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Publisher: Elsevier   (Total: 3163 journals)

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Showing 1 - 200 of 3163 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 30, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 88, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 35, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 394, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 244, 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: 10, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
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: 16, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3, SJR: 0.732, CiteScore: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 134, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 29, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, 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: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, 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: 28, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, 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: 11)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 43, 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: 53, 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: 15, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, 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: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
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: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 16, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, 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: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (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: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 385, 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: 10, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 335, 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: 10, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 436, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 10, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 50, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 51, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 43)
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: 203, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6, 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: 27, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 37, 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: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 15, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
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: 39, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 174, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)

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Journal Cover
American Journal of Cardiology
Journal Prestige (SJR): 1.93
Citation Impact (citeScore): 3
Number of Followers: 51  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9149 - ISSN (Online) 0002-9149
Published by Elsevier Homepage  [3163 journals]
  • Effects of Carvedilol Versus Metoprolol on Platelet Aggregation in
           Patients With Acute Coronary Syndrome: The PLATE-BLOCK Study
    • Authors: Federica Ilardi; Giuseppe Gargiulo; Gabriele Giacomo Schiattarella; Giuseppe Giugliano; Roberta Paolillo; Giovanni Menafra; Elena De Angelis; Laura Scudiero; Anna Franzone; Eugenio Stabile; Cinzia Perrino; Plinio Cirillo; Carmine Morisco; Raffaele Izzo; Valentina Trimarco; Giovanni Esposito
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Federica Ilardi, Giuseppe Gargiulo, Gabriele Giacomo Schiattarella, Giuseppe Giugliano, Roberta Paolillo, Giovanni Menafra, Elena De Angelis, Laura Scudiero, Anna Franzone, Eugenio Stabile, Cinzia Perrino, Plinio Cirillo, Carmine Morisco, Raffaele Izzo, Valentina Trimarco, Giovanni Esposito
      Platelet aggregation plays a pivotal role in acute coronary syndrome (ACS). In this setting, β-blockers (BBs) are used to counteract the effects of catecholamines on heart. Circulating catecholamines can also potentiate platelet reactivity, mainly through α2- and β2-adrenoceptors on human platelets' surface, thus BB may affect platelet aggregation; however, the effects of different BBs on platelet aggregation in contemporary-treated patients with ACS have been poorly investigated. One hundred patients with ACS on dual antiplatelet therapy with aspirin and ticagrelor were randomized to receive treatment with carvedilol, a nonselective BB (n = 50), or metoprolol, a selective β1-blocker (n = 50), at maximum tolerated dose. Light transmission aggregometry was performed at randomization (T0) and at 30-day follow-up (T30), and the results were expressed as a percentage of maximum platelet aggregation (MPA). The primary end point was epinephrine-induced MPA at 30 days. Patients were predominantly men (80%), and mean age was 57.3 ± 9.7 years. The 2 randomized groups were well balanced for baseline characteristics. At T0, mean MPA was similar between the groups (18.96 ± 9.05 vs 18.32 ± 9.21 with 10 µM epinephrine, 14.42 ± 9.43 vs 15.98 ± 10.08 with 20 µM adenosine diphophate (ADP), and 13.26 ± 9.83 vs 14.30 ± 9.40 with 10 µM ADP for carvedilol and metoprolol, respectively, all p = NS). At 30 days, platelet aggregation induced by epinephrine was significantly lower in the carvedilol group than in the metoprolol group (23.52 ± 10.25 vs 28.72 ± 14.37, p = 0.04), with a trend toward the lower values of ADP-induced MPA (20 µM ADP 19.42 ± 13.84 vs 24.16 ± 13.62, p = 0.09; 10 µM ADP 19.12 ± 12.40 vs 22.57 ± 13.59, p = 0.19). In conclusion, carvedilol, a nonselective BB, reduces residual platelet reactivity in patients with ACS compared with the selective BB, metoprolol.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.004
  • Predictors of Obstructive Coronary Disease and Mortality in Adults Having
           Cardiac Arrest
    • Authors: Jignesh K. Patel; Ganesh Thippeswamy; Abdo Kataya; Charles A. Loeb; Puja B. Parikh
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Jignesh K. Patel, Ganesh Thippeswamy, Abdo Kataya, Charles A. Loeb, Puja B. Parikh
      Coronary angiography is a key component of systematic, multi-disciplinary post–cardiac arrest (CA) care, however, coronary angiogram is not routinely performed in the setting of CA. We sought to identify the predictors of obstructive coronary artery disease (CAD) and mortality in adults with CA undergoing coronary angiogram. The study population included 208 consecutive patients hospitalized with CA who underwent resuscitation and subsequent coronary angiogram at an academic tertiary medical center. The primary outcome of interest was presence of obstructive CAD, defined as >1 coronary artery with >70% stenosis or >1 coronary bypass graft with >70% stenosis. The secondary outcome of interest was in-hospital mortality. Of the 208 patients studied, 160 (76.9%) had obstructive CAD while 48 (23.1%) did not. In-hospital mortality occurred in 47 patients (22.6%). In multivariate analysis, ST-elevation myocardial infarction (STEMI) (OR 7.69, 95% CI 2.89 to 20.51), defibrillation (OR 4.90, 95% CI 1.19 to 20.17), vasopressors (OR 3.53, 95% CI 1.15 to 10.81), and absence of therapeutic hypothermia (OR 0.38, 95% CI 0.15 to 0.98) were independently associated with presence of obstructive CAD while STEMI (OR 3.21, 95% CI 1.01 to 10.24), vasopressors (OR 4.92, 95% CI 1.78 to 13.62), therapeutic hypothermia (OR 3.89, 95% CI 1.47 to 10.31), and admission blood urea nitrogen (OR 1.06, 95% CI 1.00 to 1.11) were independently associated with higher rates of in-hospital mortality. In this observational contemporary study, predictors of obstructive CAD and mortality exist in adults with CA undergoing coronary angiogram. Such risk models may aid in identification of CA patients who will benefit from early angiography and percutaneous coronary intervention.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.023
  • Relation of Coronary Culprit Lesion Morphology Determined by Optical
           Coherence Tomography and Cardiac Outcomes to Serum Uric Acid Levels in
           Patients With Acute Coronary Syndrome
    • Authors: Nobuaki Kobayashi; Noritake Hata; Masafumi Tsurumi; Yusaku Shibata; Hirotake Okazaki; Akihiro Shirakabe; Masamichi Takano; Yoshihiko Seino; Wataru Shimizu
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Nobuaki Kobayashi, Noritake Hata, Masafumi Tsurumi, Yusaku Shibata, Hirotake Okazaki, Akihiro Shirakabe, Masamichi Takano, Yoshihiko Seino, Wataru Shimizu
      The aims of the present study were to elucidate features of culprit lesion plaque morphology using optical coherence tomography (OCT) in relation to elevated serum uric acid (sUA) levels and to clarify the impact of sUA levels on adverse clinical outcomes in patients with acute coronary syndrome (ACS). Clinical data and outcomes were compared between ACS patients with sUA ≥6 mg/dl (high-sUA; n = 506) and sUA <6.0 mg/dl (low-sUA; n = 608). Angiography and OCT findings were analyzed in patients with preintervention OCT and compared between groups of high-sUA (n = 206) and low-sUA (n = 273). Patients with high-sUA were more frequently male (88% vs 74%, p <0.001), younger (median 65 years vs 67 years, p = 0.017), more obese (median body mass index; 24.3 kg/m2 vs 23.2 kg/m2, p <0.001), and had a more frequent history of hypertension (72% vs 62%, p <0.001). ACS with lung congestion or cardiogenic shock was more prevalent in patients with high-sUA (30% vs 13%, p <0.001). Plaque rupture (54% vs 42%, p = 0.021) and red thrombi (55% vs 41%, p = 0.010) were more prevalently observed by OCT in patients with high-sUA. Kaplan–Meier estimate survival curves showed that the 2-year cardiac mortality was higher in patients with high-sUA (12.1% vs 4.2%, p <0.001). The multivariate Cox proportional hazard analysis showed that sUA values independently and significantly predicted cardiac death within 2 years (hazard ratio 1.41 [95% confidence interval 1.26 to 1.57], p <0.001). In conclusion, sUA levels are associated with culprit lesion coronary plaque morphology and raised sUA levels affect cardiovascular mortality after adjusting for several cardiovascular risk factors.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.022
  • Usefulness of Proneurotensin to Predict Cardiovascular and All-Cause
           Mortality in a United States Population (from the Reasons for Geographic
           and Racial Differences in Stroke Study)
    • Authors: Nicholas Wettersten; Mary Cushman; Virginia J. Howard; Oliver Hartmann; Gerasimos Filippatos; Neil Beri; Paul Clopton; George Howard; Monika M. Safford; Suzanne E. Judd; Andreas Bergmann; Joachim Struck; Alan S. Maisel
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Nicholas Wettersten, Mary Cushman, Virginia J. Howard, Oliver Hartmann, Gerasimos Filippatos, Neil Beri, Paul Clopton, George Howard, Monika M. Safford, Suzanne E. Judd, Andreas Bergmann, Joachim Struck, Alan S. Maisel
      Cardiovascular disease is a leading cause of death. Proneurotensin is a biomarker associated with the development of cardiovascular disease, cardiovascular mortality, and all-cause mortality. We assessed the association of fasting proneurotensin with mortal events by gender and race (black–white) in a US population. Using a case-cohort subpopulation of the Reasons for Geographic and Racial Differences in Stroke study, fasting proneurotensin was measured on a 1,046-person subcohort and in 651 participants with incident coronary heart disease. Higher proneurotensin was associated with all-cause mortality (hazard ratio [HR] 1.6 per interquartile range, 95% confidence interval [CI] 1.3 to 1.9) and cardiovascular mortality (HR 1.8, 95% CI 1.2 to 2.6). For all-cause and cardiovascular mortality, association was stronger in women (HR 1.9, 95% CI 1.4 to 2.6 and HR 2.5, 95% CI 1.4 to 4.7, respectively) than men (HR 1.4, 95% CI 1.0 to 1.8 and HR 1.4, 95% CI 0.9 to 2.3, respectively), although this difference was not significant. Proneurotensin predicted all-cause mortality in both races and was not predictive of cardiovascular mortality in whites but was in blacks. Proneurotensin was not associated with incident coronary heart disease events. Elevated proneurotensin levels predicted all-cause and cardiovascular mortality in both genders, with a trend toward stronger association in women. Associations were similar in blacks and whites. In conclusion, proneurotensin may be a useful biomarker for all-cause and cardiovascular mortality regardless of race, and it is potentially specific in women.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.009
  • Usefulness of Complement C1q to Predict 10-Year Mortality in Men With
           Diabetes Mellitus Referred for Coronary Angiography
    • Authors: Erdal Cavusoglu; John T. Kassotis; Ayesha Anwar; Jonathan D. Marmur; Syed Wasif Hussain; Sunitha Yanamadala; Sudhanva Hegde; Alexander Parpas; Calvin Eng; Ming Zhang
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Erdal Cavusoglu, John T. Kassotis, Ayesha Anwar, Jonathan D. Marmur, Syed Wasif Hussain, Sunitha Yanamadala, Sudhanva Hegde, Alexander Parpas, Calvin Eng, Ming Zhang
      The complement system consists of a family of proteins that play a critical role in the innate immune system. Complement activation has been implicated in many chronic inflammatory diseases, including atherosclerosis. However, a number of experimental studies have highlighted a beneficial role of component C1q in early atherosclerosis and in diabetes mellitus (DM). Despite these data, there have been no studies that have specifically examined the utility of plasma complement C1q as a clinical biomarker in patients with known or suspected coronary artery disease. In this study, baseline plasma complement C1q levels were measured in 159 men with DM who were referred for coronary angiography and who were followed up prospectively for the development of all-cause mortality for 10 years. After adjustment for baseline clinical, angiographic, and laboratory parameters, reduced plasma complement C1q levels were an independent predictor of all-cause mortality at 10 years (hazard ratio 0.66, 95% confidence interval 0.52 to 0.84, p = 0.0006). In additional multivariate models that adjusted for a variety of biomarkers with established prognostic efficacy, complement C1q remained an independent predictor of all-cause mortality at 10 years. In conclusion, reduced levels of complement C1q are associated with an increased risk of all-cause mortality at 10 years in patients with DM referred for coronary angiography. Furthermore, this association is independent of a variety of clinical, angiographic, laboratory variables, including biomarkers with established prognostic efficacy in the prediction of adverse cardiovascular outcomes.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.008
  • Markers of Reperfusion and Long-Term (8-Year) Prognosis after Primary
           Percutaneous Coronary Intervention
    • Authors: Gjin Ndrepepa; Robert A. Byrne; Salvatore Cassese; Massimiliano Fusaro; Roisin Colleran; Julia Hieber; Karl-Ludwig Laugwitz; Heribert Schunkert; Adnan Kastrati
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Gjin Ndrepepa, Robert A. Byrne, Salvatore Cassese, Massimiliano Fusaro, Roisin Colleran, Julia Hieber, Karl-Ludwig Laugwitz, Heribert Schunkert, Adnan Kastrati
      Thrombolysis in Myocardial Infarction (TIMI) flow, myocardial perfusion grade (MPG), and infarct size are established markers of reperfusion in patients with ST-segment elevation myocardial infarction. Whether these markers provide long-term prognostic information remains unknown. This study included 1,406 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention. Postreperfusion TIMI flow, MPG, and infarct size (evaluated by scintigraphy at 7 to 14 days) were measured. The primary outcome was 8-year mortality. Overall there were 190 deaths. The Kaplan-Meier estimates of mortality were 22.6% (37 deaths) and 16.8% (153 deaths) according to TIMI flow ≤2 and TIMI flow 3 (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.66 to 1.00, p = 0.058 for 1 grade increment), 21.6% (106 deaths) and 14.5% (84 deaths) according to MPG ≤2 and MPG 3 (adjusted HR 0.87 [0.77 to 0.98], p = 0.020 for 1 grade increment) and 21.7% (115 deaths) and 13.7% (75 deaths) according to infarct size >10% (median value) and infarct size ≤10% of the left ventricle (adjusted HR 1.08 [1.03 to 1.13], p = 0.001, for 5% of left ventricle increment in infarct size). The C statistic of the model for all-cause mortality was 0.810 (0.781 to 0.839) with baseline variables, 0.812 (0.783 to 0.841) after incorporation of TIMI flow (P for significance compared to the model with baseline variables = 0.140), 0.813 (0.784 to 0.841) after incorporation of MPG (p = 0.345) and 0.815 (0.786 to 0.842) after incorporation of infarct size (p = 0.08). In conclusion, markers of reperfusion independently predict long-term mortality after primary percutaneous coronary intervention but offer limited incremental prognostic value to that provided by evaluation of baseline cardiovascular risk factors and clinical data.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.353
  • A Randomized Double-Blind Placebo-Controlled Study Comparing Intracoronary
           Versus Intravenous Abciximab in Patients With ST-Elevation Myocardial
           Infarction Undergoing Transradial Rescue Percutaneous Coronary
           Intervention After Failed Thrombolysis
    • Authors: Olivier F. Bertrand; Éric Larose; Rodrigo Bagur; Frédéric Maes; Valérie Gaudreault; Bernard Noël; Gérald Barbeau; Jean-Pierre Déry; Charles Pirlet; Olivier Costerousse
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Olivier F. Bertrand, Éric Larose, Rodrigo Bagur, Frédéric Maes, Valérie Gaudreault, Bernard Noël, Gérald Barbeau, Jean-Pierre Déry, Charles Pirlet, Olivier Costerousse
      The risk and benefit ratio of glycoprotein IIb/IIIa inhibitors with dual oral antiplatelet therapy after failed thrombolysis and rescue percutaneous coronary intervention (PCI) is unclear. Using a randomized placebo-controlled, double-blind design, we compared intravenous (IV) and intracoronary (IC) abciximab delivery in 74 patients referred for rescue transradial PCI. The primary angiographic end points were the final thrombolysis in myocardial infarction flow and myocardial blush grades. Secondary end points included acute and 6-month outcomes using angiographic parameters, platelet aggregation parameters, cardiac biomarkers, cardiac magnetic resonance measurements (CMR) and clinical end points. After rescue PCI, normal thrombolysis in myocardial infarction 3 flows were obtained in 70% in the IC group, 48% in the IV group, and 71% in the placebo group, respectively (p = 0.056). Final myocardial blush grades 2 and 3 were obtained in 43% and 39% in the IC group, 48% and 26% in the IV group, and 46% and 42% in the placebo group (p = 0.67), respectively. Acutely, peak release of cardiac biomarkers, necrosis size, myocardial perfusion and no-reflow as assessed by CMR, and clinical end points were similar between the groups and did not suggest a benefit for IC or IV abciximab compared with placebo. There was no increase in bleeding or access site-related complications with abciximab compared with placebo. Clinical, angiographic, and CMR outcomes at 6 months remained comparable between the groups. In patients with ST-elevation myocardial infarction presenting with failed thrombolysis undergoing transradial rescue PCI, IC or IV abciximab had no significant clinical impact.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.007
  • Three-Year Impact of Immediate Invasive Strategy in Patients With
           Non–ST-Segment Elevation Myocardial Infarction (from the RIDDLE-NSTEMI
    • Authors: Dejan Milasinovic; Aleksandra Milosevic; Zorana Vasiljevic-Pokrajcic; Jelena Marinkovic; Vladan Vukcevic; Branislav Stefanovic; Milika Asanin; Sanja Stankovic; Branislava Ivanovic; Goran Stankovic
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Dejan Milasinovic, Aleksandra Milosevic, Zorana Vasiljevic-Pokrajcic, Jelena Marinkovic, Vladan Vukcevic, Branislav Stefanovic, Milika Asanin, Sanja Stankovic, Branislava Ivanovic, Goran Stankovic
      Previous studies compared clinical outcomes of early versus delayed invasive strategy in patients with non–ST-elevation acute coronary syndrome up to 1-year follow-up, but long-term data remain scarce. Our aim was to evaluate the long-term effects of immediate invasive intervention in patients with Non–ST-Segment Elevation Myocardial Infarction (NSTEMI). The Randomized Study of Immediate Versus Delayed Invasive Intervention in Patients With Non–ST-Segment Elevation Myocardial Infarction (RIDDLE-NSTEMI) was a randomized, investigator-initiated, parallel-group trial that assigned 323 patients with NSTEMI (1:1) to either immediate (median time to intervention 1.4 hours) or delayed invasive strategy (61.0 hours). The primary end point was the composite of death or new myocardial infarction (MI). At 3 years, immediate invasive intervention was associated with a lower rate of death or new MI, compared with a delayed invasive strategy (12.3% vs 22.5%, hazard ratio 0.50, 95% confidence interval 0.29 to 0.87, p = 0.014). The observed benefit of immediate intervention was mainly driven by an increased early reinfarction risk in delayed strategy, with similar new MI rates beyond 30 days (4.4% in the immediate and 5.6% in the delayed group, p = 0.61). Three-year mortality was 9.3% in the immediate invasive strategy, and 10.0% in the delayed strategy (p = 0.83). High baseline Global Registry of Acute Coronary Events score (>140) was associated with a significant increase in long-term mortality, regardless of the timing of invasive intervention. In conclusion, whereas immediate invasive intervention significantly reduced the early risk of new MI, the timing of invasive intervention appears to have no significant impact on clinical outcomes beyond 30 days, which seem to mostly be related to the baseline clinical risk profile.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.006
  • Meta-Analysis Comparing Outcomes After Everolimus-Eluting Bioresorbable
           Vascular Scaffolds Versus Everolimus-Eluting Metallic Stents in Patients
           with Acute Coronary Syndromes
    • Authors: Roberta De Rosa; Angelo Silverio; Attilio Varricchio; Giuseppe De Luca; Marco Di Maio; Ilaria Radano; Marta Belmonte; Maria Carmen De Angelis; Elisabetta Moscarella; Rodolfo Citro; Federico Piscione; Gennaro Galasso
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Roberta De Rosa, Angelo Silverio, Attilio Varricchio, Giuseppe De Luca, Marco Di Maio, Ilaria Radano, Marta Belmonte, Maria Carmen De Angelis, Elisabetta Moscarella, Rodolfo Citro, Federico Piscione, Gennaro Galasso
      Acute coronary syndromes (ACS) may represent an intriguing clinical scenario for implantation of bioresorbable vascular scaffold (BRS). Nevertheless, the knowledge about the performance of these devices in patients with ACS is limited. Therefore, we performed a meta-analysis of clinical studies aiming to assess the safety and efficacy of everolimus-eluting-BRS versus everolimus-eluting-metallic stents (EES) in ACS patients undergoing percutaneous coronary intervention. Six studies enrolling 2,318 patients were included and analyzed for the risk of primary safety outcome (stent or scaffold thrombosis [ST/ScT]), primary efficacy outcome (target lesion revascularisation [TLR]), and secondary outcomes (myocardial infarction, cardiac death, all-cause death). Median follow-up was 9.5 (6 to 19.5) months. Patients treated with BRS had a significantly higher risk of definite ST/ScT compared with those receiving EES (2.3% vs 1.08%, odds ratio [OR] 2.22, 95% confidence interval [CI] 1.10 to 4.45, p = 0.03, I2 = 0%). Similarly, the risk of TLR was significantly higher in the BRS compared with EES group (3.5% vs 2.5%, OR 1.79, 95% CI 1.02 to 3.16, p = 0.04, I2 = 0%). When TLRs due to thrombosis were excluded, the difference in risk estimates between the 2 groups was no longer significant (OR 1.19, 95% CI 0.48 to 2.98, p = 0.71, I2 = 25%). Risk for secondary endpoints did not differ between the 2 groups. Results were confirmed when clinical and procedural variables were tested as potential effect modifiers in the meta-regression analysis for both primary endpoints. In conclusion, compared with those receiving EES, patients with ACS treated with BRS had increased risk of definite device thrombosis and TLR at mid-term follow-up.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.003
  • Atrial Fibrillation Manifestations Risk Factors and Sex Differences in a
           Population-Based Cohort (From the Gutenberg Health Study)
    • Authors: Christina Magnussen; Francisco M. Ojeda; Philipp S. Wild; Nils Sörensen; Thomas Rostock; Boris A. Hoffmann; Jürgen Prochaska; Karl J. Lackner; Manfred E. Beutel; Maria Blettner; Norbert Pfeiffer; Nargiz Rzayeva; Christoph R. Sinning; Stefan Blankenberg; Thomas Münzel; Tanja Zeller; Renate B. Schnabel
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Christina Magnussen, Francisco M. Ojeda, Philipp S. Wild, Nils Sörensen, Thomas Rostock, Boris A. Hoffmann, Jürgen Prochaska, Karl J. Lackner, Manfred E. Beutel, Maria Blettner, Norbert Pfeiffer, Nargiz Rzayeva, Christoph R. Sinning, Stefan Blankenberg, Thomas Münzel, Tanja Zeller, Renate B. Schnabel
      Sex differences in cardiovascular risk factors, cardiac structure and function, and disease and symptom burden in the common arrhythmia atrial fibrillation (AF) have not been investigated systematically at the population level. Cross-sectional data of 14,796 subjects (age range 35 to 74 years, 50.5% men) from the population-based Gutenberg Health Study were examined to show the distribution of cardiovascular risk factors by AF status and sex, and to determine sex-specific predictors for AF. The prevalence of AF was higher in men (4.3%) than in women (1.9%). Men had a worse cardiovascular risk factor profile, a higher prevalence of cardiovascular disease, but fewer symptoms than women. Age-adjusted Cox regressions showed sex interactions in the association of high-density lipoprotein-cholesterol, triglycerides, diabetes mellitus, coronary artery disease, myocardial infarction, generalized anxiety disorder, and heart rate with AF. After multivariable adjustment, sex interactions were seen for thickness of interventricular end-diastolic septum, odds ratio (OR) per standard deviation (SD), 95% confidence interval women: 0.9 (0.8, 1.1), men: 1.2 (1.1, 1.4), interaction p value = 0.02; left atrial diameter index, OR per SD women: 1.5 (1.3, 1.8), men: 1.9 (1.7, 2.1), interaction p value = 0.03; and myocardial infarction, OR women: 2.7 (1.3, 5.6), men: 0.7 (0.5, 1.1), interaction p value = 0.002. In conclusion, in our large cohort, we observed substantial sex differences in AF distribution and clinical characteristics including comorbidities, symptom burden, and structural cardiac changes.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.028
  • Relation of Left Atrial Appendage Remodeling by Magnetic Resonance Imaging
           and Outcome of Ablation for Atrial Fibrillation
    • Authors: Promporn Suksaranjit; Nassir F. Marrouche; Frederick T. Han; Alan Morris; Gagandeep Kaur; Tyson Oswald; Brent D. Wilson
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Promporn Suksaranjit, Nassir F. Marrouche, Frederick T. Han, Alan Morris, Gagandeep Kaur, Tyson Oswald, Brent D. Wilson
      The left atrial appendage (LAA) is a nonpulmonary vein trigger site in atrial fibrillation (AF). The association of LAA structural remodeling (SRM) identified by late gadolinium enhancement magnetic resonance imaging (LGE-MRI) and AF ablation outcome has never been described. This study sought to investigate the clinical significance of LAA-SRM in AF patients who undergo ablation therapy. Consecutive patients with AF who underwent catheter ablation therapy within 14 days following MRI scan were included in this study. LAA-SRM was assessed using LGE-MRI images to quantify the extent of LAA-LGE. Patients were followed for arrhythmia recurrence after the ablation procedure. A total of 74 patients were included in the study, 68% were male, with a mean age of 72 years. Mean LAA-LGE extent was 9%. There were 37 arrhythmia recurrences (50%) observed over a mean follow-up period of 18 months. The recurrence rate was significantly higher (73.3% vs 37.5%; p = 0.045) in patients with LAA-LGE extent in the highest tier (T4) compared with the lowest tier (T1). LAA-LGE extent was independently associated with arrhythmia recurrence (adjusted hazard ratio [HR] 1.054; 95% confidence interval [CI] 1.008 to 1.103). In addition, there was an approximately fourfold increased risk of arrhythmia recurrence (adjusted HR 4.117, 95% CI 1.260 to 13.459) in patients with advanced LAA-SRM (T4 vs T1). In conclusion, the extent of LAA-SRM identified by LGE-MRI is associated with arrhythmia recurrence after AF ablation.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.027
  • Left Atrial Reverse Remodeling After Catheter Ablation of Nonparoxysmal
           Atrial Fibrillation in Patients With Heart Failure With Reduced Ejection
    • Authors: Takafumi Oka; Koichi Inoue; Koji Tanaka; Yuichi Ninomiya; Yuko Hirao; Nobuaki Tanaka; Masato Okada; Hiroyuki Inoue; Ryo Nakamaru; Yasushi Koyama; Atsunori Okamura; Katsuomi Iwakura; Yasushi Sakata; Kenshi Fujii
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Takafumi Oka, Koichi Inoue, Koji Tanaka, Yuichi Ninomiya, Yuko Hirao, Nobuaki Tanaka, Masato Okada, Hiroyuki Inoue, Ryo Nakamaru, Yasushi Koyama, Atsunori Okamura, Katsuomi Iwakura, Yasushi Sakata, Kenshi Fujii
      The efficacy of catheter ablation (CA) of nonparoxysmal atrial fibrillation (PAF) in patients with left ventricular systolic dysfunction is controversial. We investigated the outcomes of CA for non-PAF in patients with reduced left ventricular ejection fraction (LVEF) and the impact of early left atrial (LA) reverse remodeling on these outcomes. A total of 251 consecutive patients who underwent CA for non-PAF were divided into 2 groups (reduced: preoperative LVEF ≤55%, LVEF: 46.5 ± 8.7%, n = 63; normal: >55%, 65.8 ± 5.8%, n = 188). We analyzed the 4-year atrial fibrillation- or atrial tachycardia (AT)-free survival rate and assessed changes in LVEF, hemodynamics, and LA reverse remodeling at the end of a 90-day blanking period. We also evaluated LA reverse remodeling in patients with and without recurrence. The atrial fibrillation- or AT-free survival rates were similar (reduced vs normal 48% vs 42%, p = 0.32). The reduced group exhibited significant LVEF improvement (before vs after, 46.5 ± 8.7% vs 58.4 ± 11.5%, p <0.001), reduced mitral regurgitation, and spectral tissue Doppler-derived index, and had greater percent maximum left atrial volume reduction (reduced vs normal 25.3 ± 18.2% vs 19.3 ± 16.2%, p = 0.014). Percent maximum left atrial volume reduction was greater in patients without recurrence (with recurrence vs without recurrence 17.3 ± 16.7% vs 25.4 ± 16.1%, p <0.001). In conclusion, the efficacy of non-PAF CA in patients with reduced LVEF was comparable with that in patients with normal LVEF. Greater LA reverse remodeling in these patients suggests an association with a reduced recurrence rate.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.026
  • Usefulness of a Low Resting Heart Rate to Predict Recurrence of Atrial
           Fibrillation After Catheter Ablation in People ≥65 Years of Age
    • Authors: Jintao Wu; Xianwei Fan; Haitao Yang; Lijie Yan; Xianjing Xu; Hongyan Duan; Shanling Wang; Yingjie Chu
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Jintao Wu, Xianwei Fan, Haitao Yang, Lijie Yan, Xianjing Xu, Hongyan Duan, Shanling Wang, Yingjie Chu
      A low resting heart rate (RHR) is associated with an increased risk of atrial fibrillation (AF), and this is common in older people. Whether a low RHR in older people can predict recurrence of AF after catheter ablation is unclear. A total of 329 consecutive patients ≥65 years of age with paroxysmal AF who underwent index circumferential pulmonary vein isolation were prospectively enrolled. A 10-second standard resting 12-lead electrocardiogram in sinus rhythm was recorded to measure the RR interval, P-wave duration, and PR interval. The RHR was calculated based on the mean RR interval. During a mean follow-up period of 17.0 ± 8.3 months (range, 3 to 32 months), 96 (29.2%) patients developed recurrence of AF. The AF recurrence rate was 46.2%, 32.3%, and 25.4% in patients with an RHR <50, 50 to 59, and ≥60 beats/min, respectively (log-rank test, p = 0.009). Cox regression analysis with adjustment for P-wave duration and the CHADS2 score showed that an RHR <50 beats/min (hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.12 to 3.28, p = 0.017), advanced interatrial block (HR 1.82, 95% CI 1.09 to 3.04, p = 0.022), and left atrial diameter (HR 1.05, 95% CI 1.00 to 1.09, p = 0.029) were independent predictors of recurrence of AF after catheter ablation. In conclusion, in people ≥65 years of age, an RHR <50 beats/min is an independent predictor of AF recurrence in patients who have undergone catheter ablation for paroxysmal AF.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.025
  • Relation Between Lipid Profile and New-Onset Atrial Fibrillation in
           Patients With Systemic Hypertension (From the Swedish Primary Care
           Cardiovascular Database [SPCCD])
    • Authors: Georgios Mourtzinis; Thomas Kahan; Kristina Bengtsson Boström; Linus Schiöler; Louise Cedstrand Wallin; Per Hjerpe; Jan Hasselström; Karin Manhem
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Georgios Mourtzinis, Thomas Kahan, Kristina Bengtsson Boström, Linus Schiöler, Louise Cedstrand Wallin, Per Hjerpe, Jan Hasselström, Karin Manhem
      The relation between dyslipidemia and atrial fibrillation (AF) development is still controversial. To assess the impact of lipid profile on new-onset AF, we followed 51,020 primary-care hypertensive patients without AF at baseline. After a mean follow-up time of 3.5 years, AF occurred in 2,389 participants (4.7%). We evaluated the association between total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and new-onset AF. In a Poisson regression model fully adjusted for common risk factors of AF, we found that 1.0 mmol/l (39 mg/dl) increase in total cholesterol was associated with 19% lower risk of new-onset AF (95% confidence interval [CI] 9% to 28%), and 1.0 mmol/l (39 mg/dl) increase in low-density lipoprotein cholesterol was associated with 16% lower risk of new-onset AF (95% CI 3% to 27%). Gender-specific Poisson regression analyses revealed that increase in total cholesterol by 1.0 mmol/l (39 mg/dl) was found to be associated with lower risk of new-onset AF with 21% in men (95% CI 8% to 32%), and 18% in women (95% CI 1% to 31%). There was no association between high-density lipoprotein cholesterol or triglycerides and new-onset AF, neither in the whole population with respect to separate gender. In conclusion, in a large hypertensive population we found an inverse association between total cholesterol and new-onset AF for both men and women. Our results confirm previous reports of a dyslipidemia paradox, and extend these observations to the hypertensive population.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.024
  • Usefulness of Tricuspid Annular Diameter to Predict Late Right Sided Heart
           Failure in Patients With Left Ventricular Assist Device
    • Authors: Koki Nakanishi; Shunichi Homma; Jiho Han; Hiroo Takayama; Paolo C. Colombo; Melana Yuzefpolskaya; Arthur R. Garan; Maryjane A. Farr; Paul Kurlansky; Marco R. Di Tullio; Yoshifumi Naka; Koji Takeda
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Koki Nakanishi, Shunichi Homma, Jiho Han, Hiroo Takayama, Paolo C. Colombo, Melana Yuzefpolskaya, Arthur R. Garan, Maryjane A. Farr, Paul Kurlansky, Marco R. Di Tullio, Yoshifumi Naka, Koji Takeda
      Although late-onset right-sided heart failure is recognized as a clinical problem in the treatment of patients with left ventricular assist devices (LVADs), the mechanism and predictors are unknown. Tricuspid valve (TV) deformation leads to the restriction of the leaflet motion and decreased coaptation, resulting in a functional tricuspid regurgitation that may act as a surrogate marker of late right-sided heart failure. This study aimed to investigate the association of preoperative TV deformation (annulus dilatation and leaflet tethering) with late right-sided heart failure development after continuous-flow LVAD implantation. The study cohort consisted of 274 patients who underwent 2-dimensional echocardiography before LVAD implantation. TV annulus diameter and tethering distance were measured in an apical 4-chamber view. Late right-sided heart failure was defined as right-sided heart failure requiring readmission and medical and/or surgical treatment after initial LVAD implantation. During a mean follow-up of 25.1 ± 19.0 months after LVAD implantation, late right-sided heart failure occurred in 33 patients (12.0%). Multivariate Cox proportional hazard analysis demonstrated that TV annulus diameter (hazard ratio 1.221 per 1 mm, p <0.001) was significantly associated with late right-sided heart failure development, whereas leaflet tethering distance was not. The best cut-off value of the TV annular diameter was 41 mm (area under the curve 0.787). Kaplan–Meier analysis showed that patients with dilated TV annulus (TV annular diameter ≥41 mm) exhibited a significantly higher late right-sided heart failure occurrence than those without TV annular enlargement (log-rank p <0.001). In conclusion, preoperative TV annulus diameter, but not leaflet tethering distance, predicted the occurrence of late right-sided heart failure after LVAD implantation.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.010
  • Usefulness and Cost-Effectiveness of Universal Echocardiographic Contrast
           to Detect Left Ventricular Thrombus in Patients with Heart Failure and
           Reduced Ejection Fraction
    • Authors: E. Philip Lehman; Patricia A. Cowper; Tiffany C. Randolph; Andrzej S. Kosinski; Renato D. Lopes; Pamela S. Douglas
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): E. Philip Lehman, Patricia A. Cowper, Tiffany C. Randolph, Andrzej S. Kosinski, Renato D. Lopes, Pamela S. Douglas
      Contrast is a recommended but frequently unused tool in transthoracic echocardiography to improve detection of left ventricular thrombus in patients with ejection fraction (EF) ≤35%. The clinical and economic outcomes of a possible solution (i.e., universal contrast use) remain uncertain. To estimate clinical benefit, cost, and cost-effectiveness of a diagnostic strategy of universal use of contrast (vs no contrast) during echocardiography in patients with reduced EF, we created a decision analytic model using echocardiography sensitivity and specificity for left ventricular thrombus detection from a meta-analysis, as well as survival and cost estimates from published literature. Universal contrast use (vs nonuse) did not result in clinical or statistical improvement in estimated life years (8.509 vs 8.504) or quality-adjusted life years (5.620 vs 5.616). The cost of contrast was offset by reductions in subsequent health-care costs, resulting in similar total costs ($201,569 vs $201,573). In conclusion, although an intuitively attractive practice improvement strategy, universal contrast use strategy appears to offer no appreciable benefit to quality-adjusted survival or financial outcomes in patients with low EF.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.016
  • Usefulness of Psoas Muscle Area and Volume and Frailty Scoring to Predict
           Outcomes After Transcatheter Aortic Valve Implantation
    • Authors: Pawel Kleczynski; Tomasz Tokarek; Artur Dziewierz; Danuta Sorysz; Maciej Bagienski; Lukasz Rzeszutko; Dariusz Dudek
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Pawel Kleczynski, Tomasz Tokarek, Artur Dziewierz, Danuta Sorysz, Maciej Bagienski, Lukasz Rzeszutko, Dariusz Dudek
      Numerous scales were implemented for frailty assessment. However, limited evidence and recommendations for frailty tools for everyday clinical practice in patients who underwent transcatheter aortic valve implantation (TAVI) exist. Thus, we aimed to determine the long-term predictive value of different frailty scores and objective assessment of sarcopenia by imaging techniques in patients after TAVI. Frailty indexes according to Valve Academic Research Consortium-2 (VARC-2) recommendations, as well as other available scales of frailty, were assessed at baseline. Sarcopenia was evaluated with psoas muscle area (PSA) and psoas muscle volume (PSV) using computed tomography (CT) scans. The primary end point was 12-month all-cause mortality. We enrolled 153 patients who underwent TAVI with analyzable CT scans and complete frailty data. The median of PSA normalized for body surface area was 2,581.1 (2,214.9 to 2,654.9) mm2/m2, and the median of normalized PSV was 338.8 (288.1–365.6) cc/m2. At 12 months, all-cause mortality and new-onset atrial fibrillation were highest in the lowest tertile of normalized PSA. In the receiver operating characteristic analysis, all the tested frailty indexes, as well as PSA and PSV, were good predictors of 12-month all-cause mortality after TAVI with the highest area under the curve value for PSA and PSV normalized for body surface area. In conclusion, normalized PSA and PSV values are strong predictors of long-term mortality after TAVI. CT evaluation of psoas muscles could be incorporated to preprocedural comprehensive clinical models used for prediction of outcomes in patients scheduled for TAVI.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.020
  • Meta-Analysis of Studies Comparing Dual- Versus Mono-Antiplatelet Therapy
           Following Transcatheter Aortic Valve Implantation
    • Authors: Shadi Al Halabi; Joshua Newman; Michael E. Farkouh; David Fortuin; Fred Leya; John Sweeney; Amir Darki; John Lopez; Lowell Steen; Bruce Lewis; John Webb; Martin B. Leon; Verghese Mathew
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Shadi Al Halabi, Joshua Newman, Michael E. Farkouh, David Fortuin, Fred Leya, John Sweeney, Amir Darki, John Lopez, Lowell Steen, Bruce Lewis, John Webb, Martin B. Leon, Verghese Mathew
      Current guidelines recommend dual-antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI), although some studies suggest mono-antiplatelet therapy is equally efficacious with an improved safety profile. We performed a meta-analysis of studies comparing DAPT with mono-antiplatelet therapy after TAVI. Study quality and heterogeneity were assessed using Jadad score, Newcastle-Ottawa Scale, and Cochran's Q statistics. Mantel-Haenszel odds ratios (ORs) were calculated using fixed effect models as the primary analysis. Eight studies including 2,439 patients met the inclusion criteria. At 30 days, DAPT was associated with an increased risk of all-cause mortality (OR 2.06, 95% confidence interval [CI] 1.34 to 3.18, p = 0.001), major or life-threatening bleeding (OR 2.04, 95% CI 1.60 to 2.59, p <0.001), and major vascular complications (OR 2.15, 95% CI 1.51 to 3.06, p <0.001). There was no difference in the rate of the combined end point of stroke or transient ischemic attack, or myocardial infarction. Outcome data up to 6 months were available in 5 studies; all-cause mortality and stroke were similar between groups, although major or life-threatening bleeding was more frequent with DAPT. In conclusion, in patients undergoing TAVI, DAPT is associated with increased risk at 30 days of all-cause mortality, major or life-threatening bleeding, and major vascular complications without a decrease in ischemic complications; at 6 months, the excess bleeding risk persisted. These data suggest a safety concern with DAPT and justify further investigation of the optimal antiplatelet therapy regimen after TAVI.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.019
  • Relation of Velocity-Time Integral of the Left Ventricular Outflow Tract
           to that of the Descending Thoracic Aorta and Usefulness of a Fixed Ratio
           for Internal Validation
    • Authors: Rupesh Ranjan; Erik M. Valez; Anshul Haldipur; Nelson B. Schiller
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Rupesh Ranjan, Erik M. Valez, Anshul Haldipur, Nelson B. Schiller
      Measurement of left ventricular outflow tract velocity-time integral (LVOT VTI) is technician-, instrument-, and reader-dependent; variability is more common for pulsed-wave Doppler than continuous-wave Doppler. We hypothesize that in a population with normal cardiac structure and function, LVOT VTI is higher than VTI of the descending thoracic aorta (DTA) and this relation may be used clinically to validate the former. Furthermore, the DTA VTI could also be used to estimate LVOT. We retrospectively compared the LVOT VTI against VTI measured from DTA, abdominal aorta, and pulmonary artery among 108 healthy subjects. The ratio of LVOT VTI (n = 108) to DTA VTI (n = 108) was 1.27. There was a difference of 19.6% between LVOT VTI and DTA VTI with the former being higher. This percentage decrease in VTI from LVOT VTI to abdominal aortic (AA) VTI was directly proportional to the LVOT VTI. Similarly, there was a difference of 23.4% in the VTI values obtained from DTA and abdominal aorta. Moreover, there was a decrease of 40.4% when LVOT VTI was compared against AA VTI. The ratio of LVOT VTI to pulmonary VTI was 1.19. VTI values decrease in a linear fashion from the LVOT to abdominal aorta likely because of progressive decrease in circulating volume, and this change is not obscured by diminishing aortic diameter. Any deviation from this relation should be treated as abnormal and should prompt further investigation. Our findings support routine measurement of DTA VTI in clinical practice.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.017
  • Use and Disclosure of Complementary Health Approaches in US Adults With
           Cardiovascular Disease
    • Authors: Fuschia M. Sirois; Linghui Jiang; Dawn M. Upchurch
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Fuschia M. Sirois, Linghui Jiang, Dawn M. Upchurch
      Evidence indicates that use of Complementary Health Approaches (CHAs) is common in patients with cardiovascular disease (CVD) and has benefits and risks. Yet, disclosure of CHA use to physicians is not uniformly high. The present study aimed to assess the prevalence and patterns of CHA use and disclosure in patients with CVD in a nationally representative US sample. Use of specific CHA modalities and the predictors and reasons for nondisclosure were examined. In the 2012 National Health Interview Survey, a nationally representative sample of adults aged 18+ was used, and 12,364 patients who reported being diagnosed with CVD were analyzed using weighted bivariate and logistic regression. Analyses revealed that 34.75% of patients with CVD had used CHA in the previous year. Women, those with higher education and income, who had functional limitations, greater mental distress, and healthier lifestyles were significantly more likely to use CHA. Nonvitamin, nonmineral supplements was the most prevalent CHA used (19.22%). Rates of nondisclosure were highest among younger and better educated CHA users. In patients with CVD who did not disclose CHA use to their physician (33.67%), 45.51% said the reason was because physician did not ask; 8.75% said the reason was because they were not using CHA at the time. In conclusion, over 1/3 of patients with CVD used CHA in the previous year, and nonvitamin, nonmineral supplements were the most commonly used modality. The findings underscore the importance of provider-initiated communication about CHA use in patients with CVD to minimize the potentially harmful consequences of nondisclosure.

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.014
  • Functional Classes of Heart Failure and Indications for Implantable
    • Authors: Maya Guglin
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Maya Guglin

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.029
  • Mortality Risk Stratification in Small Patient Cohorts: The Post-Fontan
           Heart Transplantation Paradigm
    • Authors: Stavros Polyviou; John O'Sullivan; Asif Hasan; Louise Coats
      Abstract: Publication date: 1 July 2018
      Source:The American Journal of Cardiology, Volume 122, Issue 1
      Author(s): Stavros Polyviou, John O'Sullivan, Asif Hasan, Louise Coats

      PubDate: 2018-06-06T19:28:29Z
      DOI: 10.1016/j.amjcard.2018.03.021
  • Sedentary Behavior and the Risk of Depression in Patients With Acute
           Coronary Syndromes
    • Authors: Yidan Zhu; James A. Blumenthal; Chuan Shi; Ronghuan Jiang; Anushka Patel; Aihua Zhang; Xin Yu; Runlin Gao; Yangfeng Wu
      Pages: 1456 - 1460
      Abstract: Publication date: 15 June 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 12
      Author(s): Yidan Zhu, James A. Blumenthal, Chuan Shi, Ronghuan Jiang, Anushka Patel, Aihua Zhang, Xin Yu, Runlin Gao, Yangfeng Wu
      Although there is good evidence that sedentary behavior is associated with poor health outcomes in healthy persons and patients with cardiovascular disease, the mental health consequences of sedentary behavior have not been widely studied. In this report, we conducted a cross-sectional analysis to examine the relation of self-reported sedentary behavior and depression in a sample of 4,043 hospitalized men and women with acute coronary syndrome enrolled in a randomized clinical trial in rural China. Sedentary behavior was assessed by self-report, and depression was assessed with the Patient Health Questionnaire-9 (PHQ-9); a subset of 1,209 patients also completed the Beck Depression Inventory-II. Results revealed that greater sedentary behavior was associated with higher levels of depressive symptoms measured by both the PHQ-9 (p <0.001) and the Beck Depression Inventory-II (p <0.001). Compared with patients who reported that they were seldom sedentary, patients reporting that they were frequently sedentary were 4.7 times (odds ratio 4.73, 95% confidence interval 2.71 to 8.24) more likely to be clinically depressed defined as PHQ-9 scores ≥10 after adjusting for demographic factors, lifestyle behaviors, clinical characteristics, and in-hospital treatments. In conclusion, greater sedentary behavior is significantly related to greater depression in Chinese patients with acute coronary syndrome, independent of physical activity. These findings suggest that strategies to reduce sedentary behavior may improve medical outcomes and reduce risk for depression.

      PubDate: 2018-05-28T18:46:09Z
      DOI: 10.1016/j.amjcard.2018.02.031
  • Comparison of the Association Between High-Sensitivity Troponin I and
           Adverse Cardiovascular Outcomes in Patients With Versus Without Chronic
           Kidney Disease
    • Authors: Pratik B. Sandesara; Wesley T. O'Neal; Ayman Samman Tahhan; Salim S. Hayek; Suegene K. Lee; Jay Khambhati; Matthew L. Topel; Muhammad Hammadah; Ayman Alkhoder; Yi-An Ko; Mohamad Mazen Gafeer; Agim Beshiri; Gillian Murtagh; Jonathan H. Kim; Peter Wilson; Leslee Shaw; Stephen E. Epstein; Laurence S. Sperling; Arshed A. Quyyumi
      Pages: 1461 - 1466
      Abstract: Publication date: 15 June 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 12
      Author(s): Pratik B. Sandesara, Wesley T. O'Neal, Ayman Samman Tahhan, Salim S. Hayek, Suegene K. Lee, Jay Khambhati, Matthew L. Topel, Muhammad Hammadah, Ayman Alkhoder, Yi-An Ko, Mohamad Mazen Gafeer, Agim Beshiri, Gillian Murtagh, Jonathan H. Kim, Peter Wilson, Leslee Shaw, Stephen E. Epstein, Laurence S. Sperling, Arshed A. Quyyumi
      It is unknown whether the association of high-sensitivity troponin I (hs-TnI) with adverse cardiovascular outcomes varies by the presence of chronic kidney disease (CKD). We examined the association of hs-TnI with adverse cardiovascular outcomes in those with and without CKD in 4,107 (mean age, 64 years; 63% men; 20% black) patients from the Emory Cardiovascular Biobank who underwent coronary angiography. CKD (n = 1,073) was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2 or urine albumin/creatinine ratio >30 mg/g at baseline. Cox regression was used to compute hazard ratios (HR) for the association between hs-TnI levels (per doubling of hs-TnI: log2[hs-TnI] + 1) and death, cardiovascular death, and major adverse cardiac events (MACE), separately. Hs-TnI was a stronger predictor of death (CKD: HR 1.23, 95% confidence interval [CI] 1.15 to 1.31; no CKD: HR 1.11, 95% CI 1.05 to 1.17, p-interaction = 0.023), cardiovascular death (CKD: HR 1.24, 95% CI 1.14 to 1.34; no CKD: HR 1.15, 95% CI 1.07 to 1.22, p-interaction = 0.12), and MACE (CKD: HR 1.18, 95% CI 1.11 to 1.25; no CKD: HR 1.11, 95% CI 1.06 to 1.16, p-interaction = 0.095) in CKD compared with non-CKD. The association between hs-TnI and death in patients with CKD was stronger for patients without obstructive coronary artery disease (no obstructive coronary artery disease: HR 1.60, 95% CI 1.27 to 2.01; obstructive coronary artery disease: HR 1.19, 95% CI 1.11 to 1.27, p-interaction = 0.041). In conclusion, hs-TnI is a stronger predictor of adverse cardiovascular events in patients who have CKD than those without, even in the absence of obstructive coronary artery disease. Hs-TnI may identify CKD patients who are high risk for adverse cardiovascular outcomes in whom aggressive risk factor modification strategies are warranted.

      PubDate: 2018-05-28T18:46:09Z
      DOI: 10.1016/j.amjcard.2018.02.039
  • Myocardial Infarction Subtypes in Patients With Type 2 Diabetes Mellitus
           and the Effect of Liraglutide Therapy (from the LEADER Trial)
    • Authors: Steven P. Marso; Michael A. Nauck; Tea Monk Fries; Søren Rasmussen; Marianne Bach Treppendahl; John B. Buse
      Pages: 1467 - 1470
      Abstract: Publication date: 15 June 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 12
      Author(s): Steven P. Marso, Michael A. Nauck, Tea Monk Fries, Søren Rasmussen, Marianne Bach Treppendahl, John B. Buse
      Diabetes mellitus (DM) is a known risk factor for myocardial infarction (MI); however, data regarding MI subtypes in people with diabetes are limited. In the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial (n = 9,340), liraglutide significantly reduced the risk of major adverse cardiovascular (CV) events (composite of CV death, nonfatal MI, or nonfatal stroke) versus placebo in patients with type 2 DM and high CV risk. Liraglutide also reduced risk of first MI (292 events with liraglutide vs 339 with placebo). This post hoc analysis characterized MIs (first and recurrent) occurring in LEADER, by treatment arm and regarding incidence, outcome, subtype, and troponin levels. A total of 780 MIs (first and recurrent) were reported, with fewer in the liraglutide-treatment group than in the placebo-treatment group (359 vs 421, p = 0.022). Numerically fewer MIs were associated with CV death with liraglutide than with placebo (17 vs 28 fatal MIs, p = 0.28). Symptomatic MIs in both arms were mainly non–ST-segment elevation MI (555/641) and spontaneous MI (518/641). Numerically greater proportions of symptomatic MIs were associated with troponin levels ≤5× or ≤10× the upper reference limit with liraglutide versus placebo (p = 0.16 and p = 0.42, respectively). At baseline, more liraglutide-treated patients than placebo-treated patients with MI during the trial had a history of coronary artery bypass graft (p = 0.008), and fewer had peripheral arterial disease in the lower extremities (p = 0.005) and >50% stenosis of the coronary artery, the carotid artery, or other arteries (p = 0.044). In conclusion, this analysis showed that liraglutide reduces the incidence of MIs in patients with type 2 DM at high CV risk and may impact the clinical outcomes of MI.

      PubDate: 2018-05-28T18:46:09Z
      DOI: 10.1016/j.amjcard.2018.02.030
  • Racial Differences in Quality of Care and Outcomes After Acute Coronary
    • Authors: Celina M. Yong; Leo Ungar; Freddy Abnousi; Steven M. Asch; Paul A. Heidenreich
      Pages: 1489 - 1495
      Abstract: Publication date: 15 June 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 12
      Author(s): Celina M. Yong, Leo Ungar, Freddy Abnousi, Steven M. Asch, Paul A. Heidenreich
      Guideline adherence and variation in acute coronary syndrome (ACS) outcomes by race in the modern era of drug-eluting stents (DES) are not well understood. Previous studies also fail to capture rapidly growing minority populations, such as Asians. A retrospective analysis of 689,238 hospitalizations for ACS across all insurance types from 2008 to 2011 from the Healthcare Cost and Utilization Project database was performed to determine whether quality of ACS care and mortality differ by race (white, black, Asian, Hispanic, or Native American), with adjustment for patient clinical and demographic characteristics and clustering by hospital. We found that black patients had the lowest in-hospital mortality rates (5% vs 6% to 7% for other races, p <0.0001, odds ratio [OR] 1.02, 95% confidence interval [CI] 0.97 to 1.07), despite low rates of timely angiography in ST-elevation myocardial infarction and non–ST-elevation myocardial infarction, and lower use of DES (30% vs 38% to 40% for other races, p <0.0001). In contrast, Asian patients had the highest in-hospital mortality rates (7% vs 5% to 7% for other races, p <0.0001, odds ratio 1.13, 95% CI 1.08 to 1.20, relative to white patients), despite higher rates of timely angiography in ST-elevation myocardial infarction and non–ST-elevation myocardial infarction, and the highest use of DES (74% vs 63% to 68% for other races, p <0.0001). Asian patients had the worst in-hospital mortality outcomes after ACS, despite high use of early invasive treatments. Black patients had better in-hospital outcomes despite receiving less guideline-driven care.

      PubDate: 2018-05-28T18:46:09Z
      DOI: 10.1016/j.amjcard.2018.02.036
  • Relation of Use of Red Blood Cell Transfusion After Acute Coronary
           Syndrome to Long-Term Mortality
    • Authors: Jaakko Allonen; Markku S. Nieminen; Seppo Hiippala; Juha Sinisalo
      Pages: 1496 - 1504
      Abstract: Publication date: 15 June 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 12
      Author(s): Jaakko Allonen, Markku S. Nieminen, Seppo Hiippala, Juha Sinisalo
      Registry studies have associated red blood cell (RBC) transfusion with increased in-hospital mortality in patients with acute coronary syndrome (ACS). The impact on long-term mortality after 1-year follow-up remains unknown. Consecutive patients with ACS (n = 2,009) of a prospective Genetic Predisposition of Coronary Artery Disease cohort were followed for a median of 8.6 years (95% confidence interval [CI] 8.59 to 8.69). After discharge, 1,937 (96%) patients survived for over 30 days. Of those survivors, a subgroup of previously transfusion-naïve patients 85/1,937 (4.4%) who had received at least 1 RBC transfusion during hospitalization were compared with 1,278/1,937 patients (66.0%) who had not received any transfusion either during the hospitalization or the entire follow-up. Unadjusted long-term mortality was significantly higher in the patients transfused with RBC compared with their counterparts not transfused with RBC (58.8% vs 20.3%, p <0.001). The results remained significant for hazard ratio (HR) 1.91, 95% CI 1.39 to 2.63, p <0.001, after multivariate Cox proportional hazards model analysis and were similar after 1-year landmark analysis (HR 1.90, 95% CI 1.34 to 2.70, p <0.001). The higher all-cause mortality was largely explained by cancer mortality (15.3% vs 4.1%, p <0.001) and cardiovascular mortality (34.1% vs 12.1%, p <0.001). After 1:1 propensity score matching (n = 65 vs 65), the association of RBC transfusion with worse survival remained significant (HR 2.70, 95% CI 1.48 to 4.95, p = 0.001). Inverse probability weighted Cox analyses turned out similar results (HR 2.07, 95% CI 1.38 to 3.11, p <0.001). In conclusion, the strong association of need for RBC transfusion with increased mortality continued for patients with ACS even after a 1-year follow-up.

      PubDate: 2018-05-28T18:46:09Z
      DOI: 10.1016/j.amjcard.2018.02.035
  • Outcomes in Patients with Diabetes Mellitus According to Insulin Treatment
           After Percutaneous Coronary Intervention in the Second-Generation
           Drug-Eluting Stent Era
    • Authors: Seung-Hoon Pi; Tae-Min Rhee; Joo Myung Lee; Doyeon Hwang; Jonghanne Park; Taek Kyu Park; Jeong Hoon Yang; Young Bin Song; Jin-Ho Choi; Joo-Yong Hahn; Byung Jin Kim; Bum Soo Kim; Hyeon-Cheol Gwon; Seung-Hyuk Choi
      Pages: 1505 - 1511
      Abstract: Publication date: 15 June 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 12
      Author(s): Seung-Hoon Pi, Tae-Min Rhee, Joo Myung Lee, Doyeon Hwang, Jonghanne Park, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Jin-Ho Choi, Joo-Yong Hahn, Byung Jin Kim, Bum Soo Kim, Hyeon-Cheol Gwon, Seung-Hyuk Choi
      Limited data exist regarding the clinical outcomes of patients with diabetes mellitus (DM) after percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES), especially according to DM treatment. The purpose of this study was to compare clinical outcomes among patients without DM, with non-insulin-treated DM (non-ITDM), and with ITDM after PCI using second-generation DES. We analyzed 4,812 consecutive patients who underwent PCI using second-generation DES. Primary outcomes were patient-oriented composite outcome (a composite of all-cause mortality, any myocardial infarction, and any revascularization) at 3 years. Among the total population, 3,026 patients have no DM, 1,169 have non-ITDM, and 617 have ITDM. Patients with DM, regardless of non-ITDM and ITDM, showed significantly higher risk of patient-oriented composite outcome (21.0% vs 14.5%; adjusted hazard ratio [HRadj]1.41, 95% confidence interval [CI] 1.19 to 1.66, p <0.001), mainly driven by significantly higher risk of cardiac death and any revascularization compared with non-DM. Among DM population, ITDM showed significantly higher risk of cardiac death (7.7% vs 3.7%; HRadj 1.97, 95% CI 1.19 to 3.27, p = 0.009), any revascularization (17.0% vs 11.4%; HRadj 1.40, 95% CI 1.01 to 1.93, p = 0.041), and definite/probable stent thrombosis (1.7% vs 0.7%; HRadj 2.80, 95% CI 1.04 to 7.56, p = 0.042) compared with non-ITDM. In conclusion, even in the era of second-generation DES, patients with DM are at significantly higher risk of patient-oriented adverse events. Among these, patients with ITDM showed the highest risk of adverse events, mainly driven by higher risk of mortality, any revascularization, and definite/probable stent thrombosis.

      PubDate: 2018-05-28T18:46:09Z
      DOI: 10.1016/j.amjcard.2018.02.034
  • Efficacy and Safety of the HeartMate Percutaneous Heart Pump During
           High-Risk Percutaneous Coronary Intervention (from the SHIELD I Trial)
    • Authors: Dariusz Dudek; Adrian Ebner; Robert Sobczyński; Jarosław Trębacz; Boris Vesga; Juan Granada; Marian Zembala; Adam Witkowski; Nicolas M. Van Mieghem; Poornima Sood; Andrzej Ochała; Artur Dziewierz; Krzysztof Żmudka
      Pages: 1524 - 1529
      Abstract: Publication date: 15 June 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 12
      Author(s): Dariusz Dudek, Adrian Ebner, Robert Sobczyński, Jarosław Trębacz, Boris Vesga, Juan Granada, Marian Zembala, Adam Witkowski, Nicolas M. Van Mieghem, Poornima Sood, Andrzej Ochała, Artur Dziewierz, Krzysztof Żmudka
      This study aimed to evaluate the use of the HeartMate percutaneous heart pump, a catheter-based axial flow pump designed to provide partial left ventricular support, in patients who underwent high-risk percutaneous coronary intervention (PCI). Patients who are hemodynamically unstable, or at risk of being hemodynamically unstable, while undergoing PCI may require mechanical circulatory support. Fifty high-risk patients were enrolled in a prospective, nonrandomized, multicenter, open-label trial. Primary end points were freedom from hemodynamic compromise during PCI and a composite measure of major adverse events. Patients were followed for 30 days. No patient met the primary performance end point. Six safety end points in 5 patients occurred, including 1 access site complication requiring intervention, 1 cerebrovascular accident, 2 major bleeding complications, and 2 cases of new or worsening aortic insufficiency. No cardiac deaths, myocardial infarctions, or surgical interventions occurred. In conclusion, initial results of the HeartMate percutaneous heart pump for mechanical circulatory support during high-risk PCI are encouraging. Hemodynamic stability was achieved in all patients with a low incidence of adverse events.

      PubDate: 2018-05-28T18:46:09Z
      DOI: 10.1016/j.amjcard.2018.02.046
  • Real-Time Pathophysiologic Correlates of Left Atrial Appendage Thrombus in
           Patients Who Underwent Transesophageal-Guided Electrical Cardioversion for
           Atrial Fibrillation
    • Authors: Rowlens M. Melduni; Bernard J. Gersh; Waldemar E. Wysokinski; Naser M. Ammash; Paul A. Friedman; David O. Hodge; Krishnaswamy Chandrasekaran; Jae K. Oh; Hon-Chi Lee
      Pages: 1540 - 1547
      Abstract: Publication date: 15 June 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 12
      Author(s): Rowlens M. Melduni, Bernard J. Gersh, Waldemar E. Wysokinski, Naser M. Ammash, Paul A. Friedman, David O. Hodge, Krishnaswamy Chandrasekaran, Jae K. Oh, Hon-Chi Lee
      Although current guidelines advocate using the CHA2DS2-VASc score to assess the risk of stroke in patients with atrial fibrillation (AF), compared with transesophageal echocardiography (TEE), its ability to predict left atrial appendage thrombus (LAAT) is limited. We studied 3,324 consecutive patients with sustained AF from our prospective registry of patients who underwent first-time TEE-guided electrical cardioversion (ECV) from May 2000 through March 2012. The association of CHA2DS2-VASc score or TEE risk factors with the occurrence of LAAT was analyzed. The mean (SD) age was 69 (12.5) years and 67% were men. LAAT was identified in 49 (1.5%) during pre-ECV TEE. Compared with patients without LAAT, those with LAAT had lower peak left atrial appendage emptying velocity (LAAEV) (17.2 ± 8.5 vs 36.6 ± 20.8; p <0.001) and left ventricular ejection fraction (LVEF) (39.9 ± 17.6 vs 51.4 ± 13.7; p <0.001); their CHA2DS2-VASc score also was higher, but the difference was not statistically significant (3.6 ± 1.4 vs 3.2 ± 1.6; p = 0.06). Multivariate logistic regression analysis identified an LVEF ≤40% (adjusted odds ratio 2.48, 95% confidence interval 1.38 to 4.46), LAAEV 20.3 to 33.9 cm/s (odds ratio 12.19, 95% confidence interval 1.53 to 96.86), and LAAEV ≤20.2 cm/s as independent predictors of LAAT. An LAAEV cut-point of 20 cm/s and an LVEF ≤40% were optimal for detecting LAAT (sensitivity 75% and 62%; specificity 77% and 75%; area under the curve 0.822 and 0.776, respectively). On follow-up, LAAT was an independent risk factor of subsequent ischemic stroke but did not influence survival. In conclusion, reduced LVEF and reduced LAAEV are important pathophysiologic correlates of left atrial appendage thrombogenesis and subsequent ischemic stroke in patients who underwent TEE-guided ECV for AF.

      PubDate: 2018-05-28T18:46:09Z
      DOI: 10.1016/j.amjcard.2018.02.044
  • Clinical Features Associated With Nascent Left Ventricular Diastolic
           Dysfunction in a Population Aged 40 to 55 Years
    • Authors: Jonathan D. Mosley; Rebecca T. Levinson; Evan L. Brittain; Deepak K. Gupta; Eric Farber-Eger; Christian M. Shaffer; Josh C. Denny; Dan M. Roden; Quinn S. Wells
      Pages: 1552 - 1557
      Abstract: Publication date: 15 June 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 12
      Author(s): Jonathan D. Mosley, Rebecca T. Levinson, Evan L. Brittain, Deepak K. Gupta, Eric Farber-Eger, Christian M. Shaffer, Josh C. Denny, Dan M. Roden, Quinn S. Wells
      Diastolic dysfunction (DD), an abnormality in cardiac left ventricular (LV) chamber compliance, is associated with increased morbidity and mortality. Although DD has been extensively studied in older populations, co-morbidity patterns are less well characterized in middle-aged subjects. We screened 156,434 subjects with transthoracic echocardiogram reports available through Vanderbilt's electronic heath record and identified 6,612 subjects 40 to 55 years old with an LV ejection fraction ≥50% and diastolic function staging. We tested 452 incident and prevalent clinical diagnoses for associations with early-stage DD (n = 1,676) versus normal function. There were 44 co-morbid diagnoses associated with grade 1 DD including hypertension (odds ratio [OR] = 2.02, 95% confidence interval [CI] 1.78 to 2.28, p <5.3 × 10−29), type 2 diabetes (OR 1.96, 95% CI 1.68 to 2.29, p = 2.1 × 10−17), tachycardia (OR 1.38, 95% CI 0.53 to 2.19, p = 2.9 × 10−6), obesity (OR 1.76, 95% CI 1.51 to 2.06, p = 1.7 × 10−12), and clinical end points, including end-stage renal disease (OR 3.29, 95% CI 2.19 to 4.96, p = 1.2 × 10−8) and stroke (OR 1.5, 95% CI 1.12 to 2.02, p = 6.9 × 10−3). Among the 60 incident diagnoses associated with DD, heart failure with preserved ejection fraction (OR 4.63, 95% CI 3.39 to 6.32, p = 6.3 × 10−22) had the most significant association. Among subjects with normal diastolic function and blood pressure at baseline, a blood pressure measurement in the hypertensive range at the time of the second echocardiogram was associated with progression to stage 1 DD (p = 0.04). In conclusion, DD was common among subjects 40 to 55 years old and was associated with a heavy burden of co-morbid disease.

      PubDate: 2018-05-28T18:46:09Z
      DOI: 10.1016/j.amjcard.2018.02.042
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