<div><h4>Cardiovascular Effects of Chronic Hormone Therapy: Study on Olympic Female Athletes.</h4><i>Gioia GD, Crispino SP, Maestrini V, Monosilio S, ... Angioli R, Pelliccia A</i><br /><AbstractText>Female physiology is regulated after puberty by the menstrual cycle, whose hormonal fluctuations create a multitude of effects on several systems, including the cardiovascular one. The use of hormone therapy (HT) is quite common in female athletes and data on cardiovascular effects in this population are lacking. We sought to investigate the effects of HT in highly trained athletes to assess any difference associated with HT on cardiac remodelling, exercise capacity and clinical correlates. We studied 380 female elite athletes (mean age 25.5 ± 4.8) competing in endurance and mixed sports. 67 athletes (18%) were in chronic HT therapy. All athletes underwent baseline ECG, exercise ECG stress test, transthoracic echocardiogram, complete blood tests including lipid profile and inflammation indexes. The echocardiographic study showed a characteristic left ventricular (LV) remodelling, defined by lower LV mass index (86.2 vs. 92.5 g/m<sup>2</sup>, p<0.006), end-diastolic LV diameter (28.3 vs. 29.4 mm/m<sup>2</sup>, p<0.004) and end-diastolic LV volume (61.82 vs. 67.09 mL/m<sup>2</sup>, p<0.010) compared to controls, without changes in systolic function and diastolic relaxation/filling indexes. A lower burden of ventricular arrhythmias on exercise was observed in HT athletes (1.5% vs 8.6% in those without therapy, p=0.040). Linear regression analysis showed that HT had independent effect on LVEDDi (p=0.014), LVEDVi (p=0.030) and LVMi (p=0.020). In conclusion, chronic treatment with HT in female athletes is associated with less cardiac remodelling, including a lower LV cavity, volume and mass, with preserved systolic and diastolic function, and decreased burden of exercise-induced ventricular arrhythmias. HT, therefore, appears to be responsible for a more economic, but equally efficient, cardiac adaptation to intensive athletic conditioning.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Nov 2023; epub ahead of print</small></div>

<div><h4>Understanding Patient Perspectives Toward Shared Decision Making in Patients with Pulmonary Hypertension.</h4><i>Tobita K, Sakamoto H, Inami T, Fujisawa D, ... Soejima K, Kohno T</i><br /><AbstractText>Clinical guidelines for pulmonary hypertension (PH) recommend shared decision making (SDM) and individualized treatment. However, patient perspectives on PH treatment goals, preference toward a decision-making style of treatment, and adoption of SDM remain unclear. This cross-sectional questionnaire-based study assessed the patients\' preferred and actual participation role in treatment decision-making, rated on 5 scales (ranging from passive [patients leave all decisions to physicians] to active [patients make the decision after physicians show patients several options]) and evaluated the concordance between preferred and actual participation roles. The important factors underlying patients\' perspectives in treatment decision-making (i.e., prognosis; symptom, financial, family, and social burdens; patient values; and physician recommendation) were evaluated. Univariate logistic regression analysis was performed to determine the patients with a positive preference toward \"physician recommendation\" in treatment decision-making. Among 130 patients with PH (median age: 58 years, mean pulmonary arterial pressure: 23 mmHg, 27.7% male), 59.2% preferred that \"physicians make the decision regarding treatment after showing patients therapeutic options (i.e., intermediate between passive and active roles).\" The patient-preferred and actual participation roles in decision-making had moderate agreement (Cohen\'s kappa=0.46). The most important factor in treatment decisions was \"symptom burden reduction\" (93.8%). While 85.0% of patients chose \"physician recommendation\" as an important factor, 49.6% chose \"alignment with my values.\" The determinants of patients who chose \"physician recommendation\" were less severe hemodynamics and better functional capacity. In conclusion, PH patients preferred that the \"physicians make the decision after showing patients therapeutic options\" and prioritized physician recommendation over their values.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Nov 2023; epub ahead of print</small></div>

<div><h4>Temporal Trends in Patient Characteristics and Outcomes of Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement: A Nationwide Study.</h4><i>Lundahl C, Kragholm K, Tayal B, Karasoy D, ... De Backer O, Freeman PM</i><br /><AbstractText>With increased use of transcatheter aortic valve implantation (TAVI) in treatment of aortic stenosis, it is important to evaluate real life data trends in outcomes. This nationwide register-based study aims to present an outlook on temporal trends in characteristics and outcomes including mortality. First-time consecutive Danish TAVI patients from 2010-2019 were included in this study. Chi square and Kruskal-Wallis tests were performed to assess differences in characteristics over time and Cochrane-Armitage trend tests were used to examine changes in complications and mortality. Between 2010-2019, 4,847 patients (54.6% men, median age 82 (Q1-Q3: 77 to 85)) underwent first-time TAVI. Statistically significant decrease over time was observed for pre-procedural hypertension, ischemic heart disease and heart failure (HF), while preexisting chronic obstructive lung disease and pre-procedural pacemaker (PM) remained stable. We observed a significant decrease in 30- and 90-day post operative PM implantation from 2011 to 2017 with 15.1% and 15.9% in 2011 and 8.6% and 8.9% in 2017, respectively. Incidence of HF for 30- and 90-day significantly decreased from 19.3% and 20.3% to 8.5% and 9.1%. We observed significant changes for 30-day atrial fibrillation (AF) while the changes over time for 90-day AF and 30- and 90-day stroke/transient ischemic attack (TIA) remained insignificant. All-cause mortality within 30- and 90-days significantly decreased over time from 6.7% and 9.2% in 2011 to 1.5% and 2.7% in 2019 and 2016. In conclusion this national study provides general insight on trends in complications and mortality of TAVI, demonstrating significant reductions over time.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Nov 2023; epub ahead of print</small></div>

<div><h4>Impact of Treatment with Sacubitril/Valsartan on Erectile Dysfunction in Patients with Heart Failure with Reduced Ejection Fraction.</h4><i>Barman HA, Dogan O, Tanyolaç S, Atıcı A, ... Özyıldırım S, Yiğit Z</i><br /><AbstractText>Sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor (ARNI), has been shown to reduce the risk of cardiovascular death or heart failure hospitalization and improve symptoms among patients with chronic heart failure with reduced ejection fraction. The objective of this study was to assess the effects of S/V on erectile dysfunction in patients with heart failure with reduced ejection fraction (HFrEF). A prospective, open-label study was conducted with 59 male patients diagnosed with HFrEF and concomitant erectile dysfunction. Patients were treated with S/V for a duration of one month. The International Index of Erectile Function (IIEF) questionnaire was used to assess the severity of erectile dysfunction and sexual activities at baseline and follow-up visits. Other clinical parameters, including heart rate, were also monitored. Following S/V treatment, a significant improvement was observed in sexual activities at the 1-month follow-up visit. The IIEF score showed a statistically significant increase, indicating an improvement in the severity of erectile dysfunction. However, it should be noted that the numerical increase in the IIEF score did not reach clinical significance. This study suggests that S/V treatment in HFrEF patients may lead to improvements in sexual activities and a reduction in the severity of erectile dysfunction as measured by the IIEF score.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Nov 2023; epub ahead of print</small></div>

<div><h4>Comparison of Clinical Outcomes among Various Percutaneous Coronary Intervention Strategies for Small Coronary Artery Disease.</h4><i>Kiyohara Y, Aikawa T, Kayanuma K, Takagi H, ... Wiley J, Kuno T</i><br /><AbstractText>It remains unclear which percutaneous coronary intervention (PCI) strategy is the most preferable in small-vessel coronary artery disease (CAD) patients. We sought to evaluate the clinical efficacy of various PCI strategies for patients with small-vessel CAD through a network meta-analysis of randomized controlled trials (RCTs). We searched multiple databases for RCTs investigating the efficacy of the following PCI strategies for small-vessel CAD (<3 mm in diameter): drug-coated balloons (DCB), early-generation paclitaxel-eluting stents and sirolimus-eluting stents (SES), newer-generation drug-eluting stents (DES), bare-metal stents (BMS), cutting balloon angioplasty, and balloon angioplasty (BA). The primary outcome was the trial-defined major adverse cardiovascular events (MACE), mostly defined as a composite of death, myocardial infarction, and revascularization. The secondary outcomes included each component of MACE and angiographic binary restenosis. We performed a sensitivity analysis for RCTs without BMS or 1<sup>st</sup>-generation DES. Our search identified 29 eligible RCTs including 8,074 patients among the 8 PCI strategies. SES significantly reduced MACE compared with BA (HR: 0.23; 95% CI [0.10 to 0.54]) with significant heterogeneity (I<sup>2</sup> = 55.9%), and the rankogram analysis showed that SES was the best. There were no significant differences between DCB and newer-generation DES in any clinical outcomes, which was consistent in the sensitivity analysis. BMS and BA were ranked as the worst two for most clinical outcomes. In conclusion, SES was ranked as the best for reducing MACE. There were no significant differences in clinical outcomes between DCB and newer-generation DESs. BMS and BA were regarded as the worst strategies for small-vessel CAD.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Nov 2023; epub ahead of print</small></div>

<div><h4>Prevalence of Peripheral Arterial Disease in Patients with Coronary Artery Disease following Cardiac Catheterization: A Prospective Observational Study.</h4><i>Sunner SS, Welsh RC, Bainey KR</i><br /><AbstractText>Peripheral arterial disease (PAD) is a common vascular condition with roughly one-half of patients being asymptomatic. Moreover, PAD is commonly seen in patients with coronary artery disease (CAD) due to their shared atherosclerotic pathway. Our aim was to understand the prevalence and symptomatology of PAD in patients with established CAD seen on coronary angiography. Subjects with CAD were prospectively screened for PAD at a single-site catheterization laboratory (June 2021-April 2022). Following consent, a bedside ankle-brachial-index (ABI) (Microlife WatchBP Office ABI) was performed, and the Edinburgh Claudication Questionnaire (ECQ) (validated for PAD) was administered. PAD was defined as an ABI ≤0.90.We recruited 100 subjects (98 completed investigations: 67.5 age ± 9.5 years, 17.3% female). Twenty-one subjects (21.4%) had PAD as demonstrated by an abnormal ABI or previous diagnosis. There was a strong trend towards a higher prevalence of diabetes in those with PAD (52.4% vs. 29.9%, p=0.055). Kappa agreement between ECQ and ABI was weak (0.27). In conclusion, roughly one-quarter of subjects with CAD had ABI confirmed PAD (even more common in diabetics). The ECQ provided low agreement with ABI suggesting many of these subjects are asymptomatic. ABI can be used as a simple non-invasive tool at the bedside following cardiac catheterization to screen for PAD which has implications on subsequent clinical care.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Nov 2023; epub ahead of print</small></div>

<div><h4>Impact of atrial fibrillation on heart failure in patients treated with anthracycline chemotherapy.</h4><i>Onoue T, Kang Y, Lefebvre B, Smith AM, ... Carver JR, Scherrer-Crosbie M</i><br /><b>Background</b><br />Atrial fibrillation (AF) and anthracyclines are known risk factors for heart failure (HF). The magnitude of the effect of pre-existing AF (pre-anthracycline AF) and newly developed AF (post-anthracycline AF) in patients treated with anthracyclines on the occurrence of HF is unknown.<br /><b>Objective</b><br />The aim of our study was to characterize the impact of pre- and post-anthracycline AF on the subsequent occurrence of HF in patients treated with anthracyclines.<br /><b>Methods</b><br />In 5598 patients treated with new anthracycline therapy at a tertiary center between 2008-2021, propensity-score matching was used to match 204 pairs with or without pre-anthracycline AF and 135 pairs with or without post-anthracycline AF. The primary outcome was new-onset symptomatic HF defined by the AHA/ACC guidelines.<br /><b>Results</b><br />Patients with and without pre-and post-anthracycline AF were well matched for age, gender, medications, and cardiovascular risk factors. Forty-five patients with pre-anthracycline AF and 23 matched patients developed HF (5-year cumulative incidence: 29 % in the pre-anthracycline AF group and 13% in the matched group; p = 0.003; hazard ratio [HR]: 2.1; 95% confidence interval [CI]: 1.3-3.4; p = 0.004). One hundred and sixty-one patients (2.9%) developed post-anthracycline AF. Thirty-nine patients (5-year cumulative incidence: 40%) with post-anthracycline AF and 9 matched patients (5-year cumulative incidence: 7%) developed HF (HR: 6.1; 95% CI: 3.0-12.4, p < 0.001).<br /><b>Conclusion</b><br />Both pre-anthracycline AF and post-anthracycline AF are associated with high incidence of subsequent HF in patients treated with anthracyclines. Prospective studies of therapies are required to decrease HF in these high-risk patients.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Nov 2023; epub ahead of print</small></div>

<div><h4>Effects of Low-Osmolar Contrast Media on Long-Term Renal Impairment After Coronary Angiography: Iohexol Versus Iopromide.</h4><i>Cui Y, Zhang S, Wang W, Opara NC, ... Ju S, Wang YC</i><br /><AbstractText>To investigate the long-term effects of two commonly used low-osmolar contrast media, Iohexol and Iopromide, on renal function and survival in patients undergoing coronary angiography. A total of 14141 cardiology patients from 2006 to 2013 were recruited, of whom 1793 patients (679 patients on Iohexol and 1114 on Iopromide) were evaluated for long-term renal impairment and 5410 patients (1679 individuals on Iohexol and 3731 on Iopromide) were admitted for survival analyses spanning as long as 15 years. Univariate and multivariate logistic regression were used to explore the risk factors for long-term renal impairment. Cox proportional hazard regression was used to investigate the risk factors affecting survival. Propensity score matching and inverse probability of treatment weighting were applied to balance the baseline clinical characteristics. Patients receiving Iohexol demonstrated a greater occurrence of renal impairment compared to those who received Iopromide. Such difference remained consistent both before and after PSM or IPTW, with a statistical significance of P < 0.05. Among clinical variables, receiving contrast-enhanced CT/MRI during follow-up, anti-hypertensive medication usage, presence of proteinuria, and anemia were identified as risk factors for long-term renal impairment (P = 0.041, 0.049, 0.006 and 0.029, respectively). During survival analyses, the difference was insignificant after PSM and IPTW. In conclusion, administration of Iohexol were more likely to induce long-term renal impairment than Iopromide, particularly among patients diagnosed with anemia, proteinuria, and those taking anti-hypertensive medication and with additional contrast exposure. The all-cause mortality, however, showed no significant difference between Iohexol and Iopromide administration.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Nov 2023; epub ahead of print</small></div>

<div><h4>Is Pulmonary Capillary Wedge Pressure a Reliable Indicator of Postcapillary Pulmonary Hypertension?</h4><i>Aslanger E, Akaslan D, Ataş H, Yıldırımtürk Ö, ... Yıldızeli B, Mutlu B</i><br /><AbstractText>Although current pulmonary hypertension (PH) guidelines recommend a pulmonary capillary wedge pressure (PCWP) above 15 mmHg for the detection of a post-capillary component, the rational of this recommendation may not be quite compatible with the peculiar hemodynamics of PH. We hypothesize that a high PCWP alone does not necessarily indicate left-sided disease and this diagnosis can be improved using LV transmural pressure difference (∆P<sub>TM</sub>). In this two-center, retrospective, observational study; we enrolled 1070 patients with PH who had undergone heart catheterization with the final study population comprising of 961 cases. ∆P<sub>TM</sub> was calculated as PCWP minus right atrial pressure. The patients with group II PH had significantly higher ∆P<sub>TM</sub> values (12.6 ± 6.6 mmHg) compared to the other groups (1.1 ± 4.8 in group I, 12.4 ± 6.6 in group II, 2.5 ± 6.4 in group III and 0.8 ± 8.0 in group IV, P<0.001) despite overlapping PCWP values. A ∆P<sub>TM</sub> cut-off of 7 mmHg identifies left-heart disease when PCWP>15 (area under curve, 0.825; 95% confidence interval, 0.784 to. 0.866; P<0.001). Five-year mortality was significantly higher in patients with high ∆P<sub>TM</sub> and PCWP subgroup compared to low ∆P<sub>TM</sub> plus high PCWP (26.1% vs. 18.5%, P=0.027), and low ∆P<sub>TM</sub> and PCWP subgroups (26.1% vs. 15.6%, P<0.001). ∆P<sub>TM</sub> has supplementary discriminatory power in distinguishing patients with and without post-capillary PH. In conclusion, a new approach utilizing ∆P<sub>TM</sub> may improve our understanding of PH pathophysiology and may identify a subpopulation who may potentially benefit from PH-specific treatments.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Nov 2023; epub ahead of print</small></div>

<div><h4>Impact of Gore Cardioform ASD Occluder on atrial and ventricular electro-mechanics in a pediatric population.</h4><i>Castaldi B, Santoro G, Candia AD, Marchese P, ... Sirico D, Salvo GD</i><br /><b>Background</b><br />Transcatheter closure is the first-line treatment for ostium secundum atrial septal defect (ASD). The GORE® Cardioform ASD Occluder (GCA) is potentially innovative compared to other self-centering devices. The aim of this study was to compare the mechanical changes in atrial and ventricular properties before and after GCA implantation.<br /><b>Methods</b><br />All consecutive patients aged <18 years performing isolated ASD closure with a single GCA device were enrolled from two centers. Echocardiography and ECG were performed the day before, 24 h and 6 months after ASD closure.<br /><b>Results</b><br />Between January 2020 and February 2021, 70 pediatric ASD patients were enrolled. Mean age was 7.9±3.9 years, mean defect diameter was 17.1±4.5 mm. Global longitudinal strain analysis showed no change in left ventricular longitudinal function (T0 -23.2±2.8%; 24h -23.0±2.8%; 6 months -23.5±2.7%). An early and transient reduction in longitudinal strain was detected in basal septal segments (T0 -19.8±3.3%; 24h -18.7±3.6%; 6 months -19.2±3.4%), left atrium (T0 41.4±15.3%; 29.2±1.4% and 39.0±12.9%, respectively) and right ventricle (-27.6±5.4%, -23.6±5.0% and -27.3±4.6, respectively) 24h after closure, secondary to hemodynamic changes due to flow redirection after ASD closure. Six months after the procedure, only left atrium showed a mild global longitudinal strain reduction, due to the presence of the device within the septum.<br /><b>Conclusions</b><br />GCA device had no impact on global and regional ventricular function. Atrial mechanics was preserved, except for the segments covered by the device. This is the first device demonstrating no impact on the left and right ventricular mechanics, irrespectively from the device size.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Nov 2023; epub ahead of print</small></div>

<div><h4>Relation of Thrombolysis In Myocardial Infarction Frame Count to Invasively Measured Coronary Physiological Indices.</h4><i>Yamazaki T, Saito Y, Yamashita D, Kitahara H, Kobayashi Y</i><br /><AbstractText>In the international guidelines, higher Thrombolysis In Myocardial Infarction frame count (TFC) is indicated as evidence of coronary microvascular dysfunction (CMD). However, the association of TFC with invasively measured coronary physiological parameters, such as coronary flow reserve (CFR) and index of microcirculatory resistance (IMR), remains unclear. Patients without significant epicardial coronary lesions underwent invasive coronary physiological assessment using a thermodilution method in the left anterior descending artery. Corrected TFC (cTFC) was evaluated on coronary angiography. The cut-off values of CFR and IMR were defined as ≤2.0 and >25, and patients with abnormal CFR and/or IMR were defined as having CMD. The primary interest of this study was to assess whether cTFC >25, a cut-off value in the guidelines, was diagnostic of the presence of CMD. Of the 137 patients, 34 (24.8%) and 32 (23.3%) had cTFC >25 and CMD, respectively. The rate of CMD was not significantly different between patients with and without cTFC >25. cTFC was weakly correlated with resting and hyperemic mean transit time and IMR, while no significant correlation was observed between cTFC and CFR. The receiver operating characteristic curve analysis showed the poor diagnostic ability of cTFC for abnormal CFR and IMR, and the presence of CMD. In conclusion, among patients without epicardial coronary lesions, cTFC as a continuous value and with the cut-off value of 25 was not diagnostic of abnormal CFR and IMR, and the presence of CMD. Our results did not support the use of cTFC in the CMD evaluation.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 16 Nov 2023; epub ahead of print</small></div>

<div><h4>A Real-World Analysis of New-Onset Heart Failure After Anterior Wall ST-Elevation Acute Myocardial Infarction in the United States of America.</h4><i>Van Tassell B, Talasaz AH, Redlich G, Ziegelaar B, Abbate A</i><br /><AbstractText>The 1-year incidence of heart failure (HF) after anterior wall ST-elevation acute myocardial infarction (STEMI) remains difficult to determine due to inconsistencies in reporting, definitions, and adjudication. The objective of this study was to evaluate the 1-year incidence of HF after anterior wall STEMI in a real-world data set using a variety of potential criteria and composite definitions. In a retrospective cohort study, anonymized patient data was accessed through a federated health research network (TriNetX LLC) of 56 US healthcare organizations (US Collaborative Network). Patients were identified based upon ICD-10 criteria for anterior wall STEMI during the 10-year period from 2013-2022 and the absence of pre-specified signs or symptoms of HF. Values for 1-year incidence were calculated as 1 minus Kaplan-Meier survival at 12 months after anterior wall STEMI. Univariate Cox proportional hazards ratio was calculated to compare risk associated with potential risk factors. The analysis utilized 5 different types of definition criteria for HF: Diagnosis Codes, Signs & Symptoms, Laboratory/Imaging, Medications, and Composites. A total of 34,395 patients from the US Collaborative Network met eligibility criteria and were included in the analysis. The 1-year incidence of HF varied from 2-30% depending upon the definition criteria. While no single criteria exceeded a 1-year incidence of 20%, a simple composite of HF diagnosis (ICD-10 I50) or use of loop diuretic produced a 1-year incidence 26.1% that was used as the benchmark outcome for evaluation of risk factors. Age ≥65 years, Black race, low density lipoprotein ≥100 mg/dL, elevated hemoglobin A1c (7-9% and >9%), and body mass index≥35 kg/m<sup>2</sup> were also associated with increased risk of HF. In conclusion, patients with anterior wall STEMI continue to be at high risk for new onset HF. In the absence of structured, prospective, systematically adjudicated diagnostic criteria, composite definitions are more likely to yield accurate estimates of HF incidence.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 16 Nov 2023; epub ahead of print</small></div>

<div><h4>Impact of Hypertension on Left Ventricular Geometry and Diastolic Function in Africa: Results from the Population-Based TAHES Cohort Study.</h4><i>Vandroux D, Aboyans V, Houehanou YC, Chastaingt L, ... Magne J, Lacroix P</i><br /><AbstractText>High blood pressure leads to morphologic changes and functional alterations of the myocardial structure. Transthoracic Echocardiography (TTE) is of high clinical interest to evaluate these alterations, using reference values proposed by the American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI), largely based on studies in Caucasian whites. We aimed to assess the impact of hypertension on echocardiographic parameters in a Sub-Saharan African community, using ethnic-specific reference values. This study is a part of TAHES, a population-based prospective cohort study initiated in 2015 in the district of Tanve, Republic of Benin. Hypertension was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg and/or currently taking anti-hypertensive medications. All participants had a TTE. The patterns of diastolic dysfunction and left ventricular (LV) geometry were defined from 486 subjects of the cohort, free from cardiovascular disease, diabetes and hypertension. Among participants, 318 (65% women, median age 48 years) were hypertensive. Systolic blood pressure correlated significantly (p<0.0001) with LV mass (r=0.28), wall thickness (r=0.25), isovolumic relaxation time (r=0.27), E/A ratio (r=-0.35), lateral e\' velocity (r=-0.41) and E/E\'ratio (r=0.39). Ventricular geometry was normal in only 22% of hypertensive participants when using the ASE/EACVI reference values, vs. 69% with ethnic-specific reference ranges. The severity of hypertension was associated with ventricular geometry abnormalities. The prevalence of diastolic dysfunction was 14.5%(CI:10.6-18.4%), including relaxation impairment (9%) and pseudonormal pattern (6%). Thus, correct assessment of repercussions of hypertension on LV geometry in Black Africans requires ethnic-specific reference values.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 15 Nov 2023; epub ahead of print</small></div>

<div><h4>Relationship between calcium-phosphorus product and total coronary artery occlusion in a non-chronic kidney disease population: a cross-sectional study.</h4><i>Xiao K, Cao H, Liu L, Yang B, ... Kang Z, Feng H</i><br /><b>Background</b><br />Excessive calcium-phosphorus product (Ca-P product) in individuals with chronic kidney disease (CKD) is associated with coronary artery calcification and coronary artery disease (CAD), but the relationship between Ca-P product and CAD in non-CKD populations has rarely been reported. Therefore, we designed a cross-sectional study to investigate the role of Ca-P product in total coronary artery occlusion (TCAO) in a non-CKD population.<br /><b>Methods</b><br />We reviewed 983 individuals who underwent coronary angiography (CAG) at Guangyuan Central Hospital from February 2018 to January 2020. Ca-P product (mg<sup>2</sup>/dL<sup>2</sup>) was calculated as Ca (mmol/L) × 4 × P (mmol/L) × 3.1, and was analyzed as a continuous and tertiary variable. TCAO was defined as complete occlusion of any coronary artery by CAG (TIMI flow grade 0). Statistical analysis was performed using univariate and multivariate logistic regression models and restricted cubic splines.<br /><b>Results</b><br />Univariate logistic regression analysis showed a statistically significant association between Ca-P product and TCAO (OR, 0.97; 95% CI, 0.95-0.99; P<0.001). After stepwise adjustment for covariates, the risk of TCAO was reduced by 40% in the high versus low Ca-P group (OR, 0.6; 95% CI, 0.38-0.95; P=0.031), and the risk of TCAO was predicted to decrease by 4% (OR, 0.96; 95% CI, 0.94-0.99; P=0.006) for each unit increase in Ca-P product. Restricted cubic splines showed a nonlinear relationship between Ca-P product and TCAO, with a significant decrease in the risk of TCAO after reaching 27.46 (nonlinear P=0.047).<br /><b>Conclusions</b><br />In non-CKD populations, a higher Ca-P product (≥27.46 mg<sup>2</sup>/dL<sup>2</sup>) may help avoid TCAO.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 15 Nov 2023; epub ahead of print</small></div>

<div><h4>Comparative Effect of Loop Diuretic Prescription on Mortality and Heart Failure Readmission.</h4><i>Virkud AV, Chang PP, Funk MJ, Kshirsagar AV, ... Kosorok MR, Gower EW</i><br /><AbstractText>Loop diuretics are a standard pharmacologic therapy in heart failure (HF) management. Although furosemide is most frequently used, torsemide and bumetanide are increasingly prescribed in clinical practice, possibly because of superior bioavailability. Few real-world comparative effectiveness studies have examined outcomes across all 3 loop diuretics. The study goal was to compare the effects of loop diuretic prescribing at HF hospitalization discharge on mortality and HF readmission. We identified patients in Medicare claims data initiating furosemide, torsemide, or bumetanide after an index HF hospitalization from 2007 to 2017. We estimated 6-month risks of all-cause mortality and a composite outcome (HF readmission or all-cause mortality) using inverse probability of treatment weighting to adjust for relevant confounders. We identified 62,632 furosemide, 1,720 torsemide, and 2,389 bumetanide initiators. The 6-month adjusted all-cause mortality risk was lowest for torsemide (13.2%), followed by furosemide (14.5%) and bumetanide (15.6%). The 6-month composite outcome risk was 21.4% for torsemide, 24.7% for furosemide, and 24.9% for bumetanide. Compared with furosemide, the 6-month all-cause mortality risk was 1.3% (95% confidence interval [CI]: -3.7, 1.0) lower for torsemide and 1.0% (95% CI: -1.2, 3.2) higher for bumetanide, and the 6-month composite outcome risk was 3.3% (95% CI: -6.3, -0.3) lower for torsemide and 0.2% (95% CI: -2.5, 2.9) higher for bumetanide. In conclusion, the findings suggested that the first prescribed loop diuretic following HF hospitalization is associated with clinically important differences in morbidity in older patients receiving torsemide, bumetanide, or furosemide. These differences were consistent for the effect of all-cause mortality alone, but were not statistically significant.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 13 Nov 2023; 210:208-216</small></div>

<div><h4>ECGs Do Not Detect Myocardial Ischemia in Patients with Williams Syndrome and Non-Syndromic Elastin Arteriopathy with Coronary Artery Stenosis.</h4><i>Algaze C, Chubb H, Deitch AM, Collins RT</i><br /><AbstractText>Coronary artery stenosis (CAS) may affect up to 27% of patients with Williams syndrome (WS), which may lead to myocardial ischemia. WS patients face a 25 to 100-fold higher risk of sudden cardiac death, frequently linked to anesthesia. Assessing CAS requires either imaging while under general anesthesia or intraoperative assessment, with the latter considered the gold standard. Our study aimed to identify electrocardiogram (ECG) markers of myocardial ischemia in patients with WS or non-syndromic elastin arteriopathy and documented CAS. We retrospectively reviewed patients with WS/elastin arteriopathy who underwent supravalvar aortic stenosis (SVAS) surgery and CAS assessment from January 1, 2006, to April 30, 2021. A pediatric electrophysiologist, unaware of the patients\' CAS status, reviewed their preoperative ECGs for markers of ischemia. We assessed associations of study parameters using Wilcoxon rank-sum and Fisher\'s exact tests. Out of 34 patients, 62% were male, with a median age of 20 months [IQR: 8, 34]. Coronary artery stenosis was present in 62% (21/34), 76% (16/21) of whom were male. There were no ECG indicators of myocardial ischemia in patients with CAS. In conclusion, CAS was present in over half of children with WS/elastin arteriopathy who underwent repair of SVAS. Coronary artery stenosis in WS/non-syndromic elastin arteriopathy does not appear to exhibit typical ECG-detectable myocardial ischemia. ECGs are not a useful screening tool for CAS in WS/elastin arteriopathy. Given the high anesthesia-related cardiac arrest risk, other noninvasive indicators of CAS are needed.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 11 Nov 2023; epub ahead of print</small></div>

<div><h4>Longitudinal Strain Patterns in Stress (Takotsubo) Cardiomyopathy: Evidence of Global Myocardial Injury and Incomplete Recovery.</h4><i>Gibson LE, Davis EF, Ponzini F, Wood MJ</i><br /><b>Background</b><br />Stress cardiomyopathy develops after abrupt sympathetic stimulation, likely from catecholamine-induced myocardial toxicity. The evolution of myocardial strain during and following an episode have not been previously characterized. We aimed to determine whether pre-existing contractile abnormalities may explain the observed regional dysfunction during an acute episode, and to investigate the persistence of strain abnormalities after clinical recovery.<br /><b>Methods</b><br />We identified patients who were diagnosed with stress cardiomyopathy and had an echocardiogram performed prior to their episode, during their episode, and within 1 year after. Diagnosis was confirmed based on the absence of obstructive coronary lesions. Left ventricular (LV) longitudinal strain was calculated using speckle-tracking software and compared between baseline, episode, and follow-up echocardiograms.<br /><b>Results</b><br />LV strain analysis was performed on 23 patients. LV ejection fraction was 64±8.7% at baseline, 45±12% during the episode, and 59±10% after a median follow-up of 46 days. LV global longitudinal strain was 24±4.7% at baseline, 11±4.9% during the episode, and 19±4.6% after follow-up. Mean ejection fraction (p<0.01) and global longitudinal strain (p<0.001) remained below baseline levels at follow-up. Longitudinal strain was reduced (<18%) in 80±23% of myocardial segments during an episode and 41±21% of myocardial segments at follow-up. During the acute episode, 35±6% of the abnormal segments were in the base, outside of the region of ballooning.<br /><b>Conclusions</b><br />Our findings suggests that stress cardiomyopathy is associated with global rather than regional myocardial injury, and that contractile abnormalities persist after clinical improvement. These findings challenge prior understanding of stress cardiomyopathy and may guide future pathophysiologic understanding of this complex disease.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 07 Nov 2023; epub ahead of print</small></div>

<div><h4>Increased Left Ventricular End-diastolic Volume Index is associated with increased Adverse Events following MitraClip Implantation.</h4><i>Yoshikawa M, Arashi H, Kikuchi N, Koyanagi-Saito C, ... Niinami H, Yamaguchi J</i><br /><AbstractText>This study investigated the association between the left ventricular end-diastolic volume index (LVEDVI) and the incidence of adverse clinical events in patients following MitraClip implantation. In this retrospective observational study, 123 patients who underwent the MitraClip procedure were enrolled. Participants were divided into 2 groups according to the LVEDVI cut-off level, calculated using receiver operating characteristic (ROC) curve analysis, to predict the primary endpoint, and the occurrence of cardiovascular events was compared between the groups. The primary endpoint was all-cause mortality and hospitalization due to heart failure. ROC curve analysis for the composite primary endpoint revealed an LVEDVI cut-off point of 118 mL/m<sup>2</sup>. Based on this threshold, 61 patients (49.6%) were categorized into the LVEDVI<118 mL/m<sup>2</sup> group, while 62 (50.4%) fell into the LVEDVI≥118 mL/m<sup>2</sup> group. Over a median follow-up period of 336 days [interquartile range: 80-667], primary endpoints occurred in 15 and 26 patients in the LVEDVI<118 and LVEDVI≥118 mL/m<sup>2</sup> groups, corresponding to incidence rates of 24.6% and 41.9%, respectively. Patients in the LVEDVI≥118 mL/m<sup>2</sup> group demonstrated a significantly higher risk of adverse clinical events than those in the LVEDVI<118 mL/m<sup>2</sup> group (hazard ratio: 2.24; 95% confidence interval: 1.17-4.28; P=0.01). This trend persisted even after adjusting for several confounders (P=0.02). In conclusion, elevated LVEDVI values were associated with increased adverse clinical events after MitraClip implantation in patients with severe mitral valve regurgitation.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 07 Nov 2023; epub ahead of print</small></div>

<div><h4>Impact of Atrial Fibrillation on the Symptoms and Echocardiographic Evaluation of Patients with Aortic Stenosis.</h4><i>Niemi HJ, Suihko S, Kylmälä M, Rajala H, ... Kivistö S, Lommi J</i><br /><AbstractText>Atrial fibrillation (AF) is common among patients with aortic stenosis (AS) and complicates the assessment of AS severity. Overlapping of symptoms in these two conditions may postpone valve replacement. This study aimed to evaluate the effect of AF on the severity assessment of AS and its impact on symptoms and quality of life (QoL). Patients with severe AS were prospectively recruited. Echocardiography, symptom questionnaires and RAND-36 QoL assessment were performed preoperatively and 3 months postoperatively. Aortic valve calcium score (AVC) was measured using computed tomography. Among the 279 patients 74 (26.5%) had AF. Patients with AF had lower mean gradients and 45.9% had low-gradient phenotype with mean gradient < 40 mmHg, compared to 22.4% of those without AF (p < 0.001). AVC measurements revealed severe valve calcification equally in patients with or without AF (85.7% vs. 87.7%, p = 0.78). Patients with AF were more symptomatic at baseline with 50.0% vs. 27.3% in NYHA III or higher (p < 0.001) and after intervention. AF patients had more residual dyspnea (27.3% vs. 12.0%, p = 0.007) and exercise intolerance (36.4% vs. 17.0%, p = 0.002). QoL improved significantly in both groups but was worse at baseline in patients with AF and remained impaired after intervention. In conclusion, low-gradient AS phenotype is overrepresented in patients with AF, but they have equally severe stenosis determined using AVC despite the lower gradients. AF patients have more symptoms and worse QoL, but they improve significantly after intervention. In patients with AF multimodality imaging is important in the assessment of AS severity.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 07 Nov 2023; epub ahead of print</small></div>

<div><h4>Prognostic Role of the Progression of Late Gadolinium Enhancement in Hypertrophic Cardiomyopathy.</h4><i>Aquaro GD, Todiere G, Barison A, Grigoratos C, ... Emdin M, Neri E</i><br /><AbstractText>In hypertrophic cardiomyopathy (HCM), Late Gadolinium Enhancement (LGE) extent ≥15% of left ventricular (LV) mass is considered a prognostic risk factor. LGE extent increases over time and the clinical role of the progression of LGE over time (LGE-rate) was not prospectively evaluated. We sought to evaluate the prognostic role of LGE-rate in HCM. We enrolled 105 patients with HCM who underwent cardiac-MR at baseline (CMR-I) and after ≥2 years of follow-up (CMR-II). LGE-rate was defined as the ratio between the increase of LGE extent (g) and the time interval (months) between examinations. A combined endpoint of sudden cardiac death, resuscitated cardiac arrest, appropriate ICD intervention and sustained VT was used (hard events). The percentage of patients with LGE extent ≥15% increased from 9% to 20% from CMR-I to CMR-II (p=0.03). During a median follow-up of 52 months, 25 hard events were recorded. The presence of LGE≥15% at CMR-II allowed a significant reclassification of the risk of patients than at LGE≥15% at CMR-I (NRI 0.21, p=0.046). At MaxStat analysis the optimal prognostic cut-point for LGE-rate was >0.07 g/months. At Kaplan-Meier curve patients with LGE-rate>0.07 had worse prognosis than those without (p<0.0001). LGE-rate>0.07 allowed a significant reclassification of the risk compared to LGE≥15% at CMR-I and at CMR-II (NRI 0.49, p=0.003). In multivariable models, LGE-rate>0.07 was the best independent predictor of hard events. In conclusion, CMR should be repeated after 2 years to reclassify the risk sudden death of those patients. High LGE-rate may be considered a novel prognostic factor in HCM.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 07 Nov 2023; epub ahead of print</small></div>

<div><h4>A Novel Percutaneous Snare-Assisted Manipulation and Repositioning of a ProtekDuo Cannula in a COVID-19 Acute Respiratory Distress Syndrome.</h4><i>Haq SH, Shah SR, Golzarian H, Laird A, Cole W, Patel SM</i><br /><AbstractText>Venovenous extracorporeal membrane oxygenation [VV-ECMO] has gained increasing notoriety during the COVID-19 pandemic as a salvation therapy for fulminant respiratory failure. Various configurations can present unique challenges in management. For instance, the ProtekDuo cannula is a 29Fr to 31Fr dual-lumen cannula inserted by way of the right internal jugular vein that allows for right atrium to pulmonary artery bypass with an attached oxygenator, essentially resulting in VV-ECMO. Understanding that these different configurations inevitably dictate the types of complications that can arise during the circuit implantation and management is imperative. However, in a hemodynamically unstable patient, time or resources may not permit standard maneuvers for management. In conclusion, we present an innovative, percutaneous approach which allowed the restoration of flow and oxygenation in a decompensating ProtekDuo patient without having to explant/disconnect the circuit or implant a new VV-ECMO circuit.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 06 Nov 2023; 210:113-115</small></div>

<div><h4>Pan-Immune-Inflammation Value is Independently Correlated to Impaired Coronary Flow After Primary PCI in Patients With ST-Segment Elevation Myocardial Infarction.</h4><i>Şen F, Kurtul A, Bekler Ö</i><br /><AbstractText>Immune-inflammatory biomarkers have been shown to be correlated with impaired coronary flow (ICF) in ST-segment elevation myocardial infarction (STEMI). Herein, we assessed the relationship between a novel comprehensive biomarker, pan-immune-inflammation value (PIV), and ICF after primary percutaneous coronary intervention (pPCI) in STEMI. A total of 687 patients underwent pPCI between 2019 and 2023 were retrospectively analyzed. Blood samples were collected at admission. PIV and other inflammation parameters were compared. PIV was calculated as (neutrophil count × platelet count × monocyte count)/lymphocyte count. Post-procedural coronary flow was assessed by thrombolysis in myocardial infarction (TIMI) classification. Patients were divided into two groups: a group with ICF defined as post-procedural TIMI 0-2 and a group with normal coronary flow (NCF) defined as post-procedural TIMI flow grade of 3. The mean age was 61±12 years and 22.4% were women. Compared to the NCF group (median 492, interquartile range [IQR] 275-931), the ICF group (median 1540, IQR 834-2909) showed significantly increased PIV (p<0.001). The optimal cutoff for the PIV was 804, as determined by receiver operating characteristic curve. The incidence of ICF was 17.0% in whole subjects, 6.4% in low PIV group (<804) and 34.2% in high PIV group (≥804). Multivariate analyses revealed that a baseline PIV ≥804 was independently associated with post-pPCI ICF (Odds ratio 5.226, p<0.001). PIV was superior to neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in determining of ICF. In conclusion, a high PIV was significantly associated with an increased risk of ICF after pPCI. Moreover, PIV was a better indicator of ICF than other inflammatory markers.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 06 Nov 2023; epub ahead of print</small></div>

<div><h4>Evaluation of Inpatient Sodium-Glucose Co-Transporter-2 Inhibitor Use in Patients Hospitalized for Acute Heart Failure.</h4><i>Yan CL, Erben A, Sancassani R</i><br /><AbstractText>Hospitalization for acute heart failure (HF) represents an important opportunity for initiation and up-titration of guideline-directed medical therapy. The objective of our study was to determine whether sodium-glucose co-transporter-2 inhibitor (SGLT2I) use was safe in patients hospitalized for acute HF and whether its use was associated with improved clinical outcomes. We conducted a single-center retrospective cohort study of adults hospitalized for acute HF with any ejection fraction and separated them into two matched groups based on inpatient SGLT2I use. Matching yielded 110 patients in the SGLT2I group and 110 patients in the control group. 101 patients (91.8%) in the SGLT2I group were treated with dapagliflozin, while 9 (8.2%) were treated with empagliflozin. Mean age was 71 years, 37.7% were female, 70.9% were White, 22.7% were Black, and 64.1% were Hispanic or Latino. Length of stay was 10 days in the SGLT2I group and 11 days in the control group (p=0.43). 2 patients (1.8%) in the SGLT2I group and 13 patients (11.8%) in the control group died within 30 days of discharge (hazard ratio, 0.15; 95% CI, 0.03 to 0.66; p=0.012). 17 patients (15.5%) in the SGLT2I group and 11 patients (10.0%) in the control group had an all-cause readmission within 30 days (hazard ratio, 1.58; 95% CI, 0.74 to 3.37; p=0.239). Meanwhile, 11 patients (10.0%) in the SGLT2I group and 3 patients (2.7%) in the control group had a HF readmission within 30 days (hazard ratio, 3.75; 95% CI, 1.05 to 13.44; p=0.042). Acute kidney injury (54.5% vs. 18.2%; p<0.001) and hypotension (12.7% vs. 2.7%; p=0.005) occurred significantly more frequently in the control group. In conclusion, SGLT2I use in patients hospitalized for acute HF was associated with decreased 30-day all-cause mortality and lower rates of acute kidney injury and hypotension; however, 30-day HF readmission increased.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 06 Nov 2023; epub ahead of print</small></div>

<div><h4>USE OF ANTICOAGULATION FOR THROMBOEMBOLIC PROPHYLAXIS IN PATIENTS WITH ATRIAL HIGH-RATE EPISODES ON DEVICE MONITORING: A NARRATIVE REVIEW.</h4><i>Wing Leung AN, Bhat A</i><br /><AbstractText>Ischemic stroke and systemic thromboembolism are primary drivers of significant morbidity and mortality in individuals with atrial fibrillation (AF). While stroke is commonly the first index presentation of clinically silent AF, the growing use of continuous rhythm monitoring through cardiac implanted electronic devices (CIEDs) has enabled earlier and increased detection of AF in otherwise asymptomatic individuals prior to stroke development. Atrial high-rate episodes (AHREs) are atrial tachyarrhythmias frequently detected by CIEDs; these events represent subclinical AF and other atrial tachyarrhythmias which can lead to stroke development and AF. Whilst the presence of AHREs increases both the risk of developing clinical AF and stroke compared to those without AHREs, there has been a significant clinical variability in anticoagulation initiation in these individuals. In this narrative review, we explore the current evidence and literature surrounding the association between AHREs and stroke development as well as utility of anticoagulation in this population for thromboembolic prophylaxis.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 06 Nov 2023; epub ahead of print</small></div>

<div><h4>Impact of Transcatheter Edge-to-edge Mitral Valve Repair on Atrial Functional Mitral Regurgitation from GIOTTO Registry.</h4><i>Masiero G, Montonati C, Rubbio AP, Adamo M, ... Bedogni F, Giuseppe T</i><br /><b>Background</b><br />Atrial functional mitral regurgitation (aFMR) has peculiar pathophysiology that may have distinctive outcomes.<br /><b>Aims</b><br />We investigated the impact of transcatheter edge-to-edge repair (TEER) in aFMR compared to other FMR etiologies.<br /><b>Methods</b><br />The GIse registry Of Transcatheter treatment of MR (GIOTTO) is a multicenter, prospective study enrolling patients with symptomatic MR treated with MitraClip up to 2020. We categorized FMR patients as aFMR, ischemic (iFMR), and non-ischemic ventricular FMR (niFMR). Clinical endpoints were defined according to the Mitral Valve Academic Research Consortium.<br /><b>Results</b><br />Of a total of 1153 patients, 6% had aFMR, 47% iFMR and 47% niFMR. Patients with aFMR were older, mostly women, and had higher AF rate. They had better left ventricular (LV) ejection fraction and smaller LV volumes, with no difference in mitral effective regurgitant orifice area. The acute device and procedural success rates were similar among groups. At the longest available follow-up (median 478 days, IQR [91, 741]), the rate of MR ≥ 2+ was similar among groups. Patients with aFMR had lower rate of cardiovascular death and heart failure compared to iFMR (HR 0.43, p = 0.02) and niFMR (HR 0.45, p = 0.03). The aFMR etiology remained independently associated with the composite outcome together with post-procedural MR ≤ 1+ (HR 0.63; p<0.01) and peripheral arteriopathy (HR 1.82; p=0.003).<br /><b>Conclusion</b><br />The results of this GIOTTO sub-analysis suggested that aFMR is less prevalent and associated with better outcomes compared to other causes of FMR treated by TEER. Post-procedural MR>1+, peripheral vasculopathy, non-aFMR were independent predictors of worse outcomes.<br /><br />Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 06 Nov 2023; epub ahead of print</small></div>

<div><h4>Diagnostic and Prognostic Role of Left Ventricular Strain Imaging in Adults with Coarctation of aorta.</h4><i>Egbe AC, Miranda WR, Ahmed M, Burchill LJ, ... Kandlakunta S, Connolly HM</i><br /><b>Background</b><br />The relative diagnostic and prognostic performance of left ventricular global longitudinal strain (LVGLS) as compared to LV ejection fraction (LVEF), and the role of LVGLS for detecting early stages of LV systolic dysfunction in adults with repaired coarctation of aorta (COA) are unknown. The purpose of this study was to address these knowledge gaps.<br /><b>Methods</b><br />Retrospective cohort study of adults with repaired COA that underwent transthoracic echocardiogram (2003-2020). LV systolic function was assessed using LVEF (derived from volumetric analysis) and LVGLS (derived from speckle tracking echocardiography).<br /><b>Results</b><br />Of the 795 patients (age 36±14 years), mean LVEF and LVGLS were 62±11%, and 21±4%, respectively. The prevalence of LV systolic dysfunction was higher when assessed using LVGLS as compared to LVEF (20% versus 6%, p<0.001). Of 795 patients, 94 (12%) patients died, of which 75 (9%) died from cardiovascular causes. LVGLS provided more robust prognostic power in predicting all-cause mortality as compared to LVEF as evidenced by a higher C-statistic (0.743, 95%CI 0.730-0.755 versus 0.782, 95% CI 0.771-0.792, p<0.001). Furthermore, patients with normal LVEF in the setting of reduced LVGLS had a higher risk of all-cause mortality (as compared to patients with normal LVGLS and LVEF) and were at risk for temporal decline in LVEF during follow-up.<br /><b>Conclusions</b><br />These findings suggest that the use of LVGLS for risk stratification can help identify high-risk patients, and provide opportunities for interventions, which would in turn improve clinical outcomes. Further studies are required to empirically test these postulates.<br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 05 Nov 2023; epub ahead of print</small></div>

<div><h4>Temporal Relation Between Myocardial Infarction And New-onset Atrial Fibrillation - Results From a Nationwide Registry Study.</h4><i>Karlsson E, Kiviniemi T, Halminen O, Lehtonen O, ... Lehto M, FinACAF study group</i><br /><AbstractText>Myocardial infarction (MI) and atrial fibrillation (AF) are commonly seen in the same patient. In this study we evaluated the temporal relations and prognosis of MI and AF. This is a sub-study of the nationwide registry-based, Finnish Anticoagulation in Atrial Fibrillation (FinACAF-study), comprising all Finnish patients with new-onset AF during 2010 to 2017. Patients with MI and AF were divided into groups depending on the temporal relation between the disease onsets; (1) MI before AF (MI<AF), (2) MI ± 30 days before or after AF (MI=AF), (3) MI after AF (MI>AF), and (4) no MI. One-year mortality in the groups were studied with Cox proportional hazards model. Of the 153,207 patients with new-onset AF (mean-age 72.7; 50.0% female), 16,265 (10.6%) were diagnosed with MI. Altogether 8,889 (54.7%) of the MI patients where in the MI<AF group, 4,278 (26.3%) were in the MI=AF group; and 3,098 (19.1%) in the MI>AF group. Of all MIs 42.2% were diagnosed within 1 year from new-onset AF. The MI>AF group had the worst survival with an adjusted HR for death of 3.08 (CI 2.89 to 3.27) compared to patients with no MI. For the MI<AF and MI=AF groups the HRs were 1.34 (CI 1.27 to 1.41) and 1.69 (CI 1.59 to 1.81). In conclusion, the diagnoses of MI and AF accumulated close to one another, and the survival of patients with concomitant AF and MI varied, with the worst outcome found in patients with MI diagnosed after the new-onset AF.</AbstractText><br /><br />Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 02 Nov 2023; epub ahead of print</small></div>

<div><h4>Impact of the COVID-19 Pandemic on Infective Endocarditis Management and Outcomes: Analysis of a National Clinical Database.</h4><i>Novelli A, Ingason AB, Jirka C, Callas P, ... Dauerman HL, Polomsky M</i><br /><AbstractText>COVID-19 has widely affected health care delivery, but its impact on the management of infective endocarditis (IE), including valve surgery, is uncertain. We compared the national trends in admissions, demographics, and outcomes of IE before and after COVID-19 onset, using a national sample of IE admissions between 2016 and 2022 from the Vizient Clinical Database. The pre-COVID-19 and post-COVID-19 time periods were separated by the start of the second quarter of 2020, the time during which the COVID-19 pandemic was declared. For all admissions and for admissions involving valve surgery, pre-COVID-19 versus post-COVID-19 baseline characteristics and outcomes were compared using 2-sample t tests or chi-square tests. Propensity score-matched cohorts were similarly compared. Before COVID-19, there were 82,867 overall and 11,337 valve-related surgical admissions, and after COVID-19, there were 45,672 overall and 6,322 valve-related surgical admissions. In the matched analysis for all admissions, the in-hospital mortality increased from 11.4% to 12.4% after COVID-19 onset (p <0.001); in-hospital stroke (4.9% vs 6.0%, p <0.001), myocardial infarction (1.3% vs 1.4%, p = 0.03), and aspiration pneumonia (1.8% vs 2.4%, p <0.001) also increased, whereas other complications remained stable. In the matched analysis of surgical admissions, there was decreased in-hospital mortality (7.7% vs 6.7%, p = 0.03) and intensive care unit stay (8.5 ± 12.5 vs 8.0 ± 12.6 days, p = 0.04); other outcomes remained stable. In conclusion, patients admitted with IE after COVID-19 were more medically complex with worsened outcomes and mortality, whereas patients who underwent valve surgery had stable outcomes and improved mortality despite the pandemic.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 01 Nov 2023; 209:224-231</small></div>

<div><h4>Risk Scores for Prediction of Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis.</h4><i>Pandey A, Okaj I, Ichhpuniani S, Tao B, ... Belley-Cote EP, McIntyre WF</i><br /><AbstractText>Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and is associated with poor clinical outcomes. The objective of this systematic review and meta-analysis was to assess the performance of risk scores to predict POAF in cardiac surgery patients. We searched MEDLINE, Embase, and Cochrane CENTRAL for studies that developed/evaluated a POAF risk prediction model. Pairs of reviewers independently screened studies and extracted data. We pooled area under the receiver operating curves (AUCs), sensitivity and specificity, and adjusted odds ratios from multivariable regression analyses using the generic inverse variance method and random effects models. Forty-three studies (n = 63,847) were included in the quantitative synthesis. Most scores were originally developed for other purposes but evaluated for predicting POAF. Pooled AUC revealed moderate POAF discrimination for the EuroSCORE II (AUC 0.59, 95% confidence interval [CI] 0.54 to 0.65), Society of Thoracic Surgeons (AUC 0.60, 95% CI 0.56 to 0.63), EuroSCORE (AUC 0.63, 95% CI 0.58 to 0.68), CHADS<sub>2</sub> (AUC 0.66, 95% CI 0.57 to 0.75), POAF Score (AUC 0.66, 95% CI 0.63 to 0.68), HATCH (AUC 0.67, 95% CI 0.57 to 0.75), CHA<sub>2</sub>DS<sub>2</sub>-VASc (AUC 0.68, 95% CI 0.60 to 0.75) and SYNTAX scores (AUC 0.74, 95% CI 0.71 to 0.78). Pooled analyses at specific cutoffs of the CHA<sub>2</sub>DS<sub>2</sub>-VASc, CHADS<sub>2</sub>, HATCH, and POAF scores demonstrated moderate-to-high sensitivity (range 46% to 87%) and low-to-moderate specificity (range 31% to 70%) for POAF prediction. In conclusion, existing clinical risk scores offer at best moderate prediction for POAF after cardiac surgery. Better models are needed to guide POAF risk stratification in cardiac surgery patients.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 01 Nov 2023; 209:232-240</small></div>

<div><h4>Sex Differences in the Clinical Outcomes of Patients with Takotsubo Stress Cardiomyopathy: A Meta-analysis of Observational Studies.</h4><i>Abusnina W, Elhouderi E, Walters RW, Al-Abdouh A, ... Aboeata A, Mamas MA</i><br /><b>Background</b><br />The incidence of takotsubo stress cardiomyopathy (TSCM) in males is low compared to females. Sex-based differences in clinical outcomes of TSCM are not well characterized. The aim of this meta-analysis was to analyze whether sex-based differences are observed in TSCM clinical outcomes.<br /><b>Method</b><br />A comprehensive literature search of Pubmed, Embase, Cochrane Library database, and Web of Science was performed from inception to June 20, 2022, for studies comparing the clinical outcomes between males versus females in TSCM. The primary outcome of interest was in-hospital all-cause mortality and cardiogenic shock. The secondary outcomes were cardiovascular mortality, receipt of mechanical ventilation, intra-aortic balloon pump, and occurrence of ventricular arrhythmia, and left ventricular thrombus. A random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). Heterogenicity was assessed using the Higgins I<sup>2</sup> index.<br /><b>Results</b><br />Twelve observational studies involving 51,213 patients (4,869 males, and 46,344 females) were included in the meta-analysis. Male sex was associated with statistically significant higher in-hospital all-cause mortality when compared to females in patients with TSCM (RR 2.17; 95% CI 1.77-2.67; P < 0.001) The rate of cardiogenic shock was significantly higher in males with TSCM as compared to females (RR 1.66; 95% CI 1.29-2.12; P < 0.001).<br /><b>Conclusion</b><br />Our meta-analysis showed a difference in the clinical outcomes of TSCM between men and women. Males sex was associated with a two-fold greater in-hospital all-cause mortality risk compared to female sex. The higher mortality risk associated with male sex deserves further study, and particularly whether it represents later recognition of the condition and disparities in treatments.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 01 Nov 2023; epub ahead of print</small></div>

<div><h4>Clinical, Echocardiographic, and Longitudinal Characteristics Associated with Heart Failure with Improved Ejection Fraction.</h4><i>Romero E, Baltodano AF, Rocha P, Sellers-Porter C, ... Lopez JE, Cadeiras M</i><br /><AbstractText>Heart failure (HF) with improved ejection fraction (HFimpEF) has better outcomes than HF with reduced ejection fraction (HFrEF). However, factors contributing to HFimpEF remain unclear. This study aimed to evaluate clinical and longitudinal characteristics associated with subsequent HFimpEF. This was a single-center retrospective HFrEF cohort study. Data were collected from 2014 to 2022. Patients with HFrEF were identified using ICD codes, echocardiographic data, and natriuretic peptide levels. The main endpoints were HFimpEF (defined as ejection fraction >40% at ≥3 months with ≥10% increase) and mortality. Cox proportional hazards and mixed effects models were used for analyses. The study included 1307 HFrEF patients with a median follow-up of 16.3 months (IQR 8.0-30.6). The median age was 65 years; 68% were male while 57% were white. On follow-up, 38.7% (n=506) developed HFimpEF, while 61.3% (n=801) had persistent HFrEF. A multivariate Cox regression model identified sex, race comorbidities, echocardiographic, and natriuretic peptide as significant covariates of HFimpEF (p<0.05). The HFimpEF group had better survival compared to the persistent HFrEF group (p<0.001). Echocardiographic and laboratory trajectories differed between groups. In this HFrEF cohort, 38.7% transitioned to HFimpEF and approximately 50% met the definition within the first 12 months. In a HFimpEF model, sex, comorbidities, echocardiographic parameters, and natriuretic peptide were associated with subsequent HFimpEF. The model has the potential to identify patients at risk of subsequent persistent or improved HFrEF, thus informing the design and implementation of targeted quality-of-care improvement interventions.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 01 Nov 2023; epub ahead of print</small></div>

<div><h4>Can GRACE Risk Score Predict Mortality and The Need for Thrombolytic Treatment in Acute Pulmonary Embolism?</h4><i>Dönmez E, Özcan S, Sahin İ, Ziyrek M, Okuyan E</i><br /><AbstractText>Acute coronary syndrome and pulmonary embolism (PE) are clinical entities sharing similar presentation and risk factors. Risk scores and indexes help to identify disease severity in both diseases. In this study, we aimed to evaluate if GRACE risk score could predict 30-day mortality and the need for thrombolytic treatment in patients with acute PE. Patients hospitalized with a diagnosis of PE in our tertiary center between January 2018 and May 2022 were included in this retrospective study. PESI and GRACE risk scores on admission were calculated by using clinical, electrocardiographic and laboratory parameters for each patient. A total of 197 patients were included. The 30-day mortality rate was 28.4% whereas 32.5% of the patients required thrombolytic treatment. GRACE and PESI scores were found independent risk factors associated with 30-day mortality and the need for thrombolytic treatment. A cut-off value of 160.5 for GRACE score was associated with 88.5% sensitivity and 89.4% specificity in prediction of 30-day mortality. On the other hand, GRACE score had 61.0% sensitivity and 60.0% specificity in the prediction of the need for thrombolytic treatment when the cut-off value was 147. In conclusion, GRACE risk score has an effective discriminating power in determining the early mortality of patients with acute PE. The incidence of short-term PE related mortality was significantly increased in patients with high GRACE risk score. Concomitant use of GRACE and PESI risk scores may aid to define high-risk PE patients and help predict poor prognosis with high specificity and probability.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 01 Nov 2023; epub ahead of print</small></div>

<div><h4>Coronary Angiography and CTO angioplasty in a patient with Situs Inversus from the Right Radial Approach.</h4><i>Casazza RE, Chera H, Rodriguez CA, Ayzenberg S</i><br /><AbstractText>We present a patient who presented with known Situs inversus (SI) for cardiac catheterization which revealed a chronic total occlusion of the right coronary artery. SI, a rare congenital abnormality, is a term used to describe the inverted position of chest and abdominal organs. Cardiac Catheterization is rare with patients with this particular abnormality. It is important to customize techniques to engage coronaries and optimize guide support if PCI is required in these particular cases.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 31 Oct 2023; epub ahead of print</small></div>

<div><h4>Right Ventricular Thrombus on Echocardiography.</h4><i>Roy R, Guile B, Sun D, Szasz T, ... Lang RM, Addetia K</i><br /><AbstractText>Right ventricular thrombi (RVT) have been almost exclusively studied in patients with pulmonary embolism (PE). The implications of isolated RVT, a finding typically encountered on transthoracic echocardiography (TTE), is lacking. In this study, we sought to identify echocardiographic and clinical features associated with the presence of RVT. Between 1998-2023, 138 patients with RVT documented on the TTE were retrospectively identified. Demographic data, presence of intra-cardiac devices, hypercoagulable conditions, history of deep vein thrombosis (DVT), PE, and/or left ventricular thrombus were abstracted from electronic chart review. Measurements of right and left ventricular size, and function were performed on TTE. Out of the total population of patients with RVT, less than one-half had intracardiac devices, 29% had a documented hypercoagulable state (such as cancer or a clotting disorder). Most patients had dilated (77%) and dysfunctional (72%) right ventricles. Approximately 50% of RVTs were discovered in non-standard imaging planes, suggesting that presence of RVT is likely underestimated in clinical practice. Of those evaluated for PE, 80% had a PE. Of those evaluated for DVT, 53% had DVT. In conclusion, further investigations are warranted to better guide when to interrogate the right ventricle for RVT on TTE and the impact of RVT on patient outcomes.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 31 Oct 2023; epub ahead of print</small></div>

<div><h4>The Effect of Udenafil on Heart Rate and Blood Pressure in Adolescents With the Fontan Circulation.</h4><i>Edelson J, Zak V, Goldberg D, Fleming G, ... Garg R, Pediatric Heart Network Investigators</i><br /><AbstractText>The FUEL trial showed that treatment with udenafil was associated with improved exercise performance at the ventilatory anaerobic threshold in children with Fontan physiology. However, it is not known how the initiation of phosphodiesterase 5 inhibitor therapy affects heart rate and blood pressure in this population. These data may help inform patient selection and monitoring after the initiation of udenafil therapy. The purpose of this study is to evaluate the effects of udenafil on vital signs in the cohort of patients enrolled in the FUEL trial. This international, multicenter, randomized, double-blind, placebo-controlled trial of udenafil included adolescents with single ventricle congenital heart disease who had undergone Fontan palliation. Changes in vital signs (heart rate [HR], systolic [SBP] and diastolic blood pressure [DBP]) were compared both to subject baseline and between the treatment and the placebo groups. Additional exploratory analyses were performed to evaluate changes in vital signs for prespecified subpopulations believed to be most sensitive to udenafil initiation. Baseline characteristics were similar between the treatment and placebo cohorts (n = 200 for each). The groups demonstrated a decrease in HR, SBP, and DBP 2 hours after drug/placebo administration, except SBP in the placebo group. There was an increase in SBP from baseline to after 6-min walk test in the treatment and placebo groups, and the treatment group showed an increase in HR (87.4 ± 15.0 to 93.1 ± 19.4 beats/min, p <0.01) after exercise. When comparing changes from baseline to the 26-week study visit, small decreases in both SBP (-1.9 ± 12.3 mm Hg, p = 0.03) and DBP (-3.0 ± 9.6 mm Hg, p <0.01) were seen in the treatment group. There were no clinically significant differences between treatment and placebo group in change in HR or blood pressure in the youngest age quartile, lightest weight quartile, or those on afterload-reducing agents. In conclusion, initiation of treatment with udenafil in patients with Fontan circulation was not associated with clinically significant changes in vital signs, implying that for patients similar to those enrolled in the FUEL trial, udenafil can be started without the requirement for additional monitoring after initial administration.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 30 Oct 2023; epub ahead of print</small></div>

<div><h4>Psychometric Properties of the Kansas City Cardiomyopathy Questionnaire in a Surgical Population of Patients With Aortic Valve Stenosis.</h4><i>Borregaard B, Bruvik SM, Dahl J, Ekholm O, ... Riber LPS, Møller JE</i><br /><AbstractText>The 12-item version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) was originally developed for patients with heart failure but has been used and tested among patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation. Whether the instrument is suitable for patients with AS who underwent surgical aortic valve replacement (SAVR) is currently unknown. Thus, we aimed to investigate the psychometric properties of the KCCQ-12 before and after SAVR among patients with severe AS. We conducted a prospective cohort of 184 patients with AS who completed the KCCQ-12 and the EuroQol 5 Dimension 5 Levels before and 4 weeks after surgery. Construct validity was investigated with hypothesis testing and an analysis of Spearman\'s correlation between the two instruments. Structural validity was investigated with explorative and confirmatory factor analyses and reliability with Cronbach\'s α. All analyses were conducted on data from the two time points (preoperatively and four weeks after surgery). The hypothesis testing revealed how the New York Heart Association class was significantly correlated with the preoperative KCCQ-12 total score (higher New York Heart Association class, worse score). A longer length of hospital stay and living alone were significantly associated with poorer postoperative KCCQ-12 total score. KCCQ-12 and EuroQol 5 Dimension 5 Levels were moderately correlated in most domains/the total score/Visual Analogue Scale score. Principal component analyses revealed two 3-factor structures. The confirmatory factor analyses did not support the original model at any time point. Cronbach\'s α ranged from 0.22 to 0.84 in three preoperative factors and from 0.39 to 0.76 in the postoperative factors. The total Cronbach\'s α was 0.83 for the suggested preoperative 3-factor model and 0.83 for the postoperative model. In conclusion, the Danish version of the KCCQ-12 tested in a population of patients with AS who underwent SAVR appears to have acceptable construct validity, whereas structural validity cannot be confirmed for the original four-factor model. Overall reliability is good.</AbstractText><br /><br />Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 26 Oct 2023; 209:165-172</small></div>

<div><h4>Prognostic value of right ventricular longitudinal shortening fraction in patients with ST-elevation myocardial infarction: a prospective echocardiography study.</h4><i>Beyls C, Hermida A, Martin N, Peschanski J, ... Mahjoub Y, Leborgne L</i><br /><b>Background</b><br />Right ventricular systolic dysfunction (RVsD) frequently occurs in patients with ST-elevation myocardial infarction (STEMI). However, the diagnosis depends on the echocardiographic parameters to define RVsD. Right ventricle longitudinal shortening fraction (RV-LSF) is an accurate and reproducible two-dimensional speckle tracking parameter associated with clinical events in various pathologies.<br /><b>Objective</b><br />The aim of the study is to evaluate the association between RVsD and major adverse cardiovascular events (MACE) occurrence in a cohort of STEMI patients.<br /><b>Methods</b><br />Adult STEMI patients admitted to Amiens University Hospital\'s cardiovascular intensive care unit between May 2021 and November 2022, who underwent coronary angiography and TTE within 48 hours of admission, were included. RVsD was defined as RV-LSF < 20%. The primary outcome was MACE occurrence, including heart failure, myocardial infarction, stroke, and death within six months of admission. Multivariable Cox regression analysis with proportional hazard ratio (HR) models assessed the association between RVsD and MACE.<br /><b>Results</b><br />Among the 164 included patients, 72 (44%) had RVsD, and 92 (56%) did not. The RVsD group had a significantly higher proportion of MACE during the six-month follow-up (n = 23/72, 33%) than the no-RVsD group (n = 8/92, 9%; P = 0.001). RVsD showed an independent association with MACE at six months (HR=3.1, 95% CI [1.35-7.30], P=0.008). Left ventricular ejection fraction < 40 % and TIMI score > 4 were independently associated with RVsD (odds ratio = 2.80, 95% CI [1.34-5.98] and OR=2.15, 95% CI [1.18-4.39 respectively]; P = 0.015). The cumulative risk of MACE at six months was 33% for RV-LSF < 20% and 9% for RV-LSF ≥ 20% (log-rank test P < 0.001).<br /><b>Conclusion</b><br />RVsD, defined by RV-LSF < 20%, is associated with an increased risk of MACE after STEMI.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 26 Oct 2023; epub ahead of print</small></div>

<div><h4>Enhanced External Counterpulsation for Treatment of Angina with No Obstructive Coronary Artery Disease.</h4><i>Ashokprabhu ND, Fox J, Henry TD, Schmidt CW, ... Shah SA, Quesada O</i><br /><AbstractText>Angina and no obstructive coronary artery disease (ANOCA) is associated with poor outcomes and limited treatment options. Enhanced external counterpulsation (EECP) is a non-invasive treatment that involves applying external inflatable cuffs to the lower extremities to increase blood flow during diastole, followed by deflation during systole. Although EECP is approved for treatment in refractory angina patients, its effectiveness in treating ANOCA patients with refractory angina is limited to small studies. We assessed the efficacy of EECP treatment in ANOCA patients (defined as ≤50% stenosis in any major epicardial vessels) with refractory angina Canadian Cardiovascular Society (CCS) angina class III/IV on change in CCS class, 6-minute walk test (6MWT), Duke Activity Status Index (DASI), Seattle Angina Questionnaire (SAQ7), and weekly anginal episodes pre- and post- EECP treatment. 101 ANOCA patients with CCS class III/IV angina completed full course of EECP treatment at 2 large EECP centers. In 101 ANOCA patients with average age of 60.6±11.3 years including 62.4% female we found significant improvements post-EECP in CCS angina class (3.4± 0.5 to 2.4±2.9, p<0.001), 6MWT (1200 (972,1411) to 1358 (1170,1600), p<0.001), DASI (15.2 ± 11.6 to 31.5± 16.3, p<0.001), SAQ7 (36.2±24.7 to 31.5±16.3, p<0.001) and weekly anginal episodes (5.3±3.5 to 2.4±2.9, p<0.001). Post-EECP, 71 patients (70.3%) had an improvement of ≥1 CCS angina class with 33 (32.7%) improving by ≥2 CCS classes. In conclusion, in ANOCA patients, EECP therapy reduces CCS angina class and improves exercise tolerance and therefore should be considered a part of optimal medical therapy.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 25 Oct 2023; epub ahead of print</small></div>

<div><h4>Echocardiography versus Magnetic Resonance Imaging Quantification and Novel Algorithm for Isolated Severe Tricuspid Regurgitation.</h4><i>Wang TK, Reyaldeen R, Akyuz K, Popovic ZB, ... Griffin BP, Desai MY</i><br /><AbstractText>Transthoracic echocardiography (TTE) is the first-line tool to evaluate isolated tricuspid regurgitation (TR), but has limitations, and its TR quantification compared with magnetic resonance imaging (MRI) has been studied infrequently. We compared isolated severe TR quantification by TTE against MRI, and developed a novel TTE-based algorithm. Isolated TR patients graded severe by TTE and undergoing MRI 2007/01-2019/06 were studied. TTE and MRI measurements were analyzed by correlation, area under receiver-operative characteristics curve (AUC), and classification and regression tree algorithm of TTE parameters to best identify MRI-derived severe TR (regurgitant volume ≥45mL and/or fraction ≥50%). A total of 108/262 (41%) graded as severe TR by TTE also had severe TR by MRI. There were moderate correlations between TTE and MRI in quantification of TR severity and right atrial size (Pearson r=0.428-0.645), but none to modest correlations between them in right ventricle quantification. Key TTE parameters to identify MRI-derived severe TR in the decision tree regression algorithm were right atrial volume indexed ≥47 mL/m<sup>2</sup>, then effective regurgitant orifice area ≥0.45 cm<sup>2</sup>, and especially if right ventricle free wall strain ≥-9.5%. This novel algorithm has AUC 0.76 and 79% agreement to detect severe TR by MRI, higher than the American Society of Echocardiography criteria with AUC 0.68 and 66% agreement (P=0.006 and P<0.001 respectively). In conclusion, TTE-derived TR and right atrial quantification had moderate correlation and discrimination of severe TR by MRI, from which a novel TTE algorithm was derived, which had incrementally higher accuracy than contemporary guidelines\' criteria alone.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 25 Oct 2023; epub ahead of print</small></div>

<div><h4>Prevalence of Collateral Typology in Coronary Chronic Total Occlusion and Its Impact on Percutaneous Intervention Performance.</h4><i>Moroni A, Poletti E, Scott B, Castaldi G, ... Zivelonghi C, Agostoni P</i><br /><AbstractText>The presence of collateral channels providing distal blood supply is a distinctive characteristic of chronic total occlusion (CTO) lesions. However, data about the distinct baseline and procedural characteristics of each collateral subset are scarce. Accordingly, we sought to explore the procedural aspects specific for each collateral typology (ipsilateral collaterals [ICs], contralateral collaterals [CCs] or mixed) in CTO-percutaneous coronary intervention (PCI). A retrospective analysis of our CTO-PCI registry was performed to investigate the prevalence, procedural characteristics, and outcomes specific for each CTO-PCI subset, defined according to the inter-arterial connection anatomy. A total of 209 cases were included. Of the included cases, 45 (22%) and 92 (44%) patients displayed solely IC or CC, respectively, whereas in 72 (34%) both IC and CC were present (mixed). The procedural success rate was high (91.1%) and comparable among the different groups, despite greater lesion complexity in the CC group. The most frequent target vessel was the left circumflex in the IC group (51% of cases) and the right coronary artery in the CC (63%) and mixed (57%) groups. Among the IC cases, 42% showed a poor collateral connection function (2% and 10% for the CC and mixed group, respectively), and 46% showed a suboptimal collateral recipient artery filling (21% and 20% for the CC and mixed group, respectively). Most of the IC cases were performed using a single access (96%). In conclusion, the success and complication rates were comparable among the collateral typology groups, irrespective of the differences in the baseline and procedural characteristics. Phenotyping CTO as hereby proposed might be helpful for targeted procedural considerations.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 25 Oct 2023; epub ahead of print</small></div>

<div><h4>Left Atrial Strain Predicts Stroke Recurrence and Death in Patients With Cryptogenic Stroke.</h4><i>Vera A, Cecconi A, Ximénez-Carrillo Á, Ramos C, ... Alfonso F, DECRYTORING study investigators</i><br /><AbstractText>Left atrial strain (LAS) has been widely studied as a predictor of atrial fibrillation (AF) after cryptogenic stroke (CS). However, the evidence about its prognostic role in terms of stroke recurrence and death in this setting remains scarce. A total of 92 consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale ≥4 of unknown etiology were prospectively recruited. Echocardiography, including LAS was performed during admission. The primary outcome measure was the composite of stroke recurrence or death. The mean age was 77.5 ± 7.7, and 58% of patients were female. After a median follow up of 28 months, the primary outcome measure occurred in 15 patients (16%). The primary outcome was more frequent in patients with diabetes (53% vs 21%, p = 0.02), chronic kidney disease (33% vs 10%, p = 0.034), and a history of heart failure (13% vs 0%, p = 0.025). LAS reservoir (LASr) and LAS conduit (LAScd) were lower in patients developing the primary outcome (21% ± 7% vs 28.8% ± 11%, p = 0.017 and 7.7% ± 3.9% vs 13.7% ± 7%, p = 0.007, respectively). On multivariate analysis, LASr (hazard ratio 0.9, 95% confidence interval 0.85 to 0.99, p = 0.048) and diabetes (hazard ratio 3.3, 95% confidence interval 1.03 to 10.4, p = 0.045) were associated with stroke recurrence or all-cause death after CS. On the log-rank test (using the discriminatory cut-off value of LASr <23%), LASr (p = 0.009) was associated with higher risk of the primary outcome. In conclusion, lower values of the LAS reservoir were associated with a higher risk of stroke recurrence or death after CS. LAS may identify patients at higher risk of thromboembolism and stress conditions.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 25 Oct 2023; epub ahead of print</small></div>

<div><h4>The Efficacy of Cardiac Myosin Inhibitors versus Placebo in Patients with Symptomatic Hypertrophic Cardiomyopathy - A Meta-Analysis and Systematic Review.</h4><i>Yassen M, Changal K, Busken J, Royfman R, ... Khouri SJ, Moukarbel GV</i><br /><AbstractText>We aimed to assess the overall clinical impact of cardiac myosin inhibitors in hypertrophic cardiomyopathy (HCM). We performed a meta-analysis of published trials assessing the effect of cardiac myosin inhibitors (Mavacamten and Aficamten) on resting and Valsalva LVOT gradients and functional capacity in symptomatic HCM. The co-primary outcomes were mean percent change (mean difference, MD) from baseline in resting LVOT gradient and Valsalva LVOT gradient, as well as proportion of patients achieving NYHA Class improvement ≥ 1. Secondary outcomes included mean percent change from baseline NT ProBNP, Troponin I, and left ventricular ejection fraction (LVEF). Four studies (all randomized-control trials, including 3 Mavacamten-focused and 1 Aficamten-focused trials) involving 463 patients were included in the meta-analysis. Compared to placebo, the cardiac myosin inhibitor group demonstrated statistically significant differences in baseline percent change in mean resting LVOT gradient (MD -62.48, CI -65.44, -59.51, p <0.00001) and Valsalva LVOT gradient (MD -54.21, CI -66.05, -42.36, p <0.00001), as well as proportion of patients achieving NYHA Class improvement ≥ 1 (OR 3.43, CI 1.90, 6.20, p <0.0001). Regarding secondary outcomes, the intervention group demonstrated statistically significant reductions in mean percent change from baseline in NT-proBNP (MD -69.41, CI -87.06, -51.75, p < 0.00001), Troponin I (MD, -44.19, CI -50.59, -37.78, p < 0.00001), and LVEF (MD -6.31, CI -10.35, -2.27, p = 0.002). In conclusion, cardiac myosin inhibitors may confer clinical and symptomatic benefits in symptomatic HCM, at the possible expense of LVEF. Further trials with large sample sizes are needed to confirm our findings.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 24 Oct 2023; epub ahead of print</small></div>

<div><h4>Reversed Septal Curvature Is Associated With Nonsustained Ventricular Tachycardia in Hypertrophic Cardiomyopathy.</h4><i>He Y, Zhou J</i><br /><AbstractText>Sudden cardiac death (SCD) is associated with nonsustained ventricular tachycardia (NSVT) in patients with hypertrophic cardiomyopathy (HCM). Recently, differences regarding septal morphology have been reported, with an increased probability of sudden death in HCM patients who had reverse septal curvature (RSC). The aim of this study was to examine the relationship between RSC and NSVT in HCM. A total of 138 patients with HCM were enrolled. Of 138 patients, 47 (34.1%) were diagnosed with RSC and 42 patients (30.4%) had NSVT. Compared with the non-RSC group, those with RSC were much younger and had an increased incidence of NSVT, thicker septal thickness, larger mass, and a higher proportion of HCM or SCD family history. Furthermore, patients with RSC had a higher risk of SCD according to the European Society of Cardiology calculator (2.5 (1.6, 4.6) vs. 1.6(1.1, 2.3)(%/5 year), p <0.001). Multivariate analysis showed that RSC was a strong and independent risk factor for NSVT (odds ratio = 2.756, 95% confidence interval: 1.164-6.525, p = 0.021). In conclusion, the presence of RSC in HCM patients is independently associated with NSVT. Further studies are needed to evaluate the role of RSC as a risk factor for SCD in this population.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 24 Oct 2023; epub ahead of print</small></div>

<div><h4>Risk of Sinus Sequestration during the Redo Transcatheter Aortic Valve Implantation: the Prevalence, Predictors, and Risk Stratification.</h4><i>Higuchi R, Otaki Y, Kanisawa M, Takamisawa I, ... Iguchi N, Isobe M</i><br /><AbstractText>The number of patients undergoing transcatheter aortic valve implantation (TAVI) with the potential for re-intervention is steadily increasing; however, there is a risk of sinus sequestration (SS) during a redo TAVI. The prevalence, predictors, and risk stratification of risk for SS remain uncertain. We analyzed computed tomography acquired from 263 patients who underwent TAVI between 2021 and 2022: balloon-expandable valve (BEV), 71%, and self-expandable valve (SEV), 29%. Patients were considered at risk of SS if they met 1) BEV frame > sino-tubular junction (STJ) or SEV neo-commissure > STJ and 2) valve-to-STJ < 2 mm. The risk of left, right, and any SS in 51%, 50%, and 65%, respectively, which did not differ between BEV and SEV. The predictors of any SS were the height of the left and right coronary cusp (Odds ratio [OR], 0.81 and 0.71; cut-off, 18.6 and 19.2 mm) and STJ minus annulus diameter (OR, 0.65; cut-off, 3.7 mm) in BEV, and STJ diameter (OR, 0.47; cut-off, 27.6 mm) in SEV. The number of predictors stratified the risk of any SS: low risk with BEV, at 0 predictors (14% at risk of SS); intermediate risk, 1 predictor (65%); high risk, 2 or 3 predictors (81% and 95%); low risk with SEV, 0 predictors (33%), vs. high risk, 1 predictor (91%). In conclusion, two-thirds of patients undergoing TAVI were at risk of SS. The height of the coronary cusp and the STJ diameter were associated with, and adequately stratified the risk of SS.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 24 Oct 2023; epub ahead of print</small></div>

<div><h4>Reverse Remodeling Effects of Sacubitril-Valsartan: Structural and Functional Optimization in Stage C Heart Failure.</h4><i>Kalanatari S, Oren D, Medvedofsky D, Narang A, ... Lang RM, Uriel N</i><br /><b>Background</b><br />Sacubitril-valsartan, an angiotensin receptor-neprilysin inhibitor, reduces all-cause mortality as well as the rate of heart failure hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed to elucidate the benefits of initiating sacubitril-valsartan on ventricular remodeling in patients previously optimized on guideline directed medical therapy.<br /><b>Methods</b><br />In this prospective, single-arm longitudinal study, 40 patients with HFrEF who were optimized on guideline-directed medical therapy were transitioned to sacubitril-valsartan. The primary end-point was the change in left ventricular (LV) volume at 1 year as assessed by three dimensional transthoracic echocardiography. Other echocardiographic endpoints included change in LV function and change in right ventricular (RV) size and function.<br /><b>Results</b><br />The mean age was 55 ± 12 years and 63% were male. At 1 year, LV end-diastolic volume decreased from 242 ± 71 to 157 ± 57 ml (p <0.001) with a corresponding increase in LV ejection fraction from 32 ± 7 to 44 ± 9 % (p <0.001). RV end-diastolic volume decreased from 151 ± 51 to 105 ± 45 ml (p <0.001). While RV ejection fraction did not change (51 ± 8 vs 51 ± 10; p = 0.35), RV GLS improved from -14.9 ± 3.4 % to -19.3 ± 4.3 % (p <0.001) <br /><b>Conclusion:</b><br/>When added to standard medical therapy for heart failure, sacubitril-valsartan induces significant remodeling of both the right and left ventricles as assessed by 3D echocardiography.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 24 Oct 2023; epub ahead of print</small></div>

<div><h4>Evaluation of Madit II Risk Stratification Score among Nationwide Registry of Heart Failure Patients with Primary Prevention Implantable Cardiac Defibrillators or Resynchronization Therapy Devices.</h4><i>Rav-Acha M, Wube O, Brodie OT, Michowitz Y, ... Goldenberg I, Glikson M</i><br /><AbstractText>Current guidelines advocate prophylactic Implantable Cardioverter Defibrillator (ICD) for all symptomatic heart failure (HF) patients with low LVEF. Since many patients will never use their device, a score delineating subgroups with differential ICD benefit is crucial. We aimed to Evaluate MADIT II-based Risk Stratification Score (MRSS) feasibility to delineate ICD survival benefit among nationwide registry of HF patients with prophylactic ICDs. Accordingly, all Israeli HF patients with prophylactic ICD/CRTDs were categorized into MRSS-based risk-subgroups. Study endpoints included overall mortality, sustained ventricular arrhythmia (VA), and a competing risk of VA (potential preventable arrhythmic death, where ICD could benefit survival) versus non-arrhythmic death. Potential ICD survival benefit was estimated by the area between these cumulative incidence curves. Among 2,177 HF patients implanted prophylactic device, 189 patients (8.7%) had VA and 316 (14.5%) died during median Follow-up (F/U) of 2.9 years. MRSS risk-subgroups were significantly associated with overall mortality (p < 0.001) and weakly with VA (p 0.3). Competing risk analysis of VA versus non-arrhythmic death revealed significantly shorter duration (p < 0.001) and smaller magnitude of ICD survival benefit with increased risk subgroups, yielding estimated 76, 60, 38, and 0 life-days gained from prophylactic ICD implant during 5-year F/U for the MRSS low, intermediate, high, and very-high risk subgroups, respectively (p for trend< 0.05). In conclusion, MRSS use among nationwide registry of ischemic and non-ischemic cardiomyopathy patients, revealed subgroups with differing ICD survival benefit, suggesting it could help evaluate prophylactic ICD survival benefit.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 23 Oct 2023; epub ahead of print</small></div>

<div><h4>The Role of Natriuretic Peptides in Predicting Adverse Outcomes After Cardiac Surgery: An Updated Systematic Review.</h4><i>Rao RA, Varghese SS, Ansari F, Rao A, Meng E, El-Diasty M</i><br /><AbstractText>The increasing global burden of cardiovascular disease, particularly, in the aging population, has led to an increase in high-risk cardiac surgical procedures. The current preoperative risk stratification scores, such as the European System for Cardiac Operative Risk Evaluation and the Society for Thoracic Surgeons score, have limitations in their predictive accuracy and tend to underestimate the mortality risk in higher-risk populations. This systematic review aimed to evaluate the utility of natriuretic peptides, brain natriuretic peptide (BNP) and its precursor prohormone (N-terminal prohormone BNP), as predictive biomarkers for adverse outcomes after cardiac surgery. A comprehensive search strategy was performed, and 63 studies involving 40,667 patients who underwent major cardiac operations were included for data extraction. Preoperative levels of BNP and N-terminal prohormone BNP seemed to be associated with an increased risk of short- and long-term mortality, postoperative heart failure, kidney injury, and length of intensive care unit stay. However, their predictive value for postoperative arrhythmias and myocardial infarction was less established. Our findings suggest that natriuretic peptides may play an important role in risk prediction in patients who underwent cardiac surgery. The addition of these biomarkers to the existing clinical risk stratification strategies may enhance their predictive accuracy. However, this needs to be endorsed by data derived from wide-scale clinical trials.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 23 Oct 2023; epub ahead of print</small></div>

<div><h4>Pericardiocentesis Outcomes in Patients with Pulmonary Hypertension: A Nationwide Analysis from the United States.</h4><i>Vasquez MA, Iskander M, Mustafa M, Quintero-Martinez JA, ... de Marchena E, Chatzizisis IS</i><br /><AbstractText>Pericardiocentesis (PC) in patients with Pulmonary Hypertension (PH) and pericardial effusions has unclear benefits as it has been associated with acute hemodynamic collapse and increased mortality. Data on in-hospital outcomes in this population is limited. The National Inpatient Sample database was used to identify adult patients undergoing PC during hospitalizations between 2016 and 2020. Data was stratified by the presence or absence of PH. A multivariate regression model and case-control matching was used to estimate the association of PH with PC in-hospital outcomes. A total of 95,665 adults with a procedure diagnosis of PC were included, of which 7,770 had PH. Patients with PH tended to be older (67 ± 15.7) and female (56%), less frequently presented with tamponade (44.9% vs 52.4%). Patients with PH had significantly higher rates of CKD, coronary artery disease, heart failure, chronic lung disease, among other comorbidities. In the multivariate analysis, PC in PH was associated with higher all-cause mortality (aOR 1.40; CI: 1.30-1.51) and higher rates of post-procedure shock (aOR 1.53; CI: 1.30-1.81) compared to patients without PH. Mortality was higher among those with Pulmonary Arterial Hypertension (PAH) compared to other non-PAH PH groups (aOR 2.35, 95% CI: 1.46-3.80, p <0.001). Rates of cardiogenic shock (aOR: 1.49; 95% CI: 1.38-1.61), acute respiratory failure (aOR: 1.56; 95% CI: 1.48-1.64), and mechanical circulatory support use (aOR 1.86; 95% CI: 1.63-2.12) were also higher in patients with PH. There was no significant volume-outcome relationship between hospitals with high per annum pericardiocentesis volume compared to low volume hospitals in these patients. In conclusion, PC is associated with increased in-hospital mortality and higher rates of cardiovascular complications in patients with PH, regardless of WHO PH group.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 22 Oct 2023; epub ahead of print</small></div>

<div><h4>Prevalence and Clinical Outcomes of Non-cardiac Surgery after Transcatheter Aortic Valve Replacement.</h4><i>Kai T, Izumo M, Okuno T, Kobayashi Y, ... Sakamoto M, Akashi YJ</i><br /><b>Background</b><br />Aortic stenosis (AS) is a prevalent valvular heart disease, especially among the elderly. They often coexist with other comorbidities, and noncardiac surgery carries a higher risk due to the underlying valve condition. Despite the growing concern about the safety and optimal management of non-cardiac surgery post-transcatheter aortic valve replacement (TAVR), there is limited evidence on this matter. This study aims to assess the clinical outcomes of non-cardiac surgeries following TAVR.<br /><b>Methods and results</b><br />This retrospective study included 718 patients who underwent TAVR. Of these, 36 patients underwent non-cardiac surgery after TAVR. The primary endpoint was the incidence of cardiovascular adverse events post-TAVR and the secondary endpoint was the incidence of structural valve deterioration (SVD). Composite endpoints included disabling stroke, heart failure requiring hospitalization, and cardiac death as defined by VARC3. Most of these surgeries were orthopedic and classified as intermediate risk. All non-cardiac surgeries were performed without perioperative adverse events. There was no observed SVD, and the incidence of composite endpoints did not significantly differ between the surgical and non-surgical groups during the follow-up period.<br /><b>Conclusion</b><br />Non-cardiac surgery after TAVR can be performed safely and does not have a negative impact on prognosis. Further studies are warranted to determine the optimal strategy for non-cardiac surgery post-TAVR.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 22 Oct 2023; epub ahead of print</small></div>

<div><h4>Clinical implication of NT-proBNP burden in heart failure with reduced ejection fraction: from the GUIDE-IT.</h4><i>Dong B, Chen C, Zheng Y, Dong Y, ... Xue R, Cong C</i><br /><b>Aims</b><br />The aim of the study was to explore the prognostic implication of N-terminal pro-brain natriuretic peptide (NT-proBNP) burden on heart failure with reduced ejection fraction (HFrEF).<br /><b>Methods</b><br />We performed a post-hoc analysis of the GUIDing Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) trial. NT-proBNP burden was defined as the proportion of days with elevated NT-proBNP (≥1800 pg/ml) to the whole observation time. Cox proportional hazards regression model was used to evaluate the association with NT-proBNP burden and prognosis.<br /><b>Results</b><br />A total of 815 patients with HFrEF were analyzed in our study. Patients were categorized into 4 groups according to the degree of NT-proBNP burden. In the multivariate cox analysis, NT-proBNP burden was significantly associated with all-cause mortality, cardiovascular (CV) mortality and HF hospitalization. Compared to patients without NT-proBNP burden, the risk for composite outcome increased by 210% (HR 3.10, 95% CI 1.72-5.58, p<0.001) in NT-proBNP burden 1 (mild) group, 432% (HR 5.32, 95% CI 2.93-9.67, p<0.001) in NT-proBNP burden 2 (moderate) group and over 12 times (HR 13.15, 95% CI 7.42-23.33, p<0.001) in NT-proBNP burden 3 (severe) group. Sensitivity analyses stratified by age and renal function yielded similar results.<br /><b>Conclusions</b><br />Higher NT-proBNP burden was associated with significant increase in risks of all-cause mortality, CV mortality, HF hospitalization and composite outcome. The results suggested that NT-proBNP burden could be an important predictor of the prognosis of patients with HFrEF.<br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 22 Oct 2023; epub ahead of print</small></div>

<div><h4>Early Initiation of PCSK9 Inhibitor Therapy versus Placebo in Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.</h4><i>Justino GB, Justino LB, Müller ME, Rocha AV, ... Cardoso R, Leucker TM</i><br /><AbstractText>In patients with stable atherosclerotic cardiovascular disease, PCSK9 inhibitors (PCSK9i) have shown a 50-60% reduction in LDL-C from baseline, added to high-intensity statin therapy. However, less is known about the impact of PCSK9i in the setting of an acute coronary syndrome (ACS). Therefore, we performed a systematic review and meta-analysis comparing PCSK9i with placebo in the setting of ACS, added to guideline directed high-intensity or maximally tolerated statin therapy. We included randomized controlled trials (RCTs) with initiation of PCSK9i or placebo within 1 week of presentation or percutaneous coronary intervention for ACS. PubMed, EMBASE, and Cochrane Central were searched. This study followed Cochrane and PRISMA recommendations. Six RCTs were included, totalizing 996 patients of whom 503 (50.5%) received PCSK9i. Mean follow-up ranged from 4 to 52 weeks. LDL-C (MD -44 mg/dL; CI -54.3 to -33.8; p<0.001) and Lp(a) levels (MD -24.0 nmol/L; CI -43.0 to -4.9; p=0.01) were significantly lower at follow-up with PCSK9i. Similarly, total cholesterol (MD -49.2 mg/dL; CI -59 to -39.3), triglycerides (MD -19 mg/dL; CI -29.9 to -8.2) and Apo B (MD -33.3 mg/dL; CI -44.4 to -22.1) were significantly reduced with PCSK9i. In conclusion, in patients with ACS, early initiation of PCSK9i, added to statin, significantly reduces LDL-C and Lp(a) as compared with placebo. Whether the differences in these atherogenic lipoproteins translate into a reduction in clinical endpoints is yet to be determined.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 22 Oct 2023; epub ahead of print</small></div>

<div><h4>Echocardiographic Characteristics of Left and Right Ventricular Longitudinal Function in Patients with a History of Cardiac Surgery.</h4><i>Kuwajima K, Ogawa M, Ruiz I, Hasegawa H, ... Siegel RJ, Shiota T</i><br /><AbstractText>Previous studies have indicated a reduction in right ventricular (RV) longitudinal motion following cardiac surgery. However, the long-term effect of cardiac surgery on longitudinal motion and the involvement of left ventricular (LV) motion remain unclear. Therefore, this study aimed to comprehensively investigate the longitudinal function of the right ventricle and left ventricle in patients who had undergone cardiac surgery. The study included patients who underwent comprehensive transthoracic echocardiography (TTE) with three-dimensional RV data sets. By propensity score matching of clinical and echocardiographic variables, including LV and RV ejection fraction, the echocardiographic parameters were compared between patients with and without a history of cardiac surgery (the surgery and nonsurgery groups, respectively). In this study, the surgery group had significantly lower LV global longitudinal strain values than the nonsurgery group, despite having similar LV ejection fraction. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular velocity, and RV free wall longitudinal strain were also significantly smaller in the surgery group, whereas the RV ejection fraction was comparable between the 2 groups. Additionally, a subgroup analysis based on the time from previous surgery to TTE (≤1 and >1 year) revealed that TAPSE was reduced in both postoperative phases. In conclusion, LV and RV longitudinal parameters were reduced after cardiac surgery, despite preserved LV and RV global functions. Moreover, TAPSE was reduced even a long time following cardiac surgery. These findings emphasize the need for careful interpretation of biventricular longitudinal motion in patients with a history of cardiac surgery.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 22 Oct 2023; epub ahead of print</small></div>

<div><h4>Comparison of Ticagrelor and Clopidogrel in Patients with Acute Coronary Syndrome at High Bleeding or Ischemic Risk.</h4><i>Akyuz S, Calik AN, Yaylak B, Onuk T, ... Cetin M, Tanboga IH</i><br /><AbstractText>Current guidelines recommend individualizing the choice and duration of P2Y<sub>12</sub> inhibitor therapy based on the trade-off between bleeding and ischemic risk. However, whether a potent P2Y<sub>12</sub> inhibitor (ticagrelor) or a less potent one (clopidogrel) is more appropriate in patients with acute coronary syndrome (ACS) in the setting of high bleeding or ischemic risk is not clear. The aim of this study is to compare the clinical outcomes of clopidogrel and ticagrelor in patients with ACS at high bleeding or ischemic risk. A total of 5713 patients with ACS were included in this retrospective study. The Cox proportional hazard regression model were adjusted applying the inverse probability weighted (IPW) approach to reduce treatment selection bias. The primary clinical outcome was all-cause death. Secondary outcomes included in-hospital death, ACS, target vessel revascularization, stent thrombosis, stroke, or clinically significant or major bleeding. The median follow-up duration was 53.6 months. After multivariable Cox model using IPW, all-cause death in the overall population and subgroups of patients at high bleeding risk, and/or at high ischemic risk were not significantly different between clopidogrel and ticagrelor. Rates for secondary outcomes were also similar between the groups. In conclusion, ticagrelor and clopidogrel are associated with comparable clinical outcomes among patients with ACS irrespective of bleeding and ischemic risk.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 22 Oct 2023; epub ahead of print</small></div>

<div><h4>Late Survival After Valve-in-Valve Transcatheter Aortic Valve Implantation With Balloon- Versus Self-Expandable Valves: Meta-Analysis of Reconstructed Time-to-Event Data.</h4><i>Sá MP, Jacquemyn X, Simonato M, Brown JA, ... Dvir D, Sultan I</i><br /><AbstractText>Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) in patients with failed bioprostheses arose as an alternative to redo surgical aortic valve replacement. There is an increasing interest in exploring the differences between self-expanding valves (SEVs) and balloon-expandable valves (BEVs). Our study aimed to evaluate the all-cause mortality in ViV-TAVI with SEV versus BEV in patients with failed bioprostheses. We performed a study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published by March 30, 2023. A total of 5 studies met our eligibility criteria and included 1,454 patients who underwent ViV-TAVI (862 with SEV and 592 with BEV). Almost all BEVs were iterations of the Edwards BEVs (SAPIEN, SAPIEN XT, and SAPIEN 3) and almost all SEVs were iterations of the Medtronic SEVs (CoreValve/Evolut). During the first year after ViV-TAVI, 67 deaths (11.8%) occurred in patients treated with BEV compared with 92 deaths (11.1%) in patients treated with SEV (hazard ratio 0.92, 95% confidence interval 0.66 to 1.27, p = 0.632). At 8 years of follow-up, the all-cause death was not statistically significantly different between the groups, with mortality rates of 65.4% in the group treated BEV and 58.8% in the group treated with SEV (hazard ratio 0.91, 95% confidence interval 0.75 to 1.09, p = 0.302). The restricted mean survival time was overall 0.25 years greater with SEV than BEV, but this difference was not statistically significant (p = 0.278), which indicates no lifetime gain or loss with SEV in comparison with BEV. There seems to be no difference in terms of all-cause death in ViV-TAVI with SEV versus BEV. Randomized controlled trials are warranted to validate our results.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 21 Oct 2023; epub ahead of print</small></div>

<div><h4>Prevalence and Risk Factors of Mitral, Tricuspid, and Aortic Regurgitation: A Population-Based Study from Rural Northeast China.</h4><i>Li W, Xiong S, Yin S, Deng W, ... Guo X, Sun Y</i><br /><AbstractText>The population-based studies on the epidemiologic features of valvular regurgitation in Northeast China are scarce. We aim to estimate the prevalence and risk factors of mitral regurgitation (MR), tricuspid regurgitation (TR), and aortic regurgitation (AR) in a general population from rural Northeast China. Valvular regurgitation was assessed by color flow Doppler echocardiography in a population-based survey of 11,579 participants aged ≥35 years in rural areas of Liaoning Province during 2012 to 2013. The prevalence of mild or greater MR and TR were 1.6% and 1.5%, respectively. Trace or greater AR was present in 4.1% of the participants. In the multivariable regression model, older age, left atrial dimension, low left ventricular (LV) ejection fraction, and fasting plasma glucose were associated with higher risk of MR in men, whereas only older age and left atrial dimension increased the risk in women. Body mass index was found to be a protective factor for MR in women (odds ratio 0.847, 95% confidence interval 0.741 to 0.969). TR was independently associated with age, heart rate, low LV ejection fraction, current drinking status, and high-density lipoprotein cholesterol. The risk for AR significantly increased with age in both genders. LV mass index and aortic dimension increased the risk of AR in males, and females with higher LV mass index and high-density lipoprotein cholesterol had an increased risk for AR. In both genders, systolic blood pressure presented as a risk factor for AR, while diastolic blood pressure as a protective factor. In this large Chinese population-based study, we found remarkably low prevalence of valvular regurgitation, adding evidence for estimating disease burden and making policy strategies in Northeast China.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 21 Oct 2023; epub ahead of print</small></div>

<div><h4>Machine Learning for Predicting Postoperative Atrial Fibrillation After Cardiac Surgery: A Scoping Review of Current Literature.</h4><i>El-Sherbini AH, Shah A, Cheng R, Elsebaie A, ... Redfearn D, El-Diasty M</i><br /><AbstractText>Postoperative atrial fibrillation (POAF) occurs in up to 20% to 55% of patients who underwent cardiac surgery. Machine learning (ML) has been increasingly employed in monitoring, screening, and identifying different cardiovascular clinical conditions. It was proposed that ML may be a useful tool for predicting POAF after cardiac surgery. An electronic database search was conducted on Medline, EMBASE, Cochrane, Google Scholar, and ClinicalTrials.gov to identify primary studies that investigated the role of ML in predicting POAF after cardiac surgery. A total of 5,955 citations were subjected to title and abstract screening, and ultimately 5 studies were included. The reported incidence of POAF ranged from 21.5% to 37.1%. The studied ML models included: deep learning, decision trees, logistic regression, support vector machines, gradient boosting decision tree, gradient-boosted machine, K-nearest neighbors, neural network, and random forest models. The sensitivity of the reported ML models ranged from 0.22 to 0.91, the specificity from 0.64 to 0.84, and the area under the receiver operating characteristic curve from 0.67 to 0.94. Age, gender, left atrial diameter, glomerular filtration rate, and duration of mechanical ventilation were significant clinical risk factors for POAF. Limited evidence suggest that machine learning models may play a role in predicting atrial fibrillation after cardiac surgery because of their ability to detect different patterns of correlations and the incorporation of several demographic and clinical variables. However, the heterogeneity of the included studies and the lack of external validation are the most important limitations against the routine incorporation of these models in routine practice. Artificial intelligence, cardiac surgery, decision tree, deep learning, gradient-boosted machine, gradient boosting decision tree, k-nearest neighbors, logistic regression, machine learning, neural network, postoperative atrial fibrillation, postoperative complications, random forest, risk scores, scoping review, support vector machine.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 21 Oct 2023; 209:66-75</small></div>

<div><h4>Is Concomitant Mitral Stenosis Associated With Worse Outcomes in Patients Who Underwent TAVR? Insights from a National Database.</h4><i>Kurpad KP, Haider MZ, Garg N, Katamreddy A, ... Moussa ID, Mehta SS</i><br /><AbstractText>Concomitant mitral stenosis (MS) is present in 10% to 15% of all patients who underwent transcatheter aortic valve replacement (TAVR). Our aim is to assess outcomes of TAVR in patients with MS using a national database. The Nationwide Inpatient Sample database was used to identify patients who underwent TAVR from 2015 to 2020. We created 2 groups, patients with and those without MS. We then compared baseline characteristics, demographics, and in-hospital outcomes of the groups. Primary outcomes were in-hospital mortality, acute respiratory failure, and pacemaker placement. Secondary outcomes were length of stay and in-hospital costs. Our study indicates that patients with MS had greater incidence of acute respiratory failure (8.8% vs 4.89%, p = 0.001), complete heart block (13.54% vs 9.36%, p = 0.01), and permanent pacemaker placement (8.03% vs 6.03%, p = 0.05). In-hospital mortality was greater in the MS group; however, it was not statistically significant (1.32% vs 1.53%, p = 0.679).</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 21 Oct 2023; 209:85-88</small></div>

<div><h4>Outcomes of Provisional Stenting With Versus Without Side Branch Intervention in Patients With Bifurcation Lesion-Related ST-Segment Elevation Myocardial Infarction.</h4><i>Servoz C, Matta A, Bataille V, Philippe J, ... Carrié D, Lhermusier T</i><br /><AbstractText>To date, the best approach to coronary bifurcation lesion remains unsettled, and the parameters to guide side branch ballooning or stenting are not yet defined. This study aimed to compare the survival outcomes after provisional stenting with versus without side branch intervention. A cohort was conducted on 132 patients who underwent coronary angiography at Toulouse University Hospital for ST-segment elevation myocardial infarction with large culprit nonleft main coronary bifurcation lesion. Study participants were divided into 2 groups depending on the performance or not of a side branch intervention. We observed the living status at 1-year after hospital discharge. Side branch intervention by balloon inflation or final balloon kissing technique was performed in 34.1% of study participants. At 1-year follow-up, the incidence of all-cause mortality was 7.8 per 100 person-years (95% confidence interval [CI] 4.1 to 15), and although it seemed higher in the side branch intervention group (10 per 100 person-years [95% CI 3.8 to 26.7] vs 6.6 per 100 persons-years [95% CI 2.8 to 15.9]), the survival analyses showed no differences in survival outcomes (hazard ratio <sub>side branch intervention</sub> 1.55 [0.42 to 5.78], p = 0.513). In conclusion, in the setting of a coronary bifurcation causing ST-segment elevation myocardial infarction, simple provisional stenting without side branch intervention showed a low mortality rate and no differences in the 1-year survival outcomes.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 21 Oct 2023; 208:190-194</small></div>

<div><h4>Transcatheter Aortic Valve Implantation in a Patient With Anomalous Left Main Coronary Artery from Right Coronary Artery.</h4><i>Sudhakaran S, Joy P, Sbrocchi A, Hebeler R, Stoler R</i><br /><AbstractText>Transcatheter aortic valve implantation (TAVI) is now a well-established modality of treating severe symptomatic aortic valve stenosis in patients deemed at great surgical risk. In patients with coexisting anomalous coronary arteries, however, TAVI presents technical challenges, and coronary obstruction is a feared complication. In this study, we present the case of successful TAVI in a 78-year-old patient with anomalous left main coronary artery originating from the right coronary artery.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 19 Oct 2023; epub ahead of print</small></div>

<div><h4>Evaluation of Right-Side Filling Pressure in Patients With Obesity With Heart Failure Using Handheld Ultrasound Score.</h4><i>Albaeni A, Sharma M, Chatila KF, Shalaby M, Ahmad M, Khalife WI</i><br /><AbstractText>The goal of this investigation is to evaluate the accuracy of handheld ultrasound score in assessing right atrial (RA) pressure in patients with obesity with heart failure. We prospectively studied 123 patients with heart failure referred for right-sided cardiac catheterization. Handheld ultrasound was performed before catheterization to evaluate volume status by estimating RA pressure using end-expiratory inferior vena cava (IVC) dimension, IVC respiratory collapsibility, and right internal jugular (RIJ) vein respiratory collapsibility. A 3-point simple score was created using multiple logistic regression. The patients were divided into 2 groups based on body mass index. The performance of this score was assessed using the receiver operating characteristics curve in each subgroup and was compared with the performance of the 2-point score (expiratory IVC dimension, IVC respiratory collapsibility). Median age was 58 years (interquartile range 48 to 65), and 37% were women. The 3-point score including RIJ performed better than did the 2-point score in patients with obesity (area under the curve 0.84 [0.74 to 0.95] vs 0.69 [0.58 to 0.81], p = 0.001). The performance of the scores did not differ in patients without obesity (area under the curve 0.85 [0.74 to 0.95] vs 0.82 [0.71 to 0.93], p = 0.49). In patients with obesity, the 3-point score had a specificity of 100% and sensitivity of 21% (11% to 31%) for elevated RA pressure ≥10 mm Hg. In conclusion, a 3-point score including both RIJ and IVC assessment performed better in patients with obesity with heart failure and highlights the importance of comprehensive evaluation in patients with obesity to achieve an accurate, noninvasive assessment of volume status.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 19 Oct 2023; epub ahead of print</small></div>

<div><h4>Evolution of Echocardiography-Derived Hemodynamic Force Parameters After Cardiac Resynchronization Therapy.</h4><i>Laenens D, van der Bijl P, Galloo X, Rossi AC, ... Marsan NA, Bax JJ</i><br /><AbstractText>Echocardiography-derived hemodynamic forces (HDF) allow calculation of intraventricular pressure gradients from routine transthoracic echocardiographic images. The evolution of HDF after cardiac resynchronization therapy (CRT) has not been investigated in large cohorts. The aim was to assess HDF in patients with heart failure implanted with CRT versus healthy controls. In the patients, HDF were assessed before and 6 months after CRT. The following HDF parameters were calculated: (1) apical-basal strength, (2) lateral-septal strength, (3) the ratio of lateral-septal to apical-basal strength ratio, and (4) the force vector angle (1 and 2 representing the magnitude of HDF, 3 and 4 representing the orientation of HDF). In the propulsive phase of systole, the apical-basal impulse and the systolic force vector angle were measured. A total of 197 patients were included (age 64 ± 11 years, 62% male), with left ventricular ejection fraction ≤35%, QRS duration ≥130 ms and left bundle branch block. The magnitude of HDF was significantly lower and the orientation was significantly worse in patients with heart failure versus healthy controls. Immediately after CRT implantation, the apical-basal impulse and systolic force vector angle were significantly increased. Six months after CRT, improvement of apical-basal strength, lateral-septal to apical-basal strength ratio and the force vector angle occurred. When CRT was deactivated at 6 months, the increase in the magnitude of apical-basal HDF remained unchanged while the systolic force vector angle worsened significantly. In conclusion, HDF in CRT recipients reflect the acute effect of CRT and the effect of left ventricular reverse remodeling on intraventricular pressure gradients. Whether HDF analysis provides incremental value over established echocardiographic parameters, remains to be determined.</AbstractText><br /><br />Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 19 Oct 2023; epub ahead of print</small></div>

<div><h4>Impact on Kidney Function and Medium-Term Outcomes of Transcatheter Aortic Valve Replacement in Patients with Chronic Kidney Disease.</h4><i>Naser JA, Allen Luis S, Pislaru SV, Michelena HI, ... Pellikka PA, Nkomo VT</i><br /><AbstractText>Transcatheter aortic valve replacement (TAVR) is now widely approved for the treatment of aortic stenosis regardless of patients\' surgical risk. However, outcomes of TAVR and their determinants in patients with chronic kidney disease (CKD) beyond 1 year of follow-up are unknown. We aimed to assess medium-term outcomes of TAVR in CKD, develop a risk score to estimate the 2-year mortality in CKD patients, and evaluate changes in kidney function at discharge after TAVR. Adults who underwent TAVR were retrospectively identified. CKD stage was determined using the CKD-EPI 2021 creatinine formula. Improved kidney function was defined as post-TAVR creatinine ≤50% of pre-TAVR creatinine or decrease in creatinine of ≥0.3 mg/dl compared to pre-TAVR creatinine. Overall, 1,523 patients [median age 82 years; 59% males; 735 with CKD stage II or less, 661 with CKD III, 83 with CKD IV, and 44 with CKD V (of which 40 were on dialysis)] were included. All-cause mortality was higher in CKD stages IV and V on multivariable analysis (p <0.001) at median follow-up of 2.9 (IQR 2.0-4.2) years. Moderate or severe tricuspid regurgitation, anemia, right ventricular systolic pressure >40 mmHg and CKD stages IV and V were independent predictors of 2-year mortality and were used to develop a risk score. At hospital discharge, persisting acute kidney injury after TAVR occurred in 88/1466 (6%) patients while improved kidney function occurred in 170/1466 (12%) patients. In conclusion, CKD stage was an independent determinant of mortality beyond 2 years after TAVR. Kidney function was more likely to improve than worsen at time of hospital discharge following TAVR.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 18 Oct 2023; epub ahead of print</small></div>

<div><h4>Spontaneous Sinus Rhythm Restoration in Patients With Refractory, Permanent Atrial Fibrillation Who Underwent Conduction System Pacing and Atrioventricular Junction Ablation.</h4><i>Palmisano P, Parlavecchio A, Vetta G, Crea P, ... Accogli M, Coluccia G</i><br /><AbstractText>Ablate and pace (A&P) with conduction system pacing (CSP) improves outcomes in patients with symptomatic permanent atrial fibrillation (AF). Data on spontaneous sinus rhythm restoration (SSRR) in this setting are lacking. This study aimed to assess the incidence and the predictors of SSRR in a population of patients with permanent AF who underwent A&P with CSP. Prospective, observational study, enrolling consecutive patients with symptomatic permanent AF (of documented duration >6 months) and uncontrolled, drug-refractory high ventricular rate, who underwent A&P with CSP. The incidence and predictors of SSRR were prospectively assessed. A total of 107 patients (79.0 ± 9.1 years, 33.6% male, 74.8% with New York Heart Association class ≥III, 56.1% with ejection fraction <40%) were enrolled: 40 received His\' bundle pacing, 67 left bundle branch area pacing. During a median follow-up of 12 months SSRR was observed in 14 patients (13.1%), occurring a median of 3 months after A&P (interquartile range 1 to 6; range 0 to 17). Multivariable analysis identified a duration of permanent AF <12 months (hazard ratio 7.7, p = 0.040) and a left atrial volume index <49 ml/m<sup>2</sup> (hazard ratio 14.8, p = 0.008) as independent predictors of SSRR. In patients with coexistence of both predictors the incidence of SSRR was of 41.4%. In a population of patients with symptomatic, permanent AF, treated with A&P with CSP, SSRR was observed in 13% of patients during follow-up. A duration of permanent AF <12 months and a left atrial volume index <49 ml/m<sup>2</sup> were independent predictors of this phenomenon.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 18 Oct 2023; epub ahead of print</small></div>

<div><h4>Geographically Weighted Modeling to Explore Social and Environmental Factors Affecting County-Level Cardiovascular Mortality in People With Diabetes in the United States: A Cross-Sectional Analysis.</h4><i>Zelko A, Salerno PRVO, Al-Kindi S, Ho F, ... Deo S, Sattar N</i><br /><AbstractText>Disparities exist in the cardiovascular mortality outcomes among individuals with type 2 diabetes (T2D). Research has established that these disparities are often related to the environmental and social determinations of health. This study explores the spatial variation between air pollution, social determinants of health and T2D related age-adjusted cardiovascular mortality (aa-CVM) in the United States. We obtained county-level T2D related to aa-CVM (per 100,000 residents) from Centers for Disease Control and Prevention WONDER (Wide-ranging Online Data for Epidemiologic Research) (2010 to 2019). We fit a geographically weighted linear regression with aa-CVM (outcome) and the following covariates (ambient air pollution [particulate matter of 2.5 µm size], median annual household income, racial/ethnic minorities, higher education, rurality, food insecurity, and primary health care access) were included. Overall, the median aa-CVM rate was 92.9 and highest in the South (102.2). In the West, aa-CVM was significantly associated with particulate matter of 2.5 µm size, annual median household income, racial minority status and primary health care access. Food insecurity was the most significant exposure in the Midwest and Northeast, while in the South, annual median household income and food insecurity were significant. In conclusion, this study demonstrated a substantial regional variation of exposure to determinants of T2D related aa-CVM in the United States. These findings should be considered in policy frameworks and interventions as part of community-level approaches to addressing T2D related aa-CVM, and within broader state and national discussions of the importance of population health.</AbstractText><br /><br />Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 18 Oct 2023; epub ahead of print</small></div>

<div><h4>Perceived Social Support and Cardiovascular Risk Among Nonelderly Adults in the United States.</h4><i>Datta BK, Coughlin SS, Gummadi A, Mehrabian D, Ansa BE</i><br /><AbstractText>Hypertension, diabetes mellitus, dyslipidemia, and obesity are major risk factors of cardiovascular diseases. A recent study projected a marked surge in these cardiometabolic conditions in the United States by the year 2060, posing a challenge for cardiovascular disease management in the coming years. This study aimed to explore and quantify the relation of a key psychosocial factor, social support, with the cardiovascular risk factors among nonelderly US adults (aged 18 to 64 years). Using data on 19,827 adults from the 2021 National Health Interview Survey, we assessed whether lower level of social support was associated with higher likelihood of having cardiovascular risks. We found that for individuals who \"rarely/never\" received social support, the adjusted odds of having hypertension, high cholesterol, and diabetes were 1.42 (95% confidence interval [CI] 1.20 to 1.67), 1.39 (95% CI 1.18 to 1.65), and 1.53 (95% CI 1.22 to 1.91) times those of individuals \"always\" receiving support, respectively. Further, compared with the base outcome of no CV risk, the adjusted relative risks of having 3+ cardiovascular risks for individuals \"rarely/never\" receiving support were 1.91 (95% CI 1.49 to 2.46) times that of those \"always\" receiving support. These results were robust across socioeconomic status condition sub-groups manifested by educational attainment and income. In conclusion, our findings suggest that social support may be considered as a critical part of the comprehensive efforts to mitigate the future burden of cardiovascular diseases in the United States.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 18 Oct 2023; epub ahead of print</small></div>

<div><h4>Outcomes of Transcatheter Mitral Valve Repair Using the MitraClip System in Patients With Atrial Fibrillation. A Meta-Analysis.</h4><i>Halboni A, Hamza M, Dayco J, Al-Abcha A, ... Sattar Y, Alraies MC</i><br /><AbstractText>Transcatheter mitral valve repair (TMVR) with the MitraClip system is now approved for degenerative and functional mitral regurgitation (MR). Atrial fibrillation (AF) is commonly seen in MR. In our study, we perform a pooled analysis of the existing data to investigate the outcomes of MitraClip in patients with versus without AF. We conducted a systematic search of PubMed, Google Scholar, and SCOPUS databases through December, 2022 for studies comparing the outcomes of TMVR using the MitraClip in patients with preexisting AF versus those without AF. A meta-analysis was performed to investigate the primary outcomes of all-cause mortality and heart failure (HF) hospitalization. Secondary outcomes were cardiovascular mortality, in-hospital mortality, stroke, New York Heart Association class I or II at follow-up, length of hospital stay, and procedural time. A total of 10 studies (n = 24,111; AF = 12,789; no AF = 11,322) were included in the final analysis. Preexisting AF was associated with higher overall all-cause mortality (odds ratio 1.55, 95% confidence interval 1.32 to 1.83, p <0.0002) and higher overall HF hospitalization rate (odds ratio 1.3, 95% confidence interval 1.08 to 1.56, p <0.0154). There was no statistically significant difference in cardiovascular mortality, in-hospital mortality, stroke, length of hospital stay, procedural time, or New York Heart Association class I/II at follow-up comparing AF versus no AF. The presence of AF in patients who underwent TMVR with MitraClip is associated with higher all-cause mortality and HF hospitalization. This should be taken into consideration in the management of MR patients.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 18 Oct 2023; epub ahead of print</small></div>

<div><h4>Lipoprotein(A) and Long-Term Recurrent Infarction after an Acute Myocardial Infarction.</h4><i>Miñana G, Cordero A, Fácila L, Company M, ... Sanchis J, Núñez J</i><br /><AbstractText>Lipoprotein(a) [Lp(a)] is an emerging risk factor for incident ischemic heart disease. However, its role in risk stratification in in-hospital survivors to an index acute myocardial infarction (AMI) is more scarce, especially for predicting the risk of long-term recurrent AMI. We aimed to assess the relationship between Lp(a) and very long-term recurrent AMI after an index episode of AMI. It is a retrospective analysis that included 1223 consecutive patients with an AMI discharged from October 2000 to June 2003 in a single teaching center. Lp(a) was assessed during index admission in all cases. The relationship between Lp(a) at discharge and total recurrent AMI was evaluated through negative binomial regression. The mean age of the patients was 67.0±12.3 years, 379 (31.0%) were women, and 394 (32.2%) were diabetic. The index event was more frequently non-STEMI (66.0%). The median Lp(a) was 28.8 (11.8-63.4) mg/dL. During a median follow-up of 9.9 (4.6-15.5) years, 813 (66.6%) deaths and 1205 AMI in 532 (43.5%) patients occurred. Lp(a) values were not associated with an increased risk of long-term all-cause mortality (p=0.934). However, they were positive and non-linearly associated with an increased risk of total long-term reinfarction (p=0.016). In the subgroup analysis, there was no evidence of a differential effect for the most prevalent subgroups. In conclusion, after an AMI, elevated Lp(a) values assessed during hospitalization were associated with an increased risk of recurrent reinfarction in the very long term. Further prospective studies are warranted to evaluate their clinical implications.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Oct 2023; epub ahead of print</small></div>

<div><h4>The Influence of Pulmonary Veins\' Anatomic Features and Catheter Coaxiality on Cryoballoon Ablation Results for Paroxysmal Atrial Fibrillation.</h4><i>Pang Y, Guo W, Xu Y, Chen C, ... Wang M, Zhu W</i><br /><AbstractText>A total of 172 consecutive patients with sympathetic paroxysmal atrial fibrillation who received cryoballoon (CB) ablation from 2020 to 2021 were retrospectively analyzed in this study. Catheter coaxiality and anatomic features of pulmonary veins (PVs) on computed tomography images were explored by several parameters and their influence on the cryoablation results was then analyzed. The rate of incomplete CB occlusion was significantly higher for inferior than superior PVs. A multivariate analysis revealed that a short distance (<6.3 mm) from PV ostium to first branch (D-PVB) and a small angle (<32.5°) of first branch were independent predict factors for an incomplete CB occlusion in right inferior PVs (RIPVs). A combination of D-PVB and angle of first branch could elevate the predictor value for an incomplete balloon occlusion with a sensitivity of 0.85 and specificity of 1.0 for RIPVs. For PVs with a perfect balloon occlusion, the best catheter coaxiality was observed in right superior PV while the worst catheter coaxiality was observed in RIPV. A more aggressive catheter manipulation with a \"7\" or \"reverse-U\" shape of long sheath could obtain a better catheter coaxiality compared with conventional manipulation strategy for RIPVs. In Conclusion, a short D-PVB and a small angle of first branch were independent predict factors for an incomplete CB occlusion in RIPVs. A more aggressive catheter manipulation strategy was recommended to achieve a complete balloon occlusion and a better catheter coaxiality for RIPVs.</AbstractText><br /><br />Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 17 Oct 2023; 209:12-19</small></div>

<div><h4>Two Myocardial Infarctions and Five 8,000-m Peaks.</h4><i>Savonitto S, Piatti L, Tiberti G</i><br /><AbstractText>We report the case of a male smoker who is overweight and has no leisure time physical activity until a first acute inferolateral myocardial infarction at the age of 44 years, which was treated using coronary stenting of the left circumflex artery. He was discharged with an ejection fraction of 0.45 and the indication to quit smoking and initiate regular aerobic physical activity. After that episode, he started regular mountain hiking in the Alps, Andes, and, finally, in the Himalayas and Karakorum, where, up to the age of 65 years, he climbed 5 peaks of altitude >8,000 m, always solo and without oxygen, despite a recurrent myocardial infarction because of occlusion at the distal edge of the previously implanted stent. This case supports the indication that high-altitude per se is not contraindicated in patients with well-compensated coronary artery disease, even after an acute MI.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 17 Oct 2023; 209:8-9</small></div>

<div><h4>Natural History and Clinical Outcomes After ST-Segment Elevation Myocardial Infarction Without Stent Insertion.</h4><i>Nogic J, Cailes B, Yeoh J, Yudi M, ... Brown AJ, Clark D</i><br /><AbstractText>After restoration of coronary perfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI), discrete severe stenotic coronary lesions are not always apparent. There remains ambiguity whether drug-eluting stent (DES) insertion or initial medical management is best practice. Assess short-term clinical outcomes in patients presenting with STEMI without initial stent insertion. Patients who underwent percutaneous coronary intervention for STEMI between 2014 and 2020 were prospectively enrolled and assessed for inclusion. Patients presenting with in-stent restenosis or stent thrombosis, or who did not survive to hospital discharge were excluded. Of 13,871 patients presenting, 456 (3.3%) were treated without initial stenting. These patients were older than those treated with DES (66.1 ± 13.6 vs 62.3 ± 12.4 years, p <0.001) and had higher rates of diabetes (23.5% vs 16.0%, p <0.001) and previous revascularization with either percutaneous coronary intervention (14.0% vs 7.3%, p <0.001) or coronary artery bypass graft (3.5% vs 1.8%, p = 0.008). Thirty-day mortality rate was elevated in patients treated without stenting compared with the rate in those receiving DES (4.2% vs 0.9%, p <0.001), as were rates of myocardial infarction (1.3% vs 0.5%, p = 0.026) and major adverse cardiac events (10.5% vs 2.4%, p <0.001). After propensity matching, a trend toward increased mortality remained (4.2% vs 2.0%, p = 0.055). In conclusion, a no-stenting initial strategy, compared with DES insertion, is associated with increased 30-day mortality in those presenting with STEMI without severe stenosis. These data suggest when appropriate, current-generation DES insertion should be undertaken.</AbstractText><br /><br />Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 17 Oct 2023; epub ahead of print</small></div>

<div><h4>Comparison of Figure-of-Eight Suture and Perclose ProGlide Suture-Mediated Closure in Large Bore Venous Access Hemostasis: A Randomized Controlled Trial.</h4><i>Lodhi H, Shaukat S, Mathews A, Maini B, Khalili H</i><br /><AbstractText>Suture-mediated closure device and Figure-of-Eight suture are commonly used to achieve hemostasis after use of large bore venous access. Although both methods of closure are commonly used in clinical practice, a head-to-head comparison in a controlled setting has not been performed. Patients presenting to a single center for elective left atrial appendage occlusion or transcatheter edge-to-edge mitral valve repair were randomized to large bore venous closure using the Perclose ProGlide suture-based closure or a Figure-of-Eight suture closure. The patients were followed for 1 month after the procedure. Primary outcome, a composite of access site large ecchymosis, hematoma, infection, pain, need for unscheduled venous ultrasound and need for transfusion, was compared between the 2 arms. A total of 40 patients were randomized in a 1:1 fashion to the 2 venous closure strategies. Baseline characteristics were similar between the 2 groups. Perclose ProGlide arm required use of more devices for hemostasis (1.5 ± 0.5 vs 1 ± 0 respectively, p <0.0001), and there was a significant difference in the cost of closure device ($367.00 ± 122.00 vs $1.00 ± 0 respectively, p <0.001). At 1 month post-procedure, the primary outcome occurred in 4 patients (20%) in the Perclose arm and 7 (35%) patients in the Figure-of-Eight arm, a difference that was not statistically significant (p = 0.48). Time to hemostasis between Figure-of-Eight and Perclose arms did not reach statistical significance (2.5 ± 2.1 vs 3.7 ± 2.3, p = 0.09). In conclusion, both Perclose ProGlide suture-based device and Figure-of-Eight closure are equally feasible and safe for patients who underwent large bore venous access. Figure-of-Eight-based closure is more cost effective.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 17 Oct 2023; epub ahead of print</small></div>

<div><h4>Pericardial Adipose Tissue Thrombospondin-1 Associates With Antiangiogenesis in Ischemic Heart Disease.</h4><i>Ahmed B, Farb MG, Karki S, D\'Alessandro S, Edwards NM, Gokce N</i><br /><AbstractText>Accumulation of ectopic pericardial adipose tissue has been associated with cardiovascular complications which, in part, may relate to adipose-derived factors that regulate vascular responses and angiogenesis. We sought to characterize adipose tissue microvascular angiogenic capacity in individuals who underwent elective cardiac surgeries including aortic, valvular, and coronary artery bypass grafting. Pericardial adipose tissue was collected intraoperatively and examined for angiogenic capacity. Capillary sprouting was significantly blunted (twofold, p <0.001) in subjects with coronary artery disease (CAD) (age 60 ± 9 years, body mass index [BMI] 32 ± 4 kg/m<sup>2</sup>, low-density lipoprotein cholesterol [LDL-C] 95 ± 46 mg/100 ml, n = 29) compared with age-, BMI-, and LDL-C matched individuals without angiographic obstructive CAD (age 59 ± 10 y, BMI 35 ± 9 kg/m<sup>2</sup>, LDL-C 101 ± 40 mg/100 ml, n = 12). For potential mechanistic insight, we performed mRNA expression analyses using quantitative real-time polymerase chain reaction and observed no significant differences in pericardial fat gene expression of proangiogenic mediators vascular endothelial growth factor-A (VEGF-A), fibroblast growth factor-2 (FGF-2), and angiopoietin-1 (angpt1), or anti-angiogenic factors soluble fms-like tyrosine kinase-1 (sFlt-1) and endostatin. In contrast, mRNA expression of anti-angiogenic thrombospondin-1 (TSP-1) was significantly upregulated (twofold, p = 0.008) in CAD compared with non-CAD subjects, which was confirmed by protein western-immunoblot analysis. TSP-1 gene knockdown using short hairpin RNA lentiviral delivery significantly improved angiogenic deficiency in CAD (p <0.05). In conclusion, pericardial fat in subjects with CAD may be associated with an antiangiogenic profile linked to functional defects in vascularization capacity. Local paracrine actions of TSP-1 in adipose depots surrounding the heart may play a role in mechanisms of ischemic heart disease.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 17 Oct 2023; epub ahead of print</small></div>

<div><h4>Incidence and Prognostic Implications of Cardiac-Implantable Device-Associated Tricuspid Regurgitation: A Meta-Analysis and Meta-Regression Analysis.</h4><i>Safiriyu I, Mehta A, Mayowa A, Nagraj S, ... Shamaki GR, Bob-Manuel T</i><br /><AbstractText>New-onset or worsening tricuspid regurgitation (TR) is a well-established complication encountered after cardiac implantable electronic devices (CIEDs). However, there are limited and conflicting data on the true incidence and prognostic implications of this complication. This study aimed to bridge this current gap in the literature. Electronic databases MEDLINE, Embase, and Web of Science were systematically searched from inception to March 2023, for studies reporting the incidence and/or prognosis of CIED-associated new or worsening TR. Potentially eligible studies were screened and selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A random effect model meta-analysis and meta-regression analysis were performed, and I-squared statistic was used to assess heterogeneity. A total of 52 eligible studies, with 130,759 patients were included in the final quantitative analysis with a mean follow-up period of 25.5 months. The mean age across included studies was 69.35 years, and women constituted 46.6% of the study population. The mean left ventricular ejection fraction was 50.15%. The incidence of CIED-associated TR was 24% (95% confidence interval [CI] 20% to 28%, p <0.001) with an odds ratio of 2.44 (95% CI 1.58 to 3.77, p <0.001). CIED-associated TR was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio [aHR] 1.52, 95% CI 1.36 to 1.69, p <0.001), heart failure (HF) hospitalizations (aHR 1.82, 95% CI 1.19 to 2.78, p = 0.006), and the composite of mortality and HF hospitalizations (aHR 1.96, 95% CI 1.33 to 2.87, p = 0.001) in the follow-up period. In conclusion, CIED-associated TR occurred in nearly one-fourth of patients after device implantation and was associated with an increased risk of all-cause mortality and HF hospitalizations.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 17 Oct 2023; epub ahead of print</small></div>

<div><h4>Exploring Heart Failure Mortality Trends and Disparities in Women: A Retrospective Cohort Analysis.</h4><i>Ibrahim R, Shahid M, Tan MC, Martyn T, Lee JZ, William P</i><br /><AbstractText>Heart failure (HF) remains a significant cause of morbidity and mortality in women. Population-level analyses shed light on existing disparities and promote targeted interventions. We evaluated HF-related mortality data in women in the United States to identify disparities based on race/ethnicity, urbanization level, and geographic region. We conducted a retrospective cohort analysis utilizing the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to identify HF-related mortality in the death files from 1999 to 2020. Age-adjusted HF mortality rates were standardized to the 2000 US population. We fit log-linear regression models to analyze mortality trends. Age-adjusted HF mortality rates in women have decreased significantly over time, from 97.95 in 1999 to 89.19 in 2020. Mortality mainly downtrended from 1999 to 2012, followed by a significant increase from 2012 to 2020. Our findings revealed disparities in mortality rates based on race and ethnicity, with the most affected population being non-Hispanic Black (age-adjusted mortality rates [AAMR] 90.36), followed by non-Hispanic White (AAMR 83.25), American Indian/Alaska Native (AAMR 64.27), and Asian/Pacific Islander populations (AAMR 37.46). We also observed that nonmetropolitan (AAMR 103.36) and Midwestern (AAMR 90.45) regions had higher age-adjusted mortality rates compared with metropolitan (AAMR 78.43) regions and other US census regions. In conclusion, significant differences in HF mortality rates were observed based on race/ethnicity, urbanization level, and geographic region. Disparities in HF outcomes persist and efforts to reduce HF-related mortality rates should focus on targeted interventions that address social determinants of health, including access to care and socioeconomic status.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 16 Oct 2023; epub ahead of print</small></div>

<div><h4>Procedural Volume and Outcomes of Transfemoral Transcatheter Aortic Valve Replacement: From a Japanese Nationwide Registry.</h4><i>Ando T, Kumamaru H, Kohsaka S, Fukutomi M, ... Hayashida K, Tobaru T</i><br /><AbstractText>The impact of procedural volume on transcatheter aortic valve replacement (TAVR) outcomes in Japan remains uncertain. Japan has carefully introduced TAVR after the establishment of techniques in Western countries and therefore may not exhibit volume-outcome relations after TAVR. Data on transfemoral TAVR was collected from the Japan Transcatheter Valve Therapy (J-TVT) registry between 2018 and 2020. Hospitals were categorized into quartiles (lowest, lower, high, and highest) based on annual TAVR volume. The primary analysis compared 30-day mortality among different TAVR volume hospitals. A multivariable adjustment analysis was performed to calculate the adjusted odds ratio (aOR) and 95% confidence intervals (CIs) of 30-day all-cause mortality with highest-volume hospital as the reference. A total of 2,741 transfemoral TAVR cases from 172 hospitals were included in the analysis. Median hospital TAVR volume was 38 (interquartile range 27 to 60) per year. Unadjusted 30-day mortality was 0.46%, 0.69%, 1.17%, and 1.18% from the lowest to the highest quartile of hospitals, respectively. There was no significant difference in 30-day mortality rates for lowest-volume hospitals (aOR 0.51, 95% CI 0.24 to 1.05, p = 0.07), low-volume hospitals (aOR 0.76, 95% CI 0.46 to 1.26, p = 0.29), or high-volume hospitals (aOR 1.11, 95% CI 0.74 to 1.67, p = 0.60). An analysis from the contemporary national registry in Japan did not find an obvious inverse relation between annual hospital volume and 30-day mortality. Our results suggest that TAVR has now reached a level of procedural maturity, with standardized outcomes observed across hospitals regardless of their annual procedural volume.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 16 Oct 2023; epub ahead of print</small></div>

<div><h4>Understanding the Burden of 30-Day Readmission in Patients With Both Primary and Secondary Diagnoses of Heart Failure: Causes, Timing, and Impact of Co-Morbidities.</h4><i>Kim MJ, Aseltine RH, Tabtabai SR</i><br /><AbstractText>Although efforts to reduce 30-day readmission rates have mainly focused on patients with heart failure (HF) as a primary diagnosis at index hospitalization, patients with HF as a secondary diagnosis remain common, costly, and understudied. This study aimed to determine the incidence, etiology, and patterns of 30-day readmissions after discharge for HF as a primary and secondary diagnosis and investigate the impact of co-morbidities on HF readmission. The National Readmission Database from 2014 to 2016 was used to identify HF patients with a linked 30-day readmission. Patient and hospital characteristics, admission features, and Elixhauser-related co-morbidities were compared between the 2 groups. Readmitted patients in both groups were younger, male, with lower household income, higher mortality risk, and higher hospitalization costs. Over 60% of readmissions were for reasons other than HF, and greater than 1/3 had more than 2 readmissions within 30 days, with a median time to readmission of 12 days. Both cohorts had high readmission rates and high rates of readmission for causes other than HF. Our findings suggest that efforts to reduce 30-day readmission rates should be extended to patients with secondary HF diagnosis, with surveillance extending to 2 weeks postdischarge to identify patients at risk.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 16 Oct 2023; epub ahead of print</small></div>

<div><h4>Mitral Valve Transcatheter Edge-to-Edge Repair After TAVR: A Nationwide Analysis.</h4><i>Elkaryoni A, Saad M, Darki A, Abdelkarim I, ... Abbott JD, Stone GW</i><br /><AbstractText>Patients with persistent severe mitral regurgitation after transcatheter aortic valve replacement (TAVR) may benefit from mitral transcatheter edge-to-edge repair (M-TEER). Using the Nationwide Readmission Database, we identified patients who had M-TEER within 6 months after TAVR and compared their outcomes with patients who had M-TEER without previous recent TAVR during the same calendar year between 2014 and 2020. Because Nationwide Readmission Database data do not cross years, analysis was restricted to the last half of each calendar year. End points included in-hospital mortality and 30-day and 90-day postdischarge rehospitalization rates. In 23,885 M-TEER patients, 396 (1.7%) had a previous recent TAVR. The number of post-TAVR M-TEER procedures increased progressively over time from 16 in 2014 to 92 in 2020. Patients who had M-TEER after a recent TAVR versus those without previous TAVR had similar in-hospital mortality (adjusted odds ratio 0.38, 95% confidence interval [CI] 0.12 to 1.23, p = 0.11), but higher rates of 30-day all-cause hospitalization and heart failure hospitalization (adjusted odds ratios 1.34, 95% CI 1.11 to 1.79, p = 0.04 and 1.63, 95% CI 1.13 to 2.36, p = 0.009, respectively). Nonetheless, in patients who underwent M-TEER post-TAVR, the cumulative 90-day all-cause hospitalization and heart failure hospitalization rates were less after M-TEER compared with before M-TEER (from 45.7% to 31.5%, p = 0.007, and from 29.0% to 16.6%, respectively, both p = 0.005). In conclusion, M-TEER procedures after TAVR in the United States are increasing. Patients with M-TEER after TAVR had similar in-hospital mortality as those who underwent M-TEER without recent TAVR, but higher 30-day hospitalization rates. Nonetheless, 90-day hospitalization rates were decreased after M-TEER in patients with previous TAVR.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 16 Oct 2023; epub ahead of print</small></div>

<div><h4>Outcomes of Transcatheter Aortic Valve Replacement Patients With Different Transvalvular Flow-Gradient Patterns.</h4><i>Muratori M, Fusini L, Tamborini G, Gripari P, ... Pontone G, Pepi M</i><br /><AbstractText>Low-flow low-gradient (LF-LG) aortic stenosis (AS) may occur with preserved or depressed left ventricular ejection fraction (LVEF). Both situations represent the most challenging subset of patients to manage and generally have a poor prognosis. Few and controversial data exist on the outcomes of these patients compared with normal flow-high gradient (NF-HG) AS after transcatheter aortic valve replacement (TAVR). We sought to characterize different transvalvular flow-gradient patterns and to examine their prognostic value after TAVR. We enrolled 1,208 patients with severe AS and categorized as follow: 976 patients NF-HG (mean aortic pressure gradient [MPG] ≥40 mm Hg), 107 paradoxical LF-LG (pLF-LG, MPG <40 mm Hg, LVEF ≥50%, stroke volume index <35 ml/m<sup>2</sup>), and 125 classical LF-LG (cLF-LG) (MPG <40 mm Hg, LVEF <50%, stroke volume index <35 ml/m<sup>2</sup>). When compared with NF-HG and pLF-LG, cLF-LG had a worse symptomatic status (New York Heart Association III to IV 86% vs 62% and 67%, p <0.001), a higher prevalence of eccentric hypertrophy and a higher level of LV global afterload reflected by a higher valvuloarterial impedance. Valvular function after TAVR was excellent over time in all patients. While 30-day mortality (p = 0.911) did not differ significantly among groups, cLF-LG had a lower 5-year survival rate (LF-LG 50% vs pLF-LG 62% and NF-HG 68%, p <0.05). cLF-LG was associated with a hazard ratio for mortality of 2.41 (95% confidence interval 1.65 to 3.52, p <0.001). In conclusion, TAVR is an effective procedure regardless of transvalvular flow-gradient patterns. However, special care should be given to characterized hemodynamic of AS, as patients with pLF-LG had similar survival rates than patients with NF-HG, whereas cLF-LG is associated with a twofold increased risk of mortality at 5-year follow-up.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 16 Oct 2023; epub ahead of print</small></div>

<div><h4>Transthyretin cardiac amyloidosis disguised as light chain amyloidosis, or multiple myeloma?</h4><i>Stein AP, Matthia EL, Petty SA, Stewart B, ... Hiemenz JW, Parker AM</i><br /><AbstractText>We describe 2 challenging cases of cardiac TTR amyloidosis initially treated as cardiac AL amyloidosis in the setting of active myeloma. Endomyocardial biopsy with mass spectrometry was essential to confirm appropriate diagnosis to direct treatment.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 16 Oct 2023; epub ahead of print</small></div>

<div><h4>Myocardial Work Appraisal in Transthyretin Cardiac Amyloidosis and Nonobstructive Hypertrophic Cardiomyopathy.</h4><i>de Gregorio C, Trimarchi G, Faro DC, De Gaetano F, ... Di Bella G, Monte IP</i><br /><AbstractText>Global left ventricular (LV) myocardial work (MW) indexes can be recognized at ultrasound imaging from the LV pressure/global longitudinal strain (GLS) loop analysis. A total of 4 indexes, global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), have been demonstrated to overcome the methodological limitations of GLS and provide useful information on myocardial dysfunction in some clinical settings. Although impaired MW indexes have been demonstrated in patients with transthyretin cardiac amyloidosis (ATTR) or with nonobstructive hypertrophic cardiomyopathy (HCM), there are no comparative studies at present. This study aimed to describe the characteristics of MW in both these clinical settings compared with patients with well-controlled hypertension (HTN). A total of 83 patients, 32 with ATTR (aged 70 ± 11 years, 32% mutated, 68% wild-type, 72% men), 29 with HCM (aged 57 ± 17 years), and 22 HTN controls (aged 56 ± 5.6 years, 59% men) were prospectively enrolled at 2 clinical centers. All participants had New York Heart Association class I or II. Overall, the LV mass index was greater in both study groups than in HTN, whereas the LV ejection fraction (EF) was significantly lower in ATTR compared with other groups. Based on this finding, patients with ATTR were further divided into 2 subgroups: ATTR1 (LVEF ≤0.50), n = 14 (44%) and ATTR2 (LVEF >0.50), n = 18 (56%). Overall, the GWI and GCW were lower in all ATTR patients (mostly in ATTR1) than in the other groups (p <0.001), whereas only small differences in GWE and none in GWW were found among the groups. Of interest, the pairwise comparison and receiver operating characteristic analysis in preserved LVEF patients showed that GWI was a better discriminator of ATTR2 from HCM patients than GLS, with the cut-off value ≤1,419 mm Hg% (89% sensitivity; 55% specificity; p = 0.013). In conclusion, MW analysis was confirmed to be a modern way to investigate myocardial function in patients with hypertrophic phenocopies. GWI and GCW were more impaired in patients with ATTR compared with HCM and HTN controls. Furthermore, this study likely revealed an additional discriminative value of GWI over GLS alone in preserved LVEF settings.</AbstractText><br /><br />Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 16 Oct 2023; 208:173-179</small></div>

<div><h4>Comparison of the 2005 Montreal Criteria and the 2019 Cirrhotic Cardiomyopathy Consortium Criteria for the Diagnosis of Cirrhotic Cardiomyopathy.</h4><i>Luo Y, Yin S, Chen Q, Liu J, Chong Y, Zhong J</i><br /><AbstractText>The comparison between the diagnostic criteria for cirrhotic cardiomyopathy (CCM) first proposed in 2005 (2005 Montreal criteria), and those redefined in the 2019 Cirrhotic Cardiomyopathy Consortium (2019 CCC criteria) has generated significant controversy. Importantly, the predictive value of these criteria in cirrhotic patients (CPs) remains unclear to this date. Thus, the present study aims to compare the 2 sets of criteria and investigate their predictive value in CPs. Between April 2021 and April 2023, a total of 104 CPs with an average age of 46.4 ± 8.9 years, who had no history of other cardiac diseases or malignancies were enrolled in this prospective single-center observational cohort study, conducted at the Third Affiliated Hospital of Sun Yat-Sen University. Various echocardiographic indicators were measured and assessed for their prognostic value and association with clinical outcomes. The prevalence of CCM was found to be comparable when evaluated using both the 2019 CCC and 2005 Montreal criteria (54.8% vs 44.2%, p = 0.161). However, the diagnosis of systolic dysfunction was significantly different between the 2 criteria (52.9% vs 1.0%, p <0.001). Among patients with systolic dysfunction, 27.9% had reduced left ventricular global longitudinal strain, while 25% had increased left ventricular global longitudinal strain. Moreover, fewer patients were diagnosed with diastolic dysfunction (DD) using the 2019 CCC criteria (4.8% vs 44.2%, p <0.001). Multivariate Cox analysis revealed that CPs who had encephalopathy, a high model for end-stage liver disease score, and DD diagnosed using the 2019 CCC criteria exhibited a poorer prognosis. In conclusion, although the prevalence of CCM according to both criteria is similar, the consistency is poor, indicating that they are not the same group of patients. Importantly, CPs with DD diagnosed according to the 2019 CCC criteria might be associated with increased adverse events.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 16 Oct 2023; 208:180-189</small></div>

<div><h4>Cerebral Blood Flow, Brain Injury, and Aortic-Pulmonary Collateral Flow After the Fontan Operation.</h4><i>Fogel MA, Donnelly E, Crandell I, Hanlon A, ... Licht D, Vossough A</i><br /><AbstractText>Patients with a single ventricle develop aortopulmonary collaterals (APCs) whose flow has been shown to be inversely proportional to cerebral blood flow (CBF) in a previous cross-sectional study. Longitudinal CBF and APC flow in patients with Fontan physiology adjusting for brain injury (BI) has never been reported. Decreased CBF and BI may adversely impact neurodevelopment. A prospective longitudinal cohort of 27 patients with Fontan physiology (aged 10 ± 1.9 years, 74% male) underwent cardiac and brain magnetic resonance imaging 3 to 9 months and 6.0 ± 1.86 years after Fontan operation to measure the CBF and APC flow and to reassess the BI (focal BI, generalized insult, and hemorrhage). CBF was measured using jugular venous flow and APC flow was measured by the difference between aortic flow and caval return. Multivariate modeling was used to assess the relation between the change in APC flow and BI. A strong inverse relation was found between CBF/aortic flow change and APC flow/aortic flow and APC flow/body surface area change (R<sup>2</sup> = 0.70 and 0.72 respectively, p <0.02). Overall, the CBF decreased by 9 ± 11% and the APC flow decreased by 0.73 ± 0.67 l/min/m<sup>2</sup>. The evolution of CBF and APC flow were significantly and inversely related when adjusting for time since Fontan operation, gender, and BI on the multivariate modeling. Every unit increase in APC flow change was associated with an 8% decrease in CBF change. In conclusion, CBF and APC flow change are inversely related across serial imaging, adjusting for time from Fontan operation, gender, and BI. CBF and APC aortic flow decrease over a 6-year period. This may adversely impact neurodevelopment. Because APCs can be embolized, this may be a modifiable risk factor. Clinical trials numbers: NCT02135081 and NCT02919956.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 14 Oct 2023; 208:164-170</small></div>

<div><h4>Causes of Malfunction of Bioprostheses Inserted Percutaneously in the Aortic Valve Position in Patients Whose Native Aortic Valve Was Congenitally Bicuspid and Stenotic.</h4><i>Jeong M, Bonilla A</i><br /><AbstractText>Transcatheter aortic valve implantation (TAVI) has brought in recent years relief of cardiac-induced symptoms to a large number of patients with aortic stenosis. Whether it is better to use TAVI for the treatment of aortic valve stenosis superimposed on a congenitally bicuspid valve has been debated in contrast to its proved usefulness in aortic valve stenosis involving a tricuspid aortic valve. From January 2020 to March 2023, surgical aortic valve replacement of TAVI valve and native aortic valve was done in 6 patients. The clinical findings of the patients and morphologic findings from the surgical specimens submitted to the cardiac pathology department were subsequently examined. All the 6 native aortic valves had bicuspid configuration. The TAVI valve in each patient was excised from 9 to 88 months (mean 36 months) after it had been implanted because of paravalvular leak in 4, severe stenosis of the prosthetic valve in 1, and bioprosthetic cuspal degeneration in 1. Prosthetic valve endocarditis was clinically suspected in 2 patients, but the specimen culture was negative. Before surgical aortic valve replacement, 3 patients experienced stroke after TAVI. All 6 patients had low hemoglobin levels (mean 9.5 mg/100 ml) and low hematocrit levels (mean 29.5%). Reticulocyte count was available in 4 patients and was increased in all (mean 3.5%). When the stenotic native aortic valve configuration is bicuspid, the raphe tends to be calcified first and located perpendicular to the flow of the blood and may prevent the ring of the caged bioprosthesis from being transferred to the aortic wall, which is a requirement for full opening of the lumen of the bioprosthesis. Thus, thorough consideration needs to be made before performing TAVI in patients whose native aortic valve is stenotic and bicuspid.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 14 Oct 2023; epub ahead of print</small></div>

<div><h4>Treatment Satisfaction and Convenience for Patients With Atrial Fibrillation on Edoxaban or Vitamin K Antagonists After Transcatheter Aortic Valve Replacement: A Post Hoc Analysis from the ENVISAGE-TAVI AF Trial.</h4><i>Hengstenberg C, Van Mieghem NM, Wang R, Ye X, ... Dangas G, Unverdorben M</i><br /><AbstractText>ENVISAGE-TAVI AF (Edoxaban vs Standard of Care and Their Effects on Clinical Outcomes in Patients Having Undergone Transcatheter Aortic Valve Implantation-Atrial Fibrillation; NCT02943785) was a prospective, randomized, open-label trial comparing non-vitamin K oral anticoagulant (NOAC) edoxaban with vitamin K antagonists (VKAs) in patients with atrial fibrillation after successful transcatheter aortic valve replacement (TAVR). The effect of edoxaban- or VKA-based therapy on patient-reported outcomes remains unknown, as most studies focus on efficacy and safety. Pre-TAVR patient-reported expectations and post-TAVR Treatment Satisfaction and Convenience with edoxaban or VKA treatment (at months 3 and 12) were analyzed using the Perception of Anticoagulation Treatment Questionnaire (PACT-Q). This analysis included randomized and dosed patients with an evaluable PACT-Q1 assessment at baseline and ≥1 postbaseline assessment (PACT-Q2). Subanalyses included patients stratified by pre-TAVR anticoagulant (NOAC, VKA, no NOAC/VKA). Edoxaban- (n = 585) and VKA-treated (n = 522) patients had similar baseline characteristics and treatment expectations. Pre-TAVR anticoagulant use did not affect treatment expectations. After TAVR, edoxaban-treated patients had significantly higher Treatment Satisfaction and Convenience scores compared with VKA-treated patients at all time points (p <0.001 for all). Among edoxaban-treated patients, those who received VKAs pre-TAVR were significantly more satisfied with treatment than those who received NOACs (p <0.001) or no NOACs/VKAs (p = 0.003); however, there was no significant difference in the perception of convenience (p = 0.927 and p = 0.092, respectively). Conversely, among VKA-treated patients, the type of anticoagulant used pre-TAVR did not affect Treatment Satisfaction or Convenience scores post-TAVR. In conclusion, patients with atrial fibrillation who received edoxaban post-TAVR reported significantly higher Treatment Satisfaction and Convenience scores compared with those who received VKAs, resulting in a clinically meaningful difference between treatment groups.</AbstractText><br /><br />Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 14 Oct 2023; epub ahead of print</small></div>

<div><h4>Surgical Ablation for Atrial Fibrillation During Mitral Valve Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.</h4><i>Gemelli M, Gallo M, Addonizio M, Van den Eynde J, ... Slaughter MS, Gerosa G</i><br /><AbstractText>Although surgical ablation has been shown to produce excellent outcomes at follow-up for patients with atrial fibrillation who underwent mitral valve replacement/repair (MVR), this procedure is not commonly performed. Our objective was to conduct a systematic review and meta-analysis to evaluate the outcomes of concomitant surgical ablation during MVR. Three databases were systematically reviewed for randomized clinical trials published by August 2022. The primary outcome was sinus rhythm (SR) at 12 months. Secondary outcomes included SR at discharge and 6 months, all-cause mortality, permanent pacemaker implantation, and stroke and thromboembolic events. A random-effects meta-analysis was performed, calculating odds ratios (ORs) for each outcome. Thirteen studies were included, involving 1,089 patients comparing patients who underwent either isolated MVR (\"MVR-only\") or concomitant surgical ablation during MVR (\"MVR+Ablation\"). The odds of SR were significantly higher in the MVR+Ablation group at discharge (OR 9.62, 95% confidence interval [CI] 4.87 to 19.02, I<sup>2</sup> = 55%), at 6-month follow-up (OR 7.21, 95% CI 4.30 to 12.11, I<sup>2</sup> = 34%), and at 1-year follow-up (OR 8.41, 95% CI 5.14 to 13.77, I<sup>2</sup> = 48%). All-cause mortality was not different in the groups, as were stroke and thromboembolic events, whereas the odds of permanent pacemaker implantation were slightly higher in the MVR+Ablation group (OR 1.87, 95% CI 1.11 to 3.17, I<sup>2</sup> = 0%). Concomitant surgical ablation during MVR showed excellent outcomes at short-term follow-up, despite a slightly higher rate of permanent pacemaker implantation. Further studies with longer follow-ups are needed to assess if the SR is maintained over the years.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 14 Oct 2023; epub ahead of print</small></div>

<div><h4>Outcomes With Intravascular Ultrasound and Optical Coherence Tomography Guidance in Percutaneous Coronary Intervention.</h4><i>Arora S, Jaswaney R, Khawaja T, Jain A, ... Shah AR, Kleiman NS</i><br /><AbstractText>Intracoronary imaging has become an important tool in the treatment of complex lesions with percutaneous coronary intervention (PCI). This retrospective cohort study identified 1,118,475 patients with PCI from the Nationwide Readmissions Database from 2017 to 2019. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) were identified with appropriate International Classification of Diseases, Tenth Revision codes. The primary outcome was major adverse cardiac events. The secondary outcomes include net adverse clinical events (NACEs), all-cause mortality, myocardial infarction (MI) readmission, admission for stroke, and emergency revascularization. The multivariate Cox proportional hazard regression was used to adjust for demographic and co-morbid confounders. Of 1,118,475 PCIs, 86,140 (7.7%) used IVUS guidance and 5,617 (0.5%) used OCT guidance. The median follow-up time was 184 days. The primary outcome of major adverse cardiac events was significantly lower for the IVUS (6.5% vs 7.6%; hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.86 to 0.91, p <0.001) and OCT (4.4% vs 7.6%; HR 0.69, 95% CI 0.61 to 0.79, p <0.001) groups. IVUS was associated with significantly lower rates of NACEs (8.4% vs 9.4%; HR 0.92, 95% CI 0.89 to 0.94, p <0.001), all-cause mortality (3.5% vs 4.3%; HR 0.85, 95% CI 0.82 to 0.88, p <0.001), readmission for MI (2.7% vs 3.0%; HR 0.95, 95% CI 0.91 to 0.99, p = 0.012), and admission for stroke (0.5% vs 0.6%; HR 0.86, 95% CI 0.78 to 0.95, p = 0.002). OCT was associated with significantly lower rates of NACEs (6.6% vs 9.4%; HR 0.81, 95% CI 0.73 to 0.89, p <0.001) and all-cause mortality (1.8% vs 4.3%; HR 0.51, 95% CI 0.42 to 0.63, p <0.001). Emergency revascularization was not significantly different with IVUS guidance. Readmission for MI, stroke, and emergency revascularization were not significantly different with OCT guidance. A subgroup analysis of patients with ST-elevation MI and non-ST-elevation MI showed similar results. In conclusion, the use of IVUS and OCT guidance with PCI were associated with significantly lower rates of morbidity and mortality in real-world practice.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 14 Oct 2023; 207:470-478</small></div>

<div><h4>Accurate Prediction of Retrograde Collateral Channel Crossing in Coronary Artery Chronic Total Occlusion Intervention.</h4><i>Chang HY, Huang CC, Hung CS, Meng SW, ... Yeh CF, Kao HL</i><br /><b>Background</b><br />Successful collateral channel (CC) crossing is an essential step in retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI). We previously developed a dedicated CC score based on CC size and tortuosity to facilitate target CC selection. Validation and comparison to other scoring systems were lacking. Thus, the aims of this study were to 1) validate the CC score in a larger independent cohort, and 2) compare its accuracy and clinical usefulness with the J-channel score.<br /><b>Methods</b><br />All coronary CTO PCIs attempted by experienced high-volume operators from January, 2017 to December, 2021 were enrolled. The CC and J-channel scores were calculated for all attempted CCs with bi-plane high-resolution cine angiography images. CC crossing success was defined as guidewire reaching the distal true lumen retrogradely.<br /><b>Results</b><br />In total, 502 patients who received CTO PCI were included. The retrograde approach was utilized in 244 target CTOs, and a total of 329 CCs were attempted. The overall CC crossing rate was 67.8% (223/329) and final technical success rate 92.2% (225/244). The average CC score was 2.0 and average J-channel score was 0.71. The sensitivity and specificity of successful CC crossing with the CC score ≥2 were 81.2%, and 84.0%, respectively. Comparison between the CC score (area under the curve [AUC] 0.87; 95% confidence interval [CI] 0.83-0.90) and the J-channel score (AUC 0.61; 95% CI 0.55-0.67) demonstrated superior predictive performance of the CC score (p <0.001).<br /><b>Conclusions</b><br />The CC score was an easy-to-use and accurate tool for the prediction of successful CC crossing in retrograde CTO PCI. The CC score can help operators select the ideal target CC, thereby facilitating final procedural success.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 14 Oct 2023; epub ahead of print</small></div>

<div><h4>Gender-Based Outcome Discrepancies in Patients Who Underwent Alcohol Septal Ablation or Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis.</h4><i>Saravanabavanandan R, Jaimalani A, Khan MAN, Riaz S, ... Fawad M, Al-Tawil M</i><br /><AbstractText>Clinical evidence and emerging studies suggest that the clinical heterogeneity observed in hypertrophic cardiomyopathy could be because of gender-based differences. We aimed to explore the gender-related differences pertaining to the treatment outcomes after alcohol septal ablation (ASA) and septal myectomy (SM). We searched PUBMED/MEDLINE, EMBASE, and SCOPUS to identify studies that report gender-stratified comparison of outcomes. The primary outcome of interest was short-term (within 30 days) mortality. A total of 15 studies totaling 31,907 patients (47% men and 53% women) were included. Women were found to be significantly older at the time of intervention (ASA: mean difference [MD] 7.55 years; SM: MD 4.41). In the ASA and SM treatment arms, women had a significantly higher risk of short-term all-cause mortality (ASA: risk ratio 0.48, 95% confidence interval 0.32 to 0.71, p = 0.0003; SM: risk ratio 0.63, 95% confidence interval 0.44 to 0.90, p = 0.01), more frequent permanent pacemaker implantation (ASA; p = 0.002, SM: p = 0.05), and longer in-hospital stay (ASA: MD 1.00 days, SM: MD 0.69). Among those who underwent ASA, women had a significantly higher rate of atrioventricular block. In conclusion, regardless of ASA or SM, women consistently presented at an older age and exhibited a higher risk-increased mortality rate, a greater incidence of atrioventricular block, and a higher likelihood of permanent pacemaker requirement-and longer hospital stay among women than men. This strongly emphasizes the need for a gender-specific approach to optimize care and improve treatment outcomes in hypertrophic cardiomyopathy.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 13 Oct 2023; 208:134-142</small></div>

<div><h4>Role of Intravascular Imaging in Complex Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials.</h4><i>Singh S, Jain A, Goel S, Garg A, ... Tantry US, Gurbel PA</i><br /><AbstractText>Intravascular imaging (IVI) during percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes. However, data is limited in complex PCI and the adoption remains low. We aimed to conduct a meta-analysis of all available randomized controlled trials comparing IVI with conventional angiography in patients who underwent complex PCI. The primary outcomes of interest were major adverse cardiovascular events, all-cause death, cardiovascular death, myocardial infarction, stent thrombosis, target lesion revascularization and target vessel revascularization. Random-effects model was used to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs). A total of 10 randomized controlled trials comprising 6,368 patients with 3,452 in the IVI group and 2,916 in the angiography group were included. The mean duration of follow up was 2 years, mean age was 65 years and 73% of patients were men. As compared with PCI with routine angiography, the IVI-guided PCI group had significantly lower risks of major adverse cardiovascular events (RR 0.65, 95% CI 0.56 to 0.75, p <0.00001), stent thrombosis (RR 0.57, 95% CI 0.36 to 0.92, p = 0.02), cardiovascular deaths (RR 0.46, 95% CI 0.31 to 0.68, p = 0.0001), target lesion revascularization (RR 0.61, 95% CI 0.48 to 0.78, p <0.0001) and target vessel revascularization (RR 0.62, 95% CI 0.48 to 0.80, p = 0.0003). All-cause deaths and MI were similar in the 2 groups. In conclusion, among patients who underwent complex PCI, IVI reduces adverse events, importantly stent thrombosis and repeat revascularizations, compared with angiography alone guided PCI.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 13 Oct 2023; 208:143-152</small></div>

<div><h4>Acute Effect of Atrial Fibrillation on Circulating Natriuretic Peptides: The Influence of Heart Rate, Rhythm Irregularity, and Left Atrial Pressure Overload.</h4><i>Stojadinovic P, Wichterle D, Fukunaga M, Peichl P, ... Kautzner J, Sramko M</i><br /><AbstractText>Plasma natriuretic peptides (NPs) are increased in patients with atrial fibrillation (AF) compared with the patients with sinus rhythm. This study investigated whether this phenomenon is intrinsic to heart rhythm irregularity and independent of the heart rate and left atrial pressure (LAP) overload. We investigated 46 patients (age: 59 ± 10 years, male gender: 77%) with non-valvular paroxysmal AF who were scheduled for catheter ablation and had documented stable sinus rhythm for at least 18 hours before the procedure. All patients underwent direct measurement of right atrial pressure and LAP, simultaneously with assessment of plasma B-type NP, N-terminal pro-brain NP, and mid-regional pro-atrial NP. The baseline measurement was followed by induction of AF by rapid atrial pacing in the first 24 patients and by regular pacing from the coronary sinus at 100/min (corresponding to the mean heart rate during induced AF) in the latter 22 patients. Hemodynamic assessment and blood sampling were repeated after 20 min of the ongoing AF or fast regular paging. The baseline characteristics and hemodynamic measurements were comparable between study groups; however, patients in the regular atrial pacing group had a higher body mass index and a larger left atrial diameter compared with the induced AF group. Plasma levels of all 3 NPs increased significantly during induced AF but not during fast regular pacing, and the increase of NPs was independent of right atrial pressure and LAP. Baseline concentrations of NPs and heart rhythm irregularity were the only independent predictors of increased NPs.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 13 Oct 2023; 208:156-163</small></div>