Subjects -> MEDICAL SCIENCES (Total: 8359 journals)
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CARDIOVASCULAR DISEASES (329 journals)                  1 2 | Last

Showing 1 - 200 of 329 Journals sorted alphabetically
Acta Angiologica     Open Access   (Followers: 5)
Acta Cardiologica     Hybrid Journal   (Followers: 2)
Acute Cardiac Care     Hybrid Journal   (Followers: 7)
Adipositas - Ursachen, Folgeerkrankungen, Therapie     Hybrid Journal  
AJP Heart and Circulatory Physiology     Hybrid Journal   (Followers: 12)
Aktuelle Kardiologie     Hybrid Journal   (Followers: 1)
American Heart Journal     Hybrid Journal   (Followers: 58)
American Journal of Cardiology     Hybrid Journal   (Followers: 67)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 17)
American Journal of Hypertension     Hybrid Journal   (Followers: 28)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anatolian Journal of Cardiology     Open Access   (Followers: 6)
Angiología     Full-text available via subscription  
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Angiology     Hybrid Journal   (Followers: 3)
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (Followers: 1)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 12)
AORTA     Open Access  
Archives of Cardiovascular Diseases     Full-text available via subscription   (Followers: 5)
Archives of Cardiovascular Diseases Supplements     Full-text available via subscription   (Followers: 3)
Archives of Cardiovascular Imaging     Open Access   (Followers: 2)
Archivos de cardiología de México     Open Access   (Followers: 1)
Argentine Journal of Cardiology (English edition)     Open Access   (Followers: 2)
Arquivos Brasileiros de Cardiologia     Open Access   (Followers: 1)
Arteriosclerosis, Thrombosis and Vascular Biology     Full-text available via subscription   (Followers: 32)
Artery Research     Hybrid Journal   (Followers: 4)
ARYA Atherosclerosis     Open Access  
ASAIO Journal     Hybrid Journal   (Followers: 3)
ASEAN Heart Journal     Open Access   (Followers: 2)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2)
Aswan Heart Centre Science & Practice Services     Open Access   (Followers: 1)
Atherosclerosis : X     Open Access  
Bangladesh Heart Journal     Open Access   (Followers: 3)
Basic Research in Cardiology     Hybrid Journal   (Followers: 10)
BMC Cardiovascular Disorders     Open Access   (Followers: 22)
Brain Circulation     Open Access   (Followers: 1)
British Journal of Cardiology     Full-text available via subscription   (Followers: 16)
Canadian Journal of Cardiology     Hybrid Journal   (Followers: 18)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiac Electrophysiology Review     Hybrid Journal   (Followers: 2)
Cardiocore     Full-text available via subscription   (Followers: 1)
Cardiogenetics     Open Access   (Followers: 3)
Cardiology     Full-text available via subscription   (Followers: 20)
Cardiology and Angiology: An International Journal     Open Access  
Cardiology and Therapy     Open Access   (Followers: 12)
Cardiology Clinics     Full-text available via subscription   (Followers: 14)
Cardiology in Review     Hybrid Journal   (Followers: 8)
Cardiology in the Young     Hybrid Journal   (Followers: 34)
Cardiology Journal     Open Access   (Followers: 6)
Cardiology Plus     Open Access   (Followers: 1)
Cardiology Research     Open Access   (Followers: 15)
Cardiology Research and Practice     Open Access   (Followers: 10)
Cardiopulmonary Physical Therapy Journal     Hybrid Journal   (Followers: 7)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Cardiothoracic Surgeon     Open Access  
CardioVasc     Full-text available via subscription   (Followers: 1)
Cardiovascular & Haematological Disorders - Drug Targets     Hybrid Journal   (Followers: 1)
Cardiovascular & Hematological Agents in Medicinal Chemistry     Hybrid Journal   (Followers: 2)
CardioVascular and Interventional Radiology     Hybrid Journal   (Followers: 15)
Cardiovascular and Thoracic Open     Open Access  
Cardiovascular Diabetology     Open Access   (Followers: 10)
Cardiovascular Drugs and Therapy     Hybrid Journal   (Followers: 14)
Cardiovascular Endocrinology & Metabolism     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering and Technology     Hybrid Journal   (Followers: 1)
Cardiovascular Intervention and Therapeutics     Hybrid Journal   (Followers: 5)
Cardiovascular Journal     Open Access   (Followers: 6)
Cardiovascular Journal of Africa     Full-text available via subscription   (Followers: 5)
Cardiovascular Journal of South Africa     Full-text available via subscription   (Followers: 1)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Cardiovascular Pathology     Hybrid Journal   (Followers: 4)
Cardiovascular Regenerative Medicine     Open Access  
Cardiovascular Research     Hybrid Journal   (Followers: 15)
Cardiovascular Revascularization Medicine     Hybrid Journal   (Followers: 1)
Cardiovascular System     Open Access  
Cardiovascular Therapeutics     Open Access   (Followers: 1)
Cardiovascular Toxicology     Hybrid Journal   (Followers: 6)
Cardiovascular Ultrasound     Open Access   (Followers: 5)
Case Reports in Cardiology     Open Access   (Followers: 7)
Catheterization and Cardiovascular Interventions     Hybrid Journal   (Followers: 3)
Cerebrovascular Diseases     Full-text available via subscription   (Followers: 3)
Cerebrovascular Diseases Extra     Open Access  
Chest     Full-text available via subscription   (Followers: 100)
Choroby Serca i Naczyń     Open Access   (Followers: 1)
Circulation     Hybrid Journal   (Followers: 246)
Circulation : Cardiovascular Imaging     Hybrid Journal   (Followers: 14)
Circulation : Cardiovascular Interventions     Hybrid Journal   (Followers: 17)
Circulation : Cardiovascular Quality and Outcomes     Hybrid Journal   (Followers: 11)
Circulation : Genomic and Precision Medicine     Hybrid Journal   (Followers: 15)
Circulation : Heart Failure     Hybrid Journal   (Followers: 26)
Circulation Research     Hybrid Journal   (Followers: 35)
Cirugía Cardiovascular     Open Access  
Clínica e Investigación en Arteriosclerosis     Full-text available via subscription  
Clínica e Investigación en arteriosclerosis (English Edition)     Hybrid Journal  
Clinical and Experimental Hypertension     Hybrid Journal   (Followers: 3)
Clinical Cardiology     Hybrid Journal   (Followers: 11)
Clinical Hypertension     Open Access   (Followers: 5)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6)
Clinical Research in Cardiology     Hybrid Journal   (Followers: 6)
Clinical Research in Cardiology Supplements     Hybrid Journal  
Clinical Trials and Regulatory Science in Cardiology     Open Access   (Followers: 4)
Congenital Heart Disease     Hybrid Journal   (Followers: 6)
Congestive Heart Failure     Hybrid Journal   (Followers: 4)
Cor et Vasa     Full-text available via subscription   (Followers: 1)
Coronary Artery Disease     Hybrid Journal   (Followers: 2)
CorSalud     Open Access  
Critical Pathways in Cardiology     Hybrid Journal   (Followers: 4)
Current Cardiology Reports     Hybrid Journal   (Followers: 7)
Current Cardiology Reviews     Hybrid Journal   (Followers: 4)
Current Cardiovascular Imaging Reports     Hybrid Journal   (Followers: 1)
Current Cardiovascular Risk Reports     Hybrid Journal  
Current Heart Failure Reports     Hybrid Journal   (Followers: 5)
Current Hypertension Reports     Hybrid Journal   (Followers: 6)
Current Hypertension Reviews     Hybrid Journal   (Followers: 6)
Current Opinion in Cardiology     Hybrid Journal   (Followers: 14)
Current Problems in Cardiology     Hybrid Journal   (Followers: 3)
Current Research : Cardiology     Full-text available via subscription   (Followers: 1)
Current Treatment Options in Cardiovascular Medicine     Hybrid Journal   (Followers: 1)
Current Vascular Pharmacology     Hybrid Journal   (Followers: 5)
CVIR Endovascular     Open Access   (Followers: 1)
Der Kardiologe     Hybrid Journal   (Followers: 2)
Echo Research and Practice     Open Access   (Followers: 2)
Echocardiography     Hybrid Journal   (Followers: 4)
Egyptian Heart Journal     Open Access   (Followers: 2)
Egyptian Journal of Cardiothoracic Anesthesia     Open Access  
ESC Heart Failure     Open Access   (Followers: 4)
European Heart Journal     Hybrid Journal   (Followers: 67)
European Heart Journal - Cardiovascular Imaging     Hybrid Journal   (Followers: 10)
European Heart Journal - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 3)
European Heart Journal - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart Journal : Acute Cardiovascular Care     Hybrid Journal   (Followers: 1)
European Heart Journal : Case Reports     Open Access   (Followers: 1)
European Heart Journal Supplements     Hybrid Journal   (Followers: 8)
European Journal of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9)
European Journal of Cardio-Thoracic Surgery Supplements     Full-text available via subscription   (Followers: 2)
European Journal of Cardiovascular Nursing     Hybrid Journal   (Followers: 5)
European Journal of Heart Failure     Hybrid Journal   (Followers: 14)
European Journal of Preventive Cardiology.     Hybrid Journal   (Followers: 6)
European Stroke Organisation     Hybrid Journal   (Followers: 3)
Experimental & Translational Stroke Medicine     Open Access   (Followers: 8)
Expert Review of Cardiovascular Therapy     Full-text available via subscription   (Followers: 3)
Folia Cardiologica     Open Access  
Forum Zaburzeń Metabolicznych     Hybrid Journal  
Frontiers in Cardiovascular Medicine     Open Access   (Followers: 1)
Future Cardiology     Hybrid Journal   (Followers: 6)
General Thoracic and Cardiovascular Surgery     Hybrid Journal   (Followers: 3)
Global Cardiology Science and Practice     Open Access   (Followers: 5)
Global Heart     Hybrid Journal   (Followers: 3)
Heart     Hybrid Journal   (Followers: 48)
Heart and Mind     Open Access  
Heart and Vessels     Hybrid Journal  
Heart Failure Clinics     Full-text available via subscription   (Followers: 2)
Heart Failure Reviews     Hybrid Journal   (Followers: 3)
Heart India     Open Access   (Followers: 2)
Heart International     Full-text available via subscription  
Heart Rhythm     Hybrid Journal   (Followers: 11)
Heart Views     Open Access   (Followers: 2)
HeartRhythm Case Reports     Open Access  
Hellenic Journal of Cardiology     Open Access   (Followers: 1)
Herz     Hybrid Journal   (Followers: 3)
High Blood Pressure & Cardiovascular Prevention     Full-text available via subscription   (Followers: 2)
Hypertension     Full-text available via subscription   (Followers: 23)
Hypertension in Pregnancy     Hybrid Journal   (Followers: 9)
Hypertension Research     Hybrid Journal   (Followers: 5)
Ibrahim Cardiac Medical Journal     Open Access  
IJC Heart & Vessels     Open Access   (Followers: 1)
IJC Heart & Vasculature     Open Access   (Followers: 1)
IJC Metabolic & Endocrine     Open Access   (Followers: 1)
Indian Heart Journal     Open Access   (Followers: 5)
Indian Journal of Cardiovascular Disease in Women WINCARS     Open Access  
Indian Journal of Thoracic and Cardiovascular Surgery     Hybrid Journal  
Indian Pacing and Electrophysiology Journal     Open Access   (Followers: 1)
Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery     Hybrid Journal   (Followers: 1)
Insuficiencia Cardíaca     Open Access  
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7)
International Cardiovascular Forum Journal     Open Access  
International Journal of Angiology     Hybrid Journal   (Followers: 2)
International Journal of Cardiology     Hybrid Journal   (Followers: 18)
International Journal of Cardiovascular and Cerebrovascular Disease     Open Access   (Followers: 2)
International Journal of Cardiovascular Imaging     Hybrid Journal   (Followers: 2)
International Journal of Cardiovascular Research     Hybrid Journal   (Followers: 6)
International Journal of Heart Rhythm     Open Access  
International Journal of Hypertension     Open Access   (Followers: 8)
International Journal of Hyperthermia     Open Access  
International Journal of Stroke     Hybrid Journal   (Followers: 30)
International Journal of the Cardiovascular Academy     Open Access  
Interventional Cardiology Clinics     Full-text available via subscription   (Followers: 2)
Interventional Cardiology Review     Full-text available via subscription  
JACC : Basic to Translational Science     Open Access   (Followers: 5)
JACC : Cardiovascular Imaging     Hybrid Journal   (Followers: 18)
JACC : Cardiovascular Interventions     Hybrid Journal   (Followers: 17)
JACC : Heart Failure     Full-text available via subscription   (Followers: 14)
JAMA Cardiology     Hybrid Journal   (Followers: 28)
JMIR Cardio     Open Access  
Jornal Vascular Brasileiro     Open Access  
Journal of Clinical & Experimental Cardiology     Open Access   (Followers: 5)
Journal of Arrhythmia     Open Access  
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal of Cardiac Failure     Hybrid Journal   (Followers: 1)

        1 2 | Last

Similar Journals
Journal Cover
American Journal of Cardiology
Journal Prestige (SJR): 1.93
Citation Impact (citeScore): 3
Number of Followers: 67  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9149 - ISSN (Online) 0002-9149
Published by Elsevier Homepage  [3161 journals]
  • Prognostic Implications of Renal Dysfunction in Patients with Aortic
           Stenosis
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of CardiologyAuthor(s): E. Mara Vollema, Edgard A. Prihadi, Arnold C.T. Ng, Tea Gegenava, Nina Ajmone Marsan, Jeroen J. Bax, Victoria DelgadoABSTRACTAortic stenosis (AS) and renal dysfunction share risk factors and often occur simultaneously. The influence of renal dysfunction on the prognosis of patients with various grades of AS has not been extensively described. The present study aimed to assess the prognostic implications of renal dysfunction in a large cohort of patients with aortic sclerosis and patients with various grades of AS. Patients diagnosed with various grades of AS by transthoracic echocardiography were assessed and divided according to renal function by estimated glomerular filtration rate (eGFR). The occurrence of all-cause mortality (primary endpoint) and aortic valve replacement (AVR) was noted. Of 1178 patients (mean age 70±13 years, 60% male), 327 (28%) had aortic sclerosis, 86 (7%) had mild AS, 285 (24%) had moderate AS and 480 (41%) had severe AS. Renal dysfunction (eGFR
       
  • Metoprolol versus Carvedilol in Patients with Heart Failure, Chronic
           Obstructive Pulmonary Disease, Diabetes Mellitus, and Renal Failure
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of CardiologyAuthor(s): Maurizio Sessa, Daniel Bech Rasmussen, Magnus Thorsten Jensen, Kristian Kragholm, Christian Torp-Pedersen, Morten AndersenABSTRACTThis study aims to compare the survival and the risk of heart failure, chronic obstructive pulmonary disease, diabetes mellitus, hypoglycemia, and renal failure hospitalizations in geriatric patients that were exposed to carvedilol or metoprolol. Danish administrative healthcare registers were used as data sources. Patients aged ≥ 65 and having heart failure, chronic obstructive pulmonary disease, and diabetes mellitus were followed for 1 year from the date of the first beta-blocker prescription redemption. Baseline characteristics of patients were used to 1:1 propensity score match carvedilol and metoprolol users. A Cox regression model was used to compute the hazard ratio (HR) of study outcomes. For statistically significant associations, a conditional inference tree was used to recursively partition the predictors most associated with the outcome. In total, 1424 patients were included. No statistically significant differences were observed for survival (HR 0.86; 95% Confidence Interval, 95%CI 0.67-1.11, p=0.240) between carvedilol and metoprolol users. The same applied to chronic obstructive pulmonary disease (HR 0.88; 95%CI 0.75-1.05, p=0.177), diabetes mellitus (HR 0.95; 95%CI 0.82-1.10, p=0.485), hypoglycaemia (HR 0.88; 95%CI 0.47-1.67, p=0.707) and renal failure (HR 1.25; 95%CI 0.93-1.69, p=0.142) hospitalizations. Carvedilol users had a 38% higher hazard then metoprolol users of heart failure hospitalization during the follow-up period (HR 1.38; 95%CI 1.19-1.60, p
       
  • Utility of the Modified Frailty Index to Predict Cardiac Resynchronization
           Therapy Outcomes and Response
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of CardiologyAuthor(s): Aidan Milner, Eric D. Braunstein, Goyal Umadat, Hamza Ahsan, Juan Lin, Eugen C. PalmaAbstractThe aim of the present study was to investigate the utility of the modified frailty index (mFI) to predict outcomes in patients undergoing cardiac resynchronization therapy (CRT) device implantation. A retrospective cohort study of patients undergoing CRT implantation or upgrade over a five-year period was performed. The relationship between the pre-procedural 11-component mFI and clinical outcomes including one-year mortality, peri-procedural and 30-day adverse events, 30-day readmission, length of hospitalization after procedure, and response to CRT defined by changes in left ventricular ejection fraction (LVEF) and end-diastolic volume (LVEDV) were studied. Of 283 patients studied, 134 (47.3%) were classified as frail (mFI ≥ 3). Frailty was associated with an increased risk of one-year mortality (HR 5.87, p = 0.033 in multivariate analysis), and increased frequency of adverse events (p = 0.013), 30-day readmission (p = 0.0077), and post-procedural length of stay ≥ 3 days (p = 0.0005). Frail patients had significantly less echocardiographic response to CRT compared to non-frail patients with change in LVEF 6% vs 12% (p=0.004) and change in LVEDV -19.9 vs -43.3 mL (p = 0.006). In conclusion, frailty as assessed by the mFI is associated with an increase in one-year mortality, adverse events, 30-day readmission, length of stay, and poorer response to CRT after implantation.
       
  • Relation of Plasma Xanthine Oxidoreductase Activity to Coronary Lipid Core
           Plaques Assessed by Near-Infrared Spectroscopy Intravascular Ultrasound in
           Patients with Stable Coronary Artery Disease
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of CardiologyAuthor(s): Naoto Mori, Yuichi Saito, Kan Saito, Takaaki Matsuoka, Kazuya Tateishi, Tadayuki Kadohira, Hideki Kitahara, Yoshihide Fujimoto, Yoshio KobayashiAbstractPrevious studies reported that elevated serum uric acid level was associated with greater coronary lipid plaque. Xanthine oxidoreductase (XOR) is a rate-limiting enzyme in purine metabolism and is believed to play important roles in coronary atherosclerosis. However, the relation between XOR and coronary lipid plaque is unclear. Patients with stable coronary artery disease undergoing elective percutaneous coronary intervention under near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) guidance were prospectively included. They were divided into 3 groups according to plasma XOR activities based on a previous report: low, normal, and high. Quantitative coronary angiography and gray-scale IVUS were analyzed. The primary endpoint was coronary lipid plaques in a non-target vessel assessed by NIRS-IVUS with lipid core burden index (LCBI) and maximum LCBI in 4 mm (maxLCBI4mm). Out of 68 patients, 26, 31, and 11 patients were classified as low, normal, and high XOR activity groups. Quantitative coronary angiography demonstrated that the high XOR activity group had longer lesion length, smaller minimum lumen diameter, and higher percentage of diameter stenosis in a non-target vessel among the 3 groups. Gray-scale IVUS analysis also showed smaller lumen area in the high XOR activity group than the others. LCBI (102.1±56.5 vs. 65.6±48.5 vs. 55.6±37.8, p=0.04) and maxLCBI4mm (474.4±171.6 vs. 347.4±181.6, 294.0±155.9, p=0.04) in a non-target vessel were significantly higher in the high XOR group than in the normal and low groups. In conclusion, elevated XOR activity was associated with coronary lipid-rich plaque in a non-target vessel in patients with stable coronary artery disease.
       
  • Use of Flecainide for the Treatment of Atrial Fibrillation
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of CardiologyAuthor(s): Debra S. Echt, Jeremy N. RuskinAbstractAtrial fibrillation (AF) is the most common sustained arrhythmia and is associated with substantial morbidity and impairment of quality of life. Restoration and maintenance of normal sinus rhythm is a desirable goal for many patients with AF, however, this strategy is limited by the relatively small number of antiarrhythmic drugs (AADs) available for AF rhythm control. Although it is recommended in current medical guidelines as first-line therapy for patients without structural heart disease, the use of flecainide has been curtailed since the completion of the Cardiac Arrhythmia Suppression Trial (CAST). In clinical trials and real world use, flecainide has proven to be more effective than other AADs for the acute termination of recent onset AF. Flecainide is also moderately effective and, with the exception of amiodarone, equivalent to other AADs for the chronic suppression of paroxysmal and persistent AF. In patients without structural heart disease, flecainide has been demonstrated to be safe and well tolerated relative to other AADs. Despite this favorable profile, flecainide is underutilized, likely due to a perceived risk of ventricular proarrhythmia, a concern that has not been borne out in patients without underlying structural heart disease. Guidelines for administration and use of flecainide are summarized in this review.
       
  • Thirty-Day Readmission After Medical vs. Endovascular Therapy for
           Atherosclerotic Renal Artery Stenosis
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of CardiologyAuthor(s): David W. Louis, Dhaval Kolte, Kevin Kennedy, Fabio V. Lima, J. Dawn Abbott, Doug Shemin, Shafiq Mamdani, Herbert D. AronowAbstractWhether renal artery stenting (RAS) confers benefit over medical therapy (MT) alone in patients with atherosclerotic renal artery stenosis admitted with acute coronary syndromes (ACS), congestive heart failure (CHF), or hypertensive crisis remains unknown. We identified a nationally-weighted cohort of 116,056 patients from the Nationwide Readmissions Database (NRD) with a preexisting diagnosis of atherosclerotic renal artery stenosis and an index hospitalization diagnosis of ACS, CHF, or hypertensive crisis, and propensity-matched on the likelihood of undergoing inpatient RAS. Thirty-day readmission rates, index hospitalization complications, hospital lengths-of-stay (LOS), and cost were compared between treatment groups. Overall, all-cause, non-elective 30-day readmission rates did not differ between RAS and MT alone (18.2% vs 18.7%, respectively, p = 0.49). RAS was associated with higher index rates of acute kidney injury, major bleeding, transfusion, and vascular complications, and were similar irrespective of index hospitalization diagnosis. Index hospitalization LOS (6 vs. 4 days; p < 0.001) and cost ($23,020 vs. $11,459; p < 0.001) were higher with RAS. In conclusion, nearly 1-in-5 patients hospitalized with atherosclerotic renal artery stenosis and ACS, CHF, or hypertensive crisis were readmitted within 30-days. Index hospitalization complications occurred more frequently among those treated with RAS than MT alone, but the likelihood of readmission did not differ by treatment strategy.
       
  • Prevalence and Impact of Having Multiple Barriers to Medication Adherence
           in Nonadherent Patients With Poorly Controlled Cardiometabolic Disease
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Julie C. Lauffenburger, Thomas Isaac, Romit Bhattacharya, Thomas D. Sequist, Chandrasekar Gopalakrishnan, Niteesh K. ChoudhryAdherence to medications remains poor despite numerous efforts to identify and intervene upon nonadherence. One potential explanation is the limited focus of many interventions on one barrier. Little is known about the prevalence and impact of having multiple barriers in contemporary practice. Our objective was to quantify adherence barriers for patients with poorly controlled cardiometabolic condition, identify patient characteristics associated with having multiple barriers, and determine its impact on adherence. We used a linked electronic health records and insurer claims dataset from a large health system from a recent pragmatic trial. Barriers to medication taking before the start of the intervention were elicited by clinical pharmacists using structured interviews. We used multivariable modified Poisson regression models to examine the association between patient factors and multiple barriers and multivariable linear regression to evaluate the relation between multiple barriers and claims-based adherence. Of the 1,069 patients (mean: 61 years of age) in this study, 25.1% had multiple barriers to adherence; the most common co-occurring barriers were forgetfulness and health beliefs (31%, n = 268). Patients with multiple barriers were more likely to be non-white (relative risk [RR] 1.57, 95% confidence interval [CI] 1.21 to 1.74), be single/unpartnered (RR 1.36, 95% CI 1.06 to 1.74), use tobacco (RR 1.54, 95% CI 1.13 to 2.11), and have poor glycemic control (RR 1.77, 95% CI 1.31 to 2.39) versus those with 0 or 1 barrier. Each additional barrier worsened average adherence by 3.1% (95% CI −4.6%, −1.5%). In conclusion,>25% of nonadherent patients present with multiple barriers to optimal use, leading to meaningful differences in adherence. These findings should inform quality improvement interventions aimed at nonadherence.
       
  • Electrocardiogram in a 75-Year-Old Woman With Left-Sided Chest Pain
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Mazen M. Kawji, D. Luke GlancyIn a 75-year-old woman with left-sided chest pain and an abnormal electrocardiogram the etiology is not cardiac.
       
  • Meta-Analysis of Transcatheter Aortic Valve Implantation Versus Surgical
           Aortic Valve Replacement in Patients With Low Surgical Risk
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Sharath C. Vipparthy, Venkatesh Ravi, Sindhu Avula, Soumyasri Kambhatla, Mobasser Mahmood, Ameer Kabour, Syed Sohail Ali, Marco Barzallo, Sudhir MungeeTranscatheter aortic valve implantation (TAVI) is the current standard of care for patients with severe aortic stenosis who are at high risk for surgery. However, several recent studies have demonstrated the comparable safety and efficacy of TAVI in low-risk patients as well. We sought to pool the existing data to further assert its comparability. MEDLINE, Cochrane, and Embase databases were evaluated for relevant articles published from January 2005 to June 2019. Studies comparing outcomes of TAVI versus surgical aortic valve replacement in patients who are at low risk for surgery were included. Twelve studies (5 randomized controlled trials and 7 observational studies) totaling 27,956 patients were included. Follow-up ranged from 3 months to 5 years. Short-term all-cause mortality, short-term, and 1-year cardiac mortality were significantly lower in the TAVI group. One-year all-cause mortality, short-term, and 1-year stroke and myocardial infarction were similar in both groups. Rate of acute kidney injury and new-onset atrial fibrillation were lower in the TAVI group, whereas permanent pacemaker implantation and major vascular complications were higher in the TAVI group. Subgroup analysis of randomized controlled trials showed significantly lower 1-year all-cause mortality in the TAVI group. In conclusion, in severe aortic stenosis patients at low surgical risk, TAVI when compared with surgical aortic valve replacement, demonstrated a lower rate of short-term all-cause mortality, short-term, and 1-year cardiac mortality and similar in terms of 1-year all-cause mortality. TAVI is emerging as a safe and efficacious alternative for low surgical risk patients.
       
  • Meta-Analysis Comparing Results of Transcatheter Versus Surgical
           Aortic-Valve Replacement in Patients With Severe Aortic Stenosis
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Xinlin Zhang, Tingyu Wang, Rongfang Lan, Qing Dai, Lina Kang, Lian Wang, Yong Wang, Wei Xu, Biao XuTranscatheter aortic-valve replacement (TAVR) has emerged as a promising strategy for treating patients with severe aortic stenosis. We aimed to compare TAVR with surgical aortic-valve replacement (SAVR) and determine the performance of TAVR over time and within several subgroups. We included 8 randomized trials comparing TAVR versus SAVR. Compared with SAVR, TAVR was associated with a lower rate of all-cause mortality or disabling stroke at 30-day (odds ratio [OR], 0.72; p = 0.004), 1-year (OR, 0.83; p = 0.01), and 2-year (OR, 0.86; p = 0.02), but not at long-term follow-up (rate ratio [RR], 1.02 [confidence interval 0.92 to 1.13]; p = 0.67). Notably, 5-year data showed numerically higher incidence in TAVR (RR, 1.11 [confidence interval 0.97 to 1.27]; p = 0.12). The risks associated with TAVR versus SAVR increased over time, showing a significant interaction (p for interaction = 0.01), as were for new-onset atrial fibrillation and rehospitalization. Incidences of major bleeding, new-onset fibrillation, and acute kidney injury were lower in TAVR, whereas transient ischemic attack, major vascular complications, permanent pacemaker implantation, reintervention, and paravalvular leak were lower in SAVR. Incidences for all-cause and cardiovascular mortality, myocardial infarction, and stroke were not statistically different. TAVR with transfemoral approach and new-generation valve was associated with reduction in all-cause mortality or disabling stroke compared with corresponding comparators. In conclusion, TAVR was associated with a lower risk for all-cause mortality or disabling stroke within 2 years, but not at long-term follow-up compared with SAVR; the risks seems to increase over time. More data are needed to determine longer-term performance of TAVR.
       
  • Edwards SAPIEN Versus Medtronic Aortic Bioprosthesis in Women Undergoing
           Transcatheter Aortic Valve Implantation (from the Win-TAVI Registry)
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Cristina Giannini, Anna Sonia Petronio, Julinda Mehilli, Samantha Sartori, Jaya Chandrasekhar, Michela Faggioni, Thierry Lefèvre, Patrizia Presbitero, Piera Capranzano, Didier Tchetche, Alessandro Iadanza, Gennaro Sardella, Nicolas M. Van Mieghem, Emanuele Meliga, Nicolas Dumonteil, Chiara Fraccaro, Daniela Trabattoni, Ghada W. Mikhail, Maria C. Ferrer, Christoph NaberWe sought to analyze outcomes of women receiving balloon-expandable valves (BEV) or self-expanding valves (SEV) in contemporary transcatheter aortic valve implantation (TAVI). WIN TAVI (Women's INternational Transcatheter Aortic Valve Implantation) is the first all-female TAVI registry to study the safety and performance of TAVI in women. We compared women treated with BEV (n = 408, 46.9%) versus those treated with SEV (n = 461, 53.1%). The primary efficacy end point was the Valve Academic Research Consortium-2 (VARC-2) composite of 1-year all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction. Women receiving SEV had higher surgical risk scores, higher rate of previous stroke and pulmonary hypertension whereas women receiving BEV were more frequently denied surgical valve replacement due to frailty. BEV patients were less likely to require post-dilation and had significantly lower rates of residual aortic regurgitation grade ≥2 (9.8% vs 4.7%, p = 0.007). At 1 year, the crude incidence and adjusted risk of the primary VARC-2 efficacy end point was similar between groups (17.1% with SEV and 14.3% with BEV, p = 0.25; hazards ratio 1.09, 95% confidence interval 0.68 to 1.75). Conversely the crude rate and adjusted risk of new pacemaker implantation was higher with SEV than BEV (15% vs 8.6%, p = 0.001; hazards ratio 1.97, 95% confidence interval 1.13 to 3.43). A subanalysis on new generation valves showed no difference in the need for pacemaker implantation between the 2 devices (10.1% vs 8.0%, p = 0.56). In conclusion, in contemporary TAVI, SEV are used more frequently in women with greater co-morbidities. While there were no differences in unadjusted and adjusted risk of 1-year primary efficacy end point between the valve types, there was a greater need for permanent pacemakers after SEV implantation.
       
  • Relation of Low Triiodothyronine Syndrome Associated With Aging and
           Malnutrition to Adverse Outcome in Patients With Acute Heart Failure
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Kuniya Asai, Akihiro Shirakabe, Kazutaka Kiuchi, Nobuaki Kobayashi, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Hiroki Goda, Shota Shigihara, Kazuhiro Asano, Kenichi Tani, Fumitaka Okajima, Noritake Hata, Wataru ShimizuLow triiodothyronine (T3) syndrome has recently been evaluated as a prognostic marker of acute heart failure (AHF). However, in which cases low T3 syndrome typically leads to adverse outcomes remain unclear. Of 1,432 AHF patients screened, 1,190 were enrolled. Euthyroidism was present in 956 patients (80.3%), who were divided into 2 groups: the normal group (n = 445, FT3 ≥1.88 µIU/L) and low-FT3 group (n = 511, FT3
       
  • The Top Most-Cited and Influential Published Articles in Atrial
           Fibrillation from 1900 to 2019
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Pulwasha Maria Iftikhar, Mohammed Faisal Uddin, Fatima Ali, Azeem Husain Arastu, Javidulla Khan, Maham Munawar, Javaid SulemanCitation classics are widely being implemented in the field of medical and scientific research assessment. The frequency of citation of a particular article is used to gauge its contribution and impact on the clinical world of practice and research. A thorough search of the literature showed a lack of bibliometric analysis on atrial fibrillation (AF). Thereby the main purpose of this study is to pinpoint the trend of the top 100 cited articles on AF. In June 2019, 2 databases, Scopus and Web of Science, were used to acquire the articles published on AF, which belonged to various genres including medicine, medical and interventional cardiology, electrophysiology, and thoracic surgery. The data were thoroughly reviewed and analyzed by 2 reviewers with regards to the number of citations for each article, publications per area, document type, first author name, country of origin, institute of origin, and year of publication. Approval of the Institutional Board Review was not required as we used publically available data retrospectively. The number of citations in the top 100 articles ranged from 622 to 6,641 times with an average citation of 1041.3 per article. The most significant number of articles was published in the year 2004 which ranged up to 11 in total. All the articles are published in 21 English language journals. In these 100 articles, the most were from the United States (n = 63) followed by Canada (n = 24), and other countries (n = 17). The top 5 institutions include McMaster University (n = 9), Institut de Cardiologie de Montreal (n = 8), Population Health Research Institute (n = 8), Harvard Medical School (n = 7), and Mayo Clinic (n = 7). In conclusion, authors seeking to publish a highly referenced article on AF will be determined by source journal, the language of publication, geographic origin, methodology, or research outcome.
       
  • Usefulness of Visfatin as a Predictor of Atrial Fibrillation Recurrence
           After Ablation Procedure
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Anna E. Platek, Anna Szymanska, Ilona Kalaszczynska, Filip M. Szymanski, Janusz Sierdzinski, Krzysztof J. FilipiakVisfatin is an adipokine produced by visceral fat tissue and takes part in fibrosis and inflammatory response. In the heart muscle, it is connected with the progression of atherosclerosis. Currently, there is no data on how visfatin affects atrial fibrillation (AF) onset. The study aimed to establish if baseline visfatin levels are connected with the risk of arrhythmia recurrence after AF ablation. In this prospective, long-term, observational study, we enrolled 290 consecutive patients admitted for AF ablation. All patients were screened for cardiovascular risk factors and had blood serum taken to measure visfatin concentrations before the ablation procedure. The end point of the study was a recurrence of the AF, defined as at least one AF episode of at any moment during the follow-up period. The screening included AF of at least 30 second duration assessed with electrocardiogram (ECG) monitoring, including 24-hour ECG Holter monitoring, implantable pacemakers, implantable defibrillators, or subcutaneous ECG monitoring devices. After excluding patients disqualified from the procedure the study population consisted of 236 patients, mean age 57.8 years (64.8% male). Mean body mass index in the population was 29.6  ±  4.8 kg/m2 and arterial hypertension was highly prevalent (73.3% of patients). In 129 (54.7%) cases we observed recurrence of AF during the follow-up period. Patients with AF recurrence had higher visfatin levels (1.7 ± 2.4 vs 2.1 ± 1.9 ng/ml; p
       
  • Detecting Atrial Fibrillation in Patients With an Embolic Stroke of
           Undetermined Source (from the DAF-ESUS registry)
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): José Manuel Rubio Campal, M Araceli García Torres, Pepa Sánchez Borque, Inmaculada Navas Vinagre, Ivana Zamarbide Capdepón, Ángel Miracle Blanco, Loreto Bravo Calero, Rafael Sáez Pinel, José Tuñón Fernández, José María Serratosa FernándezAtrial fibrillation (AF) causes a substantial proportion of embolic strokes of undeterminded source (ESUS). Effective detection of subclinical AF (SCAF) has important therapeutic implications. We conducted a prospective study to determine the prevalence of SCAF in patients with ESUS through of a 21-day Holter monitoring. In an early-monitoring group, Holter was initiated immediately after hospital discharge. The results were compared with a previous cohort of patients in whom the Holter was initiated at least 1 week after hospital discharge (late-monitoring group). We included 100 patients (50 each group; 69 ± 13 years, 56% male). Mean time from ESUS to Holter was 1.2 ± 1 day in the early-monitoring group and 30 ± 15 days in the late-monitoring group. SCAF was detected in 22% of patients in the early-monitoring and 6% in the late-monitoring group (p
       
  • Effect of Renal Dysfunction on the Risks for Ischemic and Bleeding Events
           in Patients With Atrial Fibrillation Receiving Percutaneous Coronary
           Intervention
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Ko Yamamoto, Hiroki Shiomi, Takeshi Morimoto, Masahiro Natsuaki, Yasuaki Takeji, Hirotoshi Watanabe, Yusuke Yoshikawa, Yukiko Matsumura-Nakano, Satoshi Shizuta, Kengo Tanabe, Kenji Ando, Kazushige Kadota, Yoshihiro Morino, Ken Kozuma, Yoshihisa Nakagawa, Takeshi KimuraThere is a paucity of studies exploring whether the ischemia-bleeding trade-off could be different according to the stages of renal dysfunction in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI). Among 19,598 patients in a pooled database from 3 Japanese PCI studies (CREDO-Kyoto Cohort-2, RESET, and NEXT), 1,547 patients had concomitant AF. Patients were divided into 4 groups according to their renal function (Creatinine clearance [CCr]>60 ml/min: n = 703, 60≥ CCr>30 ml/min: n = 627, CCr ≤30 ml/min: n = 126, Dialysis: n = 91). The cumulative 3-year incidences of both the primary ischemic (ischemic stroke/myocardial infarction) and bleeding (GUSTO moderate/severe) outcome increased incrementally with worsening renal function (11.4%, 12.6%, 16.8%, and 31.7%, p 30 ml/min and CCr ≤30 ml/min groups (HR 0.89, 95% CI 0.62 to 1.29, p = 0.54, and HR 0.94, 95% CI 0.49 to 1.69, p = 0.83, respectively), whereas the excess adjusted risk for the primary bleeding outcome was significant in all 3 groups of renal dysfunction (HR 1.66, 95% CI 1.13 to 2.45, p = 0.01, HR 2.70, 95% CI 1.58 to 4.61, p
       
  • Dabigatran Persistence and Outcomes Following Discontinuation in Atrial
           Fibrillation Patients from the GLORIA-AF Registry
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Miney Paquette, Lionel Riou França, Christine Teutsch, Hans-Christoph Diener, Shihai Lu, Sergio J. Dubner, Chang Sheng Ma, Kenneth J. Rothman, Kristina Zint, Jonathan L. Halperin, Brian Olshansky, Menno V. Huisman, Gregory Y.H. Lip, Robby NieuwlaatProspective studies evaluating persistence to nonvitamin K antagonist oral anticoagulants in patients with atrial fibrillation are needed to improve our understanding of drug discontinuation. The study objective was to evaluate if and when patients with newly diagnosed atrial fibrillation stop dabigatran treatment and to report outcomes following discontinuation. Patients prescribed dabigatran in diverse clinical practice settings were consecutively enrolled and followed for 2 years. Dabigatran persistence over time, reasons for discontinuation, and outcomes post discontinuation were assessed. Of 4,859 patients, aged 70.2 ± 10.4 years, 55.7% were male. Overall 2-year dabigatran persistence was 70.9% (95% confidence interval [CI] 69.6 to 72.2). Persistence probability was lower in the first 6-month period (83.7% [82.7 to 84.8]) than in subsequent periods for patients on dabigatran at the start of each period (6 to 12 months, 92.5% [91.6 to 93.3]; 12 to 18 months, 95.1% [94.3 to 95.8]; 18 to 24 months, 96.3% [95.6 to 96.9]). Of 1,305 patients (26.9%) who discontinued dabigatran, adverse events were reported as the reason for discontinuation in 457 (35.0%). Standardized stroke incidence rate post discontinuation (per 100 patient-years) in patients discontinuing without switching to another oral anticoagulant was 1.76 (95% CI 0.89 to 2.76) and 1.02 (95% CI 0.43 to 1.76) in those who switched, consistent with the expected benefit of remaining on treatment. Patients persistent with treatment at 1 year had>90% probability of remaining persistent at 2 years suggesting clinical interventions to improve persistence should be focused on the early period following treatment initiation.
       
  • Usefulness of Myocardial Strain and Twist for Early Detection of
           Myocardial Dysfunction in Patients With Autoimmune Diseases
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Fu-Wei Jia, Jeffrey Hsu, Xiao-Hang Liu, Xiao-Jin Feng, Hai-Yu Pang, Xue Lin, Li-Gang Fang, Hua-Xia Yang, Wei ChenCardiac involvement in autoimmune diseases (AD) is common but underdiagnosed due to a lack of sensitive imaging methods. We aim to evaluate the characteristics of left ventricular (LV) systolic dysfunction in patients with AD using deformational parameters from 2-dimensional speckle-tracking echocardiography (STE). We retrospectively enrolled 86 AD patients and 71 healthy controls. All subjects underwent transthoracic echocardiography and STE to analyze LV strain and twist. A twist-radial displacement loop was constructed to investigate the relation between LV contractility and dimension. In AD patients, 68 had preserved LV ejection fraction (EF ≥ 50%), and 18 had reduced LVEF (EF < 50%). The patients with preserved LVEF exhibited significantly lower values of global longitudinal, circumferential, and radial strain than controls (−19.11 ± 4.18 vs −21.49 ± 2.53%, −25.17 ± 5.04% vs −27.37 ± 2.87%, 17.68 ± 5.69% vs 21.17 ± 6.44%, respectively; all p
       
  • Usefulness of a Lifestyle Intervention in Patients With Cardiovascular
           Disease
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Eva R. Broers, Giovana Gavidia, Mart Wetzels, Vicent Ribas, Idowu Ayoola, Jordi Piera-Jimenez, Jos W.M.G. Widdershoven, Mirela Habibović, Do CHANGE consortiumThe importance of modifying lifestyle factors in order to improve prognosis in cardiac patients is well-known. Current study aims to evaluate the effects of a lifestyle intervention on changes in lifestyle- and health data derived from wearable devices. Cardiac patients from Spain (n = 34) and The Netherlands (n = 36) were included in the current analysis. Data were collected for 210 days, using the Fitbit activity tracker, Beddit sleep tracker, Moves app (GPS tracker), and the Careportal home monitoring system. Locally Weighted Error Sum of Squares regression assessed trajectories of outcome variables. Linear Mixed Effects regression analysis was used to find relevant predictors of improvement deterioration of outcome measures. Analysis showed that Number of Steps and Activity Level significantly changed over time (F = 58.21, p < 0.001; F = 6.33, p = 0.01). No significant changes were observed on blood pressure, weight, and sleep efficiency. Secondary analysis revealed that being male was associated with higher activity levels (F = 12.53, p < 0.001) and higher number of steps (F = 8.44, p < 0.01). Secondary analysis revealed demographic (gender, nationality, marital status), clinical (co-morbidities, heart failure), and psychological (anxiety, depression) profiles that were associated with lifestyle measures. In conclusion results showed that physical activity increased over time and that certain subgroups of patients were more likely to have a better lifestyle behaviors based on their demographic, clinical, and psychological profile. This advocates a personalized approach in future studies in order to change lifestyle in cardiac patients.
       
  • Outcomes With Complete Versus Incomplete Revascularization in Patients
           With Multivessel Coronary Disease Undergoing Percutaneous Coronary
           Intervention With Everolimus Eluting Stents
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Sripal Bangalore, Yu Guo, Zaza Samadashvili, Edward L. HannanThe aim of the study was to evaluate the outcomes with completeness of revascularization (CR) in patients with multivessel disease (MVD) who underwent PCI using everolimus-eluting stent (EES). Patients with MVD who underwent PCI using EES in New York State were chosen. Patients were categorized into CR, attempted but failed CR or incomplete revascularization (ICR). The primary outcome was death/myocardial infarction (MI). Secondary outcomes were death/MI/repeat revascularization and the individual components of the composite outcomes. Multiple propensity score adjustment analysis was used to adjust for differences in covariates among the 3 groups. Among 15,046 patients, 4,545 (30%) had CR. The strongest predictors of ICR were the number of vessels diseased (χ2 = 428.48; p
       
  • Improving Care Pathways for Acute Coronary Syndrome: Patients Undergoing
           Percutaneous Coronary Intervention
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Amit P. Amin, John A. Spertus, Hemant Kulkarni, Christian McNeely, Sunil V. Rao, Duane Pinto, John A. House, John C. Messenger, Richard G. Bach, Abhinav Goyal, Adhir Shroff, Samir Pancholy, Steven M. Bradley, Ty J. Gluckman, Thomas M. Maddox, Jason H. Wasfy, Frederick A. MasoudiAcute coronary syndrome (ACS) admissions are common and costly. The association between comprehensive ACS care pathways, outcomes, and costs are lacking. From 434,172 low-risk, uncomplicated ACS patients eligible for early discharge (STEMI 35%, UA/NSTEMI 65%) from the Premier database, we identified ACS care pathways, by stratifying low-risk, uncomplicated STEMI and UA/NSTEMI patients by access site for PCI (trans-radial intervention [TRI] vs transfemoral intervention [TFI]) and by length of stay (LOS). Associations with costs and outcomes (death, bleeding, acute kidney injury, and myocardial infarction at 1-year) were tested using hierarchical, mixed-effects regression, and projections of cost savings with change in care pathways were obtained using modeling. In low-risk uncomplicated STEMI patients, compared with TFI and LOS ≥3 days, a strategy of TRI with LOS
       
  • Ten-Year Outcomes of Sirolimus-Eluting Versus Zotarolimus-Eluting Coronary
           Stents in Patients With Versus Without Diabetes Mellitus (SORT OUT III)
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Kevin K.W. Olesen, Manan Pareek, Morten Madsen, Lisette O. Jensen, Evald H. Christiansen, Leif Thuesen, Jens F. Lassen, Steen Dalby Kristensen, Hans Erik Bøtker, Michael MaengWe compared 10-year clinical outcomes in diabetes and nondiabetes patients treated with Endeavor zotarolimus-eluting (ZES) or Cypher sirolimus-eluting coronary stents (SES). A total of 1,162 patients were randomized to ZES (169 with diabetes) and 1,170 patients were randomized to SES (168 with diabetes). Patients were further stratified by diabetes status at the time of inclusion. A subgroup of patients with diabetes (n = 88) underwent angiographic re-evaluation 10 months after stent implantation. End points included a combined end point of death or myocardial infarction, and the individual end points of death, myocardial infarction, and revascularization. In patients with diabetes, we found no difference in the combined end point (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.53 to 1.24), death (OR 0.80, 95% CI 0.51 to 1.25), or in MI (OR 1.07, 95% CI 0.60 to 1.91). However, diabetics with ZES more frequently underwent coronary revascularization compared with SES patients (OR 1.93, 95% CI 1.05 to 3.66). In patients without diabetes, ZES and SES had similar 10-year rates of all end points (death: OR 1.13, 95% CI 0.93 to 1.39; MI: OR 0.80, 95% CI 0.61 to 1.05; revascularization: OR 0.81, 95% CI 0.61 to 1.09). Landmark analysis from 5 to 10 years showed no difference in outcomes between SES and ZES in either subgroup. In conclusion, at 10 years, SES and ZES performed similarly in patients with and without diabetes. Although coronary revascularization was more prevalent in diabetes patients with ZES, this may, in part, have been related to the angiographic follow-up that was offered to a subgroup of diabetes patients.
       
  • Comparison of Three Atherosclerotic Cardiovascular Disease Risk Scores
           With and Without Coronary Calcium for Predicting Revascularization and
           Major Adverse Coronary Events in Symptomatic Patients Undergoing Positron
           Emission Tomography-Stress Testing
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Jeffrey L. Anderson, Viet T. Le, David B. Min, Santanu Biswas, C. Michael Minder, Raymond O. McCubrey, Stacey Knight, Benjamin D. Horne, Steve Mason, Donald L. Lappe, Joseph B. Muhlestein, Kirk U. KnowltonAtherosclerotic cardiovascular disease (ASCVD) is the most important cause of morbidity and mortality nationally and internationally. Improving ASCVD risk prediction is a high clinical priority. We sought to determine which of 3 ASCVD risk scores best predicts the need for revascularization and incident major adverse coronary events (MACE) in symptomatic patients at low-to-intermediate primary ASCVD risk referred for regadenoson-stress positron emission tomography (PET). Risk scores included the standard ASCVD pooled cohort equation (PCE), the multiethnic study of atherosclerosis (MESA) risk equation, and the coronary artery calcium score (CACS), obtained by PET. All qualifying patients in our institution at primary ASCVD risk referred for PET-stress tests in whom PCE, MESA, and CAC scores could be calculated were studied. CACS categories were: 0, 1 to 10, 11 to 299, 300 to 999, and 1000+. MESA and PCE scores were divided into quartiles. Logistic regression modeling was used to predict clinical/PET-driven early revascularization (within 90 days) and 1-year MACE (death, myocardial infarction, or any-time revascularization). A total of 981 patients (54% men, age 67 ± 10 years) qualified and were studied. Scores including CAC (MESA, CACS) performed better than PCE for predicting overall 1-year MACE (MESA p
       
  • Trends, Outcomes, and Predictors of Revascularization in Cardiogenic Shock
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Muhammad Zia Khan, Muhammad Bilal Munir, Muhammad U. Khan, Mohammed Osman, Pratik Agrawal, Moinuddin Syed, Yasir Abdul Ghaffar, Anas Alharbi, Safi U. Khan, Sudarshan BallaCardiogenic shock (CS) carries high mortality and morbidity. Early revascularization is an important strategy in management of these patients. We sought to determine the outcomes and predictors of revascularization among patients with CS. Patients with CS and acute myocardial infarction were identified using the National Inpatient Sample (NIS) data from January 2002 to December 2014 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Subsequently, patients who underwent revascularization were then selected. A total of 118,618 patients with CS were identified. Out of these, about 55,735 (47%) patients underwent revascularization. Mean age of patients who underwent revascularization was lower when compared with patients not who underwent revascularization (66.40 vs 72.24 years, p < 0.01). Patients who underwent revascularization had lower mortality when compared with patients not who underwent revascularization (25.1% vs 52.2%, p < 0.01). Extracorporeal membrane oxygenation and mechanical circulatory support devices were often utilized more in patients who underwent revascularization. Overall, we found modest increased trend of revascularization over our study years with decline in mortality. Female gender, weekend admission, drug abuse, pulmonary hypertension, anemia, renal failure, neurological disorders, malignancy were associated with lower odds of revascularization. In conclusion, in this large nationally represented US population sample of CS patients, we found revascularization rate of about 47% with improvement in overall mortality over our study years.
       
  • Long-Term Efficacy of Extended Dual Antiplatelet Therapy After Left Main
           Coronary Artery Bifurcation Stenting
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Sungsoo Cho, Jung-Sun Kim, Tae Soo Kang, Sung-Jin Hong, Dong-Ho Shin, Chul-Min Ahn, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Young Bin Song, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Myeong-Ki Hong, Yansoo JangLimited data exist on the long-term efficacy of extended dual antiplatelet therapy (DAPT) after left main coronary artery (LMCA) bifurcation stenting. This study investigated the long-term clinical outcomes associated with long-term DAPT after LMCA bifurcation stenting. Using data from the multicenter KOMATE and COBIS registries, we analyzed 1,142 patients who received a drug-eluting stent for a LMCA bifurcation lesion and who experienced no adverse events for 12 months after the index procedure. Patients were divided into 2 groups: DAPT>12 months (n = 769) and DAPT ≤12 months (n = 373). The primary end point was major adverse cardiovascular events (MACEs), as a composite of cardiac death, myocardial infarction, stroke, and stent thrombosis, over 5 years of follow-up. We further performed propensity score adjustment for clinical outcomes. DAPT>12 months afforded a lower MACE rate than DAPT ≤12 months (2.3% vs 5.4%, adjusted hazard ratio [HR] 0.37; 95% confidence interval [CI] 0.19 to 0.71; p = 0.003). The use of DAPT for>12 months was an independent predictor of a reduced likelihood of MACEs (HR 0.34; 95% CI 0.17 to 0.67; p = 0.002). A DAPT score ≥2, chronic kidney disease, and age>75 years were significant independent predictors of MACEs. In subgroup analysis, the use of DAPT for>12 months consistently resulted in better clinical outcomes across all subgroups, especially among patients with ACS, compared with the use of DAPT for ≤12 months. In conclusion, an extended duration of DAPT reduces MACE rates after LMCA bifurcation stenting.
       
  • Usefulness of Social Support in Older Adults After Hospitalization for
           Acute Myocardial Infarction (from the SILVER-AMI Study)
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Yaakov S. Green, Alexandra M. Hajduk, Xuemei Song, Harlan M. Krumholz, Samir K. Sinha, Sarwat I. ChaudhryThe availability of social support is associated with health outcomes after acute myocardial infarction (AMI), yet previous studies have largely considered social support as a single entity, rather than examining its discrete domains. Furthermore, few studies have investigated the impact of social support in older AMI patients, in whom it may be especially important. We aimed to determine the associations between 5 discrete domains of social support – emotional support, informational support, tangible support, positive social interaction, and affectionate support – with 6-month readmission and mortality in older patients hospitalized for AMI, adjusting for known predictors of post-AMI outcomes. Three thousand six participants 75 years and older were recruited from a network of 94 hospitals across the United States. A 5-item version of the Medical Outcomes Study Social Support Survey was used to measure perceived social support, and readmission and mortality were ascertained 6 months after initial hospitalization. Independent associations were determined using multivariable regression. Among 3,006 participants, mean age was 82 years, 44% were female, and 11% non-white. Participants who were female, non-white, less educated, and lived alone tended to report lower social support. In multivariable analyses, low informational support was associated with readmission (odds ratio 1.22; 95% confidence interval 1.01 to 1.47), and low emotional support with mortality (odds ratio 1.43; 95% confidence interval 1.04 to 1.97). In conclusion, individual domains of social support had distinct, independent associations with post-AMI outcomes, lending a more nuanced and precise understanding of this important social determinant of health. Understanding these distinct associations can inform the development of interventions and policies to improve post-AMI outcomes.
       
  • Relation of Hypoalbuminemia to Response to Aspirin in Patients With Stable
           Coronary Artery Disease
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Arthur Shiyovich, Liat Sasson, Eli Lev, Alejandro Solodky, Ran Kornowski, Leor PerlSerum albumin (SA) level is a powerful cardiovascular prognostic marker, suggested to be involved in regulation of platelet function. High on-aspirin platelet reactivity (HAPR) is associated with increased risk for deleterious cardiovascular events. The aim of the present study was to evaluate the association between HAPR and albumin levels in patients with stable coronary artery disease (CAD) treated with aspirin. Patients with known stable CAD, who were taking aspirin (75 to 100 mg qd) regularly for at least 1 month, were screened for the present study. Exclusion criteria: cancer, sepsis or acute infection, active inflammatory/rheumatic disease, recent major surgery, chronic liver failure, the administration of other antiplatelet drugs, nonadherence with aspirin and thrombocytopenia. Blood was drawn from the participants and sent for SA level and platelet function test (VerifyNow). HAPR was defined as aspirin reaction units (ARU)>550. Overall 116 patients were analyzed; age 69 ± 10, 28% women. Twenty (17%) were hypoalbuminemic (≤3.5 g/dl). Hypoalbuminemic patients had similar characteristics to the normal albumin group except mildly higher creatinine in the former. SA levels were significantly lower in the hypoalbuminemic group (3.2 ± 0.2 g/dl vs 4.2 ± 0.4 g/dl, respectively, p
       
  • “Gambling: Part I of II”
    • Abstract: Publication date: 1 February 2020Source: The American Journal of Cardiology, Volume 125, Issue 3Author(s): Robert M. Doroghazi
       
  • Efficiency, Safety and Quality of Life After Transcatheter Aortic Valve
           Implantation Performed with Moderate Sedation Versus General Anesthesia
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of CardiologyAuthor(s): Kishore J. Harjai, Thomas Bules, Andrea Berger, Bonnie Young, Deepak Singh, Russell Carter, Shikhar Agarwal, Samuel Crockett, Vernon Mascarenhas, Yassir Nawaz, Joseph Stella, Joyce Burnside, Kimberly A. Skelding, Matthew Desciak, Alfred S. Casale, Transcatheter Interventions at GEisingeR Structural (TIGERS) Registry, Geisinger Health System, PennsylvaniaAbstractThere is growing interest in ‘minimalist’ transcatheter aortic valve implantation (M-TAVI), performed with conscious sedation instead of general anesthesia (GA-TAVI). We assessed the impact of M-TAVI on procedural efficiency, long-term safety and quality of life (QoL) in 477 patients with severe aortic stenosis (AS) (82 years, women 50%, STS 5.0), who underwent M-TAVI (n=278) or GA-TAVI (n=199). M-TAVI patients were less likely to have NYHA Class ≥3, Valve-in-Valve TAVI and receive self-expanding valves. M-TAVI was completed without conversion to GA in 269 (97%) patients. M-TAVI was more efficient that GA-TAVI including shorter LOS (2 Vs 3 days, p
       
  • Meta-analysis Comparing Direct Oral Anticoagulants versus Vitamin K
           Antagonists after Transcatheter Aortic Valve Implantation
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of CardiologyAuthor(s): Hiroki Ueyama, Toshiki Kuno, Tomo Ando, Alexandros Briasoulis, John Fox, Kentaro Hayashida, Hisato TakagiAbstractAtrial fibrillation (AF) is a common comorbidity in patients undergoing transcatheter aortic valve implantation (TAVI), but whether direct oral anticoagulants (DOACs) confer similar safety and efficacy compared with vitamin K antagonist (VKA) remains unclear in this population. The aim of our study was to investigate the safety and efficacy of DOACs compared with VKA in patients undergoing TAVI with concomitant indication of oral anticoagulation. PUBMED and EMBASE were searched through October 2019 for studies comparing DOACs versus VKA in patients undergoing TAVI with indication of oral anticoagulation. The main efficacy outcomes were all-cause mortality and stroke while the main safety outcome was major and/or life-threatening bleeding. Our search identified five eligible studies including 2,569 patients. Majority of patients had AF as indication of anticoagulation. There were no significant differences in all-cause mortality, major and/or life-threatening bleeding and stroke among patients treated with DOACs versus VKA (odds ratio [OR]=1.07, 95% confidence interval [CI] [0.73-1.57], p=0.72, OR=0.85, 95% CI [0.64-1.12], p=0.24, OR=1.52, 95% CI [0.93-2.48], p=0.09, respectively). In conclusion, among patients undergoing TAVI with concomitant indication for oral anticoagulation, all-cause mortality, major and/or life-threatening bleeding, and stroke were similar between DOACs and VKA. Further large scale randomized controlled trials are needed to search the optimal oral anticoagulation regimen in this population.
       
  • Usefulness of Post-procedural Electrophysiological Confirmation upon
           Totally Thoracoscopic Ablation in Persistent Atrial Fibrillation
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of CardiologyAuthor(s): Min Suk Choi, Young Keun On, Dong Seop Jeong, Kyoung-Min Park, Seung-Jung Park, June Soo Kim, Keumhee C. CarriereAbstractLittle information is available concerning the usefulness of electrophysiological confirmation followed by totally thoracoscopic ablation. This study aimed to examine whether post-procedural electrophysiological confirmation is always necessary after totally thoracoscopic ablation in patients with isolated persistent atrial fibrillation (AF). Forty-five patients with isolated persistent AF were randomized into 2 groups: those who received routine electrophysiological confirmation and additional catheter ablation after totally thoracoscopic ablation (the hybrid group [n = 22]) and those who did not (the TTA group [n = 23]). Electrophysiological study was performed 4 or 5 days after surgery. No early or late mortality occurred. In the hybrid group, 5 patients (23%, 5/22) required additional ablation due to residual potential in the left atrium. At a year postoperatively, normal sinus rhythm was observed in 89% of patients (40/45) and similar in both groups (Odds ratio = 0.80, 95% CI = 0.32∼1.99). During follow-up, sinus rhythm was maintained in 16 patients (70%) in the TTA group without additional catheter ablation, which was similar (p = 0.920) to the results in the hybrid group (n = 15, 68.2%). Event-free survival rate at 12 months did not differ between groups (TTA group vs. hybrid group, 78% versus 77%; p = 0.633). In simple Cox regression analysis, preoperative LAVI was associated with atrial arrhythmia (p = 0.030, Hazards ratio = 1.087, 95% CI = 1.01∼1.18). In conclusion, thoracoscopic ablation provided good one-year durability in patients with isolated persistent AF irrespective of post-procedural electrophysiological confirmation. 70% of the TTA group did not need additional catheter ablation.
       
  • Validation of Acute Ischemic Stroke Codes Using the International
           Classification of Diseases Tenth Revision
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of CardiologyAuthor(s): Mohamed Alhajji, Akram Kawsara, Mohamad Alkhouli
       
  • Meta-analysis of C-reactive Protein and Risk of Angina Pectoris
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of CardiologyAuthor(s): Ruo-fei Jia, Long Li, Hong Li, Xiao-jing Cao, Yang Ruan, Shuai Meng, Jia-yu Wang, Ze-ning JinAbstractAssociations between elevated C-reactive protein (CRP) levels and the angina pectoris risk have been reported for many years, but the results remain controversial. To address this issue, a meta-analysis was therefore conducted. Eligible studies were identified by searching PubMed, EMBASE, Cochrane library and web of science up to January 2019. Altogether, 10 prospective cohort studies and 11 case-control studies were included, and they were published from 1997 to 2013 and summed up to 18,316 samples totally. The pooled mean difference (MD) of CRP levels was 4.44 (95% confidence interval (CI), 2.71–6.17) between angina patients and healthy controls. The combined odds ratio (OR) of CRP for major adverse cardiac events in angina patients was 1.67(95% CI,1.23–2.26). In conclusion, the meta-analysis indicated that elevated CRP levels were associated with angina pectoris, especially unstable angina pectoris, and were probably a risk factor of major adverse cardiac events.
       
  • Left Ventricular Hypertrophy and Mortality Risk in Male Veteran Patients
           at High Cardiovascular Risk
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of CardiologyAuthor(s): Vasilios Papademetriou, Konstantinos Stavropoulos, Peter Kokkinos, Michael Doumas, Konstantinos Imprialos, Costas Thomopoulos, Charles Faselis, Costas TsioufisAbstractSeveral studies addressed cardiovascular risk and mortality in the general population, but data in veteran patients is lacking. This study was designed to investigate the association between echocardiographic LVH and all-cause mortality in a male, high risk, group of veterans. Valid echocardiograms were evaluated in 10,406 male Veterans, mean age 68.3±13 years. Using the LVM/BSA method 6,575 (63.1%) patients had normal left LVMI and 3,831 (37.9%) had LVH, defined as LVMI ≥116 g/m2. Of those 1,371 (13.2%) had mild LVH, 1,025 (9.9%) moderate LVH, 605 (5.8%) severe and, and 830 (8%) had extreme LVH. After a mean follow up of 5.9±4.4 years, a total of 3,550 (34.1%) patients died. Cox proportional hazard analyses adjusted for comorbidities revealed increased risk for individuals with mild LVH [hazard ratios (HR) 1.21; 95% Confidence intervals (CI): 1.09-1.33]; moderate LVH (HR 1.37; 95% CI: 1.23-1.52); Severe (HR=1.36; 95% CI: 1.19-1.56); and Extreme LVH, (HR=1.95; 95% CI: 1.74-2.17). Similar findings were observed when LVMI was defined by LVM/m2.7. When LVM index was introduced as a continuous variable, mortality risk was 6.2% higher per 10-unit change in LVMI, and 9.4% higher when defined by the m2.7 method. There was no difference in mortality risk between black and white patients, or patients with concentric or eccentric LVH. We conclude that, increased LVMI, was associated with increased risk of all-cause mortality. The incremental risk was significantly higher in patients with extreme LVH.
       
  • Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention in
           Patients with Renal Dysfunction
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of CardiologyAuthor(s): Ali O Malik, John A. Spertus, James A Grantham, Poghni Peri-Okonny, Kensey Gosch, James Sapontis, Jeffrey Moses, William Lombardi, Dimitri Karmpaliotis, William J. Nicholson, Firas Al Badarin, Adam C. SalisburyAbstractAlthough contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is performed with high success rates, 10-13% of patients presenting with CTOs have chronic kidney disease (CKD), and the comparative safety, efficacy and health status benefit of CTO PCI in these patients, has not been well defined. We examined the association of baseline renal function with periprocedural major adverse cardiovascular and cerebral events (MACCE) and health status outcomes in 957 consecutive patients (mean age 65.3 ± 10.3 years, 19.4% women, 90.3% white, 23.6 CKD [eGFR
       
  • Impact of Malnutrition on Outcomes Following Transcatheter Aortic Valve
           Implantation (From a National Cohort)
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of CardiologyAuthor(s): Sara Emami, Sarah Rudasill, Nikhil Bellamkonda, Yas Sanaiha, Mario Cale, Josef Madrigal, Nathaniel Christian-Miller, Peyman BenharashAbstractMalnutrition is associated with increased mortality in open cardiac surgery, but its impact on transcatheter aortic valve implantation (TAVI) is unknown. This study utilized the National Readmissions Database (NRD) to evaluate the impact of malnutrition on mortality, complications, length of stay (LOS), 30-day readmission, and total charges following TAVI. Adult patients undergoing isolated TAVI for severe aortic stenosis were identified using the 2011-16 NRD, which accounts for 56.6% of all US hospitalizations. The malnourished cohort included patients with nutritional neglect, cachexia, protein calorie malnutrition, postsurgical non-absorption, weight loss, and underweight status. Multivariable models were utilized to evaluate the impact of malnutrition on selected outcomes. Of 105,603 patients, 5,280 (5%) were malnourished. Malnourished patients experienced greater mortality (10.4 vs. 2.2%, P
       
  • Relation of Hypocholesterolemia with Diabetes Mellitus in Patients with
           Coronary Artery Disease
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of CardiologyAuthor(s): Gjin Ndrepepa, Salvatore Cassese, Erion Xhepa, Massimiliano Fusaro, Karl-Ludwig Laugwitz, Heribert Schunkert, Adnan KastratiAbstractThe association between hypocholesterolemia and diabetes mellitus (DM) in patients with coronary artery disease (CAD) remains poorly investigated. We undertook this study to investigate whether there is an association between hypocholesterolemia and odds of DM in these patients. This observational study included 14952 patients with CAD: 8592 without statins (statin-naïve group) and 6360 with statins on admission (statin-treated group). Hypocholesterolemia was defined as a total cholesterol within the first quintile of the total cholesterol concentration (total cholesterol
       
  • Outcomes and Hospital Utilization in Patients with Papillary Muscle
           Rupture Associated with Acute Myocardial Infarction
    • Abstract: Publication date: Available online 7 January 2020Source: The American Journal of CardiologyAuthor(s): Bhaskar Bhardwaj, Gurusukhmandeep Sidhu, Sudarshan Balla, Varun Kumar, Arun Kumar, Kul Aggarwal, Mary L. Dohrmann, Martin A. AlpertABSTRACTPapillary muscles rupture (PMR) is a rare complication of acute myocardial infarction (MI) that can lead to severe hemodynamic compromise, acute heart failure, and death. This study was designed to assess demographics, outcomes, and hospital utilization trends in the management of PMR associated with acute MI. Data were derived from the National Inpatient Sample for the years 2005-2014. ICD-9 codes 410.0-410.9 were used to identify patients with acute MI. ICD-9 code 429.6 was used to identify patients with PMR. ICD-9 procedures codes 35.23, 35.24 and 35.12 were used to identify patients undergoing mitral valve replacement (MVR) or repair. Of the 3,244,799 admissions, 932 were complicated by PMR (incidence of 0.029%). The majority of patients with PMR were ≥ 65 years old (60.1%) and male (60.4%). Of those with PMR, 57.5% underwent MVR. Compared to patients without PMR, those with PMR had a significantly higher in-hospital mortality rate (5.3 vs. 36.3%, p
       
  • Relation of Low Lymphocyte Count to Frailty and its Usefulness as a
           Prognostic Biomarker in Patients>65 Years of Age with Acute Coronary
           Syndrome
    • Abstract: Publication date: Available online 7 January 2020Source: The American Journal of CardiologyAuthor(s): Julio Núñez, Clara Sastre, Giulio D'Ascoli, Vicente Ruiz, Clara Bonanad, Gema Miñana, Ernesto Valero, Sergio Garcia-Blas, Anna Mollar, Amparo Villaescusa, Maria Arantzazu Ruescas-Nicolau, Eduardo Núñez, Francesc Formiga, Francisco J. Chorro, Juan SanchisABSTRACTLow lymphocyte count, as a marker of inflammation and immunosuppression, may be useful for identifying frail patients. In this work, we aimed to evaluate the association between low relative lymphocyte count (Lymph%) and frailty status in patients>65 years old with acute coronary syndromes (ACS), and whether Lymph% is associated with morbimortality beyond standard prognosticators and frailty. In this prospective observational study, we included 488 hospital survivors of an episode of an ACS>65 years old. Total and differential white blood cells and frailty status were assessed at discharge. Frailty was evaluated using the Fried score at discharge and defined as Fried≥3. The independent association between Lymph% and Fried≥3 was evaluated by multivariate logistic regression analysis. The associations between Lymph% with long-term all-cause mortality and recurrent admission were evaluated with Cox regression and shared frailty regression, respectively. The mean age of the sample was 78±7 years and 41% were females. The median (IQR) of the Lymph% was 21% (15-27) and 41% showed Fried≥3. In multivariate analysis, Lymph% was inversely related to the odds of frailty with an exponential increase risk from values below 15% (p=0.001). Likewise, Lymph% was inverse and independently associated with a higher risk of long-term mortality (p=0.011), recurrent all-cause (p=0.020), and cardiovascular readmissions (p=0.024). In conclusion, in patients>65 years with a recent ACS, low Lymph% evaluated at discharge is associated with a higher risk of frailty. Low Lymph% was also associated with a higher risk of long-term mortality and recurrent admissions beyond standard prognosticators and Fried score.
       
  • Atrial Fibrillation, Brain Volumes, and Subclinical Cerebrovascular
           Disease (from the Atherosclerosis Risk in Communities Neurocognitive Study
           [ARIC-NCS])
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Kasra Moazzami, Iris Yuefan Shao, Lin Yee Chen, Pamela L. Lutsey, Clifford R. Jack, Thomas Mosley, David A. Joyner, Rebecca Gottesman, Alvaro AlonsoThe aim of the present study was to investigate the association between atrial fibrillation (AF) and total and regional brain volumes among participants in the community-based Atherosclerosis Risk in Communities Neurocognitive study (ARIC-NCS). A total of 1,930 participants (130 with AF) with a mean age of 76.3 ± 5.2, who underwent 3T brain MRI scans in 2011 to 2013 were included. Prevalent AF was ascertained from study ECGs and hospital discharge codes. Brain volumes were measured using FreeSurfer image analysis software. Markers of subclinical cerebrovascular disease included lobar microhemorrhages, subcortical microhemorrhages, cortical infarcts, subcortical infarcts, lacunar infarcts, and volume of white matter hyperintensities. Linear regression models were used to assess the associations between AF status and brain volumes. In adjusted analyses, AF was not associated with markers of subclinical cerebrovascular disease. However, AF was associated with smaller regional brain volumes (including temporal, occipital, and parietal lobes; deep gray matter; Alzheimer disease signature region; and hippocampus [all p
       
  • Impact of Lifestyle Modification on Atrial Fibrillation
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Rebecca Wingerter, Nathaniel Steiger, Austin Burrows, N.A. Mark EstesAtrial Fibrillation (AF) is the most common arrhythmia in adults, and the rapid increase in AF prevalence has been classified by experts as an epidemic. The mechanisms of AF are complex and incompletely understood. While many aspects of management are now based on high quality evidence, other clinical decisions are based on experience and judgment. This article provides an up to date review relating to lifestyle modification and its effect on AF to inform clinical treatment. This comprehensive review used PubMed and Google Scholar to perform keyword searches of articles published between 1998 and the present, with the exception of the 1978 “Holiday Heart” article. Robust data has emerged identifying multiple risk factors for development of AF, including age, sex, hypertension, diabetes mellitus, obesity, alcohol consumption, exercise, and obstructive sleep apnea. Recent evidence indicates that lifestyle modification has a significant role in mitigating the risk and burden of AF. In conclusion, based on the available evidence, an interdisciplinary approach to lifestyle modification will likely reduce risk and/or symptom burden of AF.
       
  • Massive Cardiomegaly (>1000 g Heart) and Obesity
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): William C. Roberts, Omar S. KhanDescribed herein are certain clinical and morphologic findings in 9 patients who at necropsy had hearts weighing>1000 g, a weight approximately 3 times normal. With the exception of 2 patients with hypertrophic cardiomyopathy, the common finding in the remaining 7 patients was obesity. None had valvular heart disease, the previously described major cause of massive cardiomegaly. Thus, obesity needs to be added to the causes of massive cardiomegaly, a cause not previously recognized. Electrocardiograms in 4 patients disclosed high total 12-lead QRS voltage on the electrocardiogram in only one despite the massive cardiomegaly.
       
  • Relation of Change of Body Mass Index to Long-Term Mortality After Cardiac
           Catheterization
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Barak Zafrir, Elad Shemesh, Dror B. Leviner, Walid SalibaBody-mass index (BMI) is a risk marker and therapeutic target in cardiovascular prevention. The effect of changes in BMI on mortality in patients with cardiovascular diseases has not been completely delineated. We aimed to assess the association between percent change in BMI, as measured 3-years after cardiac catheterization, and long-term mortality. Patients who underwent cardiac catheterization (n = 11,220; mean age 63 ± 10 years) were categorized according to BMI groups (normal-weight, 18.50 to 24.99 kg/m2; overweight, 25.00 to 29.99 kg/m2; obesity, ≥30 kg/m2). Follow-up BMI was considered the level measured closest to the timepoint of 3 years post catheterization. Percent change in BMI was calculated and its association with long-term all-cause mortality was investigated. Change in BMI of ±5% was observed in 46% of the patients, a decrease>5% in 15.5%, and an increase of>5% of BMI in 38.5%. Compared with those with the lowest change in BMI (±5%), the adjusted hazard ratios for mortality were 1.45 (95% confidence interval [CI], 1.27 to 1.65), and 1.69 (1.46 to 1.95) in patients with 5% to 10% and>10% decrease in BMI, respectively, and 1.05 (0.94 to 1.17), 1.15 (1.03 to 1.28), and 1.40 (1.19 to 1.64) in patients with 5% to 10%, 10% to 20% and>20% increase in BMI, respectively. The pattern was similar in normal-weight, overweight, and obese subgroups at baseline. However, the magnitude of the association with decrease BMI was more pronounced in normal-weight patients (P-for-interaction 0.031). In conclusion, the association of percent changes in BMI after cardiac catheterization and all-cause mortality had a reversed J-shaped pattern, with both weight loss and weight gain being associated with increased risk. A decrease in BMI was related to higher mortality rates than was an increase in BMI for a comparable degree of percent change.
       
  • Severe Eosinophilic Myocarditis in the Portion of Left Ventricular Wall
           Excised to Insert a Left Ventricular Assist Device for Severe Heart
           Failure
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): William C. Roberts, Alexander T. KietzmanDescribed herein are 3 adults in whom histologic study of the left ventricular myocardium excised (“LV core”) to insert a left ventricular assist device (LVAD) disclosed severe acute myocarditis and the inflammatory cells included numerous eosinophils (eosinophilic myocarditis). Examination of the clinical records disclosed elevated absolute eosinophil counts at the time of insertion of the LVAD and the counts rapidly (
       
  • Examining Hearts Containing Left Ventricular Assist Devices at Necropsy
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): William C. Roberts, Nuvaira Ather, Joseph M. GuileyardoThere are no publications describing hearts at necropsy containing left ventricular assist devices (LVADs). The purpose was to study the relation of the LVAD cannula to the left ventricular (LV) cavity and wall. We studied the hearts at necropsy of 15 adults who had an LVAD inserted from 4 to 1,423 days (median 60) earlier. In 13 patients, the cannula had been inserted at an angle to the major longitudinal axis of the LV chamber, and in 11 patients, the orifice margin of the cannulas contacted the LV mural endocardium. In 3 patients, the LVAD cannula was inserted into the posterior wall, and, in another into the anterior wall. In the remaining 11 patients, the cannula had been inserted into the LV apex. Despite the insertion of the cannulas into the LV apex, the direction of the insertion was not into the longitudinal axis of the LV cavity in 9 patients. These unusual insertions in some patients may have altered flow into the orifice of the cannula; in others, based on their long postoperative survival, physiologic consequences were almost certainly absent. The presence of considerable quantities of subepicardial adipose tissue and pericardial adhesions from previous cardiac procedures (mainly coronary bypass) potentially interfered with achieving proper alignment of the LVAD cannula during its insertion. Misalignment of the cannulas of the LVAD in the LV cavity appears to be rather frequent.
       
  • Effect of Preoperative Tricuspid and/or Mitral Regurgitation on
           Development of Late Right-Sided Heart Failure After Insertion of the
           HeartWare Left Ventricular Assist Device
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Oscar Gonzalez-Fernandez, Noelia Bouzas-Cruz, Carlos Ferrera, Andrew Woods, Nicola Robinson-Smith, Sian Tovey, Gareth Parry, Guy Andrew MacGowan, Stephan SchuelerRight-sided heart failure (RHF) after left ventricular assist device implantation is a significant cause of morbidity and mortality. Although multiple predictors of early RHF have been described, information on late RHF is scarce. The aim of this study was to identify predictors of late RHF in left ventricular assist device patients. A retrospective analysis of all adult patients who underwent HeartWare-ventricular assist device implantation as a bridge to transplantation in a single-centre was performed. Late RHF was defined as RHF requiring rehospitalization after 30 days of implantation. A total of 16 (10.3%) patients from 156 implantations developed late RHF. Median time to late RHF onset was 182.5 (interquartile range 105 to 618) days. Patients developing late RHF were older at surgery. A significantly higher rate of moderate or severe tricuspid regurgitation before implantation was found in patients presenting with late RHF (81.2% vs 33.5%; p
       
  • Value of Neutrophil to Lymphocyte Ratio and Its Trajectory in Patients
           Hospitalized With Acute Heart Failure and Preserved Ejection Fraction
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Kalyani Anil Boralkar, Yukari Kobayashi, Myriam Amsallem, Jennifer Arthur Ataam, Kegan J. Moneghetti, Nicholas Cauwenberghs, Benjamin D. Horne, Kirk U. Knowlton, Holden Maecker, Tatiana Kuznetsova, Paul A. Heidenreich, Francois HaddadThe neutrophil to lymphocyte ratio (NLR) has been proposed as a simple and routinely obtained marker of inflammation. This study sought to determine whether the NLR on admission as well as NLR trajectory would be complementary to the Get with the Guidelines Heart Failure (GWTG-HF) risk score in patients hospitalized with acute heart failure with preserved ejection fraction (HFpEF).Using the Stanford Translational Research Database, we identified 443 patients between January 2002 and December 2013 hospitalized with acute HFpEF and with complete data of NLR both on admission and at discharge. The primary endpoint was all-cause mortality. Mean age was 77 ± 16 years, 58% were female, with a high prevalence of diabetes mellitus (35.4%), coronary artery disease (58.2%), systemic hypertension (96.6%) and history of atrial fibrillation (57.5%). Over a median follow-up of 2.2 years, 121 (27.3%) patients died. The median NLR on admission was 6.5 (IQR 3.6 – 11.1); a majority of patients decreased their NLR during the course of hospitalization. On multivariable Cox modeling, both NLR on admission (HR 1.18 95% CI (1.00 – .38), p = 0.04) and absolute NLR trajectory (HR 1.26 95% CI (1.10 – 1.45), p = 0.001) were shown to be incremental to GWTG-HF risk score (p 
       
  • “Some Tips on Insurance: Part II of II”
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Robert M. Doroghazi
       
  • Relations Between Physical Activity, Subclinical Myocardial Injury, and
           Cardiovascular Mortality in the General Population
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Charles German, Muhammad Imtiaz Ahmad, Yabing Li, Elsayed Z. SolimanWe examined the association between poor physical activity (PA) and subclinical myocardial injury (SC-MI), and how concomitant exposure to poor PA and SC-MI modifies their association with cardiovascular disease (CVD) mortality. This analysis included 6,044 participants free of CVD from the NHANES-III survey. Leisure time PA was defined as: ideal (3 to 5.99 METs and ≥5 times/week or any PA with ≥6METs and ≥3times/week), intermediate (any activity other than ideal), or poor (no activity at all). SC-MI was defined as an electrocardiographic cardiac infarction/injury score ≥10 units. CVD mortality was ascertained from the National Death Index. In multivariable logistic regression analysis, poor PA (odds ratio [OR] [95% confidence interval, CI]: 1.30 [1.10 to 1.54]) and intermediate PA (OR [95%CI]: 1.19 [1.02 to 1.38]), compared with ideal PA, were associated with an increased odds of SC-MI. During a median follow-up of 14 years, 589 CVD deaths occurred. In multivariable Cox-proportional hazard analysis, the presence (vs absence) of SC-MI was associated with a 33% increased risk of CVD mortality whereas poor (vs ideal) PA was associated with a 67% increased risk of CVD mortality (HR [95%CI]: 1.33 [1.11 to 1.58] and 1.67 [1.37 to 2.05], respectively). Additionally, the concomitant presence of both poor PA and SC-MI were associated with a higher risk of CVD mortality (HR [95%CI]: 2.25[1.68 to 3.00]) compared with ideal PA and the absence of SC-MI. In conclusion, poor PA is associated with an increased risk of SC-MI and their concomitant presence is associated with a marked increase in CVD mortality, underscoring the potential role of PA in preventing clinical and subclinical CVD outcomes.
       
  • Meta-analysis Comparing Combined Use of Eicosapentaenoic Acid and Statin
           to Statin Alone
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Rajkumar Doshi, Ashish Kumar, Samarthkumar Thakkar, Mariam Shariff, Devina Adalja, Abhi Doshi, Mohamed Taha, Rajeev Gupta, Rupak Desai, Jay Shah, Nageshwara GullapalliRole of omega-3-Fatty acids, especially eicosapentaenoic acid (EPA), in reducing cardiovascular events is not clear. We conducted a meta-analysis including trial sequential analysis (TSA) of all available randomized controlled trials (RCTs) assessing the impact of EPA + statin on cardiovascular risk reduction. The aim is to appraise cardiovascular risk reduction with EPA and statin taken together. A comprehensive search of PubMed and EMBASE databases was conducted for all RCTs that compared EPA + Statin versus statin alone and included outcomes related to cardiovascular health. We calculated a comprehensive odds ratio (ORs) and 95% confidence intervals (CIs) using a random-effects model. We included 5 RCTs totaling 27,415 patients. Our results demonstrated that EPA + statin resulted in 18% reduction in the incidence of MACE (OR = 0.78; 95% CI: 0.65 to 0.93, I2 = 54%, p value
       
  • Effect of Statins on Recurrent Venous Thromboembolism (from the COMMAND
           VTE Registry)
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Yusuke Yoshikawa, Yugo Yamashita, Takeshi Morimoto, Hiroshi Mabuchi, Hidewo Amano, Toru Takase, Seiichi Hiramori, Kitae Kim, Maki Oi, Masaharu Akao, Yohei Kobayashi, Mamoru Toyofuku, Toshiaki Izumi, Tomohisa Tada, Po-Min Chen, Koichiro Murata, Yoshiaki Tsuyuki, Syunsuke Saga, Yuji Nishimoto, Tomoki SasaStatins, which are considered as essential for primary and secondary prevention of atherosclerotic diseases, were also reported to reduce first venous thromboembolism (VTE). However, the effect of statins on VTE recurrence remains conflicting. We aimed to examine the association between statin use and VTE recurrence in a large observational study in Japan. The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE in 29 centers in Japan between January 2010 and August 2014. In the current study, the entire cohort was divided into statin group (N = 437) and no-statin group (N = 2590) according to the status of statin use at baseline. The statin group as compared with the no-statin group was older (statin group 71.2 vs no-statin group 66.5 years, p
       
  • Long-term Prognostic Impact of Physical Activity in Patients With Stable
           Coronary Heart Disease
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Frédéric Bouisset, Jean-Bernard Ruidavets, Vanina Bongard, Dorota. Taraszkiewicz, Emilie Bérard, Michel Galinier, Didier Carrié, Meyer Elbaz, Jean FerrièresStable coronary heart disease (CHD) patients are advised to practice regular physical activity (PA). However, data on very long-term prognosis impact of regular exercise remain scarce. We aimed to evaluate the impact of physical activity level on mortality at long term in stable CHD patients. We analyzed 822 patients with stable CHD. They answered questionnaires on medical history, underwent a standardized clinical examination, and provided a fasting blood sample. PA was evaluated by the MOSPA questionnaire. Three tertiles of patients were individualized according to PA level: 0.0-9 Metabolic Equivalent of Task (METs) hour per week (n = 267); 10-39.9 METs hour per week (n = 279); and ≥40 METs hour per week (n = 276). After a median follow-up of 14.6 years, 324 patients had died. In a multivariate analysis adjusted for age, dyslipidemia, smoking status, diabetes, high blood pressure, waist circumference, left ventricular ejection fraction, Gensini score, heart rate, ankle-brachial index and duration of disease, physical activity was significantly and independently associated with all-cause mortality. Compared to the lowest PA tertile, both the median and the highest PA tertiles, were associated to a reduction of all-cause mortality risk with hazard ratios at 0.79 (95%confidence interval [0.61:1.03], P = 0.08) and 0.71 ([0.53:0.96], P = 0.025) respectively; P for trend = 0.02. Adjusted hazard ratios for an increase of 10 METs hour per week was 0.95 [0.92 to 0.98], (P
       
  • Usefulness of Discharge Resting Heart Rate to Predict Adverse
           Cardiovascular Outcomes in Patients With Left Main Coronary Artery Disease
           Revascularized With Percutaneous Coronary Intervention vs Coronary Artery
           Bypass Grafting (from the EXCEL Trial)
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Ioanna Kosmidou, Aaron Crowley, Leon Macedo, Ori Ben-Yehuda, Bernard J. Gersh, Piet W. Boonstra, Arie Pieter Kappetein, Patrick W. Serruys, Joseph F. Sabik, Gregg W. StoneThe prognostic impact of resting heart rate (RHR) following revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD) is unknown. We aimed to assess the effect of RHR at discharge on 3-year cardiovascular outcomes following PCI and CABG for LMCAD. In the EXCEL trial, 1,905 patients with LMCAD were randomized to PCI with everolimus-eluting stents versus CABG. RHR was measured at discharge following the index hospitalization. The principal outcome measure was the composite endpoint of death, myocardial infarction (MI) or stroke at 3 years. Among 1,303 patients in sinus rhythm with available ECGs, the median (IQR) discharge RHR was 72 (62to 81) bpm. Median discharge RHR was higher after CABG versus PCI (78 [IQR 70 to 86] versus 65 [IQR 59 to 74] bpm, p
       
  • Should Non-ST-Elevation Myocardial Infarction be Treated like ST-Elevation
           Myocardial Infarction With Shorter Door-to-Balloon Time'
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): Micaela Iantorno, Evan Shlofmitz, Toby Rogers, Rebecca Torguson, Paul Kolm, Deepakraj Gajanana, Nauman Khalid, Yuefeng Chen, William S. Weintraub, Ron WaksmanIt is estimated that each year in the United States>780,000 persons will experience an acute coronary syndrome. Approximately 70% of these will have non-ST-elevation myocardial infarction (NSTEMI). Optimal timing of angiography in NSTEMI is a matter of debate. The aim of this retrospective analysis was to evaluate whether and how the timing of percutaneous coronary intervention (PCI) affects the 1-year rate of major adverse cardiac events (MACE) in patients presenting with NSTEMI. Within our PCI database, we identified 1550 patients who underwent PCI for NSTEMI. We then divided the population into 3 groups based on door-to-balloon time (D2BT) (group 1 = D2BT 90 minutes 24 hours). Primary outcome was MACE, a composite of MI, death and target vessel revascularization (TVR), or TVR at 1 year. Baseline characteristics were heterogeneous among the 3 groups, with patients who underwent angiograms>24 hours from presentation being older with more cardiovascular co-morbidities. Patients with D2BT
       
  • Perforation of a Stenotic Congenitally Bicuspid Aortic Valve Cusp by Heavy
           Calcium in the Other Cusp
    • Abstract: Publication date: 15 January 2020Source: The American Journal of Cardiology, Volume 125, Issue 2Author(s): William C. Roberts, Charles S. Roberts, Ishani KaleOn occasion in patients with stenotic congenitally bicuspid aortic valves (BAVs), the quantity of calcium in one of the cusps is considerably greater than in the other cusp. We examined operatively excised stenotic congenitally BAVs in 630 patients having isolated aortic valve replacement (No other cardiac valve was replaced, and none had had infective endocarditis.) Of the 630 valves, 3 contained a perforation in the mildly calcified cusp due to a large calcific “spur” extending across the orifice from a heavily calcified cusp. In conclusion, heavy calcific deposits in 1 of 2 BAVs may extend across the orifice causing a perforation in the noncalcified portion of the opposing cusp.
       
  • “Some Things to Know About”
    • Abstract: Publication date: Available online 31 December 2019Source: The American Journal of CardiologyAuthor(s): Robert M. Doroghazi
       
  • Impact of Type-2 Diabetes Mellitus on the Outcomes of Catheter Ablation of
           Atrial Fibrillation (European observational multicentre study)
    • Abstract: Publication date: Available online 30 December 2019Source: The American Journal of CardiologyAuthor(s): Antonio Creta, Rui Providência, Pedro Adragao, Carlo de Asmundis, Julian Chun, Gianbattista Chierchia, Pascal Defaye, Boris Schmidt, Frédéric Anselme, Malcolm Finlay, Ross Jacob Hunter, Nikolaos Papageorgiou, Pier David Lambiase, Richard John Schilling, Stephane Combes, Nicolas Combes, Jean-Paul Albenque, Paolo Pozzilli, Serge BovedaAbstractType-2 diabetes mellitus (DM) is associated with an increased risk of atrial fibrillation (AF). It is unclear whether DM is a risk factor for arrhythmia recurrence following catheter ablation of AF. We performed a non-randomised, observational study in 7 high-volume European centres. A total of 2504 patients undergoing catheter ablation of AF were included, and procedural outcomes were compared among patients with or without DM. Patients with DM (234) accounted for 9.3% of the sample, and were significantly older, had a higher BMI and suffered more frequently from persistent AF. Arrhythmia relapses at 12 months after AF ablation occurred more frequently in the DM group (32.0% vs. 25.3%, p=0.031). After adjusting for type of AF (i.e., paroxysmal vs. persistent), during a median follow-up of 17±16 months, atrial arrhythmia free-survival was lower in the diabetics with persistent AF (log-rank p=0.003), and comparable for paroxysmal AF (log-rank p=0.554). These results were confirmed in a propensity-matched analysis, and DM was also an independent predictor of AF recurrence on the multivariate analysis (HR1.39; CI95%1.07-1.88; p=0.016). There was no significant difference in the rate of peri-procedural complications among DM and non-DM patients (3.8% vs. 6.3%, p=0.128). Efficacy and safety of cryoballoon ablation were comparable to radiofrequency ablation in both DM and no-DM groups. In conclusion, catheter ablation of AF appears to be safe in patients with DM. However, DM is associated with higher rate of atrial arrhythmia relapse, particularly for patients with persistent AF.
       
  • Strict versus Lenient versus Poor Rate Control Among Patients with Atrial
           Fibrillation and Heart Failure (From the Get With The Guidelines – Heart
           Failure Program)
    • Abstract: Publication date: Available online 30 December 2019Source: The American Journal of CardiologyAuthor(s): Paul L. Hess, Shubin Sheng, Roland Matsouaka, Adam D. DeVore, Paul A. Heidenreich, Clyde W. Yancy, Deepak L. Bhatt, Larry A. Allen, Pamela N. Peterson, P. Michael Ho, William R. Lewis, Adrian F. Hernandez, Gregg C. Fonarow, Jonathan P. PicciniAbstractRandomized data suggest lenient rate control (resting heart rate
       
  • Significance of Syncope at Presentation among Patients with Pulmonary
           Emboli
    • Abstract: Publication date: Available online 28 December 2019Source: The American Journal of CardiologyAuthor(s): Sharon Shalom Natanzon, Shlomi Matetzky, Fernando Chernomordik, Israel Mazin, Romana Herscovici, Orly Goitein, Sagit Ben-Zekry, Nir Shlomo, Avishay Grupper, Roy BeigelAbstractPatients with intermediate-risk pulmonary emboli (PE) present a challenging clinical problem. While syncope has been suggested as a marker for adverse outcomes in these patients, data remain scarce. We aimed to investigate the clinical outcomes of intermediate risk PE patients presenting with syncope. We performed a retrospective cohort study comprised of consecutive, normotensive, PE patients, with evidence of right ventricular involvement. The primary outcome of major adverse clinical events (MACE) included either one or a combination of: mechanical ventilation, hemodynamic instability and need for inotropic support, reperfusion therapy, and in-hospital mortality. Secondary outcomes included: each of the above individual components including major bleeding and renal failure. Overall, 212 patients were evaluated, 40 (19%) presented with syncope, and had a higher prevalence of MACE (29% vs 9.4%, p=0.003), as well as each of the individual secondary endpoints: mechanical ventilation (10% vs 1.8%, p=0.026), hemodynamic instability (18% vs 2.9%, p=0.02), increased need of inotropic support (10% vs 0.6%, p=0.005), and bleeding (15% vs 2.4%, p=0.004). The prevalence of in-hospital mortality was very low (0.5%) with no significant difference between those with and without syncope. There was no significant difference in the need for reperfusion therapy. Upon multivariable analysis, syncope was found to be an independent predictor of adverse clinical outcomes (OR 3.8, C.I 1.48-9.76, p=0.005). In conclusion, among intermediate-risk PE patients with RV involvement, the presence of syncope is associated with a more complicated in-hospital course.
       
  • Comparison of Long-Term Outcomes of Patients Having Surgical Aortic Valve
           Replacement With versus Without Simultaneous Coronary Artery Bypass
           Grafting
    • Abstract: Publication date: Available online 28 December 2019Source: The American Journal of CardiologyAuthor(s): Markus Malmberg, Jarmo Gunn, Jussi Sipilä, Essi Pikkarainen, Päivi Rautava, Ville KytöAbstractCoronary artery disease is a common comorbidity of aortic stenosis. When needed, adding coronary artery bypass grafting (CABG) to surgical aortic valve replacement (SAVR) is the standard treatment method, but the impact of concomitant CABG on long-term outcomes is uncertain. We compared long-term outcomes of SAVR patients with and without CABG. Hospital survivors aged ≥50 years discharged after SAVR ± CABG in Finland between 2004-2014 (n=6870) were retrospectively studied using nationwide registries. Propensity score matching (1:1) was used to identify patients with comparable baseline features (n=2188 patient pairs, mean age 73 years). The primary end points were postoperative 10-year major adverse cardiovascular outcome (MACE), all-cause mortality, stroke, major bleeding, and myocardial infarction. Median follow-up was 6 years. Cumulative MACE rate (39.5% vs. 35.6%; HR 1.04; p=0.677) and mortality (32.7% vs. 31.0%; HR 1.03; p=0.729) after SAVR were comparable with or without CABG. Myocardial infarction was more common in patients with CABG (13.4% vs. 6.9%; HR 1.47; p=0.0495). Occurrence of stroke (15.1% vs. 13.5%; p=0.998) and major bleeding (20.0% vs. 21.9%; p=0.569) were comparable. The was no difference in gastrointestinal (8.1% vs. 10.3%; p=0.978) or intracranial bleeds (6.0% vs. 5.5%; p=0.794). The use of internal mammary artery in CABG did not have an impact on the results. In conclusion, matched patients with and without concomitant CABG had comparable long-term MACE, mortality, stroke, and major bleeding rates after SAVR. In conclusion, our results indicate that need for concomitant CABG has limited impact on long-term outcomes after initially successful SAVR.
       
  • Identifying Risk Factors for Massive Right Ventricular Dilation in
           Patients with Repaired Tetralogy of Fallot
    • Abstract: Publication date: Available online 28 December 2019Source: The American Journal of CardiologyAuthor(s): Clinton D. Cochran, Sunkyung Yu, Lindsey Gakenheimer-Smith, Ray Lowery, Jimmy C. Lu, Maryam Ghadimi Mahani, Prachi P. Agarwal, Adam L. DorfmanABSTRACTIn repaired tetralogy of Fallot (rTOF), pulmonary insufficiency results in varying degrees of right ventricle (RV) dilation. A subset of patients is diagnosed at initial cardiac magnetic resonance imaging (CMR) with a massively dilated RV, far beyond pulmonary valve replacement (PVR) criteria, which is unlikely to return to normal size after PVR. This study aimed to identify risk factors for massive RV dilation at initial CMR. This nested case-control study included all patients at our institution with rTOF and massive RV dilation (indexed RV end-diastolic volume [RVEDVi] ≥200 ml/m2) on initial CMR. Patients were matched by age at first CMR, gender, and type of repair with rTOF controls with RVEDVi 6 months of age (adjusted odds ratio [AOR] 2.90, 95% confidence interval [CI] 1.12–7.55, p = 0.03), longer QRS duration (AOR = 1.03, 95% CI 1.01–1.05, p = 0.005), and non-Caucasian race (AOR = 7.84, 95% CI 1.76-34.8, p = 0.01) remained independently associated with massive RV dilation. Era of repair, history of systemic to pulmonary shunt palliation, genetic anomaly and additional cardiac lesions did not differ between groups. In conclusion, these risk factors identify a subset of patients who may benefit from earlier CMR evaluation to avoid massive irreversible RV dilation.
       
  • Coronary Artery Calcification, Statin use and Long-Term Risk of
           Atherosclerotic Cardiovascular Disease Events (From the Multi-Ethnic Study
           of Atherosclerosis)
    • Abstract: Publication date: Available online 28 December 2019Source: The American Journal of CardiologyAuthor(s): Mahmoud Al Rifai, Michael J. Blaha, Jaideep Patel, Jia Xiaoming, Miguel Cainzos-Achirica, Philip Greenland, Matthew Budoff, Joseph Yeboah, Khurram Nasir, Mouaz H. Al-Mallah, Salim S. ViraniAbstractThe prognostic utility of coronary artery calcium (CAC) for individuals taking statins is unclear. We hypothesized that CAC remains associated with atherosclerotic cardiovascular disease (ASCVD) events in individuals using statins at baseline or among those started on statin at follow-up. The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study of 6,814 participants who were enrolled between 2000-2002 and were free of clinical ASCVD at baseline. Four follow-up visits were conducted in 2002-2004, 2004-2006, 2005-2007 and 2010-2012. CAC was assessed at baseline and follow-up using either an electron-beam CT scanner or a multidetector CT system. Statin use at baseline and follow up was self-reported. Among 6,811 participants with complete information on statin use, mean age was 62 (SD= 10) years, 53% were women, 38% white, 12% Chinese-American, 28% African American, and 22% Hispanic. In multivariable analyses, CAC>0 was associated with a significantly higher risk of ASCVD events regardless of baseline or incident statin use. For example, HRs (95% CI) for the association between CAC>0 and ASCVD were 2.46 (1.41,4.28) for baseline statin users, 2.08 (1.68,2.57) for baseline-statin non-users, and 2.21 (1.56,3.15) for those started on a statin at follow-up. In conclusion, current statin use does not weaken the prognostic utility of CAC. CAC is associated with incident ASCVD regardless of baseline or incident statin use.
       
  • Impact of Lipid Monitoring on Treatment Intensification of Cholesterol
           Lowering Therapies (From the Veterans Affairs Healthcare System)
    • Abstract: Publication date: Available online 27 December 2019Source: The American Journal of CardiologyAuthor(s): Xiaoming Jia, David J. Ramsey, Mahmoud Al Rifai, Sarah T. Ahmed, Julia M. Akeroyd, Dave L. Dixon, Ty J. Gluckman, Vijay Nambi, Christie M. Ballantyne, Laura A. Petersen, Neil J. Stone, Salim S. ViraniAbstractTreatment guidelines recommend monitoring of lipids to assess efficacy and adherence to lipid lowering therapy. We assessed whether lipid profile monitoring is associated with intensification of cholesterol lowering therapy. Patients from the Veterans Affairs (VA) healthcare system with atherosclerotic cardiovascular disease (ASCVD) and at least one primary care visit between October 2013 and September 2014 were included (n=1,061,753). Treatment intensification was defined as the initiation of a statin, an increase in the intensity or dose of statin therapy and/or the addition of ezetimibe. An association between the number of lipid panels and treatment intensification was assessed with adjusted regression models. During the study period, 87.1% of included patients had ≥1 lipid panel. Patients with ≥1 lipid panel were more likely to undergo treatment intensification compared with individuals with 0 lipid panels (9.3% vs 5.4% respectively, p
       
  • Usefulness of a Structured Adult Education Program in Modifying Markers of
           Cardiovascular Risk after Acute Myocardial Infarction
    • Abstract: Publication date: Available online 27 December 2019Source: The American Journal of CardiologyAuthor(s): Georgios Giannopoulos, Sofia Karageorgiou, Dimitrios Vrachatis, Maria Kousta, Styliani Tsoukala, Konstantinos Letsas, Gerasimos Siasos, Spyridon DeftereosAbstractPatient involvement in therapeutic strategies leading to lifestyle changes and increasing adherence to beneficial treatment is important for high risk coronary artery disease patients. The hypothesis of the present substudy was that a program of education specifically structured to educate post-myocardial infarction (MI) patients would lead to measurable differences in specific indices of cardiovascular risk. Post-MI patients were randomly assigned to two groups. Patients in the intervention arm attended an 8-week long educational program in addition to usual treatment and controls received standard treatment. Low-density lipoprotein cholesterol (LDLc), systolic blood pressure (SAP), body-mass index (BMI) and glycosylated hemoglobin (HbA1c) were assessed at baseline and at 12 months (values are reported as median [interquartile range]). 198 consecutively randomized patients were included in the present substudy. The median change in LDLc was -54 [-45-(-62)] mg/dl in the intervention group as compared to -35 [-28-(-43)] mg/dl in controls (p
       
  • Erratum to “Spontaneous Closure Rates of Ventricular Septal Defects
           (6,750 Consecutive Neonates)”
    • Abstract: Publication date: Available online 19 November 2019Source: The American Journal of CardiologyAuthor(s): Qu-ming Zhao, Guo-ying Huang
       
  • Cocaine Use and Pulmonary Hypertension
    • Abstract: Publication date: Available online 19 November 2019Source: The American Journal of CardiologyAuthor(s): Bashar N. Alzghoul, Amjad Abualsuod, Bilal Alqam, Ayoub Innabi, Deepak R. Palagiri, Zaid Gheith, Farah N. Amer, Nikhil K. Meena, Satish KenchaiahEvidence linking cocaine to the risk of pulmonary hypertension (PH) is limited and inconsistent. We examined whether cocaine use, in the absence of other known causes of PH, was associated with elevated systolic pulmonary artery pressure (sPAP) and increased probability of PH. We compared patients with documented cocaine use to a randomly selected age, sex, and race-matched control group without history of cocaine use. All participants had no known causes of PH and underwent echocardiography for noninvasive estimation of sPAP. We used routinely reported echocardiographic parameters and contemporary guidelines to grade the probability of PH. In 88 patients with documented cocaine use (mean age ± standard deviation 51.7 ± 9.5 years), 33% were women and 89% were of Black race. The commonest route of cocaine use was smoking (74%). Cocaine users compared with the control group had significantly higher sPAP (mean ± standard deviation, 30.1 ± 13.1 vs 22.0 ± 9.8 mm Hg, p
       
 
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