Publisher: Elsevier   (Total: 3206 journals)

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Showing 1 - 200 of 3206 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 27, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 106, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 44, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 449, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 335, 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: 2, SJR: 1.793, CiteScore: 6)
Acta Psychologica     Hybrid Journal   (Followers: 26, 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   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 13, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 193, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 13, 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: 20, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, 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: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, 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: 35, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 27, SJR: 1.562, CiteScore: 3)
Advances in Clinical Radiology     Full-text available via subscription   (Followers: 1)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 21, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Cosmetic Surgery     Full-text available via subscription   (Followers: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 16)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 14)
Advances in Digestive Medicine     Open Access   (Followers: 14)
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: 30, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 51, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Family Practice Nursing     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: 69, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 8, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 4, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 26)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Pathology     Hybrid Journal   (Followers: 1)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Ophthalmology and Optometry     Full-text available via subscription   (Followers: 1)
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: 6, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 69)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, 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: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 433, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
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: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 57, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 397, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 484, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 47, 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: 8, 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: 12)
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: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 56, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 59, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 67, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 48, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 40, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 34, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 37, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 51)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics & Gynecology MFM     Hybrid Journal   (Followers: 1)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 275, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 67, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 29, 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: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 26, 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: 6, 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: 219, 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)

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Similar Journals
Journal Cover
American Journal of Cardiology
Journal Prestige (SJR): 1.93
Citation Impact (citeScore): 3
Number of Followers: 67  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9149 - ISSN (Online) 1879-1913
Published by Elsevier Homepage  [3206 journals]
  • “Stupid Doctor Mistakes: Part Three of Many”
    • Abstract: Publication date: Available online 13 February 2020Source: The American Journal of CardiologyAuthor(s): Robert M. Doroghazi
       
  • Prevention Guidelines as Failed Minimal Standards of Care
    • Abstract: Publication date: Available online 13 February 2020Source: The American Journal of CardiologyAuthor(s): Peter A. McCulloughAbstractClinical practice guidelines have garnered considerable interest among clinicians and researchers in cardiovascular medicine. Among the guidelines, the prevention of coronary heart disease receives great attention as a summary of the clinical trials addressing primary and secondary prevention. One of the challenges to guidelines committees is reduction to clinical practice. Because it can be difficult to gain consensus from experts on broad statements, the final guidelines product represents a compromise which may not serve as a sufficient safety net for patients. Guidelines might best include patient vignettes to motivate guidelines committees to apply their recommendations to clinical practice and serve as a logic check with the aim of not failing patients in need of diagnosis and treatment.
       
  • Readers’ Comments: Aspirin and/or Other Antiplatelet Agents for the
           Prevention of Infective Endocarditis
    • Abstract: Publication date: Available online 13 February 2020Source: The American Journal of CardiologyAuthor(s): John E. Madias
       
  • Diagnostic Implications in the Aftermath of the ISCHEMIA Trial
    • Abstract: Publication date: Available online 12 February 2020Source: The American Journal of CardiologyAuthor(s): G. B. John Mancini, William E. BodenAbstractThe recently reported ISCHEMIA trial will re-ignite the debate regarding the optimal first diagnostic test when evaluating chest pain in patients suspected to have coronary artery disease (CAD). This article considers whether the debate should be re-focussed even prior to selecting any diagnostic test. The case is made to prioritize risk factor management and empiric angina pectoris control as part of optimal secondary prevention followed by expeditious clinical reassessment to determine adequacy of therapeutic responses, including quality of life, prior to embarking on diagnostic testing. Once anatomical CAD is known in diagnostic algorithms that incorporate cardiac computed tomographic angiography, there is the potential to forego an adequate trial of conservative management, thereby failing to translate the key finding of ISCHEMIA to practice. Embedded in this “Symptom-driven Path” is the principle that definitive diagnostic testing must be expeditious if symptoms persist or deteriorate and impair quality of life during conservative management. This strategy would ensure appropriate utilization of contemporary conservative management which is replete with numerous effective pharmacotherapies that modify atherosclerosis and dramatically reduce cardiovascular risk. In conclusion, diagnostic testing and invasive therapy would be minimized and dictated primarily by adequacy of patient symptoms and quality of life.
       
  • Prognostic Value of N-Terminal Pro-form B-type Natriuretic Peptide in
           Patients With Moderate Aortic Stenosis
    • Abstract: Publication date: Available online 11 February 2020Source: The American Journal of CardiologyAuthor(s): Saki Ito, William R. Miranda, Allan S. Jaffe, Jae K. OhABSTRACTPlasma B-type natriuretic peptide (BNP) and its N-terminal pro-form, NT-proBNP, can predict outcomes in patients with severe aortic stenosis (AS). However, prognostic value in moderate AS is currently unknown. The present study included 261 patients who diagnosed with moderate AS (1.0 888pg/dl). During a median follow up of 2.7 years, there were 136 (52%) deaths. Mortality rate was much higher in patients with higher-median NT-pro BNP compared to those with lower-median NT-pro BNP levels (P
       
  • Acute Isolated Coronary Artery Dissection Causing Massive Acute Myocardial
           Infarction and Leading to Unsuccessful Coronary Bypass, Extracorporeal
           Life Support, and Successful Cardiac Transplantation
    • Abstract: Publication date: Available online 11 February 2020Source: The American Journal of CardiologyAuthor(s): Julie Cox, William C. Roberts, Faris G. Araj, Jamie Jarzembowski, Cesar Y. Guerrero-Miranda, Andrea Cooley, Charles S. Roberts, Dan M. MeyerABSTRACTDescribed herein is a 42-year-old woman who suddenly developed a spontaneous isolated coronary arterial dissection which led to massive acute myocardial infarction with shock, unsuccessful coronary artery bypass grafting, transiently successful extracorporeal life support, and finally successful heart transplant. Such a sequence of events is exceedingly rare for patients with coronary dissection and prompted this report.
       
  • Alteration of Heart Rate Variability as an Early Predictor of
           Cardiovascular Events: A Look at Current Evidence
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Girolamo Manno, Giuseppina Novo, Salvatore Novo, Egle Corrado, Giuseppe Coppola
       
  • Relationship Between Provider Experience and Cardiac Performance Measures
           in Outpatients (from the NCDR)
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Kerrilynn Carney, Njeri Thande, Kensey Gosch, Nihar DesaiCompliance with cardiac performance measures for guideline-directed medical therapy remains suboptimal. There is a compelling need to identify modifiable factors that influence compliance rates, so that these factors can be addressed as targets of quality improvement. This study examines the relationship between cardiovascular provider experience and compliance with performance measures for outpatients with coronary artery disease (CAD), heart failure, and atrial fibrillation in the PINNACLE Registry. We hypothesize that providers who have been practicing longer, especially those further out from certification who may not be required to recertify, will have lower compliance rates with key cardiac performance measures. Using clinical data from January 1, 2013 to March 31, 2014 in the PINNACLE Registry, we employed a multilevel hierarchical logistic regression analysis to examine the relationship between cardiac performance measures and provider experience, defined by the number of years since initial cardiology board certification (
       
  • Assessing Pregnancy, Gestational Complications, and Co-morbidities in
           Women With Congenital Heart Defects (Data from ICD-9-CM Codes in 3 US
           Surveillance Sites)
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Cheryl Raskind-Hood, Anita Saraf, Tiffany Riehle-Colarusso, Jill Glidewell, Michelle Gurvitz, Julie E. Dunn, George K. Lui, Alissa Van Zutphen, Claire McGarry, Carol J. Hogue, Trenton Hoffman, Fred H. Rodriguez III, Wendy M. BookImproved treatment of congenital heart defects (CHDs) has resulted in women with CHDs living to childbearing age. However, no US population-based systems exist to estimate pregnancy frequency or complications among women with CHDs. Cases were identified in multiple data sources from 3 surveillance sites: Emory University (EU) whose catchment area included 5 metropolitan Atlanta counties; Massachusetts Department of Public Health (MA) whose catchment area was statewide; and New York State Department of Health (NY) whose catchment area included 11 counties. Cases were categorized into one of 5 mutually exclusive CHD severity groups collapsed to severe versus not severe; specific ICD-9-CM codes were used to capture pregnancy, gestational complications, and nongestational co-morbidities in women, age 11 to 50 years, with a CHD-related ICD-9-CM code. Pregnancy, CHD severity, demographics, gestational complications, co-morbidities, and insurance status were evaluated. ICD-9-CM codes identified 26,655 women with CHDs, of whom 5,672 (21.3%, range: 12.8% in NY to 22.5% in MA) had codes indicating a pregnancy. Over 3 years, age-adjusted proportion pregnancy rates among women with severe CHDs ranged from 10.0% to 24.6%, and 14.2% to 21.7% for women with nonsevere CHDs. Pregnant women with CHDs of any severity, compared with nonpregnant women with CHDs, reported more noncardiovascular co-morbidities. Insurance type varied by site and pregnancy status. These US population-based, multisite estimates of pregnancy among women with CHD indicate a substantial number of women with CHDs may be experiencing pregnancy and complications. In conclusion, given the growing adult population with CHDs, reproductive health of women with CHD is an important public health issue.
       
  • Late Electrocardiographic Changes in Patients With New-Onset Left Bundle
           Branch Block Following Transcatheter Aortic Valve Implantation
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Laurent Faroux, Guillem Muntané-Carol, Marina Urena, Luis Nombela-Franco, Ignacio Amat-Santos, Neal Kleiman, Antonio Munoz-Garcia, Felipe Atienza, Vicenç Serra, Marc W. Deyell, Gabriela Veiga-Fernandez, Jean-Bernard Masson, Victoria Canadas-Godoy, Dominique Himbert, Quentin Fischer, Javier Castrodeza, Jaime Elizaga, Jaume Francisco Pascual, John G. Webb, Jose M. de la TorreThis study sought to determine, in patients with new-onset persistent left bundle branch block (NOP-LBBB) after transcatheter aortic valve implantation (TAVI), the incidence and factors associated with (i) LBBB recovery and (ii) permanent pacemaker implantation (PPI) at 1-year follow-up. This was a multicenter study including 153 patients (mean age: 81 ± 5 years, 56% of women) with NOP-LBBB post-TAVI (balloon-expandable valve in 112 patients). Delta PR (ΔPR) and delta QRS (ΔQRS) were defined as the difference in PR and QRS length between baseline and hospital discharge ECG, and the relative ΔPR and ΔQRS as absolute ΔPR and ΔQRS divided by baseline PR and QRS length, respectively. The patients had a clinical visit and 12-lead ECG at 1-year follow-up. LBBB recovery was observed in 50 patients (33%), and 14 patients (9%) had advanced conduction disturbances requiring PPI during the follow-up period. No clinical or ECG variables were associated with LBBB recovery, including prosthesis type (self- or balloon-expandable valve, p = 0.563), QRS width at baseline/discharge or absolute/relative ΔQRS (p>0.10 for all). The presence of atrial fibrillation at baseline (0.026), a longer PR interval at discharge (0.009), and a longer absolute and relative ΔPR (p = 0.002 and p = 0.004, respectively) were associated with an increased risk of PPI at 1-year follow-up. In conclusion, NOP-LBBB post-TAVI resolved in one-third of patients at 1-year follow-up, but no clinical or ECG variables were associated with LBBB recovery. Conversely, a nonsinus rhythm at baseline and a longer ΔPR were associated with an increased risk of PPI within the year after TAVI.
       
  • Relevance of New Conduction Disorders After Implantation of the ACURATE
           Neo Transcatheter Heart Valve in the Aortic Valve Position
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Miriam Brinkert, Mathias Wolfrum, Federico Moccetti, Matthias Bossard, Benjamin Berte, Florim Cuculi, Richard Kobza, Stefan ToggweilerThe ACURATE neo transcatheter heart valve has been associated with very low rates of new conduction disorders (CDs). We assessed the clinical relevance of new CDs in patients undergoing transcatheter aortic valve replacement (TAVR) with this valve. Data of consecutive patients without a pre-existing left bundle branch block (LBBB) or a permanent pacemaker (PPM) undergoing TAVR with the ACURATE neo were analyzed from the prospective SwissTAVI registry. Patients with new CDs were compared with patients with an unchanged electrocardiogram (ECG). ACURATE neo was implanted in 203 patients (mean age 82 ± 6 years, 63% women), CDs occurred in 28 patients (22 [11%] developed a LBBB, 6 [3%] required a PPM). New CDs resulted in a longer median duration of hospitalization (7 vs 5 days, interquartile range 4 to 13 vs 3 to 8 days, p = 0.04). At 1-year follow-up, left ventricular ejection fraction was significantly lower in patients with new CDs comparedwith patients with an unchanged ECG (54% ± 13% vs 61% ± 9%, p
       
  • Prognostic Usefulness of Systolic Blood Pressure One-Year Following
           Cardiac Resynchronization Therapy (from MADIT-CRT)
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Khaled H. Abdulla, Saadia Sherazi, Ilan Goldenberg, Valentina Kutyifa, Wojciech Zareba, David T. Huang, Spencer Z. Rosero, Bronislava Polonsky, Scott McNitt, Mehmet K. AktasLow systolic blood pressure (SBP) is associated with increased mortality and heart failure in patients with left ventricular dysfunction. Data on the relation between SBP measured following cardiac resynchronization therapy implantation and subsequent clinical events are limited. We hypothesized that assessment of systolic blood pressure at 12 months after cardiac resynchronization therapy can be used to identify patients with increased risk for adverse cardiovascular outcomes. The study population comprised 1000 patients who underwent cardiac resynchronization therapy implantation in MADIT-CRT. Outcomes were compared between patients with low (
       
  • Prognostic Value of Serum Uric Acid in Hospitalized Heart Failure Patients
           With Preserved Ejection Fraction (from the Japanese Nationwide Multicenter
           Registry)
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Yuta Kobayashi, Kazunori Omote, Toshiyuki Nagai, Kiwamu Kamiya, Takao Konishi, Takuma Sato, Yoshiya Kato, Hirokazu Komoriyama, Shingo Tsujinaga, Hiroyuki Iwano, Kazuhiro Yamamoto, Tsutomu Yoshikawa, Yoshihiko Saito, Toshihisa AnzaiElevated serum uric acid (UA) is associated with an increased risk of cardiovascular disease and worse clinical outcome in patients with cardiovascular disease. Nevertheless, the prognostic value of serum UA level in hospitalized heart failure patients with preserved ejection fraction (HFpEF) has not been fully elucidated. The aim of this study was to investigate whether serum UA level on admission could be associated with subsequent mortality in hospitalized patients with HFpEF. We examined 516 consecutive hospitalized HFpEF (left ventricular ejection fraction ≥50%) patients with decompensated heart failure from our HFpEF-specific multicenter registry who had serum UA data on admission. The primary outcome of interest was all-cause death. During a median follow-up period of 749 (interquartile range 540 to 831) days, 90 (17%) patients died. Higher serum UA level was significantly related to increased incidence of all-cause death (p = 0.016). In addition, patients with higher serum UA (≥6.6 mg/dl, median) and plasma B-type natriuretic peptide (≥401.2 pg/ml, median) levels had the highest incidence of all-cause death in the groups (p = 0.002). In multivariable Cox regression analysis, serum UA was an independent determinant of mortality (hazards ratio 1.23, 95% confidence interval 1.10 to 1.39) even after adjustment for prespecified confounders, renal function and the use of diuretics before admission. In conclusions, higher admission serum UA was an independent determinant of mortality in hospitalized HFpEF patients. Our findings indicate the importance of assessing admission serum UA level for further risk stratification in hospitalized patients with HFpEF.
       
  • Comparison of Holter With Zio Patch Electrocardiography Monitoring in
           Children
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Meena Bolourchi, Eric S. Silver, David Muwanga, Esteban Mendez, Leonardo LibermanThe standard for ambulatory arrhythmia detection in children is the Holter monitor. The Zio XT (Zio) patch has been FDA-approved for use in adults. However, its utility in children has not been directly compared with the Holter. We studied the ability to detect arrhythmias and patient comfort of the Zio versus the Holter in children. Patients
       
  • Usefulness of Preprocedural Left Ventricular End-Systolic Volume Index and
           Early Diastolic Mitral Annular Velocity in Predicting Improvement in Left
           Ventricular Ejection Fraction Following Atrial Fibrillation Ablation in
           Patients With Impaired Left Ventricular Systolic Function
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Kyoichiro Yazaki, Koichiro Ejima, Miwa Kanai, Shohei Kataoka, Satoshi Higuchi, Daigo Yagishita, Morio Shoda, Nobuhisa HagiwaraCatheter ablation of atrial fibrillation (AF) is known to facilitate reverse remodeling of the left ventricle. However, factors that can improve the left ventricular (LV) systolic function remain elusive. In this study, we investigated factors related to LV ejection fraction (LVEF) improvement following AF ablation in patients with systolic dysfunction. A total of 140 patients with impaired LVEF (
       
  • Endothelial Dysfunction, Fibrinolytic Activity, and Coagulation Activity
           in Patients With Atrial Fibrillation According to Type II Diabetes
           Mellitus Status
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Giuseppe Patti, Elisabetta Cerchiara, Edoardo Bressi, Barbara Giannetti, Alessia Delli Veneri, Germano Di Sciascio, Giuseppe Avvisati, Raffaele De CaterinaRecent findings in atrial fibrillation (AF) patients receiving oral anticoagulation showed that diabetes without insulin therapy has a thromboembolic risk comparable to nondiabetic patients, whereas only diabetic patients on insulin have a heightened thromboembolic risk. We explored possible pathophysiological correlates of such finding on 90 AF patients on oral anticoagulation, divided according to diabetes status (n = 30 without diabetes; n = 29 with diabetes on oral antidiabetic drugs; n = 31 with insulin-requiring diabetes). We assessed von Willebrand Factor (VWF) concentration (VWF:Ag) and activity (VWF R:Co) as measures of endothelial dysfunction; and thrombin-activatable fibrinolysis inhibitor (TAFI) and prothrombin fragment 1 + 2 (F1+2) levels as markers of fibrinolytic activity and thrombin generation. Values of VWF:Ag, VWF:RCo, and TAFI were similar in the 3 groups. Patients with diabetes requiring insulin had significantly higher levels of F1+2 (median 23.1 pg/ml [interquartile range 17.6; 33.5]) than those without diabetes (16.3 pg/ml [11.5; 22.5], p = 0.036) and diabetic patients on oral antidiabetic drugs (20.6 pg/ml [13.3; 29], p = 0.046). Thus, in AF patients receiving oral anticoagulation, those with diabetes, regardless of the diabetes type (with or without insulin therapy), and those without diabetes have comparable indices of the explored parameters of endothelial dysfunction and fibrinolytic activity. Despite anticoagulant therapy, thrombin generation is selectively higher in diabetic patients' on insulin than in those without diabetes or with diabetes on oral antidiabetic drugs, with no differences between these latter 2 conditions. Thrombin generation might thus be a predominant contributor to the excess of thromboembolic risk in AF patients on insulin-requiring diabetes.
       
  • The Precious Metals
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Robert M. Doroghazi
       
  • Comparison of the Effect of Age (< 75 Versus ≥ 75) on the Efficacy and
           Safety of Dual Therapy (Dabigatran + Clopidogrel or Ticagrelor) Versus
           Triple Therapy (Warfarin + Aspirin + Clopidogrel or Ticagrelor) in
           Patients With Atrial Fibrillation After Percutaneous Coronary Intervention
           (from the RE-DUAL PCI Trial)
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Jurrien M. ten Berg, Philippe Gabriel Steg, Deepak L. Bhatt, Stefan H. Hohnloser, Anne de Veer, Matias Nordaby, Corinna Miede, Takeshi Kimura, Gregory Y.H. Lip, Jonas Oldgren, Christopher P. Cannon, RE-DUAL PCI Steering Committee and InvestigatorsThe RE-DUAL PCI trial reported that dabigatran dual therapy (110/150 mg twice daily, plus clopidogrel or ticagrelor) reduced bleeding events versus warfarin triple therapy (warfarin plus aspirin and clopidogrel or ticagrelor) in patients with atrial fibrillation who underwent percutaneous coronary intervention, with noninferiority in composite thromboembolic events. In this prespecified analysis, risks of first major or clinically relevant nonmajor bleeding event and composite end point of death, thromboembolic events, or unplanned revascularization were compared between dabigatran dual therapy and warfarin triple therapy in older (≥ 75 years) and younger (< 75 years) patients, using Cox proportional hazard regression. Of 2,725 patients randomized to treatment, 1,026 (37.7%) were categorized into older and 1,699 (62.3%) into younger age groups. Dabigatran 110 mg dual therapy lowered bleeding risk versus warfarin triple therapy in older (hazard ratio [HR] 0.67; 95% confidence interval [CI] 0.51 to 0.89) and younger patients (HR 0.40; 95% CI 0.30 to 0.54); interaction p value: 0.0125. Dabigatran 150 mg dual therapy lowered bleeding risk versus warfarin triple therapy in younger patients (HR 0.57; 95% CI 0.44 to 0.74), whereas no benefit could be observed in older patients (HR 1.21; 95% CI 0.83 to 1.77); interaction p value: 0.0013. For the thromboembolic end point, there was a trend for a higher risk with dabigatran 110 mg dual therapy in older patients, compared with warfarin triple therapy, whereas the risk was similar in younger patients. For dabigatran 150 mg dual therapy, the thromboembolic risk versus warfarin triple therapy was similar in older and younger patients. In conclusion, the benefits of dabigatran dual therapy differed in the 2 age groups, which may help dose selection when using dabigatran dual therapy.
       
  • Meta-analysis of the Relation of Body Mass Index to Cardiovascular
           Outcomes in Patients Receiving Intensive Low-Density Lipoprotein
           Cholesterol Lowering Therapy
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Safi U. Khan, Muhammad U. Khan, Haris Riaz, Paolo Raggi, Shahul Valavoor, Muhammad Zia Khan, Michalina Kołodziejczak, Muhammad Shahzeb Khan, Troy Krupica, Mohamad Alkhouli, Eliano P. NavareseThe impact of body mass index (BMI) on cardiovascular outcomes in patients receiving intensive low-density lipoprotein cholesterol (LDL-C) lowering therapy is uncertain. We performed meta-analysis of 29 randomized controlled trials using PubMed, Embase, and CENTRAL through April 2019. Therapies were grouped as more intensive LDL-C lowering therapy (statins, ezetimibe + statin or PCSK9 inhibitors) and less intensive LDL-C lowering therapy (less potent active control or placebo). Random effects meta-regressions and meta-analyses were performed to evaluate association of BMI with cardiovascular endpoints. In 265,766 patients, for every 1 kg/m2 increase in BMI, more intensive therapy compared with less intensive therapy was associated with hazard ratio (HR) of 1.07 for cardiovascular mortality (95% confidence interval 1.02 to 1.13); HR of 1.03 for all-cause mortality (0.99 to 1.06) HR of 1.06 for myocardial infarction (1.02 to 1.09), HR of 1.08 (1.03 to 1.12) for revascularization and HR of 1.04 for MACE (1.01 to 1.07). Meta-analysis showed that patients with BMI
       
  • Relation Between Operator and Hospital Volumes and Long-Term Outcomes for
           Percutaneous Coronary Intervention in New York
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Feng Qian, Ye Zhong, Edward L. HannanLittle is known about whether there is an inverse relation between provider volume and long-term adverse outcomes for percutaneous coronary interventions (PCIs). For patients who underwent PCI procedures from December 2013 through November 2014 in New York, we examined a continuous relation and different annual PCI volume cut points at hospital and operator levels to investigate the relation between volume and 1-year adverse outcomes (mortality and mortality/acute myocardial infarction). There were 34,498 patients who underwent PCI procedures from 60 hospitals and 408 operators. We detected a significant continuous inverse association between 1-year mortality and annual hospital PCI volume. However, we did not find that there was a hospital volume and 1-year mortality relation for the 2013 ACCF/AHA/SCAI's hospital annual PCI volume cutoff value of 200 or a significant inverse operator volume-outcome relation using the operator annual PCI volume cutoff value of 50, or for any other practical volume cutoffs. Similar findings were obtained when we used the 1-year mortality/acute myocardial infarction outcome. We did find that providers in the highest volume quartile were associated with lower adverse outcome rates than providers in the lowest volume quartile. In conclusion, no significant volume-outcome relations were found between annual hospital or operator PCI volume and risk-adjusted 1-year outcomes for any practical volume cutoff values including 2013 Guidelines’ recommended hospital/operator minimal annual PCI volumes. Providers in the highest annual volume quartile, however, were associated with lower adverse outcome rates than providers in the lowest volume quartile.
       
  • Comparison of Age (
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Michela Faggioni, Björn Redfors, Aaron Crowley, Bimmer E. Claessen, Serdar Farhan, Ioannis Mastoris, Bernhard Witzenbichler, Akiko Maehara, Giora Weisz, Philippe Généreux, Ori Ben-Yehuda, Roxana Mehran, Ajay J. Kirtane, Gregg W. StoneElderly patients may have increased platelet reactivity and adverse events after percutaneous coronary intervention. Whether age is an independent predictor of worse outcomes after accounting for platelet reactivity is unknown. We sought to determine the relation between age and platelet reactivity on 2-year outcomes after percutaneous coronary intervention with drug-eluting stents (DES). ADAPT-DES was a prospective observational registry comprising 8,582 DES-treated patients. Patients were categorized with an age cutoff of 75 years. On-clopidogrel platelet reactivity was evaluated with VerifyNow P2Y12 testing. Multivariable Cox proportional hazards regression models were used to describe the relation between increasing age and 2-year clinical outcomes. Patients ≥75 old were more likely to be women and had more cardiovascular risk factors and more extensive coronary artery disease than younger patients. Residual platelet reactivity on-clopidogrel increased slightly with age (adjusted r = 0.05, p
       
  • Insulin Resistance Modifies the Effects of Omega-3 Acid Ethyl Esters on
           Left Ventricular Remodeling After Acute Myocardial Infarction (from the
           OMEGA-REMODEL Randomized Clinical Trial)
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Kana Fujikura, Bobak Heydari, Yin Ge, Kyoichi Kaneko, Shuaib Abdullah, William S. Harris, Michael Jerosch-Herold, Raymond Y. KwongInsulin resistance early after acute myocardial infarction is associated with increased heart failure and mortality. OMEGA-REMODEL was a prospective double-blind 1:1 randomized control trial of patients with AMI. We reported that 6-month treatment with omega-3 fatty acid (O-3FA) 4 g/day attenuated cardiac remodeling accompanied by reduction in inflammation. We hypothesized that insulin resistance modifies the therapeutic effect of O-3FA on post-MI cardiac remodeling. The OMEGA-REMODEL study group was dichotomized according to cohort- and gender-specific median cutoff value of leptin-to-adiponectin ratio (LAR) at baseline (LAR-Hi vs LAR-Lo). Mixed model regression analyses were used to evaluate effect modification of O-3FA on reduction of left ventricular end-systolic volume index (LVESVI) by LAR status. Baseline LAR was evaluated on 325 patients (59 ± 11 years, 81% male). A total of 168 patients were categorized in LAR-Lo, and 157 in LAR-Hi. O-3FA treatment resulted in significant LVESVI reduction in patients with LAR-Lo but not with LAR-Hi (p = 0.0002 vs 0.66, respectively). Mixed model regression analysis showed significant modification of LAR on O-3FA's treatment effect in attenuating LVESVI (p = 0.021). In conclusion, this post-hoc efficacy analysis suggests that LAR status significantly modified O-3FA's treatment effect in attenuating cardiac remodeling. During the convalescent phase of acute infarct healing, patients with lower insulin resistance estimated by LAR appear to derive more therapeutic response from O-3FA toward improvement of LVESVI.
       
  • Changing Trends in the Landscape of Patients Hospitalized With Acute
           Myocardial Infarction (2001 to 2011) (from the Worcester Heart Attack
           Study)
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Regino Mercado-Lubo, Jorge Yarzebski, Darleen Lessard, Joel Gore, Robert J. GoldbergDuring the past several decades, new diagnostic tools, interventional approaches, and population-wide changes in the major coronary risk factors have taken place. However, few studies have examined relatively recent trends in the demographic characteristics, clinical profile, and the short-term outcomes of patients hospitalized for acute myocardial infarction (AMI) from the more generalizable perspective of a population-based investigation. We examined decade long trends (2001 to 2011) in patient's demographic and clinical characteristics, treatment practices, and hospital outcomes among residents of the Worcester metropolitan area hospitalized with an initial AMI (n = 3,730) at all 11 greater Worcester medical centers during 2001, 2003, 2005, 2007, 2009, and 2011. The average age of the study population was 68.5 years and 56.9% were men. Patients hospitalized with a first AMI during the most recent study years were significantly younger (mean age = 69.9 years in 2001/2003; 65.2 years in 2009/2011), had lower serum troponin levels, and experienced a shorter hospital stay compared with patients hospitalized during the earliest study years. Hospitalized patients were more likely to received evidence-based medical management practices over the decade long period under study. Multivariable-adjusted regression models showed a considerable decline over time in the hospital death rate and a significant reduction in the proportion of patients who developed atrial fibrillation, heart failure, and ventricular fibrillation during their acute hospitalization. These results highlight the changing nature of patients hospitalized with an incident AMI, and reinforce the need for surveillance of AMI at the community level.
       
  • Assessment of Cardiovascular Risk by the Combination of Clinical Risk
           Scores Plus Platelet Expression of FcγRIIa
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): David J. Schneider, Sean R. McMahon, Gregory L. Ehle, Sreedivya Chava, Heidi S. Taatjes-Sommer, Sean MeagherPlatelet expression of FcγRIIa was quantified after myocardial infarction (MI) and we found that patients with high platelet FcγRIIa expression (>11,000/platelet) had a fourfold greater risk of subsequent MI, stroke, and death. This analysis of the original cohort of 197 patients was designed to determine whether platelet expression of FcγRIIa could be used in combination with clinical risk scores (GRACE [Global Registry of Acute Coronary Events] and DAPT [Dual Antiplatelet Therapy]) to refine cardiovascular risk assessment. Platelet expression of FcγRIIa quantified with the use of flow cytometry was broadly distributed in patients stratified into high and low risk groups based on clinical risk scores. In patients identified as high risk by the GRACE score, 62% had high platelet FcγRIIa expression. Similarly, in patients identified as high risk by DAPT, 55% had high platelet FcγRIIa expression. High platelet FcγRIIa expression discriminated high and low risk cohorts in patients with high cardiovascular risk defined by either the GRACE score (high platelet FcγRIIa 18.9% vs low platelet FcγRIIa 0%; odds ratio = 15.7, p = 0.06) or the DAPT score (high platelet FcγRIIa 15.4% vs low platelet FcγRIIa 3.7%; odds ratio = 5.6, p = 0.03) assessment. Platelet expression of FcγRIIa merits additional study to determine whether low platelet FcγRIIa expression can be used to guide early transition to aspirin monotherapy and high platelet FcγRIIa expression can be used to guide continuation of DAPT.
       
  • Relation of White Blood Cell Count to Bleeding and Ischemic Events in
           Patients With Acute Coronary Syndrome (from the ATLAS ACS 2-TIMI 51 Trial)
           
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): Fahad Alkhalfan, Tarek Nafee, Megan K. Yee, Gerald Chi, Arzu Kalayci, Alexei Plotnikov, Eugene Braunwald, C. Michael GibsonAn elevated white blood cell (WBC) count is associated with an increased risk of ischemic events among acute coronary syndrome (ACS) patients, but the association between WBC count and bleeding in ACS patients is not well established. The aim of this analysis was to assess and compare the association between WBC count and the occurrence of short- and long-term bleeding and ischemic events. This was a post hoc analysis of the ATLAS ACS2-TIMI 51 trial. A subset of patients had a WBC count measurement at baseline (n = 14,231, 91.6%). Univariate and multivariable Cox proportional hazard models were constructed to determine if there is an association between WBC count at baseline and a composite outcome of Thrombolysis in Myocardial Infarction (TIMI) major and minor bleeds at 30 days and 1 year. Variables with a p
       
  • Usefulness of the Electrocardiogram in Establishing the Diagnosis and
           Prognosis of Arrhythmogenic Right Ventricular Cardiomyopathy
    • Abstract: Publication date: 1 March 2020Source: The American Journal of Cardiology, Volume 125, Issue 5Author(s): J. Warren Holshouser, Laszlo LittmannA middle-aged man had repeat hospitalizations and interventions over several years for ventricular tachyarrhythmias and then, a 2-year history of progressive heart failure. Twelve-lead electrocardiogram recorded 10 months apart established the most likely cause and prognosis of the heart failure, and predicted its definitive treatment.
       
  • Effect of Physical Exercise Training in Patients With Chagas Heart Disease
           (From the PEACH STUDY)
    • Abstract: Publication date: Available online 10 February 2020Source: The American Journal of CardiologyAuthor(s): Fernanda de Souza Nogueira Sardinha Mendes, Mauro Felippe Felix Mediano, Fernando Cesar de Castro e Souza, Paula Simplício da Silva, Fernanda Martins Carneiro, Marcelo Teixeira de Holanda, Roberto Magalhães Saraiva, Sergio Salles Xavier, Pedro Emmanuel Alvarenga Americano do Brasil, Andréa Silvestre de SousaABSTRACTChagas heart disease (HD) is a chronic fibrosing myocarditis with high mortality. The PEACH study aimed to evaluate if exercise training can improve the functional capacity of Chagas HD patients with left ventricular dysfunction and/or heart failure. The PEACH study was a single center, parallel-group, clinical trial that randomized 30 clinical stable Chagas HD patients with left ventricular ejection fraction
       
  • Hypertrophic Cardiomyopathy in “Real World” Community
           Cardiology Practice
    • Abstract: Publication date: Available online 10 February 2020Source: The American Journal of CardiologyAuthor(s): Ethan J. Rowin, Martin S. Maron, Viraj Bhatt, Linda Gillam, Barry J. MaronABSTRACTDifferences in presentation and natural history of hypertrophic cardiomyopathy (HC) in community cardiology practice compared to the experience in referral centers has been a source of considerable uncertainty. We report here a cross-sectional analysis of 253 consecutive HC patients from a “real world” clinical cardiology setting. When compared to highly selected referral center cohort, patients in clinical practice proved to be similar with regard to disease expression such as LV wall thickness, outflow obstruction, and natural history, including stable and largely benign clinical course with NYHA class I/II symptoms (61% in community practice vs. 55%, p=0.23), occurrence of atrial fibrillation (22% vs. 24%, p=0.75) and non-fatal sudden death (SD) events (3% vs. 4%, p=0.8). In contrast progressive heart failure symptoms were most common in the referral cohort (36% vs 26%, p=0.04). In clinical practice, SD was prevented by prophylactic ICDs in 5 of 44 patients (11%), although risk was overestimated in 6 patients implanted with ICDs without risk markers (14%). In 16 of 61 (26%) severely symptomatic drug-refractory patients with LV outflow obstruction, recommendation for surgical myectomy (or alcohol septal ablation) was delayed. In conclusion, clinical characteristics and course of HC patients in community practice were generally similar to those in HC referral centers. Community cardiologists managed HC patients predominantly in concert with guideline-based strategies, although risk for SD could be over-estimated, and the significance of outflow obstruction with timely reversal of refractory heart failure by intervention was under-appreciated.
       
  • Features of Sitosterolemia in Children
    • Abstract: Publication date: Available online 8 February 2020Source: The American Journal of CardiologyAuthor(s): Liyuan Xu, Wenhui Wen, Ya Yang, Jinjie Xie, Rongjuan Li, Yue Wu, Yifei Hu, Luya Wang, Mei ChongAbstractSitosterolemia is a rare lipid metabolism disease with heterogeneous manifestations. Atherosclerosis can occur in children, and therefore, early detection, diagnosis, and treatment of this disease are important. We studied 18 pediatric patients with sitosterolemia who showed a significant increase in plasma lipid levels and analyzed their clinical, biochemical, and genetic characteristics. We recorded the initial serum lipid results and clinical manifestations of the patients. Lipid and plant sterol levels were measured after homozygous or compound heterozygous mutations of ABCG5 or ABCG8 were identified by genetic testing. Plasma plant sterol levels were analyzed by gas chromatography. Fourteen cases of sitosterolemia were examined by ultrasound and echocardiography. The initial total cholesterol and low-density lipoprotein levels of the children were significantly increased, but then markedly decreased after diet control or drug treatment, and even reached normal levels. Carotid atherosclerosis and aortic valve regurgitation were present in three of 14 patients. Serum lipid levels of children with sitosterolemia and xanthomas were notably higher than those without xanthomas. There were no significant differences in clinical manifestations between patients with different genotypes. In conclusion, sitosterolemia should be considered in children with hyperlipidemia who do not present with xanthomas, especially with a significant increase in total cholesterol and low-density lipoprotein levels. There does not appear to be a correlation between clinical phenotype and genotype.
       
  • Impact Of Cirrhosis On 90-Day Outcomes After Percutaneous Coronary
           Intervention (From A Nationwide Database)
    • Abstract: Publication date: Available online 8 February 2020Source: The American Journal of CardiologyAuthor(s): Daniel Y Lu, Diala Steitieh, Dmitriy N Feldman, Jim W Cheung, S. Chiu Wong, Hadi Halazun, Karim J Halazun, Nivee Amin, Joseph Wang, John Chae, Robert L Wilensky, Luke K KimAbstractPatients with cirrhosis often have concomitant coronary artery disease (CAD) and require percutaneous coronary intervention (PCI). PCI in cirrhotics can be associated with significant risks due to thrombocytopenia, possible coagulopathies, bleeding, and renal failure. Longer-term risks of PCI in cirrhotics have not been well studied. Our study seeks to evaluate the 90-day outcomes of PCI in patients with cirrhosis. Patients receiving PCI were identified from the Nationwide Readmissions Database from 2010-2014 and stratified by the presence of comorbid cirrhosis. The total mortality during index admission and 90-day readmissions as well as the readmissions rate were examined. Adverse events including bleeding, stroke, kidney injury, and vascular complications were also compared. Patients with cirrhosis had a significantly higher number of comorbidities. The cirrhosis group had a higher overall 90-day mortality (10.3% vs 2.5%, p < 0.01), including during the index hospitalization (7.0% vs 1.8%, p < 0.01), as well as a higher 90-day readmission rate (38.2% vs 20.2%, p < 0.01). Patients with cirrhosis also had higher frequencies of overall 90-day adverse events (44.7% vs 17.7%, p < 0.01), including gastrointestinal bleeding (15.3% vs 2.7%, p < 0.01) and acute kidney injury (28.4% vs 10.1%, p < 0.01). In conclusion, patients with cirrhosis face a significantly higher risk of adverse outcomes including mortality, readmissions, and adverse events in the 90 days after hospitalization for PCI compared to the general population.
       
  • Comparison of 30-day Unplanned Readmissions to the Index Versus Non-Index
           Hospital After Percutaneous Coronary Intervention
    • Abstract: Publication date: Available online 8 February 2020Source: The American Journal of CardiologyAuthor(s): Chun Shing Kwok, Ankur Kalra, Poonam Velagapudi, Ki Park, Mohamed Mohamed, M Chadi Alraies, Richard K Cheng, Rodrigo Bagur, Mamas A. MamasAbstractThere is limited information about readmissions to index compared with non-index hospitals after PCI. This study aims to evaluate the rates, causes, and outcomes for unplanned readmissions following percutaneous coronary intervention (PCI) depending on whether the patients were admitted to the index or non-index hospital. Patients undergoing PCI between 2010 and 2014 in the U.S. Nationwide Readmission Database were evaluated for unplanned readmissions at 30 days to index and non-index hospitals. A total of 2,183,851 procedures were analyzed, with a 9.2% 30-day unplanned readmission rate documented, and 7.1% and 2.1% of these readmissions were admitted to the index and non-index hospitals, respectively. There was also a higher prevalence of co-morbidities among patients readmitted to non-index hospitals, and more patients who were discharged against medical advice at index PCI. Non-cardiac readmissions were lower among patients who were readmitted to the index compared with non-index hospital (53.4% vs. 61.1%, p
       
  • Factors Modifying the Risk of Atrial Fibrillation Associated with Atrial
           Premature Complexes in Patients with Hypertension
    • Abstract: Publication date: Available online 8 February 2020Source: The American Journal of CardiologyAuthor(s): Elsayed Z. Soliman, George Howard, Suzanne Judd, Prashant D. Bhave, Virginia J. Howard, David M. HerringtonAbstractPatients with hypertension who develop atrial premature complexes (APCs) are at a particularly high risk for atrial fibrillation (AF). We sought to identify medications and modifiable risk factors that could reduce the risk of AF imposed by presence of APCs in such a high risk group. This analysis included 4,331 participants with treated hypertension from the REGARDS study who were free of AF and cardiovascular disease at the time of enrollment (2003-2007). APCs were detected in 8.2% (n=356) of the participants at baseline. During a median follow-up of 9.4 years, 9.9% (n=429) of the participants developed AF. Participants with APCs, compared to those without, were more than twice as likely to develop AF (Odds ratio (95% confidence interval): 2.36(1.75, 3.19)). This association was significantly weaker in statin users than non-users (Odds ratio (95% confidence interval):1.42(0.81,2.48) vs. 3.01(2.11,4.32), respectively; interaction p-value= 0.02), and in angiotensin-II receptor blocker users than non-users (Odds ratio (95% confidence interval):1.31(0.66,2.61) vs. 2.78(1.99,3.89), respectively; interaction p-value= 0.05). Borderline weaker associations between APCs and AF were also observed in alpha-blocker users than non-users, non-diabetics than diabetics, and in those with systolic blood pressure level 130-139 mmHg compared to those with other systolic blood pressure levels. No significant effect modifications were observed by use of other medications or by presence of other cardiovascular risk factors. In conclusion, the significant AF risk associated with APCs in patients with hypertension could potentially be reduced by treatment with angiotensin-II receptor blockers and statins along with lowering blood pressure and management of diabetes.
       
  • Cardiovascular Safety Considerations in the Treatment of Neurogenic
           Orthostatic Hypotension
    • Abstract: Publication date: Available online 8 February 2020Source: The American Journal of CardiologyAuthor(s): Brian Olshansky, James MuldowneyAbstractNeurogenic orthostatic hypotension (nOH), a drop in blood pressure upon standing resulting from autonomic malfunction, may cause debilitating symptoms that can affect independence in daily activities and quality-of-life. nOH may also be associated with cardiovascular comorbidities (e.g., supine hypertension, heart failure, diabetes, arrhythmias), making treatment decisions complicated and requiring management that should be based on a patient's cardiovascular profile. Additionally, drugs used to treat the cardiovascular disorders (e.g., vasodilators, β-blockers) can exacerbate nOH and concomitant symptoms. When orthostatic symptoms are severe and not effectively managed with nonpharmacologic strategies (e.g., water ingestion, abdominal compression), droxidopa or midodrine may be effective. Droxidopa may be less likely than midodrine to exacerbate supine hypertension, based on conclusions of a limited meta-analysis. In conclusion, treating nOH in patients with cardiovascular conditions requires a balance between symptom relief and minimizing adverse outcomes.
       
  • Basal Ventricular Septal Hypertrophy in Systemic Hypertension
    • Abstract: Publication date: Available online 8 February 2020Source: The American Journal of CardiologyAuthor(s): Filip Loncaric, Loredana Nunno, Maria Mimbrero, Maciej Marciniak, Joao Filipe Fernandes, Laia Tirapu, Dora Fabijanovic, Laura Sanchis, Adelina Doltra, Maja Cikes, Pablo Lamata, Bart Bijnens, Marta SitgesAbstractBasal septal hypertrophy (BSH) is commonly seen in patients with systemic hypertension and has been associated with increased afterload. The impact of localized hypertrophy on left ventricular (LV) and left atrial (LA) function is still unclear. Our aim is to investigate if BSH is a marker of a more pronounced impact of hypertension on cardiac function in the early stages of hypertensive heart disease. An echocardiogram was performed in 163 well-controlled hypertensive patients and 22 healthy individuals. BSH was defined by a basal-to-mid septal thickness ratio ≥ 1.4. LV dimensions and mass were evaluated. LV global and regional deformation was assessed by 2-dimensional (2D) speckle tracking echocardiography (STE), and LV diastolic function by 2D and Doppler imaging. LA function was evaluated with phasic volume indices calculated from 2D and 3-dimensional (3D) volumes, as well as STE. The population was 54% men, mean age 57 (53-60) years. BSH was seen in 20% (n=32) of the hypertensive cohort. Patients with BSH showed decreased regional LV systolic deformation, impaired LV relaxation with a higher proportion of indeterminate LV diastolic function, and LA functional impairment defined by a reduction of reservoir strain and a change in LA functional dynamics. In conclusion, in well-controlled hypertension impairment of LV and LA function is present in patients with early LV remodeling and localized hypertrophy. BSH might be useful as an early marker of the burden of hypertensive heart disease.
       
  • Anemia, Mortality, and Hospitalizations in Heart Failure with a Preserved
           Ejection Fraction (From the TOPCAT Trial)
    • Abstract: Publication date: Available online 8 February 2020Source: The American Journal of CardiologyAuthor(s): Kartik Gupta, Rajat Kalra, Indranee Rajapreyar, Joanna Joly, Mike Pate, Marc G. Cribbs, Sameer Ather, Sumanth D. Prabhu, Navkaranbir S. BajajAbstractIn this post-hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, we evaluated the prognostic role of anemia in adverse cardiovascular (CV) outcomes in heart failure with a preserved ejection fraction (HFpEF). We defined anemia as hemoglobin of
       
  • Pattern and Impact of Off-label Underdosing of Non-Vitamin K Antagonist
           Oral Anticoagulants in Patients with Atrial Fibrillation Who Are Indicated
           for Standard Dosing
    • Abstract: Publication date: Available online 8 February 2020Source: The American Journal of CardiologyAuthor(s): Min Soo Cho, Ji Eun Yun, Ji Jeong Park, Yun Jung Kim, Jessie Lee, Hyungmin Kim, Duk-Woo Park, Gi-Byoung NamABSTRACTWith safety concerns about increasing bleeding, off-label underdosing of non-vitamin K antagonist anticoagulants (NOACs) is common in East Asian patients with atrial fibrillation (AF). We tried to investigate the pattern of NOAC underdosing and associated clinical outcomes in patients with AF who are indicated for standard dosing. Using the Korean National Health Insurance Service database, we evaluated 16568 patients with a new prescription of NOAC who are indicated for standard NOAC dosing and compared 4536 patients with warfarin with respect to thromboembolic events (ischemic stroke or systemic embolization), all-cause mortality and major bleeding. Of the 16568 patients indicated for standard NOAC dosing, 8549 (51.9%) received off-label underdosing (50.6% rivaroxaban, 53.0% apixaban). During a median follow up of 15.0 months, as compared with warfarin, underdosing of rivaroxaban was associated with lower risks of major thromboembolic events (hazard ratio (HR): 0.53; 95% confidence interval (CI): 0.41–0.69) and all-cause mortality (HR 0.57, 95% CI: 0.41–0.82), and a similar risk of major bleeding (HR 1.10, 95% CI: 0.82−1.46). However, underdosing of apixaban was associated with similar risks of major thromboembolic events (HR: 0.90; 95% CI: 0.70–1.16), all-cause mortality (HR 0.94, 95 CI: 0.71–1.24) and major bleeding (HR 0.84, 95% CI: 0.61–1.17). In conclusion, in this Korean population with AF who are indicated for standard NOAC dosing, off-label underdosing is common and its clinical benefit over warfarin was inconsistent according to types of NOAC. Notably, apixaban underdosing provides no benefit in effectiveness compared to warfarin.
       
  • Frequency and Significance of Coronary Artery Disease and Myocardial
           Bridging in Patients with Hypertrophic Cardiomyopathy
    • Abstract: Publication date: Available online 8 February 2020Source: The American Journal of CardiologyAuthor(s): Nikki van der Velde, Roy Huurman, Yuzo Yamasaki, Isabella Kardys, Tjebbe W Galema, Ricardo PJ Budde, Felix Zijlstra, Gabriel P Krestin, Arend FL Schinkel, Michelle Michels, Alexander HirschAbstractThe etiology of chest pain in hypertrophic cardiomyopathy (HC) is diverse and includes coronary artery disease (CAD) as well as HC-specific causes. Myocardial bridging (MB) has been associated with HC, chest pain, and accelerated atherosclerosis. We compared HC patients with age-, gender- and CAD pre-test probability (PTP)-matched outpatients presenting with chest pain to investigate differences in the presence of MB and CAD using coronary computed tomography angiography (CCTA). We studied 84 HC patients who underwent CCTA and compared these with 168 matched controls (age 54 ± 11 years, 70% men, PTP 12% [5% – 32%]). MB, calcium score, plaque morphology and presence and extent of CAD were assessed for each patient. Linear mixed models were used to assess differences between cases and controls. MB was more often seen in HC patients (50% vs. 25%, p
       
  • Adherence to Triple-Free-Drug Combination Therapies among Patients with
           Cardiovascular Disease
    • Abstract: Publication date: Available online 7 February 2020Source: The American Journal of CardiologyAuthor(s): Niccolò Lombardi, Giada Crescioli, Monica Simonetti, Ettore Marconi, Alfredo Vannacci, Alessandra Bettiol, Damiano Parretti, Claudio Cricelli, Francesco LapiAbstractCombination therapies are often needed to modify the concomitant risk factors for cardiovascular disease (CVD). Non-adherence to cardiovascular medications is a relevant concern, especially in polytherapy. We conducted a population-based, cohort study with the aim of quantifying the level of non-adherence and its related determinants in patients exposed to free three-drug combination therapies, namely concurrent use of angiotensin-converting-enzyme inhibitor (ACEi), calcium channel blockers (CCBs), and statins or of ACEi, statins, and low-dose aspirin. Within Health Search Database, we selected a cohort of adult patients concurrently prescribed with ACEi, CCBs, and statin, as well as those prescribed with ACEi, statins and low-dose aspirin, from the 1st January 2002 to the 31st December 2014. Non-adherent patients were concurrent users of triple free pill regimen with a proportion of days covered (PDC)
       
  • Asymptomatic patients without known heart disease have markers of occult
           heart disease
    • Abstract: Publication date: Available online 4 February 2020Source: The American Journal of CardiologyAuthor(s): Leonardo Tamariz, Ana Palacio, Robert Myerbug, Joel Fishman, Jeffrey J. Goldberger
       
  • Simpson's Paradox: Meta-Analysis Comparing Torsemide Versus Furosemide in
           Patients With Heart Failure
    • Abstract: Publication date: Available online 3 February 2020Source: The American Journal of CardiologyAuthor(s): Amiran Baduashvili
       
  • “Stupid Doctor Mistakes: Part Two of Many”
    • Abstract: Publication date: Available online 1 February 2020Source: The American Journal of CardiologyAuthor(s): Robert M. Doroghazi
       
  • Comparison of Long-Term Adverse Outcomes in Patients With Atrial
           Fibrillation Having Ablation Versus Antiarrhythmic Medications
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): James V. Freeman, Grace H. Tabada, Kristi Reynolds, Sue Hee Sung, Daniel E. Singer, Paul J. Wang, Taylor I. Liu, Nigel Gupta, Mark A. Hlatky, Alan S. GoThe impact of atrial fibrillation (AF) catheter ablation versus chronic antiarrhythmic therapy alone on clinical outcomes such as death and stroke remains unclear. We compared adverse outcomes for AF ablation versus chronic antiarrhythmic therapy in 1,070 adults with AF treated between 2010 and 2014 in the Kaiser Permanente Northern California and Southern California healthcare delivery systems. Patients who underwent AF catheter ablation were matched to patients treated with only antiarrhythmic medications, based on age, gender, history of heart failure, history of coronary heart disease, history of hypertension, history of diabetes, and high-dimensional propensity score. We compared crude and adjusted rates of death, ischemic stroke or transient ischemic attack, intracranial hemorrhage, and hospitalization. The matched cohort of 535 patients treated with AF ablation and 535 treated with antiarrhythmic therapy had a median follow-up of 2.0 (interquartile range 1.1 to 3.5) years. There was no significant difference in adjusted rates of death (adjusted hazard ratio [HR] 0.24, 95% confidence interval [CI] 0.03 to 1.95), intracranial hemorrhage (adjusted HR 0.17, CI 0.02 to 1.71), ischemic stroke or transient ischemic attack (adjusted HR 0.53, CI 0.18 to 1.60), and heart failure hospitalization (adjusted HR 0.85, CI 0.34 to 2.12), although there was a trend toward improvement in these outcomes with ablation. However, there was a significantly increased risk of all-cause hospitalization following ablation (adjusted HR 1.60, CI 1.25 to 2.05). In a contemporary, multicenter, propensity-matched observational cohort, AF ablation was not significantly associated with death, intracranial hemorrhage, ischemic stroke or transient ischemic attack, or heart failure hospitalization, but was associated with a higher rate of all cause-hospitalization.
       
  • Stroke Risk Based on CHA2DS2-VASc Score in the
           Absence of Atrial Fibrillation
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Raj Nayyar, Dwijesh Sheth, Lovely Chhabra
       
  • Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Patients
           With Heart Failure and Chronic Kidney Disease
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Mohammad Saud Khan, Muhammad Shahzeb Khan, Abdelmoniem Moustafa, Allen S. Anderson, Rupal Mehta, Sadiya S. KhanMineralocorticoid receptor antagonists (MRA) improve clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and reduce risk of heart failure (HF) hospitalization in patients with heart failure with preserved ejection fraction (HFpEF). However, the benefit and risks of MRA use are not clear in HF patients and chronic kidney disease (CKD) with estimated glomerular filtration rate (eGFR)
       
  • “Dear Frits”—“Dear Howard” Commentary on the Correspondence
           Between Two Cardiologist Friends, Howard Burchell and Frits Meijler, from
           1964 to 2006
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Henry Blackburn, Claus Pierach
       
  • High Sensitivity Troponin and Risk of Incident Peripheral Arterial Disease
           in Chronic Kidney Disease (from the Chronic Renal Insufficiency Cohort
           [CRIC] Study)
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Scott E. Janus, Jamal Hajjari, Sadeer G. Al-KindiPatients with chronic kidney disease (CKD) are at increased risk for peripheral arterial disease (PAD). A novel biomarker to accurately and reliably predict new onset PAD in high risk patients is needed. High sensitivity troponin (HsTP) is a new assay which allows detection of very low troponin levels with high precision. We sought to explore the association between HsTP and risk of PAD in CKD. The Chronic Renal Insufficiency Cohort (CRIC) is a prospective cohort of 3,939 individuals with mild to moderate CKD using age related criteria for glomerular filtration rate. High sensitivity troponin T was measured at study enrollment. Patients with previous history of PAD or coronary artery disease were excluded. Patients were followed for new-onset adjudicated PAD, and the association between HsTP and incident PAD was examined. A total of 2,909 participants free of PAD and coronary artery disease at enrollment were included in this analysis. Over a mean follow up 7.4 years [interquartile ranges 5.8 to 8.5] years, 79 (2.7%) patients developed PAD. The 3-, 6-, and 9-year incidence of PAD was 1.00%, 2.03%, and 2.72%, respectively. At 9 years, the cumulative rates of PAD increased with HsTP (Quartile 1: 0.3%, Quartile 2: 2.4%, Quartile 3: 3.7%, Quartile 4: 10.7%; p 
       
  • Utility of Computed Tomography to Predict Ventricular Arrhythmias in
           Patients With Nonischemic Cardiomyopathy Receiving Cardiac
           Resynchronization Therapy
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Vincent Galand, Brian Ghoshhajra, Jackie Szymonifka, Saumya Das, Christophe Leclercq, Raphaël P. Martins, Quynh A. Truong, Jagmeet P. SinghThe residual risk of ventricular arrhythmia (VA) after cardiac resynchronization therapy (CRT) implantation in patients with nonischemic cardiomyopathy (NICM) remains difficult to evaluate. The impact of left ventricular (LV) wall thickness (WT) measured using computed tomography (CT) on the occurrence of VA after CRT implantation has never been investigated. In this pilot study, we examined the association of LV WT and the occurrence of VA in NICM patients receiving CRT. Thirty three patients with NICM scheduled for CRT underwent preprocedural CT. Reduced LV WT was defined as WT
       
  • Computed Tomography Features of Cuspal Thrombosis and Subvalvular Tissue
           Ingrowth after Transcatheter Aortic Valve Implantation
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Hyun Jung Koo, Jooae Choe, Do-Yoon Kang, Euihong Ko, Jung-Min Ahn, Duk-Woo Park, Seung-Jung Park, Ho Jin Kim, Joon Bum Kim, Suk Jung Choo, Joon-Won Kang, Dong Hyun YangPost-transcatheter aortic valve implantation (TAVI) computed tomography (CT) findings have not been fully elucidated, except hypoattenuating leaflet thickening (HALT). The objective of this study was to describe cardiac CT findings after TAVI, and investigate factors associated with HALT. This retrospective study included patients who underwent TAVI and post-TAVI cardiac CT scans. On CT, abnormal findings such as hypoattenuating subvalvular thickening (HAST), thrombus within the sinus of Valsalva, HALT, and leaflet motion limitation were thoroughly reviewed. Clinical and CT findings were compared between patients with HALT and those without HALT. Logistic regression analysis was performed to determine factors associated with HALT. A total of 138 patients (64 male, mean 78.5 ± 5.2 years of age) with post-TAVI CT scans were included. The median duration from TAVI to CT was 17.5 days (interquartile range, 3 to 390.8 days). HAST and thrombus within the sinus of Valsalva were detected in 32 (23%) and 5 (4%) patients, respectively. HALT and leaflet motion limitations were found in 25 (18%) and 20 (14%) of patients, respectively. Pannus was diagnosed in 2 patients. TAVI device implant duration (odds ratio [OR], 1.5; p = 0.01), hypertension (OR, 0.2; p = 0.03), and HAST (OR, 4.9; p = 0.003) were associated with HALT. Implant durations were longer in patients with HAST, HALT, or leaflet motion limitation (p 
       
  • Effectiveness and Safety of Transcatheter Aortic Valve Implantation in
           Patients With Aortic Stenosis and Variable Ejection Fractions (50%)
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Ilan Merdler, Itamar Loewenstein, Aviram Hochstadt, Samuel Morgan, Sivan Schwarzbard, Ben Sadeh, Yogev Peri, Yacov Shacham, Ariel Finkelstein, Arie SteinvilWe evaluated the safety and efficacy of transcatheter aortic valve implantation (TAVI) in aortic stenosis patients with mid-range ejection fraction (ASmrEF) and compared it to aortic stenosis patients with reduced ejection fraction (ASrEF) and preserved ejection fraction (ASpEF). TAVI cases were stratified by baseline ejection fraction (ASrEF, ASmrEF, ASpEF) and compared for characteristics, procedural outcomes, and change in echocardiographic parameters at 1 year and mortality over a 5-year follow-up. The final study population included 708 patients who underwent TAVI. ASmrEF patients presented with improved EF at 1-year after procedure (49.0 ± 9.8 at 1 year vs 43.0 ± 2.5 at baseline, p
       
  • Effect of Serum Albumin Levels in Patients With Heart Failure With
           Preserved Ejection Fraction (from the TOPCAT Trial)
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Stuart B. Prenner, Anupam Kumar, Lei Zhao, Mary E. Cvijic, Michael Basso, Thomas Spires, Zhuyin Li, Melissa Yarde, Priyanka Bhattacharya, Payman Zamani, Jeremy Mazurek, Zhaoqing Wang, Dietmar Seiffert, David A. Gordon, Julio A. ChirinosLittle data are available regarding the determinants and prognostic significance of serum albumin in Heart Failure with Preserved Ejection Fraction (HFpEF). We sought to examine the phenotypic correlates of albumin and its independent prognostic implications in HFpEF. We analyzed data from 3,254 subjects enrolled the TOPCAT trial. We stratified subjects according to tertiles of albumin and examined differences in various phenotypic traits between these strata, including 8 protein biomarkers selected ad hoc and measured from frozen samples available in a subset of participants (n = 372). We also assessed the relationship between albumin and the trial primary endpoint. Lower albumin was associated with older age, black race, and greater prevalence of NYHA class III-IV, peripheral arterial disease, atrial fibrillation and diabetes mellitus. Lower albumin was also associated with increased levels of several inflammatory biomarkers, markers of liver fibrosis, albuminuria, and greater arterial stiffness, diastolic dysfunction and pulmonary hypertension. Albumin was a strong predictor of the primary trial endpoint, even after adjustment for the MAGGIC risk score (hazard ratio [HR] 0.72, confidence interval [CI] 0.67 to 0.78; p
       
  • Acute Effects of Red Bull Energy Drinks on Atrial Electromechanical
           Function in Healthy Young Adults
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Cem Özde, Adnan Kaya, Ismail Hakkı Akbudak, Gulşah Aktüre, Osman KayapinarEnergy drinks (EDs) are widely consumed by adolescents and young adults. Almost all kinds of arrhythmias have been reported following EDs consumption, most of which is atrial fibrillation (AF). Atrial conduction time prolongation and heterogeneous sinusal impulses propagation to the atriums are the key electrophysiological mechanisms leading AF. We aimed to evaluate the acute effects of Red Bull ED ingestion on atrial electromechanical conduction times in healthy young adults. After a 12-hour fasting, 54 healthy young adults consumed 330 mL of Red Bull ED. Atrial electromechanical coupling (PA), intra-atrial electromechanical delay (intra-AEMD), and interatrial electromechanical delay (inter-AEMD) were measured at baseline and 2-hour after Red Bull ED ingestion by echocardiographic tissue-Doppler imaging (TDI) method. PA-lateral (49.7 ± 11.2 vs 54.1 ± 11.0 msn, p = 0.001) and PA-septal (40.8 ± 9.1 vs 43.7 ± 10.5 msn, p = 0.032) times were statistically significantly prolonged after Red Bull ED ingestion. There was also a statistically significant increase in the duration of inter-AEMD (14.4 ± 10.6 vs 18.1 ± 8.5 msn, p = 0.010) after ED ingestion. It was showed that even a single can of ED can acutely increase atrial electromechanical conduction times in young adults. These findings may be the cause of ED-associated AF.
       
  • The Theory of Gambler's Ruin and Your Investments
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Robert M. Doroghazi
       
  • Survey of Personal Use of Statins by Prescribers
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Peter S. Stack, Gerald O. OgolaA total of 829 physicians and advanced practice providers within a large, mostly primary care network were surveyed about their personal use of statins and their attitudes toward patient use of these medications. The 239 respondents included 60 clinicians who were current users, most for extended periods, and 15 who had stopped statin use. Nearly one-third of the clinicians over age 40 who took statins used them for primary prevention, compared with just 7.6% of the general adult US population. Half of the current statin users felt that their personal use had a positive effect on their likelihood of prescribing them to patients. More than 10% of users had discontinued statin use due to muscle effects, with virtually no other adverse effects mentioned among the survey respondents. The incidence of statin-associated muscle symptoms was high enough to suggest that as yet unmeasurable statin muscle pathology may be a real phenomenon that has been overlooked.
       
  • Usefulness of Certain Protein Biomarkers for Prediction of Coronary Heart
           Disease
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Kwok Leung Ong, Rosanna Wing Shan Chung, Nicholas Hui, Karin Festin, Anna Kristina Lundberg, Kerry-Anne Rye, Lena Jonasson, Margareta KristensonIdentification of biomarkers can help monitor and prevent cardiovascular disease (CVD) risk. We performed an exploratory analysis to identify potential biomarkers for coronary heart disease (CHD) in participants from the Life Conditions, Stress, and Health study. A total of 1,007 participants (50% women), randomly selected from the general population, were followed for incident CHD at 8 and 13 years of follow-up. Plasma levels of 184 CVD-related biomarkers were measured in samples collected at baseline in 86 cases with CHD and 184 age- and sex-matched controls by proximity extension assay. Biomarker levels were presented as normalized protein expression values (log 2 scale). After adjusting for confounding factors, 6 biomarkers showed significant association with incident CHD at 13 years. In a sensitivity analysis, this association remained significant at 8 years for 3 biomarkers; collagen α-1(I) chain (COL1A1), bone morphogenetic protein-6 (BMP-6), and interleukin-6 receptor α chain (IL-6Rα). When entering these biomarkers in the full adjustment model simultaneously, their association with incident CHD at 13 years remained significant, hazards ratio being 0.671, 0.335, and 2.854, respectively per unit increase in normalized protein expression values. Subjects with low COL1A1, low BMP-6, and high IL-6Rα levels had a hazards ratio of 5.097 for incident CHD risk (p = 0.019), compared with those without. In conclusion, we identified COL1A1, BMP-6 and IL-6Rα as biomarkers for incident CHD over a long-term follow-up in this exploratory analysis. For COL1A1 and BMP-6 this has not been previously reported. Further studies are needed to confirm our findings and establish their clinical relevance.
       
  • Statin Therapy and Risk of Incident Diabetes Mellitus in Adults With
           Cardiovascular Risk Factors
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Alan S. Go, Andrew P. Ambrosy, Kevin Kheder, Dongjie Fan, Sue Hee Sung, Alda I. Inveiss, Victoria Romo-LeTourneau, Sheila M. Thomas, Andrew Koren, Joan C. Lo, for the Kaiser Permanente Cholesterol-Lowering Therapy in High-Risk Adults: Management and Patient Risks (KP CHAMP) StudyThe association between statins and diabetes mellitus (DM) remains controversial. The Kaiser Permanente CHAMP Study identified adults without DM who had cardiovascular (CV) risk factors and no previous lipid lowering therapy (LLT) between 2008 and 2010. The CV risk factors included known atherosclerotic CV disease (ASCVD), elevated low-density lipoprotein cholesterol ≥190 mg/dl, or a low-density lipoprotein cholesterol between 70 and 189 mg/dl and an estimated 10-year ASCVD risk ≥7.5%. Incident DM was defined as ≥2 abnormal tests (i.e., A1C ≥6.5% or a fasting blood glucose ≥126 mg/dl) or ≥1 abnormal test result plus a new diagnostic code or medication for DM. Among 213,289 eligible adults, 28,149 patients initiating statins were carefully matched to an equal number of patients who remained off LLT during follow-up. Compared with matched patients not receiving statins, those initiating statin therapy had the same mean age (67.9 ± 9.4 years) and gender (42.8% women). The crude rate (per 100 person-years) of incident DM was low (0.55, 95% confidence interval [CI] 0.52 to 0.59) but was marginally higher in patients who were treated with a statin (0.69, 95% CI 0.64 to 0.74) versus no LLT (0.42, 95% CI 0.38 to 0.46). After additional adjustment, statin therapy was associated with a modestly increased risk of incident DM (adjusted hazard ratio 1.17, 95% CI 1.02 to 1.34). In conclusion, in adults without DM at increased ASCVD risk, initiation of statin therapy was independently associated with a modestly higher risk of incident DM.
       
  • Impact of Lipoprotein(a) on Long-Term (Mean 6.2 Years) Outcomes in
           Patients With Three-Vessel Coronary Artery Disease
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Na Xu, Lin Jiang, Lianjun Xu, Jian Tian, Ce Zhang, Xueyan Zhao, Xinxing Feng, Dong Wang, Yin Zhang, Kai Sun, Jingjing Xu, Ru Liu, Bo Xu, Wei Zhao, Rutai Hui, Runlin Gao, Zhan Gao, Lei Song, Jinqing YuanThe aim of the cohort study was to investigate the relation between plasma lipoprotein(a) (Lp[a]) and long-term clinical outcomes in patients with three-vessel disease (TVD) after the following treatment strategies, including medical therapy alone, percutaneous coronary intervention, and coronary artery bypass grafting. A total of 6,175 consecutive patients with angiographically confirmed TVD and available baseline Lp(a) data were included in this study. Based on the median level of Lp(a) at admission, the patient was divided into 2 subgroups. Primary endpoint was major adverse cardiovascular events (MACE), of which all-cause death, myocardial infarction, and unplanned revascularization were all included. In general, the median value of Lp(a) reached 13.76 mg/dl for all patients. The median follow-up time of all patients was 6.2 years. For MACE, a total of 1,433 cases were generated, accounting for 23.2%, including 804 (13.0%) all-cause death, 302 (4.9 %) myocardial infarction, and 494 (8.0%) unplanned revascularization. For the incidence of MACE, the high Lp (a) and low Lp (a) groups were 24.3% to 22.1% (p = 0.015), respectively. When the risk factors were adjusted, the multivariate analysis showed that high Lp(a) levels was an independent predictor of primary outcome (adjusted hazard ratio 1.169, 95% confidence interval 1.046 to 1.306, p = 0.006). Except for gender group, there is a relatively consistent correlation in the various subgroups. In conclusion, plasma Lp(a) is a potential biomarker for risk stratification and prognosis in patients diagnosed with TVD.
       
  • Meta-analysis of Antithrombotic Therapy in Patients With Atrial
           Fibrillation Undergoing Percutaneous Coronary Intervention
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Toshiki Kuno, Hiroki Ueyama, Hisato Takagi, Tomo Ando, Yohei Numasawa, Alexandros Briasoulis, John Fox, Sripal BangaloreFor patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI), antithrombotic therapy including oral anticoagulants and antiplatelets are indicated. The optimal combination is not known. We investigated the efficacy and safety of different antithrombotic strategies in patients with AF undergoing PCI. PUBMED and EMBASE were searched through September 2019 for randomized trials investigating the efficacy and safety of different antithrombotic strategies in patients with AF who underwent PCI and/or acute coronary syndrome. Nine antithrombotic strategies were compared including combinations of vitamin K antagonist (VKA) with dual antiplatelet therapy (DAPT) or P2Y12 inhibitor, combinations of direct oral anticoagulants (DOAC) (apixaban, dabigatran, rivaroxaban, and edoxaban) with DAPT or P2Y12 inhibitor (clopidogrel, prasugrel, and ticagrelor). The primary safety outcome was trial defined primary bleeding outcome. The primary efficacy outcome was trial defined major adverse cardiovascular events. Our search identified 5 eligible trials that enrolled a total of 11,532 patients and compared 9 treatment strategies. VKA + DAPT significantly increased bleeding when compared with most combinations (for example, vs VKA + P2Y12 inhibitor: odds ratio 2.11; 95% confidence interval [1.76 to 2.52], p
       
  • Meta-Analysis Comparing Complete Versus Infarct-Related Artery
           Revascularization in Patients With ST-Elevation Myocardial Infarction and
           Multivessel Coronary Disease
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Mohammed Osman, Safi U. Khan, Peter D. Farjo, Noor Chima, Babikir Kheiri, Firas Zahr, Mohamad AlkhouliA strategy of complete revascularization (CR) versus infarct-related artery revascularization (IRA) in patients with ST-elevation myocardial infarction (STEMI) continues to be a subject of debate. We performed an updated meta-analysis to compare the 2 strategies. Outcomes of interest included major adverse cardiovascular events (MACE), cardiovascular mortality, all-cause mortality, stroke, repeat revascularization, myocardial infarction, and contrast-induced nephropathy. Ten randomized trials including 7,423 patients (CR = 3,574 and IRA = 3,849), with a follow-up of 2.0 ± 0.8 years were included. There was a significant reduction in MACE with CR versus IRA (10.7% vs 18.6%, relative risk [RR] 0.64, 95% confidence interval [CI] 0.51 to 0.81, p = 0.002, I2 = 66%), with higher risk reduction with immediate versus stages revascularization (RR 0.40, 95% CI 0.32 to 0.5 vs RR 0.69, 95% CI 0.54 to 0.89, P-interaction = 0.002). Complete revascularization was associated with lower rates of repeat revascularization (4.0% vs 11.7%, RR 0.44, 95% CI 0.28 to 0.70, p 
       
  • Hemodynamic Validation of the E/e’ Ratio as a Measure of Left
           Ventricular Filling Pressure in Patients With Non-ST Elevation Myocardial
           Infarction
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Sandhir B. Prasad, Anthony Camuglia, Ada Lo, David J. Holland, Kristyan Guppy-Coles, Gillian Whalley, Liza Thomas, John J. AthertonThe E/e’ ratio has an established role in the assessment of left ventricular filling pressure (LVFP) in stable patients, but its accuracy in acute myocardial ischemia is less well established. The aim of this study was to validate the relation between the E/e’ ratio and invasively measured LVFP in patients with non-ST elevation myocardial infarction (NSTEMI). A total of 120 unselected patients with NSTEMI underwent cardiac catheterization with measurement of left ventricular end-diastolic pressure (LVEDP; elevated ≥15 mm Hg) and Doppler echocardiography with either simultaneous (n = 30) or same-day (n = 90) measurement of E/e’. Patients were aged 64.1 ± 11.8 years, 72% were male and mean left ventricular ejection fraction was 48.0 ± 20.9%. Septal, lateral, and average E/e’ ratios all showed a significant correlation with LVEDP (Pearson's r: 0.42, 0.43, 0.48, respectively [all p
       
  • Incidence and Prognostic Impact of Atrial Fibrillation After Discharge
           Following Revascularization for Significant Left Main Coronary Artery
           Narrowing
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Ioanna Kosmidou, Yangbo Liu, Zixuan Zhang, Björn Redfors, Arie Pieter Kappetein, Patrick W. Serruys, Bernard J. Gersh, David E. Kandzari, Marie-Claude Morice, Paweł E. Buszman, Andrzej Bochenek, Erick Schampaert, Joseph F. Sabik, Ori Ben-Yehuda, Gregg W. StoneThe incidence, recurrence rate, and prognostic significance of atrial fibrillation or flutter (AF) following hospital discharge after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) are unknown. We sought to determine the 3-year incidence and clinical impact of postdischarge AF in patients with LMCAD treated with PCI or CABG. In the EXCEL trial, 1,905 patients with LMCAD were randomized to PCI versus CABG. We analyzed the occurrence of postdischarge AF through 3 years and its time-adjusted association with adverse outcomes. A total of 1,802 patients without AF at baseline comprised the study cohort. Within 3 years, 227 episodes of AF occurred (29 [12.8%] in the PCI arm and 198 [87.2%] in the CABG arm, p
       
  • Incidence of Adverse Events at 3 Months Versus at 12 Months After Dual
           Antiplatelet Therapy Cessation in Patients Treated With Thin Stents With
           Unprotected Left Main or Coronary Bifurcations
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Fabrizio D'Ascenzo, Umberto Barbero, Mohamed Abdirashid, Daniela Trabattoni, Giacomo Boccuzzi, Nicola Ryan, Giorgio Quadri, Davide Capodanno, Giuseppe Venuti, Saverio Muscoli, Francesco Tomassini, Michele Autelli, Andrea Montabone, Wojciech Wojakowski, Andrea Rognoni, Diego Gallo, Radoslaw Parma, Leonardo De Luca, Filippo Figini, Satoru MitomoIncidence and predictors of adverse events after dual antiplatelet therapy (DAPT) cessation in patients treated with thin stents (
       
  • Feasibility and Safety of Low-Dose Intra-Coronary Tenecteplase During
           Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial
           Infarction (ICE T-TIMI 49)
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): C. Michael Gibson, Varun Kumar, Lakshmi Gopalakrishnan, Priyamvada Singh, Jianping Guo, Samer Kazziha, Chandan Devireddy, Duane Pinto, J. Jeffrey Marshall, George A. Stouffer, Kreton Mavromatis, Laura Grip, Kevin R. Bainey, For the TIMI & PERFUSE Study GroupFollowing primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction, microvascular perfusion is often impaired secondary to thrombotic embolization. Intracoronary (IC) fibrinolytic administration may reduce thrombotic burden and distal embolization. The ICE-T-TIMI-49 study evaluated the feasibility and safety of low-dose IC tenecteplase (TNK) during PPCI. The study randomized 40 PPCI patients to a volume matched bolus of IC TNK (4 mg) (n = 20) or IC saline placebo (n = 20) before and following PPCI. The primary end point was percent diameter stenosis of the culprit lesion following first bolus. The primary end point did not differ between IC placebo (median 100%, interquartile range [IQR] 83.0,100.0) and IC TNK (median 100% stenosis, IQR 91.0,100.0; p = 0.522). However, the proportion of patients with reduction in thrombus following first bolus tended to be greater with IC TNK (placebo: 12.5% vs IC TNK: 40.0%, p = 0.133). Following PPCI, the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (cTFC) was lower (faster) with placebo (16.0 frames [IQR 12.0,24.0] vs 24.0 frames [22.0,32.0], p = 0.045) due to a trend towards greater frequency of hyperemia (cTFC
       
  • Familial Mitral Arcade, Tricuspid Dysplasia, Left Ventricular
           Noncompaction and Short-Chain Acyl-CoA Reductase Deficiency
    • Abstract: Publication date: 15 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 4Author(s): Amina Adil, Fatima Samad, Michelle L. Bush, Patrycja Z. Galazka, A. Jamil TajikMitral arcade is a rare entity that is mostly reported in pediatric patients. We present the first 2 adult cases of mitral arcade in combination with tricuspid dysplasia, left ventricular noncompaction, and short-chain acyl-CoA deficiency in 2 brothers. We examined clinical and echocardiographic data on 2 brothers with a combination of short-chain acyl-CoA deficiency, mitral arcade, tricuspid dysplasia, and left ventricular noncompaction (LVNC), highlighting their clinical course and outcomes. Two-dimensional and 3-dimensional transthoracic echocardiography revealed direct attachment of the papillary muscles to the mitral leaflets, namely mitral arcade, as well as mild mitral regurgitation along with LVNC and tricuspid dysplasia. Over the past 7 years, both brothers have remained asymptomatic with excellent exercise capacity (13 and 10 metabolic equivalents (METS), respectively). Mitral and tricuspid regurgitation remain mild with unchanged left ventricular function (ejection fraction: 65% and 59%). In conclusion, we highlight 2 cases with a constellation of pathology including short-chain acyl-CoA deficiency, mitral arcade, tricuspid dysplasia, and LVNC, which has never been described before.
       
 
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