Saibal Kar, Shephal K Doshi, Mohamad Alkhouli, A John Camm, Megan Coylewright, Michael C Gibson, Christopher B Granger, Mahmut E Gurol, Kenneth Huber, Moussa Mansour, Devi G Nair, Andrea Natale, Stuart J Pocock, Vivek R Reddy, Walid Saliba, Thomas Christen, Dominic J Allocco, Kenneth A Ellenbogen, Martin B Leon
BACKGROUND: Percutaneous left atrial appendage (LAA) closure (LAAC) was developed as a nonpharmacologic alternative to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) who are at an increased risk for stroke or systemic embolism. The Watchman device permanently seals off the LAA to prevent thrombi from escaping into the circulation. Previous randomized trials have established the safety and efficacy of LAAC compared to warfarin. However, direct OACs (DOACs) have become the preferred pharmacologic strategy for stroke prevention in patients with AF, and there is limited data comparing Watchman FLX to DOACs in a broad AF patient population...
October 2023: American Heart Journal
Esli Osmanlliu, Neil M Kalwani, Vijaya Parameswaran, Lubna Qureshi, Rajesh Dash, David Scheinker, Fatima Rodriguez
BACKGROUND: The COVID-19 pandemic accelerated adoption of telemedicine in cardiology clinics. Early in the pandemic, there were sociodemographic disparities in telemedicine use. It is unknown if these disparities persisted and whether they were associated with changes in the population of patients accessing care. METHODS: We examined all adult cardiology visits at an academic and an affiliated community practice in Northern California from March 2019 to February 2020 (pre-COVID) and March 2020 to February 2021 (COVID)...
September 2023: American Heart Journal
Roopinder K Sandhu, Satish R Raj, Rasha Hamzeh, Robert S Sheldon
BACKGROUND: Vasovagal syncope (VVS) is common, recurs, and is associated with markedly reduced quality of life, anxiety, and frequent injuries. The few pharmacological therapies for VVS proven to have a moderate benefit in reducing recurrences are limited to patients without coexisting conditions such as hypertension or heart failure. Although there is some data to suggest Atomoxetine, a norepinephrine reuptake transport inhibitor (NET), may be a promising treatment option, an adequately powered randomized placebo-controlled trial is needed...
August 2023: American Heart Journal
Augustin Coisne, Samy Aghezzaf, Laura Butruille, Eloise Woitrain, Sandro Ninni, Francis Juthier, Arnaud Sudre, André Vincentelli, Nicolas Lamblin, Gilles Lemesle, David Montaigne, Christophe Bauters
BACKGROUND: Severe aortic stenosis (AS) has been associated with bleeding. However, there is a lack of prospective assessment of bleeding events and their clinical significance in a large population of outpatients with variable degree of AS severity. OBJECTIVES: To assess the incidence, source, determinants, and prognostic impact of major bleeding in patients with variable degree of AS severity. METHODS: Between May 2016 and December 2017, consecutive outpatients were included...
August 2023: American Heart Journal
Simon Parlow, Pietro Di Santo, Lee H Sterling, Laura Goodliffe, Pouya Motazedian, Graeme Prosperi-Porta, Baylie Morgan, Zandra Koopman, Richard G Jung, Melissa Fay Lepage-Ratte, Lisa Robinson, Hannah Feagan, Trevor Simard, George A Wells, Kwadwo Kyeremanteng, Craig Ainsworth, Faizan Amin, Jeffrey A Marbach, Shannon M Fernando, Marino Labinaz, Emilie P Belley-Cote, Benjamin Hibbert, Rebecca Mathew
BACKGROUND: Cardiogenic shock (CS) is a state of end-organ hypoperfusion related to cardiac dysfunction. Current guidelines recommend consideration of inotrope therapy in patients with CS, however no robust data support their use. The purpose of the CAPITAL DOREMI2 trial is to examine the efficacy and safety of inotrope therapy against placebo in the initial resuscitation of patients with CS. METHODS AND DESIGN: This is a multi-center, double-blind, randomized, placebo-controlled trial comparing single-agent inotrope therapy to placebo in patients with CS...
August 2023: American Heart Journal
Simona Chiusolo, Christian Sørensen Bork, Francesco Gentile, Søren Lundbye-Christensen, William S Harris, Erik Berg Schmidt, Raffaele De Caterina
BACKGROUND: Tissue levels of n-3 polyunsaturated fatty acids (PUFAs) have been inversely related with risk of myocardial infarction (MI). Whether ratios of n-3 to n-6 PUFAs, reflecting both dietary intake of n-3 PUFAs and competing n-6 PUFAs, are better predictors of future MI than n-3 PUFA fractions is unclear. We aimed at investigating whether such ratios in adipose tissue better predict MI than n-3 PUFA fractions. METHODS: Subcutaneous adipose tissue biopsies were obtained in a random sample (n = 3,500) of the Diet, Cancer and Health cohort (n = 57,053)...
August 2023: American Heart Journal
Patrick C Demkowicz, Sanket S Dhruva, Erica S Spatz, Alexis L Beatty, Joseph S Ross, Rohan Khera
BACKGROUND: While the US Food and Drug Administration (FDA) has cleared smartwatch software for detecting atrial fibrillation (AF), there is lack of guidance on management by physicians. We sought to evaluate the approach to management of Apple Watch alerts for AF by physicians and assess whether respondent and case characteristics were associated with their approach. METHODS: We conducted a case-based survey of physicians practicing primary care, emergency medicine, and cardiology at 2 large academic centers (Yale and University of California San Francisco) between September and December 2021...
August 2023: American Heart Journal
Avishag Laish-Farkash, Emanuel Harari, Michael Rahkovich, Yonatan Kogan, Gergana Marincheva, Guy Scheinman, Eyal Ben-Assa, Eli I Lev
BACKGROUND: A robotic Radiaction Shielding System (RSS) was developed to provide a full-body protection to all medical personnel during fluoroscopy-guided procedures, by encapsulating the imaging beam and blocking scattered radiation. OBJECTIVES: We aimed to evaluate its efficacy in real-world electrophysiologic (EP) laboratory- both during ablations and cardiovascular implantable electronic devices (CIED) procedures. METHODS: A prospective controlled study comparing consecutive real-life EP procedures with and without RSS using highly sensitive sensors in different locations...
July 2023: American Heart Journal
Jung-Joon Cha, Soon Jun Hong, Ju Hyeon Kim, Subin Lim, Hyung Joon Joo, Jae Hyoung Park, Cheol Woong Yu, Pil Hyung Lee, Seung Whan Lee, Cheol Whan Lee, Jae Youn Moon, Jong-Young Lee, Jung-Sun Kim, Jae Suk Park, Kyounghoon Lee, Sang Yup Lim, Jin Oh Na, Jin-Man Cho, Seok Yeon Kim, Do-Sun Lim
BACKGROUND: Current guidelines recommend that patients with established atherosclerotic cardiovascular disease (ASCVD) use high-intensity statin therapy to lower low-density lipoprotein (LDL)-cholesterol levels by at least 50%, irrespective of age. However, in real-world practice, there is reluctance to maintain statin use in response to side-effects, particularly statin-associated muscle symptoms (SAMS). Moreover, no randomized trial has been conducted on the safety of statin therapy in elderly patients...
July 2023: American Heart Journal
Luigi Gnudi, Nikolaos Fountoulakis, Angeliki Panagiotou, Antonella Corcillo, Giuseppe Maltese, Maria Flaquer Rife, Ioannis Ntalas, Russell Franks, Amedeo Chiribiri, Salma Ayis, Janaka Karalliedde
BACKGROUND: Active vitamin-D deficiency is a potential modifiable risk factor for increased ventricular mass. We explored the effects of active vitamin-D (calcitriol) treatment on left ventricular mass in patients with type-2 diabetes (T2D) and chronic kidney disease (CKD). METHODS: We performed a 48-week duration single center randomized double-blind parallel group trial examining the impact of calcitriol, 0.5 mcg once daily, as compared to placebo on a primary endpoint of change from baseline in left ventricular mass index (LVMI) measured by magnetic resonance imaging ...
July 2023: American Heart Journal
Marwah E Alnewais, Lauren Adams, Abdulaziz S Alfehaid, Shayma Alzaidi, Erin R Weeda
BACKGROUND: This study aimed to evaluate the geographic distribution of United States (US) clinical trial sites utilizedfor guideline changing studies of cholesterol management. METHODS: Randomized trials evaluating pharmacologic interventions for cholesterol treatment and reporting location data (ie, zip code of trial sites) were identified. Location data was abstracted from RESULTS: Half of US counties were over 30 miles from a study site and, social determinants of health were more favorable in counties with versus without clinical trial sites...
June 26, 2023: American Heart Journal
Chen Li, John W Eikelboom, Zihang Zhong, Xiwen Zhang, Kun Liu, Li Zhu, Naiquan Yang, Xin Chen, Xiaoyan Wang, Xin Zhao, Jun Jiang, Jun Pu, Bo Zhao, Fumin Zhang, Jun Zhu, Jun Huang, Xiangqing Kong, Hao Yu, Chunyue Tan, Wenhao Zhang, Qin Wang, Xiaoxuan Gong, Jianling Bai, Chunjian Li
BACKGROUND: Time to reperfusion is the key to the treatment of patients with ST-elevation myocardial infarction (STEMI). It is uncertain whether adjunctive thrombolytic therapy combined with contemporary antiplatelet agent ticagrelor improves outcomes as administered prior to primary percutaneous coronary intervention (PCI) expected to be performed within 120 minutes. METHODS: OPTIMA-6 is a multicenter, randomized, double-blind, placebo-controlled, and superiority trial to evaluate the efficacy of a bolus of half-dose recombinant staphylokinase (r-SAK) vs placebo prior to timely primary PCI in patients with STEMI...
June 25, 2023: American Heart Journal
Michael P Gray, Yemima Berman, Giordano Bottà, Stuart M Grieve, Amy Ho, Jessica Hu, Karice Hyun, Jodie Ingles, Garry Jennings, Gary Kilov, Jean-Frederic Levesque, Peter Meikle, Julie Redfern, Tim Usherwood, Stephen T Vernon, Stephen J Nicholls, Gemma A Figtree
BACKGROUND: Identifying and targeting established modifiable risk factors has been a successful strategy for reducing the burden of coronary artery disease (CAD) at the population-level. However, up to 1-in-4 patients who present with ST elevation myocardial infarction do so in the absence of such risk factors. Polygenic risk scores (PRS) have demonstrated an ability to improve risk prediction models independent of traditional risk factors and self-reported family history, but a pathway for implementation has yet to be clearly identified...
June 25, 2023: American Heart Journal
Kriyana P Reddy, Lauren A Eberly, Howard M Julien, Jay Giri, Alexander C Fanaroff, Peter W Groeneveld, Sameed Ahmed M Khatana, Ashwin S Nathan
BACKGROUND: Racial residential segregation is associated with racial health inequities, but it is unclear if segregation may exacerbate Black-White disparities in cardiovascular disease (CVD) mortality. This study aimed to assess associations between Black-White residential segregation, CVD mortality rates among Non-Hispanic (NH) Black and NH White populations, and Black-White disparities in CVD mortality. METHODS: This cross-sectional study analyzed Black-White residential segregation as measured by county-level interaction index, of US counties, county-level CVD mortality among NH White and NH black adults aged 25 years and older, and county-level Black-White disparities in CVD mortality in years 2014 to 2017...
June 24, 2023: American Heart Journal
Apoorva Gangavelli, Zihao Liu, Jeffrey Wang, Alexis Okoh, Rebecca Steinberg, Krishan Patel, Ambarish Pandey, Deepak K Gupta, Neal Dickert, Shivani A Patel, Alanna A Morris
BACKGROUND: Some patients with heart failure (HF) have low natriuretic peptide (NP) levels. It is unclear whether specific populations are disproportionately excluded from participation in randomized clinical trials (RCT) with inclusion requirements for elevated NPs. We investigated factors associated with unexpectedly low NP levels in a cohort of patients hospitalized with HF, and the implications on racial diversity in a prototype HF RCT. METHODS: We created a retrospective cohort of 31,704 patients (age 72 ± 16 years, 49% female, 52% Black) hospitalized with HF from 2010-2020 with B-type natriuretic peptide (BNP) measurements...
June 19, 2023: American Heart Journal
Renato D Lopes, Pedro G M de Barros E Silva, Conrado Roberto Hoffmann Filho, Margaret Assad Cavalvante, Claudia Madeira Miranda, Rodrigo Barbosa Esper, Gustavo Glotz de Lima, Luiz Eduardo Fonteles Ritt, Rose Mary Ferreira Lisboa da Silva, Marcelo A Nakazone, Adail Paixão Almeida, Ricardo Pavanello, Carlos Eduardo Batista de Lima, Luciano Marcelo Backes, Lucas Hollanda Oliveira, Olga Ferreira de Souza, Adalberto Menezes Lorga Filho, Epotamenides Maria Good God, José Carlos Moura Jorge, Alcirley de Almeida Luiz, Simone Fialho Pereira Pimentel Martins, Rogério Carregoza Dantas, Ricardo D Oliveira Vieira, Leandro Ioschpe Zimerman, Álvaro Rabelo Alves Júnior, Márcio Jansen de Oliveira Figueiredo, Samara Pinheiro do Carmo Gomes, Lucas Martins de Lima, Lucas Petri Damiani, Ricardo Alkmim Teixeira, Alexandro Alves Fagundes, Eduardo Benchimol Saad
BACKGROUND: It is estimated that atrial fibrillation (AF) affects approximately 1.5 million people in Brazil; however, epidemiological data are limited. We sought to evaluate the characteristics, treatment patterns, and clinical outcomes in patients with AF in Brazil by creating the first nationwide prospective registry. METHODS: RECALL was a multicenter, prospective registry that included and followed for 1 year 4,585 patients with AF at 89 sites across Brazil from April 2012 to August 2019...
June 15, 2023: American Heart Journal
Ziqian Weng, Chen Zhao, Yuhan Qin, Cong Liu, Weili Pan, Sining Hu, Luping He, Yishuo Xu, Ming Zeng, Xue Feng, Rui Gao, Xianghao Yu, Minghao Liu, Boling Yi, Dirui Zhang, Ekaterina Koniaeva, Timur Musin, Diler Mohammad, Bin Zhu, Yanli Sun, Jingbo Hou, Jiawei Tian, Gary S Mintz, Haibo Jia, Bo Yu
BACKGROUND: Plaque rupture (PR) and plaque erosion (PE) are two distinct, different, and most common culprit lesion morphologies responsible for acute coronary syndrome (ACS). However, the prevalence, distribution, and characteristics of peripheral atherosclerosis in ACS patients with PR vs PE has never been studied. The aim of this study was to assess peripheral atherosclerosis burden and vulnerability evaluated by vascular ultrasound in ACS patients with coronary PR versus PE identified by optical coherence tomography (OCT)...
June 14, 2023: American Heart Journal
Sonya Kirmani, Pamela K Woodard, Ling Shi, Taye H Hamza, Charles E Canter, Steven D Colan, Elfriede Pahl, Jeffrey A Towbin, Steven A Webber, Joseph W Rossano, Melanie D Everitt, Kimberly M Molina, Paul F Kantor, John L Jefferies, Brian Feingold, Linda J Addonizio, Stephanie M Ware, Wendy K Chung, Jean A Ballweg, Teresa M Lee, Neha Bansal, Hiedy Razoky, Jason Czachor, Fatima I Lunze, Edward Marcus, Paul Commean, James D Wilkinson, Steven E Lipshultz
BACKGROUND: Myocardial fibrosis, as diagnosed on cardiac magnetic resonance imaging (cMRI) by late gadolinium enhancement (LGE), is associated with adverse outcomes in adults with hypertrophic cardiomyopathy (HCM), but its prevalence and magnitude in children with HCM have not been established. We investigated: 1) the prevalence and extent of myocardial fibrosis as detected by LGE cMRI; 2) the agreement between echocardiographic and cMRI measurements of cardiac structure; and 3) whether serum concentrations of N-terminal pro hormone B-type natriuretic peptide (NT-proBNP) and cardiac troponin-T are associated with cMRI measurements...
June 12, 2023: American Heart Journal
Masaru Seguchi, Alp Aytekin, Lena Steiger, Philipp Nicol, Costanza Pellegrini, Tobias Rheude, Leif-Christopher Engel, Hector A Alvarez-Covarrubias, Erion Xhepa, N Patrick Mayr, Martin Hadamitzky, Adnan Kastrati, Heribert Schunkert, Michael Joner, Tobias Lenz
BACKGROUND: Transcatheter aortic valve implantation (TAVI) was established as a standard treatment for high-operative risk patients with severe aortic stenosis (AS). Although coronary artery disease (CAD) often coexists with AS, clinical and angiographic evaluations of stenosis severity are unreliable in this specific setting. To provide precise risk stratification of coronary lesions, combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS) was developed to integrate morphological and molecular information on plaque composition...
June 12, 2023: American Heart Journal
Christoffer Læssøe Madsen, Jesper Park-Hansen, Akhmadjon Irmukhamedov, Christian Lildal Carranza, Sulman Rafiq, Rafael Rodríguez Lecoq, Neiser Palmer Camino, Ivy Susanne Modrau, Emma C Hansson, Anders Jeppsson, Rakin Hadad, Angel Moya-Mitjans, Anders Møller Greve, Robin Christensen, Helle Gervig Carstensen, Nis Baun Høst, Ulrik Dixen, Christian Torp-Pedersen, Lars Køber, Ismail Gögenur, Thomas Clement Truelsen, Christina Kruuse, Ahmad Sajadieh, Helena Domínguez
Current recommendations regarding the use of surgical left atrial appendage (LAA) closure to prevent thromboembolisms lack high-level evidence. Patients undergoing open-heart surgery often have several cardiovascular risk factors and a high occurrence of postoperative atrial fibrillation (AF) - with a high recurrence rate - and are thus at a high risk of stroke. Therefore, we hypothesized that concomitant LAA closure during open-heart surgery will reduce mid-term risk of stroke independently of preoperative AF status and CHA2 DS2 -VASc score...
June 9, 2023: American Heart Journal
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