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Publisher: Elsevier   (Total: 3183 journals)

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Showing 1 - 200 of 3183 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 25, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 100, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 27, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 38, 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: 434, 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: 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: 295, 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: 17, 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: 178, 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: 16, 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: 28, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 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: 49, 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: 65, 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: 20, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 25, 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: 23)
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: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 20, 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: 7, 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: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 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: 25, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 17)
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: 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: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 65)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 419, 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: 36, 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: 5, 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: 373, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 469, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, 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: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 11)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 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: 53, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 5, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
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: 45, 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: 35, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 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: 242, 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: 30, 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: 64, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 23, 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: 206, 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: 210, 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)

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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  [3183 journals]
  • Reply to “Comparison of Accuracy of Left Atrial Area and Volume by
           Two-Dimensional Transthoracic Echocardiography Versus Computed
           Tomography”
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Piercarlo Ballo, Stefano Nistri, Matteo Cameli, Alfredo Zuppiroli, Sergio Mondillo
       
  • Type 2 Myocardial Infarction: Trying to Fit a Square Peg Into a Round
           Hole'
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Ellis W. Lader
       
  • Smeloff-Cutter Mechanical Prosthesis in the Aortic Position for 49 Years
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Robin A. Chalkley, Chong W. Kim, James W. Choi, William C. Roberts, Jeffrey M. SchusslerWe describe a 76-year-old male physician who at age 27 underwent replacement of his stenotic aortic valve with a Smeloff-Cutter mechanical prosthesis which functioned normally for 49 years. He died of a noncardiac condition. A normally functioning substitute cardiac valve for this length of time has not been previously reported (1).
       
  • Leadless Pacemaker Implant After Heart Transplant
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Faris G. Araj, Robert M. Morlend, James D. DanielsConduction abnormalities are known to occur after heart transplantation. In some cases, a permanent pacemaker is required. Conventional transvenous pacemakers can result in several complications, mainly related to the leads and device pocket. Leadless pacemaker technology was developed to overcome these issues. We report what we believe is the first US case of a leadless pacemaker implant (specifically in a heart transplant recipient) with the longest reported duration of follow-up.
       
  • “Buying a Home: Part I: When Not to Buy”
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Robert M. Doroghazi
       
  • Ambulatory Cardiac Rehabilitation for Heart Failure Patients
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Gerald F. Fletcher
       
  • Mechanisms of Left Atrial Enlargement in Obesity
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Norman N. Aiad, Christopher Hearon, Michinari Hieda, Katrin Dias, Benjamin D. Levine, Satyam SarmaLeft atrial (LA) enlargement is common in obesity. We sought to determine the influence of ventricular (LV) remodeling on LA size in obesity. We studied 50 otherwise healthy obese subjects (body mass index 37.2 ± 4.6 kg/m2, 50 ± 6 years) and 58 age and gender-matched nonobese controls (body mass index 26.2 ± 2.9 kg/m2, 52 ± 5 years). Diastolic function, relative wall thickness (RWT), and LV mass were assessed using echocardiography. LA and LV volume was measured by 3D-echocardiography. Primary outcome was the ratio of LA volume indexed to LV volume in obese and control subjects. Obese subjects had substantially larger LA volumes compared with control subjects (61.0 ± 16.9 vs 38.9 ± 9.2 ml, p < 0.0001). When scaled to body size or lean mass, differences in LA size persisted. However, when indexed to LV end-diastolic volume, LA volumes between control and obese subjects were comparable (obese vs controls: 0.44 ± 0.15 vs 0.42 ± 0.10, p = 0.46). A small subset of obese subjects (26%) had LA volume markedly out of proportion to LV volume (LA/LV volume ratio ≥0.5) and displayed concentric LV remodeling with larger RWT and LV mass compared with obese subjects with LA/LV
       
  • Left Ventricular Relaxation Half-Time as a Predictor of Cardiac Events in
           Idiopathic Dilated Cardiomyopathy and Hypertrophic Cardiomyopathy With
           Left Ventricular Systolic and/or Diastolic Dysfunction
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Tsuyoshi Yokoi, Ryota Morimoto, Hideo Oishi, Hiroo Kato, Yoshihito Arao, Shogo Yamaguchi, Tasuku Kuwayama, Tomoaki Haga, Hiroaki Hiraiwa, Toru Kondo, Kenji Furusawa, Kenji Fukaya, Akinori Sawamura, Takahiro Okumura, Akihiro Hirashiki, Toyoaki MuroharaPurpose: Diastolic dysfunction preceding systolic dysfunction is considered an important interaction in cardiomyopathy with poor prognosis. The aim of this study was to compare left ventricular (LV) isovolumic relaxation with the other parameters as a potential prognostic marker for patients with idiopathic dilated cardiomyopathy (IDC) and hypertrophic cardiomyopathy (HC). Methods: A total of 145 patients with IDC and 116 with HC were evaluated for hemodynamic parameters; LV pressure was directly measured by a micromanometer catheter, and relaxation half-time (T1/2) was used to determine LV isovolumic relaxation. The median follow-up period was 4.7 years. Results: The mean ages of the patients with IDC and HC were 52.0 ± 12.0 and 57.1 ± 12.4 years, respectively. Each patient group was further divided into 2 groups based on the median value of T1/2: (1)
       
  • Outcome of Transcatheter Aortic Valve Implantation in Patients with
           Peripheral Vascular Disease
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Fahed Darmoch, M. Chadi Alraies, Yasser Al-khadra, Homam Moussa Pacha, Mohamad Soud, Amir Kaki, Tanveer Rab, Cindy L. Grines, Rodrigo Bagur, Chun Shing Kwok, Mamas Mamas, Subhash Banerjee, Wael AlJaroudi, Duane S. PintoPeripheral vascular disease (PVD) is common in patients referred for transcatheter aortic valve implantation (TAVI). We sought to investigate the impact of PVD on patients who underwent TAVI. Using data from the National Inpatient Sample database 2011 and 2014, we identified patients who had undergone TAVI. We studied the clinical characteristics and procedural outcomes in patients with PVD who underwent TAVI compared with those patients without PVD using propensity score matching score matching. Results: A total of 42,215 patients underwent TAVI; of which 1,388 patients were matched using propensity score matched scores to 694 in each (PVD vs no PVD) patients. The population had a mean age of 81 years old and 55.8% were of female gender. African-Americans constituted 4.3%. PVD patients who underwent TAVI were found to have higher rates of vascular complications (11.8% vs 5.9 % p
       
  • Effects of Aortic Valve Replacement on Left Ventricular Diastolic Function
           in Patients With Aortic Valve Stenosis
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): G. Benfari, M. Noni, F. Onorati, L.F. Cerrito, M. Pernigo, G. Vinco, M. Cameli, G.E. Mandoli, G. Borio, G. Geremia, C. Zivelonghi, R. Abbasciano, G. Mazzali, M. Zamboni, G. Faggian, A. Rossi, F.L. RibichiniThe afterload increase imposed by severe aortic valve stenosis (AS) creates concentric left ventricular (LV) remodeling and diastolic dysfunction (DD), which are both markers of poor clinical outcome. Ideally, a correctly timed surgery for isolated AS can reverse the LV remodeling. However, data on LV DD after aortic valve replacement (AVR) are sparse and contrasting. Aims of the study are to define the markers of a favorable evolution of the DD at follow-up. Patients with severe isolated AS, scheduled for AVR were prospectively enrolled. Transthoracic echocardiography with DD assessment was performed before surgery, and at 12 months after surgery. Global LV longitudinal and circumferential strain, peak atrial longitudinal and contraction strain (PALS, PACS) were obtained at baseline. LV septal biopsy to assess fibrosis was performed at the time of AVR. Sixty-seven patients were enrolled, age 72 ± 8 years, 66% female, ejection fraction 61 ± 8%, E/e’ 13 ± 6, PALS 23 ± 7%. Normal estimated left atrial pressure was detected in 19/67 (28%) versus 43/67 (64%) at follow-up (p
       
  • Implications of Perceived Dyspnea and Global Well-Being Measured by Visual
           Assessment Scales During Treatment for Acute Decompensated Heart Failure
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Nicholas S. Hendren, Mark H. Drazner, Ambarish Pandey, W.H. Wilson Tang, Justin L. GrodinSymptomatic improvement through decongestive therapy is a cornerstone for treatment of acute decompensated heart failure (ADHF). Visual analog scales (VAS) are instruments that can capture patients' perceptions of dyspnea (DVAS) or global well-being (GVAS). However, the clinical implications of these instruments and their changes over time during treatment for ADHF need further clarification. DVAS and GVAS were collected in 657 patients randomized in the DOSE-AHF and ROSE-AHF trials. To determine factors associated with symptom change, multivariable predictors of changes in DVAS and GVAS over 72 hours were determined. In addition, time-to-event analyses determined the association between these assessments and post-discharge clinical outcomes. The median baseline DVAS and GVAS scores were 54 (interquartile range 35 to 76) and 50 (30 to 66), respectively. These scores increased from baseline to 72 hours (ΔDVAS 16 [0 to 35] and ΔGVAS 19 [2 to 37]). Although changes in both scales were associated with their baseline values, 72-hour change in NT-proBNP was associated with each scale in multivariable analysis. However, there were additional variables associated with 72-hour change in GVAS including 72-hour change in creatinine, implantable cardioverter-defibrillator presence, baseline loop diuretic dose, and 72-hour total loop diuretic dose. There were no consistent associations between DVAS or GVAS and clinical composite outcomes at 60 days. In conclusion, DVAS and GVAS may be related to different clinical factors during treatment for ADHF and VAS scores were not consistently associated with clinical outcomes in ADHF. These findings inform the utility of the DVAS and GVAS instruments as measurements of symptom change for future ADHF clinical trials and registries.
       
  • Relation between the Updated Blood Pressure Classification according to
           the American College of Cardiology/American Heart Association Guidelines
           and Carotid Intima-Media Thickness
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Hidetaka Itoh, Hidehiro Kaneko, Hiroyuki Kiriyama, Yuriko Yoshida, Koki Nakanishi, Yoshiko Mizuno, Masao Daimon, Hiroyuki Morita, Yutaka Yatomi, Issei KomuroAmerican College of Cardiology/American Heart Association recently updated their guidelines for hypertension, and lowered the threshold of normal blood pressure (BP). However, the validity of the updated guidelines remains controversial. We investigated the relation between the revised BP classification and carotid intima-media thickness, using a community-based cohort. We examined 1,241 subjects who underwent health check-ups at our institute. They were divided into 3 groups based on their BP levels: normal blood pressure (sBP
       
  • Efficacy of Direct Acting Oral Anticoagulants in Treatment of Left
           Ventricular Thrombus
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Adam M. Fleddermann, Charles H. Hayes, Anthony Magalski, Michael L. MainDirect acting oral anticoagulants (DOACs) are increasingly used as off-label alternatives to vitamin K antagonists for the treatment of left ventricular (LV) thrombus. However, efficacy data is limited to small case series and one meta-analysis of case reports. We aimed to determine the efficacy and safety of DOACs in treatment of LV thrombus utilizing transthoracic echocardiography (TTE) and clinical outcomes. We identified 52 patients (mean age = 64 years, 71% men) treated with a DOAC for LV thrombus (n = 26 apixaban, n = 24 rivaroxaban, and n = 2 dabigatran). Thirty-five of the 52 patients had a follow-up TTE after DOAC initiation. The primary end point was defined as resolution of LV thrombus (in patients with a subsequent TTE), or death, major bleeding requiring transfusion, intracranial hemorrhage, ischemic stroke, or peripheral embolization. An experienced echocardiographer (M.L.M.) reviewed all TTEs for presence or absence of LV thrombus without knowledge of time point or clinical data. Twenty-nine of the 35 (83%) patients who underwent follow-up TTE had resolution of LV thrombus, with a mean duration of 264 days. Of the total study population, there was 1 cardioembolic event (transient ischemic attack) 52 days after initiating DOAC, 3 gastrointestinal bleeds requiring transfusion, and 1 patient with epistaxis requiring transfusion. All patients with a hemorrhagic complication were receiving concomitant antiplatelet therapy. DOAC therapy appears promising for the treatment of LV thrombus. A larger, prospective study is warranted to confirm these results.
       
  • Prognostic Role of Left Ventricular Dysfunction in Patients With Coronary
           Artery Disease After an Ambulatory Cardiac Rehabilitation Program
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Sara Doimo, Enrico Fabris, Sabrina Chiapolino, Giulia Barbati, Luigi Priolo, Renata Korcova, Andrea Perkan, Patrizia Maras, Gianfranco SinagraThe relationship between left ventricular ejection fraction (LVEF) and outcomes after cardiac rehabilitation (CR) is not well established; therefore we assessed the prognostic role of LVEF at the end of ambulatory CR program in patients (pts) who received coronary revascularization. LVEF was evaluated at hospital discharge and re-assessed at the end of CR in all ST-elevation myocardial infarction and coronary artery bypass graft pts, while in pts with non-ST-elevation MI or elective percutaneous coronary intervention the echocardiography was repeated if they had an impaired LVEF at discharge. New hospitalizations for cardiovascular causes at 1-year, and cardiovascular mortality during long-term follow-up were analyzed. We enrolled in CR 3078 pts, 86% showed LVEF ≥40% and 9% LVEF
       
  • Effect of Chronic Hematologic Malignancies on In-Hospital Outcomes of
           Patients With ST-Segment Elevation Myocardial Infarction
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Gaurav Patel, Neha Pancholy, Lisa Thomas, Anvit Rai, Akhil Kher, Christopher Peters, Amit Amin, Tejas M. Patel, Samir PancholyIn view of hemorrhagic and prothrombotic tendencies, ST-segment elevation myocardial infarction (STEMI) patients with chronic hematologic malignancies (CHM) are felt to be at a higher risk and hence denied standard reperfusion strategies. In-hospital outcomes of CHM patients presenting with STEMI are unclear. The Nationwide Inpatient Sample data files from 2003 to 2014 were used to extract adult patients who presented with a primary diagnosis of STEMI. Patients who had a diagnosis of CHM defined as chronic myelogenous leukemia, chronic lymphocytic leukemia, essential thrombocythemia, polycythemia vera, chronic monocytic leukemia, and multiple myeloma were identified. The primary study outcome measure was in-hospital mortality. Inverse probability weighting-adjusted binary logistic regression was performed to identify independent predictors of in-hospital mortality. Of 2,715,807 STEMI patients included in the final analyses, 11,974 (0.4%) patients had a diagnosis of CHM. Patients with CHM were significantly older, had a higher prevalence of co-morbidities, and had a significantly higher unadjusted in-hospital mortality (14.9% vs 9.0%; p
       
  • Relation of Left Atrial Volumes in Patients With Myocardial Infarction to
           Left Ventricular Filling Pressures and Outcomes
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): Sandhir B. Prasad, Kristyan Guppy-Coles, Tony Stanton, James Armstrong, Rathika Krishnaswamy, Gillian Whalley, John J. Atherton, Liza ThomasThe inter-relationships between minimal and maximal left atrial volume index (LAVI), left ventricular filling pressures and survival have not been well studied. This study aimed to compare LAVImin with LAVImax with respect to (1) relative prognostic value, and (2) correlation with left ventricular end-diastolic pressures (LVEDP), in patients with myocardial infarction (MI). A retrospective study involving consecutive patients with a first-ever MI (n = 419) was undertaken. LAVIs were determined using Simpson's biplane method from 2D echocardiography performed the day after admission. LAVmin ≥ 18 mls/m2 and LAVImax ≥ 34 mls/m2 were considered enlarged. The primary end point was composite major adverse cardiovascular events (MACE) (death/MI/heart failure). Correlation between LVEDP and LAVI was assessed in 120 patients who underwent echocardiography and cardiac catheterization either simultaneously (n = 30) or same-day (n = 90). At a median follow-up of 24 months, there were 61 MACE events. On Cox proportional hazards multivariate analysis incorporating significant clinical predictors and LVEF, whereas both LAVImin ≥ 18 mls/m2 (hazard ratio 3.15 [95% confidence interval 1.70 to 5.54], p
       
  • Readers' Comments: Was the Interatrial Block in Patients With Takotsubo
           Syndrome in the Spanish National RETAKO Registry Partially or Totally
           Reversible'
    • Abstract: Publication date: 1 August 2019Source: The American Journal of Cardiology, Volume 124, Issue 3Author(s): John E. Madias
       
  • Trial Sequential Analysis of Drug-Eluting Stents Versus Bare-Metal Stents
           in Saphenous Vein Graft Intervention
    • Abstract: Publication date: Available online 6 June 2019Source: The American Journal of CardiologyAuthor(s): Babikir Kheiri, Mohammed Osman, Ghassan Bachuwa, Joaquin E. Cigarroa
       
  • Frequency of Utilization of Beta Blockers in Patients With Heart Failure
           and Depression and Their Effect on Mortality
    • Abstract: Publication date: Available online 6 June 2019Source: The American Journal of CardiologyAuthor(s): Cy Kim, Lewei Duan, Derek Q. Phan, Ming-Sum LeeBeta blockers reduce mortality and morbidity in patients with heart failure. Early reports linking β-blockers with depression may have limited their use in heart failure patients with co-morbid depression. Although more recent studies have challenged the association between β-blocker therapy and depression, patient and physicians remain concerned. The goal of this study is to evaluate the utilization and outcomes of β-blocker therapy in heart failure patients with depression. This is a retrospective cohort study of patients at a multicenter integrated healthcare system with a diagnosis of heart failure from 2008 to 2014. Among 6,915 patients with heart failure with left ventricular ejection fraction of
       
  • Underlying Differences in the Treatment of Left Ventricular Thrombus with
           Non-Vitamin K Antagonist Oral Anticoagulants
    • Abstract: Publication date: Available online 5 July 2019Source: The American Journal of CardiologyAuthor(s): Aloysius Sheng-Ting Leow, Ching-Hui Sia, Benjamin Yong-Qiang Tan, Mark Yan-Yee Chan, Joshua Ping-Yun Loh
       
  • Defining Subclinical Myocardial Dysfunction and Implications for Patients
           with Diabetes Mellitus and Preserved Ejection Fraction
    • Abstract: Publication date: Available online 1 July 2019Source: The American Journal of CardiologyAuthor(s): Arnold CT Ng, Matteo Bertini, See Hooi Ewe, Enno T van der Velde, Dominic Y Leung, Victoria Delgado, Jeroen J. Bax Left 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 were followed up for the occurrence of all-cause mortality. Both 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 (HR 2.83, 95% CI 1.40 – 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 – 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.
       
  • Global Longitudinal Strain and Immune Status among Persons Living with
           Human Immunodeficiency Virus
    • Abstract: Publication date: Available online 29 June 2019Source: The American Journal of CardiologyAuthor(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. VelazquezABSTRACTImprovement in survival among PLHIV has led to increased prevalence of cardiovascular disease. Whether HIV-associated immune dysfunction is associated with preclinical LV dysfunction despite normal LV ejection fraction (LVEF) is unclear. Accordingly, we investigated the relationship of immune status and left ventricular (LV) function in persons living with human immunodeficiency virus (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 relationship 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 IQR from (-16.7 to -13.6). All participants had an LVEF ≥ 50%. In adjusted analyses, proximal CD4 < 500 cells/mm3, and nadir CD4 < 250 cells/mm3 were significantly inversely correlated with GLS (p=0.01 and p=0.004, respectively). In PLHIV, person with plasma HIV RNA < 400 copies/ml at baseline had a trend toward significantly more negative values of GLS compared to those patients without viral suppression at baseline (p=0.08). In conclusion, this study is the first to demonstrate such a high prevalence of abnormal GLS in PLHIV, and the first to identify that proximal and nadir CD4 cell count are independently associated with GLS despite normal LV ejection fraction.
       
  • “Embezzlement”
    • Abstract: Publication date: Available online 27 June 2019Source: The American Journal of CardiologyAuthor(s): Robert M. Doroghazi
       
  • Chest Pain and Electrocardiographic Changes
    • Abstract: Publication date: Available online 27 June 2019Source: The American Journal of CardiologyAuthor(s): Mazen M. Kawji, D. Luke Glancy A 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.
       
  • Trends of Inpatient Venous Thromboembolism in United States before and
           after the Surgeon General's Call to Action
    • Abstract: Publication date: Available online 26 June 2019Source: The American Journal of CardiologyAuthor(s): Kathan D. Mehta, Sudeep K. Siddappa Malleshappa, Smit Patel, Smith Giri, Hong Wang, Roy Smith, Rahul A. Parikh Venous 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 analyse 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 (NIS), Healthcare Cost and Utilization Project (HCUP) and measured trends of Inpatient VTE by annual % change using joinpoint regression software. From 2004 to 2013 the NIS contained data on 78 million hospitalizations (weighted N=385 million). Among 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 amongst 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.
       
  • Usefulness of Blunted Heart Rate Reserve as an Imaging-independent
           Prognostic Predictor during Dipyridamole Stress Echocardiography
    • Abstract: Publication date: Available online 26 June 2019Source: The American Journal of CardiologyAuthor(s): Lauro Cortigiani, Clara Carpeggiani, Patrizia Landi, Mauro Raciti, Francesco Bovenzi, Eugenio PicanoABSTRACTA 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 undergoing 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 modelling and validation group of equal size. During a median follow-up time of 1,004 days, 321 hard events occurred: 231 deaths and 90 non-fatal myocardial infarctions. HRR ≤1.22 identified by ROC analysis in the modeling group was an independent predictor of infarction-free survival in the modeling (Hazard Ratio 1.83, 95% CI, 1.30-2.60, p=0.001), in the validation (Hazard Ratio 1.47, 95% CI, 1.08-2.01, p =0.02) and in the overall group (Hazard Ratio 1.60, 95 % CI 1.27-2.02, p
       
  • An Explanation for the Effect of Different Storage Conditions on
           Sublingual Nitroglycerin Tablet Stability
    • Abstract: Publication date: Available online 26 June 2019Source: The American Journal of CardiologyAuthor(s): Linda A Felton, David A Lauber, Jason Koury, James J Nawarskas
       
  • Meta-analysis of Oral Anticoagulant Monotherapy as an Antithrombotic
           Strategy in Patients with Stable Coronary Artery Disease and Non-valvular
           Atrial Fibrillation
    • Abstract: Publication date: Available online 25 June 2019Source: The American Journal of CardiologyAuthor(s): So-Ryoung Lee, Tae-Min Rhee, Do-Yoon Kang, Eue-Keun Choi, Seil Oh, Gregory Y H Lip Guidelines recommend oral anticoagulant (OAC) monotherapy without antiplatelet therapy in patients with non-valvular 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 to OAC plus antiplatelet therapy. 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 antiplatelet therapy (SAPT) for patients with stable CAD and non-valvular AF. The primary endpoint was major adverse cardiovascular events (MACEs, composite of ischemic or thrombotic events) and secondary outcomes included major bleeding, stroke, all-cause death, and net adverse events (NAEs, composite of ischemic, thrombotic, or bleeding events). From 6 trials, 8,855 patients were included. There was no significant difference in MACE in AF patients treated using OAC plus SAPT compared to those treated with OAC monotherapy (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.92-1.29). OAC plus SAPT was associated with a significantly higher risk of major bleeding compared to OAC monotherapy (HR, 1.61; 95% CI, 1.38-1.87), as well as in terms of NAE (HR, 1.21; 95% CI, 1.02-1.43). 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 to OAC plus SAPT in patients with non-valvular AF and stable CAD.
       
  • Meta-analysis of Relation of Skipping Breakfast with Heart Disease
    • Abstract: Publication date: Available online 25 June 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 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.
       
  • A Cluster Analysis of the Japanese Multicenter Outpatient Registry of
           Patients with Atrial Fibrillation
    • Abstract: Publication date: Available online 25 June 2019Source: The American Journal of CardiologyAuthor(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 Kohsaka Recently, 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, 2458 AF patients (median [IQR] age, 68.0 [60.0-76.0]; 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 three clusters: 1) Younger paroxysmal AF (N=1190); 2) Persistent/permanent AF with LA enlargement (N=1143); 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 non-atherosclerotic 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.
       
  • Differentiating Constriction from Restriction (from the Mayo Clinic
           Echocardiographic Criteria)
    • Abstract: Publication date: Available online 25 June 2019Source: The American Journal of CardiologyAuthor(s): Salima Qamruddin, Saqer Khaled Alkharabsheh, Kimi Sato, Arnav Kumar, Paul C. Cremer, add Michael Chetrit, Douglas Johnston, Allan L. Klein Constrictive 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 in 107 patients with surgically proven CP from 30 patients with Restrictive Cardiomyopathy (RCM) due to cardiac Amyloidosis. Five principal echocardiographic and Doppler variables were re-measured 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 pulsed Doppler diastolic flow reversal ratio. Etiology of CP included viral/idiopathic or autoimmune (75%), post cardiac surgery (13%) and post radiation (7%). Univariate logistic regression analysis showed that: 1) respiration related ventricular septal shift, 2) percentage change in Mitral E velocity, 2) medial e’ velocity ≥9 cm/sec, 3) medial e’/lateral e’ ratio ≥ 0.91, 4) 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, while medial e’ velocity ≥9 cm/s has the highest specificity to diagnose CP (AUC-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 hepatic vein reversal ratio to this combination further increased the specificity (97%) but dropped the sensitivity (70%) to diagnose CP.
       
  • Interrelation between Electrocardiographic Left Atrial Abnormality, Left
           Ventricular Hypertrophy and Mortality in Participants with Hypertension
    • Abstract: Publication date: Available online 25 June 2019Source: The American Journal of CardiologyAuthor(s): Muhammad Imtiaz Ahmad, Mohammadtokir Mujtaba, Muhammad Ali Anees, Yabing Li, Elsayed Z. Soliman Left 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 (HR (95% 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 sex or race was observed. In models with similar adjustment where ECG-LVH and ECG-LAA were entered as two 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 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: Available online 24 June 2019Source: The American Journal of CardiologyAuthor(s): Pil Hyung Lee, Hanbit Park, Ji Sung Lee, Seung-Whan Lee, Cheol Whan LeeABSTRACTThere 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 multi-vessel 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 endpoint 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] 0.58–0.96, P = 0.024). The lower risk of MI with CABG as compared to PCI was more evident during a longer duration of follow-up (≥3 years, RR 0.69, 95% CI 0.52–0.91, P=0.008; ≥5 years, RR 0.64, 95% CI 0.48–0.86, P=0.003) and in the diabetic population (RR 0.55, 95% CI 0.44–0.70, P
       
  • Meta-analysis for Impact of Statin on Mortality after Transcatheter Aortic
           Valve Implantation
    • Abstract: Publication date: Available online 24 June 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 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 5170 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.
       
  • Comparison of Acute Versus Subacute Coronary Angiography in Patients with
           NON-ST-Elevation Myocardial Infarction (From the NONSTEMI Trial)
    • Abstract: Publication date: Available online 24 June 2019Source: The American Journal of CardiologyAuthor(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 Terkelsen The optimal timing of coronary angiography (CAG) in high-risk patients with acute coronary syndrome without persisting ST-segment elevation (NST-ACS) remains undetermined. The NONSTEMI (NON-ST-Elevation Myocardial Infarction) trial aimed to compare outcomes among 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 (< 2 h, n=245) or subacute CAG (< 72 h, n=251). The primary endpoint was a composite of all-cause death, re-infarction, and readmission with congestive heart failure within 1 year from randomization. A final acute coronary syndrome (ACS) diagnosis was assigned to 429 (86.5%) patients. The median time from randomization to revascularization was 1.3 hours in the acute CAG group versus 51.1 hours in the subacute CAG group (P < 0.001). The composite endpoint occurred in 25 patients (10.2%) in the acute CAG group and 29 (11.6%) in the subacute CAG group, P = 0.62. The acute CAG group had a 1-year all-cause mortality of 5.7% compared with 5.6% in the subacute CAG group, P = 0.96. In conclusion, neither the composite endpoint of all-cause death, re-infarction, and readmission with congestive heart failure nor mortality differed between an acute and subacute CAG approach in NSTE-ACS patients. However, identification of NSTE-ACS patients in the prehospital phase and direct triage to an invasive centre is feasible, safe and may facilitate early diagnosis and revascularization.
       
  • Impact of Tricuspid Regurgitation in Patients with Heart Failure and
           Mitral Valve Disease from a Nationwide Cohort Study
    • Abstract: Publication date: Available online 24 June 2019Source: The American Journal of CardiologyAuthor(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 Kapadia Concomitant heart failure (HF) and mitral valve disease (MVD) portend significant morbidity and mortality. While 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 2013–2014 Nationwide Readmission Database (NRD). We excluded patients without MVD, patients
       
  • Changes in Management Following Detection of Previously Unknown Atrial
           Fibrillation by an Insertable Cardiac Monitor (From the REVEAL AF Study)
    • Abstract: Publication date: Available online 24 June 2019Source: The American Journal of CardiologyAuthor(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. Reiffel The 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 following 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 18-30 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 (OAC), rhythm or rate control pharmacotherapy, cardioversion, ablation and cardiac sub-specialist referral. Among 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 following 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 OAC (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 to 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.
       
  • Prognosis is Different than Treatment Effect
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Steven D. Stovitz, John Mandrola
       
  • Characteristics, Outcomes, and Predictors of Significant Pericardial
           Complications in Patients who Underwent Transcatheter Aortic Valve
           Implantation
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Gbolahan O Ogunbayo, Naoki Misumida, Elliott Goodwin, Robert Pecha, Ayman Elbadawi, Claude S Elayi, Ahmed Abdel-Latif, John Gurley, Adrian W Messerli, Khaled Ziada
       
  • Reader's Comments: Subclinical Hypothyroidism and the Risk of
           Cardiovascular Disease
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Antonio Ponzetto, Gaetano De Ferrari
       
  • Libman-Sacks Endocarditis Involving a Bioprosthesis in the Aortic Valve
           Position in Systemic Lupus Erythematosus
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): William C. Roberts, Andy Y. Lee, Stuart R. Lander, Charles S. Roberts, Baron L. HammanDescribed herein is a 39-year-old man with systemic lupus erythematosus not receiving corticosteroid therapy who developed Libman-Sacks endocarditis causing stenosis of a bioprosthesis in the aortic valve position.
       
  • Familial Spontaneous Coronary Artery Dissection and the SMAD-3 Mutation
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Amir Solomonica, Rodrigo Bagur, Tawfiq Choudhury, Shahar LaviSpontaneous coronary artery dissection (SCAD) is a cause of about 4% of acute coronary syndrome. The pathophysiology of SCAD is not yet fully understood. Loeys-Dietz syndrome is a connective tissue disorder characterized by aortic aneurysms, arterial tortuosity, and aortic dissections. It is caused by mutations in the genes affecting the transforming growth factor β pathway. We describe a family with a SMAD3 gene mutation and Loeys-Dietz syndrome presenting with recurrent SCAD episodes.
       
  • Investing 101: How to Achieve Financial Security
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Robert M. Doroghazi
       
  • Thromboembolism in the Absence of Atrial Fibrillation
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Jeffrey Smietana, Anna Plitt, Jonathan L. HalperinAtrial fibrillation (AF) is associated with thrombus formation in the left atrial appendage and systemic embolic events including ischemic stroke. Cardiogenic thromboembolism can also occur in the absence of clinical AF as a result of various pathological conditions affecting the endocardium. The inconsistent temporal relation between AF and ischemic events has stimulated exploration for factors other than clinical AF that contribute to thromboembolism. These include subclinical AF, a thrombogenic atrial cardiomyopathy, and left atrial appendage dysfunction and embolism from other sources. In conclusion, thromboembolism during normal sinus rhythm is likely multifactorial, involving intertwined pathologic processes. Patients at risk, if accurately identified, could theoretically benefit from anticoagulation.
       
  • Understanding by General Providers of the Echocardiogram Report
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Amanda Trang, June Kampangkaew, Robin Fernandes, Jasleen Tiwana, Arunima Misra, Ihab Hamzeh, Alvin Blaustein, David Aguilar, Tina Shah, Christie Ballantyne, Miguel Quinones, Sherif F. Nagueh, Hisham Dokanish, Salim S. Virani, Anita Deswal, James N. Kirkpatrick, Vijay NambiEchocardiograms are the second most frequently utilized cardiac test after electrocardiograms and are most commonly ordered by noncardiology providers. Echocardiogram reports are designed to communicate a comprehensive interpretation of cardiac function; however, it is not known how well these reports are understood by ordering providers. In order to identify gaps in understanding and target potential areas for improvement, we developed a questionnaire testing various topics reported on a standard transthoracic echocardiogram report. This questionnaire was administered to general medicine and cardiology trainees and attending physicians at 2 large academic institutions. Questionnaire response rate was 81%. There were several topics that were not well understood by general providers; these included viability of an akinetic region, pulmonary artery systolic pressure, left ventricular filling pressure, recognition of abnormal structures, and method of identifying of intracardiac thrombus. In conclusion, strategies such as improved communication techniques and adjustment of reporting format should be implemented to increase the clinical value of the echocardiogram.
       
  • Echocardiographic Predictors of Long-Term Mortality in Patients Presenting
           With Acute Pulmonary Embolism
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Andrew D Terluk, Siddharth J Trivedi, Leonard Kritharides, Vincent Chow, Ee-May Chia, Karen Byth, Christian J Mussap, Austin C.C. Ng, Liza ThomasPulmonary embolism (PE) is associated with a high mortality; whether echocardiographic evaluation at presentation predicts long-term adverse outcomes is of importance. We sought to determine if a composite of routinely obtained echocardiographic parameters could determine long-term adverse events in PE patients. Right ventricular (RV) size and function and right atrial (RA) size were retrospectively evaluated in 233 consecutive PE patients with an inpatient echocardiogram, and compared with 70 healthy controls; mortality at 3 years was confirmed. PE patients had increased RV size (RV parasternal long-axis diameter [RVPLAX] and RV end-diastolic volume [p < 0.001 for both]) and RA area (p < 0.001). RV function was reduced in PE patients (RV fractional area change and RV ejection fraction [p 37 mm (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.3 to 4.2; p = 0.005), RA area>20 cm2 (HR 2.0, 95% CI 1.1 to 3.5; p = 0.016), and TR velocity>2.9 ms−1 (HR 1.9, 95% CI 1.1 to 3.4; p = 0.021), were independent echocardiographic predictors of mortality. Patients with all 3 “risk markers” had ∼17-fold increased mortality compared with those with no “risk markers” (HR 16.9, 95% CI 6.1 to 47.2; p < 0.001). In conclusion, a composite of routinely collected echocardiographic parameters, namely an enlarged RA and RV (RVPLAX diameter), and TR velocity, were independent predictors of mortality in PE patients, with an exponential increase in mortality when all 3 parameters were significantly altered. Prospective validation is required to confirm these preliminary observations.
       
  • Significance of Coronary Artery Calcium Found on
           Non–Electrocardiogram-Gated Computed Tomography During Preoperative
           Evaluation for Liver Transplant
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Brian H. West, Christopher G. Low, Biraj B. Bista, Eric H. Yang, Gabriel Vorobiof, Ronald W. Busuttil, Matthew J. Budoff, David Elashoff, Jonathan M. Tobis, Henry M. HondaGuidelines to evaluate patients for coronary artery disease (CAD) during preoperative evaluation for orthotopic liver transplantation (OLT) are conflicting. Cardiac catheterization is not without risk in patients with end-stage liver disease. No study to date has looked at the utility of non–electrocardiogram-gated chest computed tomography (CT) in the preliver transplant population. Our hypothesis was that coronary artery calcium scores (CACSs) from chest CT scans ordered during the liver transplant workup can identify patients who would benefit from invasive angiography. Nine hundred and fifty-three patients who underwent coronary angiography as part of their OLT workup were considered. Charts were randomly selected and reviewed for the presence of a chest CT performed before coronary angiography during the OLT workup. Agatston and Weston scores were calculated. CACS results were compared with coronary angiography findings. Nine of 54 patients were found to have obstructive CAD by angiography. Receiver-operating characteristic analysis demonstrated that an Agatston score of 251 and a Weston score of 6 maximized sensitivity and specificity for detection of obstructive coronary disease. An Agatston score
       
  • Usefulness of Longitudinal Strain to Assess Remodeling of Right and Left
           Cardiac Chambers Following Transcatheter Aortic Valve Implantation
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Diego Medvedofsky, Edward Koifman, Tatsuya Miyoshi, Toby Rogers, Zuyue Wang, Steven A. Goldstein, Itsik Ben-Dor, Lowell F. Satler, Rebecca Torguson, Ron Waksman, Federico M. AschRemodeling after transcatheter aortic valve implantation (TAVI) has been well characterized for the left ventricle (LV) but not for the other cardiac chambers. We aimed to describe conventional indices of cardiac remodeling and novel longitudinal strain (LS) in all 4 cardiac chambers post-TAVI and to explore gender remodeling disparities. Consecutive patients with significant aortic stenosis who underwent TAVI were included if echocardiograms in sinus rhythm before and 1-year postprocedure were available. Speckle tracking analysis was performed retrospectively to evaluate size and function of the 4 cardiac chambers. Baseline and 1-year data were compared. From a total of 612 patients who underwent TAVI, 213 were included in this study (82 ± 9 years old, 42% men). Although no significant size or function changes were seen for right cardiac chambers at follow-up, significant improvements were seen for ejection fraction (EF) and LS in both the LV and left atrium (LA) (p < 0.05 for both). The absolute percentage of LV and LA function improvement was higher for LS than for EF (p < 0.05). Women had smaller LV and right ventricular (RV) size, whereas parameters of LV and RV function were higher. All 1-year remodeling parameters were similar for men and women. Conventional LV remodeling parameters (LV mass) failed to improve 1 year after TAVI. However, novel strain-derived parameters of size and function showed remodeling of left chambers but not of RV or right atrium. The degree of LV and LA remodeling by LS is almost twice that of EF. Remodeling was similar for both genders.
       
  • Relation of Isolated Systolic Hypertension and Pulse Pressure to
           High-Sensitivity Cardiac Troponin-T and N-Terminal pro-B-Type Natriuretic
           Peptide in Older Adults (from the Atherosclerosis Risk in Communities
           Study)
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Nidhi Madan, Alexandra K. Lee, Kunihiro Matsushita, Ron C. Hoogeveen, Christie M. Ballantyne, Elizabeth Selvin, John W. McEvoyIsolated systolic hypertension (ISH) and elevated pulse pressure (PP) are common blood pressure (BP) abnormalities in older adults, reflect poor vascular compliance, and can signify risk for cardiovascular outcomes. We sought to characterize the associations of ISH and widened PP with high-sensitivity Troponin-T (hs-cTnT; a marker of myocardial damage) and N-terminal pro-B-type natriuretic peptide (NT-proBNP; a marker of hemodynamic stress) levels in older adults. We performed a cross-sectional analysis of 5,251 Atherosclerosis Risk in Communities (ARIC) study participants without heart failure who attended visit 5 (2011 to 2013). We used logistic regression to evaluate the association of ISH (systolic BP ≥140 mm Hg and diastolic BP < 90 mm Hg) and quartiles of PP with detectable (≥5 ng/L) and elevated hs-cTnT (≥14 ng/L); as well as elevated NT-proBNP (≥100 pg/mL). The mean age was 75 years, 58% were women, and 78% were white. ISH was present in 24.7% and PP ≥ 70 mm Hg in 30.3% of this cohort. Compared to participants with nonhypertensive BP (
       
  • Comparison of Left Ventricular Mass Calculation Methods via
           Two-Dimensional Echocardiogram in Children, Adolescents, and Young Adults
           With Systemic Hypertension
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Sean M. Lang, Benjamin R. Ittleman, Eunice Hahn, Ryan A. Moore, Philip R. Khoury, Nicholas J. Ollberding, Thomas R. Kimball, Christopher J. StatileLeft ventricular (LV) mass is a major determining tool for myocardial injury in hypertensive patients. Issues with LV mass calculations exist given that there are multiple methods to assess mass, including from the parasternal long axis (PLA), parasternal short axis (PSA), and 2-dimensional (2D) volumetric methods. The aim of this study was to compare the agreement of LV mass calculations using the PLA, PSA, and 2D volumetric methods. This study retrospectively reviewed 200 consecutive, initial echocardiograms for the indication of hypertension. A single reader calculated the LV mass in each patient via the PLA, PSA, and 2D volumetric methods. Percent differences for each study were calculated. LV mass threshold cutoffs of 51 g/m2.7 (cardiac organ injury) and 38.6 g/m2.7 (elevated LV mass) were used to compare categorical differences between the different measurement methods. Paired comparisons demonstrated an absolute mean percent difference of 8.46% to 9.41% among the different methods. LV mass calculated by the 2D volumetric method was less compared with PLA and PSA methods (31.64 vs 33.90 vs 35.51 g/m2.7; p < 0.0001). Fewer patients were classified as having cardiac target organ injury or elevated LV mass via 2D volumetric calculation, compared with PLA and PSA methods (p = 0.02 and p = 0.03, respectively). In conclusion, there is a small but important difference in LV mass calculations for patients with hypertension. These results emphasize the need for consistency within echocardiography laboratories as surveillance studies are common in this patient population.
       
  • Predictive Factors and Safety of Noninvasive Mechanical Ventilation in
           Combination With Propofol Deep Sedation in Left Atrial Ablation Procedures
           
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Aneida Vevecka, Carolina Schwab, Mathias Forkmann, Steffi Butz, Ajmi Issam, Oliver Turschner, Christian Mahnkopf, Johannes Brachmann, Sonia BuschCatheter ablation is nowadays the core treatment of atrial fibrillation (AF). Propofol infusion sedation is an accepted safety strategy; however, respiratory depression with respiratory variations is frequent. Noninvasive mechanical ventilation (NIV) added to deep sedation could improve procedural safety and success. We sought to assess the predictive factors and safety of NIV in combination to propofol deep sedation in left atrial ablation procedures. Procedural data from 252 consecutive patients who underwent left atrial ablation (166 [66%] persistent, 86 [34%] for paroxysmal AF) were analyzed. Sedation with 1% propofol was used in all procedures and controlled by electrophysiologists. Arterial blood gas analysis was performed regularly during the procedure. NIV was indicated for respiratory depression with pH 50 mm Hg or agitated patient with the need for more profound sedation. No patient needed endotracheal intubation, and no procedure was abandoned due to adverse effects of sedation. NIV was used in 25 patients (10%). Predictive factors for the use of NIV were high-dose propofol sedation (p = 0.010), persistent AF (p = 0.029), prolonged procedure time (p = 0.006), increased body mass index (p = 0.008) and presence of obstructive sleep apnea (OSA; p
       
  • Sinus Node Sparing Novel Hybrid Approach for Treatment of Inappropriate
           Sinus Tachycardia/Postural Orthostatic Sinus Tachycardia With New
           Electrophysiological Finding
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Carlo de Asmundis, Gian-Battista Chierchia, Juan Sieira, Erwin Ströker, Vincent Umbrain, Jan Poelaert, Pedro Brugada, Mark La MeirThe ideal treatment of Inappropriate Sinus Tachycardia (IST) and Postural Orthostatic Tachycardia Syndrome (POTS) still needs to be defined. Medical treatment yields suboptimal results, endocardial ablation of the sinus node (SN) may risk phrenic nerve damage and open heart surgery may be accompanied by unjustified invasive risks. We describe our first experience of 50 consecutive patients (41 females, 22.83 ± 3.91 years) having undergone a novel hybrid thoracoscopic ablation for drug resistant IST (n = 39, 78%) or POTS (n = 11, 22%). The SN was identified with the help of 3D mapping. Surgery was performed through 3 (5 mm) ports from the right side. A minimally invasive approach with a radio frequency bipolar clamp was utilized to a new target sparing the SN region, to isolate the superior and the inferior caval veins, and a crista terminalis line was made. All lines were interconnected. Normal SR was restored in all patients at the end of the procedure. All patients discontinued medication during the follow-up. After a blanking period of 6 months all patients presented stable SR. At a mean of 28.4 ± 1.2 months, normal SN ruction and chronotropic response to exercise was present. In the 11 patients initially diagnosed with POTS, no syncope occurred. During the follow-up, pericarditis was the most common complication (39 patients; 78%) with complete resolution in all cases. In conclusions the preliminary results of our first experience with a SN sparing novel hybrid ablation of IST/POTS, using surgical thoracoscopic video-assisted epicardial ablation combined with concomitant endocardial 3D mapping may prove an efficient and safe therapeutic option in patients with symptomatic drug resistant IST and POTS. Importantly, in our study all patients had a complete resolution of the symptoms and restored normal SN activity.
       
  • Incremental Prognostic Value of Exercise Stress Testing in Primary
           Prevention
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Alaa Alashi, Haris Riaz, Richard Lang, Raul Seballos, Steven Feinleib, Roxanne Sukol, Leslie Cho, Paul Cremer, Wael Jaber, Brian P Griffin, Milind Y DesaiIn primary prevention, addition of C-reactive protein and family history to standard risk factor assessment (Reynolds Risk Score or RRS) provides superior risk stratification for future cardiovascular (CV) events. We sought to assess whether addition of functional capacity to RRS provided incremental prognostic value. This was a prospective observational cohort study of 3,964 consecutive asymptomatic adults without documented CV disease (mean age 51 years, 78% men) evaluated between 2005 and 2013, who underwent clinical and treadmill stress testing at baseline. RRS was calculated; % age-gender predicted metabolic equivalents (AGP-METs) achieved and heart rate recovery (HRR) were recorded. End point was death and myocardial infarction. Findings were tested in derivation (n = 1,982) and validation samples (n = 1,982). Mean RRS and C-reactive protein were 3.7 ± 4 and 2 ± 4 mg/dl. Nine percent had family history of premature CV disease. %AGP-METs achieved, and HRR were 113 ± 20 and 24 ± 8 beats/min. Forty-six percent achieved
       
  • Relation of Marital Status and QT Interval Prolongation (from the Third
           National Health and Nutrition Examination Survey)
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Muhammad Imtiaz Ahmad, Chaudry Nasir Majeed, Dipendra Chaudhary, Abhishek Dutta, Hanumantha R. Jogu, Elsayed Z. SolimanAlthough the link between marital status and mortality is well established, the pathophysiological basis is unclear. An investigation of the association of marital status with prolonged QT interval may highlight the underlying mechanism for poor outcomes associated with being unmarried. This analysis included 6,562 participants (mean age 58.6 years, 52% women, 50.1% non-Hispanic whites) without a history of cardiovascular disease from the Third National Health and Nutrition Examination Survey. QT was automatically measured from digital 12-lead electrocardiogram in a central reading center. Marital status was defined by self-report as married and unmarried (never married, divorced/separated or widowed). A multivariable logistic regression model was used to examine cross-sectional association between marital status and prolonged QT interval (≥450 ms in men, ≥460 ms in women). Compared with married, unmarried was associated with 46% higher odds of the prolonged QT interval (odds ratio [OR] 95% confidence interval [95% CI]: 1.46[1.16–1.83]). This association was stronger among men versus women (OR[95% CI]: 1.75[1.27–2.41] vs 1.26[0.92–1.73] respectively; interaction p value = 0.03) and in younger versus older participants (OR [95% CI]: 1.72[1.21–2.42] vs 1.40[1.05–1.88], respectively; interaction p value = 0.002). When the types of unmarried were compared to married, a dose-response relation with prolonged QT was observed with the highest odds in never married followed by divorced/separated, and then widowed. In conclusion, marital status is associated with a prolonged QT interval, especially among men and younger participants. Prolonged QT interval may indicate a biologic substrate through which social isolation defined by unmarried state increases the risk of poor outcomes in the future.
       
  • Readmissions Following Isolated Coronary Artery Bypass Graft Surgery in
           the United States (from the Nationwide Readmissions Database 2010 to 2014)
           
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Habib Khoury, Yas Sanaiha, Sarah E Rudasill, Alexandra L. Mardock, Sohail Sareh, Peyman BenharashReadmission following cardiac surgery is associated with poor outcomes and increased healthcare expenditure. However, a nationwide understanding of the incidence, cost, causes, and predictors of 30-day readmission following coronary artery bypass grafting is limited. The Nationwide Readmissions Database was used to identify all adult patients who underwent isolated coronary artery bypass grafting (CABG) with no other concomitant surgery between 2010 and 2014. The primary outcome was all-cause readmission within 30 days of discharge after surgery. Risk-adjusted multivariable analyses were used to develop a model of readmission risk. Of 855,836 patients, 95,504 (11.2%) had an emergent 30-day readmission following CABG. The most common causes of readmission were related to respiratory complications (17.1%), infection (13.5%), and heart failure (11.9%). Readmission cost an average of $13,392 per patient, accounting for an estimated annual cost of over $250 million. Independent predictors of 30-day readmission encompassed female gender (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.24 to 1.31), emergent index admission (OR 1.29; 95% CI 1.25 to 1.33), and preoperative co-morbidities, including atrial fibrillation (OR 1.24; 95% CI 1.21 to 1.28), liver disease (OR 1.29; 95% CI 1.17 to 1.41), renal failure (OR 1.38; 95% CI 1.34 to 1.43), among others. CABG performed at a high CABG volume hospital was protective of readmission (OR 0.95; 95% CI 0.91 to 0.99). In conclusion, we characterized using a national sample the incidence, causes, costs, and predictors of 30-day readmission following CABG. Targeting modifiable risk factors for readmission should be a priority to reduce rates of readmission and decrease healthcare expenditure.
       
  • Comparative Effectiveness and Safety of Polymer-Free Biolimus-Eluting
           Stent and Durable Polymer Everolimus-Eluting Stent in All-Comer Patients
           Who Underwent Percutaneous Coronary Interventions
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Martino Pepe, Giuseppe Biondi-Zoccai, Nicola Corcione, Palma Luisa Nestola, Paolo Ferraro, Alberto Morello, Sirio Conte, Francesco Prati, Francesco Paolo Bianchi, Alessandro Santo Bortone, Arturo GiordanoWe aim to compare Polymer-Free Biolimus-Eluting Stent (PF-BES) with Durable Polymer Everolimus-Eluting stent (DP-EES) in unselected patients. PF-BES showed a favorable profile in high-bleeding risk patients who underwent percutaneous coronary intervention. Limited data are available on PF-BES compared with second-generation durable polymer-coated drug-eluting stents in patients eligible for standard dual antiplatelet therapy. A total of 848 consecutive patients were enrolled: 306 patients were treated with PF-BES and 542 with DP-EES. Stent performance was tested in a propensity score-matched population and in a Complex Higher-Risk and Indicated Patients (CHIP) subpopulation. A per-lesion analysis on 1,204 lesions (PF-BES = 424 vs DP-EES = 780) was also performed. At a medium follow-up of 18.5 ± 5.0 months, no differences in the matched population were found in terms of major adverse cardiac events (PF-BES 9.0% vs DP-EES 4.5%; p 0.091), myocardial infarction (PF-BES 6.2% vs DP-EES 2.3%; p 0.111), stent restenosis (PF-BES 2.3% vs DP-EES 0.0%; p 0.123), definite or probable stent thrombosis (PF-BES 2.8% vs DP-EES 1.1%; p 0.448). A significant inferior rate of restenosis was observed in the DP-EES arm in the whole (PF-BES 2.3% vs DP-EES 0.6%; p 0.041) and CHIP populations (PF-BES 4.3% vs DP-EES 0.5%; p 0.023), as well as in the per-lesion analysis (DP-EES 0.4% vs PF-BES 1.7%; p 0.039). In conclusion, in a real-world cohort PF-BES performed similarly to DP-EES in terms of restenosis and stent thrombosis in the matched population. Nonetheless, in the whole and CHIP populations, as well as in the per-lesion analysis, restenosis occurrence resulted higher in the PF-BES group.
       
  • Shared Decision-Making in Femoral Versus Radial Cardiac Catheterization
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Logan Schwarzman, Talya Miron-Shatz, Katherine Maki, Leon Hsueh, Eden Liu, Danit Tarashandegan, Felipe Mendez, Mladen I. VidovichShared decision-making is a strategy to assist with patient involvement in medical decisions. One of its pillars is patient knowledge and understanding of the risks and benefits associated with specific procedures. We studied patient knowledge about transradial (TRA) and transfemoral (TFA) cardiac catheterization. A prospective study was conducted in 100 patients hospitalized following diagnostic and therapeutic cardiac catheterization—TRA in 71% of patients and remaining TFA. All patients were presented a standard balanced informed consent outlining risks and benefits. Following catheterization, patients were verbally administered an 11-item open-ended questionnaire to assess knowledge of cardiac catheterization and the associated risks and benefits. A patient knowledge index (PKI) was developed with 1 point given for: identifying the procedure; correctly describing the procedure; identifying at least 1 risk of TRA; and/or TFA; and at least 1 benefit of TRA; and/or TFA. Maximum PKI score was 6. The mean PKI score was 2.6 ± 1.1. A PKI score ≥4 was observed in 21% of patients with only 1 patient obtaining the maximum 6 points. Over 80% of patients were unable to recall procedure risks provided at the time of informed consent. The majority of patients were unable to discriminate between TRA and TFA risks and benefits, PKI 2.52 versus 2.60, respectively (p = 0.718). On multivariate analysis, higher education levels were correlated with increased PKI scores (odds ratio = 0.65, p = 0.014) whereas black race was associated with lower PKI scores (odds ratio = −0.48, p = 0.045). In conclusion, patient retention of information from the informed consent was low. The majority of patients had no preference or deferred to their physician's expertise when deciding TRA compared with TFA. This study identifies challenges with implementing shared decision-making and the need for improved patient education and involvement regarding cardiac catheterization.
       
  • Diagnostic Accuracy of Microcatheter Derived Fractional Flow Reserve
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Ozan M. Demir, Satoru Mitomo, Antonio Mangieri, Marco B. Ancona, Damiano Regazzoli, Giuseppe Lanzillo, Francesco Giannini, Luca Testa, William Wijns, Antonio Colombo, Azeem LatibMicrocatheter derived fractional flow reserve (FFRMC) system has an increased profile compared with pressure-wire derived fractional flow reserve (FFRW). Consequently, the FFRMC system itself may increase the degree of coronary artery stenosis and lower the measured FFR value. This can affect the diagnostic accuracy of the FFRMC system and inadvertently result in erroneous therapy for patients. Our aim was to evaluate the diagnostic accuracy FFRMC measurements and provide a means for clinicians to interpret individual FFRMC results with respect to FFRW. Correlation between FFR measurement techniques was analyzed in this lesion level analysis of 413 patients and 441 lesions from 6 studies. The reference standard to determine physiological significant stenosis was FFRW value ≤0.80. The mean values for FFRMC and FFRW were 0.80 ± 0.11 and 0.83 ± 0.09, respectively. Bland-Altman analysis demonstrated a bias toward overestimation of FFR by FFRMC (bias, −0.03 [0.05]). The overall lesion level diagnostic accuracy of the FFRMC system was 80.4% (95% confidence interval [CI] 76.2% to 84.0%). The diagnostic accuracy for FFRMC values 0.85 were 83.7% (95% CI 71.4% to 92.4%), 72.3% (95% CI 59.8% to 75.6%), and 99.2% (95% CI 94.8% to 99.8%), respectively. Using the FFRW threshold of ≤0.80, 16.3% of lesions would have had inappropriate revascularization according to FFRMC measurements. Receiver-operating characteristics suggested the optimal cut-off value of FFRMC to determine ischemia was 0.78. In conclusion, the diagnostic accuracy of FFRMC varies markedly across the spectrum of disease with marked deterioration for values between 0.75 and 0.85. This may result in clinicians to inadvertently revascularize patients with FFR measurements>0.80.
       
  • Correlation of Circulating miR-765, miR-93-5p, and miR-433-3p to
           Obstructive Coronary Heart Disease Evaluated by Cardiac Computed
           Tomography
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Teresa Infante, Ernesto Forte, Bruna Punzo, Filippo Cademartiri, Carlo Cavaliere, Andrea Soricelli, Marco Salvatore, Claudio NapoliEpigenetic-sensitive mechanisms may be correlated both to pathogenesis and prognosis of coronary heart disease (CHD). We prospectively investigated some plasma circulating microRNA levels in patients undergoing cardiac computed tomography for suspected CHD (n = 95).We show that let-7c-5p, miR-765, miR-483-5p, miR-31-5p, and miR-206 were upregulated in CHD patients (n = 66) versus healthy subjects HS (n = 29); moreover, let-7c-5p, miR-765, miR- 483-5p showed higher expression in obstructive CHD (n = 36) compared to no obstructive CHD patients (n = 66). Remarkably, miR-765, miR-93-5p, and miR-433-3p showed an upregulation in patients with critical coronary stenosis. Multivariate regression analysis demonstrated that miR-765, miR-31-5p, and miR-206 were independently associated with CHD while circulating levels of miR-765 (p = 0.035), miR-433-3p (p = 0.043), and miR-93-5p (p = 0.041) were significantly higher in critical stenosis patients. Receiver operating characteristic curve analysis revealed a good performance for miR-765, miR-93-5p, and miR-433-3p on predicting CHD severity. In conclusion, our study represents a combined epigenetic/imaging approach useful to support the diagnosis and prediction of CHD.
       
  • Adherence to Blood Cholesterol Treatment Guidelines Among Physicians
           Managing Patients With Atherosclerotic Cardiovascular Disease
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): Eddison Ramsaran, Peggy Preusse, Devi Sundaresan, Stefan DiMario, Jeetvan Patel, David Harrison, Michael Munsell, Joseph MenzinThe ACC/AHA blood cholesterol treatment guidelines recommend statin therapy for all patients after experiencing an acute cardiovascular event. Previous analyses have shown that physicians have been slow to adopt guidelines, and many patients remain untreated or undertreated with statins after a cardiovascular event. However, reasons for this remain unknown. This analysis used electronic medical records and patient chart data from Reliant Medical Group (Worcester, Massachusetts) to evaluate physician adherence to the 2013 ACC/AHA blood cholesterol guidelines when treating patients with evidence of acute atherosclerotic cardiovascular disease and the reasons for the observed treatment decisions. Less than 50% of acute atherosclerotic cardiovascular disease patients were treated according to the ACC/AHA guidelines. Nearly 42% of patients not treated according to guidelines received a lower statin intensity than recommended. The most common reason cited by 41.8% of physicians for treating with a statin intensity below the recommended intensity was low-density lipoprotein cholesterol stable or at goal, despite ACC/AHA guidelines recommending specific statin intensities rather than specific low-density lipoprotein cholesterol levels. In conclusion, physician and patient education on the importance of maximizing lipid-lowering therapy in this high-risk patient population should be emphasized.
       
  • Some Thoughts About the Different Ballooning Patterns in Patients With
           Recurrent Takotsubo Syndrome from the Ones During Their Index Takotsubo
           Episode
    • Abstract: Publication date: 15 July 2019Source: The American Journal of Cardiology, Volume 124, Issue 2Author(s): John E. Madias
       
  • Implications of Initial Recorded Rhythm on Cardioverter-Defibrillator
           Insertion and Subsequent All-Cause Mortality in Sudden Cardiac Arrest
           Survivors
    • Abstract: Publication date: Available online 14 June 2019Source: The American Journal of CardiologyAuthor(s): Vincenzo B. Polsinelli, Norman C. Wang, Krishna Kancharla, Aditya Bhonsale, Sandeep K. Jain, Samir Saba Sudden cardiac arrest (SCA) rhythms have been traditionally divided into shockable [ventricular tachycardia (VT)/ventricular fibrillation (VF)] and non-shockable [(asystole (ASY)/ pulseless electrical activity (PEA)] rhythms. It is unclear if the specific rhythm has implications on patient management and outcomes. We evaluated 1433 patients who were admitted with SCA between 2000 and 2012 and were discharged alive. Of those, 1123 patients had a recorded initial SCA rhythm. Subjects included were>18 years of age, and without an ICD in place at the time of the event. The likelihood of receiving an ICD for each SCA rhythm and the time to death were analyzed. Of the overall cohort of 1123 SCA survivors (age of 62±15 years; 39.2% women; 56.3% in-hospital SCA; 83% white; 67% coronary artery disease), 355 (31.6%) received an ICD and 493 (43.9%) died over a mean follow-up of 3.8±3.2 years. Patients with VF (n=254, 43.6%) or VT (n=83, 43.9%) were more likely to receive ICD therapy compared to those with ASY (n=9, 5.3%) or PEA (n=9, 4.8%) (P
       
  • Effect of Race on Echocardiographic Measures of Cardiac Structure and
           Function
    • Abstract: Publication date: Available online 13 June 2019Source: The American Journal of CardiologyAuthor(s): Troy M. LaBounty, David S. Bach, Eduardo Bossone, Theodore J. KoliasABSTRACTThe relations between race and cardiac structure and function are incompletely understood. We hypothesized that race-specific differences in echocardiography measurements exist. We compared the relation between echocardiography measurements and race among 12,429 non-obese adults without known cardiovascular disease undergoing echocardiography. We compared measurements between whites (n=10,508), blacks (n=792), Asians (n=628), Hispanics (n=315), Native Americans (n=34), and multiracial/other (n=152) cohorts. Multivariate analysis compared measurements indexed to body surface area (BSA) between races and adjusted for variables including age, gender, and mean blood pressure. Mean age was 46.9±17.4 years and 60.5% were female. After multivariable adjustment and using whites as a baseline, there were significant differences (p
       
  • Clinical Differences in Japanese Patients Between Brugada Syndrome and
           Arrhythmogenic Right Ventricular Cardiomyopathy with Long-term Follow-up
    • Abstract: Publication date: Available online 12 June 2019Source: The American Journal of CardiologyAuthor(s): Naoya Kataoka, Satoshi Nagase, Tsukasa Kamakura, Kenzaburo Nakajima, Mitsuru Wada, Kenichiro Yamagata, Kohei Ishibashi, Yuko Y. Inoue, Koji Miyamoto, Takashi Noda, Takeshi Aiba, Chisato Izumi, Teruo Noguchi, Satoshi Yasuda, Shiro Kamakura, Kengo KusanoABSTRACTSome Brugada syndrome (BrS) patients have been suspected of being in the initial state of arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aimed to clarify the electrocardiographic (ECG) and clinical differences between BrS and ARVC in long-term follow-up (mean 11.9 ± 6.3 years). A total of 50 BrS and 65 ARVC patients with fatal ventricular tachyarrhythmia (VTA) were evaluated according to the revised Task Force Criteria for ARVC. Based on the current diagnostic criteria concerning ECG, repolarization abnormality was positive in 2.0% and 2.6% of BrS patients at baseline and follow-up, and depolarization abnormality was positive in 6.0% and 12.8% of BrS patients at baseline and follow-up, respectively. At baseline, none of the BrS patients were definitively diagnosed with ARVC. Considering patients’ lives since birth, Kaplan-Meier analysis revealed that age at first VTA attack showed the same tendency between the groups (BrS: mean 42.2 ± 12.5 years old vs. ARVC: mean 44.8 ± 13.7 years old, log-rank p = 0.123). Moreover, the incidence of VTA recurrence was similar between the groups during follow-up (log-rank p = 0.906). Incidence of sustained monomorphic ventricular tachycardia was significantly higher in ARVC than in BrS whereas the opposite was true for ventricular fibrillation (log-rank p < 0.001 and p < 0.001, respectively). None of the diagnoses of BrS patients were changed to ARVC during follow-up. During long-term follow-up, although age at first VTA attack and VTA recurrence were similar, BrS consistently exhibited features that differed from those of ARVC.
       
  • Prevalence of Mental Illness in Adolescents and Adults with Congenital
           Heart Disease from the Colorado Congenital Heart Defect Surveillance
           System
    • Abstract: Publication date: Available online 11 June 2019Source: The American Journal of CardiologyAuthor(s): Amber D Khanna, Lindsey M Duca, Joseph D Kay, Jay Shore, Sarah L Kelly, Tessa CrumeABSTRACTThe aim of this study was to estimate the prevalence of the full spectrum of mental illness among adolescents (aged 11-17) and adults (aged 18-64) with congenital heart defects (CHDs) in the population-level Colorado Congenital Heart Disease Surveillance System (COCHD). Further we sought to investigate whether severity of the defect, frequency of recent cardiac procedures or underlying genetic disorders influence these estimates. The cohort included individuals in clinical care for CHDs between January 1, 2011 and December 31, 2013, identified across multiple healthcare systems and insurance claims. Of 2,192 adolescents with CHDs, 20% were diagnosed with a mental illness with the most prevalent categories being developmental disorders (8%), anxiety disorders (6%), attention, conduct, behavior, and impulse control disorders (6%), and mood disorders (5%). Of 6,924 adults with CHDs, 33% were diagnosed with a mental illness with the most prevalent categories being mood disorders (13%), anxiety disorders (13%), and substance-related disorders (6%). Greater lesion complexity was associated with a higher likelihood of anxiety and developmental disorders among both adolescents and adults. Adolescents and adults who had ≥2 cardiac procedures in the 3 year surveillance period had a 3- and 4.5-fold higher likelihood of a mental illness diagnosis, respectively, compared to those who had fewer than 2 cardiac procedures. Finally, individuals with a genetic syndrome were more likely to have a mental illness diagnosis. In conclusion, mental illness is a prevalent comorbidity in the adolescent and adult population with CHDs, thus comprehensive care should include mental health care.
       
  • Predictors and Outcomes of Persistent Tricuspid Regurgitation After
           Transcatheter Aortic Valve Implantation
    • Abstract: Publication date: Available online 10 June 2019Source: The American Journal of CardiologyAuthor(s): Jun Yoshida, Hiroki Ikenaga, Atsushi Hayashi, Satoshi Yamaguchi, Takafumi Nagaura, Florian Rader, Robert J. Siegel, Raj R. Makkar, Takahiro Shiota Persistent tricuspid regurgitation (TR) after transcatheter aortic valve implantation (TAVI) has been reported to increase mortality. The aim of this study was to investigate clinical and echocardiographic determinants and outcome of persistent TR after TAVI. We reviewed 1085 patients who underwent TAVI. Among them, 100 patients who had ≥moderate TR without organic dysfunction of the tricuspid valve apparatus were studied. Preprocedural and follow-up transthoracic echocardiography after TAVI were analyzed. After TAVI, patients were divided into persistent TR group and improved TR group. Clinical event was defined as all-cause mortality and readmission for heart failure within 1000 days. Fifty-three (53%) patients had persistent TR, while 47 (47%) patients had improved TR. Risk of clinical event was significantly higher in the persistent TR group compared with the improved TR group. Atrial fibrillation (AF) and tricuspid annular dimension (TAD) (p
       
  • “A Wedding as an Investment”
    • Abstract: Publication date: Available online 8 June 2019Source: The American Journal of CardiologyAuthor(s): Robert M. Doroghazi
       
  • Usefulness of Excellent Functional Capacity in Men and Women with Ischemic
           Exercise Electrocardiography to Predict a Negative Stress Imaging Test and
           Very Low Late Mortality
    • Abstract: Publication date: Available online 7 June 2019Source: The American Journal of CardiologyAuthor(s): Neil Beri, Patricia Dang, Amogh Bhat, Sandhya Venugopal, Ezra A. AmsterdamABSTRACTExercise electrocardiography (ExECG) is widely employed to assess patients for coronary artery disease (CAD) but it has limited diagnostic accuracy. Many patients with positive (ischemic) tests based on exercise-induced ST depression undergo secondary evaluation by noninvasive stress imaging. We hypothesized that high functional capacity in patients with positive ExECG could predict: (1) negative results in secondary evaluation by exercise echocardiography (ESE) or myocardial perfusion scintigraphy (MPS) and (2) low mortality on late follow-up. We evaluated 511 consecutive patients (312 men, 199 women; age 51±9 yrs) referred for ESE or MPS after an ischemic ExECG at a treadmill workload of ≥10 METs. All-cause mortality was also obtained. Of 511 patients, 401 underwent ESE and 110 had MPS for secondary study. ESE was negative in 94% (376/401) and positive in 6% (25/401). MPS was also negative in 94% (103/110) and positive in 6% (7/110). Total stress imaging results were negative in 92% (286/312) of men and 97% (193/199) of women. During follow-up of approximately 6 yrs, there were 3 deaths with total all-cause mortality of 0.6% and average annual mortality of 0.1%. In conclusion, high functional capacity in patients with an ischemic ExECG predicts a negative ESE or MPS in a large majority of patients and very favorable late survival in both men and women. These results suggest that patients with ischemic ExECGs and a workload of ≥10 METS during ExECG may not require additional noninvasive or invasive evaluation.
       
  • A Lethal Blow to the Chest as an Underdiagnosed Cause of Sudden Death in
           United Kingdom Sports (Football, Cricket, Rugby)
    • Abstract: Publication date: Available online 7 June 2019Source: The American Journal of CardiologyAuthor(s): Susanna Cooper, Noel W. Woodford, Barry J. Maron, Kevin M. Harris, Mary N. Sheppard Non-penetrating blunt force trauma to the front of the chest can lead to commotio cordis, a cardiac rhythm disturbance, which can result in cardiac arrest and death. The condition is particularly noted during sport. No series of such cases has been published in the United Kingdom (UK). This study is a retrospective analysis of a database of 6000 cases of sudden cardiac death (SCD) examining commotio cordis in the setting of collapse and death shortly following a blow to the precordium where no structural heart disease was identified at autopsy. Of the 17 cases, 16 were male, and 11 were 18 years old or younger. 11 occurred whilst playing sport while 6 involved physical interaction including assault. The most common circumstance of death involved a youth being struck in the chest by a ball during sporting activity. In conclusion, this study demonstrates that cases of commotio cordis in the UK follow a similar circumstantial and age profile to those reported in the United States, and indicates that ball sports such as football, cricket and rugby expose young participants to a similar risk. There is currently no nation-wide registry of deaths occurring during sporting activity in the UK, and although the true incidence of this condition is not currently known, it is most probably under-recognised and underdiagnosed.
       
  • Serial Changes in Left Ventricular Ejection Fraction and Outcomes in
           Outpatients with Heart Failure and Preserved Ejection Fraction
    • Abstract: Publication date: Available online 6 June 2019Source: The American Journal of CardiologyAuthor(s): Andreas P. Kalogeropoulos, Samuel Kim, Sahil Rawal, Arvin Jadonath, Rasika Tangutoori, Vasiliki Georgiopoulou Limited data exist on the course of left ventricle ejection fraction (LVEF) among outpatients with heart failure (HF) and preserved ejection fraction (HFpEF) and its impact on outcomes. We evaluated 322 consecutive outpatients with confirmed HF, LVEF>40%, no previous LVEF ≤40%, and no specific cardiomyopathies or primary right-sided or valvular heart disease. Median age was 73 years (interquartile range: 63–82); 57.1% were women, 50.3% White, and 45.0% Black; median LVEF was 55% (50%–60%); and 45.6% had coronary artery disease. After a median of 37 months (32–38) and 4.5 follow-up echocardiograms (4–6) per patient, 11.4% of patients (95%CI 5.2%–17.7%) developed LVEF 130 mmHg was associated with more LVEF decline. During follow-up, 50 patients died (3-year mortality 15.3%) and 67 additional patients were hospitalized for HF (3-year death plus HF hospitalization 35.6%). Development of LVEF
       
  • Risk of Mortality Associated with Therapeutic Hypothermia among Sudden
           Cardiac Arrest Survivors with Known Heart Failure
    • Abstract: Publication date: Available online 6 June 2019Source: The American Journal of CardiologyAuthor(s): Waqas T. Qureshi, Abhishek Dutta, Youssef Masmoudi, Usama bin Nasir, Chaudry Nasir Majeed, John Azizian, Lawson McDonald, Deval Shah, Anthony Bleyer, Hanumantha JoguABSTRACTCurrent guidelines do not inform about use of therapeutic hypothermia among heart failure (HF) patients that suffer from cardiac-arrest. We assessed the risk of mortality associated with hypothermia among cardiac-arrest survivors with HF. This analysis includes 1416 comatose patients with cardiac-arrest that achieved return of spontaneous circulation on admission and had a left ventricular ejection fraction (LVEF) assessment or HF admission within the previous year. HF was defined as either prior episode of HF or presence of LVEF
       
  • The Digital Stethoscope- Two Senses Are Better Than One
    • Abstract: Publication date: Available online 6 June 2019Source: The American Journal of CardiologyAuthor(s): Faris G Araj, Julie Cox BSN
       
 
 
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