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Publisher: Elsevier   (Total: 3030 journals)

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Showing 1 - 200 of 3030 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 79, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 22, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 303, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 196, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 21, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
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Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 120, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 24, SJR: 0.169, h-index: 4)
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Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
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Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 38, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 41, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 18, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 33, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 7, SJR: 0.764, h-index: 15)
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: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 6, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 20, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 14)
Advances in Pharmacology     Full-text available via subscription   (Followers: 13, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 17, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 56)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 1, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 332, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 7)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 28, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 14)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 12)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 42, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 304, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 390, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 29, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 36, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 48, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 3, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 7, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 45, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 45, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 48, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 174, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 51, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 22, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 32, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 13, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 3)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 154, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 7, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 143, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
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Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Cardiology
  [SJR: 2.063]   [H-I: 186]   [47 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9149 - ISSN (Online) 0002-9149
   Published by Elsevier Homepage  [3030 journals]
  • Changing Trends of Atherosclerotic Risk Factors Among Patients With Acute
           Myocardial Infarction and Acute Ischemic Stroke
    • Authors: Shikhar Agarwal; Karan Sud; Badal Thakkar; Venu Menon; Wael Jaber; Samir Kapadia
      First page: 32
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Shikhar Agarwal, Karan Sud, Badal Thakkar, Venu Menon, Wael A. Jaber, Samir R. Kapadia
      We aimed to evaluate the secular trends in demographics, risk factors, and clinical characteristics of patients presenting with acute myocardial infarction (AMI) or acute ischemic stroke (AIS), using a large nationally representative data set of in-hospital admissions. We used the 2003 to 2013 Nationwide Inpatient Sample. All admissions with primary diagnosis of AMI or AIS were included. Across 2003 to 2013, a total of 1,360,660 patients with AMI and 937,425 patients with AIS were included in the study. We noted a progressive reduction in the mean age of patients presenting with AMI and AIS (p trend <0.001 for all groups), implying that the burden of young patients with these acute syndromes is progressively increasing. In addition, there was a progressive increase in the proportion of patients who are uninsured among patients presenting with AMI and AIS. Furthermore, despite a progressively younger age at presentation, there was an observed increase in the prevalence of atherosclerotic risk factors including hypertension, hyperlipidemia, diabetes, smoking, and obesity among patients presenting with AMI or AIS during 2003 to 2013. Significant disparities were noted in the prevalence of risk factors among various demographic and geographical cohorts. Low socioeconomic status as well as uninsured patients had a significantly higher prevalence of preventable risk factors like smoking and obesity as compared to the high socioeconomic status and insured patients, respectively. In conclusion, there have been significant changes in the risk factor profile of patients presenting with AMI and AIS over the last decade.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/s0735-1097(17)33421-6
       
  • Incidence, Predictors, and Outcomes of High-Grade Atrioventricular Block
           in Patients With ST-Segment Elevation Myocardial Infarction Undergoing
           Primary Percutaneous Coronary Intervention (from the HORIZONS-AMI Trial)
    • Authors: Ioanna Kosmidou; Björn Redfors; Rushad Dordi; José M. Dizon; Thomas McAndrew; Roxana Mehran; Ori Ben-Yehuda; Gary S. Mintz; Gregg W. Stone
      Pages: 1295 - 1301
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Ioanna Kosmidou, Björn Redfors, Rushad Dordi, José M. Dizon, Thomas McAndrew, Roxana Mehran, Ori Ben-Yehuda, Gary S. Mintz, Gregg W. Stone
      High-grade atrioventricular block (HAVB) is historically considered a marker of worse outcomes in patients with ST-segment elevation myocardial infarction (STEMI). However, the predictors and prognostic impact of HAVB in the primary percutaneous coronary intervention (PCI) era remain poorly understood. We sought to describe the characteristics and predictors of HAVB in patients undergoing primary PCI in STEMI and to assess the prognostic significance of HAVB in the contemporary reperfusion era. The present analysis includes 3,115 patients presenting with STEMI from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial who underwent primary PCI. Outcomes were examined according to the presence of HAVB on a presenting electrocardiogram, as interpreted by an independent electrocardiography core laboratory. HAVB (second-degree Mobitz II or third-degree atrioventricular block) was present at baseline in 46 patients (1.5%). Independent predictors of HAVB included increased age, diabetes mellitus, right coronary artery occlusion, sum of ST-segment deviation, and baseline Thrombolysis In Myocardial Infarction flow 0/1. Thrombolysis In Myocardial Infarction flow 3 was restored in 83.7% and 91.5% of patients with versus without baseline HAVB respectively (p = 0.06). Mortality rate was significantly higher in patients with versus without HAVB at 30-day, 1-, and 3-year follow-ups (unadjusted hazard ratio [HR] 3.83, 95% CI 1.40 to 10.48; unadjusted HR 4.37, 95% CI 2.09 to 9.38 and unadjusted HR 2.78, 95% CI 1.31 to 5.91, respectively). After covariate adjustment, mortality rate was significantly higher in patients with HAVB at 1 year (adjusted HR 2.45, 95% CI 1.09 to 5.50, p = 0.03) but not at 30 days (adjusted HR 1.70, 95% CI 0.58 to 5.01, p = 0.33) or 3 years (adjusted HR 0.71 to 3.41, p = 0.27). In conclusion, HAVB is a rare complication of STEMI but remains associated with increased mortality, even after primary PCI.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.019
       
  • Relation of Prolonged P-Wave Duration to Risk of Sudden Cardiac Death in
           the General Population (from the Atherosclerosis Risk in Communities
           Study)
    • Authors: Ankit Maheshwari; Faye L. Norby; Elsayed Z. Soliman; M. Chadi Alraies; Selcuk Adabag; Wesley T. O'Neal; Alvaro Alonso; Lin Y. Chen
      Pages: 1302 - 1306
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Ankit Maheshwari, Faye L. Norby, Elsayed Z. Soliman, M. Chadi Alraies, Selcuk Adabag, Wesley T. O'Neal, Alvaro Alonso, Lin Y. Chen
      Prolonged P-wave duration, a marker of left atrial abnormality, is associated with myocardial fibrosis, atrial fibrillation, and all-cause death. It is not known if prolonged P-wave duration is associated with sudden cardiac death (SCD) in the general population. We aimed to evaluate whether prolonged P-wave duration is independently associated with SCD risk in the Atherosclerosis Risk in Communities Study, a community-based prospective cohort study. We included 15,321 participants in our analysis (age 54.2 ± 5.7 years, 55.2% women, 26.4% black). Prolonged P-wave duration was defined as maximum P-wave duration >120 ms and was determined from 12-lead electrocardiograms obtained during 4 exams (1987 to 1999). SCD was physician adjudicated and defined as a sudden, pulseless condition in a previously stable patient without evidence for noncardiac cause of death. We used Cox proportional hazard models to assess the association between prolonged P-wave duration and SCD, adjusting for cardiovascular risk factors and conditions including atrial fibrillation. During a mean follow-up of 12.5 years (1987 to 2001), 268 SCDs were identified. The multivariable hazard ratio (95% confidence interval) of prolonged P-wave duration for SCD was 1.70 (1.31 to 2.20). This association was attenuated but remained significant after updating covariates to the end of follow-up with a hazard ratio of 1.35 (1.04 to 1.76). In conclusion, prolonged P-wave duration is independently associated with an increased risk of SCD in the general population. This association is independent of atrial fibrillation and is only partially mediated by shared cardiovascular risk factors.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.012
       
  • Comparison of Electrocardiography Markers and Speckle Tracking
           Echocardiography for Assessment of Left Ventricular Myocardial Scar Burden
           in Patients With Previous Myocardial Infarction
    • Authors: Eirik Nestaas; Jhih-Yuan Shih; Marit K. Smedsrud; Ola Gjesdal; Einar Hopp; Kristina H. Haugaa; Thor Edvardsen
      Pages: 1307 - 1312
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Eirik Nestaas, Jhih-Yuan Shih, Marit K. Smedsrud, Ola Gjesdal, Einar Hopp, Kristina H. Haugaa, Thor Edvardsen
      Myocardial scar burden is an important prognostic factor after myocardial infarction. This cohort study compared assessment of left ventricle scar burden between pathological Q waves on electrocardiography (ECG), Selvester multiparametric ECG scoring system for scar burden, and global longitudinal strain (GLS) by speckle-tracking echocardiography 6 months after myocardial infarction. The scar burden was defined by late gadolinium enhancement cardiac magnetic resonance as fraction of total left ventricle tissue. ECG measures were presence of pathologic Q waves and Selvester scores. GLS was the average of peak strain from 16 left ventricle segments. In 34 patients aged 58 ± 10 years (mean ± SD), the scar burden was 19% (9, 26) (median [quartiles]) and 79% had scar burden >5%. Patients with scar burden >5% more frequently had pathologic Q waves (63% vs 14%) and had worse Selvester scores (5 [3, 7] vs 0 [0, 1]) and worse GLS (−16.6 ± 2.4% vs −19.9 ± 1.1%). Pathologic Q waves, Selvester scores, ejection fraction, and GLS related to scar burden in univariable analyses. Sensitivity and specificity for detecting scar burden >5% was 63% and 86% (pathologic Q waves), 89% and 86% (Selvester score), 81% and 86% (ejection fraction), 89% and 86% (GLS), and 96% and 71% (combination of Q waves, Selvester score, and GLS). In conclusion, Selvester score and GLS related to scars 6 months after myocardial infarction, and pathologic Q waves were only weakly associated with scar and GLS was associated with scar independently of ECG markers.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.020
       
  • Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as
           Assessed by Optical Coherence Tomography
    • Authors: Chee Yang Chin; Mitsuaki Matsumura; Akiko Maehara; Wenbin Zhang; Cheolmin Tetsumin Lee; Myong Hwa Yamamoto; Lei Song; Yasir Parviz; Nisha B. Jhalani; Sumit Mohan; Lloyd E. Ratner; David J. Cohen; Ori Ben-Yehuda; Gregg W. Stone; Richard A. Shlofmitz; Tsunekazu Kakuta; Gary S. Mintz; Ziad A. Ali
      Pages: 1313 - 1319
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Chee Yang Chin, Mitsuaki Matsumura, Akiko Maehara, Wenbin Zhang, Cheolmin Tetsumin Lee, Myong Hwa Yamamoto, Lei Song, Yasir Parviz, Nisha B. Jhalani, Sumit Mohan, Lloyd E. Ratner, David J. Cohen, Ori Ben-Yehuda, Gregg W. Stone, Richard A. Shlofmitz, Tsunekazu Kakuta, Gary S. Mintz, Ziad A. Ali
      Coronary arteries in patients with chronic kidney disease (CKD) have been shown to exhibit more extensive atherosclerosis and calcium. We aimed to assess characteristics of coronary plaque in hemodialysis (HD)-dependent patients using optical coherence tomography (OCT). This was a multicenter, retrospective study of 124 patients with stable angina who underwent OCT imaging. Sixty-two HD-dependent patients who underwent pre-intervention OCT for coronary artery disease were compared 1:1 with a cohort of patients without CKD, matched for age, diabetes mellitus, gender, and culprit vessel. Baseline characteristics were comparable. Pre-intervention OCT imaging identified 62 paired culprit, 53 paired non-culprit, and 19 paired distal vessel lesions. Lesion length, minimum lumen area, and area stenosis were similar between groups. The HD-dependent group had greater mean calcium arcs in culprit (54.3° vs 26.4°, p = 0.004) and non-culprit lesions (34.3° vs 24.5°, p = 0.02) and greater maximum calcium arc in distal vessel segments (101.6° vs 0°, p = 0.03). There were no differences in lipid arcs between groups. There was a higher prevalence of thin intimal calcium, defined as an arc of calcium >30° within intima <0.5 mm thick, in patients in the HD-dependent group (41.9% vs 4.8%, p <0.001). There was a higher prevalence of calcified nodules in the HD-dependent group (24.2% vs 9.7%, p = 0.049) but no differences in medial calcification or thin-cap fibroatheroma. In conclusion, in this OCT study, HD-dependent patients, compared with matched patients without CKD, had more extensively distributed coronary calcium and uniquely, a higher prevalence of non-atherosclerotic thin intimal calcium. This thin intimal calcium may cause an overestimation of calcium burden by intravascular ultrasound and may contribute to the lack of correlation between increased coronary artery calcification scores with long-term outcomes in patients with CKD.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.022
       
  • Comparison of Rotational Atherectomy Versus Orbital Atherectomy for the
           Treatment of Heavily Calcified Coronary Plaques
    • Authors: Michael S. Lee; Kyung Woo Park; Evan Shlofmitz; Richard A. Shlofmitz
      Pages: 1320 - 1323
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Michael S. Lee, Kyung Woo Park, Evan Shlofmitz, Richard A. Shlofmitz
      We evaluated the outcomes of patients with severe coronary artery calcification (CAC) who underwent rotational atherectomy (RA) and orbital atherectomy (OA). Severe CAC increases the complexity of percutaneous coronary intervention (PCI) because of the difficulty in optimizing stent expansion, leading to worse clinical outcomes. Both devices are effective treatment strategies for severe CAC. No comparisons have been performed to evaluate the clinical outcomes after RA and OA. The outcomes of 67 patients with severe CAC who underwent RA from July 2012 to June 2015 and 60 patients who underwent OA from February 2014 to September 2016 were evaluated. The primary end point was the rate of 30-day major adverse cardiac and cerebrovascular events, comprising cardiac death, myocardial infarction, target vessel revascularization, and stroke. The primary end point was similar in the RA and OA groups (6% vs 6%, p >0.9), as were the individual end points of death (0% vs 2%, p = 0.8), myocardial infarction (6% vs 4%, p = 0.7), target vessel revascularization (0% vs 0%, p >0.9), and stroke (0% vs 0%, p >9). Procedural success was achieved in all patients. Angiographic complications were uncommon in both groups. No patient had stent thrombosis. In conclusion, both RA and OA are safe and effective for the treatment of severe CAC as they provided similar clinical outcomes at short-term follow-up.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.025
       
  • Comparison of Baseline Characteristics and Inhospital Outcomes of Patients
           and Use of Bare Metal Versus Drug-Eluting Stents During Percutaneous
           Coronary Intervention 2005 to 2015 at a Single Tertiary Hospital
    • Authors: Romain Didier; Michael A. Gaglia; Michael J. Lipinski; Edward Koifman; Sarkis Kiramijyan; Smita Negi; Jiaxiang Gai; Rebecca Torguson; Augusto D. Pichard; Ron Waksman
      Pages: 1324 - 1330
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Romain Didier, Michael A. Gaglia, Michael J. Lipinski, Edward Koifman, Sarkis Kiramijyan, Smita Negi, Jiaxiang Gai, Rebecca Torguson, Augusto D. Pichard, Ron Waksman
      With steady growth in the use of drug-eluting stents (DES), the indications for bare metal stents (BMS) have significantly changed over the last decade. This study aims to describe trends in the use of BMS and the evolution of the population receiving them over the past 10 years and determine patient characteristics associated with using BMS. Consecutive patients who underwent percutaneous coronary intervention (PCI) at the Washington Hospital Center from January 2005 through March 2015 were included. Baseline characteristics and inhospital outcomes of patients who underwent PCI with BMS versus DES were compared during 2 different time periods: from 2005 to 2010 and from 2011 to 2015. Multivariable analyses were performed for each period of time to determine independent variables associated with the choice of BMS rather than DES; 20,321 patients who underwent PCI were included in the present study. The mean age was 65.0 ± 12.5 years, 65.2% were men, and 30.4% were black. BMS use peaked in 2007 (47%) but has fallen steadily since; BMS accounted for only 10% of stents used in 2015. Presentation with acute coronary syndrome or cardiogenic shock was more common in patients receiving a BMS; this was reflected in higher rates of inhospital mortality and major bleeding among patients receiving BMS versus DES. Covariables independently associated with receiving a BMS common to both time periods included black race, Hispanic ethnicity, cardiogenic shock or acute coronary syndrome, oral anticoagulation, current smoking, increasing age, lower hematocrit, and history of chronic renal insufficiency. In conclusion, there has been a precipitous decline in the use of BMS over the last decade. Newer stent technology that promises shorter duration of dual antiplatelet therapy is likely to lead to the extinction of BMS over the next decade.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.016
       
  • In-Hospital and 1-Year Outcomes of Rotational Atherectomy and Stent
           Implantation in Patients With Severely Calcified Unprotected Left Main
           Narrowings (from the Multicenter ROTATE Registry)
    • Authors: Alfonso Ielasi; Hiroyoshi Kawamoto; Azeem Latib; Giacomo G. Boccuzzi; Gennaro Sardella; Roberto Garbo; Emanuele Meliga; Fabrizio D'Ascenzo; Patrizia Presbitero; Sunao Nakamura; Antonio Colombo
      Pages: 1331 - 1337
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Alfonso Ielasi, Hiroyoshi Kawamoto, Azeem Latib, Giacomo G. Boccuzzi, Gennaro Sardella, Roberto Garbo, Emanuele Meliga, Fabrizio D'Ascenzo, Patrizia Presbitero, Sunao Nakamura, Antonio Colombo
      Heavily calcified unprotected left main (ULM) disease continues to be a challenging situation and represent a high-risk subset for interventional cardiologist. To date, there are limited data investigating the results after rotational atherectomy (RA) in this setting. The aim of this study was to investigate the in-hospital and 1-year outcomes after RA of heavily calcified ULM lesions. A retrospective cohort analysis was performed on all calcified patients with ULM (n = 86) enrolled in the multicenter international ROTATE registry (overall patients, n = 962). End points of the study were the in-hospital and 1-year incidence of major adverse cardiovascular events (MACE): a composite of death, myocardial infarction, and target-vessel revascularization in the ULM versus non-ULM group. Patients in the ULM group were older (p = 0.01) and more frequently with diabetes (p = 0.001) compared with the non-ULM group, whereas intravascular ultrasound guidance was higher, even if not systematic, in the ULM group (p <0.001). No difference was reported between ULM versus non-ULM groups in terms of in-hospital MACE (5.8% vs 8%). At 1 year, MACE rate was higher in ULM versus non-ULM (26.4% vs 14.9%, p = 0.002) mostly driven by target-vessel revascularization (20.3% vs 12.7%, p = 0.05). Even definite/probable stent thrombosis rate was higher in the ULM group (3.9% vs 0.8%). All these events were subacute and 2/3 (75%) were fatal. In conclusion, our multicenter experience shows that RA followed by stent implantation in patients with heavily calcified ULM narrowing is feasible and associated with good in-hospital results. Patient (age and diabetes) and procedural aspects (relatively low intravascular ultrasound guidance) may affect the worse subacute mid-term prognosis in the more complex ULM group.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.014
       
  • Meta-Analysis of Randomized Control Trials Comparing Drug-Eluting Stents
           Versus Coronary Artery Bypass Grafting for Significant Left Main Coronary
           Narrowing
    • Authors: Cheng Qian; Hong Feng; Jianlei Cao; Baozhu Wei; Yanggan Wang
      Pages: 1338 - 1343
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Cheng Qian, Hong Feng, Jianlei Cao, Baozhu Wei, Yanggan Wang
      Previous meta-analyses showed that drug-eluting stent (DES) implantation may serve as an alternative to coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) stenosis, largely driven by data from registries. Hence, we performed a meta-analysis of randomized controlled trials (RCTs) to overcome this limitation. PubMed, the Cochrane Library, and Scopus were systematically searched through October 2016 to identify eligible RCTs. The primary outcomes were major adverse cardiac and cerebrovascular events (MACCE) at 1-year and long-term (≥3 years) follow-ups. This meta-analysis included 5 RCTs, totaling 4,595 patients with ULMCA disease. Compared with CABG, DES showed similar 1-year rates of MACCE (risk ratio [RR] 1.14, 95% confidence interval [CI] 0.91–1.42), all-cause death, and myocardial infarction, with a higher incidence of revascularization (RR 1.68, 95% CI 1.24–2.27) and lower incidence of stoke (RR 0.43, 95% CI 0.23–0.78). At long-term follow-up, DES placement was inferior to CABG in terms of MACCE (RR 1.27, 95% CI 1.13–1.43) and revascularization (RR 1.70, 95% CI 1.43–2.01). There was no difference in long-term risk of other outcomes between these 2 strategies. In conclusion, DES stenting and CABG for ULMCA disease yield comparable rates of MACCE at 1-year follow-up; however, CABG is associated with a decreased risk of long-term MACCE compared with DES, exclusively driven by the considerable reduction in revascularization events.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.027
       
  • Comparative Efficacy of Coronary Revascularization Procedures for
           Multivessel Coronary Artery Disease in Patients With Chronic Kidney
           Disease
    • Authors: John K. Roberts; Sunil V. Rao; Linda K. Shaw; Dianne S. Gallup; Oscar C. Marroquin; Uptal D. Patel
      Pages: 1344 - 1351
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): John K. Roberts, Sunil V. Rao, Linda K. Shaw, Dianne S. Gallup, Oscar C. Marroquin, Uptal D. Patel
      Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease and death, yet little data exist regarding the comparative efficacy of coronary revascularization procedures in CKD patients with multivessel disease. We created a cohort of 4,687 adults who underwent cardiac catheterization, had a serum creatinine value measured within 30 days, and had more than one vessel with ≥50% stenosis. We used Cox proportional hazard regression modeling weighted by the inverse probability of treatment to examine the association between 4 treatment strategies (medical management, percutaneous coronary intervention [PCI] with bare metal stent, PCI with drug-eluting stent, and coronary artery bypass grafting [CABG]) and mortality among patients across categories of estimated glomerular filtration rate; secondary outcome was a composite of mortality, myocardial infarction, or revascularization. Compared with medical management, CABG was associated with a reduced risk of death for patients of any nondialysis CKD severity (hazard ratio [HR] range 0.43 to 0.59). There were no significant mortality differences between CABG and PCI, except a decreased death risk in CABG-treated CKD patients (HR range 0.54 to 0.55). Compared with medical management and PCI, CABG was associated with a lower risk of death, myocardial infarction, or revascularization in nondialysis CKD patients (HR range 0.41 to 0.64). There were similar associations between decreased estimated glomerular filtration rate and increased mortality across all multivessel coronary artery disease patient treatment groups. When accounting for treatment propensity, surgical revascularization was associated with improved outcomes in patients of all CKD severities. A prospective randomized trial in CKD patients is required to confirm our findings.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.029
       
  • Relation of Fasting Triglyceride-Rich Lipoprotein Cholesterol to Coronary
           Artery Calcium Score (from the ELSA-Brasil Study)
    • Authors: Marcio S. Bittencourt; Raul D. Santos; Henrique Staniak; Rodolfo Sharovsky; Rao Kondapally; Antonio J. Vallejo-Vaz; Kausik K. Ray; Isabela Bensenor; Paulo Lotufo
      Pages: 1352 - 1358
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Marcio S. Bittencourt, Raul D. Santos, Henrique Staniak, Rodolfo Sharovsky, Rao Kondapally, Antonio J. Vallejo-Vaz, Kausik K. Ray, Isabela Bensenor, Paulo Lotufo
      Although low-density lipoprotein cholesterol (LDL-C) is widely accepted as the principal lipid fraction associated with atherosclerosis, emerging evidence suggests a causal relation between lifelong elevations in triglyceride-rich lipoprotein cholesterol (TRL-C) and cardiovascular disease (CVD) in genetic studies. To provide further evidence for the potential relevance of TRL-C and atherosclerosis, we have evaluated the relation between TRL-C and coronary artery calcium (CAC) score. We included 3,845 subjects (49.9 ± 8.4 years, 54% women) who had no history of CVD, were not using lipid-lowering medications, and underwent CAC evaluation. We assessed the relation between increasing fasting TRL-C and the graded increase in CAC and to what extent TRL-C were independently associated with CAC over and above LDL-C using logistic regression models. Overall, 973 (25%) of the participants had a CAC >0 and 308 (8%) had a CAC >100. The median TRL-C level was 22 mg/dL (IQR 16 to 32). Subjects with CAC >0 had higher TRL-C levels than those with CAC = 0 (p <0.001). Similarly, subjects with CAC >0 had higher levels of LDL-C, non–high-density lipoprotein cholesterol, and lower high-density lipoprotein cholesterol (all p <0.001). After multivariate adjustment, log-transformed TRL-C remained associated with the presence and severity of CAC (all p <0.05). When TRL-C was added to models that contained demographic factors and conventional lipids, it significantly improved the model to predict the presence of CAC >0 (p = 0.01). In conclusion, in a large cohort of asymptomatic subjects, TRL-C was associated with subclinical atherosclerosis supporting a potentially causal role in CVD.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.033
       
  • Relation of Epicardial Adipose Tissue Radiodensity to Coronary Artery
           Calcium on Cardiac Computed Tomography in Patients at High Risk for
           Cardiovascular Disease
    • Authors: Bas T. Franssens; Hendrik M. Nathoe; Frank L.J. Visseren; Yolanda van der Graaf; Tim Leiner; Ale Algra; Yolanda van der Graaf; Diederick E. Grobbee; Guy E.H.M. Rutten; Frank L.J. Visseren; Gert Jan de Borst; L.J. (Jaap) Kappelle; Tim Leiner; Hendrik M. Nathoe
      Pages: 1359 - 1365
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Bas T. Franssens, Hendrik M. Nathoe, Frank L.J. Visseren, Yolanda van der Graaf, Tim Leiner
      Adipose tissue radiodensity detected by computed tomography (CT) is hypothesized to be associated with differences in adipose tissue composition which may contribute to the development of coronary atherosclerosis independent of epicardial adipose tissue volume. The aim of the present study is to quantify the relation between epicardial adipose tissue radiodensity and presence, distribution, and density of coronary artery calcium (CAC) in patients at high risk for cardiovascular disease. A total of 140 patients of the Secondary Manifestations of ARTerial disease (SMART) study underwent cardiac-CT angiography. Ordinal logistic and linear regression was used to quantify the relation between epicardial adipose tissue radiodensity (in Hounsfield Units, HU) and CAC. One SD lower attenuation (5 HU) was associated with a 1.90 (95% confidence interval [CI] 1.14 to 3.19) higher odds for men and a 1.07 (95% CI 0.41 to 2.75) higher odds for women of being in a higher CAC class (0, 1 to 100, 101 to 400, and >400), independent of age, coronary artery bypass graft history, epicardial adipose tissue volume, and body mass index. One SD lower attenuation was not associated with more diffuse distribution of CAC, but increased the odds of being in a higher tertile of CAC density per plaque (odds ratio 1.77, 95% CI 1.18 to 2.66). In conclusion, low epicardial adipose tissue CT attenuation is associated with higher CAC scores in men at high risk for cardiovascular disease, independent of epicardial depot volume and body mass index. Present results suggest a potential role for epicardial adipose tissue radiodensity as a measure of adipose tissue composition and may inform on the contribution of epicardial adipose tissue composition to coronary atherosclerosis.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.031
       
  • Efficacy of Intravenous Sotalol for Treatment of Incessant
           Tachyarrhythmias in Children
    • Authors: Xiaomei Li; Yan Zhang; Haiju Liu; He Jiang; Haiyan Ge; Yi Zhang
      Pages: 1366 - 1370
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Xiaomei Li, Yan Zhang, Haiju Liu, He Jiang, Haiyan Ge, Yi Zhang
      Our objective was to evaluate the efficacy and safety of intravenous (IV) sotalol in the treatment of incessant tachyarrhythmias in children with normal cardiac function. Eighty-three children admitted to hospital from October 2011 to December 2014 were treated with IV sotalol or IV sotalol plus IV propafenone. The time to conversion to sinus rhythm and maintaining sinus rhythm were evaluated. Blood pressure, heart rate, QTc, PR intervals, and rhythm were monitored; 50 patients (60%) were converted to sinus rhythm with IV sotalol; time to conversion was 12.0 ± 18.0 hours; 12 additional patients (15%) were converted with IV sotalol combined with IV propafenone; time to conversion was 13.1 ± 17.6 hours. A total of 62 patients (75%) were converted. Success rates of IV sotalol for different tachycardias were similar, whereas the time to conversion differed. The time to conversion for atrioventricular reentrant tachycardia was shorter than atrial tachycardia or atrial flutter (p <0.05). QTc prolongation (from 253 to 486 ms and from 398 ms to 500 ms) was seen in 2 patients (2%) within 48 hours after conversion. The QTc reverted to normal range at 48 and 144 hours, respectively, after withdrawal of IV sotalol. A 1 month old with atrial flutter developed bradycardia (7:1 atrioventricular conduction) 5 minutes after IV sotalol, and heart rate increased gradually after drug withdrawal. No other adverse effects were observed. In conclusion, IV sotalol can be safely and effectively used to terminate pediatric tachycardias in patients with normal cardiac function. No proarrhythmic or significant toxicities were detected. Close monitoring of QTc and heart rate is required after IV sotalol. Adding IV propafenone to IV sotalol in resistant cases enhance conversion.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.034
       
  • Frequency and Associated Clinical Features of Functional Tricuspid
           Regurgitation in Patients With Chronic Atrial Fibrillation
    • Authors: Susan X. Zhao; Nima Soltanzad; Aravind Swaminathan; W. David Ogden; Nelson B. Schiller
      Pages: 1371 - 1377
      Abstract: Publication date: 1 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 9
      Author(s): Susan X. Zhao, Nima Soltanzad, Aravind Swaminathan, W. David Ogden, Nelson B. Schiller
      Significant functional tricuspid regurgitation (TR) can develop in some but not all patients with chronic atrial fibrillation (AF). This study sought to identify factors likely to be involved in determining the severity of TR in patients with chronic AF. In this retrospective cohort study of adult patients referred for transthoracic echocardiography for evaluation of AF between 2004 and 2015, we identified 170 patients with chronic AF in the absence of structural or known coronary heart disease. Patients were classified into nonsevere (89 patients) versus severe TR (81 patients) groups based on a comprehensive assessment of color Doppler, spectral Doppler, and morphologic parameters of the tricuspid valve and right side of the heart. Patients with severe TR were significantly older (76 ± 10 vs 70 ± 11, p <0.001), with smaller body surface area (1.7 ± 0.3 m2 vs 1.9 ± 0.23 m2, p = 0.001) and with female predominance (percentage of men 30% vs 57%, p <0.001). Although comorbidities, use of cardiovascular medications, and left-sided cardiac parameters were statistically indistinguishable between these 2 groups, right-sided cardiac dimensions, tricuspid valve tethering height, and tricuspid valve tethering area were significantly larger in the severe TR group. A comprehensive multivariate logistic regression model (model 1) identified the age, gender, right ventricular systolic pressure, right atrial volume index, and right ventricular end-diastolic area as independent factors associated with TR severity. A simplified logistic regression model using only clinical factors (model 2) confirmed the age, gender, and right ventricular systolic pressure as clinically relevant factors in relation to TR.

      PubDate: 2017-04-18T11:28:05Z
      DOI: 10.1016/j.amjcard.2017.01.037
       
  • Prognostic Value of the Clinical SYNTAX Score on 2-Year Outcomes in
           Patients With Acute Coronary Syndrome Who Underwent Percutaneous Coronary
           Intervention
    • Authors: Chen He; Ying Song; Chuang-shi Wang; Yi Yao; Xiao-fang Tang; Xue-yan Zhao; Run-lin Gao; Yue-jin Yang; Bo Xu; Jin-qing Yuan
      Pages: 1493 - 1499
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Chen He, Ying Song, Chuang-shi Wang, Yi Yao, Xiao-fang Tang, Xue-yan Zhao, Run-lin Gao, Yue-jin Yang, Bo Xu, Jin-qing Yuan
      This prospective, single-center, observational study evaluated prognostic value of clinical SYNTAX score (CSS) on 2-year outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). The SYNTAX score (SS) is a scoring system based on the complexity and severity of coronary lesions and is thought to be a prognostic tool to predict long-term outcomes. However, SS was a sole angiographic grading tool only with no consideration for clinical factors. There are few studies investigating the prognostic value of CSS in patients with ACS who underwent PCI. From January 2013 to December 2013, 6,099 consecutive patients with ACS admitted to FuWai hospital and underwent PCI were enrolled in this study. Based on CSS, patients were divided into low CSS group (CSS ≤ 6.5; 2,012 patients), mid-CSS group (6.5 < CSS < 13.8; 2,056 patients), and high CSS group (CSS ≥ 13.8; 2,031 patients). At 2-year follow-up, rates of cardiac death and major adverse cardiac events (MACE) were significantly higher in the high CSS group. Compared with baseline SS, CSS demonstrated significantly improved performance for 2-year cardiac death (receiver-operating characteristic curve C-statistic: 0.74 vs 0.62, p <0.001) but not for MACE (receiver-operating characteristic curve C-statistic: 0.60 vs 0.59, p = 0.29). By multivariable analysis, the CSS combined with PCI history and hypertension were strong predictors for cardiac death and CSS, intra-aortic balloon pump support, diabetes, and successful PCI were independent predictors for MACE. In conclusion, compared with the anatomic SS, CSS was suitable in risk stratifying and predicting 2-year clinical outcome among ACS population.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.031
       
  • Effect of Tailored Antiplatelet Therapy to Reduce Recurrent Stent
           Thrombosis and Cardiac Death After a First Episode of Stent Thrombosis
    • Authors: Thea C. Godschalk; Laura M. Willemsen; Bastiaan Zwart; Thomas O. Bergmeijer; Paul Willem A. Janssen; Johannes C. Kelder; Christian M. Hackeng; Jurriën M. ten Berg
      Pages: 1500 - 1506
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Thea C. Godschalk, Laura M. Willemsen, Bastiaan Zwart, Thomas O. Bergmeijer, Paul Willem A. Janssen, Johannes C. Kelder, Christian M. Hackeng, Jurriën M. ten Berg
      The recurrence rate of coronary stent thrombosis (ST) is high. Patients with ST often demonstrate high on-treatment platelet reactivity (HPR). It is suggested that patients at high risk of atherothrombotic events, that is patients with ST, could benefit from tailored antiplatelet therapy (APT). This study evaluated whether tailored APT, based on platelet function testing, reduced the rate of cardiac death and/or recurrent ST at 1 year after ST, compared with a historical cohort of patients with ST without tailored APT. Patients with definite ST visited our ST outpatient clinic for platelet function testing and tailored APT. These patients were evenly matched to a historical cohort of patients with ST treated with aspirin and clopidogrel, which was the standard of care at that time. The primary end point was a composite of cardiac death and/or recurrent definite ST after 1 year. In total, 113 patients who visited the outpatient clinic were included. HPR was observed in 46%, 6.7%, and 0% of the patients on clopidogrel, prasugrel, and ticagrelor, respectively. After tailored APT, 93% of the patients with HPR demonstrated normal platelet reactivity. The primary end point was observed in 4 patients who had visited the outpatient clinic and in 23 patients of the historical cohort. The odds ratio of tailored APT on the primary end point was 0.26 (95% confidence interval 0.11 to 0.64, p = 0.003), independent from the possible confounders prior myocardial infarction and stent type. In conclusion, the outpatient ST clinic was associated with lower HPR rates in patients with ST after tailored APT. Patients who visited the ST outpatient clinic had a lower risk for cardiac death and/or recurrent ST compared with a historical cohort of patients with ST without tailored APT. Regarding the high HPR rate in patients with ST on clopidogrel, these patients might benefit in particular from the strategy of tailored APT.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.033
       
  • Comparison of Propensity Score–Matched Analysis of Acute Kidney Injury
           After Percutaneous Coronary Intervention With Transradial Versus
           Transfemoral Approaches
    • Authors: Arie Steinvil; Hector M. Garcia-Garcia; Toby Rogers; Eddie Koifman; Kyle Buchanan; M. Chadi Alraies; Rebecca Torguson; Augusto D. Pichard; Lowell F. Satler; Itsik Ben-Dor; Ron Waksman
      Pages: 1507 - 1511
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Arie Steinvil, Hector M. Garcia-Garcia, Toby Rogers, Eddie Koifman, Kyle Buchanan, M. Chadi Alraies, Rebecca Torguson, Augusto D. Pichard, Lowell F. Satler, Itsik Ben-Dor, Ron Waksman
      Transradial percutaneous coronary intervention (TR-PCI) may be associated with reduced rates of acute kidney injury (AKI). There is limited data from real-world registries about AKI rates stratified by PCI access. Our aim was to evaluate AKI rates and correlates in TR-PCI versus transfemoral PCI (TF-PCI) in a propensity score–matched analysis of patient data from a large, single-center registry. We performed a 1:1 propensity score–matched analysis on consecutive patients who underwent PCI from January 2011 to June 2016, excluding those on dialysis. A multivariate logistic regression model was adjusted to variables found to be significant in univariate models. AKI was defined by creatinine increase of ≥0.3 mg/dL post-PCI during hospitalization. During the study period, 6,743 patients underwent PCI (TR-PCI n = 1,119). Initial univariate models revealed significant differences between patients with TF-PCI and TR-PCI. Contrast amount and procedure duration were both increased with TR-PCI versus TF-PCI (162 vs 154 ml, p = 0.003; and 86 vs 79 minutes, p <0.001, respectively). Multivariate propensity score analysis matched 536 pairs of patients. In this matched cohort, TR-PCI was associated with a reduced risk for AKI compared with TF-PCI in univariate (4.3% vs 10.4%, p <0.001) and multivariate adjusted models (odds ratio 0.28, 95% confidence interval 0.19 to 0.59, p <0.001).

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.032
       
  • Comparison of Coronary Intimal Plaques by Optical Coherence Tomography in
           Arteries With Versus Without Internal Running Vasa Vasorum
    • Authors: Hideo Amano; Masayuki Koizumi; Ryo Okubo; Takayuki Yabe; Ippei Watanabe; Daiga Saito; Mikihito Toda; Takanori Ikeda
      Pages: 1512 - 1517
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Hideo Amano, Masayuki Koizumi, Ryo Okubo, Takayuki Yabe, Ippei Watanabe, Daiga Saito, Mikihito Toda, Takanori Ikeda
      It has been reported that the internal running vasa vasorum (VV) was associated with plaque vulnerability, and microchannels in optical coherence tomography (OCT) are consistent pathologically with VV. We investigated plaque vulnerability and incidence of slow flow during percutaneous coronary intervention of the internal longitudinal running VV. Subjects were 71 lesions that underwent OCT before percutaneous coronary intervention. Internal running VV was defined as intraplaque neovessels running from the adventitia to plaque. Lesions with internal running VV were found in 47% (33 of 71). Compared with lesions without internal running VV, lesions with internal running VV showed significantly higher incidence of intimal laceration (64% [21 of 33] vs 16% [6 of 38], p <0.001), lipid-rich plaque (79% [26 of 33] vs 26% [10 of 38], p <0.001), plaque rupture (52% [17 of 33] vs 13% [5 of 38], p <0.001), thin-cap fibroatheroma (58% [19 of 33] vs 11% [4 of 38], p <0.001), macrophage accumulation (61% [20 of 33] vs 26% [10 of 38], p = 0.004), intraluminal thrombus (36% [12 of 33] vs 3% [1 of 38], p <0.001), and slow flow after stent implantation (42% [14 of 33] vs 13% [5 of 38], p = 0.007). The multivariable analysis showed that internal running VV was an independent predictor of slow flow after stent implantation (odds ratio 4.23, 95% confidence interval 1.05 to 17.01, p = 0.042). In conclusion, compared with those without, plaques with internal running VV in OCT had high plaque vulnerability with more intimal laceration, lipid-rich plaque, plaque rupture, thin-cap fibroatheroma, macrophage accumulation, and intraluminal thrombus, and they had high incidence of slow flow after stent implantation.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.025
       
  • Ideal Guiding Catheter Position During Bilaterally Engaged Percutaneous
           Coronary Intervention
    • Authors: Kensuke Yokoi; Masahiko Hara; Yasunori Ueda; Satoru Sumitsuji; Masaki Awata; Youssef K. Salah; Daijiro Kabata; Ayumi Shintani; Yasushi Sakata
      Pages: 1518 - 1524
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Kensuke Yokoi, Masahiko Hara, Yasunori Ueda, Satoru Sumitsuji, Masaki Awata, Youssef K. Salah, Daijiro Kabata, Ayumi Shintani, Yasushi Sakata
      Using a novel combined angiography computed tomography (CT) system, we evaluated the impact of the intra-aortic root position of a right coronary artery (RCA) catheter on its coaxiality. We retrospectively enrolled 19 patients who underwent CT scans during bilaterally engaged percutaneous coronary intervention. Coaxiality was defined as the angle between the RCA and the RCA catheter. The coaxiality was better when the RCA catheter was placed anterior to the left main coronary artery catheter (median 27.0° vs 53.7°, p = 0.02). The position of the RCA catheter had a significant impact on the coaxiality of it, with a coaxiality improvement ratio of 0.506 (95% confidence interval 0.294 to 0.871, p = 0.017). Three-dimensional reconstructed CT images of the right anterior oblique projection could determine the position of catheters in all cases. In conclusion, the RCA catheter should be placed anterior, rather than posterior, to the left main coronary artery catheter for better coaxiality during bilaterally engaged percutaneous coronary intervention. The right anterior oblique projection is useful for determining the catheter position.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.026
       
  • Meta-Analysis of the Optimal Percutaneous Revascularization Strategy in
           Patients With Acute Myocardial Infarction, Cardiogenic Shock, and
           Multivessel Coronary Artery Disease
    • Authors: Giuseppe Tarantini; Gianpiero D'Amico; Paola Tellaroli; Claudia Colombo; Sorin J. Brener
      Pages: 1525 - 1531
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Giuseppe Tarantini, Gianpiero D'Amico, Paola Tellaroli, Claudia Colombo, Sorin J. Brener
      The optimal percutaneous coronary intervention (PCI) revascularization strategy in patients with multivessel (MV) coronary artery disease (CAD) who present with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) has not been systematically addressed. Accordingly, we performed a study-level meta-analysis comparing 2 PCI strategies in these patients—infarct-related artery (IRA) only versus MV revascularization. Studies including patients with AMI and MV CAD complicated with CS who received primary PCI were searched from 2000 to 2016. The primary end points were in-hospital/30-day and mid- to long-term (≥6 month) mortality. Fixed and random effects models were used for analysis. Ten studies (9 prospective and 1 retrospective) involving 6,068 patients met our inclusion criteria. IRA-only PCI was the most frequently used revascularization strategy (4,872 patients, 80%), while MV PCI was performed in 1,196 patients (20%). The MV PCI strategy was associated with higher short-term mortality compared with the IRA-only PCI strategy (odds ratio 1.41, 95% confidence interval 1.15 to 1.71, p = 0.008). There was no difference in mid- to long-term mortality between MV PCI and IRA-only strategies (odds ratio 1.02, 95% confidence interval 0.65 to 1.58, p = 0.94). In conclusion, in patients with AMI and MV CAD complicated by CS, the IRA-only PCI strategy seems to be associated with lower short-term, but not mid- to long-term mortality compared with MV PCI. This finding is different from the revascularization strategy recommended by current professional guidelines and suggests the need for dedicated randomized clinical trials.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.028
       
  • Comparison of Displacement Encoding With Stimulated Echoes to Magnetic
           Resonance Feature Tracking for the Assessment of Myocardial Strain in
           Patients With Acute Myocardial Infarction
    • Authors: Yoshitaka Goto; Masaki Ishida; Shinichi Takase; Andreas Sigfridsson; Mio Uno; Motonori Nagata; Yasutaka Ichikawa; Kakuya Kitagawa; Hajime Sakuma
      Pages: 1542 - 1547
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Yoshitaka Goto, Masaki Ishida, Shinichi Takase, Andreas Sigfridsson, Mio Uno, Motonori Nagata, Yasutaka Ichikawa, Kakuya Kitagawa, Hajime Sakuma
      The aim of this study was to compare myocardial strain by cardiovascular magnetic resonance feature tracking (CMR-FT) to those derived from displacement encoding with stimulated echoes (DENSE) in patients with acute myocardial infarction (AMI). Twenty patients (65 pa13 years) with AMI underwent cine, DENSE, black-blood T2-weighted and late gadolinium enhancement CMR at 1.5 T. Global and segmental strain was determined by CMR-FT analysis and DENSE on matched 3 short-axis planes. Global circumferential strain by CMR-FT showed a good agreement with that by DENSE (r = 0.85, p <0.001; bias 0.02, limits of agreement −0.03 to 0.06). For segmental circumferential strain, r coefficient between CMR-FT and DENSE was 0.61 (p <0.001) with bias of 0.02, limits of agreement of −0.07 to 0.11. Regional circumferential strain determined by CMR-FT in infarct segments (−0.08 ± 0.05) was significantly altered compared with that in remote normal segments (−0.15 ± 0.05, p <0.001). CMR-FT measurement of regional and global circumferential strain showed good agreement with DENSE in patients with AMI.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.029
       
  • Association of Obesity With In-Hospital Mortality of Cardiogenic Shock
           Complicating Acute Myocardial Infarction
    • Authors: Kshitij Chatterjee; Tanush Gupta; Abhinav Goyal; Dhaval Kolte; Sahil Khera; Anusha Shanbhag; Kavisha Patel; Pedro Villablanca; Nayan Agarwal; Wilbert S. Aronow; Mark A. Menegus; Gregg C. Fonarow; Deepak L. Bhatt; Mario J. Garcia; Nikhil K. Meena
      Pages: 1548 - 1554
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Kshitij Chatterjee, Tanush Gupta, Abhinav Goyal, Dhaval Kolte, Sahil Khera, Anusha Shanbhag, Kavisha Patel, Pedro Villablanca, Nayan Agarwal, Wilbert S. Aronow, Mark A. Menegus, Gregg C. Fonarow, Deepak L. Bhatt, Mario J. Garcia, Nikhil K. Meena
      Several previous studies have shown obesity to be counterintuitively associated with more favorable mortality in patients with acute myocardial infarction (AMI); however, the association of obesity with in-hospital mortality of cardiogenic shock complicating AMI has not been previously examined. We queried the 2004 to 2013 National Inpatient Sample databases to identify all patients ≥18 years hospitalized with the principal diagnosis of AMI. Multivariable regression models adjusting for demographics, hospital characteristics, and co-morbidities were used to examine differences in incidence and in-hospital mortality of cardiogenic shock complicating AMI between obese and nonobese patients. Of 6,097,817 patients with AMI, 290,894 (4.8%) had cardiogenic shock. There was no difference in risk-adjusted incidence of cardiogenic shock between obese and nonobese patients (adjusted odds ratio 1.00, 95% CI 0.98 to 1.01; p = 0.46). Of the patients with cardiogenic shock complicating AMI, 8.9% had a documented diagnosis of obesity. Obese patients were on average 6 years younger and had higher prevalence of most cardiovascular co-morbidities. Obese patients were more likely to receive revascularization (73.0% vs 63.4%, p <0.001) and had lower risk-adjusted in-hospital mortality compared with nonobese patients (28.2% vs 36.5%; adjusted odds ratio 0.89, 95% CI 0.86 to 0.92; p <0.001). Similar findings were seen in subgroups of patients with cardiogenic shock complicating ST elevation or non-ST elevation MI. In conclusion, this large retrospective analysis of a nationwide cohort of patients with cardiogenic shock complicating AMI demonstrated that obese patients were younger, more likely to receive revascularization, and had modestly lower risk-adjusted in-hospital mortality compared with nonobese patients.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.030
       
  • Effect of Chronic Obstructive Pulmonary Disease on In-Hospital Mortality
           and Clinical Outcomes After ST-Segment Elevation Myocardial Infarction
    • Authors: Manyoo Agarwal; Sahil Agrawal; Lohit Garg; Aakash Garg; Nirmanmoh Bhatia; Dipen Kadaria; Guy Reed
      Pages: 1555 - 1559
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Manyoo Agarwal, Sahil Agrawal, Lohit Garg, Aakash Garg, Nirmanmoh Bhatia, Dipen Kadaria, Guy Reed
      There is controversy regarding in-hospital mortality, revascularization, and other adverse outcomes in patients with ST-segment elevation (STEMI) and chronic obstructive pulmonary disease (COPD). We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients aged ≥18 years with a primary diagnosis of STEMI. Univariate and multivariate analyses were performed to evaluate the association of COPD with in-hospital clinical outcomes. Patients with COPD comprised 13.2% of 2,120,005 patients with STEMI. COPD was associated with older age, Medicare insurance, greater co-morbidities, and lower socioeconomic status. Compared with non-COPD patients, patients with COPD had higher inpatient mortality even after adjustment for multiple potential other factors (12.5% vs 8.6%, adjusted odds ratio [AOR] 1.13, 95% CI 1.11 to 1.15, p <0.001). Patients with COPD were more likely to develop new-onset heart failure (AOR 2.01, 95% CI 1.99 to 2.03), cardiogenic shock (AOR 1.24, 95% CI 1.22 to 1.26), and acute respiratory failure (AOR 2.46, 95% CI 2.43 to 2.50) during their hospital stay. Patients with COPD were less likely to undergo diagnostic angiographies and any revascularization procedures. The mean length of stay (6.0 vs 4.6 days; p <0.001) was greater in patients with COPD, as were hospital average hospital charges ($63,956 vs $58,536; p <0.001). In conclusion, among patients with STEMI, COPD is associated with a greater risk of in-hospital mortality, new-onset heart failure, acute respiratory failure, and cardiogenic shock.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.024
       
  • Triggers and Timing of Acute Coronary Syndromes
    • Authors: Geoffrey H. Tofler; Eran Kopel; Robert Klempfner; Michael Eldar; Thomas Buckley; Ilan Goldenberg
      Pages: 1560 - 1565
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Geoffrey H. Tofler, Eran Kopel, Robert Klempfner, Michael Eldar, Thomas Buckley, Ilan Goldenberg
      Previous studies have shown that an acute coronary syndrome (ACS) may be triggered by external activities; however, their frequency, predictors, and significance are uncertain. We evaluated data from the National Israel Survey of Acute Coronary Syndromes, which was conducted in 2004 (February to March) in all 25 coronary care units and cardiac wards in Israel. Demographic and clinical data were recorded for consecutive participants, including potential triggers and time of symptom onset of ACS. Among the 1,849 patients who completed the trigger question, 1/4 (25.9%) reported a possible trigger, comprising heavy physical exertion (15.2%), emotional stress (8.3%), anger (1.1%), heavy meal (1.3%), and sexual activity (0.5%). Predictors of a triggered ACS were age <65 years, previous angina, no previous angiotensin-converting enzyme inhibitors/angiotensin 2 receptor blockers, impaired functional class, not having typical chest pain on admission, and a final diagnosis of unstable angina. The highest proportion of triggered ACS was between noon and 6 p.m. Physical exertion as a trigger was associated with reduced in-hospital mortality (0.4% vs 2.8%, p <0.05) and 1-year mortality. Emotional stress as a trigger did not influence in-hospital or 1-year mortality; however among those discharged from hospital, it was associated with increased 30-day rehospitalization (27.6% vs 19.3%, p <0.05) and a trend toward increased mortality (4.1% vs 2.0%, p = 0.10).

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.022
       
  • Presence, Characteristics, and Volumes of Coronary Plaque Determined by
           Computed Tomography Angiography in Young Type 2 Diabetes Mellitus
    • Authors: Negin Nezarat; Matthew J. Budoff; Yanting Luo; Sirous Darabian; Rine Nakanishi; Dong Li; Nasim Sheidaee; Michael Kim; Anas Alani; Suguru Matsumoto; Sina Rahmani; Mitsuru Kanisawa; Indre Ceponiene; Kazuhiro Osawa; Hong Qi; Sajad Hamal; Pieter Kitslaar; Alexander Broersen; Ferdinand Flores; Eli Ipp; Bahram Khazai
      Pages: 1566 - 1571
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Negin Nezarat, Matthew J. Budoff, Yanting Luo, Sirous Darabian, Rine Nakanishi, Dong Li, Nasim Sheidaee, Michael Kim, Anas Alani, Suguru Matsumoto, Sina Rahmani, Mitsuru Kanisawa, Indre Ceponiene, Kazuhiro Osawa, Hong Qi, Sajad Hamal, Pieter Kitslaar, Alexander Broersen, Ferdinand Flores, Eli Ipp, Bahram Khazai
      Prevention and management of coronary artery disease (CAD) is of great concern in patients with diabetes mellitus. Although the impact of coronary atherosclerosis is described well for subjects older than 40 years, the prevalence and types of coronary atherosclerosis in young patients are not well known. The aim of this study was to evaluate the prevalence, extent, severity, and volumes of coronary plaque in type 2 diabetes mellitus (T2DM) population younger than of 40 years. This prospective study enrolled 181 subjects (25-40 year old) undergoing coronary computed tomography angiography, with 86 T2DM and 95 nondiabetic age/gender-matched subjects. Coronary artery calcium (CAC), plaque assessment including total segment stenosis (sum of individual segmental stenosis), total plaque scores (sum of semiquantitative segmental plaque burden), segment involvement scores (number of segments with plaque) were evaluated. In addition, we quantitatively measured plaque volumes in total, fibrous, fibrous fatty, dense calcified, and low-attenuation plaque using novel plaque software. Compared with nondiabetic patients, the prevalence of CAD, calcified, and noncalcified plaques was higher in patients with T2DM (19% vs 58%; p <0.001). In patients with a zero CAC, T2DM had a higher prevalence (46%) of noncalcified plaque (p <0.0001). In multivariate linear regression models after adjusting for traditional cardiovascular risk factors, increased total segmental stenosis, total plaque scores, and segment involvement scores were associated with T2DM. Regarding quantitative plaque assessment, all volumes in noncalcified plaque type were approximately threefold higher in patients with T2DM. In conclusion, young patients with T2DM are susceptible to premature CAD with more calcified and noncalcified plaques. Early prevention program using computed tomography angiography might be helpful in identifying young diabetic patients with subclinical atherosclerosis.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.023
       
  • Prognostic Significance of Early Rehospitalization After Takotsubo
           Cardiomyopathy
    • Authors: Arash Nayeri; Nirmanmoh Bhatia; Meng Xu; Eric Farber-Eger; Marcia Blair; John McPherson; Thomas Wang; Quinn Wells
      Pages: 1572 - 1575
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Arash Nayeri, Nirmanmoh Bhatia, Meng Xu, Eric Farber-Eger, Marcia Blair, John McPherson, Thomas Wang, Quinn Wells
      Short-term complications, particularly rehospitalization, after a diagnosis of takotsubo cardiomyopathy (TTC) are poorly described. We sought to characterize the rates, causes, clinical associations, and prognostic implications of early rehospitalization in this patient population. We performed a retrospective observational study of all adult subjects diagnosed with TTC at an academic tertiary care hospital from 2005 to 2015. The primary outcome was rehospitalization within 30 days of index discharge. Multivariable logistic regression was used to test for association between clinical variables and rehospitalization. Association between rehospitalization and survival after index discharge was assessed as a secondary outcome using a multivariable Cox proportional hazard model. Two hundred sixty-three subjects met the inclusion criteria for the study. There were 38 rehospitalizations among 32 subjects (12%). Ninety-five percent of rehospitalizations were due to nonheart failure causes, and 76% were related to noncardiovascular complaints. In multivariable analysis, recent hospitalization before TTC diagnosis and increased length of index hospitalization were associated with greater risk of rehospitalization (odds ratio 4.58, 95% CI 1.97 to 10.65, p <0.001 and odds ratio 1.05, 95% CI 1.01 to 1.10, p = 0.026, respectively). Early rehospitalization after TTC was associated with decreased survival (hazard ratio 3.17, 95% CI 1.53 to 6.56, p = 0.002).

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.019
       
  • Effects of RG7652, a Monoclonal Antibody Against PCSK9, on LDL-C, LDL-C
           Subfractions, and Inflammatory Biomarkers in Patients at High Risk of or
           With Established Coronary Heart Disease (from the Phase 2 EQUATOR Study)
    • Authors: Amos Baruch; Sofia Mosesova; John D. Davis; Nageshwar Budha; Alexandr Vilimovskij; Robert Kahn; Kun Peng; Kyra J. Cowan; Laura Pascasio Harris; Thomas Gelzleichter; Josh Lehrer; John C. Davis; Whittemore G. Tingley
      Pages: 1576 - 1583
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Amos Baruch, Sofia Mosesova, John D. Davis, Nageshwar Budha, Alexandr Vilimovskij, Robert Kahn, Kun Peng, Kyra J. Cowan, Laura Pascasio Harris, Thomas Gelzleichter, Josh Lehrer, John C. Davis, Whittemore G. Tingley
      RG7652 (MPSK3169A), a fully human immunoglobulin G1 (IgG1) monoclonal antibody directed against proprotein convertase subtilisin/kexin type 9 (PCSK9), blocks the interaction between PCSK9 and low-density lipoprotein (LDL) receptor. EQUATOR ( ClinicalTrials.gov NCT01609140), a randomized, double-blind, and dose-ranging phase 2 study, evaluated RG7652 in patients (1) at high risk for or (2) with coronary heart disease (CHD). The primary end point was change in LDL cholesterol (LDL-C) from baseline to day 169. Patients (n = 248; median age, 64 years; 57% men; 52% with established CHD; 82% on statins) with baseline LDL-C levels of 90 to 250 mg/dl (mean, 126 mg/dl) continuing on standard-of-care therapy were randomized to receive 1 of 5 RG7652 doses or placebo, subcutaneously every 4, 8, or 12 weeks for 24 weeks. Significant dose-dependent reductions in LDL-C levels from baseline to nadir (56 to 74 mg/dl [48% to 60%]) were observed in all RG7652-dosed patients; effects persisted to day 169 with the highest doses (reduction vs placebo up to 62 mg/dl [51%]) with no unexpected safety signals. RG7652 reduced apolipoprotein B and lipoprotein(a) levels. LDL-C subfraction analysis by nuclear magnetic resonance spectroscopy revealed a prominent decrease in large LDL-C and some decrease in small LDL particles. There was significant reduction in mean particle size of LDL-C on day 169 but no significant reductions in systemic markers of inflammation (high-sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-alpha). RG7652 reduced LDL-C levels and was well tolerated in patients at high risk for or with CHD on standard-of-care therapy. In conclusion, RG7562 treatment affected large LDL-C and, to a lesser extent, small LDL-C particles; RG7562 did not affect systemic circulating pro-inflammatory cytokines or high-sensitivity C-reactive protein.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.020
       
  • Relation of Risk Factors and Abdominal Aortic Calcium to Progression of
           Coronary Artery Calcium (from the Framingham Heart Study)
    • Authors: Oyere K. Onuma; Karol Pencina; Saadia Qazi; Joseph M. Massaro; Ralph B. D'Agostino; Michael L. Chuang; Caroline S. Fox; Udo Hoffmann; Christopher J. O'Donnell
      Pages: 1584 - 1589
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Oyere K. Onuma, Karol Pencina, Saadia Qazi, Joseph M. Massaro, Ralph B. D'Agostino, Michael L. Chuang, Caroline S. Fox, Udo Hoffmann, Christopher J. O'Donnell
      Coronary artery calcium (CAC) and abdominal aortic calcium (AAC) on multidetector computed tomography (MDCT) permit assessment of the presence and burden of coronary and systemic atherosclerosis. Risk factors for progression of CAC and AAC and the association of AAC with CAC progression have not been well characterized in a community-dwelling cohort. We studied 1,959 asymptomatic participants from the Framingham Heart Study who underwent serial MDCT scans with a median interval of 6.1 years. Primary outcomes were (a) the incidence of CAC and AAC (CAC >0 and AAC >0 with baseline CAC = 0 and AAC = 0) and (b) absolute progression of CAC (CAC > baseline CAC and AAC > baseline AAC). Covariates were collected at adjacent cycle examinations and included age, gender, use of antihypertensive therapy, use of lipid-lowering therapy, cigarette smoking, and total and high-density lipoprotein cholesterol. Predictors for CAC and AAC progression included baseline CAC, baseline AAC, lipid-lowering therapy, diabetes, high-density lipoprotein cholesterol, BMI, and serum creatinine. Multivariable stepwise logistic and linear regression models were used to test the association of these risk factors with CAC and AAC. Those who developed incident CAC on follow-up scanning comprised 18.8% of 1,124 participants, and 84.9% of 780 participants, with detectable baseline CAC, had further progression. Baseline AAC was a predictor of both CAC incidence and progression, independent of other risk factors. In stepwise models, addition of baseline AAC slightly improved the area under the curve from 0.72 (0.68 to 0.76) to 0.74 (0.70 to 0.78). In conclusion, standard cardiovascular disease risk factors are associated with incidence and progression of CAC and AAC, and AAC augments CAC incidence and progression above cardiovascular disease risk factors.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.021
       
  • Management of Major Bleeding in Patients With Atrial Fibrillation Treated
           With Non–Vitamin K Antagonist Oral Anticoagulants Compared With Warfarin
           in Clinical Practice (from Phase II of the Outcomes Registry for Better
           Informed Treatment of Atrial Fibrillation [ORBIT-AF II])
    • Authors: Benjamin A. Steinberg; DaJuanicia N. Simon; Laine Thomas; Jack Ansell; Gregg C. Fonarow; Bernard J. Gersh; Peter R. Kowey; Kenneth W. Mahaffey; Eric D. Peterson; Jonathan P. Piccini
      Pages: 1590 - 1595
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Benjamin A. Steinberg, DaJuanicia N. Simon, Laine Thomas, Jack Ansell, Gregg C. Fonarow, Bernard J. Gersh, Peter R. Kowey, Kenneth W. Mahaffey, Eric D. Peterson, Jonathan P. Piccini
      Non–vitamin K antagonist oral anticoagulants (NOACs) are effective at preventing stroke in patients with atrial fibrillation (AF). However, little is known about the management of bleeding in contemporary, clinical use of NOACs. We aimed to assess the frequency, management, and outcomes of major bleeding in the setting of community use of NOACs. Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry, we analyzed rates of International Society on Thrombosis and Haemostasis major bleeding and subsequent outcomes in patients treated with NOACs versus warfarin. Outcomes of interest included acute and chronic bleeding management, recurrent bleeding, thromboembolic events, and death. In total, 344 patients with atrial fibrillation experienced major bleeding events over a median follow-up of 360 days follow-up: n = 273 on NOAC (3.3 per 100 patient-years) and n = 71 on warfarin (3.5 per 100 patient-years). Intracranial bleeding was uncommon but similar (0.34 per 100 patient-years for NOAC vs 0.44 for warfarin, p = 0.5), as was gastrointestinal bleeding (1.8 for NOAC vs 1.3 for warfarin, p = 0.1). Blood products and correction agents were less commonly used in NOAC patients with major bleeds compared with warfarin-treated patients (53% vs 76%, p = 0.0004 for blood products; 0% vs 1.5% for recombinant factor; p = 0.0499); no patients received pharmacologic hemostatic agents (aminocaproic acid, tranexamic acid, desmopressin, aprotinin). Within 30 days, 23 NOAC-treated patients (8.4%) died versus 5 (7.0%) on warfarin (p = 0.7). At follow-up, 126 NOAC-treated (46%) and 29 warfarin-treated patients (41%) were not receiving any anticoagulation. In conclusion, rates of major bleeding are similar in warfarin and NOAC-treated patients in clinical practice. However, NOAC-related bleeds require less blood product administration and rarely require factor replacement.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.015
       
  • Comparison of Morphologic Features and Flow Velocity of the Left Atrial
           Appendage Among Patients With Atrial Fibrillation Alone, Transient
           Ischemic Attack, and Cardioembolic Stroke
    • Authors: Yonggu Lee; Hwan-Cheol Park; Youkyung Lee; Soon-Gil Kim
      Pages: 1596 - 1604
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Yonggu Lee, Hwan-Cheol Park, Youkyung Lee, Soon-Gil Kim
      The left atrial appendage (LAA) is a major source of emboli responsible for cardioembolic stroke (CES). We hypothesized that there could be differences in the morphologic and functional features of LAAs among patients with atrial fibrillation (AF) alone, patients with cardioembolic transient ischemic attack (CETIA), and patients with CES. Patients with AF and CETIA/CES were included in either a CETIA group or a CES group. Patients with AF without past histories of stroke were included in an AF/non-CVA (cerebrovascular accident) group. Cardiac computerized tomography and transesophageal echocardiography were employed for morphologic and functional assessments of LAAs. Cauliflower LAA morphology increased and chicken wing LAA morphology decreased in frequency in the following order: AF/non-CVA, CETIA, and CES group. LAA orifice diameters were larger in the CETIA and CES groups than in the AF/non-CVA group. LAA flow velocity was higher in the CES group than in the other groups. Multiple multinominal regression analyses showed that the cauliflower morphology was associated with CETIA and CES; however, after LAA orifice diameters and flow velocity were adjusted, LAA morphology was associated with neither of them. Receiver operating characteristic curve analysis showed that LAA orifice diameter and flow velocity accurately predicted CETIA (c-statistic 0.839) and CES (c-statistic 0.896), respectively. In conclusion, cauliflower LAA morphology is associated with an increased risk of CETIA and CES through its large LAA orifice diameters and low LAA flow velocity. There are clear differences in LAA orifice diameters and flow velocity among patients with AF alone, CES, and CETIA.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.016
       
  • Propranolol Versus Digoxin in the Neonate for Supraventricular Tachycardia
           (from the Pediatric Health Information System)
    • Authors: Elijah H. Bolin; Sean M. Lang; Xinyu Tang; R. Thomas Collins
      Pages: 1605 - 1610
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Elijah H. Bolin, Sean M. Lang, Xinyu Tang, R. Thomas Collins
      Conflicting data exist for the appropriate management of a neonate with supraventricular tachycardia (SVT). We sought to assess postnatal prescribing trends for neonates with SVT and to evaluate if there were therapy-specific mortality and resource utilization benefits. Nationally distributed data from 44 pediatric hospitals in the 2004 to 2015 Pediatric Health Information System database were used to identify patients admitted at ≤2 days of age with structurally normal hearts and treated with an antiarrhythmic medication. Outcome variables were mortality, cost, and length of stay (LOS). Multivariable models and propensity score matching were used. There were 2,657 neonates identified with a median gestational age of 37 weeks (interquartile range 34 to 39). Digoxin and propranolol were most commonly prescribed; digoxin use steadily decreased to 23% of antiarrhythmic medication administrations over the study period, whereas propranolol increased to 77%. Multivariable comparisons revealed that the odds of mortality for neonates on propranolol were 0.32 times those on digoxin (95% confidence interval 0.17 to 0.59; p <0.001); hospital costs were $16,549 lower for propranolol versus digoxin (95% confidence interval $5,502 to $27,596, p = 0.003). No difference was found for LOS. Propensity score matching and subset analyses of patients with only arrhythmia diagnostic codes confirmed mortality benefits for propranolol, although longer LOS was observed. In conclusion, propranolol use for the neonate with SVT is associated with lower in-hospital mortality and hospital costs compared with digoxin.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.017
       
  • Sinus Bradycardia in Habitual Cocaine Users
    • Authors: Sona M. Franklin; Sudarone Thihalolipavan; John M. Fontaine
      Pages: 1611 - 1615
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Sona M. Franklin, Sudarone Thihalolipavan, John M. Fontaine
      Common physiological manifestations of cocaine are related to its adrenergic effects, due to inhibition of dopamine and norepinephrine uptake at the postsynaptic terminal. Few studies have documented bradycardia secondary to cocaine use, representing the antithesis of its adrenergic effects. We assessed the prevalence of sinus bradycardia (SB) in habitual cocaine users and postulated a mechanism for this effect. One hundred sixty-two patients with a history of cocaine use were analyzed and compared with age- and gender-matched controls. SB was defined as a rate of <60 beats/min and habitual cocaine use as 2 or more documented uses >30 days apart. Propensity score–matching analysis was applied to balance covariates between cocaine users and nonusers and reduce selection bias. Patients with a history of bradycardia, hypothyroidism, or concomitant beta-blocker use were excluded. Mean age of study patients was 44 ± 8 years. SB was observed in 43 of 162 (27%) cocaine users and in 9 of 149 (6%) nonusers (p = 0.0001). Propensity score–matching analysis matched 218 patients from both groups. Among matched patients SB was observed in 25 of 109 (23%) cocaine users and in 5 of 109 (5%) nonusers (p = 0.0001). Habitual cocaine use was an independent predictor of SB and associated with a sevenfold increase in the risk of SB (95% CI 2.52 to 19.74, p = 0.0002). In conclusion, habitual cocaine use is a strong predictor of SB and was unrelated to recency of use. A potential mechanism for SB may be related to cocaine-induced desensitization of the beta-adrenergic receptor secondary to continuous exposure. Symptomatic SB was not observed; thus, pacemaker therapy was not indicated.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.018
       
  • Prevalence and Management of Systemic Hypertension in Athletes
    • Authors: Stefano Caselli; Antonia Vaquer Sequì; Erika Lemme; Filippo Quattrini; Alberto Milan; Flavio D'Ascenzi; Antonio Spataro; Antonio Pelliccia
      Pages: 1616 - 1622
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Stefano Caselli, Antonia Vaquer Sequì, Erika Lemme, Filippo Quattrini, Alberto Milan, Flavio D'Ascenzi, Antonio Spataro, Antonio Pelliccia
      The aim of the present study was to evaluate the prevalence, determinants, and clinical management of systemic hypertension in a large cohort of competitive athletes: 2,040 consecutive athletes (aged 25 ± 6 years, 64% men) underwent clinical evaluation including blood test, electrocardiogram, exercise test, echocardiography, and ophthalmic evaluation. Sixty-five athletes (3%) were identified with hypertension (men = 57; 87%) including 5 with a secondary cause (thyroid dysfunction in 3, renal artery stenosis in 1, and drug induced in 1). The hypertensive athletes had greater left ventricular hypertrophy and showed more often a concentric pattern than normotensive ones. Moreover, they showed a mildly reduced physical performance and were characterized by a higher cardiovascular risk profile compared with normotensive athletes. Multivariate logistic regression analysis showed that family hypertension history (odds ratio 2.05; 95% confidence interval 1.21 to 3.49; p = 0.008) and body mass index (odds ratio 1.32; 95% confidence interval 1.23 to 1.40; p <0.001) were the strongest predictors of hypertension. Therapeutic intervention included successful lifestyle modification in 57 and required additional pharmacologic treatment in 3 with essential hypertension. Secondary hypertension was treated according to the underlying disorder. After a mean follow-up of 18 ± 6 months, all hypertensive athletes had achieved and maintained optimal control of the blood pressure, without restriction to sport participation. In conclusion, the prevalence of hypertension in athletes is low (3%) and largely related to family history and overweight. In the vast majority of hypertensives, lifestyle modifications were sufficient to achieve an optimal control of blood pressure values.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.011
       
  • Gender Differences in Left Ventricular Ejection Fraction and Outcomes
           Among Patients Hospitalized for Acute Decompensated Heart Failure
    • Authors: Katsuya Kajimoto; Yuichiro Minami; Naoki Sato; Shigeru Otsubo; Hiroshi Kasanuki
      Pages: 1623 - 1630
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Katsuya Kajimoto, Yuichiro Minami, Naoki Sato, Shigeru Otsubo, Hiroshi Kasanuki
      In patients with acute decompensated heart failure (HF), the association of gender and left ventricular ejection fraction (LVEF) with clinical outcomes has not been fully investigated. The aim of this study was to evaluate gender differences in LVEF and adverse outcomes across the full spectrum of LVEF in patients hospitalized for acute decompensated HF. Of the 4,842 patients enrolled in the Acute Decompensated Heart Failure Syndromes registry, 4,231 patients (2,461 men and 1,770 women) discharged alive after hospitalization for acute decompensated HF were investigated to assess the association of gender and LVEF with the primary end point (all-cause death and readmission for HF). Men or women were divided into 5 groups based on the LVEF at hospital discharge (<30%, 30% to <40%, 40% to <50%, 50% to <60%, and ≥60%). The median follow-up period after discharge was 523 (384 to 791) days. The frequency of the primary end point did not differ between men and women (36.5% vs 38.1%, p = 0.291). After adjustment for multiple comorbidities, male patients with an LVEF <30%, 30% to <40%, 40% to <50%, or 50% to <60% had a significantly higher risk of the primary end point than those with an LVEF ≥60%, indicating an inverse association between LVEF and adverse outcomes. In contrast, the adjusted risk of the primary end point was similar for all 5 LVEF groups of female patients. In conclusions, the association between LVEF and outcomes differs markedly between men and women hospitalized for acute decompensated HF, although event-free survival is similar for both genders.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.012
       
  • Usefulness of Serial Measurements of Inferior Vena Cava Diameter by
           VscanTM to Identify Patients With Heart Failure at High Risk of
           Hospitalization
    • Authors: Raj M. Khandwalla; Kade T. Birkeland; Raymond Zimmer; Timothy D. Henry; Roland Nazarian; Madhuri Sudan; James Mirocha; Jeena Cha; Ilan Kedan
      Pages: 1631 - 1636
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Raj M. Khandwalla, Kade T. Birkeland, Raymond Zimmer, Timothy D. Henry, Roland Nazarian, Madhuri Sudan, James Mirocha, Jeena Cha, Ilan Kedan
      Estimation of volume status is integral to heart failure (HF) management. Measurement of inferior vena cava (IVC) diameter (IVCd) by ultrasound provides a noninvasive estimate of right atrial pressures. The GE Vscan is a handheld ultrasound (HHU) device that allows for point-of-care measurements to assess volume status. We hypothesize that IVCd measurements using HHU can predict the risk of HF admission. We retrospectively analyzed a cohort of patients with HF treated in an ambulatory care setting over 17 months. Serial measurements of IVCd were obtained using HHU in the supine position from the subcostal window. Log-binomial regression models were used to compare IVCd measurements between patients with and without HF admissions and to estimate the association between IVCd and risk of HF admission. Of the 355 patients with systolic (38%) and diastolic HF (62%) who were analyzed, 45% were women with a mean age of 73 years at the time of the first IVCd measurement. Overall, 3,488 measurements were obtained, and 32.4% of patients were hospitalized during follow-up. Patients with at least 1 hospital admission had a greater mean IVCd than those who were not admitted (2.0 vs 1.8 cm, p <0.01). In our analysis, every 0.5-cm increase in the mean IVCd was associated with a 38% increase in risk of HF admission (risk ratio [RR] 1.38, 95% CI 1.16 to 1.62, p <0.01). The risk of HF admission was also significantly increased in patients with IVCd 2.0 to 2.49 cm (RR 1.79, 95% CI 1.27 to 2.52, p <0.01) and ≥2.5 cm (RR 2.39, 95% CI 1.55 to 3.67, p <0.01), compared with patients with an IVCd < 2.0 cm. Increasing IVCd as measured by HHU at the point-of-care is associated with an increased risk of HF admission and may provide clinically useful information at the point-of-care to guide HF management.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.007
       
  • Frequency of Left Ventricular End-Diastolic Volume–Mediated Declines in
           Ejection Fraction in Patients Receiving Potentially Cardiotoxic Cancer
           Treatment
    • Authors: Giselle C. Meléndez; Bunyapon Sukpraphrute; Ralph B. D'Agostino; Jennifer H. Jordan; Heidi D. Klepin; Leslie Ellis; Zanetta Lamar; Sujethra Vasu; Glenn Lesser; Gregory L. Burke; Kathryn E. Weaver; William O. Ntim; W. Gregory Hundley
      Pages: 1637 - 1642
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Giselle C. Meléndez, Bunyapon Sukpraphrute, Ralph B. D'Agostino, Jennifer H. Jordan, Heidi D. Klepin, Leslie Ellis, Zanetta Lamar, Sujethra Vasu, Glenn Lesser, Gregory L. Burke, Kathryn E. Weaver, William O. Ntim, W. Gregory Hundley
      We sought to determine the frequency by which decreases in left ventricular (LV) end-diastolic volume (LVEDV) with and without increases in end-systolic volume (LVESV) influenced early cancer treatment-associated declines in LV ejection fraction (LVEF) or LV mass. One hundred twelve consecutively recruited subjects (aged 52 ± 14 years) with cancer underwent blinded cardiovascular magnetic resonance measurements of LV volumes, mass, and LVEF before and 3 months after initiating potentially cardiotoxic chemotherapy (72% of participants received anthracyclines). Twenty-six participants developed important declines in LVEF of >10% or to values <50% at 3 months, in whom 19% versus 60%, respectively, experienced their decline in LVEF due to isolated declines in LVEDV versus an increase in LVESV; participants who dropped their LVEF due to decreases in LVEDV lost more LV mass than those who dropped their LVEF due to an increase in LVESV (p = 0.03). Nearly one fifth of subjects experience marked LVEF declines due to an isolated decline in LVEDV after initiating potentially cardiotoxic chemotherapy. Because reductions in intravascular volume (which could be treated by volume repletion) may account for LVEDV-related declines in LVEF, these data indicate that LV volumes should be reviewed along with LVEF when acquiring imaging studies for cardiotoxicity during the treatment for cancer.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.008
       
  • Determinants of Late Tricuspid Regurgitation After Aortic-Mitral Double
           Valve Replacement
    • Authors: Dong Seop Jeong; Pyo Won Park; Kiick Sung; Wook Sung Kim; Young Tak Lee
      Pages: 1643 - 1649
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Dong Seop Jeong, Pyo Won Park, Kiick Sung, Wook Sung Kim, Young Tak Lee
      The aims of this study are to evaluate the long-term outcomes of double valve replacement (aortic and mitral valves) and to investigate the determinants of late tricuspid regurgitation (TR). A total of 239 consecutive patients who underwent double valve replacement were enrolled. Valve pathology was rheumatic in 86.6% (207/239) and degenerative in 13.4% (32/239) of patients. Among these patients, 116 patients underwent concomitant tricuspid annuloplasty, and follow-up was completed for all 239 patients (mean = 7.3 ± 4.1, maximum = 15.9 years). We used propensity score matching to match 67 patients without tricuspid annuloplasty to the 114 patients who underwent annuloplasty. There was 1 in-hospital death and 9.7% (23/238) of patients experienced late cardiac-related mortality. Analysis of aortic valves indicated that the transprosthetic mean pressure gradient increased with time (13.4 ± 5.2 vs 15.4 ± 9.0 mm Hg, p = 0.002). Aortic transprosthetic mean pressure gradient increased more notably in woman and was associated with late TR (odds ratio 1.1, p = 0.010). In patients with mild TR, those who underwent tricuspid valve repair were less likely to experience a cardiac-related death within 10 years of surgery (hazards ratio 6.1, p = 0.036).

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.013
       
  • Comparison of Clinical and Electrocardiographic Predictors of Ischemic and
           Nonischemic Cardiomyopathy During the Initial Evaluation of Patients With
           Reduced (≤40%) Left Ventricular Ejection Fraction
    • Authors: Nathaniel R. Smilowitz; Arvind R. Devanabanda; George Zakhem; Sohah N. Iqbal; William Slater; John T. Coppola
      Pages: 1650 - 1655
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Nathaniel R. Smilowitz, Arvind R. Devanabanda, George Zakhem, Sohah N. Iqbal, William Slater, John T. Coppola
      Invasive coronary angiography is routinely performed during the initial evaluation of patients with suspected cardiomyopathy with reduced left ventricular function. Clinical and electrocardiographic (ECG) data may accurately predict ischemic cardiomyopathy (IC). Medical records of adults referred for coronary angiography for evaluation of left ventricular ejection fraction ≤40% from 2010 to 2014 were retrospectively reviewed. Patients with myocardial infarction (MI), previous coronary revascularization, cardiac surgery, or left-sided valvular disease were excluded. IC was defined as ≥70% diameter stenosis of the left main, proximal left anterior descending, or involvement of ≥2 epicardial coronary arteries. A risk model was developed from logistic regression coefficients, with a dichotomous cut-point based on the maximal Youden's index from the receiver-operating characteristic curve. A total of 273 patients met study inclusion criteria. Mean age was 56.8 ± 11.6 and 68.1% were men. IC was identified in 41 patients (15%). Patients with IC were more likely to have ECG evidence of Q-wave MI (34% vs 13%, p <0.001) and less likely to have left bundle branch block (2% vs 15%, p = 0.03) than non-IC. A model including age, hypertension, diabetes mellitus, tobacco use, ECG evidence of ST or T-wave abnormalities concerning for ischemia, and previous Q-wave MI, yielded a 95% negative predictive value for IC. In conclusion, at an urban referral hospital, the prevalence of IC was low. Left bundle branch block on electrocardiography was rarely associated with IC. A risk score incorporating clinical and ECG abnormalities identified patients at a low likelihood for IC.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.014
       
  • Comparison of Ventricular Septal Measurements in Hypertrophic
           Cardiomyopathy Patients Who Underwent Surgical Myectomy Using
           Multimodality Imaging and Implications for Diagnosis and Management
    • Authors: Dermot Phelan; Brett W. Sperry; Paaladinesh Thavendiranathan; Patrick Collier; Zoran B. Popović; Harry M. Lever; Nicholas G. Smedira; Milind Y. Desai
      Pages: 1656 - 1662
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Dermot Phelan, Brett W. Sperry, Paaladinesh Thavendiranathan, Patrick Collier, Zoran B. Popović, Harry M. Lever, Nicholas G. Smedira, Milind Y. Desai
      Accurate and reproducible quantification of ventricular septal (VS) thickness in hypertrophic cardiomyopathy (HC) is essential for diagnosis, surgical planning, and risk stratification. We sought to compare VS thickness measurements using transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac magnetic resonance (CMR) in patients with HC. Prospectively reported measurements of VS thickness were compared using analysis of variance and Bland-Altman plots in 90 consecutive patients with HC who underwent a TTE, TEE, and CMR within 3 months. A subset was re-measured on 2 separate occasions by 2 readers to assess inter- and intraobserver variability. There was modest correlation between modalities, with CMR and TTE measurements of VS thickness showing the greatest correlation (CMR vs TTE, r = 0.70; CMR vs TEE, r = 0.60; TTE vs TEE, r = 0.56). Smaller measurements were seen using CMR versus either echocardiographic technique (13% smaller vs TEE, 8% smaller vs TTE, p <0.001 for both). The variability of measurement between modalities was not correlated with the degree of VS thickness. There was significantly lower intraobserver variability with CMR versus echocardiography (p = 0.01 for both), but no difference in interobserver variability. CMR delineated a different area of maximal VS thickness other than the basal anteroseptum more frequently than echocardiography (44% of cases vs 24% for TTE and 11% for TEE). In conclusion, CMR assessment of VS thickness differs significantly from echocardiography in patients with HC, with a systemic bias toward lower measurements seen with CMR.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.009
       
  • Incremental Prognostic Value of Global Longitudinal Strain and
           18F-Fludeoxyglucose Positron Emission Tomography in Patients With Systemic
           Sarcoidosis
    • Authors: Brett W. Sperry; Ahmed Ibrahim; Kazuaki Negishi; Tomoko Negishi; Parag Patel; Zoran B. Popović; Daniel Culver; Richard Brunken; Thomas H. Marwick; Balaji Tamarappoo
      Pages: 1663 - 1669
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Brett W. Sperry, Ahmed Ibrahim, Kazuaki Negishi, Tomoko Negishi, Parag Patel, Zoran B. Popović, Daniel Culver, Richard Brunken, Thomas H. Marwick, Balaji Tamarappoo
      In independent studies, abnormal global longitudinal strain (GLS) and myocardial inflammation or scar detected by 18F-fludeoxyglucose positron emission tomography (FDG-PET) are associated with poor prognosis among patients with high likelihood for cardiac sarcoidosis. However, commonly used imaging modalities have not been evaluated in the same population. Our goals were to examine the relation between GLS and FDG-PET, and to evaluate the incremental prognostic value of these imaging techniques for predicting major adverse cardiac events (MACE) in patients suspected to have cardiac sarcoidosis. We identified patients with systemic sarcoidosis who underwent an echocardiogram and FDG-PET within 60 days. Regional strain (average of base, mid, and apical segmental strains from each of 6 wall regions) was calculated and compared with regional FDG-PET findings. The associations among GLS, FDG-PET findings, and MACE (defined as death, ventricular tachycardia, heart failure hospitalization, or transplantation) were evaluated using a Cox model. Of 84 patients, 51 had abnormal FDG-PET. GLS was impaired in patients with abnormal versus normal FDG-PET (−14.2 ± 4.7% vs −17.9 ± 3.5%, p <0.01). After adjusting for clinical risk factors, both GLS and the number of segments with abnormal perfusion and metabolism on FDG-PET were associated with adverse cardiac events (p <0.01 for both). In conclusion, GLS and regional LS are impaired in patients with abnormal perfusion and metabolism detected using FDG-PET. Additionally, both GLS and abnormal FDG-PET have incremental prognostic value for predicting MACE in patients with systemic sarcoidosis.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.010
       
  • Frequency of Development of Aortic Valve Disease in Unrepaired
           Perimembranous Ventricular Septal Defects
    • Authors: Asif Padiyath; Elizabeth S. Makil; Katherine T. Braley; Elijah H. Bolin; Xinyu Tang; Jeffery M. Gossett; R. Thomas Collins
      Pages: 1670 - 1674
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Asif Padiyath, Elizabeth S. Makil, Katherine T. Braley, Elijah H. Bolin, Xinyu Tang, Jeffery M. Gossett, R. Thomas Collins
      We sought to determine the natural history of aortic valve disease in patients with unrepaired perimembranous ventricular septal defects (pVSDs) and to identify echocardiographic parameters predictive of increased risk of surgical repair of pVSD because of aortic valve disease. We retrospectively analyzed all echocardiograms of patients with a diagnosis of pVSD at our institution from January 1999 to January 2015. All available echocardiographic data were collected. Patients were excluded if there was another structural cardiac anomaly other than bicuspid aortic valve, small patent foramen ovale, or ductus arteriosus. The prevalences of aortic valve prolapse and regurgitation, as well as aortic valve disease progression, were determined. A total of 2,114 echocardiograms from 657 patients with unrepaired pVSD were reviewed. Median age at the time of echocardiogram was 1.9 years (interquartile range [IQR] 0.2 to 5.4). Median duration of follow-up was 1.7 years (IQR 0.2 to 7.4). pVSD-associated aortic valve disease prompted surgical intervention in 1.5% (10 of 657) of patients. Median age at the time of surgery was 4.8 years (IQR 1.7 to 8.4). A pVSD-to-aortic annulus diameter ratio of 0.66 ± 0.05 was present in 90% (9 of 10) of patients who underwent surgical closure because of pVSD-associated aortic valve disease. In conclusion, pVSD-associated aortic valve disease is uncommon, and progression of aortic regurgitation is rare. These data suggest that the majority of patients with pVSD do not require frequent follow-up and that frequent follow-up can be saved for a subset with echocardiographic markers placing them at higher risk of aortic valve diseases.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.004
       
  • Mortality Risk Stratification in Fontan Patients Who Underwent Heart
           Transplantation
    • Authors: Christopher J. Berg; Brenton S. Bauer; Abbie Hageman; Jamil A. Aboulhosn; Leigh C. Reardon
      Pages: 1675 - 1679
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Christopher J. Berg, Brenton S. Bauer, Abbie Hageman, Jamil A. Aboulhosn, Leigh C. Reardon
      The number of patients who require orthotopic heart transplantation (OHT) for failing Fontan physiology continues to grow; however, the methods and tools to evaluate risk of OHT are limited. This study aimed to identify a set of preoperative variables and characteristics that were associated with a greater risk of postoperative mortality in patients who received OHT for failing Fontan physiology. Thirty-six Fontan patients were identified as having undergone OHT at University of California-Los Angeles Medical Center from 1991 to 2014. Data were collected retrospectively and analyzed. The primary end point was designated as postoperative mortality. After an average follow-up time of 3.5 years, 17 (44%) patients suffered postoperative mortality. Patient characteristics including (1) age <18 years at the time of OHT, (2) Fontan-OHT interval of <10 years, (3) systemic ventricular ejection fraction <20%, (4) moderate-to-severe atrioventricular valve insufficiency, (5) an elevated Model of End-stage Liver Disease, eXcluding INR score, or (6) need for advanced mechanical support before surgery were associated with an increased incidence of postoperative mortality. Using these risk factors, we present a theoretical framework to stratify risk of postoperative death in failing Fontan patients after OHT. In conclusion, a method such as this may aid in the transplantation evaluation and listing process of patients with failing Fontan physiology.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.005
       
  • Comparison of Late Mortality Among Twins Versus Singletons With Congenital
           Heart Defects
    • Authors: Anne Maria Herskind; Lisbeth Aagaard Larsen; Dorthe Almind Pedersen; Kaare Christensen
      Pages: 1680 - 1686
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Anne Maria Herskind, Lisbeth Aagaard Larsen, Dorthe Almind Pedersen, Kaare Christensen
      In 2014, in the United States, nearly 7% of newborns were twins. Congenital heart defects (CHDs) are more frequent in both monozygotic and dizygotic twins than in singletons. Still, the longer-term prognosis for CHD twins is unknown. Here we assess the mortality pattern for CHD twins up to age 36 years and compare it with that for non-CHD twins, non-CHD co-twins, and CHD singletons. We identified all twins and a 5% random sample of all singletons born in Denmark from 1977 to 2009 by linking Danish national population and health registers. CHD cases were defined as subjects having a primary inpatient diagnosis of CHD (excluding preterm ductus) within the first year of life, and mortality was assessed through 2013. Among 63,362 live-born twin individuals, a total of 373 twins (0.59%) had a CHD diagnosis, whereas the corresponding numbers for singletons were 383 of 98,647 (0.39%). During the follow-up, 82 (22.0%) CHD twins died compared with 91 (23.8%) CHD singletons (p = 0.56). Despite a 5 times higher proportion of prematurity, CHD twins had a tendency toward only a moderately increased neonatal mortality compared with CHD singletons (hazard ratio 1.5, 95% confidence interval 0.94 to 2.5), and after the neonatal period up to age 36 the tendency was reversed (hazard ratio 0.8, 95% confidence interval 0.5 to 1.2). A potential underlying mechanism for this mortality pattern is selective intrauterine and neonatal mortality of twins with the most severe CHD. In conclusion, the study indicates that the overall survival prognosis for CHD twins is similar to that of CHD singletons.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.006
       
  • Impact of Left Ventricular Diastolic Property on Left Atrial Function from
           Simultaneous Left Atrial and Ventricular Three-Dimensional
           Echocardiographic Volume Measurement
    • Authors: Michiyo Yamano; Tetsuhiro Yamano; Yumi Iwamura; Takeshi Nakamura; Hirokazu Shiraishi; Takeshi Shirayama; Satoaki Matoba
      Pages: 1687 - 1693
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Michiyo Yamano, Tetsuhiro Yamano, Yumi Iwamura, Takeshi Nakamura, Hirokazu Shiraishi, Takeshi Shirayama, Satoaki Matoba
      Simultaneous left atrial (LA) and left ventricular (LV) 3-dimensional (3D) echocardiographic volume measurements enable the quantifying of precise LA function, by virtue of their independence on any geometric assumption and capability of measurement for net LA conduit volume. We sought to elucidate the impact of conventional Doppler LV diastolic property on LA volume and function derived from this method. Our study subjects consisted of 381 patients who underwent 3D echocardiography. From LA time-volume curve, maximum and minimum volume index (VI) and VI before atrial contraction (LAVIpre-c) were determined; subsequently, active emptying volume was calculated as LAVIpre-c − minimum LAVI. From LA and LV volume measurement, conduit volume was calculated as LV stroke VI − (maximum LAVI − minimum LAVI). LA volume increased depending on the severity of diastolic dysfunction. Compared with patients with normal diastolic function, LA booster pump function, as the contribution of active emptying volume to LV filling, was higher in those with mild diastolic dysfunction. Additionally, it gradually decreased as diastolic dysfunction was advanced from mild to moderate and moderate to severe degree (23.2 ± 15.5%, 29.5 ± 15.1%, 25.1 ± 16.2%, 14.9 ± 14.1%, respectively; p <0.001). Contrarily, conduit contribution was significantly higher in patients with severe diastolic dysfunction than in those with mild diastolic dysfunction; furthermore, conduit function tended to increase, reciprocally to booster pump function, as diastolic dysfunction grade was advanced (39.1 ± 28.8%, 36.8 ± 26.2%, 42.7 ± 25.6%, 52.9 ± 26.2%, respectively; p = 0.034). In conclusion, simultaneous LA and LV volumetric analyses through 3D echocardiography clearly demonstrate the characteristic LA functional alterations following LA dilation caused by LV diastolic dysfunction.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.002
       
  • National Trends and In-Hospital Outcomes in Pregnant Women With Heart
           Disease in the United States
    • Authors: Fabio V. Lima; Jie Yang; Jianjin Xu; Kathleen Stergiopoulos
      Pages: 1694 - 1700
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Fabio V. Lima, Jie Yang, Jianjin Xu, Kathleen Stergiopoulos
      Investigation of trends and outcomes in heart disease (HD) and pregnancy has been limited. We chose to identify the prevalence, trends, and outcomes of pregnant women with different forms of HD in the United States. Healthcare Cost and Utilization Project's National Inpatient Sample was screened for hospital admissions for delivery in pregnant women with HD from 2003 to 2012. Maternal clinical characteristics and outcomes were identified in women with and without HD, and in HD subtypes: congenital (CHD), valvular HD, cardiomyopathy, and pulmonary hypertension (PH). Primary outcomes of interest were prevalence, trends, and major adverse cardiac events (MACEs), a composite of in-hospital death, acute myocardial infarction, heart failure, arrhythmia, cerebrovascular event, embolic events, or cardiac complications of anesthesia. We studied 81,295 patients with HD and 39,894,032 without. CHD was the most frequent type (41.8%, 33,982 of 81,295 patients), followed by valvular HD (30.9%, 25,138 of 81,295 patients), cardiomyopathy (20.8%, 16,926 of 81,295 patients), and PH (6.5%, 5,250 of 81,295 patients). MACE was highest among women with cardiomyopathy and lowest among women with CHD (44.0%, 7,449 of 16,926 vs 6.2%, 2,102 of 33,982; p <0.0001). PH patients had the highest in-hospital death, followed by cardiomyopathy patients (1.0%, 51 of 5,250 and 0.7%, 124 of 16,926, respectively). Pregnant women with HD significantly increased by 24.7%, related to increases in cardiomyopathy, CHD, and PH from 2003 to 2012. MACE significantly increased by 18.8%. In conclusion, pregnancy in women with HD is increasing, particularly for high risk conditions such as cardiomyopathy and PH. There is a significant and gradual increase in MACE for women with HD.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2017.02.003
       
  • Chest Pain and ST-Segment Elevation in an 18-Year-Old Man
    • Authors: Mazen M. Kawji; D. Luke Glancy
      Pages: 1701 - 1702
      Abstract: Publication date: 15 May 2017
      Source:The American Journal of Cardiology, Volume 119, Issue 10
      Author(s): Mazen M. Kawji, D. Luke Glancy
      An 18-year-old man came to the hospital because of 1 day of chest pain typical of pericarditis. He had had an upper respiratory infection 10 days earlier. His electrocardiograms indicated evolving pericarditis. His echocardiogram showed mild, diffuse left ventricular hypokinesia, and his troponin I level peaked at 47.5 ng/ml. Thus, he had myopericarditis.

      PubDate: 2017-04-25T11:57:05Z
      DOI: 10.1016/j.amjcard.2016.11.073
       
 
 
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