin-treated and noninsulin-treated DM. A total of 1104 consecutive patients undergoing PCI with PF-BES, enrolled in the RUDI-FREE observational, multicenter, single-arm registry, were stratified by diabetic status; diabetic population was further divided on the basis of insulin treatment. Primary endpoints of the study were target lesion failure (TLF) (composite of cardiac death, target vessel myocardial infarction, target lesion revascularization) and major adverse cardiac and cerebrovascular events (MACCE) (composite of cardiac death, stroke, myocardial infarction). Multiple ischemic adverse events were also single-handedly considered as secondary endpoints. At 1 year, TLF was significantly higher in the diabetic cohort, as compared with non-diabetic patients (6.0% vs 3.1%, p 0.022). None of the endpoints resulted significantly different between non-diabetics and noninsulin-treated diabetic patients. Divergently, compared to non-diabetic, insulin-treated diabetic patients faced significant higher rates of TLF (10.8% vs 3.1%, p 0.003), MACCE (10.8% vs 3.4%, p 0.004), and of most of the analyzed adverse events. In conclusion, patients with DM had a higher risk of TLF compared to non-diabetics; nonetheless, the worse outcome of the diabetic population seems to be driven by the insulin-treated diabetic subpopulation. This finding suggests a different risk profile of insulin-treated and noninsulin-treated diabetic patients in the modern era of PCI.
       
  • Infliximab for Refractory Cardiac Sarcoidosis
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of CardiologyAuthor(s): Logan J Harper, Meghann McCarthy, Manuel L. Ribeiro Neto, Rory Hachamovitch, Karla Pearson, Barbara Bonanno, Josephine Shaiah, Richard Brunken, Emer Joyce, Daniel A Culver Cardiac sarcoidosis (CS) is frequently difficult to treat. Infliximab (IFX) is useful for extracardiac sarcoidosis, but its use in CS has been limited due to concerns about cardiotoxicity and an FDA blackbox warning about use in heart failure. We reviewed 36 consecutive patients treated with infliximab for CS refractory to standard therapies. IFX was initiated for patients with refractory dysrhythmias, moderate to severe cardiomyopathy, and evidence of persistent F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) scan, despite standard therapies. We compared the prednisone dose, ejection fraction (EF), and dysrhythmias before and after IFX therapy. The prednisone-equivalent steroid dose decreased from a median of 20 mg at initiation of infliximab to 7.5 at 6 months and 5mg at 12 months post initiation of infliximab (p
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
Home (Search)
Subjects A-Z
Publishers A-Z
Customise
APIs
Your IP address: 34.237.76.91
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-