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Showing 1 - 200 of 3089 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 7)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 25, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 86, 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: 30, 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: 363, 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   (Followers: 1)
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: 228, 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   (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: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 24, 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: 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)
Acute Pain     Full-text available via subscription   (Followers: 13)
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: 6)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 132, 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: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, 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: 26, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
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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: 25, SJR: 2.215, h-index: 78)
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Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
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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: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, 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)
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Advances in Digestive Medicine     Open Access   (Followers: 7)
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: 45, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 26, 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: 43, 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: 51, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
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: 22, 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: 26)
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: 36, 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: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
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: 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: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 8, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
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: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
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: 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: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
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: 2, 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: 360, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
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: 44, 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: 330, 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: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 417, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 16, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 40, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 55, 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: 8)
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: 8, 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: 4, 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: 46, 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: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 40, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, 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: 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: 46, 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: 200, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 59, 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: 25, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 35, 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: 58, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 12)
Anales de Cirugia Vascular     Full-text available via subscription  
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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: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 166, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
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  

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Journal Cover American Journal of Cardiology
  [SJR: 2.063]   [H-I: 186]   [48 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9149 - ISSN (Online) 0002-9149
   Published by Elsevier Homepage  [3049 journals]
  • Doppler Versus Thermodilution-Derived Coronary Microvascular Resistance to
           Predict Coronary Microvascular Dysfunction in Patients With Acute
           Myocardial Infarction or Stable Angina Pectoris
    • Authors: Rupert P. Williams; Guus A. de Waard; Kalpa De Silva; Matthew Lumley; Kaleab Asrress; Satpal Arri; Howard Ellis; Awais Mir; Brian Clapp; Amedeo Chiribiri; Sven Plein; Paul F. Teunissen; Maurits R. Hollander; Michael Marber; Simon Redwood; Niels van Royen; Divaka Perera
      Pages: 1 - 8
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Rupert P. Williams, Guus A. de Waard, Kalpa De Silva, Matthew Lumley, Kaleab Asrress, Satpal Arri, Howard Ellis, Awais Mir, Brian Clapp, Amedeo Chiribiri, Sven Plein, Paul F. Teunissen, Maurits R. Hollander, Michael Marber, Simon Redwood, Niels van Royen, Divaka Perera
      Coronary microvascular resistance is increasingly measured as a predictor of clinical outcomes, but there is no accepted gold-standard measurement. We compared the diagnostic accuracy of 2 invasive indices of microvascular resistance, Doppler-derived hyperemic microvascular resistance (hMR) and thermodilution-derived index of microcirculatory resistance (IMR), at predicting microvascular dysfunction. A total of 54 patients (61 ± 10 years) who underwent cardiac catheterization for stable coronary artery disease (n = 10) or acute myocardial infarction (n = 44) had simultaneous intracoronary pressure, Doppler flow velocity and thermodilution flow data acquired from 74 unobstructed vessels, at rest and during hyperemia. Three independent measurements of microvascular function were assessed, using predefined dichotomous thresholds: (1) coronary flow reserve (CFR), the average value of Doppler- and thermodilution-derived CFR; (2) cardiovascular magnetic resonance (CMR) derived myocardial perfusion reserve index; and (3) CMR-derived microvascular obstruction. hMR correlated with IMR (rho = 0.41, p <0.0001). hMR had better diagnostic accuracy than IMR to predict CFR (area under curve [AUC] 0.82 vs 0.58, p <0.001, sensitivity and specificity 77% and 77% vs 51% and 71%) and myocardial perfusion reserve index (AUC 0.85 vs 0.72, p = 0.19, sensitivity and specificity 82% and 80% vs 64% and 75%). In patients with acute myocardial infarction, the AUCs of hMR and IMR at predicting extensive microvascular obstruction were 0.83 and 0.72, respectively (p = 0.22, sensitivity and specificity 78% and 74% vs 44% and 91%). We conclude that these 2 invasive indices of coronary microvascular resistance only correlate modestly and so cannot be considered equivalent. In our study, the correlation between independent invasive and noninvasive measurements of microvascular function was better with hMR than with IMR.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.012
  • Experience With an On-Site Coronary Computed Tomography-Derived Fractional
           Flow Reserve Algorithm for the Assessment of Intermediate Coronary
    • Authors: Patrick M. Donnelly; Márton Kolossváry; Júlia Karády; Peter A. Ball; Stephanie Kelly; Donna Fitzsimons; Mark S. Spence; Csilla Celeng; Tamás Horváth; Bálint Szilveszter; Hendrik W. van Es; Martin J. Swaans; Béla Merkely; Pál Maurovich-Horvat
      Pages: 9 - 13
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Patrick M. Donnelly, Márton Kolossváry, Júlia Karády, Peter A. Ball, Stephanie Kelly, Donna Fitzsimons, Mark S. Spence, Csilla Celeng, Tamás Horváth, Bálint Szilveszter, Hendrik W. van Es, Martin J. Swaans, Béla Merkely, Pál Maurovich-Horvat
      Fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) is a new technique for the diagnosis of ischemic coronary artery stenoses. The aim of this prospective study was to evaluate the diagnostic performance of a novel on-site computed tomography-based fractional flow reserve algorithm (CT-FFR) compared with invasive FFR as the gold standard, and to determine whether its diagnostic performance is affected by interobserver variations in lumen segmentation. We enrolled 44 consecutive patients (64.6 ± 8.9 years, 34% female) with 60 coronary atherosclerotic lesions who underwent coronary CTA and invasive coronary angiography in 2 centers. An FFR value ≤0.8 was considered significant. Coronary CTA scans were evaluated by 2 expert readers, who manually adjusted the semiautomated coronary lumen segmentations for effective diameter stenosis (EDS) assessment and on-site CT-FFR simulation. The mean CT-FFR value was 0.77 ± 0.15, whereas the mean EDS was 43.6 ± 16.9%. The sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR versus EDS with a cutoff of 50% were the following: 91%, 72%, 63%, and 93% versus 52%, 87%, 69%, and 77%, respectively. The on-site CT-FFR demonstrated significantly better diagnostic performance compared with EDS (area under the curve 0.89 vs 0.74, respectively, p <0.001). The CT-FFR areas under the curve of the 2 readers did not show any significant difference (0.89 vs 0.88, p = 0.74). In conclusion, on-site CT-FFR simulation is feasible and has better diagnostic performance than anatomic stenosis assessment. Furthermore, the diagnostic performance of the on-site CT-FFR simulation algorithm does not depend on the readers' semiautomated lumen segmentation adjustments.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.018
  • Long-Term Results of High-Intensity Exercise-Based Cardiac Rehabilitation
           in Revascularized Patients for Symptomatic Coronary Artery Disease
    • Authors: Birgitta Blakstad Nilsson; Pernille Lunde; Haakon Kiil Grøgaard; Inger Holm
      Pages: 21 - 26
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Birgitta Blakstad Nilsson, Pernille Lunde, Haakon Kiil Grøgaard, Inger Holm
      Exercise capacity is a strong predictor of survival rate in patients with and without coronary artery disease. Exercise-based cardiac rehabilitation (CR) with improvements in the peak oxygen uptake (VO2peak) of 3.5 ml/kg/min or more has been shown to be beneficial in earlier observational studies. Long-term results on VO2peak after CR are rare. The aim of this study was to assess if a 12-week outpatient CR program including high-intensity interval training would preserve or improve VO2peak 15 months after CR entry. A total of 133 coronary patients attended the CR program (the Norwegian Ullevaal model). At baseline, at the end of the program, and after 15 months, the patients were evaluated with a cardiopulmonary exercise test, body mass index, blood pressure, self-reported exercise habits, and quality of life (the COOP-WONCA questionnaire). Long-term outcomes were available for 86 patients (65 %). The mean age was 57 ± 9 years and 87% were men. VO2peak improved significantly from baseline (31.9 ± 7.6 ml/kg/min) to program end (35.9 ± 8.6 ml/kg/min) (p <0.001), and further progress was seen at the long-term follow-up (36.8 ± 9.2 ml/kg/min) (p <0.05). COOP-WONCA was significantly enhanced in all domains (p <0.001) with a meaningful clinical improvement in “physical fitness” from baseline to long-term follow-up. In conclusion, at follow-up, the patients still exercised (mean 2.5 ± 1 times per week) and had improved or preserved their VO2peak and quality of life.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.011
  • Incidence of Left Ventricular Thrombus in Patients With Acute ST-Segment
           Elevation Myocardial Infarction Treated with Percutaneous Coronary
    • Authors: Tiffany F. Mao; Ata Bajwa; Preetham Muskula; Tina R. Coggins; Kevin Kennedy; Anthony Magalski; David G. Skolnick; Michael L. Main
      Pages: 27 - 31
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Tiffany F. Mao, Ata Bajwa, Preetham Muskula, Tina R. Coggins, Kevin Kennedy, Anthony Magalski, David G. Skolnick, Michael L. Main
      Previous studies using 2-dimensional non-contrast echocardiography have reported a post-ST segment elevation myocardial infarction (STEMI) left ventricular (LV) thrombus incidence of 3% to 24%. However, these studies were not performed with ultrasound contrast agents (UCAs), which improve accuracy in the diagnosis of LV thrombus. We aimed to determine the early incidence and clinical correlates of LV thrombus in a large consecutive cohort of patients with STEMI. This study included consecutive patients admitted to Saint Luke's Mid America Heart Institute with STEMI who also underwent early percutaneous coronary intervention (PCI) and an echocardiogram. A total of 1,698 patients (1,205 men, mean age 61 ± 13 years) comprised the study group. Echocardiography was performed on hospital day 2, and a UCA was used in 1,292 patients (76%). LV thrombus was identified in 28 (1.6%) patients. A multivariable logistic regression model showed that left anterior descending intervention was independently associated with LV thrombus (odds ratio = 7.58, 95% confidence interval [CI] 2.20 to 26.19, p = 0.001), thrombolysis in myocardial infarction III flow was marginally associated with less LV thrombus (odds ratio = 0.41, 95% CI 0.16 to 1.04, p = 0.060), and higher LVEF was associated with less LV thrombus (odds ratio = 0.96, 95% CI 0.91 to 0.97, p <0.001). In conclusion, LV thrombus was identified in only 1.6% of patients in a large STEMI cohort, significantly lower than previous studies. A UCA was used in most echocardiograms, and it improves accuracy in the detection and exclusion of LV thrombus.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.010
  • Meta-Analysis of Aspirin Versus Dual Antiplatelet Therapy Following
           Coronary Artery Bypass Grafting
    • Authors: Nayan Agarwal; Ahmed N. Mahmoud; Nimesh Kirit Patel; Ankur Jain; Jalaj Garg; Mohammad Khalid Mojadidi; Sahil Agrawal; Arman Qamar; Harsh Golwala; Tanush Gupta; Nirmanmoh Bhatia; R. David Anderson; Deepak L. Bhatt
      Pages: 32 - 40
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Nayan Agarwal, Ahmed N. Mahmoud, Nimesh Kirit Patel, Ankur Jain, Jalaj Garg, Mohammad Khalid Mojadidi, Sahil Agrawal, Arman Qamar, Harsh Golwala, Tanush Gupta, Nirmanmoh Bhatia, R. David Anderson, Deepak L. Bhatt
      Although aspirin monotherapy is considered the standard of care after coronary artery bypass grafting (CABG), more recent evidence has suggested a benefit with dual antiplatelet therapy (DAPT) after CABG. We performed a meta-analysis of observational studies and randomized controlled trials comparing outcomes of aspirin monotherapy with DAPT in patients after CABG. Subgroup analyses were conducted according to surgical technique (i.e., on vs off pump) and clinical presentation (acute coronary syndrome vs no acute coronary syndrome). Random effects overall risk ratios (RR) were calculated using the DerSimonian and Laird model. Eight randomized control trials and 9 observational studies with a total of 11,135 patients were included. At a mean follow-up of 23 months, major adverse cardiac events (10.3% vs 12.1%, RR 0.84, confidence interval [CI] 0.71 to 0.99), all-cause mortality (5.7% vs 7.0%, RR 0.67, CI 0.48 to 0.94), and graft occlusion (11.3% vs 14.2%, RR 0.79, CI 0.63 to 0.98) were less with DAPT than with aspirin monotherapy. There was no difference in myocardial infarction, stroke, or major bleeding between the 2 groups. In conclusion, DAPT appears to be associated with a reduction in graft occlusion, major adverse cardiac events, and all-cause mortality, without significantly increasing major bleeding compared with aspirin monotherapy in patients undergoing CABG.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.022
  • Validation of Peripherally Inserted Central Catheter-Derived Fick Cardiac
           Outputs in Patients with Heart Failure
    • Authors: Kristen M. Tecson; Anupama Vasudevan; Amarinder Bindra; Susan M. Joseph; Joost Felius; Shelley A. Hall; Parag Kale
      Pages: 50 - 54
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Kristen M. Tecson, Anupama Vasudevan, Amarinder Bindra, Susan M. Joseph, Joost Felius, Shelley A. Hall, Parag Kale
      The pulmonary artery catheter (PAC) remains the gold standard to calculate Fick cardiac outputs (FCOs) in patients with heart failure admitted to the intensive care unit (ICU). The peripherally inserted central catheter (PICC) provides long-term intravenous access and is used outside the ICU; however, there is scant literature validating venous oxygen saturations (VOSs) from PICC lines. Heart failure patients in the ICU with an existing PAC requiring a PICC line to transition were enrolled. Three blood samples were taken per person (1 at PICC, 1 at central venous pressure [CVP], and 1 at distal PAC). We performed repeated measures analysis of variance, as well as reliability analysis on 31 subjects (77% male, 71% Caucasian, mean ± standard deviation age 60 ± 8 years, 80% on inotropes). The average VOSs were 62 ± 11%, 62 ± 12%, and 61 ± 9% for the PICC line, CVP, and distal port, respectively (p = 0.66); there was excellent reliability (0.79). The median FCOs were 5 [4, 6], 5 [4, 6], and 5 [4, 6] L/min at the PICC, CVP, and distal port, respectively (p = 0.91); there was fair-to-good reliability (0.67). In conclusion, VOS and FCO did not differ by location, on average. Reliable data may be obtained through the PICC line, after evaluation from the PAC. The PICC may provide longer-term hemodynamic assessment while improving patient comfort.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.020
  • Coronary Venous Dissection from Left Ventricular Lead Placement During
           Cardiac Resynchronization Therapy With Defibrillator Implantation and
           Associated in-Hospital Adverse Events (from the NCDR ICD Registry)
    • Authors: Jonathan C. Hsu; Paul D. Varosy; Haikun Bao; Thomas A. Dewland; Jeptha P. Curtis; Gregory M. Marcus
      Pages: 55 - 61
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Jonathan C. Hsu, Paul D. Varosy, Haikun Bao, Thomas A. Dewland, Jeptha P. Curtis, Gregory M. Marcus
      Coronary venous dissection is a known complication of left ventricular lead placement during implantation of a cardiac resynchronization with defibrillator (CRT-D) system. A large-scale evaluation of the prevalence of coronary venous dissection and associated in-hospital clinical outcomes has not been performed. We sought to identify predictors of coronary venous dissection and evaluate subsequent in-hospital adverse events in those with the complication. We studied 140,991 first-time CRT-D recipients in the implantable cardioverter-defibrillator (ICD) Registry implanted between 2006 and 2011. Using hierarchical multivariable logistic regression adjusting for patient, implanting physician, and hospital characteristics, we examined predictors of coronary venous dissection and its association with other major complications, length of hospital stay, and in-hospital mortality. Coronary venous dissection occurred in 392 patients (0.28%). After multivariable adjustment, female gender and left bundle branch block were associated with greater odds of coronary venous dissection. Conversely, atrial fibrillation, previous coronary artery bypass graft, and higher implanter procedure volume were associated with lower odds of coronary venous dissection (all p values <0.05). After multivariable adjustment, CRT-D recipients with coronary venous dissection had greater odds of major complications (odds ratio [OR] 10.47, 95% confidence interval [CI] 6.75 to 16.24, p <0.0001), postprocedural hospital stays >3 days (OR 1.71, 95% CI 1.29 to 2.29, p <0.0001), but not in-hospital death (OR 0.78, 95% CI 0.12 to 5.25, p = 0.8012). In conclusion, in a large population of first-time CRT-D recipients, specific patient and implanter characteristics predicted coronary venous dissection risk. Coronary venous dissection was associated with major in-hospital complications and prolonged hospitalization, but not death.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.019
  • Frequency and Significance of Intravascular Hemolysis Before and After
           Transcatheter Aortic Valve Implantation in Patients With Severe Aortic
    • Authors: Tsung-Yu Ko; Mao-Shin Lin; Lung-Chun Lin; Ying-Ju Liu; Chih-Fan Yeh; Ching-Chang Huang; Ying-Hsien Chen; Yih-Sharng Chen; Hsien-Li Kao
      Pages: 69 - 72
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Tsung-Yu Ko, Mao-Shin Lin, Lung-Chun Lin, Ying-Ju Liu, Chih-Fan Yeh, Ching-Chang Huang, Ying-Hsien Chen, Yih-Sharng Chen, Hsien-Li Kao
      Intravascular hemolysis (IVH) has been identified in patients with surgical prosthetic valves, but few have been reported after transcatheter aortic valve implantation (TAVI). We conducted a prospective analysis of 64 TAVI patients. The hemolysis profiles were collected at baseline and 6 months after TAVI. The echocardiography was performed at baseline and 6 months after TAVI. There are 14 patients (21.9%) with IVH before and 24(37.5%) after TAVI. The serum haptoglobin values before and 6 months after TAVI are 126.7 ± 75.1 vs 86.3 ± 57.1 mg/dl (p < 0.001). More ≥moderate paravalvular leakage (PVL) (50% vs 7.5%, p < 0.001), bicuspid aortic valve (BAV) (33.3% vs 5.0%, p = 0.004), use of 23 mm prosthesis (29.2% vs 7.5%, p = 0.03), higher residual valvular pressure gradient (17.9 ± 6.8 mm Hg vs 14.7 ± 5.7 mm Hg, p = 0.05), and lower effective orifice area index (1.05 ± 0.21 vs 1.21 ± 0.29, p = 0.03) were observed in patients with post-TAVI IVH. On multivariate regression analysis, BAV and ≥moderate PVL are independently related to post-TAVI IVH. With log-rank test, 1-year rates of readmission due to cardiovascular cause were significantly higher in patients with post-TAVI IVH (odds ratio 4.5; 95% confidence interval 1.3 to 15.6; p = 0.02), after adjusting age and gender. In conclusion, ≥moderate PVL and BAV are predictors of post-TAVI IVH, which is associated with increased cardiovascular readmission in 1-year follow-up.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.023
  • Influence of the Quantity of Aortic Valve Calcium on the Agreement Between
           Automated 3-Dimensional Transesophageal Echocardiography and Multidetector
           Row Computed Tomography for Aortic Annulus Sizing
    • Authors: Tomaz Podlesnikar; Edgard A. Prihadi; Philippe J. van Rosendael; E. Mara Vollema; Frank van der Kley; Arend de Weger; Nina Ajmone Marsan; Franjo Naji; Zlatko Fras; Jeroen J. Bax; Victoria Delgado
      Pages: 86 - 93
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Tomaz Podlesnikar, Edgard A. Prihadi, Philippe J. van Rosendael, E. Mara Vollema, Frank van der Kley, Arend de Weger, Nina Ajmone Marsan, Franjo Naji, Zlatko Fras, Jeroen J. Bax, Victoria Delgado
      Accurate aortic annulus sizing is key for selection of appropriate transcatheter aortic valve implantation (TAVI) prosthesis size. The present study compared novel automated 3-dimensional (3D) transesophageal echocardiography (TEE) software and multidetector row computed tomography (MDCT) for aortic annulus sizing and investigated the influence of the quantity of aortic valve calcium (AVC) on the selection of TAVI prosthesis size. A total of 83 patients with severe aortic stenosis undergoing TAVI were evaluated. Maximal and minimal aortic annulus diameter, perimeter, and area were measured. AVC was assessed with computed tomography. The low and high AVC burden groups were defined according to the median AVC score. Overall, 3D TEE measurements slightly underestimated the aortic annulus dimensions as compared with MDCT (mean differences between maximum, minimum diameter, perimeter, and area: −1.7 mm, 0.5 mm, −2.7 mm, and −13 mm2, respectively). The agreement between 3D TEE and MDCT on aortic annulus dimensions was superior among patients with low AVC burden (<3,025 arbitrary units) compared with patients with high AVC burden (≥3,025 arbitrary units). The interobserver variability was excellent for both methods. 3D TEE and MDCT led to the same prosthesis size selection in 88%, 95%, and 81% of patients in the total population, the low, and the high AVC burden group, respectively. In conclusion, the novel automated 3D TEE imaging software allows accurate and highly reproducible measurements of the aortic annulus dimensions and shows excellent agreement with MDCT to determine the TAVI prosthesis size, particularly in patients with low AVC burden.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.016
  • Bleeding Complications After Percutaneous Mitral Valve Repair With the
    • Authors: Maria Isabel Körber; Julia Silwedel; Kai Friedrichs; Victor Mauri; Michael Huntgeburth; Roman Pfister; Stephan Baldus; Volker Rudolph
      Pages: 94 - 99
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Maria Isabel Körber, Julia Silwedel, Kai Friedrichs, Victor Mauri, Michael Huntgeburth, Roman Pfister, Stephan Baldus, Volker Rudolph
      Bleeding after cardiac surgery or cardiovascular interventions is associated with worse patient outcome. Only very limited data are available on the subject of bleeding after percutaneous edge-to-edge mitral valve repair (PMVR). We performed a single center analysis including 347 consecutive patients who underwent PMVR. Bleeding was defined according to the Mitral Valve Academic Research Consortium (MVARC) end point definition. The incidence of MVARC bleeding was 21.6% (n = 75), whereas major MVARC bleeding (hemoglobin decrease ≥3 g/dl) occurred in 7.4% (n = 26). Only 33.3% of all bleeding cases were access site-related. In multivariate regression analyses, independent predictors of MVARC bleeding were the presence of coronary artery disease (2.809, 95% CI 1.123 to 7.022, p = 0.027) and intervention duration (1.010, 95% CI 1.002 to 1.018, p = 0.010). Patients experiencing MVARC bleeding had longer hospital stays (p = 0.026); however, neither major nor extensive MVARC bleeding was associated with increased 30-day or 1-year mortality. A decrease in hemoglobin levels ≥3 g/dl without clinically visible bleeding sign—not considered in the MVARC bleeding definition—occurred in 9.5% of patients. A hemoglobin decrease of ≥4 g/dl had a strong association with worse survival in those patients with obscure bleeding. In conclusion, these data show a relevant incidence of bleeding after PMVR. In contrast to other cardiovascular interventions, the majority of bleedings were not access site-related. Particularly, patients with obscure bleeding, which are not included in the MVARC end point definitions, had worse outcomes and should therefore be considered for a more intensive workup.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.027
  • Effect of Body Mass Index on Exercise Capacity in Patients With
           Hypertrophic Cardiomyopathy
    • Authors: Carolyn M. Larsen; Caroline A. Ball; Virginia B. Hebl; Kevin C. Ong; Konstantinos C. Siontis; Thomas P. Olson; Michael J. Ackerman; Steve R. Ommen; Thomas G. Allison; Jeffrey B. Geske
      Pages: 100 - 106
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Carolyn M. Larsen, Caroline A. Ball, Virginia B. Hebl, Kevin C. Ong, Konstantinos C. Siontis, Thomas P. Olson, Michael J. Ackerman, Steve R. Ommen, Thomas G. Allison, Jeffrey B. Geske
      The objective of this study was to evaluate the relation between body mass index (BMI), exercise capacity, and symptoms in patients with hypertrophic cardiomyopathy (HC) and to utilize results of cardiopulmonary exercise tests (CPX) and transthoracic echocardiograms to understand the mechanism(s) of reduced exercise capacity across body mass index groups. Over a 6-year period, 510 consecutive patients with HC seen at a tertiary referral center underwent (CPX) and a transthoracic echocardiogram. Increasing BMI was associated with decreased exercise capacity as assessed by peak VO2 (ml/kg/min). However, the prevalence of cardiac impairment did not vary by BMI group. In conclusion, these findings suggest that in some patients with hypertrophic cardiomyopathy, cardiac impairment is not the primary cause of exercise limitation and weight loss may result in improved exercise capacity.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.026
  • Influence of Body Mass Index on Long-Term Survival After Cardiac
    • Authors: Barak Zafrir; Ronen Jaffe; Ronen Rubinshtein; Basheer Karkabi; Moshe Y. Flugelman; David A. Halon
      Pages: 113 - 119
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Barak Zafrir, Ronen Jaffe, Ronen Rubinshtein, Basheer Karkabi, Moshe Y. Flugelman, David A. Halon
      We examined 18,654 patients who underwent cardiac catheterization in a single center to clarify the association between catheterization indication, body mass index (BMI), and long-term survival over a mean follow-up of 81 months. Patients were grouped by indication for catheterization: (a) acute coronary syndromes (ACS), 7,426 patients; (b) coronary artery disease (CAD) evaluation in stable clinical presentation, 6,911 patients; and (c) primarily non-CAD cardiac evaluations, 4,317 patients. Compared with normal weight, overweight and obesity (but not morbid obesity) was associated with lower risk of long-term mortality. Underweight patients had the greatest risk of mortality. After multivariate adjustment, survival benefit of the overweight and obese was retained in the ACS group [hazard ratio 0.86, 95% confidence interval (0.77–0.96), p = 0.006 and 0.79, (0.68–0.91), p = 0.001, respectively] and in overweight patients in the stable presentation CAD group [0.83, (0.72–0.94), p = 0.005], whereas there was no survival benefit in any of the BMI categories in those catheterized primarily for non-CAD indications. Further analysis of matched cohorts showed similar patterns of survival benefit of the overweight/obese. In conclusion, among patients who underwent cardiac catheterization, an inverse association between BMI and long-term mortality was observed, with the lowest risk noted in the overweight and obese population; the obesity paradox was principally demonstrated in patients with ACS, and was eliminated after covariate adjustment in those catheterized primarily for non-CAD indications.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.028
  • Frequency of Inverted Electrocardiographic T Waves (Cerebral T Waves) in
           Patients With Acute Strokes and Their Relation to Left Ventricular Wall
           Motion Abnormalities
    • Authors: Jeremy Stone; Victor Mor-Avi; Agnieszka Ardelt; Roberto M. Lang
      Pages: 120 - 124
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Jeremy Stone, Victor Mor-Avi, Agnieszka Ardelt, Roberto M. Lang
      Transient, symmetric, and deep inverted electrocardiogram (ECG) T waves in the setting of stroke, commonly referred to as cerebral T waves, are rare, and the underlying mechanism is unclear. Our study aimed to test the hypothesis that cerebral T waves are associated with transient cardiac dysfunction. This retrospective study included 800 patients admitted with the primary diagnosis of hemorrhagic or ischemic stroke. ECGs were examined for cerebral T waves, defined as T-wave inversion of ≥5 mm depth in ≥4 contiguous precordial leads. Echocardiograms of those meeting these criteria were examined for the presence of left ventricular (LV) wall motion abnormalities. Follow-up evaluation included both ECG and echocardiogram. Of the 800 patients, 17 had cerebral T waves on ECG (2.1%). All 17 patients had ischemic strokes, of which 11 were in the middle cerebral artery distribution (65%), and 2 were cerebellar (12%), whereas the remaining 4 involved other locations. Follow-up ECG showed resolution of the T-wave changes in all 17 patients. Of these patients, 14 (82%) had normal wall motion, and 3 had transient wall motion abnormalities (18%). Two of these patients had Takotsubo-like cardiomyopathy with apical ballooning, and the third had globally reduced LV function. Coronary angiography showed no significant disease to explain the LV dysfunction. In summary, in our cohort of patients with acute stroke, cerebral T waves were rare and occurred only in ischemic stroke. Eighteen percent of patients with cerebral T waves had significant transient wall motion abnormalities. Patients with stroke with cerebral T waves, especially in those with ischemic strokes, should be assessed for cardiac dysfunction.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.025
  • Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial
           Fibrillation and End-Stage Renal Disease
    • Authors: Marin Nishimura; Jonathan C. Hsu
      Pages: 131 - 140
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Marin Nishimura, Jonathan C. Hsu
      Over the past decade, there have been tremendous advancements in anticoagulation therapies for stroke prevention in patients with atrial fibrillation (AF). Although the non–vitamin K antagonist oral anticoagulants (NOACs) demonstrated favorable clinical outcomes compared with warfarin overall, the decision to anticoagulate and the choice of appropriate agent in patients with AF and concomitant chronic kidney disease (CKD) or end-stage renal disease (ESRD) are a particularly complex issue. CKD and ESRD increase both the risk of stroke and bleeding, and since all of the NOACs undergo various levels of renal clearance, renal dysfunction inevitably affects the pharmacokinetics of the drug in each patient. Furthermore, the randomized controlled clinical trials of each NOAC versus warfarin often did not include patients with advanced CKD or ESRD. In this focused review, we describe the available evidence supporting the use of NOACs for prevention of stroke in patients with AF with concomitant advanced CKD or ESRD. Although questions of safety and appropriate use of these new agents in CKD and ESRD remain, NOACs offer a significant step forward in the anticoagulation management of at-risk patients with AF.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.030
  • Serum Potassium Levels During Admissions for Acute Decompensated Heart
           Failure: Identifying Possible Threats to Outcome
    • Authors: Wouter Kok; Khibar Salah; Susan Stienen
      First page: 141
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Wouter Kok, Khibar Salah, Susan Stienen

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.032
  • Impact of Left Atrial Appendage Exclusion on Cardiovascular Outcomes in
           Patients With Atrial Fibrillation Undergoing Coronary Artery Bypass
           Grafting—The Surgeon's Comment
    • Authors: Etem Caliskan; Sacha P. Salzberg; Maximilian Y. Emmert
      First page: 142
      Abstract: Publication date: 1 January 2018
      Source:The American Journal of Cardiology, Volume 121, Issue 1
      Author(s): Etem Caliskan, Sacha P. Salzberg, Maximilian Y. Emmert

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.017
  • Coronary Computed Tomographic Angiography-Derived Fractional Flow Reserve
           for Therapeutic Decision Making
    • Authors: Christian Tesche; Rozemarijn Vliegenthart; Taylor M. Duguay; Carlo N. De Cecco; Moritz H. Albrecht; Domenico De Santis; Marcel C. Langenbach; Akos Varga-Szemes; Brian E. Jacobs; David Jochheim; Moritz Baquet; Richard R. Bayer; Sheldon E. Litwin; Ellen Hoffmann; Daniel H. Steinberg; U. Joseph Schoepf
      Pages: 2121 - 2127
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Christian Tesche, Rozemarijn Vliegenthart, Taylor M. Duguay, Carlo N. De Cecco, Moritz H. Albrecht, Domenico De Santis, Marcel C. Langenbach, Akos Varga-Szemes, Brian E. Jacobs, David Jochheim, Moritz Baquet, Richard R. Bayer, Sheldon E. Litwin, Ellen Hoffmann, Daniel H. Steinberg, U. Joseph Schoepf
      This study investigated the performance of coronary computed tomography angiography (cCTA) with cCTA-derived fractional flow reserve (CT-FFR) compared with invasive coronary angiography (ICA) with fractional flow reserve (FFR) for therapeutic decision making in patients with suspected coronary artery disease (CAD). Seventy-four patients (62 ± 11 years, 62% men) with at least 1 coronary stenosis of ≥50% on clinically indicated dual-source cCTA, who had subsequently undergone ICA with FFR measurement, were retrospectively evaluated. CT-FFR values were computed using an on-site machine-learning algorithm to assess the functional significance of CAD. The therapeutic strategy (optimal medical therapy alone vs revascularization) and the appropriate revascularization procedure (percutaneous coronary intervention vs coronary artery bypass grafting) were selected using cCTA-CT-FFR. Thirty-six patients (49%) had a functionally significant CAD based on ICA-FFR. cCTA-CT-FFR correctly identified a functionally significant CAD and the need of revascularization in 35 of 36 patients (97%). When revascularization was deemed indicated, the same revascularization procedure (32 percutaneous coronary interventions and 3 coronary artery bypass grafting) was chosen in 35 of 35 patients (100%). Overall, identical management strategies were selected in 73 of the 74 patients (99%). cCTA-CT-FFR shows excellent performance to identify patients with and without the need for revascularization and to select the appropriate revascularization strategy. cCTA-CT-FFR as a noninvasive “one-stop shop” has the potential to change diagnostic workflows and to directly inform therapeutic decision making in patients with suspected CAD.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.08.034
  • Comparison of Delay Times Between Symptom Onset of an Acute ST-elevation
           Myocardial Infarction and Hospital Arrival in Men and Women <65 Years
           Versus ≥65 Years of Age.
    • Authors: Karl-Heinz Ladwig; Xiaoyan Fang; Kathrin Wolf; Sophia Hoschar; Loai Albarqouni; Joram Ronel; Thomas Meinertz; Derek Spieler; Karl-Ludwig Laugwitz; Heribert Schunkert
      Pages: 2128 - 2134
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Karl-Heinz Ladwig, Xiaoyan Fang, Kathrin Wolf, Sophia Hoschar, Loai Albarqouni, Joram Ronel, Thomas Meinertz, Derek Spieler, Karl-Ludwig Laugwitz, Heribert Schunkert
      Early administration of reperfusion therapy in acute ST-elevation myocardial infarctions (STEMI) is crucial to reduce mortality. Although female sex and old age are key factors contributing to an inadequate long prehospital delay time, little is known whether women ≥65 years are a particular risk population. Hence, we studied the interaction of sex and age (<65 years or ≥65 years) and the contribution of chest pain to delay time during STEMI. Bedside interview data were collected in 619 STEMI patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Sex and age group stratification disclosed an excess delay risk for women ≥65 years, accounting for a 2.39 (95% confidence interval (CI) 1.39 to 4.10)-fold higher odds to delay longer than 2 hours compared with all other patient groups including younger women (p ≤0.002). Median delay time was 266 minutes in women ≥65 years and 148 minutes in younger women (p <0.001). Chest pain during STEMI had the lowest frequency both in women (81%) and men ≥65 years (83%) and the highest frequency (95%) in younger women. Experiencing non–chest pain was 2.32-fold (95% CI, 1.20 to 4.46, p <0.05) higher in women ≥65 years than in all other patients. Mediation analysis disclosed that the effect accounted for only 9% of the variance. Age specific educational strategies targeting women ≥65 years at risk are urgently needed. To tailor adequate strategies, more research is required to understand age- and sex driven barriers to timely identification of ischemic symptoms.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.005
  • Impact of Transient or Persistent Contrast-induced Nephropathy on
           Long-term Mortality After Elective Percutaneous Coronary Intervention
    • Authors: Mitsuru Abe; Takeshi Morimoto; Yoshihisa Nakagawa; Yutaka Furukawa; Koh Ono; Takao Kato; Kazushige Kadota; Kenji Ando; Mitsuru Ishii; Nobutoyo Masunaga; Masaharu Akao; Takeshi Kimura
      Pages: 2146 - 2153
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Mitsuru Abe, Takeshi Morimoto, Yoshihisa Nakagawa, Yutaka Furukawa, Koh Ono, Takao Kato, Kazushige Kadota, Kenji Ando, Mitsuru Ishii, Nobutoyo Masunaga, Masaharu Akao, Takeshi Kimura
      Contrast-induced nephropathy (CIN) is associated with increased long-term mortality. However, it is still controversial whether CIN is the cause of increased mortality or merely a marker of high-risk patients. The current study population included 5,516 patients who underwent their first elective percutaneous coronary intervention (PCI) in the Coronary REvascularization Demonstrating Outcome Study in Kyoto registry cohort-2. CIN was defined as an elevation in the peak serum creatinine (SCr) of ≥0.5 mg/dl from the baseline within 5 days after PCI. CIN, seen in 218 patients (4.0%), was independently associated with an increased long-term mortality risk (hazard ratio [HR] 1.43, 95% confidence interval [CI],1.11 to 1.83; p = 0.005). SCr data at 1 year (180 to 550 days) after PCI were available in 3,986 patients, who were subdivided into persistent CIN (follow-up SCr elevation ≥0.5 mg/dl: n = 50 [1.3%]), transient CIN (follow-up SCr elevation <0.5 mg/dl: n = 90 [2.3%]), and non-CIN (n = 3,846 [96.5%]). In the landmark analysis at 1 year after PCI, 524 patients (13.1%) died during a median follow-up of 1,521 days. After adjustment for the 37 confounders, persistent CIN, but not transient CIN, was significantly correlated with a higher long-term mortality risk compared with non-CIN (HR 1.84, 95% CI 1.12 to 3.03; p = 0.02, and HR 1.11, 95% CI 0.71 to 1.76; p = 0.6, respectively). In conclusion, only persistent CIN was independently associated with increased long-term mortality.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.08.036
  • Comparison of the Coronary Artery Calcium Score and Number of Calcified
           Coronary Plaques for Predicting Patient Mortality Risk
    • Authors: Yoav Arnson; Alan Rozanski; Heidi Gransar; John D. Friedman; Sean W. Hayes; Louise E. Thomson; Balaji Tamarappoo; Piotr Slomka; Frances Wang; Guido Germano; Damini Dey; Daniel S. Berman
      Pages: 2154 - 2159
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Yoav Arnson, Alan Rozanski, Heidi Gransar, John D. Friedman, Sean W. Hayes, Louise E. Thomson, Balaji Tamarappoo, Piotr Slomka, Frances Wang, Guido Germano, Damini Dey, Daniel S. Berman
      Multiple coronary artery calcium (CAC) parameters have recently been proposed to improve risk prediction in patients with intermediate clinical risk based on CAC scoring, but outcome data that assess these variables are relatively sparse. We analyzed data from 11,633 consecutive asymptomatic patients undergoing CAC scanning that were followed for 8.8 ± 3.5 years for all-cause mortality (ACM). The patients who had coronary artery calcification were grouped by the number of calcified coronary plaques: 0, 1 to 5, 6 to 20, and >20 plaques. We examined the independent prognostic value of plaque number and its synergistic prognostic value when added to the CAC score. We observed a stepwise increase in ACM with increasing plaque number. In patients with a CAC score of 1 to 99, 6 plaques or more were associated with increased mortality. In patients with CAC scores of 100 to 399, there was a stepwise increase in ACM with increasing plaque number. For CAC >400, the risk of ACM was high regardless of plaque number. After risk adjustment, the number of plaques was a significant predictor of risk for ACM in the patients with an intermediate CAC score. In these patients, additional consideration of plaque number improved net reclassification improvement for predicting ACM by 29%. In conclusion, the number of calcified plaques adds to risk stratification beyond the CAC score in patients with intermediate CAC scores.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.001
  • Impact of Hypothyroidism on Occurrence and Outcome of Acute Coronary
           Syndrome from the National Inpatient Sample
    • Authors: Rashmi Dhital; Sijan Basnet; Dilli Ram Poudel
      Pages: 2160 - 2163
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Rashmi Dhital, Sijan Basnet, Dilli Ram Poudel
      Thyroid hormones have a profound effect on cardiovascular physiology. We utilized a large national inpatient database in the United States (National Inpatient Sample) to study hypothyroidism in relation to the prevalence of coronary heart disease (CHD) and its impact on outcomes (mortality, the length of stay, and hospitalization cost) in the acute coronary syndrome (ACS) subgroup of CHD patients. We found that although hypothyroidism has an increased association with CHD (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.09 to 1.12, p <0.001), the odds of developing ACS in these CHD patients is lower in the hypothyroid group (OR 0.71, 95% CI 0.70 to 0.72, p <0.001) after adjusting for multiple risk factors. Additionally, patients with hypothyroid ACS have a reduced odds of in-hospital mortality (OR 0.86, 95% CI 0.83 to 0.88, p <0.001), shorter length of stay by 0.45 days (p <0.001), and lower hospitalization cost by $1,531.45 (p <0.001) compared with the euthyroid group. Our findings suggest that hypothyroidism has an increased CHD risk but a lower risk of development of ACS in hospitalized CHD patients, as well as a better short-term prognosis including ACS-associated mortality.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.08.035
  • Effect of Exceptional Parental Longevity and Lifestyle Factors on
           Prevalence of Cardiovascular Disease in Offspring
    • Authors: Sriram Gubbi; Elianna Schwartz; Jill Crandall; Joe Verghese; Roee Holtzer; Gil Atzmon; Rebecca Braunstein; Nir Barzilai; Sofiya Milman
      Pages: 2170 - 2175
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Sriram Gubbi, Elianna Schwartz, Jill Crandall, Joe Verghese, Roee Holtzer, Gil Atzmon, Rebecca Braunstein, Nir Barzilai, Sofiya Milman
      Offspring of parents with exceptional longevity (OPEL) manifest lower prevalence of cardiovascular disease (CVD), but the role of lifestyle factors in this unique cohort is not known. Our study tested whether OPEL have lesser prevalence of CVD independent of lifestyle factors. Prevalence of CVD and CVD risk factors was assessed in a population of community-dwelling Ashkenazi Jewish adults aged 65 to 94 years. Participants included OPEL (n = 395), defined as having at least 1 parent living past the age of 95 years, and offspring of parents with usual survival (OPUS, n = 450), defined as having neither parent survive to 95 years. Medical and lifestyle information was obtained using standardized questionnaires. Socioeconomic status was defined based on validated classification scores. Dietary intake was evaluated with the Block Brief Food Frequency Questionnaire (2000) in a subgroup of the study population (n = 234). Our study found no significant differences in the prevalence of obesity, smoking, alcohol use, physical activity, social strata scores, and dietary intake between the 2 groups. After adjustment for age and gender, the OPEL demonstrated 29% lower odds of having hypertension (95% confidence interval [CI] 0.53 to 0.95), 65% lower odds of having had a stroke (95% CI 0.14 to 0.88), and 35% lower odds of having CVD (95% CI 0.43 to 0.98), compared with OPUS. In conclusion, exceptional parental longevity is associated with lower prevalence of CVD independent of lifestyle, socioeconomic status, and nutrition, thus highlighting the potential role of genetics in disease-free survival among individuals with exceptional parental longevity.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.08.040
  • Usefulness of the 2MACE Score to Predicts Adverse Cardiovascular Events in
           Patients With Atrial Fibrillation
    • Authors: José Miguel Rivera-Caravaca; Francisco Marín; María Asunción Esteve-Pastor; Paula Raña-Míguez; Manuel Anguita; Javier Muñiz; Ángel Cequier; Vicente Bertomeu-Martínez; Mariano Valdés; Vicente Vicente; Gregory Yoke Hong Lip; Vanessa Roldán
      Pages: 2176 - 2181
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): José Miguel Rivera-Caravaca, Francisco Marín, María Asunción Esteve-Pastor, Paula Raña-Míguez, Manuel Anguita, Javier Muñiz, Ángel Cequier, Vicente Bertomeu-Martínez, Mariano Valdés, Vicente Vicente, Gregory Yoke Hong Lip, Vanessa Roldán
      We investigated the incidence of nonembolic adverse events in 2 cohorts of patients with atrial fibrillation (AF) and validated the 2MACE score ([metabolic syndrome, age ≥75] [doubled]; [myocardial infarction or revascularization, congestive heart failure {HF}, and stroke, transient ischemic attack or thromboembolism]) as predictor of major adverse cardiovascular events (MACEs). We recruited 2,630 patients with AF from 2 different cohorts (Murcia AF and FANTASIIA). The 2MACE score was calculated, and during a median of 7.2 years (Murcia AF cohort) and 1.01 years (FANTASIIA) of follow-up, we recorded all nonembolic adverse events and MACEs (composite of nonfatal myocardial infarction or revascularization and cardiovascular death). Receiver operating characteristic curves comparison, reclassification and discriminatory analyses, and decision curve analyses were performed to compare predictive ability and clinical usefulness of the 2MACE score against CHA2DS2-VASc. During follow-up, there were 65 MACEs in the Murcia cohort and 60 in the FANTASIIA cohort. Events rates were higher in the high-risk category (score ≥3) (1.94%/year vs 0.81%/year in the Murcia cohort; 6.01%/year vs 1.71%/year, in FANTASIIA, both p <0.001). The predictive performance of 2MACE according to the receiver operating characteristic curve was significantly higher than that of CHA2DS2-VASc (0.662 vs 0.618, p = 0.008 in the Murcia cohort; 0.656 vs 0.565, p = 0.003 in FANTASIIA). Decision curve analyses demonstrated improved clinical usefulness of the 2MACE compared with the CHA2DS2-VASc score. In conclusion, in “real-world” patients with AF, the 2MACE score is a good predictor of MACEs. A score ≥3 should be used to categorize patients at “high risk,” in identifying patients at risk of MACE.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.003
  • Anemia and the Risk of Life-threatening Ventricular Tachyarrhythmias from
           the Israeli Implantable Cardioverter Defibrillator Registry
    • Authors: Ido Goldenberg; Alon Barsheshet; Avishag Laish-Farkash; Moshe Swissa; Jorge E. Schliamser; Yoav Michowitz; Michael Glikson; Mahmoud Suleiman
      Pages: 2187 - 2192
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Ido Goldenberg, Alon Barsheshet, Avishag Laish-Farkash, Moshe Swissa, Jorge E. Schliamser, Yoav Michowitz, Michael Glikson, Mahmoud Suleiman
      Anemia was shown to be associated with increased risk for adverse events in patients with heart failure (HF). However, there are limited data on the association between anemia and the risk for ventricular arrhythmias (VAs) in patients with an implantable cardioverter defibrillator (ICD). The present study population comprised 2,352 patients who were enrolled and prospectively followed up in the Israeli ICD Registry. The risk for a first appropriate ICD shock for VA was assessed by the presence of anemia, categorized at the lower tertile of hemoglobin distribution (≤12 g/dL [n = 753]). Patients who had anemia displayed higher risk clinical characteristics including older age, more advanced HF symptoms, and atrial fibrillation (p <0.01 for all). Kaplan-Meier survival analysis showed that at 2.5 years of follow-up the rate of appropriate shocks was significantly higher in patients with low (11%) versus high (6%) hemoglobin (log-rank p <0.005). Multivariate analysis showed that anemia was independently associated with a significant 56% increased risk for first appropriate ICD shock (p <0.026). When hemoglobin was assessed as a continuous measure, each 1 g/dL reduction in hemoglobin was independently associated with a significant 8% increased risk for first appropriate shock (p <0.03). Anemia was also associated with increased risk for all-cause mortality (hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.4 to 2.27], p <0.001), HF hospitalizations or death (HR 1.78, 95% CI 1.48 to 1.13, p <0.001), but not with inappropriate ICD shocks (HR 1.24, 95% CI 0.70 to 2.21, p = 0.47). In conclusion, our findings suggest that the presence of anemia in patients with ICD is associated with increased risk for VA during long-term follow-up.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.08.041
  • Gender Differences in Cardiac Resynchronization Therapy Device Choice and
           Outcome in Patients ≥75 Years of Age with Heart Failure
    • Authors: Yanting Wang; Michael S. Sharbaugh; Mohammad Bilal Munir; Evan C. Adelstein; Norman C. Wang; Andrew D. Althouse; Samir Saba
      Pages: 2201 - 2206
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Yanting Wang, Michael S. Sharbaugh, Mohammad Bilal Munir, Evan C. Adelstein, Norman C. Wang, Andrew D. Althouse, Samir Saba
      Cardiac resynchronization therapy (CRT) is an established therapy for heart failure and can be delivered through a CRT pacemaker (CRT-P) or a CRT defibrillator (CRT-D). CRT-P devices are smaller and less expensive, have better battery longevity, and have been subject to fewer recalls and advisories but cannot deliver high-energy shocks to terminate potentially lethal ventricular arrhythmias. As published guidelines do not distinguish between CRT-P and CRT-D indications, we examined the practice of prescribing these devices in older women and men with heart failure. A total of 512 CRT recipients (age ≥75 years, 26% women, 21% CRT-P) were included in this analysis. Baseline characteristics were collected on all patients, and overall survival was compared by gender and type of CRT device implanted. Women were more likely to receive CRT-Ps than men (26% vs 19%). Men with CRT-Ps were significantly older than women with CRT-Ps and both men and women with CRT-Ds (p = 0.04). In addition, women had lower all-cause mortality compared with men (hazard ratio [HR] 0.75, confidence interval [CI] 0.58 to 0.99, p = 0.04), mainly among CRT-P recipients (HR 0.48, CI 0.26 to 0.8, p = 0.02), but this association was attenuated after adjusting for differences in patient characteristics (HR 0.56, CI 0.26 to 1.18, p = 0.13). In conclusion, women are more likely to receive CRT-Ps than men. Whether this difference is driven by patient preference or physician biases remains unclear. Women with CRT, particularly CRT-Ps, have a better overall survival than men. These differences, which may be driven by unbalanced baseline characteristics of patients or by differences in gender response to CRT, deserve further investigation.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.08.044
  • Effect of Age and Renal Function on Survival After Left Ventricular Assist
           Device Implantation
    • Authors: Rahatullah Muslem; Kadir Caliskan; Sakir Akin; Yunus E. Yasar; Kavita Sharma; Nisha A. Gilotra; Isabella Kardys; Brian Houston; Glenn Whitman; Ryan J. Tedford; Dennis A. Hesselink; Ad J.J.C. Bogers; Olivier C. Manintveld; Stuart D. Russell
      Pages: 2221 - 2225
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Rahatullah Muslem, Kadir Caliskan, Sakir Akin, Yunus E. Yasar, Kavita Sharma, Nisha A. Gilotra, Isabella Kardys, Brian Houston, Glenn Whitman, Ryan J. Tedford, Dennis A. Hesselink, Ad J.J.C. Bogers, Olivier C. Manintveld, Stuart D. Russell
      Left ventricular assist devices (LVAD) are increasingly used, especially as destination therapy in in older patients. The aim of this study was to evaluate the effect of age on renal function and mortality in the first year after implantation. A retrospective multicenter cohort study was conducted, evaluating all LVAD patients implanted in the 2 participating centers (age ≥18 years). Patients were stratified according to the age groups <45, 45–54, 55–64, and ≥65 years old. Overall, 241 patients were included (mean age 52.4 ± 12.9 years, 76% males, 33% destination therapy). The mean estimated Glomerular Filtration Rate (eGFR) at 1 year was 85, 72, 69, and 49 mL/min per 1.73 m2 in the age groups <45(n = 65, 27%), 45–54(n = 52, 22%), 55–64(n = 87, 36%), and ≥65 years (n = 37, 15%) p <0.001)), respectively. Older age and lower eGFR at baseline (p <0.01) were independent predictors of worse renal function at 1 year. The 1-year survival post-implantation was 79%,84%, 68%, and 54% for those in the age group <45, 45–54, 55–64 and ≥65 years (Log-rank p = 0.003). Older age, lower eGFR and, INTERMACS class I were independent predictors of 1-year mortality. Furthermore, older patients (age > 60 years) with an impaired renal function (eGFR <55 mL/min per 1.73 m2) had a 5-fold increased hazard ratio for mortality during the first year after implantation (p <0.001). In conclusion, age >60 years is an independent predictor for an impaired renal function and mortality. Older age combined with reduced renal function pre-implantation had a cumulative adverse effect on survival in patients receiving a LVAD.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.08.045
  • Prevalence and Prognostic Relevance of Ventricular Conduction Disturbances
           in Patients With Aortic Stenosis
    • Authors: Edgard A. Prihadi; Melissa Leung; E. Mara Vollema; Arnold C.T. Ng; Nina Ajmone Marsan; Jeroen J. Bax; Victoria Delgado
      Pages: 2226 - 2232
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Edgard A. Prihadi, Melissa Leung, E. Mara Vollema, Arnold C.T. Ng, Nina Ajmone Marsan, Jeroen J. Bax, Victoria Delgado
      The prevalence and prognostic implications of ventricular conduction disturbances in aortic stenosis (AS) have not been extensively evaluated. The present retrospective study investigated the prevalence and prognostic implications of ventricular conduction abnormalities (including the QRS morphology and duration) in AS. A total of 1,245 patients (mean age 66 ± 14 years, 62.8% men) with varying AS severity (aortic sclerosis 33.9%, mild AS 11.5%, moderate AS 29.9%, and severe AS 24.7%) were evaluated. Demographic, clinical variables, and presence of ventricular conduction abnormalities on the electrocardiogram (based on QRS morphology and duration) were related to occurrence of all-cause mortality, correcting for occurrence of aortic valve replacement. The prevalence of ventricular conduction disorders increased in parallel with AS severity, which was particularly significant for left bundle branch block (4.3% in aortic sclerosis, 2.1% in mild AS, 4.6% in moderate AS, and 8.1% in severe AS; p = 0.042). The QRS duration showed a slight prolongation with increasing AS severity (102 ± 21 ms in aortic valve sclerosis, 99 ± 18 ms in mild AS, 104 ± 22 ms in moderate AS, and 105 ± 22 ms in severe AS; p = 0.044). During a mean follow-up of 8.1 ± 4.8 years, 40.9% of patients died. Right bundle branch block morphology (hazard ratio 1.59, 95% confidence interval 1.18 to 2.13, p = 0.002) and increase of QRS duration (hazard ratio 1.06, 95% confidence interval 1.02 to 1.11; p = 0.006) were independently associated with all-cause mortality. In conclusion, ventricular conduction disorders became more prevalent with increasing severity of AS and have an impact on survival.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.08.046
  • Transcatheter Aortic Valve Implantation Futility Risk Model Development
           and Validation Among Treated Patients With Aortic Stenosis
    • Authors: Oren Zusman; Ran Kornowski; Guy Witberg; Adi Lador; Katia Orvin; Amos Levi; Abid Assali; Hana Vaknin-Assa; Ram Sharony; Yaron Shapira; Alexander Sagie; Uri Landes
      Pages: 2241 - 2246
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Oren Zusman, Ran Kornowski, Guy Witberg, Adi Lador, Katia Orvin, Amos Levi, Abid Assali, Hana Vaknin-Assa, Ram Sharony, Yaron Shapira, Alexander Sagie, Uri Landes
      Risk-benefit assessment for transcatheter aortic valve implantation (TAVI) is still evolving. A sizeable group of patients do not fully benefit from intervention despite a technically successful procedure. All patients who underwent TAVI with device success and with no Valve Academic Research Consortium (VARC)-2 defined complications were included. Various demographic data, clinical details, and echocardiographic findings were examined. The outcome was defined as 1-year composite of mortality, stroke, lack of functional-class improvement (by New York Heart Association class), and readmissions (≥1 month after the procedure). Logistic regression was used to fit the prediction model. We used a 10-fold cross-validation to validate our results. Of 543 patients, 435 met the inclusion criteria. The mean age was 82 (±6.5) years, 43% were men, and the mean Society of Thoracic Surgeons score was 6.6 (±4.7). At 1 year, 66 of 435 patients (15%) experienced the study end point. The final logistic regression model included diabetes, baseline New York Heart Association functional class, diastolic dysfunction, need for diuretics, mean gradient, hemoglobin level, and creatinine level. The area under the curve was 0.73 and was reduced to 0.71 after validation, with a 97% specificity using a single cutoff. Dividing to low-, medium-, and high-risk groups for futility produced a corresponding prevalence of 6%, 19%, and 59% futility. A web application for the prediction model was developed and provided. In conclusion, this prediction score may provide an important insight and may facilitate identification of patients who, despite a technically successful and uncomplicated procedure, have risk that may outweigh the benefit of a contemplated TAVI.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.09.007
  • Interaction of Adverse Disease Related Pathways in Hypertrophic
    • Authors: Ethan J. Rowin; Martin S. Maron; Raymond H. Chan; Anais Hausvater; Wendy Wang; Hassan Rastegar; Barry J. Maron
      Pages: 2256 - 2264
      Abstract: Publication date: 15 December 2017
      Source:The American Journal of Cardiology, Volume 120, Issue 12
      Author(s): Ethan J. Rowin, Martin S. Maron, Raymond H. Chan, Anais Hausvater, Wendy Wang, Hassan Rastegar, Barry J. Maron
      Hypertrophic cardiomyopathy (HC) has been characterized as a generally progressive genetic heart disease, creating an ominous perspective for patients and managing cardiologists. We explored the HC disease burden and interaction of adverse clinical pathways to clarify patient expectations over long time periods in the contemporary therapeutic era. We studied 1,000 consecutive HC patients (52 ± 17 years) at Tufts Medical Center, followed 9.3 ± 8 years from diagnosis, employing a novel disease pathway model: 46% experienced a benign course free of adverse pathways, but 42% of patients progressed along 1 major pathway, most commonly refractory heart failure to New York Heart Association class III or IV requiring surgical myectomy (or alcohol ablation) or heart transplant; repetitive or permanent atrial fibrillation; and least commonly arrhythmic sudden death events. Eleven percent experienced 2 of these therapeutic end points at different times in their clinical course, most frequently the combination of advanced heart failure and atrial fibrillation, whereas only 1% incurred all 3 pathways. Freedom of progression from 1 to 2 disease pathways, or from 2 to 3 was 80% and 93% at 5 years, respectively. Annual HC-related mortality did not differ according to the number of pathways: 1 (0.8%), 2 (0.8%), or 3 (2.4%) (p = 0.56), and 93% of patients were in New York Heart Association classes I or II at follow-up. In conclusion, it is uncommon for HC patients to experience multiple adverse (but treatable) disease pathways, underscoring the principle that HC is not a uniformly progressive disease. These observations provide a measure of clarity and/or reassurance to patients regarding the true long-term disease burden of HC.

      PubDate: 2017-12-11T13:49:05Z
      DOI: 10.1016/j.amjcard.2017.08.048
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