Publisher: Elsevier   (Total: 3206 journals)

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Showing 1 - 200 of 3206 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 27, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 106, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 44, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 8)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 451, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 339, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 3, SJR: 1.793, CiteScore: 6)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 10, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 14, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 196, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 13, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 20, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 35, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 27, SJR: 1.562, CiteScore: 3)
Advances in Clinical Radiology     Full-text available via subscription   (Followers: 2)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 21, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Cosmetic Surgery     Full-text available via subscription   (Followers: 2)
Advances in Dermatology     Full-text available via subscription   (Followers: 16)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 14)
Advances in Digestive Medicine     Open Access   (Followers: 14)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 30, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 51, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Family Practice Nursing     Full-text available via subscription   (Followers: 2)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 69, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 8, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 4, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 10, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 26)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Pathology     Hybrid Journal   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Ophthalmology and Optometry     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 6, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 69)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 434, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 37, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 57, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 400, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 484, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 47, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 56, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 59, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 67, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 48, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 17, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 40, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 35, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 37, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 51)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics & Gynecology MFM     Hybrid Journal   (Followers: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 277, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 67, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 29, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 26, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 6, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 224, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)

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Similar Journals
Journal Cover
American Heart Journal
Journal Prestige (SJR): 3.267
Citation Impact (citeScore): 4
Number of Followers: 59  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-8703 - ISSN (Online) 1097-6744
Published by Elsevier Homepage  [3206 journals]
  • Exploring the socioeconomic consequences of infective endocarditis
    • Abstract: Publication date: Available online 21 February 2020Source: American Heart JournalAuthor(s):
       
  • Future Research Prioritization in Cardiac Resynchronization Therapy
    • Abstract: Publication date: Available online 21 February 2020Source: American Heart JournalAuthor(s): Marat Fudim, Frederik Dalgaard, Sana M. Al-Khatib, Daniel Friedman, Kathryn Lallinger, William T. Abraham, John G.F. Cleland, Anne B. Curtis, Michael R. Gold, Valentina Kutyifa, Cecilia Linde, Daniel E. Schaber, Anthony Tang, Fatima Ali-Ahmed, Sarah Goldstein, Brystana Kaufman, Robyn Fortman, J. Kelly Davis, Lurdes Y.T. Inoue, Gillian D. SandersAbstractBackgroundAlthough cardiac resynchronization therapy (CRT) is effective for some patients with heart failure and a reduced left ventricular ejection fraction (HFrEF), evidence gaps remain for key clinical and policy areas.ObjectiveReview the data on the effects of CRT for patients with HFrEF receiving pharmacological therapy alone or pharmacological therapy and an ICD and then, informed by a diverse group of stakeholders, to identify evidence-gaps, prioritize them and develop a research plan.MethodRelevant studies were identified using PubMed and EMBASE and ongoing trials using clinicaltrials.gov. Forced-ranking prioritization method was applied by stakeholders to reach a consensus on the most important questions.
       
  • Adoption of Sacubitril-valsartan in the Medicare population
    • Abstract: Publication date: Available online 19 February 2020Source: American Heart JournalAuthor(s): Peter A. Kahn, Ralph J. Riello, Tariq Ahmad, Nihar R. Desai
       
  • Optimal treatment of underlying conditions improves rhythm control outcome
           in atrial fibrillation – Data from RACE 3
    • Abstract: Publication date: Available online 14 February 2020Source: American Heart JournalAuthor(s): Bao-Oanh Nguyen, Michiel Rienstra, Anne H. Hobbelt, Jan G.P. Tijssen, Marcelle D. Smit, Robert G. Tieleman, Bastiaan Geelhoed, Dirk J. Van Veldhuisen, Harry J.G.M. Crijns, Isabelle C. Van Gelder, RACE 3 InvestigatorsAbstractAtrial fibrillation (AF) is a progressive disease, and maintenance of sinus rhythm is cumbersome. In this analysis of the Routine versus Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) trial we aimed to determine whether optimal treatment of underlying conditions of AF improves maintenance of sinus rhythm in patients with persistent AF and moderate heart failure (HF). Our data showed that optimal treatment of blood pressure, LDL-cholesterol and heart failure was associated with an increase in sinus rhythm maintenance compared to conventional therapy (87% versus 63%, P = .002, respectively).
       
  • Specificity of Administrative Coding for Acute Heart Failure
           Hospitalizations
    • Abstract: Publication date: Available online 11 February 2020Source: American Heart JournalAuthor(s): Lauren B. Cooper, Mitchell A. Psotka, Shashank Sinha, Brahmajee K. Nallamothu, Christopher R. deFilippi, Wayne Batchelor, Christopher M. O’Connor, Abdulla A. Damluji
       
  • Sedentary time and peripheral artery disease: The Hispanic community
           health study/study of Latinos
    • Abstract: Publication date: Available online 8 February 2020Source: American Heart JournalAuthor(s): Jonathan T. Unkart, Matthew A. Allison, Humberto Parada, Michael H. Criqui, Qibin Qi, Keith M. Diaz, Jordan A. Carlson, Daniela Sotres-Alvarez, Robert J. Ostfeld, Leopoldo Raij, John BellettiereAbstractBackgroundExperimental evidence suggests sedentary time (ST) may contribute to cardiovascular disease by eliciting detrimental hemodynamic changes in the lower limbs. However, little is known about objectively-measured ST and lower extremity peripheral artery disease (PAD).MethodsWe included 7609 Hispanic/Latinos (ages 45–74) from the Hispanic Community Health Study/Study of Latinos. PAD was measured using the ankle brachial index (ABI ≤ 0.9). ST was measured using accelerometry. We used multivariable logistic regression to assess associations of quartiles of ST and PAD then used the same logistic models with restricted cubic splines (RCS) to investigate continuous non-linear associations of ST and PAD. Models were sequentially adjusted for traditional PAD risk factors, leg pain, and moderate-vigorous intensity physical activity (MVPA).ResultsMedian ST was 12.2 hours/day and 5.4% of individuals had PAD. Fully adjusted RCS models accounting for traditional PAD risk factors, leg pain, and MVPA, ST had a significant overall (P = .048) and non-linear (P = .024) association with PAD. A threshold effect was seen such that time spent above median ST was associated with higher odds of PAD. That is, compared to median ST, 1, 2 and 3 hours above median ST was associated with a PAD OR of 1.16 (95% CI: 1.02–1.31), 1.44 (1.06–1.94) and 1.80 (1.11–2.90), respectively.ConclusionsAmong Hispanic/Latino adults, ST was associated with higher odds of PAD, independent of leg pain, MVPA, and traditional PAD risk factors. Notably, we observed a threshold effect such that these associations were only observed at the highest levels of ST.
       
  • Mild+sleep+restriction+increases+24-hour+ambulatory+blood+pressure+in+pre-menopausal+women+with+no+indication+of+mediation+by+psychological+effects&rft.title=American+Heart+Journal&rft.issn=0002-8703&rft.date=&rft.volume=">Mild sleep restriction increases 24-hour ambulatory blood pressure in
           pre-menopausal women with no indication of mediation by psychological
           effects
    • Abstract: Publication date: Available online 8 February 2020Source: American Heart JournalAuthor(s): Marie-Pierre St-Onge, Ayanna Campbell, Brooke Aggarwal, Jasmine L. Taylor, Tanya M. Spruill, Arindam RoyChoudhuryAbstractStudies assessing the impact of sleep restriction (SR) on blood pressure (BP) are limited by short study length, extreme SR (
       
  • Impact of creatinine clearance on clinical outcomes in elderly atrial
           fibrillation patients receiving apixaban: J-ELD AF registry sub-analysis
    • Abstract: Publication date: Available online 8 February 2020Source: American Heart JournalAuthor(s): Masaharu Akao, Takeshi Yamashita, Shinya Suzuki, Ken Okumura, on behalf of J-ELD AF investigatorsAbstractBackgroundRandomized clinical trials demonstrated the efficacy and safety of apixaban in preventing stroke in patients with atrial fibrillation (AF). However, data on patients with low creatinine clearance (CCr), especially CCr 15–29 mL/min, are limited.Method and ResultsThe J-ELD AF Registry is a large-scale, multicenter prospective observational study of Japanese non-valvular AF patients aged ≥75 years taking on-label dose (standard dose of 5 mg bid or reduced dose of 2.5 mg bid) of apixaban. The entire cohort (3015 patients from 110 institutions) was divided into three CCr subgroups: CCr ≥50 mL/min (n = 1165, 38.6%), CCr 30–49 mL/min (n = 1395, 46.3%), and CCr 15–29 mL/min (n = 455, 15.1%). The event incidence rates (/100 person-years) were 1.76, 1.39, and 1.67 for stroke or systemic embolism (log rank P = .762), 1.39, 1.93, and 3.13 for bleeding requiring hospitalization (log rank P = .159), 1.75, 2.76, and 7.87 for total deaths (log rank P 
       
  • Association of Postoperative Complications and Outcomes Following Coronary
           Artery Bypass Grafting
    • Abstract: Publication date: Available online 8 February 2020Source: American Heart JournalAuthor(s): Oliver K Jawitz, Brian C Gulack, J Matthew Brennan, Dylan P Thibault, Alice Wang, Sean M O'Brien, Jacob N Schroder, Jeffrey G Gaca, Peter K SmithAbstractBackgroundThe long-term effects of postoperative complications following coronary artery bypass grafting (CABG) are unknown.MethodsMedicare-linked records from the Society of Thoracic Surgeons Adult Cardiac Surgery Database were queried for isolated CABG records from 2007 through 2012. Unadjusted and adjusted associations between individual postoperative complications and both mortality and all-cause rehospitalization were evaluated to 7 years using Cox proportional hazards models and cumulative incidence functions. Due to non-proportional hazards, associations are presented as early (0 to 90 days) and late (90 days to 7 years).ResultsOf the 294,533 isolated CABG patients who had records linked to Medicare for long-term follow-up, (median age, 73 yrs.; 30% female), 120,721 (41%) experienced at least one of the complications of interest, including new onset atrial fibrillation (30.0%), prolonged ventilation (12.3%), renal failure (4.5%), reoperation (3.5%), stroke (1.9%), and sternal wound infection (0.4%). Each of the six postoperative complications was associated with a significantly increased risk of mortality and rehospitalization to 7 years, despite adjustment for baseline characteristics and the presence of multiple complications. Although the predominant effect of postoperative complications was observed in the first 90 days, the increased risk-adjusted hazard for death and rehospitalization continued through 7 years.ConclusionsPostoperative complications are associated with an increased risk of both early and late mortality and all-cause rehospitalization, particularly during the “value” window within 90 days of CABG. These findings underscore the need to develop avoidance strategies as well as cost-adjustment methods for each of these complications.
       
  • Information for Readers
    • Abstract: Publication date: March 2020Source: American Heart Journal, Volume 221Author(s):
       
  • Clinical predictors of left ventricular involvement in Arrhythmogenic
           right ventricular Cardiomyopathy
    • Abstract: Publication date: Available online 7 February 2020Source: American Heart JournalAuthor(s): Deniz Akdis, Ardan M. Saguner, Haran Burri, Argelia Medeiros-Domingo, Christian M. Matter, Frank Ruschitzka, Felix C. Tanner, Corinna Brunckhorst, Firat DuruAbstractAimThe impact of clinical characteristics for predicting patterns of ventricular involvement in arrhythmogenic right ventricular cardiomyopathy (ARVC) are not well defined. The aims of this study were to characterize different patterns of ventricular involvement in patients with ARVC and to stratify them based on clinical characteristics exercise and underlying genetic mutations.MethodsSixty-four patients with definite ARVC from the Swiss ARVC Registry were enrolled. Right and left ventricular functions were assessed at baseline and most recent follow-up. All patients received genetic testing. Serum high-sensitivity cardiac Troponin T (hs-cTNT) and N-terminal of pro-brain natriuretic peptide (NT-proBNP) were determined at baseline.ResultsThirty-five patients (55%) had isolated right ventricular (RV) involvement, twelve patients (19%) had biventricular (BiV) involvement at baseline and seventeen patients (26%) had no left ventricular (LV) involvement at baseline, but revealed new onset LV involvement at mean follow-up of 7.5 years. Patients with BiV involvement at baseline harbored significantly more desmoplakin and multiple mutations and patients with new-onset LV involvement at follow-up frequently showed non-desmosomal mutations. Patients engaging in competitive sports more often showed LV involvement during follow-up. Baseline hs-cTNT and NT-proBNP levels were higher in patients developing BiV involvement.ConclusionMultiple mutations are more common in patients with BiV involvement. Competitive exercise is associated with disease progression resulting in BiV involvement. Hs-cTNT and NT-proBNP are elevated in patients with BiV involvement and may help to identify ARVC patients at risk for developing BiV disease.
       
  • Transcatheter InterAtrial shunt device for the treatment of heart failure:
           Rationale and Design of the Pivotal Randomized Trial to REDUCE elevated
           
    • Abstract: Publication date: Available online 11 November 2019Source: American Heart JournalAuthor(s): Natalia Berry, Laura Mauri, Ted Feldman, Jan Komtebedde, Dirk J. van Veldhuisen, Scott D. Solomon, Joseph M. Massaro, Sanjiv J. ShahBackgroundA randomized, sham-controlled trial in patients with heart failure (HF) and left ventricular ejection fraction (LVEF) ≥40% demonstrated reductions in pulmonary capillary wedge pressure (PCWP) with a novel transcatheter InterAtrial Shunt Device (IASD). Whether this hemodynamic effect will translate to an improvement in cardiovascular outcomes and symptoms requires additional study.Study Design and ObjectivesREDUCE Elevated Left Atrial Pressure in Patients with Heart Failure II (REDUCE LAP HF-II) is a multicenter, prospective, randomized, sham-controlled, blinded trial designed to evaluate the clinical efficacy of the IASD in symptomatic HF and elevated left atrial (LA) pressures. Up to 608 HF patients age ≥ 40 years with LVEF≥40%, PCWP≥25 mmHg during supine ergometer exercise, and PCWP≥5 mmHg higher than right atrial pressure will be randomized 1:1 to the IASD versus sham control. Key exclusion criteria include hemodynamically significant valvular disease, evidence of pulmonary arterial hypertension, and right heart dysfunction. The primary endpoint is a hierarchical composite of (1) cardiovascular mortality or first non-fatal ischemic stroke; (2) HF hospitalizations or healthcare facility visits for intravenous diuresis; and (3) change in Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score, all at 12 months, analyzed by Finkelstein-Schoenfeld methodology. Follow-up echocardiography will be performed at 6, 12, and 24 months to evaluate shunt flow and cardiac chamber size/function. Patients will be followed for a total of 5 years after the index procedure.ConclusionsREDUCE LAP-HF II is designed to evaluate the clinical efficacy of the IASD device in patients with symptomatic HF with elevated LA pressure and LVEF≥40%.
       
  • Primary outcomes should be of primary interest to readers
    • Abstract: Publication date: Available online 11 November 2019Source: American Heart JournalAuthor(s): Matthew J Budoff
       
  • Primary outcomes should be of primary interest to readers
    • Abstract: Publication date: Available online 11 November 2019Source: American Heart JournalAuthor(s): Bogdan Enache
       
  • Outcome impact of different tranexamic acid regimens in cardiac surgery
           with cardiopulmonary bypass (OPTIMAL): Rationale, design, and study
           protocol of a multi-center randomized controlled trial
    • Abstract: Publication date: Available online 21 October 2019Source: American Heart JournalAuthor(s): Jia Shi, Chenghui Zhou, Sheng Liu, Hansong Sun, Yang Wang, Fuxia Yan, Wei Pan, Zhe ZhengAbstractBackgroundTranexamic acid (TxA) reduces perioperative blood transfusion in cardiac surgery; however, the optimal dose of TxA remains unknown.Methods and ResultsThis large-scale, double-blind, randomized controlled trial with a 1-year follow-up enrolls patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients are randomly assigned 1:1 into either the high-dose TxA group (intravenous bolus [30 mg/kg] after anesthesia followed by intravenous maintenance [16 mg/kg/hour] throughout the operation, and a pump prime dose of 2 mg/kg) or the low-dose TxA group (intravenous bolus and maintenance are 10 mg/kg and 2 mg/kg/hour, respectively, and a pump prime dose of 1 mg/kg). The primary efficacy endpoint is the rate of perioperative allogeneic red blood cell (RBC) transfusion defined as the number (%) of patients who will receive at least one RBC unit from operation day to discharge. The primary safety endpoint is the 30-day rate of the composite of perioperative seizures, renal dysfunction, myocardial infarction, ischemic stroke, deep vein thrombosis, pulmonary embolism, and all-cause mortality. The secondary endpoints are perioperative allogeneic RBC transfusion volume, the non-RBC blood transfusion rate, postoperative bleeding, reoperation rate, mechanical ventilation duration, ICU stay, hospital length of stay, total hospitalization cost, each component of composite primary safety endpoint, and the 6-month/1-year follow-up mortality and morbidity. We estimated a sample size of 3,008 participants.ConclusionsThe study is designed to identify a TxA dose with maximal efficacy and minimal complications. We hypothesize that the high dose has superior efficacy and non-inferior safety to the low dose.
       
  • Distal evaluation of functional performance with intravascular sensors to
           assess the narrowing effect – Combined pressure and Doppler FLOW
           velocity measurements (DEFINE-FLOW) trial: Rationale and trial design
    • Abstract: Publication date: Available online 1 September 2019Source: American Heart JournalAuthor(s): Valérie E. Stegehuis, Gilbert W.M. Wijntjens, Tim P. van de Hoef, Lorena Casadonte, Richard L. Kirkeeide, Maria Siebes, Jos A.E. Spaan, K. Lance Gould, Nils P. Johnson, Jan J. PiekAbstractBackgroundIt remains uncertain if invasive coronary physiology beyond fractional flow reserve (FFR) can refine lesion selection for revascularization or provide additional prognostic value. Coronary flow reserve (CFR) equals the ratio of hyperemic to baseline flow velocity and has a wealth of invasive and non-invasive data supporting its validity. Due to fundamental physiologic relationships, binary classification of FFR and CFR disagree in approximately 30–40% of cases. Optimal management of these discordant cases requires further study.AimTo determine the prognostic value of combined FFR and CFR measurements to predict the 24-month rate of major adverse cardiac events (MACE). Secondary endpoints include repeatability of FFR and CFR, angina burden, and the percentage of successful FFR/CFR measurements which will not be excluded by the corelab.MethodsThis prospective, non-blinded, non-randomized, and multi-center study enrolled 455 subjects from 12 sites in Europe and Japan. Patients underwent physiologic lesion assessment using the 0.014” Philips Volcano ComboWire XT that provides simultaneous pressure and Doppler velocity sensors. Intermediate coronary lesions received only medical treatment unless both FFR (≤0.8) and CFR ( 0.80 and CFR ≥ 2.0. Enrollment has been completed and final follow-up will occur in November 2019.
       
  • Screening coronary artery disease with computed tomography angiogram
           should limit normal invasive coronary angiogram, regardless of pre-test
           probability
    • Abstract: Publication date: Available online 30 January 2020Source: American Heart JournalAuthor(s): Sonia Houssany-Pissot, Julien Rosencher, Philippe Allouch, Christophe Bensouda, Remy Pillière, Léa Cacoub, Christophe Caussin, Simon El-Hadad, Serge Makowski, Fabrizio Beverelli, Patrice CacoubAbstractBackgoundPerforming functional testing (FT) or a computed tomography angiogram (CCTA) before invasive coronary angiogram (ICA) is recommended for coronary artery disease (CAD). We aimed to evaluate, in a real life setting, the rate of strictly normal invasive coronary angiogram (ICA) following a positive non-invasive test.MethodsWe included all patients who underwent an ICA with a prior positive FT or CCTA. Patients were categorized in 5 subgroups, according to pre-test probability (PTP) of having a coronary artery disease (CAD). Main results of ICA were defined as normal ICA, non-obstructive CAD (non-oCAD) and obstructive CAD (oCAD).ResultsFor 4952 patients who underwent ICA following either a positive FT (3276, 66.2%) or CCTA (1676, 33.8%), the PTP was: (1) low [< 15%; n = 968,19.5%], (2) lower intermediate [15 to 35%; n = 1336,27.0%], (3) higher intermediate [35 to 50%; n = 806,16.3%], (4) high [50% to 65%; n = 806,17.7%], and (5) very high [> 65%; n = 965, 19.5%]. ICA showed no CAD (819 patients, 16.5%), non-oCAD (1193 patients, 24.1%) or oCAD (2940 patients, 59.4%). Without considering the PTP values, CCTA compared to FT showed less frequently normal ICA (7% vs. 16.5%), and more frequently CAD (non-oCAD 27.9% vs. 22.2%; oCAD 65.1% vs. 56.4%)(all P 
       
  • Primacy of coronary CT angiography as the gatekeeper for the cardiac
           catheterization laboratory
    • Abstract: Publication date: Available online 30 January 2020Source: American Heart JournalAuthor(s): Mohammed N Meah, Rong Bing, David E. Newby
       
  • Targeting all-comers—Are we doing as well as we can'
    • Abstract: Publication date: Available online 23 November 2019Source: American Heart JournalAuthor(s): James M. Brophy
       
  • A 4-item PRECISE-DAPT score for dual antiplatelet therapy duration
           decision-making
    • Abstract: Publication date: Available online 30 January 2020Source: American Heart JournalAuthor(s): Francesco Costa, David van Klaveren, Antonio Colombo, Fausto Feres, Lorenz Räber, Thomas Pilgrim, Myeong-Ki Hong, Hyo-Soo Kim, Stephan Windecker, Ewout W. Steyerberg, Marco Valgimigli, for the PRECISE-DAPT Study InvestigatorsAbstractThe originally-proposed PRECISE-DAPT score is a 5-item risk score supporting decision-making for dual antiplatelet therapy1 duration after PCI. It is unknown if a simplified version of the score based on 4 factors (age, hemoglobin, creatinine clearance, prior bleeding), and lacking white-blood cell count, retains potential to guide DAPT duration. The 4-item PRECISE-DAPT was used to categorize 10,081 patients who were randomized to short (3–6 months) or long (12–24 months) DAPT regimen according to high (HBR defined by PRECISE-DAPT ≥25 points) or non-high bleeding risk (PRECISE-DAPT
       
  • Aldosterone-to-renin ratio and blood pressure in young adults from the
           general population
    • Abstract: Publication date: Available online 29 January 2020Source: American Heart JournalAuthor(s): Stefanie Aeschbacher, Michel Mongiat, Raffaele Bernasconi, Steffen Blum, Pascal Meyre, Philipp Krisai, Selinda Ceylan, Martin Risch, Lorenz Risch, David ConenAbstractBackgroundThe effect of the renin angiotensin system (RAS) on blood pressure (BP) values in young adults from the general population is not well studied. We investigated the relationship between the aldosterone-to-renin ratio (ARR) and various BP indices in this population.MethodsWe assembled a population-based sample of adults aged 25–41 years. Conventional and 24-h BP recordings were obtained in all patients. Direct renin concentration (DRC) and plasma aldosterone concentration (PAC) were measured. Multivariable regression models were constructed to assess the relationships of ARR with BP and hypertension.ResultsWe included 1353 individuals (mean age 37 years, 56% women). The median (interquartile range) ARR, DRC and PAC were 13.8 (8.7; 22.9), 7.2 ng/l (4.4; 11.0) and 94 ng/l (68; 134). All BP indices were higher across sex-specific ARR quartiles. Per 1-unit increase in log-transformed ARR, the multivariable adjusted β–coefficients (95% confidence intervals (CI)) for conventional, 24-h, daytime and nighttime systolic BP were 1.68 (0.87; 2.48), P 
       
  • Epidemiology of in-hospital cardiac arrest complicating non-ST-segment
           elevation myocardial infarction receiving early coronary angiography
    • Abstract: Publication date: Available online 29 January 2020Source: American Heart JournalAuthor(s): Saraschandra Vallabhajosyula, Saarwaani Vallabhajosyula, Barry Burstein, Bradley W Ternus, Pranathi R Sundaragiri, Roger D White, Gregory W Barsness, Jacob C JentzerAbstractIn the period between 2000 and 2014, 584,704 admissions with non-ST-segment elevation myocardial infarction that received early coronary angiography (day zero) were identified from the National Inpatient Sample. In-hospital cardiac arrest was noted in 4349 (0.8%), of which ~47% were from ventricular arrhythmias and ~90% of occurred within ≤4 days. Non-ST-segment elevation myocardial infarction admissions with in-hospital cardiac arrest had higher in-hospital mortality compared to those without (61% vs. 1.6%) with an unchanged temporal trend of in-hospital cardiac arrest rates (adjusted odds ratio 1.29 [95% confidence interval 0.73–2.28]) in 2014 compared to 2000).
       
  • XATOA: Rationale and design of a prospective registry study to assess
           rivaroxaban 2.5 mg twice daily plus aspirin for prevention of
           atherothrombotic events in coronary artery disease, peripheral artery
           disease, or both
    • Abstract: Publication date: Available online 28 January 2020Source: American Heart JournalAuthor(s): Keith A.A. Fox, Sonia S. Anand, Victor Aboyans, Martin R. Cowie, E. Sebastian Debus, Uwe Zeymer, Danja Monje, Kai Vogtländer, Robert Lawatscheck, Alain GayAbstractPatients with coronary artery disease (CAD), peripheral artery disease (PAD), or both remain at risk of cardiovascular events (including peripheral ischemic events), even when they receive the current guideline-recommended treatment. The phase III COMPASS trial demonstrated that treatment with rivaroxaban vascular dose 2.5 mg twice daily plus aspirin (dual pathway inhibition [DPI] regimen) significantly reduced the risk of major adverse cardiovascular events (including peripheral ischemic events) and increased the risk of major bleeding, but not fatal bleeding or intracranial hemorrhage, versus aspirin alone in patients with CAD, PAD, or both. The results of the COMPASS trial supported the regulatory approval of the DPI regimen in several geographic regions. However, it is unclear whether the patients selected for treatment with the DPI regimen in clinical practice will have a similar risk profile and event rates compared with the COMPASS trial population. The prospective post-approval XATOA registry study aims to assess treatment patterns, as well as ischemic and bleeding outcomes in patients with CAD, PAD, or both, who receive DPI therapy in routine clinical practice. Up to 10,000 patients from at least 400 centers in 22 countries will be enrolled and followed up for a minimum of 12 months, and all treatment will be at the discretion of the prescribing physician. The primary objective of the XATOA study will be to describe early treatment patterns, while ischemic and bleeding outcomes will be described as a secondary objective.Trial registration number: NCT03746275
       
  • Comparison between ticagrelor and clopidogrel on myocardial blood flow in
           patients with acute coronary syndrome, using 13 N-ammonia positron
           emission tomography
    • Abstract: Publication date: Available online 27 January 2020Source: American Heart JournalAuthor(s): Young Jin Jeong, Kyungil Park, Young-Dae KimBackgroundThe PLEIO (comParison of ticagreLor and clopidogrEl on mIcrocirculation in patients with acute cOronary syndrome) study showed that six months of ticagrelor therapy significantly improved microvascular dysfunction in acute coronary syndrome (ACS) patients with stent implantation compared to clopidogrel. Improved microvascular function may affect myocardial blood flow (MBF). We compared the effects of ticagrelor and clopidogrel on MBF over a 6-month follow-up period among patients diagnosed with ACS treated with percutaneous coronary intervention (PCI).MethodsIn the PLEIO trial, 120 participants were randomized to receive ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily after at least 6 months. 13 N-ammonia positron emission tomography (PET) imaging was performed in 94 patients to measure MBF at the 6-month follow-up visit.ResultsOn a per-patient level, MBF (1.88 ± 0.52 versus 1.67 ± 0.64 mL/min per gram, P = .01) was significantly higher with ticagrelor compared with clopidogrel in the hyperemic state, but not under resting state (0.75 ± 0.24 versus 0.75 ± 0.19 mL/min per gram, P = .84). On a culprit-vessel analysis, the resting MBF was similar (0.69 ± 0.20 versus 0.70 ± 0.21, P = .89) between the two groups. However, the hyperemic MBF and myocardial flow reserve in the ticagrelor group were significantly higher compared with clopidogrel (1.75 ± 0.46 versus 1.52 ± 0.59, P = .03 and 2.71 ± 0.89 versus 2.20 ± 0.81, P = .02, respectively). These differences were not observed in non-culprit vessels.ConclusionsMaintenance treatment of ticagrelor increased the hyperemic MBF and myocardial flow reserve compared with clopidogrel.Clinical trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT02618733
       
  • Effects of the chymase inhibitor fulacimstat on adverse cardiac remodeling
           after acute myocardial infarction – Results of the CHIARA MIA 2 trial
    • Abstract: Publication date: Available online 25 January 2020Source: American Heart JournalAuthor(s): Hans-Dirk Duengen, Raymond J. Kim, Doron Zahger, Katia Orvin, Ran Kornowski, Dan Admon, Jiri Kettner, Avraham Shimony, Christiane Otto, Michael Becka, Friederike Kanefendt, Andres Iniguez Romo, Tal Hasin, Petr Ostadal, Gonzalo Calvo Rojas, Michele Senni, on behalf of all investigators of the CHIARA MIA 2 trialAbstractBackgroundAdverse cardiac remodeling is a major risk factor for the development of post myocardial infarction (MI) heart failure (HF). This study investigates the effects of the chymase inhibitor fulacimstat on adverse cardiac remodeling after acute ST-segment-elevation myocardial infarction (STEMI).MethodsIn this double-blind, randomized, placebo-controlled trial patients with first STEMI were eligible. To preferentially enrich patients at high risk of adverse remodeling, main inclusion criteria were a left-ventricular ejection fraction (LVEF) ≤ 45% and an infarct size>10% on day 5 to 9 post MI as measured by cardiac MRI. Patients were then randomized to 6 months treatment with either 25 mg fulacimstat (n = 54) or placebo (n = 53) twice daily on top of standard of care starting day 6 to 12 post MI. The changes in LVEF, LV end-diastolic volume index (LVEDVI), and LV end-systolic volume index (LVESVI) from baseline to 6 months were analyzed by a central blinded cardiac MRI core laboratory.ResultsFulacimstat was safe and well tolerated and achieved mean total trough concentrations that were approximately tenfold higher than those predicted to be required for minimal therapeutic activity. Comparable changes in LVEF (fulacimstat: 3.5% ± 5.4%, placebo: 4.0% ± 5.0%, P = .69), LVEDVI (fulacimstat: 7.3 ± 13.3 mL/m2, placebo: 5.1 ± 18.9 mL/m2, P = .54), and LVESVI (fulacimstat: 2.3 ± 11.2 mL/m2, placebo: 0.6 ± 14.8 mL/m2, P = .56) were observed in both treatment arms.ConclusionFulacimstat was safe and well tolerated in patients with left-ventricular dysfunction (LVD) after first STEMI but had no effect on cardiac remodeling.
       
  • Rationale and Design for a Multicenter, randomized, double-blind,
           placebo-controlled, phase 2 study evaluating the safety and efficacy of
           the soluble Guanylate Cyclase stimulator Praliciguat over 12 weeks in
           patients with heart failure with preserved ejection fraction (CAPACITY
           HFpEF)
    • Abstract: Publication date: Available online 21 January 2020Source: American Heart JournalAuthor(s): James E. Udelson, Gregory D. Lewis, Sanjiv J. Shah, Michael R. Zile, Margaret M. Redfield, John Burnett, Robert S. Mittleman, Albert T. Profy, Jelena P. Seferovic, David Reasner, Marvin A. KonstamBackgroundHeart failure with preserved ejection fraction (HFpEF), is a significant cause of morbidity and mortality worldwide. Exercise intolerance is the main symptom of HFpEF and is associated with a poor quality of life and increased mortality. Currently, there are no approved medications for the treatment of HFpEF. Praliciguat (IW-1973), a novel sGC stimulator that may help restore deficient NO-sGC-cGMP signaling, is being investigated for the treatment of patients with HFpEF.MethodsCAPACITY HFpEF is a phase 2, multicenter, randomized, double-blind, placebo-controlled, parallel-group trial designed to evaluate the safety and efficacy of praliciguat over 12 weeks in approximately 184 patients with HFpEF. Eligible patients must have evidence supporting clinical HFpEF and at least two of the following four conditions associated with NO deficiency: diabetes/prediabetes, hypertension, obesity, age> 70 years. The primary efficacy endpoint is the change from baseline in peak VO2 by cardiopulmonary exercise test (CPET). Secondary endpoints include the change from baseline in 6-minute walk test distance and the change in ventilatory efficiency on CPET, as well as number of CPET responders. Other exploratory endpoints include changes in echocardiographic parameters, New York Heart Association functional classification, cardiac events, blood and urine biomarkers pathophysiologically relevant to heart failure, and patient-reported outcomes including Kansas City Cardiomyopathy Questionnaire.ConclusionThe CAPACITY HFpEF trial will provide data on short-term safety and efficacy of praliciguat on peak exercise capacity, as well as multiple secondary endpoints of submaximal functional capacity, patient-reported outcomes, and biomarkers.
       
  • Contraceptive methods of privately-insured U.S. women with congenital
           heart defects
    • Abstract: Publication date: Available online 21 January 2020Source: American Heart JournalAuthor(s): Kayla N. Anderson, Naomi K. Tepper, Karrie Downing, Elizabeth C. Ailes, Ginnie Abarbanell, Sherry L. FarrAbstractBackgroundThe American Heart Association recommends women with congenital heart defects (CHD) receive contraceptive counseling early in their reproductive years, but little is known about contraceptive method use among women with CHD. We describe recent female sterilization and reversible prescription contraceptive method use by presence of CHD and CHD severity in 2014.MethodsUsing IBM MarketScan Commercial Databases, we included women aged 15–44 years with prescription drug coverage in 2014 who were enrolled ≥11 months annually in employer-sponsored health plans between 2011–2014. CHD, CHD severity, contraceptive methods, and obstetric-gynecology and cardiology provider encounters were identified using billing codes. We used log-binomial regression to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to compare contraceptive method use overall and by effectiveness tier by CHD presence and, for women with CHD, severity.ResultsRecent sterilization or current reversible prescription contraceptive method use varied slightly among women with (39.2%) and without (37.3%) CHD, aPR = 1.04, 95% CI [1.01–1.07]. Women with CHD were more likely to use any Tier I method (12.9%) than women without CHD (9.3%), aPR = 1.41, 95% CI [1.33–1.50]. Women with severe, compared to non-severe, CHD were less likely to use any method, aPR = 0.85, 95% CI [0.78–0.92], or Tier I method, aPR = 0.84, 95% CI [0.70–0.99]. Approximately 60% of women with obstetric-gynecology and
       
  • Treatment strategies and subsequent changes in the patient-reported
           quality-of-life among elderly patients with atrial fibrillation
    • Abstract: Publication date: Available online 21 January 2020Source: American Heart JournalAuthor(s): Kotaro Miura, Nobuhiro Ikemura, Takehiro Kimura, Yoshinori Katsumata, Ikuko Ueda, Kojiro Tanimoto, Takahiro Ohki, Daisuke Shinmura, Koji Negishi, Keiichi Fukuda, Seiji Takatsuki, Shun KohsakaAbstractBackgroundRhythm-control strategy, including catheter ablation (CA) application, constitutes an integral part of atrial fibrillation (AF) management. However, elderly patients are underrepresented in clinical trials, and reports on patient-reported outcome of various rhythm-control treatments remain limited. Therefore, we aimed to investigate the application of a rhythm-control strategy for elderly patients with AF.MethodsUsing a prospective, multicenter Japanese registry, we analyzed 733 patients with AF aged ≥70 years who completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire at baseline and 1-year visit. Improvement in patient-reported quality-of-life (QOL) was assessed according to their initial treatment strategy.ResultsA total of 321 patients (43.8%) were managed with rhythm-control strategy, of which 125 (17.1%) received treatment with antiarrhythmic drugs (AADs) alone and 196 (26.7%) underwent CA. Compared with the rate-control group, the rhythm-control group was younger and less likely to have comorbid conditions but had lower baseline AFEQT-overall summary (OS) scores (71.8 [standard deviation 20.3] vs. 80.0 [standard deviation 16.1]; P 
       
  • EMERGEncy versus delayed coronary angiogram in survivors of
           out-of-hospital cardiac arrest with no obvious non-cardiac cause of
           arrest: Design of the EMERGE trial
    • Abstract: Publication date: Available online 17 January 2020Source: American Heart JournalAuthor(s): Caroline Hauw-Berlemont, Lionel Lamhaut, Jean-Luc Diehl, Christophe Andreotti, Olivier Varenne, Pierre Leroux, Jean-Baptiste Lascarrou, Patrice Guerin, Thomas Loeb, Eric Roupie, Cédric Daubin, Farzin Beygui, Sophie Glippa, Juliette Djadi-Prat, Gilles Chatellier, Alain Cariou, Christian Spaulding, for the EMERGE investigatorsBackgroundIn adults, the most common cause of out-of-hospital cardiac arrests (OHCA) is acute coronary artery occlusion. If an immediate coronary angiogram (CAG) is recommended for survivors presenting a ST segment elevation on the electrocardiogram (ECG) performed after resuscitation, there is still a debate regarding the best strategy in patients without ST segment elevation.HypothesisPerforming an immediate CAG after an OHCA without ST segment elevation on the post-resuscitation ECG and no obvious non-cardiac cause of arrest could lead to a better 180-day survival rate with no or minimal neurological sequel as compared with a delayed CAG performed 48 to 96 hours after the arrest.DesignThe EMERGE trial is a prospective national, randomized, open and parallel group trial, in which 970 survivors of OHCA will be randomized (1:1) to either immediate (as soon as possible after return of spontaneous circulation) or delayed (48 to 96 h) CAG. Participants will be OHCA patients with no ST segment elevation on the post resuscitation ECG and no obvious non-cardiac cause of arrest. The primary endpoint of the study is the 180-day survival rate with no or minimal neurological sequel corresponding to Cerebral Performance Category (CPC) 1 or 2. The secondary endpoints are: occurrence of shock during the first 48 hours, ventricular tachycardia and/or fibrillation during the first 48 hours, change in left ventricular ejection fraction between baseline and 180 days assessed by echocardiogram, neurological status evaluated by the CPC score at intensive care unit (ICU) discharge and day 90 neurological status assessed by the Glasgow Outcome Scale Extended score (GOSE) at 90 and 180 days, overall survival rate, and hospital length of stay.SummaryThe EMERGE trial is a prospective, multicenter, randomized, controlled trial that will assess the 180-day survival rate with no or minimal neurologic sequel in patients resuscitated from an OHCA without ST segment elevation and who will be managed with either immediate or delayed CAG.
       
  • Study design of Dal-GenE, a pharmacogenetic trial targeting reduction of
           cardiovascular events with dalcetrapib
    • Abstract: Publication date: Available online 17 January 2020Source: American Heart JournalAuthor(s): Jean-Claude Tardif, Marie-Pierre Dubé, Marc A. Pfeffer, David D. Waters, Wolfgang Koenig, Aldo P. Maggioni, John J.V. McMurray, Vincent Mooser, Harvey D. White, Therese Heinonen, Donald M. Black, Marie-Claude Guertin, the dal-GenE Investigators.AbstractThe objectives of precision medicine are to better match patient characteristics with the therapeutic intervention to optimize the chances of beneficial actions while reducing the exposure to unneeded adverse drug experiences. In a retrospective genome-wide association study of the overall neutral placebo-controlled dal-Outcomes trial, the effect of the cholesteryl ester transfer protein (CETP) modulator dalcetrapib on the composite of cardiovascular death, myocardial infarction or stroke was found to be influenced by a polymorphism in the adenylate cyclase type 9 (ADCY9) gene. Whereas patients with the AA genotype at position rs1967309 experienced fewer cardiovascular events with dalcetrapib, those with the GG genotype had an increased rate and the heterozygous AG genotype exhibited no difference from placebo. Measurements of cholesterol efflux and C-reactive protein (CRP) offered directionally supportive genotype-specific findings. In a separate, smaller, placebo-controlled trial, regression of ultrasonography-determined carotid intimal-medial thickness was only observed in dalcetrapib-treated patients with the AA genotype. Collectively, these observations led to the hypothesis that the cardiovascular effects of dalcetrapib may be pharmacogenetically determined, with a favorable benefit-risk ratio only for patients with this specific genotype. We describe below the design of dal-GenE, a precision medicine, placebo-controlled clinical outcome trial of dalcetrapib in patients with a recent acute myocardial infarction with the unique feature of selecting only those with the AA genotype at rs1967309 in the ADCY9 gene.
       
  • Incidence, underlying conditions, and outcomes of patients receiving acute
           renal replacement therapies in tertiary cardiac intensive care units: An
           analysis from the critical care cardiology trials network registry
    • Abstract: Publication date: Available online 15 January 2020Source: American Heart JournalAuthor(s): Sean van Diepen, Wayne Tymchak, Erin A. Bohula, Jeong-Gun Park, Lori B. Daniels, Nicholas Phreaner, Christopher F. Barnett, Benjamin B Kenigsberg, Andrew DeFilippis, Narayana Sarma Singam, Gregory W. Barsness, Jacob C. Jentzer, Bradley Ternus, David A. Morrow, Jason N. Katz, Critical Care Cardiology Trials Network InvestigatorsBackgroundThe prevalence of renal disease in cardiac intensive care units (CICUs) is increasing, but little is known about the utilization, concurrent therapies, and outcomes of patients requiring acute renal replacement therapy (RRT) in this specialized environment.MethodsIn the Critical Care Cardiology Trials Network, 16 centers submitted data on CICU admissions including acute RRT (defined as continuous renal replacement therapy and/or acute intermittent dialysis).ResultsAmong 2985 admissions, 178 (6.0%; interhospital range 1.0%–16.0%) received acute RRT. Patients receiving RRT, versus not, were more commonly admitted for cardiogenic shock (15.7% vs 4.2%, P 
       
  • Implementation of best practices – Developing and optimizing regional
           Systems of Stroke Care: Design and methodology
    • Abstract: Publication date: Available online 15 January 2020Source: American Heart JournalAuthor(s): Matthew E Ehrlich, Brad J Kolls, Mayme Roettig, Lisa Monk, Shreyansh Shah, Ying Xian, James G Jollis, Christopher B Granger, Carmelo GraffagninoAbstractThe AHA Guidelines recommend developing multi-tiered systems for the care of patients with acute stroke.1 An ideal stroke system of care should ensure that all patients receive the most efficient and timely care, regardless of how they first enter or access the medical care system. Coordination among the components of a stroke system is the most challenging but most essential aspect of any system of care.The Implementation of Best Practices For Acute Stroke Care – Developing and Optimizing Regional Systems of Stroke Care (IMPROVE Stroke Care) project, is designed to implement existing guidelines and systematically improve the acute stroke system of care in the Southeastern United States. Project participation includes 9 hub hospitals, approximately 80 spoke hospitals, numerous pre-hospital agencies (911, fire, and emergency medical services) and communities within the region. The goal of the IMPROVE Stroke program is to develop a regional integrated stroke care system that identifies, classifies, and treats acute ischemic stroke patients more rapidly and effectively with reperfusion therapy. The project will identify gaps and barriers to implementation of stroke systems of care, leverage existing resources within the regions, aid in designing strategies to improve care processes, bring regional representatives together to agree on and implement best practices, protocols, and plans based on guidelines, and establish methods to monitor quality of care. The impact of implementation of stroke systems of care on mortality and long-term functional outcomes will be measured.
       
  • Underweight is associated with inferior short and long-term outcomes after
           MitraClip implantation: Results from the German TRAnscatheter mitral valve
           interventions (TRAMI) registry
    • Abstract: Publication date: Available online 10 January 2020Source: American Heart JournalAuthor(s): D. Kalbacher, E. Tigges, P. Boekstegers, M. Puls, B. Plicht, H. Eggebrecht, G. Nickenig, R.S.v. Bardeleben, C.S. Zuern, J. Franke, H. Sievert, T. Ouarrak, J. Senges, E. LubosAbstractBackgroundUnderweight and obesity represent classical risk factors for adverse outcome in patients treated for cardiovascular disease.AimsThe current analysis examines the impact of underweight, overweight and obesity on intra-hospital, short and long-term outcomes in patients treated by MitraClip therapy.Methods and ResultsFrom 08/2010 until 07/2013, 799 patients (age 75.3 ± 8.6 years, male gender 60.7%, median logistic EuroSCORE 20% [12; 31], functional mitral regurgitation (MR): 69.3%) were prospectively enrolled into the multicenter German Transcatheter Mitral Valve Interventions registry. Patients were stratified according to body mass index (BMI) into four groups: BMI
       
  • Long-term clinical outcomes with use of an angiotensin-converting enzyme
           inhibitor early after heart transplantation
    • Abstract: Publication date: Available online 9 January 2020Source: American Heart JournalAuthor(s): Hiroyuki Arashi, Takuma Sato, Jon Kobashigawa, Helen Luikart, Yuhei Kobayashi, Kozo Okada, Seema Sinha, Yasuhiro Honda, Alan C. Yeung, Kiran Khush, William F. FearonAbstractBackgroundThe safety and efficacy of angiotensin converting enzyme inhibition (ACEI) after heart transplantation (HT) is unknown. This study examined long-term clinical outcomes after ACEI in HT recipients.MethodsThe ACEI after HT study was a prospective, randomized trial that tested the efficacy of ACEI with ramipril after HT. In this study, long-term clinical outcomes were assessed in 91 patients randomized to either ramipril or placebo (median, 5.8 years). The primary endpoint was a composite of death, retransplantation, hospitalization for rejection or heart failure, and coronary revascularization.ResultsThe primary endpoint occurred in 10 of 45 patients (22.2%) in the ramipril group and in 14 of 46 patients (30.4%) in the placebo group (Hazard ratio (HR), 0.68; 95% CI, 0.29–1.51; P = .34). When the analysis was restricted to comparing patients who remained on a renin-angiotensin system inhibitor beyond one year with those who did not, there was a trend to improved outcomes (HR, 0.54; 95% CI, 0.22–1.28, P = .16). There was no significant difference in creatinine, blood urea nitrogen, and potassium at 3 years after randomization. The cumulative incidence of the primary endpoint was significantly higher in patients in whom the index of microcirculatory resistance increased from baseline to one year compared with those in whom it did not (39.1 vs 17.4%, HR: 3.36; 95% CI, 1.07–12.7; P = .037).ConclusionThe use of ramipril after HT safely lowers blood pressure and is associated with favorable long-term clinical outcomes.
       
  • Outcomes following Cardioversion for patients with cardiac amyloidosis and
           atrial fibrillation or atrial flutter
    • Abstract: Publication date: Available online 8 January 2020Source: American Heart JournalAuthor(s): Rahul S Loungani, Michael R. Rehorn, Kyle R. Geurink, Amanda C. Coniglio, Eric Black-Maier, Sean D. Pokorney, Michel G. KhouriAbstractAtrial arrhythmias commonly occur in patients with cardiac amyloidosis (CA), but there is limited data on safety or efficacy of cardioversion (DCCV) for management of these rhythms in CA. We identified 25 patients with CA (20 with transthyretin (TTR) and 5 with light-chain (AL) amyloidosis) at Duke University who underwent DCCV for atrial arrhythmias and documented procedural success, complications, and long-term morbidity and mortality. While DCCV successfully restored sinus rhythm in 96% of patients, 36% of patients experienced immediate procedural complications (primarily bradycardia and hypotension), 80% had recurrence of atrial arrhythmias at one year, and 52% died at 3 years, highlighting short-term safety concerns, long-term inefficacy, and poor prognosis associated with symptomatic atrial arrhythmias requiring DCCV in CA.
       
  • Impact of Rejection-Related Immune Responses on the Initiation and
           Progression of Cardiac Allograft Vasculopathy
    • Abstract: Publication date: Available online 8 January 2020Source: American Heart JournalAuthor(s): Michael Dandel, Roland HetzerAbstractGiven the causal association between acute rejection (AR) and CAV, early detection of AR, selection of appropriate rejection management strategies and close monitoring of AR therapy results, can delay the development and/or aggravation of CAV. Due to the complexity of AR surveillance, no single invasive or noninvasive diagnostic method can provide all the needed information for preventing AR-related coronary vascular damages. Certain combinations of available non-invasive surveillance techniques can detect patients at imminent risk for AR and therefore enable the replacement of unnecessary routine surveillance endomyocardial biopsies (EMBs) by a lower number of diagnostic EMBs and also help for severity grading of biopsy-proven AR. Decisions about the need for AR therapy, selection of therapies, and determination of therapy duration can also help to delay the development and progression of CAV. Regarding this, the search for antibody-mediated rejection in all EMBs is mandatory and the use of certain non-invasive surveillance methods like sensitive echocardiographic techniques, monitoring of complement-activating donor specific antibodies and gene expression analysis can be particularly useful. Given its ability to identify patients at high risk for future rejections, gene expression analysis also facilitates an individualized immunosuppression. This article gives an overview of the current knowledge about the immunology of CAV and its linkage with AR. Special attention is focused on the impact of asymptomatic early and late low-grade ARs on the pathogenesis and the course of CAV. Overall, the review aimed to provide a theoretical and practical basis for all those engaged in this particularly demanding up-to-date topic.
       
  • Interim effects of salt substitution on urinary electrolytes and blood
           pressure in the China Salt Substitute and Stroke Study (SSaSS)
    • Abstract: Publication date: Available online 7 January 2020Source: American Heart JournalAuthor(s): Liping Huang, Maoyi Tian, Jie Yu, Qiang Li, Yishu Liu, Xuejun Yin, Jason HY Wu, Matti Marklund, Yangfeng Wu, Nicole Li, Paul Elliot, Lijing L. Yan, Darwin R. Labarthe, Zhixin Hao, Jingpu Shi, Xiangxian Feng, Jianxin Zhang, Yuhong Zhang, Ruijuan Zhang, Bo ZhouAbstractThe Salt Substitute and Stroke Study is an ongoing 5-year large-scale cluster randomized trial investigating the effects of potassium-enriched salt substitute compared to usual salt on the risk of stroke. The study involves 600 villages and 20,996 individuals in rural China.Intermediate risk markers were measured in a random subsample of villages every 12 months over 3 years to track progress against key assumptions underlying study design. Measures of 24-hour urinary sodium, 24-hour urinary potassium, blood pressure and participants’ use of salt substitute were recorded, with differences between intervention and control groups estimated using generalized linear mixed models. The primary outcome of annual event rate in the two groups combined was determined by dividing confirmed fatal and non-fatal strokes by total follow-up time in the first 2 years.The mean differences (95% confidence interval) were -0.32 g (-0.68 to 0.05) for 24-hour urinary sodium, +0.77 g (+0.60 to +0.93) for 24-hour urinary potassium, -2.65 mmHg (-4.32 to -0.97) for systolic blood pressure and +0.30 mmHg (-0.72 to +1.32) for diastolic blood pressure. Use of salt substitute was reported by 97.5% in the intervention group versus 4.2% in the control group (P
       
  • Risk of Major Cardiovascular and Neurologic Events with Obstructive Sleep
           Apnea among Patients with Atrial Fibrillation
    • Abstract: Publication date: Available online 7 January 2020Source: American Heart JournalAuthor(s): Frederik Dalgaard, MR Rebecca North, Karen Pieper, Gregg C. Fonarow, Peter R. Kowey, Bernard J. Gersh, Kenneth W. Mahaffey, Sean Pokorney, Benjamin A. Steinberg, Gerald Naccarrelli, Larry A. Allen, James A. Reiffel, Michael Ezekowitz, Daniel E. Singer, Paul S. Chan, Eric D. Peterson, Jonathan P. PicciniStructured AbstractBackgroundObstructive sleep apnea (OSA) is a known risk factor for atrial fibrillation (AF). However, it remains unclear whether OSA is independently associated with worse cardiovascular and neurological outcomes in patients with AF.MethodWe used the ORBIT-AF I and ORBIT-AF II to conduct a retrospective cohort study of 22,760 patients with AF with and without OSA. Adjusted multivariable Cox proportional hazards models was used to determine whether OSA was associated with increased risk for major adverse cardiac and neurologic events (MACNE) (cardiovascular death, myocardial infarction, stroke/transient ischemic attack/non-CNS embolism (stroke/SE), and new-onset heart failure) , combined and individually.ResultsA total of 4,045 (17.8%) patients had OSA at baseline. Median follow-up time was 1.5 (IQR: 1-2.2) years and 1,895 patients experienced a MACNE event. OSA patients were younger (median [IQR] 68 [61-75] years vs. 74 [66-81] years, were more likely male (70.7% vs. 55.3%), and had increased BMI (median 34.6 kg/m2 [29.8-40.2] vs. 28.7 kg/m2 [25.2-33.0]). Those with OSA had a higher prevalence of concomitant comorbidities such as diabetes, chronic obstructive pulmonary disease, and heart failure. OSA patients had higher use of antithrombotic therapy. After adjustment, the presence of OSA was significantly associated with MACNE (HR: 1.16 [95% CI: 1.03-1.31], p=0.011). OSA was also an independent risk factor for stroke/SE beyond the CHA2DS2-VASc risk factors (HR: 1.38 [95% CI 1.12-1.70], p=0.003), but not cardiovascular death, myocardial infarction, new-onset heart failure or major bleeding.ConclusionAmong patients with AF, OSA is an independent risk factor for MACNE and, more specifically, stroke/SE.Graphical AbstractUnlabelled Image
       
  • Complex High and Indicated Percutaneous Coronary Intervention for Stable
           Angina: Does Operator Volume Influence Patient Outcome'
    • Abstract: Publication date: Available online 7 January 2020Source: American Heart JournalAuthor(s): Tim Kinnaird, Sean Gallagher, James C. Spratt, Peter Ludman, Mark de Belder, Samuel Copt, Richard Anderson, Simon Walsh, Colm Hanratty, Nick Curzen, Adrian Banning, Mamas MamasBackgroundComplex high-risk and indicated revascularisation using percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly studied.ObjectivesTo define temporal changes in CHIP-PCI volumes, and the relationship between operator CHIP-PCI volume and patient outcomes.Methods and ResultsData were analysed on all CHIP-PCI procedures undertaken for stable angina in England and Wales between 2007 and 2014. Operator volume data was available for 2012-14. CHIP-PCI was defined by patient characteristics (age ≥80years, left ventricular (LV) ejection fraction
       
  • The mechanisms of recurrent atrial arrhythmias after second-generation
           cryoballoon ablation
    • Abstract: Publication date: March 2020Source: American Heart Journal, Volume 221Author(s): Shinsuke Miyazaki, Tomoki Horie, Hitoshi Hachiya, Kanae Hasegawa, Takatsugu Kajiyama, Tomonori Watanabe, Hiroaki Nakamura, Eri Ishikawa, Moe Mukai, Daisetsu Aoyama, Minoru Nodera, Kenichi Kaseno, Yoshito Iesaka, Hiroshi TadaBackgroundIn patients with paroxysmal atrial fibrillation (PAF), 10%-15% of patients require repeat procedures after second-generation cryoballoon pulmonary vein isolation (CB-PVI). We sought to explore the mechanisms of recurrences after cryoballoon ablation.MethodsThe data of 122 PAF patients who underwent second procedures for recurrent arrhythmias 7.0 (4.0-12.0) months after the CB-PVI were analyzed. During second procedures, non-PV AF foci were explored with isoproterenol, adenosine, and repetitive cardioversions.ResultsIn total, 378/487 (77.6%) PVs remained isolated, and reconnections were not observed in any PVs in 59 (48.4%) patients. PV reconnections were associated with recurrences in 38 (31.1%) patients, of whom 33 (86.8%) had reconnections of at least 1 upper PV. In 6 (4.9%) patients, non-PV AF foci were identified in the upper PV antra where cryoballoons cannot isolate but within the circumferential radiofrequency PVI line. Non-PV AF foci were identified in the superior vena cava, right atrial body, left atrial body, and atrial septum in 28 (23.0%), 18 (14.7%), 4 (3.3%), and 5 (4.1%) patients, respectively. Twelve (9.8%) patients had multiple non-PV AF foci. Four (3.3%), 3 (2.4%), and 8 (6.5%) patients underwent second procedures for atrioventricular nodal reentrant tachycardia, atrial flutter, and atrial tachycardias. During 16.0 (8.0-24.0) months of follow-up, freedom from any atrial arrhythmia at 1 year and 2 years after the second procedure was 79.2% and 60.6%. Nineteen (15.5%) patients had antiarrhythmic drug therapy at the last follow-up.ConclusionsOur study suggested that improvement in the upper PV PVI durability, eliminating arrhythmogenic superior vena cavae and coexisting atrial arrhythmias, and bonus cryoballoon applications at PV antra might improve the single procedure outcome in cryoballoon ablation.
       
  • Association between frequency of primary care provider visits and
           evidence-based statin prescribing and statin adherence: Findings from the
           Veterans Affairs system
    • Abstract: Publication date: March 2020Source: American Heart Journal, Volume 221Author(s): Sarah T. Ahmed, Dhruv Mahtta, Hasan Rehman, Julia Akeroyd, Mahmoud Al Rifai, Fatima Rodriguez, Hani Jneid, Khurram Nasir, Zainab Samad, Mahboob Alam, Laura A. Petersen, Salim S. ViraniBackgroundStatin use remains suboptimal in patients with atherosclerotic cardiovascular disease (ASCVD). We assessed if the frequency of visits with primary care providers (PCPs) is associated with higher use of evidence-based statin prescriptions and adherence among patients with ASCVD.MethodsWe identified patients with ASCVD aged ≥18 years receiving care in 130 facilities and associated community-based outpatient clinics in the entire Veterans Affairs Health Care System between October 1, 2013 and September 30, 2014. Patients were divided into frequent PCP visitors (annual PCP visits ≥ median number of PCP visits for the entire cohort) and infrequent PCP visitors (annual PCP visits < median number of patient visits). We assessed any- and high-intensity statin prescription as well as statin adherence which was defined by proportion of days covered (PDC).ResultsWe included 1,249,061 patients with ASCVD (mean age was 71.9 years; 98.0% male). Median number of annual PCP visits was 3. Approximately 80.1% patients were on statins with 23.8% on high-intensity statins. Mean PDC was 0.715 ± 0.336 with 58.3% patients with PDC ≥0.8. Frequent PCP visitors had higher frequency of statin use (82.2% vs 77.4%), high-intensity statin use (26.4% vs 20.3%), and statin adherence (mean PDC 0.73 vs 0.68; P 
       
  • Rationale and design of the British Heart Foundation (BHF) Coronary
           Microvascular Function and CT Coronary Angiogram (CorCTCA) study
    • Abstract: Publication date: March 2020Source: American Heart Journal, Volume 221Author(s): Novalia P Sidik, Margaret McEntegart, Giles Roditi, Thomas J Ford, Michael McDermott, Andrew Morrow, John Byrne, Jacqueline Adams, Allister Hargreaves, Keith G Oldroyd, David Stobo, Olivia Wu, Claudia-Martina Messow, Alex McConnachie, Colin BerryBackgroundMicrovascular and/or vasospastic anginas are relevant causes of ischemia with no obstructive coronary artery disease (INOCA) in patients after computed tomography coronary angiography (CTCA).ObjectivesOur research has 2 objectives. The first is to undertake a diagnostic study, and the second is to undertake a nested, clinical trial of stratified medicine.DesignA prospective, multicenter, randomized, blinded, sham-controlled trial of stratified medicine (NCT03477890) will be performed. All-comers referred for clinically indicated CTCA for investigation of suspected coronary artery disease (CAD) will be screened in 3 regional centers. Following informed consent, eligible patients with angina symptoms are enrolled before CTCA and remain eligible if CTCA excludes obstructive CAD.Diagnostic study: Invasive coronary angiography involving an interventional diagnostic procedure (IDP) to assess for disease endotypes: (1) angina due to obstructive CAD (fractional flow reserve ≤0.80); (2) microvascular angina (coronary flow reserve 25); (3) microvascular angina due to small vessel spasm (acetylcholine); (4) vasospastic angina due to epicardial coronary spasm (acetylcholine); and (5) noncoronary etiology (normal coronary function). The IDP involves direct invasive measurements using a diagnostic coronary guidewire followed by provocation testing with intracoronary acetylcholine. The primary outcome of the diagnostic study is the reclassification of the initial CTCA diagnosis based on the IDP.Stratified medicine trial: Participants are immediately randomized 1:1 in the catheter laboratory to therapy stratified by endotype (intervention group) or not (control group). The primary outcome of the trial is the mean within-subject change in Seattle Angina Questionnaire score at 6 months.Secondary outcomes include safety, feasibility, diagnostic utility (impact on diagnosis and certainty), and clinical utility (impact on treatment and investigations). Health status assessments include quality of life, illness perception, anxiety-depression score, treatment satisfaction, and physical activity. Participants who are not randomized will enter a follow-up registry. Health and economic outcomes in the longer term will be assessed using electronic patient record linkage.ValueCorCTCA will prospectively characterize the prevalence of disease endotypes in INOCA and determine the clinical value of stratified medicine in this population.Graphical abstractUnlabelled Image
       
  • Impact of EMpagliflozin on cardiac function and biomarkers of heart
           failure in patients with acute MYocardial infarction—The EMMY trial
    • Abstract: Publication date: March 2020Source: American Heart Journal, Volume 221Author(s): Norbert J Tripolt, Ewald Kolesnik, Peter N Pferschy, Nicolas Verheyen, Klemens Ablasser, Sandra Sailer, Hannes Alber, Rudolf Berger, Carl Kaulfersch, Katharina Leitner, Michael Lichtenauer, Arthur Mader, Deddo Moertl, Abderrahim Oulhaj, Christian Reiter, Thomas Rieder, Christoph H. Saely, Jolanta Siller-Matula, Franz Weidinger, Peter M ZechnerBackgroundSodium glucose cotransporter 2 (SGLT2) inhibitors are established antidiabetic drugs with proven cardiovascular benefit. Although growing evidence suggests beneficial effects on myocardial remodeling, fluid balance and cardiac function, the impact of empagliflozin initiated early after acute myocardial infarction (AMI) has not been investigated yet. Therefore, the impact of EMpagliflozin on cardiac function and biomarkers of heart failure in patients with acute MYocardial infarction (EMMY) trial was designed to investigate the efficacy and safety of empagliflozin in diabetic and non-diabetic patients after severe AMI.MethodsWithin a multicenter, randomized, double-blind, placebo-controlled, phase 3b trial we will enroll patients with AMI and characteristics suggestive of severe myocardial necrosis are randomized in a 1:1 ratio to empagliflozin (10 mg once daily) or matching placebo. The primary endpoint is the impact of empagliflozin on changes in NT-proBNP within 6 months after AMI. Secondary endpoints include changes in echocardiographic parameters, levels of ketone body concentrations, HbA1c levels and body weight, respectively. Hospitalization rate due to heart failure or other causes, the duration of hospital stay and all-cause mortality will be assessed as exploratory secondary endpoints.DiscussionThe EMMY trial will test empagliflozin in patients with AMI regardless of their diabetic status. The EMMY trial may therefore underpin the concept of SGLT2 inhibition to improve cardiac remodeling, pre-and afterload reduction and cardiac metabolism regardless of its antidiabetic effects. Results will provide the rationale for the conduct of a cardiovascular outcome trial to test the effect of empagliflozin in patients with AMI.
       
  • Transesophageal echocardiography complications associated with
           interventional cardiology procedures
    • Abstract: Publication date: March 2020Source: American Heart Journal, Volume 221Author(s): Afonso B. Freitas-Ferraz, Josep Rodés-Cabau, Lucía Junquera Vega, Jonathan Beaudoin, Kim O'Connor, Pierre Yves Turgeon, Jean-Michel Paradis, Alfredo Ferreira-Neto, Lluis Asmarats, Jean Champagne, Gilles O'Hara, Mathieu BernierBackgroundAlthough there have been several reports documenting complications related with transesophageal echocardiography (TEE) manipulation following cardiac surgery, there is a paucity of data regarding the safety of TEE used to guide catheter-based interventions. The aim of this study was to determine the prevalence, types and risk factors of complications associated with procedures requiring active TEE guidance.MethodsThis study included 1249 consecutive patients undergoing either transcatheter aortic valve implantation (TAVI), Mitraclip, left atrial appendage occlusion (LAAO) or paravalvular leak closure (PVLC). Patients were divided into 2 cohorts based on the degree of probe manipulation required to guide the procedure and the risk of developing a TEE-related complication: low-risk (TAVI, n = 1037) and high-risk (Mitraclip, LAAO and PVLC, n = 212). Patients were further analyzed according to the occurrence of major and minor TEE-related complications.ResultsThe overall incidence of TEE-related complications was 0.9% in the TAVI group and 6.1% in the rest of the cohort (P 
       
  • Central venous pressure and the risk of diuretic-associated acute kidney
           injury in patients after cardiac surgery
    • Abstract: Publication date: Available online 27 December 2019Source: American Heart JournalAuthor(s): Ian E. McCoy, Maria E. Montez-Rath, Glenn M. Chertow, Tara I. ChangAbstractBackgroundWhen prescribing diuretics in the post-cardiac surgical intensive care unit (ICU), clinicians may use central venous pressure (CVP) to assess volume status and the risk of acute kidney injury (AKI). In this study, we examined how the risk of diuretic-associated AKI varied with CVP in patients undergoing cardiac surgery.MethodsWe used the MIMIC-III database to study adults admitted to the post-cardiac surgical ICU at an urban, academic medical center between 2001 and 2012. We examined the odds of AKI per 1 mmHg increase in CVP among patients receiving intravenous loop diuretics using multivariable adjusted logistic regression. We examined the risk of AKI among patients with diuretic use (versus non-use) across tertiles of CVP using inverse probability treatment weighting.ResultsAmong 4164 patients receiving intravenous loop diuretics, the adjusted odds of subsequent AKI were 1.11 (95% confidence interval [CI] 1.08–1.13) times higher per mmHg increase in mean CVP. This association was log-linear across the entire range of CVPs observed. In the analysis of diuretic use (n = 5396), the adjusted risk ratio for AKI with diuretic use (versus non-use) was 1.33 (95% CI 1.21–1.47), and did not materially differ across tertile of CVP.ConclusionsHigher rather than lower CVP is an independent marker of AKI risk. The risk of AKI associated with diuretic use may not be influenced by CVP. Novel methods of assessing volume status and AKI risk are needed to guide patient selection for diuretic therapy.
       
  • Rationale and Design of the Flow Evaluation to Guide Revascularization in
           Multivessel ST-Elevation Myocardial Infarction (FLOWER-MI) trial
    • Abstract: Publication date: Available online 27 December 2019Source: American Heart JournalAuthor(s): Etienne Puymirat, Tabassome Simon, Bernard de Bruyne, Gilles Montalescot, Gabriel Steg, Guillaume Cayla, Isabelle Durand-Zaleski, Didier Blanchard, Nicolas Danchin, Gilles Chatellier, FLOWER-MI study investigatorsAbstractBackgroundIn ST-elevation myocardial infarction (STEMI) patients presenting with multivessel disease (MVD), recent studies have demonstrated the superiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for non-culprit lesions compared to culprit lesion treatment-only therapy. FFR- and angio-guided PCI have however never been compared in STEMI patients.Trial designFLOWER MI is an open label multicenter national randomized clinical trial. The aim is to investigate FFR-guided complete revascularization in comparison to angio-guided complete revascularization in STEMI patients with successful PCI of the culprit lesion and ≥50% stenosis in at least one additional non-culprit lesion requiring PCI. Eligible patients will be randomized after successful primary PCI in a 1:1 fashion to either FFR-guided or angio-guided complete revascularization during the index procedure or a staged procedure before discharge (≤5-Day). Patients assigned to FFR guidance first have FFR measured in each non-culprit vessel and only undergo PCI if FFR is ≤0.80. The primary end point of the study is a composite of major adverse cardiac events, including all-cause death, non-fatal MI, and unplanned hospitalization leading to urgent revascularization at 1 year. Secondary end points will include the individual adverse events, cost-effectiveness, quality of life, and 30-day, 6-month, and 3-year outcomes. Based on estimated event rates, a sample size of 1170 patients is needed to show superiority of the FFR-guided revascularization with 80% power.ConclusionThe aim of FLOWER-MI trial is to assess whether FFR-guided complete revascularization in the acute setting is superior angio-guided complete revascularization.ClinicalTrials.gov Identifier: NCT02943954
       
  • Feasibility of combining serial smartphone single-Lead electrocardiograms
           for the diagnosis of ST-elevation myocardial infarction
    • Abstract: Publication date: Available online 27 December 2019Source: American Heart JournalAuthor(s): Joseph Boone Muhlestein, Jeffrey L. Anderson, Charles F. Bethea, Harry W. Severance, Robert J. Mentz, Gregory W. Barsness, Alejandro Barbagelata, David Albert, Viet T. Le, T. Jared Bunch, Frank Yanowitz, Heidi T. May, Benjamin Chisum, Brianna S. Ronnow, Joseph Brent Muhlestein, Duke University Cooperative Cardiovascular Society (DUCCS) investigatorsAbstractBackgroundThe rate-limiting step in STEMI diagnosis often is the availability of a 12-lead electrocardiogram (ECG) and its interpretation. The potential may exist to speed the availability of 12-lead ECG information by using commonly available mobile technologies. We sought to test whether combining serial smartphone single-lead ECGs to create a virtual 12-lead ECG can accurately diagnose STEMI.MethodsConsenting patients presenting with symptoms consistent with a possible STEMI had contemporaneous standard 12-lead and smartphone ‘12-lead equivalent’ ECG (produced by electronically combining serial single-lead ECGs) recordings obtained. Matched ECGs were evaluated qualitatively and quantitatively by a panel of blinded readers and classified as STEMI/STEMI equivalent (LBBB), Not-STEMI, or uninterpretable. Interpretable ECG pairs were graded as showing good, fair, or poor correlation.Results204 subjects (age = 60 years, males = 57%, STEMI activation = 45%) were enrolled from 5 international sites. Smartphone ECG quality was graded as good in 151 (74.0%), fair in 32 (15.7%), poor in 8 (3.9%), and uninterpretable in 13 (6.4%). A STEMI/STEMI equivalent diagnosis was identified by standard 12-lead ECG in 57/204 (27.9%) recordings. For all interpretable pairs of smartphone ECGs compared with standard ECGs (n = 190), the sensitivity, specificity, and positive and negative predictive values for STEMI/STEMI equivalent by smartphone were 0.89, 0.84, 0.70 and 0.95, respectively.ConclusionsA ‘12-lead equivalent’ ECG obtained from multiple serial single-lead ECGs from a smartphone can identify STEMI with good correlation to a standard 12-lead ECG. This technology holds promise to improve outcomes in STEMI by enhancing the reach and speed of diagnosis and thereby early treatment.
       
  • Modeling defibrillation benefit for survival among cardiac
           resynchronization therapy defibrillator recipients
    • Abstract: Publication date: Available online 27 December 2019Source: American Heart JournalAuthor(s): Kenneth C. Bilchick, Yongfei Wang, Jeptha P. Curtis, Alan Cheng, Kumar Dharmarajan, Ramin Shadman, Todd F Dardas, Inder Anand, Lars H. Lund, Ulf Dahlström, Ulrik Sartipy, Aldo Maggioni, Christopher O'Connor, Wayne C. LevyBackgroundPatients with heart failure having a low expected probability of arrhythmic death may not benefit from implantable cardioverter defibrillators (ICDs).ObjectiveThe objective was to validate models to identify cardiac resynchronization therapy (CRT) candidates who may not require CRT devices with ICD functionality.MethodsHeart failure (HF) patients with CRT-Ds and non-CRT ICDs from the National Cardiovascular Data Registry and others with no device from 3 separate registries and 3 heart failure trials were analyzed using multivariable Cox proportional hazards regression for survival with the Seattle Heart Failure Model (SHFM; estimates overall mortality) and the Seattle Proportional Risk Model (SPRM; estimates proportional risk of arrhythmic death).ResultsAmong 60,185 patients (age 68.6 ± 11.3 years, 31.9% female) meeting CRT-D criteria, 38,348 had CRT-Ds, 11,389 had non-CRT ICDs, and 10,448 had no device. CRT-D patients had a prominent adjusted survival benefit (HR 0.52, 95% CI 0.50–0.55, P 
       
  • Myocardial fibrosis and the effect of primary prophylactic defibrillator
           implantation in patients with non-ischemic systolic heart failure –
           DANISH-MRI
    • Abstract: Publication date: Available online 24 December 2019Source: American Heart JournalAuthor(s): Marie Bayer Elming, Sophia Hammer-Hansen, Inga Voges, Eva Nyktari, Anna Axelsson Raja, Jesper Hastrup Svendsen, Steen Pehrson, James Signorovitch, Lars Køber, Sanjay K. Prasad, Jens Jakob ThuneAimsPatients with non-ischemic systolic heart failure have an increased risk of sudden cardiac death (SCD). Myocardial fibrosis, detected as late gadolinium enhancement (LGE) with cardiac magnetic resonance (CMR), has been shown to predict all-cause mortality. We hypothesized that LGE can identify patients with non-ischemic heart failure who will benefit from ICD implantation.Methods and resultsIn this prospective observational sub-study of the Danish Study to Assess the Efficacy of ICDs in Patients with Nonischemic Systolic Heart Failure on Mortality (DANISH), 252 patients underwent CMR. LGE was quantified by the full width/half maximum method. The primary endpoint was all-cause mortality. LGE could be adequately assessed in 236 patients, median age was 61 years and median duration of heart failure was 14 months; there were 108 patients (46%) randomized to ICD. Median follow-up time was 5.3 years. Median left ventricular ejection fraction on CMR was 35%. In all, 50 patients died. LGE was present in 113 patients (48%). The presence of LGE was an independent predictor of all-cause mortality (HR 1.82; 95% CI 1.002–3.29; P = .049) after adjusting for known cardiovascular risk factors. ICD implantation did not impact all-cause mortality, for either patients with LGE (HR 1.18; 95% CI 0.59–2.38; P = .63), or for patients without LGE (HR 1.00; 95% CI 0.39–2.53; P = .99), (p for interaction =0.79).ConclusionIn patients with non-ischemic systolic heart failure, LGE predicted all-cause mortality. However, in this cohort, LGE did not identify a group of patients who survived longer by receiving an ICD.
       
  • Cryoballoon catheter ablation versus antiarrhythmic drugs as a FIRST-line
           therapy for patients with paroxysmal atrial fibrillation: Rationale and
           Design of the International Cryo-FIRST study
    • Abstract: Publication date: Available online 18 December 2019Source: American Heart JournalAuthor(s): Jean Sylvain Hermida, Jian Chen, Christian Meyer, Saverio Iacopino, Giuseppe Arena, Nikola Pavlovic, Vedran Velagic, Stewart Healey, Douglas L. Packer, Heinz-Friedrich Pitschner, Carlo de Asmundis, Malte Kuniss, Gian Battista ChierchiaBackgroundRadiofrequency current (RFC) catheter ablation for patients with paroxysmal atrial fibrillation (AF) has been shown to be safe and effective in first-line therapy. Recent data demonstrates that RFC ablation provides better clinical outcomes compared to antiarrhythmic drug (AAD) in the treatment of early AF disease. Furthermore, studies comparing RFC and cryoballoon have established comparable efficacy and safety of pulmonary vein isolation (PVI) for patients with symptomatic paroxysmal AF.ObjectivesThe Cryo-FIRST trial was designed to compare AAD treatment against cryoballoon PVI as a first-line therapy in treatment naïve patients with AF. Efficacy and safety will be compared between the two cohorts and amongst subgroups.MethodsThe primary hypothesis is that cryoablation is superior to AAD therapy. To test this hypothesis, patients will be randomized in a 1: 1 design. Using a 90-day blanking period, primary efficacy endpoint failure is defined as (at least) one episode of atrial arrhythmia with a duration>30 sec (documented by 7-day Holter or 12-lead ECG). Secondary endpoints (Quality-of-Life, rehospitalization, arrhythmia recurrence rate, healthcare utilization, and left atrial function) and adverse events will also be evaluated. Study enrollment will include 218 patients in up to 16 centers.ConclusionsThis study will be a multi-national randomized controlled trial comparing cryoablation against AAD as a first-line treatment in patients with paroxysmal AF. The results may help guide the selection of patients for early AF disease therapy via cryoballoon ablation.Graphical abstractUnlabelled Image
       
  • Comparison of expected and observed outcomes for septal myectomy in
           hypertrophic obstructive cardiomyopathy
    • Abstract: Publication date: Available online 18 December 2019Source: American Heart JournalAuthor(s): Jeffrey B. Geske, C. Noelle Driver, Vidhushei Yogeswaran, Steve R. Ommen, Hartzell SchaffAbstractBackgroundSeptal myectomy remains the gold standard for treatment of symptomatic, medically-refractory hypertrophic cardiomyopathy (HCM). There is no specific surgical risk calculator for septal myectomy.MethodsThis study compares the outcomes of septal myectomy at a tertiary referral center with predicted outcomes of mitral valve (MV) repair and aortic valve replacement (AVR) using the Society of Thoracic Surgeons Adult Cardiac Surgery Risk Calculator (STS Calculator). 298 consecutive patients with HCM underwent isolated septal myectomy from 2011–2014. Observed outcomes of septal myectomy were compared with the STS Calculator predicted risk of isolated MV repair and AVR predicted within this population using one-sample tests of proportions.Results30-day mortality for myectomy in this cohort was zero. STS Calculator predicted risk of mortality for MV repair was 0.7% (P = .14) and for AVR = 1.1% (P = .06). Follow-up for vital status was 6.0 ± 0.7 years, at which 294 (98.7%) patients were alive. Hospital stay length was 4.9 ± 1.9 days. One (0.3%) patient experienced a post-operative deep sternal wound infection and one (0.3%) patient experienced a prolonged ventilated state. Post-operative atrial fibrillation occurred in 64 (21.4%) patients. During 30 days of follow-up, no patients experienced stroke, renal failure, or needed dialysis.ConclusionsSeptal myectomy, performed in a tertiary referral center, had a 30-day mortality rate of 0% and low morbidity rate. There was no difference between observed myectomy mortality and STS Calculator predicted risk for AVR and MV repair. It is possible that a larger sample could reveal lower mortality than STS prediction.
       
  • Identifying nonischemic cardiomyopathy patients who would benefit from an
           implantable Cardioverter-defibrillator: Can late gadolinium enhancement on
           cardiovascular magnetic resonance imaging help'
    • Abstract: Publication date: Available online 17 December 2019Source: American Heart JournalAuthor(s): Rajat Kalra, Chetan Shenoy
       
  • Consequences of impressive myectomy results in a Center of Excellence: The
           paradox of evidence-based medicine era
    • Abstract: Publication date: Available online 17 December 2019Source: American Heart JournalAuthor(s): Josef Veselka
       
  • Is there sex Bias against women reflected in industry payments and does it
           matter'
    • Abstract: Publication date: Available online 17 December 2019Source: American Heart JournalAuthor(s): Andrea M. Russo
       
  • Association of HDL particle concentration with cardiovascular risk
           following acute coronary syndrome: A case-cohort analysis of the
           dal-outcomes trial
    • Abstract: Publication date: Available online 16 December 2019Source: American Heart JournalAuthor(s): Taufiq Salahuddin, John Kittelson, Jean-Claude Tardif, Prediman K. Shah, Anders G. Olsson, Stephen J. Nicholls, Eran Leitersdorf, Lawrence A. Leiter, David Kallend, Donald M. Black, Philip J. Barter, Christie M. Ballantyne, Gregory G. SchwartzAbstractBackgroundHDL cholesterol (HDL-C) concentration is inversely related to risk of major adverse cardiovascular events (MACE) in epidemiologic studies but is a poorer predictor of MACE in patients with established coronary heart disease. HDL particle concentration (HDLP) has been proposed as a better predictor of risk. We investigated whether HDLP is associated with risk of MACE after acute coronary syndrome (ACS).MethodsThe dal-Outcomes trial compared the CETP inhibitor dalcetrapib with placebo in patients with recent ACS. In a nested case-cohort analysis, total, large, medium and small HDLP were measured by NMR spectroscopy at baseline (4–12 weeks after ACS) in 476 cases with MACE and 902 controls. Hazard ratios (HRs; case:control) for 1 standard deviation increment of HDLP or HDL-C at baseline were calculated with and without adjustment for demographic, clinical, laboratory, and treatment variables. Similarly, HRs for MACE were calculated for changes in HDLP or HDL-C from baseline to Month 3 of assigned treatment.ResultsOver median follow-up of 28 months, the risk of MACE was not associated with baseline HDLP (adjusted HR = 0.98, 95% confidence interval = 0.84–1.15, P = .81), any HDLP subclass or HDL-C. Dalcetrapib increased HDL-C and total, medium, and large HDLP and decreased small HDLP, but had no effect on MACE compared with placebo. There was no association of risk of MACE with change in HDLP or HDL-C and no interaction with assigned study treatment.ConclusionsNeither baseline HDLP nor the change in HDLP on treatment with dalcetrapib or placebo is associated with risk of MACE after ACS.
       
  • Corrigendum to “Randomized controlled trial of influenza vaccine in
           patients with heart failure to reduce adverse vascular events (IVVE):
           Rationale and design” [212 (2019) 36–44]
    • Abstract: Publication date: Available online 12 December 2019Source: American Heart JournalAuthor(s): Mark Loeb, Hisham Dokainish, Antonio Dans, Lia M Palileo-Villanueva, Ambuj Roy, Kamilu Karaye, Jun Zhu, Yan Liang, Fastone Goma, Albertino Damasceno, Khalid F AlHabib, Gerald Yonga, Charles Mondo, Wael Almahmeed, Arif Al Mulla, Salim Yusuf, IVVE investigators
       
  • Estimating the prevalence of congenital heart disease among adolescents
           and adults in Colorado adjusted for incomplete case ascertainment
    • Abstract: Publication date: Available online 5 December 2019Source: American Heart JournalAuthor(s): Lindsey M Duca, Laura Pyle, Amber D Khanna, Toan Ong, Michael G Kahn, Carolyn DiGuiseppi, Kenneth Scott, Matthew F Daley, Everett Costa, Arthur J Davidson, Tessa L CrumeBackgroundCongenital heart defects (CHDs), the most common type of birth defect in the United States, are increasing in prevalence in the general population. Though CHD prevalence at birth has been well described in the United States at about 1%, little is known about long-term survival and prevalence of CHDs beyond childhood. This study aimed to estimate the prevalence of CHDs among adolescents and adults in Colorado.MethodsThe prevalence of CHDs among adolescents and adults residing in Colorado during 2011–2013 was estimated using log-linear capture-recapture methods to account for incomplete case ascertainment. Five case-finding data sources were used for this analysis including electronic health record data from four major health systems and a state-legislated all payer claims database.Results12,293 unique individuals with CHDs (2481 adolescents and 9812 adults) were identified in one or more primary data sources. We estimated the crude prevalence of CHDs in adolescents and adults in Colorado to be 3.22 per 1000 individuals (95% CI 3.19–3.53). After accounting for incomplete case ascertainment, the final capture-recapture model yielded an estimated total adolescent and adult CHD population of 23,194 (95% CI 22,419-23,565) and an adjusted prevalence of 6.07 per 1000 individuals (95% CI 5.86–6.16), indicating 47% of the cases in the catchment area were not identified in the case-identifying data sources.ConclusionThis statewide study yielded new information on the prevalence of CHDs in adolescents and adults. These high prevalence rates underscore the need for additional specialized care facilities for this population with CHDs.
       
  • Gastrointestinal bleeding in patients with atrial fibrillation treated
           with Apixaban or warfarin: Insights from the ARISTOTLE trial
    • Abstract: Publication date: Available online 31 October 2019Source: American Heart JournalAuthor(s): David A. Garcia, Deborah A. Fisher, Hillary Mulder, Lisa Wruck, Raffele De Caterina, Sigrun Halvorsen, Christopher B. Granger, Claes Held, Lars Wallentin, John H. Alexander, Renato D. LopesAbstractObjectivesA history of gastrointestinal bleeding (GIB) in patients with atrial fibrillation (AF) may impact decisions about anticoagulation treatment. To sought to determine whether prior GIB in patients with AF taking anticoagulants was associated with an increased risk of stroke or major hemorrhage.MethodsWe analyzed key efficacy and safety outcomes in patients with prior GIB in ARISTOTLE. Centrally adjudicated outcomes according to GIB history were analyzed using Cox proportional hazards models adjusted for randomized treatment and established risk factors.ResultsA total of 784 (4.3%) patients had prior GIB (321 [41%] lower, 463 [59%] upper); 215 (27%) occurred
       
 
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