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Publisher: Elsevier   (Total: 3175 journals)

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Showing 1 - 200 of 3175 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 28, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 33, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 376, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 235, 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: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14)
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: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 128, 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: 12, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, 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: 2, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 28, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.183, 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: 10, 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: 19, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 14)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 10)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 21)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 6)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 42, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 7)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 54, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 14, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 7)
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: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 1, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, 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: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, 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: 6, 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: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, 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: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
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: 6, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, 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: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 18, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 375, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 333, 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: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 429, 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: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, 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: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
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)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 50, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10, 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: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 42, 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: 189, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
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: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 61, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
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: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 165, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)

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

Journal Cover American Journal of Cardiology
  [SJR: 2.063]   [H-I: 186]   [50 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9149 - ISSN (Online) 0002-9149
   Published by Elsevier Homepage  [3175 journals]
  • Recurrent Cardiovascular Events in Survivors of Myocardial Infarction With
           ST-Segment Elevation (from the AMI-QUEBEC Study)
    • Authors: Thao Huynh; Martine Montigny; Umair Iftikhar; Roxanne Gagnon; Mark Eisenberg; Claude Lauzon; Samer Mansour; Stephane Rinfret; Marc Afilalo; Michel Nguyen; Simon Kouz; Jean-Pierre Déry; Richard Harvey; Robert De LaRocheliere; Bernard Cantin; Eerick Schampaert; Jean-Claude Tardif
      Pages: 897 - 902
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Thao Huynh, Martine Montigny, Umair Iftikhar, Roxanne Gagnon, Mark Eisenberg, Claude Lauzon, Samer Mansour, Stephane Rinfret, Marc Afilalo, Michel Nguyen, Simon Kouz, Jean-Pierre Déry, Richard Harvey, Robert De LaRocheliere, Bernard Cantin, Eerick Schampaert, Jean-Claude Tardif
      The characteristics and predictors of long-term recurrent ischemic cardiovascular events (RICEs) after myocardial infarction with ST-segment elevation (STEMI) have not yet been clarified. We aimed to characterize the 10-year incidence, types, and predictors of RICE. We obtained 10-year follow-up of STEMI survivors at 17 Quebec hospitals in Canada (the AMI-QUEBEC Study) in 2003. There were 858 patients; mean age was 60 years and 73% were male. The majority of patients receive reperfusion therapy; 53.3% and 39.2% of patients received primary percutaneous coronary intervention (PCI) and fibrinolytic therapy, respectively. Seventy-five percent of patients underwent in-hospital PCI (elective, rescue, and primary). At 10 years, 42% of patients suffered a RICE, with most RICEs (88%) caused by recurrent cardiac ischemia. The risk of RICE was the highest during the first year (23.5 per patient-year). At 10 years, the all-cause mortality was 19.3%, with 1/3 of deaths being RICE-related. Previous cardiovascular event, heart failure during the index STEMI hospitalization, discharge prescription of calcium blocker increased the risk of RICE by almost twofold. Each point increase in TIMI (Thrombolysis In Myocardial Infarction) score augmented the risk of RICE by 6%, whereas discharge prescription of dual antiplatelets reduced the risk of RICE by 23%. Our findings suggested that survivors of STEMI remain at high long-term risk of RICE despite high rate of reperfusion therapy and in-hospital PCI. Patients with previous cardiovascular event, in-hospital heart failure, and high TIMI score were particularly susceptible to RICE. Future studies are needed to confirm the impacts of calcium blocker and dual antiplatelets on long-term risk of RICE.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2017.12.037
       
  • Relation of Waist-Hip Ratio to Long-Term Cardiovascular Events in Patients
           With Coronary Artery Disease
    • Authors: Jose R. Medina-Inojosa; John A. Batsis; Marta Supervia; Virend K. Somers; Randal J. Thomas; Sarah Jenkins; Chassidy Grimes; Francisco Lopez-Jimenez
      Pages: 903 - 909
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Jose R. Medina-Inojosa, John A. Batsis, Marta Supervia, Virend K. Somers, Randal J. Thomas, Sarah Jenkins, Chassidy Grimes, Francisco Lopez-Jimenez
      We aimed to assess the association between measures of obesity and outcomes in coronary artery disease (CAD) patients. We included consecutive patients referred to cardiac rehabilitation for previous CAD events, who were classified using body mass index (BMI) groups and gender-specific tertiles of waist-to-hip ratio (WHR). Follow-up was ascertained using a population-based, record linkage system. Major cardiovascular event (MACE) was defined as the composite outcome including acute coronary syndromes, coronary revascularization, ventricular arrhythmias, stroke, or death from any cause. We used Cox proportional hazards models adjusted for potential confounders. The cohort included 1,529 patients (74% men), 63.1 ± 12.5 years (mean age ± SD), of whom 40% were obese by BMI. Eighty-eight percent of men and 57% of women were classified as having central obesity by WHR. Median follow-up was 5.7 years and 415 patients had MACE. After adjustment, a high WHR tertile was a significant predictor for MACE in women (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.16, 2.94, p = 0.01) but not in men (HR 0.92, 95% CI 0.69, 1.22, p = 0.54). This relation in women persisted after further adjustment for BMI (HR 1.75, 95% CI 1.07, 2.87, p = 0.03). Obesity by BMI was not associated with MACE in either men (HR 1.07, 95% CI 0.76, 1.51, p = 0.69) or women (HR 0.98, 95% CI 0.62, 1.56, p = 0.95). In conclusion, WHR is associated with a higher risk of MACE among women with CAD but not in men. There was no obesity paradox when assessing obesity by BMI in patients with CAD when including nonfatal events.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2017.12.038
       
  • Usefulness of Carotid Plaques as Predictors of Obstructive Coronary Artery
           Disease and Cardiovascular Events in Asymptomatic Individuals With
           Diabetes Mellitus
    • Authors: Anand Jeevarethinam; Shreenidhi Venuraju; Alain Dumo; Sherezade Ruano; Miranda Rosenthal; Devaki Nair; Mark Cohen; Daniel Darko; Avijit Lahiri; Roby Rakhit
      Pages: 910 - 916
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Anand Jeevarethinam, Shreenidhi Venuraju, Alain Dumo, Sherezade Ruano, Miranda Rosenthal, Devaki Nair, Mark Cohen, Daniel Darko, Avijit Lahiri, Roby Rakhit
      Carotid intima-media thickness (CIMT) measurement and carotid plaque detection by B-mode ultrasound are frequently used as surrogates to predict coronary artery disease (CAD). However, their systematic use in routine clinical management of asymptomatic patients with diabetes mellitus (DM) has not been studied. The aim of the study was to identify carotid parameters that predict cardiovascular events in patients with asymptomatic type 2 DM by evaluating the relation between carotid disease and CAD. This multicenter, observational, prospective study included 259 asymptomatic patients with type 2 DM followed-up for 34 months after measurement of CIMT and carotid plaque with carotid ultrasound, and CAD assessment with computed tomography coronary angiography. Statistically significant differences between patients with and without carotid plaque were found for coronary plaque >50% stenosis (59 vs 36, p = 0.02). Greater maximal CIMT was associated with an increased risk of coronary plaque >50% (odds ratio 1.21 [1.02, 1.44], p = 0.03) and >70% stenosis (odds ratio 1.23 [1.01, 1.50], p = 0.04) after adjusting for traditional risk factors. At 34-month follow-up, the occurrence of total major adverse cardiovascular event was estimated to be 7.1% (mean age 68 years, 6% male and 1.1% female) in the whole study population. The subgroup of patients with carotid plaque showed increased incidence of major adverse cardiovascular event compared with patients with no carotid plaque (p = 0.005). In conclusion, carotid plaque was a strong predictor of future cardiovascular events and may be a prognostic marker in asymptomatic patients with type 2 DM. Carotid plaque and maximal intima-media thickness were independently associated with obstructive CAD.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.01.001
       
  • Measurements of Lumen Areas and Diameters of Proximal and Middle Coronary
           Artery Segments in Subjects Without Coronary Atherosclerosis
    • Authors: Jaroslaw Skowronski; Jerzy Pregowski; Gary S. Mintz; Mariusz Kruk; Cezary Kepka; Pawel Tyczynski; Ilona Michalowska; Lukasz Kalinczuk; Maksymilian P. Opolski; Michal Ciszewski; Rafal Wolny; Zbigniew Chmielak; Adam Witkowski
      Pages: 917 - 923
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Jaroslaw Skowronski, Jerzy Pregowski, Gary S. Mintz, Mariusz Kruk, Cezary Kepka, Pawel Tyczynski, Ilona Michalowska, Lukasz Kalinczuk, Maksymilian P. Opolski, Michal Ciszewski, Rafal Wolny, Zbigniew Chmielak, Adam Witkowski
      There are plenty of data on morphology and lumen dimensions of diseased coronary arteries. However, information on normal coronary vessel anatomy is scarce. We provided computed tomography angiography-derived reference values of lumen dimensions in proximal and middle coronary segments in a healthy population with respect to gender and vessel dominance. Consecutive 2,849 computed tomography angiography examinations were reviewed to identify 201 subjects (77 men, patient age 50 ± 13 years) whose coronary arteries were free from any sign of atherosclerosis (calcium score 0, no detectable plaque). For all proximal and middle coronary segments, lumen areas (LAs) and lumen diameters were measured. Coronary vessel segmentation and dominance pattern were defined using the Syntax Score. Normal values of LAs and lumen diameters were significantly smaller for women compared with men except for the proximal right coronary artery and the left main coronary artery (LMCA) (20.2 ± 6.6 mm2 vs 23.0 ± 6.1 mm2, p = 0.0003, and 5.0 ± 0.8 mm vs 5.4 ± 0.7 mm, p = 0.0001). The lower limit of normal for the LMCA (defined as mean LA − 2 standard deviations) equaled 7.0 and 10.8 mm2 for women and men, respectively. Subjects with left (vs right) coronary dominance had significantly larger areas and diameters of the LMCA (26.2 ± 9.2 mm2 vs 20.7 ± 6.0 mm2, p = 0.0017, and 5.7 ± 1.0 mm vs 5.1 ± 0.7 mm, p = 0.0017, respectively) and proximal left circumflex (13.8 ± 2.7 mm2 vs 10.4 ± 3.8 mm2, p = 0.0001, and 4.2 ± 0.4 mm vs 3.6 ± 0.7 mm, p = 0.0001, respectively) and smaller areas and diameters of the proximal right coronary artery (7.1 ± 2.0 mm2 vs 13.3 ± 3.6 mm2, p <0.0001, and 3.0 ± 0.4 mm vs 4.1 ± 0.6 mm, p <0.0001, respectively). In conclusion, gender and coronary artery dominance pattern significantly impact normal LAs and dimensions in subjects without coronary atherosclerosis.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.01.002
       
  • A Meta-Analysis Comparing Percutaneous Coronary Intervention With
           Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected
           Left Main Disease
    • Authors: Vamsi Kodumuri; Senthil Balasubramanian; Aviral Vij; Sisir Siddamsetti; Ankur Sethi; Rommy Khalafallah; Sandeep Khosla
      Pages: 924 - 933
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Vamsi Kodumuri, Senthil Balasubramanian, Aviral Vij, Sisir Siddamsetti, Ankur Sethi, Rommy Khalafallah, Sandeep Khosla
      Coronary artery bypass grafting (CABG) is the preferred revascularization strategy for unprotected left main disease (UPLMD). Multiple small-scale trials and registry data showed that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a noninferior strategy with a Class IIa American College of Cardiology/American Heart Association recommendation in patients with high surgical risk and favorable anatomy. However, 2 recent large-scale randomized trials showed conflicting evidence. We conducted a meta-analysis of the existing data to compare outcomes of PCI with DES versus CABG for UPLMD. Four randomized and 8 nonrandomized trials involving 10,284 patients were included. Primary end point was composite of death, stroke, or myocardial infarction (MI) at 3 years or longer. Secondary end points were MACCE (Major Adverse Cardiac and Cerebrovascular Events) and its individual components (death, stroke, MI, or repeat revascularization). Mantel-Haenszel random effects model was used to calculate combined odds ratio for outcomes. A separate analysis of randomized data was also performed. There was no significant difference in primary composite outcome between PCI and CABG. However, MACCE was significantly higher in PCI, primarily driven by significantly high repeat revascularization. A subgroup analysis stratified by Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score showed that MACCE and repeat revascularization were not significantly different between PCI and CABG in low to intermediate SYNTAX score (<33), whereas they were significantly higher in PCI with higher SYNTAX score. Thus, although CABG remains the preferred method of treatment in UPLMD, PCI with DES can be considered as a reasonable alternative in patients with favorable anatomy and high surgical risk.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2017.12.039
       
  • Efficacy and Safety of Alirocumab in High-Risk Patients With Clinical
           Atherosclerotic Cardiovascular Disease and/or Heterozygous Familial
           Hypercholesterolemia (from 5 Placebo-Controlled ODYSSEY Trials)
    • Authors: Peter A. McCullough; Christie M. Ballantyne; Santosh K. Sanganalmath; Gisle Langslet; Seth J. Baum; Prediman K. Shah; Andrew Koren; Jonas Mandel; Michael H. Davidson
      Pages: 940 - 948
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Peter A. McCullough, Christie M. Ballantyne, Santosh K. Sanganalmath, Gisle Langslet, Seth J. Baum, Prediman K. Shah, Andrew Koren, Jonas Mandel, Michael H. Davidson
      Patients with previous atherosclerotic cardiovascular disease (ASCVD) and/or heterozygous familial hypercholesterolemia (HeFH) are at high risk of future cardiovascular events. Despite maximally tolerated doses of statins, many patients still have elevated low-density lipoprotein cholesterol (LDL-C) levels. We evaluated the efficacy and safety of alirocumab in patients with ASCVD and/or HeFH on a maximally tolerated dose of statin (rosuvastatin 20 or 40 mg, atorvastatin 40 or 80 mg, or simvastatin 80 mg, or lower doses with an investigator-approved reason) ± other lipid-lowering therapies from 5 placebo-controlled phase 3 trials (52 to 78 weeks). Patients with (n = 2,449) and without (n = 1,050) ASCVD were pooled from the FH I, FH II, HIGH FH, LONG TERM, and COMBO I trials. Patients with HeFH with (n = 575) and without ASCVD (n = 682) were pooled from all trials except COMBO I. High-intensity statins were utilized in 55.7% to 59.0% and in 72.4% to 87.6% of the ASCVD and the HeFH groups, respectively. Efficacy end points included LDL-C percent change from baseline to week 24 stratified by alirocumab dose. Mean baseline demographics and lipid levels were comparable in alirocumab- and placebo-treated patients. LDL-C reductions from baseline at week 24 ranged from 46.6% to 51.3% for alirocumab 75/150 mg and from 54.1% to 61.9% for alirocumab 150 mg in ASCVD and HeFH groups and were sustained for up to 78 weeks. LDL-C reductions with alirocumab were independent of ASCVD and/or HeFH status (interaction p value >0.05). Concordant results were observed for other lipids analyzed. The overall safety in the subgroups analyzed was similar in both treatment arms. Injection-site reactions were observed more frequently with alirocumab versus placebo.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2017.12.040
       
  • Relative Prognostic Value of Cardiac Troponin I and C-Reactive Protein in
           the General Population (from the Nord-Trøndelag Health [HUNT] Study)
    • Authors: Fjola D. Sigurdardottir; Magnus N. Lyngbakken; Oddgeir L. Holmen; Håvard Dalen; Kristian Hveem; Helge Røsjø; Torbjørn Omland
      Pages: 949 - 955
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Fjola D. Sigurdardottir, Magnus N. Lyngbakken, Oddgeir L. Holmen, Håvard Dalen, Kristian Hveem, Helge Røsjø, Torbjørn Omland
      C-reactive protein and cardiac troponin I measured with high-sensitivity assays (high-sensitivity C-reactive protein [hs-CRP] and high-sensitivity troponin I [hs-TnI]) have been associated with risk of fatal and nonfatal cardiovascular events in the general population. The relative prognostic merits of hs-CRP and hs-TnI, and whether these markers of inflammation and subclinical myocardial injury provide incremental information to established cardiovascular risk prediction models, remain unclear. hs-CRP and hs-TnI were measured in 9,005 participants from the prospective observational Nord-Trøndelag Health (HUNT) study. All study subjects were free from known cardiovascular disease at baseline. During a median follow-up period of 13.9 years, 733 participants reached the composite end point of hospitalization for acute myocardial infarction or heart failure, or cardiovascular death. In adjusted models, increased hs-TnI concentrations (>10 ng/L for women and >12 ng/L for men) were associated with the incidence of the composite end point (hazard ratio 3.61, 95% confidence interval [CI] 2.89 to 4.51]), whereas the risk associated with increased hs-CRP concentrations (>3 mg/L for both genders) appeared to be weaker (HR 1.71, 95% CI 1.40 to 2.10). The addition of hs-TnI to established cardiovascular risk prediction models led to a net reclassification improvement of 0.35 (95% CI 0.27 to 0.42), superior to that of hs-CRP (0.21, 95% CI 0.13 to 0.28). The prognostic accuracy of hs-TnI, assessed by C-statistics, was significantly greater than that of hs-CRP (0.753, 95% CI 0.735 to 0.772, vs 0.644, 95% CI 0.625 to 0.663). In conclusion, in subjects from the general population without a history of cardiovascular disease, hs-TnI provides prognostic information superior to that provided by hs-CRP and may therefore be a preferred marker for targeted prevention.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.01.004
       
  • Long-Term Change in Cardiorespiratory Fitness in Relation to Atrial
           Fibrillation and Heart Failure (from the Kuopio Ischemic Heart Disease
           Risk Factor Study)
    • Authors: Hassan Khan; Setor K. Kunutsor; Rainer Rauramaa; Faisal M. Merchant; Jari A. Laukkanen
      Pages: 956 - 960
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Hassan Khan, Setor K. Kunutsor, Rainer Rauramaa, Faisal M. Merchant, Jari A. Laukkanen
      The benefits of aerobic fitness in relation to all-cause and cardiovascular mortality is well established; however, the associations of long-term change in cardiorespiratory fitness (CRF) with incident heart failure (HF) and atrial fibrillation (AF) have not been studied before. The Kuopio Ischaemic Heart Disease Risk Factor Study is a prospective cohort comprising men aged 42 to 60 years from the city of Kuopio and its surroundings, with a baseline examination between 1984 and 1989 (V1), a re-examination at 11 years (V2), and up to 15 years of follow-up from V2. CRF, as assessed by VO2max, was measured at both visits using respiratory gas exchange during maximal exercise tolerance test. The difference (ΔVO2max) was estimated as VO2max (V2) − VO2max (V1). Participants with no missing data on both baseline and 11-year exercise test were included (n = 481). The mean ΔVO2max was −5.4 ml/min⋅kg (standard deviation 5.4). During a median follow-up of 14.3 years (interquartile range 13.3 to 15.1), 46 incident HF (9.6%) and 73 incident AF (15.2%) events were recorded. In a multivariate analysis adjusted for baseline age, baseline VO2max, systolic blood pressure, smoking, type 2 diabetes, and cardiovascular disease, per 1 ml/min⋅kg higher ΔVO2max was log linearly associated with incident HF with a 10% relative risk reduction of HF (hazard ratio 0.90, 95% confidence interval 0.83 to 0.97). No significant relation of ΔVO2max with incident AF was observed. In conclusion, overall long-term improvement in CRF is associated with reduced risk of HF, indicating the importance of maintaining good CRF over time.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.01.003
       
  • Effect of Elevated C-Reactive Protein Level at Discharge on Long-Term
           Outcome in Patients Hospitalized for Acute Heart Failure
    • Authors: Yuichiro Minami; Katsuya Kajimoto; Naoki Sato; Nobuhisa Hagiwara
      Pages: 961 - 968
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Yuichiro Minami, Katsuya Kajimoto, Naoki Sato, Nobuhisa Hagiwara
      In the acute heart failure (AHF) setting, the usefulness of C-reactive protein (CRP) at admission as a risk marker is challenged by the possible confounding effect of an acute-phase response. We thus evaluated the relation of CRP level at discharge (i.e., after stabilization of AHF) with subsequent postdischarge outcome in patients hospitalized for AHF. The acute decompensated heart failure syndromes study prospectively registered 4,269 hospitalized AHF patients with data on CRP levels at discharge. The median CRP level was 3.1 mg/L (interquartile range 1.1 to 9.5 mg/L). Within 120 days after discharge, only CRP levels in the fourth quartile (≥9.6 mg/L) were independently associated with higher all-cause mortality (adjusted hazard ratio [HR], 1.68) according to multivariable models with first-quartile (≤1.1 mg/L) as the reference. However, the HR for CRP levels in the fourth quartile decreased markedly with time, and CRP levels in the second (1.2 to 3.1 mg/L) and third (3.2 to 9.5 mg/L) quartiles were independently associated with poorer survival after the 120-day follow-up period (adjusted HR, 1.41 and 1.63, respectively). In addition, only CRP levels in the third quartile were independently associated with the composite end point of all-cause death and readmission for AHF after the 120 days of long-term follow-up (adjusted HR, 1.31). In conclusion, our results suggest that a modestly elevated CRP level (approximately 3 to 10 mg/L) at discharge had unique long-term prognostic implications in hospitalized patients with AHF.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2017.12.046
       
  • Effect of Optimizing Guideline-Directed Medical Therapy Before Discharge
           on Mortality and Heart Failure Readmission in Patients Hospitalized With
           Heart Failure With Reduced Ejection Fraction
    • Authors: Tetsuo Yamaguchi; Takeshi Kitai; Takamichi Miyamoto; Nobuyuki Kagiyama; Takahiro Okumura; Keisuke Kida; Shogo Oishi; Eiichi Akiyama; Satoshi Suzuki; Masayoshi Yamamoto; Junji Yamaguchi; Takamasa Iwai; Sadahiro Hijikata; Ryo Masuda; Ryoichi Miyazaki; Nobuhiro Hara; Yasutoshi Nagata; Toshihiro Nozato; Yuya Matsue
      Pages: 969 - 974
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Tetsuo Yamaguchi, Takeshi Kitai, Takamichi Miyamoto, Nobuyuki Kagiyama, Takahiro Okumura, Keisuke Kida, Shogo Oishi, Eiichi Akiyama, Satoshi Suzuki, Masayoshi Yamamoto, Junji Yamaguchi, Takamasa Iwai, Sadahiro Hijikata, Ryo Masuda, Ryoichi Miyazaki, Nobuhiro Hara, Yasutoshi Nagata, Toshihiro Nozato, Yuya Matsue
      Guideline-directed medical therapy (GDMT) is recommended for patients with heart failure with reduced ejection fraction (HFrEF). However, the prognostic impact of medication optimization at the time of discharge in patients hospitalized with heart failure (HF) is unclear. We analyzed 534 patients (73 ± 13 years old) with HFrEF. The status of GDMT at the time of discharge (prescription of angiotensin converting enzyme inhibitor [ACE-I]/angiotensin receptor blocker [ARB] and β blocker [BB]) and its association with 1-year all-cause mortality and HF readmission were investigated. Patients were divided into 3 groups: those treated with both ACE-I/ARB and BB (Both group: n = 332, 62%), either ACE-I/ARB or BB (Either group: n = 169, 32%), and neither ACE-I/ARB nor BB (None group: n = 33, 6%), respectively. One-year mortality, but not 1-year HF readmission rate, was significantly different in the 3 groups, in favor of the Either and Both groups. A favorable impact of being on GDMT at the time of discharge on 1-year mortality was retained even after adjustment for covariates (Either group: hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.21 to 0.90, p = 0.025 and Both group: HR 0.29, 95% CI 0.13–0.65, p = 0.002, vs None group). For 1-year HF readmission, no such association was found. In conclusion, optimization of GDMT before the time of discharge was associated with a lower 1-year mortality, but not with HF readmission rate, in patients hospitalized with HFrEF.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.01.006
       
  • Prognostic Significance and Clinical Utility of Intraventricular
           Conduction Delays on the Preoperative Electrocardiogram
    • Authors: Karl M. Richardson; Sharon T. Shen; Deepak K. Gupta; Quinn S. Wells; Jesse M. Ehrenfeld; Jonathan P. Wanderer
      Pages: 997 - 1003
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Karl M. Richardson, Sharon T. Shen, Deepak K. Gupta, Quinn S. Wells, Jesse M. Ehrenfeld, Jonathan P. Wanderer
      The prognostic significance of the preoperative electrocardiogram (ECG), particularly intraventricular conduction delays (IVCDs), on postoperative outcomes among patients undergoing noncardiac surgery is uncertain. In a retrospective cohort, we evaluated the risk associated with preoperative IVCDs on in-hospital death and postoperative myocardial infarction (POMI). The 152,479 patients who underwent noncardiac surgery were categorized by preoperative electrocardiographic findings: normal (36.1%), left bundle branch block (LBBB, 1.2%), right bundle branch block (2.9%), nonspecific IVCD (3.3%), and any other ECG abnormality (56.5%). The primary and secondary outcomes were postoperative in-hospital mortality and POMI, respectively. In multivariable-adjusted models, compared with normal ECGs, each electrocardiographic abnormality category was associated with increased risk of postoperative death: LBBB odds ratio (OR) 1.89 (95% confidence interval [CI] 1.35 to 2.65), right bundle branch block OR 1.73 (95% CI 1.33 to 2.24), nonspecific IVCD OR 1.95 (95% CI 1.53 to 2.48), and other abnormal ECG OR 1.94 (95% CI 1.68 to 2.25). ECGs with conduction delays did not confer increased risk of postoperative death compared with other ECG abnormalities. Moreover, receiver operating characteristic analysis of models incorporating demographic and co-morbidity data demonstrated marginal additive benefit of any electrocardiographic data. Risk of POMI was not significantly increased among ECGs with conduction delays compared with both normal and other abnormal ECGs. In conclusion, patients with intraventricular conduction disease, including LBBB, on preoperative ECG are not at greater risk of postoperative in-hospital death or POMI compared with patients with other ECG abnormalities. Furthermore, any preoperative electrocardiographic abnormalities, including intraventricular delays, provide marginal clinical utility beyond demographic and clinical history for predicting postoperative in-hospital death or POMI.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.01.009
       
  • Frequency of Electrocardiographic Abnormalities in Patients With Psoriasis
    • Authors: Peter Riis Hansen; Christian Rimer Juhl; Jonas Lynggaard Isaksen; Gregor Borut Jemec; Christina Ellervik; Jørgen Kim Kanters
      Pages: 1004 - 1007
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Peter Riis Hansen, Christian Rimer Juhl, Jonas Lynggaard Isaksen, Gregor Borut Jemec, Christina Ellervik, Jørgen Kim Kanters
      Psoriasis is a chronic inflammatory disease associated with cardiovascular disease, for example, myocardial infarction, stroke, cardiovascular death, and arrhythmias. The resting electrocardiogram may carry prognostic information, but limited evidence is available of electrocardiographic findings in subjects with psoriasis. The electrocardiographic results were compared between 1,131 subjects with self-reported psoriasis and 18,397 controls participating in the Danish General Suburban Population Study (GESUS). The mean heart rate was marginally increased in patients with psoriasis (66 ± 11 vs 65 ± 11 beats/min, p = 0.007), but not after adjustment for smoking and body mass index. All other examined electrocardiographic variables, including QT interval corrected for heart rate with the Fridericia formula, PR interval, QRS duration, R axis, P-wave duration in lead V1, P-terminal force, J point elevation in lead V1, electrocardiographic criteria for left ventricular hypertrophy, electrocardiographic signs of previous myocardial infarction, and premature ventricular or supraventricular complexes, respectively, were comparable between the 2 groups. In conclusion, psoriasis was associated with a marginal increase in resting heart rate, which was driven by smoking and increased body mass index. All other examined electrocardiographic variables were similar between the 2 groups. The results suggest that psoriasis per se is not associated with significant abnormalities of the electrocardiogram.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2017.12.045
       
  • Is It Fair to Screen Only Competitive Athletes for Sudden Death Risk, or
           Is It Time to Level the Playing Field'
    • Authors: Barry J. Maron; N.A. Mark Estes; Martin S. Maron
      Pages: 1008 - 1010
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Barry J. Maron, N.A. Mark Estes, Martin S. Maron


      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2017.12.043
       
  • Diagnosis and Management of Stress-Induced Cardiomyopathy in Cancer
           Patients
    • Authors: Mahmoud Abdelghany; Kan Liu
      First page: 1011
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Mahmoud Abdelghany, Kan Liu


      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.01.005
       
  • Anticoagulant Agents for Atrial Fibrillation in Cancer Patients
    • Authors: Marc Sorigue; Edurne Sarrate; Mireia Franch-Sarto; Mireia Santos-Gomez; Elisa Orna
      Pages: 1011 - 1012
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Marc Sorigue, Edurne Sarrate, Mireia Franch-Sarto, Mireia Santos-Gomez, Elisa Orna


      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2017.12.042
       
  • Not All Electrocardiographic Variants in Black Patients Can be Considered
           “Normal”
    • Authors: Brooks Walsh; Stephen W. Smith
      Pages: 1012 - 1013
      Abstract: Publication date: 15 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 8
      Author(s): Brooks Walsh, Stephen W. Smith


      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.01.008
       
  • Relation of Bleeding Events to Mortality in Patients With ST-Segment
           Elevation Myocardial Infarction Treated by Percutaneous Coronary
           Intervention (a DANAMI-3 Substudy)
    • Authors: Golnaz Sadjadieh; Thomas Engstrøm; Steffen Helqvist; Dan Eik Høfsten; Lars Køber; Frants Pedersen; Peter Nørkjær Laursen; Lars Nepper-Christensen; Peter Clemmensen; Ole Kristian Møller-Helgestad; Rikke Sørensen; Jan Ravkilde; Christian Juhl Terkelsen; Erik Jørgensen; Kari Saunamäki; Hans-Henrik Tilsted; Henning Kelbæk; Lene Holmvang
      Pages: 781 - 788
      Abstract: Publication date: 1 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 7
      Author(s): Golnaz Sadjadieh, Thomas Engstrøm, Steffen Helqvist, Dan Eik Høfsten, Lars Køber, Frants Pedersen, Peter Nørkjær Laursen, Lars Nepper-Christensen, Peter Clemmensen, Ole Kristian Møller-Helgestad, Rikke Sørensen, Jan Ravkilde, Christian Juhl Terkelsen, Erik Jørgensen, Kari Saunamäki, Hans-Henrik Tilsted, Henning Kelbæk, Lene Holmvang
      Bleeding events in relation to treatment of ST-segment elevation myocardial infarction (STEMI) have previously been associated with mortality. In this study, we investigated the incidence and prognosis of, and variables associated with serious bleedings within 30 days after primary percutaneous coronary intervention in patients from The Third Danish Study of Optimal Acute Treatment of Patients with ST-Segment Elevation Myocardial Infarction (DANAMI-3) (n = 2,217). Hospital charts were read within 30 days postadmission to assess bleeding events using thrombolysis in myocardial infarction (TIMI) and Bleeding Academic Research Consortium criteria. TIMI minor/major bleeding (TMMB) occurred in 59 patients (2.7%). Variables associated with TMMB were female gender (hazard ratio [HR] 3.9, 95% confidence interval [CI] 2.2 to 6.7, p <0.0001), symptom-to-catheterization time >3 hours (HR 1.9, 95% CI 1.1 to 3.3, p = 0.02), use of glycoprotein IIb/IIIa inhibitor (HR 2.1, 95% CI 1.2 to 3.7, p = 0.01), and increasing S-creatinine (HR 1.1, 95% CI 1.0 to 1.2, p = 0.001). Undergoing 2 in-hospital procedures were not associated with increased risk of TMMB. TMMB was strongly associated with 30-day mortality in multivariable analysis (HR 4.8, 95% CI 2.2 to 10.4, p <0.0001) but not with mortality days 31 to 365. When excluding fatal bleedings from the analysis, a TMMB was no longer associated with 30-day mortality. In conclusion, we found that in a contemporary STEMI-population, the incidence of 30-day TMMB was low. A TMMB was strongly associated with 30-day mortality but not with mortality days 31 to 365. If patients survived a serious bleeding, their short- and long-term prognoses were not affected.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2017.12.019
       
  • Relation of Age and Health-Related Quality of Life to Invasive Versus
           Ischemia-Guided Management of Patients with Non-ST Elevation Myocardial
           Infarction
    • Authors: Krishna K. Patel; Suzanne V. Arnold; Philip G. Jones; Mohammed Qintar; Karen P. Alexander; John A. Spertus
      Pages: 789 - 795
      Abstract: Publication date: 1 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 7
      Author(s): Krishna K. Patel, Suzanne V. Arnold, Philip G. Jones, Mohammed Qintar, Karen P. Alexander, John A. Spertus
      In older patients with non–ST-elevation myocardial infarction, an initial invasive strategy reduces cardiovascular events compared with an ischemia-guided approach; however its association with health status outcomes is unknown. Among patients with non–ST-elevation myocardial infarction from 2 multicenter US acute myocardial infarction (AMI) registries, health status was assessed at baseline and at 1, 6, and 12 months after AMI using the Seattle Angina Questionnaire (SAQ) and the 12-item Short-Form Health Survey (SF-12). Routine invasive management was defined as coronary angiography within 72 hours of admission without a preceding stress test. Among 3,559 patients with NSTEMI, 2,455 (69.0%) were treated with routine invasive treatment, which was more common in younger patients. In propensity-adjusted analyses, invasive treatment was associated with higher SAQ physical limitation, angina frequency, and summary scores over the year after AMI; however, the differences were small (<5 points, all p <0.05). Although there was a trend toward worse health status in patients aged ≥85 years treated with an initial invasive treatment, the interaction between age and treatment for any health status measure (all p ≥0.09) was not significant, except for SF-12 physical component score (p = 0.02), where worse scores were observed with invasive treatment in patients 85 years or older. In conclusion, an initial invasive treatment for patients with NSTEMI is associated with a small benefit in health status of marginal clinical significance, mainly in younger patients. The oldest old group trended toward less health status benefit from a routine invasive strategy—results that will need to be confirmed in a larger study.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2017.12.034
       
  • Impact of Selective Aspiration Thrombectomy on Mortality in Patients With
           ST-Segment Elevation Myocardial Infarction
    • Authors: Istvan Hizoh; Gyongyver Banhegyi; Dominika Domokos; Zalan Gulyas; Laszlo Major; Robert Gabor Kiss
      Pages: 796 - 804
      Abstract: Publication date: 1 April 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 7
      Author(s): Istvan Hizoh, Gyongyver Banhegyi, Dominika Domokos, Zalan Gulyas, Laszlo Major, Robert Gabor Kiss
      Although routine aspiration thrombectomy (AT) is not recommended by the current American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guideline, for selected cases, a class IIb indication is given because of lack of data. We studied the impact of selective AT on mortality in patients with ST-segment elevation myocardial infarction using a prospective registry. We analyzed data of 1,255 patients, of whom 535 underwent AT based on operator's decision. Separate propensity score matching procedures were performed including all patients and only those with initial TIMI (Thrombolysis In Myocardial Infarction) 0 to 1 flow, indicating the highest thrombus burden. Primary outcome measure was time to all-cause death at 1 year. Both studies were sufficiently powered to detect the hazard ratio (HR) of 0.52 seen in the TAPAS (Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study) trial. In the study with open inclusion criteria, 1-year mortality rates were 15.5% and 14.5% in the AT and conventional percutaneous coronary intervention arm, respectively (p = 0.77). The unadjusted HR was 1.05 (95% CI 0.73 to 1.51), p = 0.80, whereas the adjusted HR was 0.97 (95% CI 0.66 to 1.41), p = 0.87. In patients with initial TIMI 0 to 1 flow, mortality rate at 1 year was 15.6% in the AT and 16.7% in the standard percutaneous coronary intervention group (p = 0.76). The unadjusted and adjusted HRs were similar: 0.91 (95% CI 0.62 to 1.34), p = 0.65 and 0.93 (95% CI 0.62 to 1.37), p = 0.70, respectively. In conclusion, selective AT based on operator's discretion offers no mortality benefit of the magnitude detected in the TAPAS trial, even for patients with initial TIMI 0 to 1 flow grade.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2017.12.033
       
  • Relation of Early Repolarization (J-Point Elevation) to Mortality in
           Blacks (From the Jackson Heart Study)
    • Authors: Jacob P. Kelly; Melissa Greiner; Elsayed Z. Soliman; Tiffany C. Randolph; Kevin L. Thomas; Shannon M. Dunlay; Lesley H. Curtis; Emily C. O'Brien; Robert J. Mentz
      Abstract: Publication date: Available online 12 April 2018
      Source:The American Journal of Cardiology
      Author(s): Jacob P. Kelly, Melissa Greiner, Elsayed Z. Soliman, Tiffany C. Randolph, Kevin L. Thomas, Shannon M. Dunlay, Lesley H. Curtis, Emily C. O'Brien, Robert J. Mentz
      Conflicting data exist regarding the associations of early repolarization (ER) with electrocardiogram (ECG) and clinical outcomes in blacks. We examined the association of ER defined by JPE and all-cause mortality as well as heart failure (HF) hospitalization in Blacks in the Jackson Heart Study (JHS) cohort. We included JHS participants with ECGs obtained at the baseline visit coding J-point amplitude (JAMP) and excluded participants with paced rhythms or QRS duration ≥120 ms. JAMP was measured from standardized and digitally recorded ECGs. We compared the cumulative incidence of 10-year all-cause mortality and 8-year HF hospitalization by presence of JPE ≥ 0.1 mV in any ECG lead at baseline using Kaplan-Meier estimates and multivariable Cox models. Of the 4978 participants, 1410 (28%) had JPE at baseline: anterior leads 1,379 (97.8%), lateral leads 117 (8.3%), and inferior leads 41 (2.9%). Compared with participants without JPE, those with JPE were younger, more likely to be male and current smokers, and less likely to have hypertension. Over a median follow-up of 8 years, there were no significant differences in the cumulative incidence or multivariable-adjusted hazards of all-cause mortality or HF hospitalization in participants with and without JPE in any lead (adjusted HR 0.97, 95% confidence interval (CI) 0.89 – 1.52, and adjusted HR 1.18, 95% CI 0.9 – 1.54, respectively). Of 2523 participants who completed exam 3 and did not have JPE at baseline, 246 (10%) developed JPE over follow-up. In conclusion, JPE on ECG was not associated with long-term mortality or HF hospitalization in a large prospective Black community cohort suggesting that ER may represent a benign ECG finding in Blacks.

      PubDate: 2018-04-15T07:52:02Z
      DOI: 10.1016/j.amjcard.2018.04.004
       
  • Novel Echocardiographic Parameters in Patients with Aortic Stenosis and
           Preserved Left Ventricular Systolic Function Undergoing Surgical Aortic
           Valve Replacement
    • Authors: Chetan P. Huded; Kenya Kusunose; Fatima Shahid; Andrew L. Goodman; Alaa Alashi; Richard A. Grimm; A. Marc Gillinov; Douglas R. Johnston; L. Leonardo Rodriguez; Zoran B. Popovic; Kimi Sato; Lars G. Svensson; Brian P. Griffin; Milind Y. Desai
      Abstract: Publication date: Available online 12 April 2018
      Source:The American Journal of Cardiology
      Author(s): Chetan P. Huded, Kenya Kusunose, Fatima Shahid, Andrew L. Goodman, Alaa Alashi, Richard A. Grimm, A. Marc Gillinov, Douglas R. Johnston, L. Leonardo Rodriguez, Zoran B. Popovic, Kimi Sato, Lars G. Svensson, Brian P. Griffin, Milind Y. Desai
      We sought to study the incremental prognostic impact of baseline valvuloarterial impedance (Zva) and left ventricular global longitudinal strain (LV-GLS) in patients with severe AS and preserved LV ejection fraction (LVEF) treated with surgical aortic valve replacement (AVR). We included 961 consecutive patients (68±13 years; 63% men) with severe AS (indexed AV area < 0.6cm2) and LVEF > 50% who underwent surgical AVR at our institution between 1/07 and 12/08. The analysis is based on derivation (n=637) and validation (n=324) subgroups. Society of Thoracic Surgeons (STS) score was calculated. Zva (systolic arterial pressure+mean AV gradient)/ LV stroke volume index and LV-GLS (measured offline using Velocity Vector Imaging, Siemens) were calculated. Primary outcome was death. Median Zva and LV-GLS were 4.5 mm Hg*ml-1*m2 and -14.5%, respectively. AVR was performed at a median of 34 days from initial evaluation (isolated AVR in 46%, bioprosthetic AVR in 93%). At 7.5±3 years, 320 (33%) died (30-day/in-hospital death in 0.5%). In the derivation subgroup, on multivariate Cox survival analysis, higher STS score (Hazard ratio or HR 1.06), higher Zva (HR 1.13) and worse LV-GLS (HR 1.07) were independently associated with long-term survival (all p<0.01). When Zva and LV-GLS were sequentially added to STS score, the c-statistic improved from 0.63 [0.55-0.77] to 0.70 [0.60-0.81] and 0.78 [0.69-0.83], respectively, all p<0.001). Findings were confirmed in the validation subgroup. In conclusion, in patients with severe AS and preserved LVEF treated with surgical AVR, baseline Zva and LV-GLS provide improved risk stratification and provide synergistic prognostic value.

      PubDate: 2018-04-15T07:52:02Z
      DOI: 10.1016/j.amjcard.2018.03.359
       
  • Effect of Serum C-Reactive Protein Level on Admission to Predict Mortality
           after Transcatheter Aortic Valve Implantation
    • Authors: Hirofumi Hioki; Yusuke Watanabe; Ken Kozuma; Masanori Yamamoto; Toru Naganuma; Motoharu Araki; Norio Tada; Shinichi Shirai; Futoshi Yamanaka; Akihiro Higashimori; Kazuki Mizutani; Minoru Tabata; Kensuke Takagi; Hiroshi Ueno; Kentaro Hayashida
      Abstract: Publication date: Available online 12 April 2018
      Source:The American Journal of Cardiology
      Author(s): Hirofumi Hioki, Yusuke Watanabe, Ken Kozuma, Masanori Yamamoto, Toru Naganuma, Motoharu Araki, Norio Tada, Shinichi Shirai, Futoshi Yamanaka, Akihiro Higashimori, Kazuki Mizutani, Minoru Tabata, Kensuke Takagi, Hiroshi Ueno, Kentaro Hayashida
      The relationship between C-reactive protein (CRP) level on admission and mortality after transcatheter aortic valve implantation (TAVI) remains unclear. To evaluate the impact of serum CRP level on mortality after TAVI, we assessed 1016 TAVI patients with CRP and 538 TAVI patients with high-sensitive CRP (hs-CRP) level on admission in the OCEAN (Optimized transCathEter vAlvular interveNtion)-TAVI registry. Study population was stratified into two groups (high/low), according to the median of CRP and hs-CRP on admission. We assessed the impact of high CRP and hs-CRP level on all-cause death after TAVI. During 2-year follow-up, all-cause death after TAVI was 9.4% in patients with CRP and 11.9% in patients with hs-CRP. Median value of serum CRP was 0.10mg/dL in both CRP and hs-CRP. Patients with high CRP (> 0.10mg/dL) had significantly higher incidence of all-cause death compared to those with low CRP (11.5% vs. 7.6%, log-rank P = 0.015). Multivariate Cox regression analysis with a time-varying covariate demonstrated that high CRP was an independent predictor of all-cause death within the first 3-month (HR, 2.78; 95%CI, 1.30–5.95) compared to from 3-month onward to 2-year (HR, 0.80; 95%CI, 0.47–1.36) (P for interaction = 0.008). Inversely, these results were not observed in the stratification using hs-CRP on admission. In conclusions, high CRP on admission was significantly associated with an increased risk of all-cause death after TAVI, particularly within the first 3-month after TAVI. Risk stratification using CRP may be a simple and useful strategy to identify high-risk patients who undergo TAVI.

      PubDate: 2018-04-15T07:52:02Z
      DOI: 10.1016/j.amjcard.2018.04.005
       
  • Prevalence of Ideal Cardiovascular Health Metrics in the Million Veteran
           Program
    • Authors: Xuan-Mai T. Nguyen; Rachel M. Quaden; Sarah Wolfrum; Rebecca J. Song; Joseph Q. Yan; David R. Gagnon; Peter W.F. Wilson; Kelly Cho; Christopher O'Donnell; J. Michael Gaziano; Luc Djousse
      Abstract: Publication date: Available online 12 April 2018
      Source:The American Journal of Cardiology
      Author(s): Xuan-Mai T. Nguyen, Rachel M. Quaden, Sarah Wolfrum, Rebecca J. Song, Joseph Q. Yan, David R. Gagnon, Peter W.F. Wilson, Kelly Cho, Christopher O'Donnell, J. Michael Gaziano, Luc Djousse
      No data exist on the prevalence of ideal cardiovascular health metrics in a national sample of US veterans. We assessed the prevalence of ideal Life's Simple Seven (LSS) metrics in a cross-sectional study of 554,855 US veterans enrolled in the Million Veteran Program (MVP) from 2011-2017. We used the American Heart Association's established criteria to categorize each LSS metric as either poor, intermediate or ideal for a veteran at time of MVP enrollment. Information on adiposity/BMI, smoking status, diet and physical activity was obtained from self-reported survey data and clinical measurements for total cholesterol, blood pressure and plasma glucose were obtained from electronic health records. Complete data on all LSS health factors were available for 201,745 veterans. The prevalence of having 0, 1, 2, 3, 4, 5, 6, and 7 ideal cardiovascular health metrics was 29.2%, 34.6%, 22.6%, 10.0%, 3.0%, 0.6%, <0.1%, and 0%, respectively. The frequency of ideal BMI, physical activity, smoking status, total cholesterol, blood pressure, and plasma glucose was 19.4%, 3.8%, 27.0%, 21.8%, 17.8%, and 34.5%, respectively, in our study population. Among the seven metrics, MVP participants were least likely to achieve ideal diet (0.4%), particularly the recommendation for fruit and vegetable (at least 4.5cups/day) intake. Our data show an extremely low prevalence of ideal cardiovascular health factors among veterans in the MVP, especially for diet and physical activity. These findings underscore the need to improve adherence to modifiable lifestyle factors which could result in subsequent reduction in CVD burden among veterans.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.04.002
       
  • Effect of the Metabolic Syndrome on Outcomes in Patients Aged <50 Years
           Versus >50 Years with Acute Myocardial Infarction
    • Authors: Inna Kim; Min Chul Kim; Doo Sun Sim; Young Joon Hong; Ju Han Kim; Myung Ho Jeong; Jeong Gwan Cho; Jong Chun Park; Ki-Bae Seung; Kiyuk Chang; Youngkeun Ahn
      Abstract: Publication date: Available online 11 April 2018
      Source:The American Journal of Cardiology
      Author(s): Inna Kim, Min Chul Kim, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park, Ki-Bae Seung, Kiyuk Chang, Youngkeun Ahn
      The presence of the metabolic syndrome (MS) is associated with an increased risk of cardiovascular disease morbidity and mortality. And, data are lacking on the association of MS with clinical outcomes in young adults with acute myocardial infarction (AMI). This study was a retrospective analysis of 2082 patients with AMI who underwent percutaneous coronary intervention. The term young was defined as age <50 years. The prevalence of patients aged <50 years was 18.4%. Among those patients, 43.4% had the MS. The highest incidence of long-term major adverse cardiac and cerebral events (MACCEs) were in old patients without MS (30.7% in young patients with MS, 22.2% in young patients without MS, 38.4% in old patients with MS, and 40.4% in old patients without MS, p<0.001). However, recurrent AMI (re-AMI) was the highest in young AMI patients with MS (4.8%, 1.4%, 2.1%, 1.5%, p=0.035, respectively). In Kaplan-Meier curve young AMI patients with MS tend to have highest incidence of re-AMI (p=0.050). The presence of MS in young AMI patients was an independent predictor of 6-year MACCE (HR: 3.320; 95% CI: 1.073 to10.283; p=0.038) and re-AMI (HR: 7.782; 95% CI: 1.290 to 45.298; p=0.022). In conclusion, almost half of young AMI patients had MS. The young AMI patients with MS had the highest incidence of re-AMI compared with the other groups. Aggressive pharmacological intervention and lifestyle modification are needed for the management of AMI in young patients with MS.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.03.366
       
  • Usefulness of a Simple Algorithm to Identify Hypertensive Patients Who
           Benefit From Intensive Blood Pressure Lowering
    • Authors: Shidan Wang; Rohan Khera; Sandeep R. Das; Rebecca Vigen; Tao Wang; Xin Luo; Rong Lu; Xiaowei Zhan; Guanghua Xiao; Wanpen Vongpatanasin; Yang Xie
      Abstract: Publication date: Available online 11 April 2018
      Source:The American Journal of Cardiology
      Author(s): Shidan Wang, Rohan Khera, Sandeep R. Das, Rebecca Vigen, Tao Wang, Xin Luo, Rong Lu, Xiaowei Zhan, Guanghua Xiao, Wanpen Vongpatanasin, Yang Xie
      Large randomized trials have provided inconsistent evidence regarding the benefit of intensive blood pressure (BP) lowering in hypertensive patients. Identifying which patients derive a higher net benefit is essential in informing clinical decision-making. We used patient-level data from two trials that tested intensive vs. standard BP lowering: SPRINT and ACCORD, to assess whether stratification by cardiovascular disease (CVD) risk will identify patients with a more favorable risk/benefit profile for intensive BP lowering. Within SPRINT, we selected a subset of patients at the extremes of major adverse cardiovascular event (MACE) rates to develop a decision-tree using recursive partitioning modeling. We then validated its predictive effects in the remaining ‘intermediate’ SPRINT subset (n=8,357) and externally in ACCORD (n=2,258). Recursive partitioning produced a three-variable decision-tree model consisting of age≥74 years, urinary albumin/creatinine ratio (UACR) ≥34, and history of clinical CVD. It classified 48.6% of SPRINT and 55.3% of ACCORD patients as “high-risk”. Compared with standard treatment, intensive BP lowering was associated with lower rates of MACE in this high-risk population in both SPRINT cross-validation data (HR=0.66, 95% CI 0.52-0.85) and ACCORD (HR=0.67, 95% CI 0.50-0.90), but not in the remaining low-risk patients (SPRINT: HR=0.83, 95% CI 0.56-1.25; ACCORD: HR=1.09, 95% CI 0.64-1.83). Additionally, intensive BP lowering did not confer an excess risk of serious adverse events in the high-risk group. In conclusion, this simple risk prediction model consisting of age, UACR, and clinical CVD history successfully identified a subset of hypertensive patients who derived a more favorable risk/benefit profile for intensive BP lowering.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.03.361
       
  • Usefulness of Electrocardiographic Left Atrial Abnormality to Predict
           Response to Cardiac Resynchronization Therapy in Patients with Mild Heart
           Failure and Left Bundle Branch Block (a MADIT-CRT Sub-Study)
    • Authors: Maria A. Baturova; Valentina Kutyifa; Scott McNitt; Bronislava Polonsky; Scott Solomon; Wojciech Zareba; Pyotr G. Platonov
      Abstract: Publication date: Available online 11 April 2018
      Source:The American Journal of Cardiology
      Author(s): Maria A. Baturova, Valentina Kutyifa, Scott McNitt, Bronislava Polonsky, Scott Solomon, Wojciech Zareba, Pyotr G. Platonov
      Cardiac resynchronization therapy (CRT) has proven prognostic benefit in heart failure (HF) patients with left bundle branch block (LBBB) QRS morphology. Electrocardiographic left atrial (LA) abnormality has been proposed as a non-invasive marker of atrial remodeling. We aimed to assess the impact of electrocardiographic LA abnormality for prognosis in HF patients treated with CRT. Baseline resting 12-lead ECG recorded from 941 patients enrolled in the CRT-arm of the MADIT-CRT trial were processed automatically using Glasgow algorithm, which included automated assessment of P-wave terminal force in lead V1 (PTF-V1) as a marker of LA abnormality. PTF-V1≥0.04 mm*s was considered abnormal. The primary endpoint was HF event and/or death. Total mortality and appropriate defibrillator therapies were the secondary endpoints. At baseline 550 patients treated with CRT-D had LBBB QRS morphology and normal PTF-V1. Normal PTF-V1 was associated with significant risk reduction for all assessed endpoints and for the primary endpoint comprised HR 0.55 (95%CI 0.36-0.84) compared to LBBB patients with abnormal PTF-V1 (n=120); and HR 0.42 (95%CI 0.32-0.55) compared to patients with implanted defibrillator (n=729). In CRT-treated patients with HF, electrocardiographic LA abnormality appears to be an ECG indicator of poor long-term outcome among patients with LBBB. In conclusion, our data suggest that PTF-V1 bears additive prognostic information in the context of CRT therapy thus further strengthening the role of ECG diagnostics in risk stratification of patients with HF.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.03.364
       
  • Sudden Death Following Hospitalization for Heart Failure with Reduced
           Ejection Fraction (From the EVEREST Trial)
    • Authors: Muthiah Vaduganathan; Ravi B. Patel; Robert J. Mentz; Haris Subacius; Neal A. Chatterjee; Stephen J. Greene; Andrew P. Ambrosy; Aldo P. Maggioni; James E. Udelson; Karl Swedberg; Marvin A. Konstam; Christopher M. O'Connor; Javed Butler; Mihai Gheorghiade; Faiez Zannad
      Abstract: Publication date: Available online 11 April 2018
      Source:The American Journal of Cardiology
      Author(s): Muthiah Vaduganathan, Ravi B. Patel, Robert J. Mentz, Haris Subacius, Neal A. Chatterjee, Stephen J. Greene, Andrew P. Ambrosy, Aldo P. Maggioni, James E. Udelson, Karl Swedberg, Marvin A. Konstam, Christopher M. O'Connor, Javed Butler, Mihai Gheorghiade, Faiez Zannad
      Patients with chronic heart failure with reduced ejection fraction (HFrEF) benefit from medical and device therapies targeting sudden cardiac death (SCD). Contemporary estimates of SCD risk after hospitalization for HF are limited. We describe the incidence, timing, and clinical predictors of SCD following hospitalization for HFrEF (≤40%) in the EVEREST trial. Multiple logistic regression analyses tested >30 baseline covariates (including treatment randomization, demographics, comorbid conditions, natriuretic peptides, EF, medical and device therapies) to identify predictors of 1-year SCD. Of the 4,024 (97%) trial patients discharged alive, there were 268 (7%) SCD and 703 (17%) non-SCD deaths during median 9.9 months follow-up. Implantable cardioverter-defibrillator use at baseline was 14.5%. Estimates of SCD at 1-, 3-, 6-, and 12-months were 0.8%, 2.3%, 4.1%, and 7.4%, respectively. Most patients were readmitted prior to SCD (n=147, 55%). Male sex, black race, diabetes mellitus, and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use were potential predictors of 1-year SCD following hospitalization for HFrEF (all P<0.10), however this final model demonstrated poor discrimination (C-statistic 0.57). In conclusion, in EVEREST, patients hospitalized for HFrEF faced risks of 1-year post-discharge SCD of 7%, which accrued gradually over time, and were balanced with high competing risks of non-sudden death (17%). Traditional clinical characteristics fail to adequately predict SCD risk. Further data are needed to identify patients at greatest relative risk for SCD (compared with non-SCD) after hospitalization for HFrEF.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.03.362
       
  • Markers of Reperfusion and Long-Term (8-Year) Prognosis after Primary
           Percutaneous Coronary Intervention
    • Authors: Gjin Ndrepepa; Robert A. Byrne; Salvatore Cassese; Massimiliano Fusaro; Roisin Colleran; Julia Hieber; Karl-Ludwig Laugwitz; Heribert Schunkert; Adnan Kastrati
      Abstract: Publication date: Available online 9 April 2018
      Source:The American Journal of Cardiology
      Author(s): Gjin Ndrepepa, Robert A. Byrne, Salvatore Cassese, Massimiliano Fusaro, Roisin Colleran, Julia Hieber, Karl-Ludwig Laugwitz, Heribert Schunkert, Adnan Kastrati
      Thrombolysis in Myocardial Infarction (TIMI) flow, myocardial perfusion grade (MPG) and infarct size are established markers of reperfusion in ST-segment elevation myocardial infarction (STEMI) patients. Whether these markers provide long-term prognostic information remains unknown. This study included 1406 patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Post-reperfusion TIMI flow, MPG and infarct size (evaluated by scintigraphy at 7-14 days) were measured. The primary outcome was 8-year mortality. Overall there were 190 deaths. The Kaplan-Meier estimates of mortality were 22.6% (37 deaths) and 16.8% (153 deaths) according to TMI flow ≤2 and TMI flow 3 (adjusted hazard ratio [HR]=0.82, 95% confidence interval [CI] 0.66 to 1.00, P=0.058 for 1 grade increment), 21.6% (106 deaths) and 14.5% (84 deaths) according to MPG≤2 and MPG 3 (adjusted HR=0.87 [0.77-0.98], P=0.020 for 1 grade increment) and 21.7% (115 deaths) and 13.7% (75 deaths) according to infarct size >10% (median value) and infarct size ≤10% of the left ventricle (adjusted HR=1.08 [1.03-1.13], P=0.001, for 5% of left ventricle increment in infarct size). The C statistic of the model for all-cause mortality was 0.810 [0.781-0.839] with baseline variables, 0.812 [0.783-0.841] after incorporation of TIMI flow (P for significance compared to the model with baseline variables =0.140), 0.813 [0.784-0.841] after incorporation of MPG (P=0.345) and 0.815 [0.786-0.842] after incorporation of infarct size (P=0.08). In conclusion, markers of reperfusion independently predict long-term mortality after primary PCI but offer limited incremental prognostic value to that provided by evaluation of baseline cardiovascular risk factors and clinical data.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.03.353
       
  • Mortality Risk Stratification in Small Patient Cohorts; the Heart
           Transplant Post Fontan Paradigm
    • Authors: Stavros Polyviou; John O'Sullivan; Asif Hasan; Louise Coats
      Abstract: Publication date: Available online 6 April 2018
      Source:The American Journal of Cardiology
      Author(s): Stavros Polyviou, John O'Sullivan, Asif Hasan, Louise Coats


      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.03.021
       
  • Functional Classes of Heart Failure and Indications for Implantable
           Cardioverter-Defibrillator
    • Authors: Maya Guglin
      Abstract: Publication date: Available online 3 April 2018
      Source:The American Journal of Cardiology
      Author(s): Maya Guglin


      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.03.029
       
  • Predictors of Obstructive Coronary Disease and Mortality in Adults Having
           Cardiac Arrest
    • Authors: Jignesh K. Patel; Ganesh Thippeswamy; Abdo Kataya; Charles A. Loeb; Puja B. Parikh
      Abstract: Publication date: Available online 3 April 2018
      Source:The American Journal of Cardiology
      Author(s): Jignesh K. Patel, Ganesh Thippeswamy, Abdo Kataya, Charles A. Loeb, Puja B. Parikh
      “Coronary angiography is a key component of systematic, multi-disciplinary post-cardiac arrest (CA) care, however, coronary angiogram is not routinely performed in the setting of CA. We sought to identify the predictors of obstructive coronary artery disease (CAD) and mortality in adults with CA undergoing coronary angiogram. The study population included 208 consecutive patients hospitalized with CA who underwent ACLS-guided resuscitation and subsequent coronary angiogram at an academic tertiary medical center. The primary outcome of interest was presence of obstructive CAD, defined as > 1 coronary artery with > 70% stenosis or > 1 coronary bypass graft with > 70% stenosis. The secondary outcome of interest was in-hospital mortality. Of the 208 patients studied, 160 (76.9%) had obstructive CAD while 48 (23.1%) did not. In-hospital mortality occurred in 47 patients (22.6%). In multivariate analysis, ST-elevation myocardial infarction (STEMI) (OR 7.69, 95% CI 2.89-20.51), defibrillation (OR 4.90, 95%CI 1.19-20.17), vasopressors (OR 3.53, 95%CI 1.15-10.81), and absence of therapeutic hypothermia (OR 0.38, 95%CI 0.15 – 0.98) were independently associated with presence of obstructive CAD while STEMI (OR 3.21, 95% CI 1.01–10.24), vasopressors (OR 4.92, 95%CI 1.78-13.62), therapeutic hypothermia (OR 3.89, 95%CI 1.47-10.31), and admission blood urea nitrogen (OR 1.06, 95%CI 1.00 – 1.11) were independently associated with higher rates of in-hospital mortality. In this observational contemporary study, predictors of obstructive CAD and mortality exist in adults with CA undergoing coronary angiogram. Such risk models may aid in identification of CA patients who will benefit from early angiography and percutaneous coronary intervention.”

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.03.023
       
  • Editorial: Robertsonian Perspectives on Atherosclerosis: the Power of
           Direct Observation
    • Authors: Peter A. McCullough
      Abstract: Publication date: Available online 3 April 2018
      Source:The American Journal of Cardiology
      Author(s): Peter A. McCullough


      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.02.019
       
  • Relation of Velocity Time Integral of the Left Ventricular Outflow Tract
           to That of the Descending Aorta and Usefulness of a Fixed Ratio for
           Internal Validation
    • Authors: Rupesh Ranjan; Erik M. Valez; Anshul Haldipur; Nelson B. Schiller
      Abstract: Publication date: Available online 3 April 2018
      Source:The American Journal of Cardiology
      Author(s): Rupesh Ranjan, Erik M. Valez, Anshul Haldipur, Nelson B. Schiller
      Measurement of left ventricular outflow tract (LVOT) velocity time integral (VTI) is technician, instrument and reader dependent; variability is more common for pulse (PWD) than continuous wave Doppler (CWD). We hypothesize that in a population with normal cardiac structure and function LVOT VTI is higher than VTI of the descending thoracic aorta (DTA) and this relationship may be used clinically to validate the former. Furthermore, the DTA VTI could also be used to estimate LVOT. We retrospectively compared the LVOT VTI against VTI measured from DTA, abdominal aorta (AA) and pulmonary artery among 108 healthy subjects. The ratio of LVOT VTI (n=108) to DTA VTI (n=108) was 1.27. There was a difference of 19.6% between LVOT VTI and DTA VTI with the former being higher. This percentage decrease in VTI from LVOT VTI to AA VTI was directly proportional to the LVOT VTI. Similarly, there was a difference of 23.4% in the VTI values obtained from DTA and AA. Moreover, there was a decrease of 40.4% when LVOT VTI was compared against AA VTI. The ratio of LVOT VTI to pulmonary VTI was 1.19. VTI values decrease in a linear fashion from the LVOT to AA likely due to progressive decrease in circulating volume and this change is not obscured by diminishing aortic diameter. Any deviation from this relationship should be treated as abnormal and prompt further investigation. Our findings support routine measurement of DTA VTI in clinical practice.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.03.017
       
  • Effects of Carvedilol Versus Metoprolol on Platelet Aggregation in
           Patients with Acute Coronary Syndrome: The PLATE-BLOCK Study
    • Authors: Federica Ilardi; Giuseppe Gargiulo; Gabriele Giacomo Schiattarella; Giuseppe Giugliano; Roberta Paolillo; Giovanni Menafra; Elena De Angelis; Laura Scudiero; Anna Franzone; Eugenio Stabile; Cinzia Perrino; Plinio Cirillo; Carmine Morisco; Raffaele Izzo; Valentina Trimarco; Giovanni Esposito
      Abstract: Publication date: Available online 3 April 2018
      Source:The American Journal of Cardiology
      Author(s): Federica Ilardi, Giuseppe Gargiulo, Gabriele Giacomo Schiattarella, Giuseppe Giugliano, Roberta Paolillo, Giovanni Menafra, Elena De Angelis, Laura Scudiero, Anna Franzone, Eugenio Stabile, Cinzia Perrino, Plinio Cirillo, Carmine Morisco, Raffaele Izzo, Valentina Trimarco, Giovanni Esposito
      Platelet aggregation plays a pivotal role in acute coronary syndromes (ACS). In this setting, beta-blockers (BB) are used to counteract catecholamines effects on heart. Circulating catecholamines can also potentiate platelet reactivity, mainly through α2- and β2-adrenoceptors on human platelets surface, thus BB may affect platelet aggregation, however, the effects of different BB on platelet aggregation in contemporary-treated ACS patients have been poorly investigated. One hundred ACS patients on dual antiplatelet therapy (DAPT) with aspirin and ticagrelor were randomized to receive treatment with carvedilol, a nonselective β-blocker (n=50), or metoprolol, a selective β1-blocker (n=50), at maximum tolerated dose. Light Transmittance Aggregometry was performed at randomization (T0), and at 30-day follow up (T30) and results were expressed as a percentage of maximum platelet aggregation (MPA). The primary endpoint was epinephrine-induced MPA at 30-day. Patients were predominantly males (80%) and mean age was 57.3±9.7 years. The two randomized groups were well-balanced for baseline characteristics. At T0, mean MPA was similar between the groups (18.96±9.05 vs 18.32±9.21 with epinephrine 10µM, 14.42±9.43 vs 15.98±10.08 with ADP 20µM and 13.26±9.83 vs 14.30±9.40 with ADP 10µM for carvedilol and metoprolol, respectively, all p=NS). At 30 days, platelet aggregation induced by epinephrine was significantly lower in carvedilol group than in metoprolol group (23.52±10.25 vs 28.72±14.37, p=0.04) with a trend toward the lower values of ADP-induced MPA (ADP 20µM: 19.42±13.84 vs 24.16±13.62, p=0.09; ADP 10µM: 19.12±12.40 vs 22.57±13.59, p=0.19). In conclusion, carvedilol, a nonselective BB, reduces residual platelet reactivity in ACS patients compared to the selective BB metoprolol.

      PubDate: 2018-04-12T07:44:34Z
      DOI: 10.1016/j.amjcard.2018.03.004
       
 
 
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