Journal: Am J Cardiol

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Abstract

Combined Cardiovascular Syphilis and Aortic Valve Stenosis (Due to a Congenitally Unicuspid Valve).

Makhdumi M, Roberts WC
Described herein is a 53-year-old man who underwent resection of a fusiform aneurysm of the ascending aorta, and excision of a congenitally malformed stenotic unicuspid aortic valve. Examination of the wall of the aortic aneurysm disclosed classic features of syphilis. Although some degree of pure aortic regurgitation is common in patients with aortic syphilis, the presence of associated aortic valve stenosis, such as occurred in this patient, has been mentioned in only 4 previous publications, none of which included morphologic examination of the ascending aorta or aortic valve.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 01 Jun 2022; 172:144-145
Makhdumi M, Roberts WC
Am J Cardiol: 01 Jun 2022; 172:144-145 | PMID: 35569880
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Abstract

Reflections on Six Decades of Hypertrophic Cardiomyopathy From Eugene Braunwald.

Maron BJ, Maron MS
On October 16 to 18, 2021, the 3-day 7th International Summit of Hypertrophic Cardiomyopathy was held virtually with almost 700 registrants and faculty from 40 countries and 42 states (Drs. Martin and Barry Maron, Directors). This meeting, the largest for this disease, was an opportunity to engage on a wide variety of topics with insights relevant to hypertrophic cardiomyopathy provided by 47 lectures, debates, and comprehensive discussions from 36 distinguished international speakers, including Dr. Eugene Braunwald.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 01 Jun 2022; 172:150-153
Maron BJ, Maron MS
Am J Cardiol: 01 Jun 2022; 172:150-153 | PMID: 35569882
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Abstract

Jeff Zucker Says Hypertrophic Cardiomyopathy is a Curable Disease: A Patient\'s Perspective.

Maron BJ, Maron MS
LV outflow obstruction in patients with hypertrophic cardiomyopathy can cause marked limiting symptoms of heart failure, reversible with surgical septal myectomy. Here we provide a patient\'s perspective on heart failure in hypertrophic cardiomyopathy and personal experience undergoing the myectomy operation to correct his substantial disability.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 01 Jun 2022; 172:154-156
Maron BJ, Maron MS
Am J Cardiol: 01 Jun 2022; 172:154-156 | PMID: 35569883
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Abstract

Examination of Operatively-Excised Bioprostheses in the Mitral Valve Position to Determine the Reason for Dysfunction.

Roberts WC, Salam YM
Described herein are some clinical and morphologic findings in 23 patients who underwent operative replacement of a previously implanted bioprosthesis in the mitral valve position. Photographs of the operatively excised bioprostheses were provided in 15 (65%) of the 23 patients. A variety of causes were responsible for the bioprosthetic dysfunction. Twelve surgeons excised the dysfunctioning bioprostheses, an average of <2/surgeon, and a variety of techniques were employed to excise the bioprosthesis.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 01 Jun 2022; 172:98-106
Roberts WC, Salam YM
Am J Cardiol: 01 Jun 2022; 172:98-106 | PMID: 35569884
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Abstract

Comparison of Frequency of Ventricular Tachyarrhythmia in Men-Versus-Women in Patients with Implantable Cardioverter-Defibrillator for Primary Prevention.

Ojo A, Younis A, Saxena S, Kutyifa V, ... Zareba W, Goldenberg I
Current guidelines do not account for possible sex differences in the risk of ventricular tachyarrhythmia (VTA). We sought to identify specific factors associated with increased risk for VTA in women implanted with a primary prevention implantable cardioverter-defibrillator (ICD). Our study cohort consisted of 4,506 patients with an ICD or cardiac resynchronization therapy-defibrillator who were enrolled in the 4 landmark MADIT studies - MADIT-II, MADIT-RISK, MADIT-CRT and MADIT-RIT (1,075 women [24%]). Fine and Gray regression models were used to identify female-specific risk factors for the primary end point of VTA, defined as ICD-recorded, treated, or monitored, sustained ventricular tachycardia ≥170 beats per minute or ventricular fibrillation. At 3.5 years of follow-up, the cumulative incidence of VTA was significantly lower in women than men (17% vs 26%, respectively; p <0.001 for the entire follow-up). Use of amiodarone at enrollment, Black race, and history of previous myocardial infarction without previous revascularization was found to be independent risk factors of VTA in women. Of these factors, only Black race was associated with a statistically significant risk increase in men. At 3.5 years, the cumulative incidence of VTA in women with one or more of these risk factors was 27% compared with 14% in women with none of the risk factors (hazard ratio [confidence interval] = 2.08 [1.49 to 2.91]). In conclusion, our study, comprising 4 landmark ICD clinical trials, shows that sex and race have the potential to be used for improved risk stratification of patients who are candidates for primary prevention ICD.

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Am J Cardiol: 20 May 2022; epub ahead of print
Ojo A, Younis A, Saxena S, Kutyifa V, ... Zareba W, Goldenberg I
Am J Cardiol: 20 May 2022; epub ahead of print | PMID: 35606170
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Abstract

Usefulness of Serum Biomarkers of Endothelial Glycocalyx Damage in Prognosis of Decompensated Patients with Heart Failure with Reduced Ejection Fraction.

Kim YH, Kitai T, Morales R, Kiefer K, Chaikijurajai T, Tang WHW
The surface layer of endothelium contains the endothelial glycocalyx (eGC), consisting of proteoglycan polymers. Syndecan-1, heparan sulfate, and hyaluronic acid are major constituents of eGC, and their increasing detection in serum represents active degradation of eGC. Serum was obtained from patients with no heart failure (non-HF) and with HF with reduced ejection fraction (HFrEF) of <40%, either stable chronic HF (CHF) or acute decompensated HF (ADHF). Syndecan-1, heparan sulfate, and hyaluronic acid were measured for comparisons in the groups, adjusting for clinical and laboratory values. In our study cohort, 51 non-HF, 66 ADHF, and 72 patients with CHF were enrolled. Between ADHF and CHF, left ventricular (LV) mass index, LV ejection fraction, and pulmonary capillary wedge pressure did not differ. Patients with ADHF had significantly higher levels of eGC constituents compared with CHF and non-HF. During follow-up, 21 patients with HF died, and the mortality rate was higher in patients with higher serum syndecan-1 or heparan sulfate (log-rank p = 0.007 and 0.016, respectively). In multivariate analysis, a doubling of serum heparan sulfate concentration amounted to a 31.5% increase in all-cause mortality (hazard ratio = 1.315, confidence interval = 1.012-1.709, p = 0.040). In conclusion, serum biomarkers of eGC were elevated in ADHF (but not in CHF) in patients with HFrEF, suggesting the potential roles of eGC degradation and endothelial dysfunction in HF decompensation. Only elevated heparin sulfate was associated with higher all-cause mortality after adjusting for traditional risk variables in patients with HFrEF.

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Am J Cardiol: 20 May 2022; epub ahead of print
Kim YH, Kitai T, Morales R, Kiefer K, Chaikijurajai T, Tang WHW
Am J Cardiol: 20 May 2022; epub ahead of print | PMID: 35606171
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Abstract

One-Year Ischemic and Bleeding Events According to Renal Function in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Treated With Percutaneous Coronary Intervention and Third-Generation Antiplatelet Drugs.

Ndrepepa G, Lahu S, Aytekin A, Scalamogna M, ... Mayer K, Kastrati A
The optimal antiplatelet therapy of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and chronic kidney disease (CKD) remains unknown. This study included 2,364 patients with NSTE-ACS undergoing predominantly percutaneous coronary intervention (PCI), who were randomized to ticagrelor or prasugrel in the ISAR-REACT 5 trial. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. The primary end point was 1-year mortality. Overall, there were 85 deaths (3.6%): 6 deaths (17.1%) in patients with eGFR <30, 31 deaths (6.9%) in patients with eGFR 30 to <60, 34 deaths (3.0%) in patients with eGFR 60 to <90, and 14 deaths (2.0%) in patients with eGFR ≥90 ml/min/1.73 m2; adjusted hazard ratio (HR)=1.15, 95% confidence interval (CI) 1.01 to 1.31; p = 0.033 for 10 ml/min/1.73 m2 decrement in the eGFR. Bleeding occurred in 129 patients (5.5%): 7 bleeds (20.2%) in patients with eGFR <30, 36 bleeds (8.0%) in patients with eGFR 30 to <60, 64 bleeds (5.6%) in patients with eGFR 60 to <90, and 22 bleeds (3.1%) in patients with eGFR ≥90 ml/min/1.73 m2; adjusted HR=1.11 (1.01 to 1.23); p = 0.045 for 10 ml/min/1.73 m2 decrement in the eGFR. One-year mortality and bleeding did not differ significantly between ticagrelor and prasugrel in all categories of impaired renal function. In conclusion, in patients with NSTE-ACS undergoing PCI with drug-eluting stents and third-generation antiplatelet drugs, impaired renal function was independently associated with higher risk of 1-year mortality and bleeding. The ischemic and bleeding risks appear to differ little between ticagrelor and prasugrel in all categories of impaired renal function.

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Am J Cardiol: 20 May 2022; epub ahead of print
Ndrepepa G, Lahu S, Aytekin A, Scalamogna M, ... Mayer K, Kastrati A
Am J Cardiol: 20 May 2022; epub ahead of print | PMID: 35606172
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Abstract

Usefulness of Statins as Secondary Prevention Against Recurrent and Terminal Major Adverse Cardiovascular Events.

Tecson KM, Kluger AY, Cassidy-Bushrow AE, Liu B, ... VanWormer JJ, McCullough PA
Clinical guidelines recommend statins for patients with atherosclerotic cardiovascular disease (ASCVD), but many remain untreated. The goal of this study was to assess the impact of statin use on recurrent major adverse cardiovascular events (MACE). This study used medical records and insurance claims from 4 health care systems in the United States. Eligible adults who survived an ASCVD hospitalization from September 2013 to September 2014 were followed for 1 year. A multivariable extended Cox model examined the outcome of time-to-first MACE, then a multivariable joint marginal model investigated the association between post-index statin use and nonfatal and fatal MACE. There were 8,168 subjects in this study; 3,866 filled a statin prescription ≤90 days before the index ASCVD event (47.33%) and 4,152 filled a statin prescription after the index ASCVD event (50.83%). These post-index statin users were younger, with more co-morbidities. There were 763 events (315/763, 41.3% terminal) experienced by 686 (8.4%) patients. The adjusted overall MACE risk reduction was 18% (HR 0.82, 95% CI 0.70 to 0.95, p = 0.007) and was more substantial in the first 180 days (HR 0.72, 95% CI 0.60 to 0.86, p <0.001). There was a nonsignificant 19% reduction in the number of nonfatal MACE (rate ratio 0.81, 95% CI 0.49 to 1.32, p = 0.394) and a 65% reduction in the risk of all-cause death (HR 0.35, 95% CI 0.22 to 0.56, p <0.001). In conclusion, we found a modest increase in statin use after an ASCVD event, with nearly half of the patients untreated. The primary benefit of statin use was protection against early death. Statin use had the greatest impact in the first 6 months after an ASCVD event; therefore, it is crucial for patients to quickly adhere to this therapy.

Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 20 May 2022; epub ahead of print
Tecson KM, Kluger AY, Cassidy-Bushrow AE, Liu B, ... VanWormer JJ, McCullough PA
Am J Cardiol: 20 May 2022; epub ahead of print | PMID: 35606173
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Abstract

Five-Year Outcomes After Coronary Computed Tomography Angiography (From 110,599 Patients in a Danish Nationwide Register-Based Follow-Up Study).

Kragholm K, Rasmussen JG, Søndergaard MM, Zaremba T, ... Mamas M, Freeman P
The long-term cardiovascular risk for patients examined with coronary computed tomography angiography (CCTA) to rule out coronary heart disease compared with population controls remains unexplored. A nationwide register-based study including first-time CCTA-examined patients between 2007 and 2017 in Denmark alive 180 days post-CCTA was conducted. We evaluated 5-year outcomes of myocardial infarction (MI) or revascularization and all-cause mortality in 3 distinct CCTA-groups: (1) no post-CCTA preventive pharmacotherapy use (cholesterol-lowering drugs, antiplatelets, or anticoagulants); (2) post-CCTA preventive pharmacotherapy use; and (3) revascularization or MI within 180 days post-CCTA. For each patient group, population controls were matched on age, gender, and calendar year. Absolute risks standardized to the age, gender, selected co-morbidity, and anti-anginal pharmacotherapy distributions of the specific CCTA-examined patients and respective controls were obtained from multivariable Cox regression. Of 110,599 CCTA-examined patients, (1) 48,231 patients were not prescribed preventive pharmacotherapy 180 days post-CCTA; (2) 42,798 patients were prescribed preventive pharmacotherapy within 180 days post-CCTA; and (3) 19,570 patients were diagnosed with MI or revascularized within 180 days post-CCTA. For patient groups 1 to 3 versus respective controls, 5-year MI or revascularization risks were <0.1% versus 2.0%, <0.1% versus 3.8%, and 19.0% versus 2.5%, all p<0.001. Five-year all-cause mortality were 2.8% versus 4.2%, 5.5% versus 8.8%, and 6.7% versus 8.5%, all p <0.001. In conclusion, the 5-year MI or revascularization risk can be considered very low for CCTA-examined patients without ischemic events within 180 days post-CCTA. Conversely, CCTA-examined patients with MI or revascularization events within 180 days post-CCTA have significantly elevated 5-year MI or revascularization risk.

Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 20 May 2022; epub ahead of print
Kragholm K, Rasmussen JG, Søndergaard MM, Zaremba T, ... Mamas M, Freeman P
Am J Cardiol: 20 May 2022; epub ahead of print | PMID: 35606174
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Abstract

Relation of Ischemic Heart Disease to Outcomes in Patients With Acute Respiratory Distress Syndrome.

Biondi M, Jain S, Fuery M, Thomas A, ... Desai NR, Miller PE
Patients with ischemic heart disease (IHD) are often excluded from acute respiratory distress syndrome (ARDS) clinical trials. As a result, little is known about the impact of IHD in this population. We sought to assess the association between IHD and clinical outcomes in patients with ARDS. Participants from 4 ARDS randomized controlled trials with shared study criteria, definitions, and end points were included. Using multivariable logistic regression, we assessed for the association between IHD and a primary outcome of 60-day mortality. Secondary outcomes included 90-day mortality, 28-day ventilator-free days, and 28-day organ failure. Among 1,909 patients, 102 had a history of IHD (5.4%). Patients with IHD were more likely to be older and male (p <0.05). Noncardiac co-morbidities, severity of illness, and other markers of ARDS severity were not statistically different (all, p >0.05). Patients with IHD had a higher 60-day (39.2% vs 23.3%, p <0.001) and 90-day (40.2% vs 24.0%, p <0.001) mortality, and experienced more frequent renal (45.1% vs 32.0%, p = 0.006) and hepatic (35.3% vs 25.2%, p = 0.023) failure. After multivariable adjustment, 60-day (odds ratio [OR] 1.76; 95% confidence interval [CI]: 1.07 to 2.89, p = 0.025) and 90-day (OR 1.74; 95% CI: 1.06 to 2.85, p = 0.028) mortality remained higher. IHD was associated with 10% fewer ventilator-free days (incidence rate ratio 0.90; 95% CI: 0.85 to 0.96, p = 0.001). In conclusion, co-morbid IHD was associated with higher mortality and fewer ventilator-free days in patients with ARDS. Future studies are needed to identify predictors of mortality and improve treatment paradigms in this critically ill subgroup of patients.

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Am J Cardiol: 20 May 2022; epub ahead of print
Biondi M, Jain S, Fuery M, Thomas A, ... Desai NR, Miller PE
Am J Cardiol: 20 May 2022; epub ahead of print | PMID: 35606175
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Abstract

Massive Calcification of the Ascending Aorta Secondary to Irradiation for Hodgkin\'s Disease Decades Earlier in Association with Aortic Valve Stenosis.

Roberts WC, Jeong M
Described herein are findings in 2 men who developed massively calcified non-dilated ascending aortas decades after receiving mediastinal irradiation for treatment of Hodgkin\'s disease associated with aortic valve stenosis. The quantity of the intimal aortic calcium was remarkable and much greater than in other aortic conditions. The ascending aorta had to be excised in one patient in order to replace the stenotic aortic valve. The other patient underwent percutaneous transluminal aortic valve implantation.

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Am J Cardiol: 20 May 2022; epub ahead of print
Roberts WC, Jeong M
Am J Cardiol: 20 May 2022; epub ahead of print | PMID: 35606176
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Abstract

Management and outcomes of ST-segment elevation myocardial infarction in hospitalized frail patients in the United States.

Rubens M, Ramamoorthy V, Saxena A, Zevallos JC, ... Chaparro S, Jimenez Carcamo J
Cardiovascular diseases and frailty are common conditions of aging populations and often coexist. In this study, we examined the in-hospital management, outcomes, and resource use of frail patients hospitalized for ST-segment elevation myocardial infarction (STEMI). This was a retrospective analysis of the 2005-2014 data from the Nationwide Inpatient Sample. Patients were classified into to versus \'nonfrail\' using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. The primary outcome was STEMI management, whereas secondary outcomes were in-hospital mortality, length of stay, and cost. Outcomes were compared between frail and nonfrail patients using propensity score-matched analysis. There were 1,360,597 STEMI hospitalizations, of which 36,316 (2.7%) were frail. Propensity score-matched analysis showed that in in-hospital management options for STEMI, the odds of overall revascularization (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.55 to 0.65), percutaneous coronary intervention (OR, 0.53; 95% CI, 0.49 to 0.57), and coronary angiography (OR, 0.59; 95% CI, 0.55 to 0.64) were significantly lower for frail patients. The odds of receiving coronary artery bypass grafting (OR, 1.66; 95% CI, 1.48 to 1.86) and overall hemodynamic support (OR, 1.26; 95% CI, 1.15 to 1.39) were significantly higher for frail patients. In-hospital mortality (18.7% vs 8.2%, p <0.001), length of stay (7.7 vs 3.7 days, p <0.001) and costs ($90,060 vs $63,507, p <0.001) were significantly higher in frail patients. Our findings suggest that collaborative efforts by cardiologists and cardiovascular surgeons for identifying frailty in patients with STEMI and incorporating frailty in risk estimation measures may improve management strategies, resource use and optimize patient outcomes.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 19 May 2022; epub ahead of print
Rubens M, Ramamoorthy V, Saxena A, Zevallos JC, ... Chaparro S, Jimenez Carcamo J
Am J Cardiol: 19 May 2022; epub ahead of print | PMID: 35599189
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Abstract

Timing of Repair in Postinfarction Ventricular Septal Defect.

Jaswaney R, Arora S, Khwaja T, Shah N, ... Abu-Omar Y, Shishehbor MH
The optimal timing of postinfarction ventricular septal defect (PI-VSD) repair is subject to debate. Patients with ventricular septal defect (VSD) and ST-elevation myocardial infarction (STEMI) were queried using appropriate International Classification of Diseases, Ninth and Tenth Revision Clinical Modification codes from the National Inpatient Sample (2003 to 2018). VSD repair was identified using appropriate International Classification of Diseases, Ninth and Tenth Revision Procedure Coding System codes. Data were stepwise stratified by cardiogenic shock (CS) and time of repair from admission to create 6 clinically relevant groups: shock 1 (CS; 0 to 7 days), shock 2 (CS; 8 to 14 days), and shock 3 (CS; >14 days). Nonshock groups were classified similarly. The primary outcome was in-hospital mortality. Multilevel hierarchical logistic regression was used to adjust for confounders for each group. We identified 10,902 patients with PI-VSD. In shock 1 (n = 5,794), VSD repair was associated with lower mortality (OR 0.76; 95% CI 0.68 to 0.86, p <0.001) compared to no VSD repair. In shock 2 (n=1,009) mortality was numerically lower in those who received VSD repair, but not statistically different. In shock 3 (n=483), mortality was numerically higher in those who received VSD repair, but not statistically different. In nonshock 1 (n=5,108), VSD repair was associated with higher mortality (odds ratio [OR] 1.59; 95% confidence interval [CI] 1.33 to 1.90; p <0.001). In nonshock 2 (n = 1,265), mortality was numerically higher in patients with VSD repair, although not statistically different. In nonshock 3 (n = 472), mortality was numerically lower in patients with VSD repair, although not statistically different. Mechanical circulatory support use increased over the 16 years (relative change + 18%, p <0.001), with no significant change in mortality among patients with PI-VSD. In conclusion, in patients with CS, early PI-VSD repair was associated with lower mortality. However, in patients without CS, early PI-VSD repair was associated with higher mortality.

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Am J Cardiol: 18 May 2022; epub ahead of print
Jaswaney R, Arora S, Khwaja T, Shah N, ... Abu-Omar Y, Shishehbor MH
Am J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597625
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Abstract

Echocardiographic Abnormalities in Adults With Anorexia Nervosa.

Scheggi V, Castellini G, Vanni F, Menale S, ... Ricca V, Marchionni N
Anorexia nervosa (AN) is a psychiatric disorder that may lead to cardiac complications. The objective of this study was to evaluate global and regional longitudinal strain changes in patients affected by AN as an early marker of myocardial damage. We prospectively enrolled 48 consecutive patients with AN and 44 age-matched and gender-matched healthy controls. In all subjects, we performed echocardiography, including global longitudinal strain (GLS) measurement. A subset of 33 patients with AN had further echocardiographic examinations during the follow-up. Compared with healthy controls, patients with AN had a greater prevalence of pericardial effusion (9 of 48 vs 0 of 44, p = 0.003), a smaller left ventricular mass (63 ± 15 vs 99 ± 30 g, p < 0.001), a lower absolute value of GLS (-18.9 ± 2.8 vs -20.2 ± 1.8%, p = 0.010) and of basal LS (-15.4 ± 6.0 vs -19.4 ± 2.6%, p < 0.001). The bull\'s eye mapping showed a plot pattern with blue basal areas in 18 of 48 patients with AN versus 1 of 44 controls (p < 0.001). During the follow-up, of 13 patients with blue areas in the first bull\'s eye mapping, 11 recovered completely, and of 20 patients with a red bull\'s eye at the first examination, none presented blue areas at the second one. In conclusion, GLS is significantly altered in patients with AN, and a basal blue pattern on bull\'s eye mapping identifies more severe cases. These changes seem to be reversible.

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Am J Cardiol: 18 May 2022; epub ahead of print
Scheggi V, Castellini G, Vanni F, Menale S, ... Ricca V, Marchionni N
Am J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597626
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Abstract

Risk Stratification of New Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Implantation.

Tsushima T, Main A, Al-Kindi SG, Dallan LAP, ... Barbanti M, Attizzani GF
Previous studies reported that new-onset persistent left bundle branch block (NOP-LBBB) was related to worse outcomes after transcatheter aortic valve implantation (TAVI). However, these results can be confounded by the presence of permanent pacemaker (PPM) implantation before and after TAVI. Long-term outcomes and the risk stratification of NOP-LBBB not having PPM implantation before and after TAVI have not been fully investigated. This is an international, multicenter, retrospective study of patients who underwent TAVI from July 31, 2007, to May 8, 2020. A total of 2,240 patients were included, and 17.5% of patients developed NOP-LBBB. NOP-LBBB was associated with cardiac mortality (adjusted hazard ratio [aHR] 1.419, 95% confidence interval [CI] 1.014 to 1.985, p = 0.041) and the composite outcomes of cardiac mortality and/or heart failure readmission (aHR 1.313, 95% CI 1.027 to 1.678, p = 0.030). Patients who developed NOP-LBBB with pre-TAVI left ventricular ejection fraction (LVEF) <40% were significantly associated with cardiac mortality (aHR 2.049, 95% CI 1.039 to 4.041, p = 0.038), heart failure (aHR 3.990, 95% CI 2.362 to 6.741, p <0.001), and the composite outcome (aHR 2.729, 95% CI 1.703 to 4.374, p <0.001). Although NOP-LBBB with pre-TAVI LVEF >40% had a significant decrease in LVEF 6 to 12 months after TAVI (-1.8 ± 9.7% vs +0.6 ± 8.1%, p = 0.003), NOP-LBBB with pre-TAVI LVEF <40% had a significant increase in LVEF 6 to 12 months after TAVI (+9.7 ± 13.6% vs +13.0 ± 11.7%, p = 0.157). In conclusion, patients with NOP-LBBB without pre-TAVI and post-TAVI PPM developed significantly worse long-term outcomes, especially in patients with pre-TAVI LVEF <40%. Further prospective investigation should be undertaken.

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Am J Cardiol: 18 May 2022; epub ahead of print
Tsushima T, Main A, Al-Kindi SG, Dallan LAP, ... Barbanti M, Attizzani GF
Am J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597627
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Abstract

Mechanistic Insights into Tricuspid Regurgitation Secondary to Pulmonary Arterial Hypertension.

Kassis N, Layoun H, Goyal A, Dong T, ... Kapadia SR, Harb SC
The simultaneous presence of pulmonary arterial hypertension (PAH) and secondary tricuspid regurgitation (STR) portends particularly poor outcomes. However, not all patients with PAH develop significant STR, and the mechanisms and clinical implications underlying this phenomenon remain unclear. We sought to describe the functional, anatomic, hemodynamic, and clinical characteristics of patients with PAH with and without STR. Patients diagnosed with PAH between 2007 and 2013 were included. STR, defined by absent primary tricuspid valve disease on transthoracic echocardiogram, was considered significant if ≥ moderate in severity. The characteristics of right-sided chambers and tricuspid valve annuli and leaflets were compared between patients with significant versus nonsignificant STR using a transthoracic echocardiogram, cardiac computed tomography, and right-sided cardiac catheterization. These features were then correlated with the composite outcome of all-cause mortality and PAH hospitalization. Of 88 included patients, 52 had significant STR. No baseline clinical differences, including atrial fibrillation, were observed. Patients with significant STR had worse right ventricular dysfunction (tricuspid annular planar systolic excursion = 1.5 vs 2.1 cm; p = 0.02) and increased right ventricular sphericity (sphericity index = 1.8 vs 2; p = 0.004), with similar annular dimensions/shape, lengths/angles of the mural and septal leaflets, and tenting height. After a median of 54 months, right atrial mean pressure was independently associated with the composite outcome on multivariable analysis (hazard ratio = 1.07, p = 0.02). In conclusion, anatomic and functional alterations in the right ventricle rather than the tricuspid valve are implicated in developing significant STR in PAH. Multimodality imaging provides mechanistic insight, and hemodynamic assessment may offer prognostic guidance in this population.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 18 May 2022; epub ahead of print
Kassis N, Layoun H, Goyal A, Dong T, ... Kapadia SR, Harb SC
Am J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597628
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Abstract

Effect of Short-Term Exposure to Fine Particulate Matter and Particulate Matter Pollutants on Triggering Acute Myocardial Infarction and Acute Heart Failure.

Yen CC, Chen PL
Long-term exposure to high concentrations of air pollution is known to lead to increased cardiovascular disease, but it remains unclear whether short-term exposure increases the incidence of acute myocardial infarction (AMI) and acute heart failure (AHF). A time-stratified case-crossover design was used, including data from the 2-year period (January 1, 2017 to December 31, 2018), from the National Health Insurance Academic Research Database of Taiwan. Air pollution data were obtained from the Air Quality Monitoring Station of the Environmental Protection Agency of the Executive Yuan. A generalized linear model was used for statistical analysis. In areas with a long-term moderate severity of air pollution, a 10 μg/m3 increase in fine particulate matter (PM2.5) and particulate matter (PM10) exposure in a short period of time coincided with an increase in AMI by 6.5% to 6.7% and 0.9% to 1.1%, respectively, and AHF by 6.1% to 6.4% and 0.9% to 1.0%, respectively. A long-term high severity of air pollution (PM2.5 and PM10) coincided with an increase in AMI by 7.9% to 8.8% and 4.4% to 4.9%, respectively, and AHF by 7.6% to 8.4% and 4.3% to 4.8%, respectively. In areas with a long-term moderate or high severity of air pollution, short-term exposure to high concentrations of PM2.5 and PM10 pollution is positively correlated with AMI and AHF.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 17 May 2022; epub ahead of print
Yen CC, Chen PL
Am J Cardiol: 17 May 2022; epub ahead of print | PMID: 35595553
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Abstract

Impact of Body Mass Index on Mortality in Hospitalized Patients With Hypertrophic Cardiomyopathy.

Sreenivasan J, Lloji A, Khan MS, Hooda U, ... Michos ED, Naidu SS
Although obesity is associated with increased phenotypic expression in patients with hypertrophic cardiomyopathy (HC), the effect of body mass index (BMI) on in-hospital mortality in hospitalized patients with HC has not been established. We evaluated the National Inpatient Sample in the United States to identify all adults with HC hospitalized for cardiac illnesses between 2008 and 2017. Using International Classification of Diseases codes, the study cohort was stratified into underweight (BMI ≤19.9 kg/m2), normal weight (BMI 20.0 to 24.9 kg/m2), overweight (BMI 25.0 to 29.9 kg/m2), class I (BMI 30.0 to 34.9 kg/m2), class II (BMI 35.0 to 39.9 kg/m2), and class III (BMI ≥40.0 kg/m2) obesity. Multiple logistic regression analysis was used to analyze the independent association of various BMI categories and mortality. The study included a total of 2,392,325 hospitalizations (mean age-66.1 ± 12.2 years; 42.0% female). The patients with class III obesity (adjusted mortality rate [AMR] 3.3%, adjusted odds ratio [AOR] 1.53, 95% confidence interval [CI] 1.29 to 1.82, p <0.001) and underweight patients (AMR 4.4%, AOR 2.07, 95% CI 1.74-2.46, p <0.001) had higher in-hospital mortality whereas overweight patients (AMR 1.6%, AOR 0.26, 95% CI 0.19 to 0.34, p <0.001), patients with class I obesity (AMR 0.8%, AOR 0.35, 95% CI 0.27 to 0.45, p <0.001) and patients with class II obesity (AMR 0.8%, AOR 0.34, 95% CI 0.26 to 0.45, p <0.001) had lower mortality compared with patients with normal BMI (AMR 2.9%). In conclusion, BMI has a nonlinear U-shaped relation with in-hospital mortality in patients with HC. The patients who were underweight and morbidly obese had significantly higher mortality, whereas those patients with overweight, class I, and class II obesity had lower mortality than normal BMI.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 17 May 2022; epub ahead of print
Sreenivasan J, Lloji A, Khan MS, Hooda U, ... Michos ED, Naidu SS
Am J Cardiol: 17 May 2022; epub ahead of print | PMID: 35595554
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Abstract

Utilization of Implantable Cardioverter-Defibrillators in Patients With Heart Transplant (from National Inpatient Sample Database).

Minhas AMK, Mahmood Shah SM, Shahid I, Siddiqi TJ, ... Ijaz SH, Dani SS
Heart transplant (HT) recipients represent a unique and vulnerable population in whom medium and long-term outcomes are significantly affected by the risk of arrhythmias and sudden cardiac death. The use of implantable cardioverter-defibrillators (ICDs) in this population remains debated. A retrospective analysis of the National Inpatient Sample data between 2009 and 2018 was conducted. Hospitalization data on patients who underwent HT, or who had a preexisting HT, and who received a new ICD were included (excluding the preexisting ICD). Outcomes assessed included inpatient mortality, length of stay, and inflation-adjusted costs. We explored temporal trends in ICD placement and mean length of stay, and predictors of ICD placement. Between 2009 and 2018, 22,673 hospitalizations were recorded for HT, during which patients either received a concurrent new ICD placement (n = 70 [0.31%]) or no new ICD placement (n = 22,603 [99.7%]). During the same period, 146,555 admissions were recorded in patients with a history of HT. ICD placement in patients with a preexisting HT was associated with significantly higher inflation-adjusted costs ($55,680.7 vs $17,219.2; p <0.001). Predictors of ICD placement in preexisting patients with HT included cardiac arrest during hospitalization (odds ratio [OR]:14.3 [3.5 to 58.6]), drug abuse (OR:6.0 [1.3 to 27.1]), and previous PCI (OR:6.0 [2.1 to 17.3]). In conclusion, ICD placement in patients with HT history was associated with significantly higher inflation-adjusted costs. In patients with HT history, factors predicting ICD placement included cardiac arrest at hospitalization, previous PCI, and drug abuse.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 17 May 2022; epub ahead of print
Minhas AMK, Mahmood Shah SM, Shahid I, Siddiqi TJ, ... Ijaz SH, Dani SS
Am J Cardiol: 17 May 2022; epub ahead of print | PMID: 35595555
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Abstract

Contemporary Trends and Comparison of Racial Differences in Hospitalizations of Adults With Congenital Heart Disease.

Hendrickson MJ, Arora S, Chew C, Sharma M, ... Yancy C, Byku M
As advancements in care improve longevity in patients with congenital heart disease (CHD), it is crucial to further characterize this rapidly growing adult population. It is also essential that equitable care is offered across demographic groups. Hospitalizations for adults with CHD in the National Inpatient Sample were identified to describe trends in overall and cause-specific rates of admission per 1,000 adults with CHD from 2000 to 2018. Primary admission causes were then analyzed and stratified by race. An aggregate rate of left-ventricular assist device placements and heart transplants was calculated for each group and trended over the years. A total of 1,562,001 weighted hospitalizations were identified. Overall, annual rates of hospital admissions increased from 39 per 1,000 adults with CHD in 2000 to 74 per 1,000 in 2018, as did rates of cardiovascular admissions (16 of 1,000 to 34 of 1,000, p <0.001 for both). Transient ischemic attack/stroke (2.5 of 1,000 to 10.7 of 1,000), coronary artery disease (4.1 of 1,000 to 5.6 of 1,000), arrhythmias (2.8 of 1,000 to 4.6 of 1,000), and heart failure (2.8 of 1,000 to 5.0 of 1,000) were the most common cardiovascular primary causes of admission (other than CHD itself), and each significantly increased over time (p <0.001 for each). Mean age at all-cause and primary heart failure hospitalization increased for all races but remained 7 to 9 years younger for Black and Hispanic adults than White adults. In conclusion, hospitalization rates of adults with CHD in the United States increased from 2000 to 2018, largely driven by an increase in adults ≥55 years. Although the age at hospitalization increased overall, Black and Hispanic patients were substantially younger at presentation for advanced heart failure. Anticoagulation guidelines in this population may need revisiting as transient ischemic attack/stroke hospitalizations were frequent.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 16 May 2022; epub ahead of print
Hendrickson MJ, Arora S, Chew C, Sharma M, ... Yancy C, Byku M
Am J Cardiol: 16 May 2022; epub ahead of print | PMID: 35589425
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Abstract

Relation of Monocyte Number to Progression of Aortic Stenosis.

Han K, Xia Y, Shi D, Yang L, ... Ma X, Zhou Y
Rapid progression of aortic stenosis (AS) is associated with poor prognosis. However, the relation between monocyte number and AS progression is unknown. Here, we detected the relation between monocyte number and AS progression. We retrospectively analyzed 220 patients with AS with at least 2 echocardiograms with the maximal interval ≥180 days from January 2016 to June 2021. AS severity was categorized by aortic jet velocity (Vmax) and mean pressure gradient. Rapid progression of AS was defined when Vmax increased ≥0.3 m/s/year. Patients were divided into low and high monocyte groups according to the cut-off value of the receiver-operating characteristic curve. AS progression was compared between the 2 groups. Various models of binary logistic regression were used to reveal the association between monocyte number and rapid progression. During a median of 601 days of echocardiographic follow-up (interquartile range 353 to 909), 52.7% of the population was in rapid progression. Patients in the high monocyte group had more rapid progression in both Vmax and mean pressure gradient (p = 0.020 and p = 0.030, respectively). The percentage of patients with severe AS was increased by 5.4% in the low monocyte group and 16.9% in the high monocyte group. Different models of binary logistic regression showed that the monocyte number was positively associated with the rapid progression. In conclusion, a higher monocyte number was associated with the rapid progression of AS.

Copyright © 2022. Published by Elsevier Inc.

Am J Cardiol: 15 May 2022; 171:122-126
Han K, Xia Y, Shi D, Yang L, ... Ma X, Zhou Y
Am J Cardiol: 15 May 2022; 171:122-126 | PMID: 35341577
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Abstract

Outcomes of Percutaneous Coronary Intervention in Patients With Acquired Immunosuppression.

Doolub G, Kobo O, Mohamed MO, Ullah W, ... Bagur R, Mamas MA
There are limited data on the clinical outcomes of percutaneous coronary intervention (PCI) in patients with acquired immunosuppression who are frequently underrepresented in clinical trials. All PCI procedures between October 2015 and December 2018 in the Nationwide Inpatient Sample were retrospectively analyzed, stratified by immunosuppression status. Multivariable logistic regression models were performed to examine (1) the association between immunosuppression status and in-hospital outcomes, expressed as adjusted odds ratio (aOR) with 95% confidence intervals (CIs) and (2) predictors of mortality among patients with severe acquired immunosuppression. In this contemporary analysis of nearly 1.5 million PCI procedures, approximately 4% of patients who underwent PCI had acquired immunosuppression. Of these, chronic steroid use accounted for approximately half of the cohort who underwent PCI who had acquired immunosuppression, with the remainder divided between hematologic cancer, solid organ active malignancy, and metastatic cancer, with the latter group having the highest rates of composite of in-hospital mortality or stroke (9.3%) (mortality 7.5% and acute ischemic stroke 2.4%). In conclusion, immunosuppression was independently associated with increased adjusted odds of adverse clinical outcomes, specifically mortality or stroke (aOR 1.11, 95% CI 1.06 to 1.15, p <0.001) and in-hospital mortality (aOR 1.21, 95% CI 1.13 to 1.29, p <0.001), with outcomes dependent on the cause of immunosuppression.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 May 2022; 171:40-48
Doolub G, Kobo O, Mohamed MO, Ullah W, ... Bagur R, Mamas MA
Am J Cardiol: 15 May 2022; 171:40-48 | PMID: 35303973
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Abstract

Relation of Menopause With Cardiovascular Risk Factors in South Asian American Women (from the MASALA Study).

Vijay A, Kandula NR, Kanaya AM, Khan SS, Shah NS
The menopausal transition is a time of accelerating risk of cardiovascular disease (CVD), and promoting cardiovascular health during midlife is an important period of time to prevent CVD in women. The association of menopause with cardiovascular risk factors or subclinical atherosclerosis has not previously been evaluated in South Asian American women, a population with a disproportionately higher CVD burden compared with other race/ethnic groups. The objective of this study was to evaluate the association of menopause with CVD risk factors and subclinical cardiometabolic disease markers. We studied women aged 40 to 84 years from the Mediators of Atherosclerosis in South Asians Living in America study. The association of self-reported menopausal status with multiple demographic and clinical variables was assessed with linear and logistic regression adjusted for age and cardiovascular health behaviors. In a secondary (\"age-restricted\") analysis, postmenopausal participants outside the age range of premenopausal participants were excluded. In the age-restricted sample, menopause was associated with a higher adjusted odds of hypertension (odds ratio = 1.19, 95% confidence interval [CI] 1.02 to 1.41), and higher systolic blood pressure (β = 6.34, 95% CI 0.82 to 11.87), and significantly higher subcutaneous fat area (β = 42.8, 95% CI 5.8 to 91.4). No significant associations between menopause and ectopic fat deposition, coronary artery calcium, or carotid intima-media thickness were observed. In South Asian American women in the Mediators of Atherosclerosis in South Asians Living in America study, menopause was associated with cardiovascular risk factors and higher subcutaneous fat deposition. Menopausal status is an important factor to examine and address CVD risk factors.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 May 2022; 171:165-170
Vijay A, Kandula NR, Kanaya AM, Khan SS, Shah NS
Am J Cardiol: 15 May 2022; 171:165-170 | PMID: 35303974
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Abstract

All-Cause Mortality in Ischemic Heart Failure Patients with Functional Mitral Regurgitation Undergoing Percutaneous Coronary Intervention.

Cai A, Qiu W, Xiao X, Xia S, Zhou Y, Li L
This study aimed to evaluate the association between percutaneous coronary intervention (PCI) treatment and all-cause mortality in patients with ischemic heart failure with left ventricular systolic dysfunction and functional mitral regurgitation (FMR). We included 1,483 patients of which 39.5% (n = 586) had moderate-to-severe FMR. Multivariable Cox proportional hazard model was used to assess the association between PCI treatment and all-cause mortality. Furthermore, propensity score matching was used to account for nonrandom treatment assignment. In those with none-to-mild FMR, after a median follow-up of 3.1 years, the cumulative rate of all-cause mortality between the PCI and non-PCI groups was comparable (10.1% vs 14.2%), with an adjusted hazard ratio (HR) of 0.731 (95% confidence interval [CI] 0.438 to 1.221, p = 0.232). In those with moderate-to-severe FMR, after a median follow-up of 2.9 years, the cumulative rate of all-cause mortality was lower in the PCI group (20.4% vs 31.6%), with an adjusted HR of 0.660 (95% CI 0.469 to 0.929, p = 0.017). The result was confirmed with propensity matching (HR 0.596 and 95% CI 0.363 to 0.977, p = 0.038). The mortality benefit associated with PCI treatment in patients with moderate-to-severe FMR was consistent regardless of the age, gender, reason for admission, presence of diabetes mellitus, left ventricular ejection fraction value, left main and 3-vessels disease. In conclusion, in patients with ischemic heart failure with left ventricular systolic dysfunction and moderate-to-severe FMR, PCI treatment was associated with improvement in all-cause mortality. Randomized clinical trials are needed to confirm the current results.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 May 2022; 171:55-64
Cai A, Qiu W, Xiao X, Xia S, Zhou Y, Li L
Am J Cardiol: 15 May 2022; 171:55-64 | PMID: 35305782
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Abstract

Echocardiographic and Cardiac Magnetic Resonance Imaging-Derived Strains in Relation to Late Gadolinium Enhancement in Hypertrophic Cardiomyopathy.

Klettas D, Georgiopoulos G, Rizvi Q, Oikonomou D, ... Aimo A, Nihoyannopoulos P
We compared speckle tracking echocardiography (STE) and feature tracking cardiovascular magnetic resonance (FT-CMR) in patients with hypertrophic cardiomyopathy (HC) with a varying extent of fibrosis as defined by late gadolinium enhancement to look at the level of agreement between methods and their ability to relate those to myocardial fibrosis. At 2 reference centers, 79 patients with HC and 16 volunteers (the control group) underwent STE and CMR with late gadolinium enhancement and FT-CMR. Patients were classified into 3 categories: no detectable, limited, and extensive fibrosis. Global longitudinal strain (GLS) and global radial strain (GRS) were derived using FT-CMR and STE. STE-derived GRS was decreased in all HC categories compared with the control group (p <0.001), whereas FT-CMR GRS was reduced only in patients with HC with fibrosis (p <0.05). Reduced STE-derived GLS was associated with extensive fibrosis (p <0.05) and a value less than -15.2% identified those with extensive fibrosis (sensitivity 79%, specificity 92%, area under the curve 0.863, 95% confidence interval [CI] 0.76 to 0.97, p <0.001). Inter-modality agreement was moderate for STE versus CMR-GLS (overall population intra-class correlation coefficient = 0.615, 95% CI 0.42 to 0.75, p <0.001; patients with HC 0.63, 0.42 to 0.76, p <0.001) and GRS (overall population intra-class correlation coefficient = 0.601, 95% CI 0.397 to 0.735, p <0.001). A low level of agreement for GRS was seen between methods in patients with HC. In conclusion, strain indexes measured using echocardiography and CMR are reduced in patients with HC compared with the control group and correlate well with the burden of myocardial fibrosis. Reduced STE-GLS can identify patients with extensive fibrosis, but whether there is an added value for risk stratification for sudden cardiac death remains to be determined.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 May 2022; 171:132-139
Klettas D, Georgiopoulos G, Rizvi Q, Oikonomou D, ... Aimo A, Nihoyannopoulos P
Am J Cardiol: 15 May 2022; 171:132-139 | PMID: 35305784
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Abstract

Development and Validation of a Novel Risk Stratification Model for Slow-Flow/No-Reflow During Primary Percutaneous Coronary Intervention (the RK-SF/NR Score).

Kumar R, Ammar A, Saghir T, Sial JA, ... Qamar N, Karim M
In this study, we developed and validated a novel risk stratification model to predict slow-flow/no-reflow (SF/NR) during the primary percutaneous coronary intervention (PCI), namely the RK-SF/NR score. A total of 1,711 consecutive patients with ST-segment elevation myocardial infarction (STEMI) undergone primary PCI. A novel risk stratification model was developed in the development dataset and tested in the validation dataset. The overall incidence rate of SF/NR during the procedure was 28.8% (493/1,711). The final solution consisted of 9 variables: female gender (points = 2), total ischemic time ≥8 hours (points = 1), cardiac arrest at presentation (points = 2), left ventricular end-diastolic pressure ≥24 mm Hg (points = 3), left ventricular ejection fraction ≤30% (points = 2), culprit proximal left anterior descending artery (points = 3), thrombus grade ≥4 (points = 6), preprocedure thrombolysis in myocardial infarction (TIMI) 0 flow (points = 2), and lesion length ≥35 mm (points = 3). In the validation set, the area under the curve the RK-SF/NR score was 0.775 (0.722 to 0.829) and a score ≥10 has sensitivity of 77.9% (68.2% to 85.8%), negative predictive value of 87.3% (82.3% to 91.0%), specificity of 62.6% (56.0% to 68.9%), and positive predictive value of 46.3% (41.4% to 51.2%). In conclusion, RK-SF/NR score had shown good discriminating power for predicting SF/NR during primary PCI with good sensitivity and negative predictive value. Hence, the proposed model can have good clinical utility for screening patients at high risk of developing SF/NR during primary PCI.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 15 May 2022; 171:32-39
Kumar R, Ammar A, Saghir T, Sial JA, ... Qamar N, Karim M
Am J Cardiol: 15 May 2022; 171:32-39 | PMID: 35305786
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Abstract

The Trajectory of Lipoprotein(a) During the Peri- and Early Postinfarction Period and the Impact of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibition.

Vavuranakis MA, Jones SR, Ziogos E, Blaha MJ, ... Gerstenblith G, Leucker TM
Lipoprotein(a), or Lp(a), levels and the effect of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition on Lp(a) during the peri-infarction and early postinfarction period are not well characterized. This study aimed to describe the trajectory of Lp(a), as well as the effect of PCSK9 inhibition on that trajectory during the peri-infarction and early postinfarction period. Lp(a) levels were obtained within 24 hours of hospital admission as well as within 24 hours of hospital discharge and at 30 days from 74 participants who presented with a NSTEMI (troponin I >5 ng/ml) or with a STEMI and were enrolled in 2 randomized, double-blind trials of evolocumab and placebo (Evolocumab in Acute Coronary Syndrome [EVACS I]; ClinicalTrials.gov, NCT03515304 and Evolocumab in Patients With STEMI [EVACS II]; ClinicalTrials.gov Identifier: NCT04082442). There was a significant increase from the pretreatment level in the placebo-treated patients, from 64 (41,187) nmol/L to 80 (47, 172) nmol/L at hospital discharge and to 82 (37, 265) at 30 days. This was primarily driven by the results from participants with high Lp(a) at hospital admission (>75 nmol/L) in whom the median increase was 28% as compared with a 10% increase in those with pretreatment Lp(a) of <75 nmol/L. In contrast, there was no significant change from the pretreatment level in the evolocumab-treated patients regardless of pretreatment Lp(a) levels. In conclusion, Lp(a) rises during the peri-infarction and early postinfarction period in patients with acute myocardial infarction. The increase was prevented by a single dose of subcutaneous evolocumab given within 24 hours of hospital admission.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 May 2022; 171:1-6
Vavuranakis MA, Jones SR, Ziogos E, Blaha MJ, ... Gerstenblith G, Leucker TM
Am J Cardiol: 15 May 2022; 171:1-6 | PMID: 35314069
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Abstract

Effect of Chronic Kidney Disease on 5-Year Outcome in Patients With Heart Failure and Secondary Mitral Regurgitation Undergoing Percutaneous MitraClip Insertion.

Sisinni A, Munafò A, Pivato CA, Adamo M, ... Godino C, MiZüBr registry
Chronic kidney disease (CKD) is strongly related to outcomes in cardiovascular diseases. Limited data are available regarding the independent prognostic role of CKD after transcatheter mitral valve repair with MitraClip. We sought to evaluate the real impact of CKD in a large series of patients with heart failure (HF) and secondary mitral regurgitation (SMR) who underwent MitraClip treatment. The study included 565 patients with severe SMR from a multicenter international registry. Patients were stratified into 3 groups according to estimated glomerular filtration rate (eGFR) assessment before MitraClip implantation: normal eGFR (≥60 ml/min/1.73 m2) (n = 196), mild-to-moderate CKD (30 to 59 ml/min/1.73 m2) (n = 267), and severe CKD (<30 ml/min/1.73 m2) (n = 102). The primary end point was a composite of overall death and the first rehospitalization for HF, the secondary end points were overall death, cardiac death, and first rehospitalization for HF. CKD was present in about 2/3 of patients. At 5-year Kaplan-Meier analysis, primary clinical end point occurred in 60% of patients with normal eGFR, compared with 73% cases in patients with mild-to-moderate CKD and 91% in patients with severe CKD (p <0.001). Long-term overall death rate significantly decreased with increasing eGFR, and cardiac death and rehospitalization for HF rates. Multivariate Cox regression analysis identified severe CKD as the strongest independent predictor of adverse outcome (hazard ratio 2.136, 95% confidence interval 1.164 to 3.918, p = 0.014). In conclusion, CKD affected about 2/3 of patients who underwent MitraClip treatment for severe SMR, and it was a strong and independent predictor of 5-year adverse outcomes.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 May 2022; 171:105-114
Sisinni A, Munafò A, Pivato CA, Adamo M, ... Godino C, MiZüBr registry
Am J Cardiol: 15 May 2022; 171:105-114 | PMID: 35317926
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Abstract

Early Discontinuation of Antithrombotic Treatment Following Left Atrial Appendage Closure.

Mesnier J, Cruz-González I, Arzamendi D, Freixa X, ... O\'Hara G, Rodés-Cabau J
Although antithrombotic treatment is recommended after left atrial appendage closure (LAAC), some patients require discontinuation of antithrombotic treatment after LAAC without evidence on the safety of such a strategy. We sought to evaluate outcomes of patients who had early antithrombotic treatment discontinuation after LAAC. This is a multicenter study including 1,082 patients who underwent successful LAAC. Early discontinuation of antithrombotic treatment was defined as discontinuation of all antiplatelet/anticoagulant treatment within 6 months following the procedure. A propensity-matched analysis was used to compare outcomes of patients with and without early antithrombotic treatment discontinuation. A total of 148 patients (13.7%) had early antithrombotic treatment discontinuation. In the entire population, antithrombotic treatment discontinuation patients exhibited a lower CHA2DS2-VASc score (p <0.001) and a higher rate of previous gastrointestinal bleeding episodes (p = 0.01) compared with patients without discontinuation. After a median follow-up of 2.1 (1,1-3.1) years after antithrombotic treatment discontinuation, the rates of death, ischemic stroke, and major bleeding were 12.1, 0.6, and 3.3 per 100 patient-years. In 119 matched pairs with similar baseline characteristics, antithrombotic treatment discontinuation patients had a similar risk of death (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.65 to 1.71, p = 0.82), ischemic stroke (HR 0.39, 95% CI 0.04 to 3.79, p = 0.42) and major bleeding (HR 1.48, 95% CI 0.56 to 3.88, p = 0.43) compared with those without discontinuation. In conclusion, antithrombotic treatment was discontinued in 1 of 7 selected patients within 6 months after LAAC, and this was not associated with an increased risk of death or thromboembolic events after a median follow-up of 2 years. These data support the safety of shorter periods of antithrombotic therapy after LAAC in high bleeding risk patients based on clinician judgment. Further trials are warranted.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 May 2022; 171:91-98
Mesnier J, Cruz-González I, Arzamendi D, Freixa X, ... O'Hara G, Rodés-Cabau J
Am J Cardiol: 15 May 2022; 171:91-98 | PMID: 35317927
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Abstract

Trends in Hospital Admissions for Systolic and Diastolic Heart Failure in the United States Between 2004 and 2017.

Afzal A, van Zyl J, Nisar T, Kluger AY, ... Hall SA, Kale P
Heart failure (HF) affects 6 million people in the United States and costs $30 billion annually. It is unclear whether improvements in length of stay and mortality over the last few decades hold true for both systolic and diastolic HF. To better assess the epidemiological and economic burden of HF, we assessed the trends in outcomes and costs for both systolic and diastolic HF. We identified hospitalizations for systolic and diastolic HF in the National Inpatient Sample database and evaluated trends over the period from 2004 to 2017, adjusting for demographics and co-morbidities. The proportion of patients admitted with an exacerbation of systolic HF increased from 42% to 63% over the study period. We found an overall decreasing trend between 2004 and 2011 in the length of stay for HF in general with a sharper decrease in diastolic than systolic HF. Inpatient mortality decreased between 2004 and 2007 and stabilized between 2008 and 2016. Systolic HF was associated with higher mortality than diastolic HF. The total inflation-adjusted cost did not change significantly over the study period, with systolic HF costing, on average, $3,036 more than diastolic HF per admission. In conclusion, systolic HF overtook diastolic HF, accounting for most HF hospitalizations in 2008. The higher hospitalization costs for systolic HF relative to diastolic HF may have resulted, in part, from greater use of advanced support devices in patients with systolic HF.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 May 2022; 171:99-104
Afzal A, van Zyl J, Nisar T, Kluger AY, ... Hall SA, Kale P
Am J Cardiol: 15 May 2022; 171:99-104 | PMID: 35365288
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Abstract

Contemporary Outcome Trends in Transcatheter Aortic Valve-in-Valve Implantation Versus Redo Aortic Valve Replacement.

Demal TJ, Gordon C, Bhadra OD, Linder M, ... Westermann D, Conradi L
As valve-in-valve (ViV) transcatheter aortic valve implantation is still an evolving method, we evaluated the development of early and midterm outcomes after ViV and conventional redo-surgical aortic valve replacement (SAVR) over the past 2 decades. In-hospital databases were retrospectively screened for patients ≥60 years treated for failing bioprosthetic aortic valves at our center. Clinical and follow-up characteristics were compared between patients who underwent ViV or redo-SAVR according to valve academic research consortium-2 (VARC-2) definitions. The comparison of outcome parameters was adjusted for baseline differences between groups. Between June 2002 and April 2020, 209 patients with ViV and 65 redo-SAVR patients met inclusion criteria. No significant differences were found in 30 days (ViV 3.8%, SAVR 3.1%, p = 0.778) or 6-month mortality (ViV 14.0%, SAVR 7.5%, p = 0.283). As patients with ViV less frequently experienced acute kidney injury (stage II or III) and life-threatening bleeding, they more frequently reached the 30-day VARC-2 combined safety end point (79.2% vs 61.5%, odds ratio [OR] 2.540, p = 0.023). Patients with ViV less frequently reached clinical efficacy (68.3% vs 84.6%, OR 0.408, p = 0.041) and device success (79.9% vs 92.3%, OR 0.311, p = 0.040) end points, because of higher frequency of postprocedural transvalvular gradients >20 mm Hg. However, over the past decade, VARC-2 clinical efficacy and device success rates continuously increased in ViV cases. In conclusion, ViV and SAVR were associated with similar acute mortality and different beneficial and adverse outcome profiles in this single-center cohort. Results after ViV procedures have continuously improved over the past years.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 May 2022; 171:115-121
Demal TJ, Gordon C, Bhadra OD, Linder M, ... Westermann D, Conradi L
Am J Cardiol: 15 May 2022; 171:115-121 | PMID: 35307189
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Abstract

Coronary Artery Aneurysms in ST-Elevation Myocardial Infarction (From a United States Based National Cohort).

Changal K, Mir T, Royfman R, Devarasetty PP, ... Sheikh M, Eltahawy E
This study aimed to study group differences in patients presenting with ST-elevation myocardial infarction (STEMI) based on the presence or absence of associated coronary artery aneurysms (CAA). The cause-and-effect relationship between CAAs and STEMI is largely unknown. The Nationwide Readmission database was used to identify and study group differences of patients with STEMI and with and without CAA from 2014 to 2018. The primary outcome in the 2 groups was mortality. Secondary outcomes in the 2 groups included differences in clinical outcomes, cardiovascular interventions performed, and prevalence of coronary artery dissection. The total number of patients with STEMI included was 1,038,299. In this sample, 1,543 (0.15%) had CAA. Compared with those without CAA, patients with CAAs and STEMI were younger (62.6 vs 65.4), more likely to be male (78 vs 66%), and had a higher prevalence of a history of Kawasaki disease (2.5 vs 0.01%). A difference exists in the prevalence of coronary dissection in patients with STEMI with and without CAA (73% vs 1%). Patients with CAA were more often treated with coronary artery bypass grafting (13.1 vs 5.6%), thrombectomy (16.5 vs 6%), and bare-metal stent implantation (8 vs 4.4). Patients in the CAA STEMI group had lower all-cause mortality (6.3 vs 11.7%). In conclusion, there are important differences in patients with STEMI with and without CAA, which include, but are not limited to, factors such as patient profile, the risk for coronary dissection, treatment, outcomes, and mortality.

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Am J Cardiol: 15 May 2022; 171:23-27
Changal K, Mir T, Royfman R, Devarasetty PP, ... Sheikh M, Eltahawy E
Am J Cardiol: 15 May 2022; 171:23-27 | PMID: 35321805
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Abstract

Ethnicity in Complex High-Risk but Indicated Percutaneous Coronary Intervention Types and Outcomes.

Shamkhani W, Kinnaird T, Wijeysundera HC, Ludman P, Rashid M, Mamas MA
Complex High-risk but indicated Percutaneous coronary interventions (CHiPs) is increasingly common in contemporary practice. However, data on ethnic differences in CHiP types, outcomes, and trends in patients with stable angina are limited; this is pertinent given the population of Black, Asian, and other ethnic minorities (BAME) in Europe is increasing. We conducted a retrospective analysis of CHiP procedures undertaken in patients with stable angina using data obtained from the BCIS (British Cardiovascular Intervention Society) registry (2006 to 2017). CHiP cases were identified and categorized by ethnicity into White and BAME groups. We then performed multivariable regression analysis and propensity score matching to determine adjusted odds ratios (aORs) of in-hospital mortality, major bleeding, and major adverse cardiovascular and cerebral events (MACCEs) in BAME compared with Whites. Of 424,290 procedure records, 105,949 were CHiP (25.0%) (White 89,038 [84%], BAME 16,911 [16%]). BAME patients were younger (median 68.1 vs 70.6 years). Previous coronary artery bypass surgery (33.4% vs 38.3%), followed by chronic total occlusion percutaneous coronary intervention (31.9% vs 32%) were common CHiP variables in both groups. The third common variable was age 80 years and above (23.6%) in White patients and severe vascular calcifications in BAME patients (18.8%). BAME patients had higher rates of diabetes (41.1 vs 23.6%), hypertension (68 vs 66.5%), previous percutaneous coronary intervention (43.7 vs 37.6%), and previous myocardial infarction (44.9 vs 42.5%), (p <0.001 for all). Mortality (aOR 1.1, 95% confidence interval [CI] 0.8 to 1.5) and MACCE (aOR 1.0, 95% CI 0.8 to 1.1) odds were similar among the groups. Bleeding odds (aOR 0.7, 95% CI 0.6 to 0.9) were lower in BAME. In conclusion, CHiP procedures differed among the ethnic groups. BAME patients were younger and had worse cardiometabolic profiles. Similar odds of death and MACCE were seen in BAME compared with their White counterparts. Bleeding odds were 30% lower in the BAME group.

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Am J Cardiol: 14 May 2022; epub ahead of print
Shamkhani W, Kinnaird T, Wijeysundera HC, Ludman P, Rashid M, Mamas MA
Am J Cardiol: 14 May 2022; epub ahead of print | PMID: 35581040
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Abstract

Rural-Urban Disparities in Heart Failure and Acute Myocardial Infarction Hospitalizations.

Minhas AMK, Sheikh AB, Ijaz SH, Mostafa A, ... Loccoh EC, Warraich HJ
Substantial gaps in clinical outcomes exist in rural and urban hospitals in the United States. We used the National Inpatient Sample to examine trends in hospitalizations, in-hospital mortality, length of stay, and inflation-adjusted cost of adults admitted for heart failure (HF) and acute myocardial infarction (AMI) in rural and urban hospitals between 2004 and 2018. From 2004 to 2013 and 2014, there was an initial decrease in age-adjusted HF hospitalizations in both urban (annual percent change [APC] -3.9 [95% confidence interval [CI] -4.3 to -3.5] p <0.001) and rural hospitals (APC -5.9 [95% CI -6.4 to -5.3] p <0.001), after which hospitalizations for HF increased in urban areas (APC 4.2 [95% CI 3.2 to 5.3] p <0.001) and remained stable in rural areas (APC 0.2 [95% CI -2.1 to 2.6] p = 0.863). Urban AMI hospitalizations decreased between 2004 and 2010 (APC -4.4 [95% CI -5.3 to -3.3] p <0.001) and subsequently remained stable (APC 0.2 [95% CI -0.5 to 0.9] p = 0.552), whereas rural AMI hospitalizations had a consistent decrease throughout the study period (APC -4.2 [95% CI -5.0 to -3.4] p <0.001). Overall, urban hospitals had lower in-hospital mortality for HF and AMI than rural hospitals (3.1% vs 3.5%, p <0.001% and 5.4% vs 6.5%, p <0.001), respectively. Initially, in-hospital mortality was higher in rural hospitals; however, the rural-urban hospital mortality gap decreased during the study period for both HF and AMI. Rural hospitals had a shorter mean length of stay for HF and AMI (4.4 vs 5.5 days, p <0.001 and 3.9 vs 4.7 days, p <0.001) and lower inflation-adjusted costs for both HF and AMI ($8,897.1 vs $13,420.8, p <0.001 and $15,301.6 vs $22,943.7, p <0.001) when compared with urban hospitals. In conclusion, a consistent decrease in the in-hospital mortality gap in rural and urban hospitals for HF and AMI suggests improvement in inpatient rural cardiovascular care during the study period. Continued healthcare policy reforms are warranted to alleviate the disparities in rural-urban cardiovascular outcomes.

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Am J Cardiol: 13 May 2022; epub ahead of print
Minhas AMK, Sheikh AB, Ijaz SH, Mostafa A, ... Loccoh EC, Warraich HJ
Am J Cardiol: 13 May 2022; epub ahead of print | PMID: 35577603
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Abstract

Relation of a Maximal Exercise Test to Change in Exercise Tolerance During Cardiac Rehabilitation.

Brawner CA, Pack Q, Berry R, Kerrigan DJ, Ehrman JK, Keteyian SJ
The purpose of this study was to test the hypothesis that an individualized exercise training target heart rate (HR) based on a maximal graded exercise test (GXT) is associated with greater improvements in exercise tolerance during cardiac rehabilitation (CR) compared with no GXT. In this retrospective study, we identified patients who completed 9 to 36 visits of CR between 2001 and 2016, with a length of stay ≤18 weeks and a visit frequency of 1 to 3 days per week. Patients were grouped based on whether their exercise was guided by a target HR determined from a GXT. To assess the relation between GXT and change in exercise training metabolic equivalents of task (METs), we used generalized linear models adjusted for age, gender, race, referral reason, CR visits, CR frequency, METs at start, CR location, and year of participation. Out of 4,455 patients (37% female, 48% White, median age = 62 years), 53% were prescribed a target HR based on a GXT. Compared with no GXT, a GXT was associated with a significantly greater increase in covariate-adjusted METs during CR and percentage change from start (+0.44 METs [95% confidence interval [CI] 0.38 to 0.51] and +17% [95% CI 14% to 19%], respectively). In a sensitivity analysis limited to patients with 24 to 36 visits at ≥2 days per week (n = 1,319), a GXT was associated with a significantly greater increase in covariate-adjusted exercise training METs (+0.51 [95% CI 0.36 to 0.66]; +19% [95% CI 13% to 24%]). In conclusion, to maximize the potential increase in exercise capacity during CR, patients should undergo a GXT to determine an individualized exercise training target HR.

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Am J Cardiol: 12 May 2022; epub ahead of print
Brawner CA, Pack Q, Berry R, Kerrigan DJ, Ehrman JK, Keteyian SJ
Am J Cardiol: 12 May 2022; epub ahead of print | PMID: 35570164
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Abstract

Acute Myocardial Infarction After Russell\'s Viper (Daboia russelii) Bite.

Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM
Russell\'s viper (Daboia russelii) is a deadly venomous snake that causes most snakebite deaths in Sri Lanka. It is widely distributed all over the country, and it commonly causes venom-induced consumption coagulopathy and neuroparalysis. Cardiotoxic manifestations after Russell\'s viper bites are rare. We report a 60-year-old man diagnosed with ST-elevation myocardial infarction after a proved Russell\'s viper bite.

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Am J Cardiol: 11 May 2022; epub ahead of print
Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM
Am J Cardiol: 11 May 2022; epub ahead of print | PMID: 35568568
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Abstract

Characteristics and Prognosis of Patients With Fibromuscular Dysplasia in a Population of Spontaneous Coronary Artery Dissections (from the French Registry of Spontaneous Coronary Artery Dissections \"DISCO\").

Combaret N, Liabot Q, Deiri M, Lhermusier T, ... Cassagnes L, Motreff P
Spontaneous coronary artery dissection (SCAD) and fibromuscular dysplasia (FMD) are pathologies that appear to be closely related. This study compares the characteristics of the FMD population to the non-FMD population in a SCAD cohort. It thus assesses the involvement of the FMD phenotype in a SCAD population. From the data of the French DISCO registry, we included patients with a diagnosis of SCAD and in whom a search for FMD was performed. We collected the following characteristics of this population: the clinical and angiographic presentation, the data concerning the management, and the events occurring during the follow-up. In the 373 SCADs confirmed in the DISCO registry, we obtained imaging data for 340 of them. FMD was found in 45% of cases. The mean age was higher in the FMD group, 53.2 ± 8.8 years, versus 50.1 ± 11 years in the non-FMD group. High blood pressure and postmenopausal status were significantly higher in the FMD group. Clinical presentation, angiographic data, and management were comparable. The major adverse cardiac event rate and recurrence rate were not different between the 2 groups after 1 year of follow-up. In conclusion, we confirmed a 45% prevalence of FMD in the SCAD population. The median age was higher in the FMD group, suggesting that FMD may develop over time. The rate of major adverse cardiac events and recurrence were similar in the FMD group versus the non-FMD group after 1 year of follow-up.

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Am J Cardiol: 10 May 2022; epub ahead of print
Combaret N, Liabot Q, Deiri M, Lhermusier T, ... Cassagnes L, Motreff P
Am J Cardiol: 10 May 2022; epub ahead of print | PMID: 35562298
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Abstract

Comparison of In-Hospital Outcomes and Readmission Rates of Transcatheter Aortic Valve Implantation in Mixed Aortic Valve Disease Versus Pure Aortic Stenosis.

Grant JK, Rubin P, Chambers S, Dangl M, ... Colombo R, Braghiroli J
Recently, transcatheter aortic valve implantation (TAVI) has been performed in patients with combined aortic stenosis (AS) and aortic regurgitation. We sought to evaluate in-hospital outcomes and readmission rates after TAVI in patients with mixed aortic valve disease (MAVD). A total of 100,573 TAVI procedures were identified between 2011 and 2017 using International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision procedure codes the from Nationwide Readmissions Database. We separated patients into 2 cohorts, those with MAVD and those with pure AS. The primary outcome was all-cause inpatient mortality after TAVI, and secondary outcomes included rates of 30- and 90-day readmissions and postprocedural complications. A total of 3,260 patients had MAVD (median age 83 years, 43.5% women). In-hospital mortality (2.5% vs 2.6%, p = 0.531) and rates of paravalvular leak (1.0% vs 1.3%, p = 0.056) were similar between the MAVD and pure AS groups. Major bleeding (7.4% vs 9.6%, p <0.001), 30-day readmission (0.5% vs 8.8%, p <0.001) and 90-day readmission rates (0.8% vs 16.0%, p <0.001), acute kidney injury (12.9% vs 15.1%, p <0.001), postoperative ischemic stroke (2.0% vs 5.7%, p <0.001), and mechanic circulatory support use (1.9% vs 4.5%, p <0.001) were less prevalent in the MAVD cohort. Using a multivariate logistic regression model to adjust for confounding factors, MAVD was not predictive of mortality in patients who underwent TAVI (adjusted odds ratio [adjOR] 1.25, 95% confidence interval [CI] 0.99 to 1.57, p = 0.056); however, MAVD was associated with: decreased odds of 30-day readmission (adjOR 0.05, 95% CI 0.03 to 0.08, p <0.001), 90-day readmission rates (adjOR 0.04, 95% CI 0.03 to 0.06, p <0.001), and higher odds of pacemaker implantation (adjOR 1.46, 95% CI 1.29 to 1.65, p <0.001). In conclusion, despite differences in the aortic valve and left ventricular anatomy (pressure vs volume-related adaptive changes) in patients with MAVD and pure AS, TAVI appears safe and feasible. However, patients with MAVD were more likely to have permanent pacemakers implanted. The results of our study warrant further randomized controlled studies to confirm these findings.

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Am J Cardiol: 10 May 2022; epub ahead of print
Grant JK, Rubin P, Chambers S, Dangl M, ... Colombo R, Braghiroli J
Am J Cardiol: 10 May 2022; epub ahead of print | PMID: 35562299
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Abstract

Prevalence and Outcomes of Primary Left Ventricular Dysfunction in Marfan Syndrome.

Connor BS, Algaze CA, Narkevičiūtė A, Anguiano B, ... Zarate YA, Collins RT
Even in the absence of significant valvular disease, patients with Marfan syndrome (MFS) have evidence of impaired left ventricular (LV) performance, suggestive of a primary cardiomyopathy. However, the true prevalence and long-term outcomes of this disease process remain largely unknown. We performed a retrospective analysis of all adult patients with confirmed MFS followed at Stanford Health Care. Those with significant valvular regurgitation, coronary artery disease, or previous cardiac surgery were excluded. LV systolic dysfunction was defined as a LV ejection fraction (LVEF) <55% on transthoracic echocardiography. A total of 753 patients with confirmed MFS were followed up over a median duration of 8 years (interquartile range 4 to 13). Of those, 241 patients (53% women, 71% White) met inclusion criteria and comprised the study cohort. LV systolic dysfunction was present in 30 patients (12%), with a median age of onset of 25 years (interquartile range 19 to 37), median EF of 52% (interquartile range 48 to 54), and evidence of clinical heart failure (New York Heart Association functional class ≥II) in 10% of patients. LV systolic dysfunction was more common in patients with larger aortic root diameters (≥4.0 cm: Odds ratio = 4.5, 95% confidence interval = 1.2 to 17.1) but was not associated with other cardiovascular manifestations of MFS or traditional atherosclerotic risk factors. In conclusion, apart from significant valvular pathology, LV systolic dysfunction was prevalent in MFS from a young age, suggestive of a primary cardiomyopathy. LV dysfunction was typically mild and subclinical and occurred more commonly in patients with more pronounced aortopathies.

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Am J Cardiol: 09 May 2022; epub ahead of print
Connor BS, Algaze CA, Narkevičiūtė A, Anguiano B, ... Zarate YA, Collins RT
Am J Cardiol: 09 May 2022; epub ahead of print | PMID: 35550817
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Abstract

Relation of Extracardiac Vascular Disease and Outcomes in Patients With Diabetes (1.1 Million) Hospitalized for Acute Myocardial Infarction.

Istanbuly S, Matetic A, Roberts DJ, Myint PK, ... Bharadwaj A, Mamas MA
The association between vascular disease and outcomes of patients with acute myocardial infarction (AMI) has not been well-defined in the diabetes mellitus (DM) population. All patients with DM presenting with AMI between October 2015 and December 2018 in the National Inpatient Sample database were stratified by number and site of extracardiac vascular comorbidity (cerebrovascular [CVD], renovascular, neural, retinal and peripheral [PAD] diseases). Multivariable logistic regression was used to determine the adjusted odds ratios (aORs) of in-hospital adverse outcomes and procedures. Of 1,116,670 patients with DM who were hospitalized for AMI, 366,165 had ≥1 extracardiac vascular comorbidity (32.8%). Patients with vascular disease had an increased aOR for mortality (aOR 1.05, 95% confidence interval [CI] 1.04 to 1.07), major adverse cardiovascular and cerebrovascular events (MACCEs) (aOR 1.19, 95% CI 1.18 to 1.21), stroke (aOR 1.72, 95% CI 1.68 to 1.76), and major bleeding (aOR 1.11, 95% CI 1.09 to 1.13) and had lower odds of receiving coronary angiography (CA) (aOR 0.90, 95% CI 0.90 to 0.91) and percutaneous coronary intervention (PCI) (aOR 0.82, 95% CI 0.82 to 0.83) than patients without extracardiac vascular disease. Patients with PAD had the highest odds of mortality (aOR 1.29, 95% CI 1.27 to 1.32), whereas patients with CVD had the greatest odds of MACCEs, stroke, and major bleeding (aOR 1.82, 95% CI 1.78 to 1.87, aOR 4.25, 95% CI 4.10 to 4.40, and aOR 1.51, 95% CI 1.45 to 1.57, respectively). Patients with DM presenting with AMI and concomitant extracardiac vascular disease were more likely to develop clinical outcomes and less likely to undergo CA or PCI. Patients with PAD had the highest risk of mortality, whereas patients with CVD had the greatest risk of MACCEs, stroke, and major bleeding.

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Am J Cardiol: 09 May 2022; epub ahead of print
Istanbuly S, Matetic A, Roberts DJ, Myint PK, ... Bharadwaj A, Mamas MA
Am J Cardiol: 09 May 2022; epub ahead of print | PMID: 35550818
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Abstract

Comparison of Dabigatran Versus Warfarin Treatment for Prevention of New Cerebral Lesions in Valvular Atrial Fibrillation.

Cho MS, Kim M, Lee SA, Lee S, ... Kang DH, Choi KJ
Warfarin is the standard anticoagulation therapy for valvular atrial fibrillation (AF); however, new oral anticoagulants have emerged as an alternative. We compared the efficacy and safety of dabigatran with conventional treatment in AF associated with left-sided valvular heart disease (VHD), including mitral stenosis (MS). Patients with AF and left-sided VHD were randomly assigned to receive dabigatran or conventional treatment. The primary end point was the occurrence of clinical stroke or a new brain lesion (silent brain infarct and microbleed) on 1-year follow-up brain magnetic resonance imaging. Patients in the dabigatran group were switched from warfarin (n = 52), antiplatelets alone (n = 5), or no therapy (n = 2) to dabigatran. In the conventional group, 53 used warfarin (including 42 MS patients), and 7 used antiplatelets. No death or clinical stroke event occurred in either group during follow-up. Silent brain infarct and microbleed occurred in 20 and 2 patients in the dabigatran group and 20 and 4 patients in the conventional treatment group. The incidence rate of the primary end point did not significantly differ between groups (34% vs 40%, relative risk 0.87, 95% confidence interval 0.59 to 1.29, p = 0.491). The primary end point rate was similar between groups in 82 patients (40 in the dabigatran group and 42 in the conventional group) with MS (32% vs 34%, relative risk 0.93, 95% confidence interval: 0.57 to 1.50, p = 0.759). In conclusion, primary end point rates after treatment with dabigatran were similar to conventional treatment in patients with significant VHD and AF. New oral anticoagulants could be a reasonable alternative to warfarin in patients with AF and VHD, which should be confirmed in future large-scale studies.

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Am J Cardiol: 09 May 2022; epub ahead of print
Cho MS, Kim M, Lee SA, Lee S, ... Kang DH, Choi KJ
Am J Cardiol: 09 May 2022; epub ahead of print | PMID: 35550819
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Abstract

Relation of Left Ventricular Hypertrophy Subtype to Long-Term Mortality in Those With Subclinical Cardiovascular Disease (from the Multiethnic Study of Atherosclerosis [MESA]).

Ha ET, Ivanov A, Yeboah J, Seals A, ... Aronow WS, Frishman WH
The clinical and biochemical profile of differing Left ventricular hypertrophy phenotypes and its effect on long-term outcomes is ill-defined. The study investigated the differences in risk profiles and prognostic effect of concentric (CH) and eccentric hypertrophy (EH) on long-term adverse outcomes in a contemporary, ethnically diverse cohort. We analyzed follow-up data over 15 years from the Multiethnic Study of Atherosclerosis study. A total of 4,979 participants with cardiac magnetic resonance performed at baseline enrollment were included. Descriptive statistics, Kaplan-Meier curves, and regression models were applied. Independent variables associated with CH were black and Hispanic race/ethnicity, systolic blood pressure, and metabolic syndrome. Independent variables associated with EH were systolic blood pressure and urine creatinine, whereas serum creatinine had an inverse association. The primary end point of all-cause death (n = 1,137, 22.8%) occurred in 21.7%, 47.4%, and 56.6% of participants with no, CH, or EH, respectively (p- < 0.001). Age (hazard ratio [HR] per year = 1.10 [1.09 to 1.11], p <0.001), male gender (HR = 1.48 [1.29 to 1.69], p <0.001), black race (HR = 1.17 [1.005 to 1.36], p = 0.04), fasting glucose (HR = 1.005 [1.003 to 1.007], p <0.001), baseline creatinine (HR per mg/100 ml = 1.29 [1.15 to 1.46], p <0.001), left ventricular ejection fraction (HR per 1% = 0.98 [0.98 to 0.99], p = 0.005), IL-6 (HR per pg/ml = 1.17 [1.12 to 1.22], p <0.001), CH (HR = 1.84 [1.41 to 2.41], p <0.001), and EH (HR = 2.58 [1.77 to 3.76], p <0.001) were significant predictors of all-cause mortality. In conclusion, CH and EH are 2 distinct clinical phenotypes of left ventricular hypertrophy with differing gender and racial predisposition, both of which are associated with worse long-term adverse outcomes.

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Am J Cardiol: 09 May 2022; epub ahead of print
Ha ET, Ivanov A, Yeboah J, Seals A, ... Aronow WS, Frishman WH
Am J Cardiol: 09 May 2022; epub ahead of print | PMID: 35550820
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Abstract

Meta-Analysis of Relation Between Left Ventricular Dysfunction and Outcomes After Transcatheter Mitral Edge-to-Edge Repair.

Scotti A, Massussi M, Latib A, Munafò A, ... Maisano F, Godino C
Randomized controlled trials (RCTs) and observational studies provided conflicting results regarding the role of left ventricular (LV) function on outcomes after transcatheter edge-to-edge repair (TEER). The study aimed to provide a comprehensive assessment of the interplay between severe LV dysfunction and TEER outcomes. Multiple electronic databases, including PubMed, EMBASE, Scopus, Web of Science, and CENTRAL, were searched to identify studies on TEER for secondary mitral regurgitation reporting outcomes stratified for LV ejection fraction <30% and ≥30%. The prespecified primary end points were the composite of all-cause death or heart failure (HF) hospitalization and New York Heart Association (NYHA) class III/IV. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by random-effects models. Multiple sensitivity analyses accounting for baseline characteristics and study design were applied. A total of 6 studies (1,957 patients) with 1 year or 2 years of follow-up were available. Severe LV dysfunction was associated with an increased risk of death or HF hospitalization (OR 1.71, 95% CI 1.14 to 2.57). Conversely, comparable rates of NYHA class III/IV (OR 1.06, 95% CI 0.82 to 1.38) or secondary end points (reinterventions, recurrence of significant secondary mitral regurgitation) were found regardless of the baseline LV function. Subgroup meta-analysis found no difference in the composite primary end point between patients with LV ejection fraction <30% and ≥30% enrolled in RCTs. In conclusion, TEER seems to be associated with higher mortality or HF hospitalization rates in patients with severe LV dysfunction. However, RCTs found no differences between groups. No impact of LV function was found on the risk of NYHA class III/IV or other clinical outcomes.

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Am J Cardiol: 09 May 2022; epub ahead of print
Scotti A, Massussi M, Latib A, Munafò A, ... Maisano F, Godino C
Am J Cardiol: 09 May 2022; epub ahead of print | PMID: 35550821
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Abstract

Prognostic Impact of Plasma Glucose on Patients With Cardiogenic Shock With or Without Diabetes Mellitus from the SMART RESCUE Trial.

Choi SH, Yoon GS, Lee MJ, Park SD, ... Yang JH, Gwon HC
Although the presence of hyperglycemia has been shown to affect the clinical outcome of patients with cardiogenic shock, the extent of hyperglycemia and its association with prognosis have not been fully addressed in a large population. A total of 1,177 consecutive patients with cardiogenic shock were enrolled from January 2014 to December 2018 at 12 hospitals in South Korea. The primary outcome was in-hospital mortality. Patients were divided into 4 groups according to their initial plasma glucose level in patients with diabetes mellitus (DM) (n = 752) and patients without DM (n=425); group 1 (≤8 mmol/L or 144 mg/100 ml), group 2 (8 to 12 mmol/L or 144 to 216 mg/100 ml), group 3 (12 to 16 mmol/L or 216 to 288 mg/100 ml), and group 4 (≥16 mmol/L or 288 mg/100 ml). The groups with higher admission plasma glucose were associated with lower systolic blood pressure and higher lactic acid levels in patients with and without DM. In-hospital mortality increased in groups with higher admission plasma glucose level in patients without DM (group 1:24.2%, group 2: 28.6%, group 3: 38.1%, group 4: 49.0%, p <0.01), whereas in patients with DM, mortality and admission plasma glucose level showed no significant association (group 1: 45%, group 2: 35.4%, group 3: 33.3%, group 4: 43.1%, p = 0.26). Even after multivariate analysis, high plasma glucose was an independent predictor of in-hospital mortality in patients without DM. In patients with cardiogenic shock, plasma glucose obtained at admission was associated with in-hospital mortality in patients without DM.

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Am J Cardiol: 09 May 2022; epub ahead of print
Choi SH, Yoon GS, Lee MJ, Park SD, ... Yang JH, Gwon HC
Am J Cardiol: 09 May 2022; epub ahead of print | PMID: 35550823
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Abstract

Sex Disparities in Hemodynamics and Outcomes in Patients Who Underwent Contemporary Transcatheter Aortic Valve Implantation.

Medranda GA, Rogers T, Case BC, Zhang C, ... Ben-Dor I, Waksman R
Studies have reported worse outcomes after transcatheter aortic valve implantation (TAVI) in women receiving early generation transcatheter heart valves (THVs). They have smaller aortic annuli, which could result in higher gradients and more patient-prosthesis mismatch (PPM) after TAVI. We investigated the interactions between contemporary THV hemodynamics and outcomes in women who underwent TAVI. We conducted a retrospective, observational study of patients who underwent contemporary TAVI from 2015 to 2020. We compared baseline characteristics, in-hospital outcomes, and hemodynamics according to sex. We then dichotomized women according to aortic annular area (<430 or ≥430 mm2). Included were 869 patients who underwent TAVI with the SAPIEN 3 or CoreValve Evolut PRO/PRO+. Most patients with small annuli were female (82.5%). They had nonsignificantly higher mortality (30-day: 1.5% vs 0.6%, p = 0.313; 1-year: 4.1% vs 2.7%, p = 0.265). Those who received self-expanding THVs had lower gradients (8.0 mm Hg vs 13.8 mm Hg, p <0.001), resulting in less moderate PPM (21.2% vs 73.6%, p <0.001), similar severe PPM (19.5% vs 15.3%, p = 0.454), and higher rates of pacemaker implantation (14.4% vs 4.2%, p = 0.009). Women with small annuli who received a balloon-expandable THV had nonsignificantly higher mortality (30-day: 2.1% vs 0.8%, p = 0.631; 1-year: 6.3% vs 1.7%, p = 0.118). In conclusion, women who underwent contemporary TAVI had nonsignificantly higher mortality, which could be due to higher PPM rates. These findings were more pronounced in the subset of women with small annuli, in whom those who received self-expanding THVs demonstrated superior hemodynamics at the cost of increased rates of pacemaker implantation.

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Am J Cardiol: 09 May 2022; epub ahead of print
Medranda GA, Rogers T, Case BC, Zhang C, ... Ben-Dor I, Waksman R
Am J Cardiol: 09 May 2022; epub ahead of print | PMID: 35550824
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Abstract

Preprocedural Prognostic Factors in Acute Decompensated Aortic Stenosis.

Patel KP, Badiani S, Ganeshalingam A, Vijayakumar M, ... Mullen MJ, Lloyd G
Acute decompensated aortic stenosis (ADAS) is common and associated with poor outcomes. Myocardial remodeling and function, including a novel echo staging classification (0 to 4, representing increasing degrees of cardiac damage/dysfunction), impact outcomes in stable aortic stenosis. However, this has not been assessed in patients with ADAS. This study aims to evaluate the impact of the myocardium, echo staging classification, and clinical parameters on mortality in ADAS. ADAS was defined as an acute deterioration in symptoms (New York Heart Association 4, Canadian Cardiovascular Society 3/4, or syncope) that warranted admission to the hospital and urgent aortic valve replacement. Using a retrospective observational study design, 292 consecutive patients with ADAS who underwent transcatheter aortic valve implantation (TAVI) were identified and included in this study. Echocardiographic and clinical characteristics were evaluated using regression analysis. The outcome was all-cause mortality after TAVI. At 1 year after TAVI, advanced echo staging (>2) independently predicted mortality (hazards ratio: 1.85, 95% confidence interval: 1.01 to 3.39; p = 0.045). At a follow-up of 2.4 ± 1.4 years, myocardial, valvular, and clinical parameters did not predict mortality, except for frailty (hazards ratio: 2.31, 95% confidence interval: 1.38 to 3.85; p = 0.001). In patients with ADAS, short-term mortality after TAVI is influenced by more advanced cardiac damage/dysfunction based on the echo staging classification, whereas mid-term mortality is driven by frailty rather than echo staging classification.

Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 05 May 2022; epub ahead of print
Patel KP, Badiani S, Ganeshalingam A, Vijayakumar M, ... Mullen MJ, Lloyd G
Am J Cardiol: 05 May 2022; epub ahead of print | PMID: 35527043
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Abstract

Usefulness of Tissue Tracking by Cardiac Magnetic Resonance to Predict Events in Patients With Hypertrophic Cardiomyopathy.

Martínez-Vives P, Cecconi A, Vera A, Fernández C, ... Jiménez-Borreguero LJ, Alfonso F
Hypertrophic cardiomyopathy (HC) is the most common cardiovascular inherited disease, and it is associated with arrhythmic events, heart failure, and death. Strain analysis by tissue tracking (TT) techniques on cardiac magnetic resonance (CMR) is a novel noninvasive diagnostic tool. However, the usefulness of CMR-TT to identify patients with HC at risk of adverse outcomes remains unknown. CMR strain parameters by CMR-TT were prospectively measured in a cohort of 136 consecutive patients with HC. Clinical (death or readmission for heart failure) and arrhythmic (any ventricular tachycardia) events during follow-up were prospectively recorded. Global radial systolic strain rate and global radial diastolic strain rate showed the best area under the receiver operating characteristic curve (ROC curve) to predict adverse clinical events. On Cox multivariate regression models, a global radial systolic strain rate value <1.4/s and a global radial diastolic strain rate value ≥ -1.38/s were independently associated with clinical events at follow-up (adjusted hazard ratio 6.57, 95% confidence interval [CI] 2.01 to 21.49, p = 0.002; adjusted hazard ratio 5.96, 95% CI 1.79 to 19.89, p = 0.004, respectively). Regarding arrhythmic events, global radial peak strain <27% showed the best area under the ROC curve and remained independently associated with ventricular tachycardia after adjustment for confounders (odds ratio 7.33, 95% CI 1.07 to 50.41, p = 0.043). CMR strain parameters by TT predict clinical and arrhythmic events in patients with HC.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 04 May 2022; epub ahead of print
Martínez-Vives P, Cecconi A, Vera A, Fernández C, ... Jiménez-Borreguero LJ, Alfonso F
Am J Cardiol: 04 May 2022; epub ahead of print | PMID: 35525624
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Abstract

Incidence and Outcomes of Gastrointestinal Bleeding in Patients With Percutaneous Mechanical Circulatory Support Devices.

Pahuja M, Mony S, Adegbala O, Sheikh MA, ... Brady P, Waksman R
Percutaneous mechanical circulatory support (pMCS) devices are increasingly used in patients with cardiogenic shock as a bridge to recovery or bridge to decision to advanced heart failure therapies. Gastrointestinal bleeding (GIB) is a common complication that can be catastrophic. Because of the paucity of data describing the association of GIB with pMCS, we analyzed this population using the United States National Inpatient Sample database. We performed a retrospective study in patients with pMCS devices who had GIB during the index hospitalization using the National Inpatient Sample. Multivariate logistic regression analysis was performed to determine independent predictors of GIB in these patients. A total of 466,627 patients were included. We observed an overall increase in the incidence of adjusted GIB from 2.9% to 3.5% (p = 0.0025) from 2005 to 2014. In comparison to patients without GIB, those with GIB had significantly higher in-hospital mortality, length of stay, and hospitalization cost. In addition to the usual co-morbid conditions, the presence of small bowel and colonic ischemia, colon cancer, diverticulosis, chronic liver disease, and peptic ulcer disease were noted to be significant predictors of GIB for all (p <0.001). In conclusion, patients with pMCS and GIB have higher in-hospital mortality, longer length of stay, and higher cost of hospitalization. Awareness of patient risk factors for bleeding and gastrointestinal disorders are important before the use of mechanical circulatory support devices because they are associated with a substantially higher risk for bleeding.

Copyright © 2022. Published by Elsevier Inc.

Am J Cardiol: 03 May 2022; epub ahead of print
Pahuja M, Mony S, Adegbala O, Sheikh MA, ... Brady P, Waksman R
Am J Cardiol: 03 May 2022; epub ahead of print | PMID: 35523591
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Abstract

Outcomes of Hospitalizations With Septic Shock Complicated by Types 1 and 2 Myocardial Infarction.

Kamat IS, Nazir S, Minhas AMK, Nambi V, ... Plana JC, Jneid H
Septic shock is a life-threatening host response to infection and a significant contributor to cost burden in the United States. Furthermore, sepsis-related inflammation has been linked to myocardial infarction (MI). We sought to examine the association of type 1 and type 2 MI with outcomes in hospitalizations admitted with septic shock. The National Readmission Database 2018 was queried to identify hospitalizations with hospital discharge diagnoses of septic shock without MI, septic shock with type 1 MI, or septic shock with type 2 MI. Complex-sample multivariable logistic and linear regression models were used to determine the association of these conditions with clinical outcomes. Of 354,528 hospitalizations with septic shock, 11,519 had type 1 MI (3.2%) and 13,970 had type 2 MI (3.9%). Compared with septic shock without MI, type 1 MI was associated with higher mortality (adjusted odds ratio [OR] 1.67, 95% confidence interval [CI] 1.57 to 1.77), costs (adjusted parameter estimate $4,571, 95% CI 3,020 to 6,122), and discharge to facility (adjusted OR 1.09, 95% CI 1.01 to 1.17). In contrast, septic shock with type 2 MI was associated with similar mortality and discharge to nursing facility and higher costs (adjusted parameter estimate 1,798, 95% CI 549 to 3,047). Septic shock hospitalizations with type 1 MI had higher in-hospital mortality (adjusted OR 1.74, 95% CI 1.60 to 1.90, p <0.001) compared with type 2 MI. In conclusion, type 1 MI is associated with higher mortality and resource utilization among septic shock hospitalizations. Furthermore, type 2 MI was associated with higher resource utilization.

Copyright © 2022. Published by Elsevier Inc.

Am J Cardiol: 03 May 2022; epub ahead of print
Kamat IS, Nazir S, Minhas AMK, Nambi V, ... Plana JC, Jneid H
Am J Cardiol: 03 May 2022; epub ahead of print | PMID: 35523592
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Abstract

Cardiac Findings at Necropsy in Acute Type A Aortic Dissection.

Roberts CS, Roberts CC, Roberts WC
Described herein are necropsy findings in 97 patients aged 22 to 82 years (mean 55), 37 women, 60 men, studied at necropsy with acute aortic dissection (AD) with the intimal-medial tear in the ascending aorta. The cases were studied from 1966 to 1989, a period when echocardiography and computed tomography were relatively infrequently available for diagnosis of AD. Arteriography was the method for diagnosis in most cases. Of the 97 cases, 30(31%) had operative intervention and 67 did not. Most appeared to have had systemic hypertension before the acute AD; only 4 had previous heart failure; only 8 had considerable atherosclerotic coronary disease; only 4 had a left ventricular (LV) scar and in each it was small; most (96%) had a normal-sized LV cavity (suggesting normal cardiac indices in them), and the other 4 had only a mildly dilated cavity; the heart weight in all 97 patients was increased; the quantity of subepicardial adipose tissue was increased in most patients, and the frequency of a congenitally malformed aortic valve was much higher than in the general population (6% - vs- 1%), but still uncommon. Thus, in > 90% of patients with acute Type A AD, coronary atherosclerosis was insignificant, myocardial fibrosis is absent, and the aortic valve has 3 cusps without stenosis.

Copyright © 2021 Elsevier Inc. All rights reserved.

Am J Cardiol: 01 May 2022; 170:155-159
Roberts CS, Roberts CC, Roberts WC
Am J Cardiol: 01 May 2022; 170:155-159 | PMID: 35400482
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Abstract

Aortic Valve Replacement for Active Infective Endocarditis Limited to the Native Aortic Valve.

Roberts WC, Salam YM, Roberts CS
Described herein are certain clinical and morphologic findings in 27 patients who underwent aortic valve replacement (AVR) for active infective endocarditis (IE) limited to the aortic valve. The major focus was to describe and illustrate the operatively-excised aortic valves. The aortic valves were tricuspid in 17 patients, and in each of them the infection appeared to involve a previously normal valve as evidenced by the cusps being entirely normal in areas where vegetation was not present. The infection in the tricuspid valves produced considerable regurgitation. Of the 10 patients in whom the IE involved a congenitally bicuspid valve, 3 were considerably calcified and stenotic before the IE occurred and the IE produced ring abscess in each of these 3 patients. In contrast, ring abscess occurred in only 1 of the 17 patients with tricuspid aortic valves. The cuspid tissue in the other 7 patients with bicuspid valves was either minimally scarred, entirely normal, and free of calcific deposits.

Copyright © 2021 Elsevier Inc. All rights reserved.

Am J Cardiol: 01 May 2022; 170:76-82
Roberts WC, Salam YM, Roberts CS
Am J Cardiol: 01 May 2022; 170:76-82 | PMID: 35400483
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Abstract

Epidemiology and Outcomes of Patients Readmitted to the Intensive Care Unit After Cardiac Intensive Care Unit Admission.

Padkins M, Fanaroff A, Bennett C, Wiley B, ... Katz JN, Jentzer JC
Readmission to the intensive care unit (ICU) during the index hospitalization is associated with poor outcomes in medical or surgical ICU survivors. Little is known about critically ill patients with acute cardiovascular conditions cared for in a cardiac intensive care unit (CICU). We sought to describe the incidence, risk factors, and outcomes of all ICU readmissions in patients who survived to CICU discharge. We retrospectively reviewed Mayo Clinic patients from 2007 to 2015 who survived the index CICU admission and identified patients with a second ICU stay during their index hospitalization; these patients were categorized as ICU transfers (patients who went directly from the CICU to another ICU) or ICU readmissions (patients initially transferred from the CICU to the ward, and then back to an ICU). Among 9,434 CICU survivors (mean age 67 years), 138 patients (1.5%) had a second ICU stay during the index hospitalization: 60 ICU transfers (0.6%) and 78 ICU readmissions (0.8%). The most common indications for ICU readmission were respiratory failure and procedure/surgery. On multivariable modeling, respiratory failure, severe acute kidney injury, and Charlson Comorbidity Index at the time of discharge from the index ICU stay were associated with ICU readmission. Death during the first ICU readmission (n = 78) occurred in 7.7% of patients. In-hospital mortality was higher for patients with a second ICU stay. In conclusion, few CICU survivors have a second ICU stay during their index hospitalization; these patients are at a higher risk of in-hospital and 1-year mortality. Respiratory failure, severe acute kidney injury, and higher co-morbidity burden identify CICU survivors at elevated risk of ICU readmission.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 01 May 2022; 170:138-146
Padkins M, Fanaroff A, Bennett C, Wiley B, ... Katz JN, Jentzer JC
Am J Cardiol: 01 May 2022; 170:138-146 | PMID: 35393081
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Abstract

Serum Low-Density Lipoprotein Cholesterol and Cardiovascular Disease Risk Across Chronic Kidney Disease Stages (Data from 1.9 Million United States Veterans).

Hashemi L, Hsiung JT, Arif Y, Soohoo M, ... Kalantar-Zadeh K, Streja E
In the general population, elevated low-density lipoprotein (LDL) cholesterol levels are an important risk factor for cardiovascular disease (CVD) and mortality; however, the association of LDL with mortality risk and cardiovascular events are less clear in chronic kidney disease (CKD). We sought to examine the relationship of LDL with mortality and rates of atherosclerotic cardiovascular disease (ASCVD) and non-atherosclerotic cardiovascular-related (non-ASCVD) hospitalizations across CKD stages. Our analytical cohort consisted of 1,972,851 United States veterans with serum LDL data between 2004 and 2006. Associations of LDL with all-cause and cardiovascular mortality across CKD stages were evaluated using Cox proportional hazard models with adjustment for demographics, comorbid conditions, smoking status, prescription of statins and non-statin lipid-lowering drugs, body mass index, albumin, high-density lipoprotein, and triglycerides. Associations between LDL and ASCVD and non-ASCVD hospitalizations were estimated using negative binomial regression models across CKD stages. The cohort consisted of 5% female, 14% Black, 29% diabetic, 33% statin-users, and 44% current smokers, with a mean patient age of 64 ± 14 years. Patients with high LDL (≥160 mg/dL) had a higher risk of all-cause and cardiovascular mortality as well as ASCVD and non-ASCVD hospitalization rates across all CKD stages compared with the reference (LDL 70 to <100 mg/dL). The associations with all-cause and cardiovascular mortality and ASCVD hospitalization rate were attenuated at higher CKD stages. These trends were reversed with amplification of the association of high LDL with non-ASCVD hospitalization at higher CKD stages. In conclusion, associations of LDL with mortality and both ASCVD and non-ASCVD hospitalizations are modified according to kidney disease stage.

Published by Elsevier Inc.

Am J Cardiol: 01 May 2022; 170:47-55
Hashemi L, Hsiung JT, Arif Y, Soohoo M, ... Kalantar-Zadeh K, Streja E
Am J Cardiol: 01 May 2022; 170:47-55 | PMID: 35300833
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Abstract

Meta-Analysis of Catheter Ablation Outcomes in Patients With Cardiac Sarcoidosis Refractory Ventricular Tachycardia.

Adhaduk M, Paudel B, Liu K, Ashwath M, Giudici M
Cardiac sarcoidosis (CS) frequently leads to ventricular tachycardia (VT), which is often refractory to antiarrhythmic and/or immunosuppressive medications and requires catheter ablation. We conducted a systematic review and meta-analysis to evaluate the role of catheter ablation in patients with refractory VT undergoing catheter ablation. We searched PubMed, Embase, and Scopus databases from their inception to December 31, 2021 with search terms \"cardiac sarcoidosis\" AND \"electrophysiological studies OR ablation.\" Fifteen studies were ultimately included for evaluation. Patient demographics, VT mapping, and acute and long-term procedural outcomes were extracted. A total of 15 studies were included in our meta-analysis, with a total of 401 patients, of whom 66% were male, with ages ranging from 39 to 64 years. A total of 95% of patients were on antiarrhythmics and 79% of patients were on immunosuppressants. Left ventricular ejection fraction ranged from 35% to 49% and procedure duration ranged from 269 to 462 minutes. Ablation was reported using both irrigated and nonirrigated catheter tips. A total of 25% of patients (84/339) underwent repeat ablation. Acute procedural success was achieved in 57% (161/285). Procedure complications occurred in 5.7% (17/297) procedures. VT recurrence after first ablation was 55% (confidence interval 48% to 63%, 213/401); VT recurrence after multiple ablations was 37% (81/220). The composite end point of death, heart transplant, and left ventricular assist device implantation was 21% (confidence interval 14% to 30%, 55/297). In conclusion, catheter ablation is a useful modality in patients with CS with refractory VT. However, patients with CS presenting with refractory VT after undergoing VT ablation carry a poor prognosis.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 30 Apr 2022; epub ahead of print
Adhaduk M, Paudel B, Liu K, Ashwath M, Giudici M
Am J Cardiol: 30 Apr 2022; epub ahead of print | PMID: 35504741
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Abstract

Risk Factors Associated With New-Onset Myocardial Perfusion Abnormalities in Kidney Transplant Candidates.

Godwin L, Zheng Z, Kundu S, Cousins R, ... Moncayo V, Mitchell AJ
The optimal coronary artery disease surveillance strategy for end-stage renal disease patients being evaluated for kidney transplantation is unknown. It is unclear what risk factors are associated with the development of new-onset perfusion abnormalities on serial myocardial perfusion imaging. Potential kidney transplant recipients who underwent 2 myocardial perfusion imaging studies at Emory University Hospital between January 2010 and December 2019 were identified. We assessed the frequency of development of any new perfusion defect and development of moderate to severe ischemia (reversible perfusion defect >10%) on serial imaging. Finally, we identified the clinical and imaging factors associated with new perfusion defects and explored the association between new perfusion defects and all-cause mortality. History of myocardial infarction (MI) and peripheral artery disease was associated with an increased risk of developing a new perfusion defect. History of MI was also associated with the risk of developing moderate-severe ischemia. Female patients were less likely to develop new perfusion defects or moderate-severe ischemia. There was no association between either outcome and all-cause mortality. In conclusion, a history of MI, peripheral artery disease, and male gender are risk factors for developing new perfusion defects, although only the history of MI and male gender predict moderate to severe ischemia. Interval development of any abnormal perfusion is not associated with increased mortality.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 30 Apr 2022; epub ahead of print
Godwin L, Zheng Z, Kundu S, Cousins R, ... Moncayo V, Mitchell AJ
Am J Cardiol: 30 Apr 2022; epub ahead of print | PMID: 35504743
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Abstract

Meta-Analysis of Point-of-Care Lung Ultrasonography Versus Chest Radiography in Adults With Symptoms of Acute Decompensated Heart Failure.

Chiu L, Jairam MP, Chow R, Chiu N, ... Poterucha TJ, Topkara VK
Acute decompensated heart failure (ADHF) is a primary cause of older adults presenting to the emergency department with acute dyspnea. Point-of-care lung ultrasound (LUS) has shown comparable or superior diagnostic accuracy in comparison with a chest x-ray (CXR) in patients presenting with symptoms of ADHF. The systematic review and meta-analysis aimed to elucidate the sensitivity and specificity of LUS in comparison with CXR for diagnosing ADHF and summarize the rapidly growing body of evidence in this domain. A total of 5 databases were searched through February 18, 2021, to identify observational studies that reported on the use of LUS compared with CXR in diagnosing ADHF in patients presenting with shortness of breath. Meta-analysis was conducted on the sensitivities and specificities of each diagnostic method. A total of 8 studies reporting on 2,787 patients were included in this meta-analysis. For patients presenting with signs and symptoms of ADHF, LUS was found to be more sensitive than CXR (91.8% vs 76.5%) and more specific than CXR (92.3% vs 87.0%) for the detection of cardiogenic pulmonary edema. In conclusion, LUS is more sensitive and specific than CXR in detecting pulmonary edema. This highlights the importance of sonographic B-lines, along with the accurate interpretation of clinical data, in the diagnosis of ADHF. In addition to its convenience, reduced costs, and reduced radiation exposure, LUS should be considered an effective alternative to CXR for evaluating patients with dyspnea in the setting of ADHF.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 30 Apr 2022; epub ahead of print
Chiu L, Jairam MP, Chow R, Chiu N, ... Poterucha TJ, Topkara VK
Am J Cardiol: 30 Apr 2022; epub ahead of print | PMID: 35504747
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Abstract

Left Ventricular Structure, Tissue Composition, and Aortic Distensibility in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications.

Turkbey EB, Backlund JC, Gai N, Nacif M, ... Bluemke DA, DCCT/EDIC Research Group
Alterations in myocardial structure, function, tissue composition (e.g., fibrosis) may be associated with metabolic syndrome (MetS). This study aimed to determine the relation of MetS and its individual components to markers of cardiovascular disease in patients with type 1 Diabetes Mellitus (T1DM). A total of 978 subjects of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications T1DM cohort (age: 49 ± 7 years, 47% female, DM duration 28 ± 5 years) underwent cardiovascular magnetic resonance. In a subset of 200 patients, myocardial tissue composition was measured with cardiovascular magnetic resonance T1 mapping after contrast administration. MetS was defined as T1DM plus 2 other abnormalities based on the American Heart Association/National Cholesterol Education Program criteria. MetS was present in 34.1% of subjects. After adjustment for age, height, scanner, study cohort, gender, smoking, mean glycated hemoglobin levels, history of macroalbuminuria and end-stage renal disease, left ventricle mass was greater by 12.3 g, end-diastolic volume was higher by 5.4 ml, and mass to end-diastolic volume ratio was higher by 5% in patients with MetS versus those without MetS (p <0.001 for all). Myocardial T1 times were lower by 29 ms in patients with MetS than those without (p <0.001). Elevated waist circumference showed the strongest associations with left ventricle mass (+10.1 g), end-diastolic volume (+6.7 ml), and lower myocardial T1 times (+31 ms) in patients with MetS compared with those without (p <0.01). In conclusion, in a large cohort of patients with T1DM, 34.1% of subjects met MetS criteria. MetS was associated with adverse myocardial structural remodeling and change in myocardial tissue composition.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 29 Apr 2022; epub ahead of print
Turkbey EB, Backlund JC, Gai N, Nacif M, ... Bluemke DA, DCCT/EDIC Research Group
Am J Cardiol: 29 Apr 2022; epub ahead of print | PMID: 35501170
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Abstract

Relation of Myocardial Perfusion Reserve and Left Ventricular Ejection Fraction in Ischemic and Nonischemic Cardiomyopathy.

Wang S, Patel H, Miller T, Ameyaw K, ... Mor-Avi V, Patel AR
Quantification of myocardial perfusion reserve (MPR) using vasodilator stress cardiac magnetic resonance is increasingly used to detect coronary artery disease. However, MPR can also be altered because of changes in microvascular function. We aimed to determine whether MPR can distinguish between ischemic cardiomyopathy (IC) secondary to coronary artery disease and non-IC (NIC) with microvascular dysfunction and no underlying epicardial coronary disease. A total of 60 patients (mean age 65 ± 14 years, 30% women), including 31 with IC and 29 with NIC, were identified from a pre-existing vasodilator stress cardiac magnetic resonance registry. Short-axis cine slices were used to measure left ventricular ejection fraction (LVEF) using the Simpson method of disks. MPR index (MPRi) was determined from first-pass myocardial perfusion images during stress and rest using the upslope ratio, normalized for the arterial input and corrected for rate pressure product. Patients in both groups were divided into subgroups of LVEF ≤35% and LVEF >35%. Differences in MPRi between the subgroups were examined. MPRi was moderately correlated with LVEF in patients with NIC (r = 0.53, p = 0.03), whereas the correlation in patients with IC was lower (r = 0.32, p = 0.22). Average LVEF in NIC and IC was 34% ± 8% and 35% ± 8%, respectively (p = 0.63). MPRi was not significantly different in IC compared with NIC (1.17 [0.88 to 1.61] vs 1.23 [1.07 to 1.66], p = 0.41), including the subgroups of LVEF (IC: 1.20 ± 0.56 vs NIC: 1.15 ± 0.24, p = 0.75 for LVEF ≤35% and IC: 1.35 ± 0.44 vs NIC: 1.58 ± 0.50, p = 0.19 for LVEF >35%). However, MPRi was significantly lower in patients with LVEF ≤35% compared with those with LVEF>35% (1.17 ± 0.40 vs 1.47 ± 0.47, p = 0.01). Similar difference between LVEF groups was noted in the patients with NIC (1.15 ± 0.24 vs 1.58 ± 0.50, p = 0.006) but not in the patients with IC (1.20 ± 0.56 vs 1.35 ± 0.44, p = 0.42). MPRi can be abnormal in the presence of left ventricular dysfunction with nonischemic etiology. This is a potential pitfall to consider when using this approach to detect ischemia because of epicardial coronary disease using myocardial perfusion imaging.

Copyright © 2022. Published by Elsevier Inc.

Am J Cardiol: 26 Apr 2022; epub ahead of print
Wang S, Patel H, Miller T, Ameyaw K, ... Mor-Avi V, Patel AR
Am J Cardiol: 26 Apr 2022; epub ahead of print | PMID: 35487776
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Abstract

Effect of No-Charge Coronary Artery Calcium Scoring on Cardiovascular Prevention.

Al-Kindi S, Tashtish N, Rashid I, Gupta A, ... Simon DI, Rajagopalan S
Prevention of cardiovascular disease is currently guided by probabilistic risk scores that may misclassify individual risk and commit many middle-aged patients to prolonged pharmacotherapy. The coronary artery calcium (CAC) score, although endorsed for intermediate-risk patients, is not widely adopted because of barriers in reimbursement. The impact of removing cost barrier on cardiovascular outcomes in real-world settings is not known. Within the University Hospitals Health System (Cleveland, Ohio), CAC was offered to patients with at least 1 cardiovascular risk factor at low charge between 2014 and 2017 ($99) and no charge from January 1, 2018 onward. CAC use and access, patient characteristics, reclassification of risk compared with the pooled cohort equations (PCEs) for atherosclerotic vascular disease, statin use, changes in parameters of cardiometabolic health, downstream cardiovascular testing, downstream coronary revascularization, and cardiovascular outcomes were evaluated. A total of 52,151 patients underwent CAC testing over the study period. Median 10-year PCE for atherosclerotic vascular disease, in the entire cohort was 8.3% (4.0% to 15.9%). Among patients with PCE >20%, 21% had CAC <100, whereas 37% of those with PCE <7.5% had CAC ≥100. Among patients who were not on statin before CAC testing, 1-year statin prescription was 24% and was significantly associated with higher CAC scores. Total cholesterol, low-density lipoprotein cholesterol, and triglycerides all decreased significantly 1-year after CAC, and the degree of decrease was strongly linked with CAC scores. One year after CAC, 14% underwent noninvasive ischemic evaluation, 1.4% underwent invasive coronary angiography, and 0.9% underwent revascularization. The majority (74%) of revascularization procedures occurred in patients with CAC >400. In conclusion, reducing or removing the cost burden of CAC leads to significant test uptake by patients, which is followed by reclassification of statin eligibility, increases in the use of preventive medications, and improvement in risk factors, with very low rates of invasive downstream testing.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 26 Apr 2022; epub ahead of print
Al-Kindi S, Tashtish N, Rashid I, Gupta A, ... Simon DI, Rajagopalan S
Am J Cardiol: 26 Apr 2022; epub ahead of print | PMID: 35487777
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Abstract

Cardiorespiratory Fitness, Inflammation, and Risk of Sudden Cardiac Death in Middle-Aged Men.

Laukkanen JA, Kurl S, Voutilainen A, Mäkikallio T, Kunutsor SK
Inflammation and cardiorespiratory fitness (CRF) are each independently related to the risk of sudden cardiac death (SCD). The interplay between CRF, inflammation and SCD is not well understood. We aimed to study the separate and joint associations of inflammation (high-sensitivity C-reactive protein [hsCRP]) and CRF with SCD risk in a cohort of Caucasian men. In 1,749 men aged 42 to 61 years without a history of coronary heart disease at baseline, serum hsCRP was measured using an immunometric assay, and CRF was assessed using a respiratory gas exchange analyzer during exercise testing. hsCRP was categorized as normal and high (≤3 and >3 mg/L, respectively) and CRF as low and high (median cutoff). A total of 148 SCD events occurred during a median follow-up of 28.9 years. Comparing high versus normal hsCRP, the multivariable-adjusted hazard ratio (95% confidence interval) for SCD was 1.65 (1.11 to 2.45), which remained similar on further adjustment for CRF 1.62 (1.09 to 2.40). Comparing high versus low CRF, the multivariable-adjusted hazard ratio for SCD was 0.61 (0.42 to 0.89), which remained persistent after adjustment for hsCRP 0.64 (0.44 to 0.93). Compared with normal hsCRP-low CRF, normal hsCRP-high CRF was associated with a decreased SCD risk of 0.65 (0.43 to 0.99), high hsCRP-low CRF was associated with an increased SCD risk of 1.72 (1.10 to 2.69), with no evidence of a relationship between high hsCRP-high CRF and SCD risk 0.86 (0.39 to 1.88). Positive additive and multiplicative interactions were found between hsCRP and CRF. In a middle-aged Finnish male population, both hsCRP and CRF are independently associated with SCD risk. However, high CRF levels appear to offset the increased SCD risk related to high hsCRP levels.

Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 26 Apr 2022; epub ahead of print
Laukkanen JA, Kurl S, Voutilainen A, Mäkikallio T, Kunutsor SK
Am J Cardiol: 26 Apr 2022; epub ahead of print | PMID: 35483978
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Abstract

Long-Term Safety and Efficacy of Bempedoic Acid in Patients With Atherosclerotic Cardiovascular Disease and/or Heterozygous Familial Hypercholesterolemia (from the CLEAR Harmony Open-Label Extension Study).

Ballantyne CM, Banach M, Bays HE, Catapano AL, ... Lei L, Ray KK
`Limited data exist on the long-term safety and efficacy of bempedoic acid, an adenosine triphosphate-citrate lyase inhibitor, for lowering low-density lipoprotein cholesterol (LDL-C). This 78-week, phase 3, open-label extension (OLE) study followed the CLEAR Harmony phase 3 study, where patients were randomized 2:1 to bempedoic acid or placebo for 52 weeks; during the OLE, patients who received bempedoic acid continued treatment (≤130 weeks) and patients who received placebo initiated bempedoic acid (≤78 weeks). Safety assessments included treatment-emergent adverse events, adverse events of special interest, and clinical laboratory abnormalities. Efficacy assessments included % change from the parent study baseline in LDL-C, other lipid parameters, and high-sensitivity C-reactive protein (hsCRP). Of 1,462 patients who enrolled in the OLE study, 970 received bempedoic acid in the parent study; laboratory abnormalities and reductions in LDL-C, other lipid parameters, and hsCRP observed in the parent study remained stable through 130 weeks of treatment. On initiation of bempedoic acid treatment, 492 patients who received placebo in the parent study experienced reductions in LDL-C, other lipid parameters, and hsCRP, mirroring reductions observed in patients who received bempedoic acid in the parent study who remained stable through 78 weeks of therapy. During the OLE, incidence of treatment-emergent adverse events and adverse events of special interest were comparable in patients who received 130 weeks (78%) versus 78 weeks (78%) of bempedoic acid treatment. In conclusion, bempedoic acid was generally well tolerated and demonstrated sustained efficacy with up to 2.5 years of continuous treatment. Bempedoic acid safety profiles were similar between the parent and OLE studies.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 25 Apr 2022; epub ahead of print
Ballantyne CM, Banach M, Bays HE, Catapano AL, ... Lei L, Ray KK
Am J Cardiol: 25 Apr 2022; epub ahead of print | PMID: 35483979
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Abstract

Effect of Ground-Based Walk Training in Pulmonary Hypertension.

Ertan O, Aslan GK, Akinci B, Bilge AK, Inanc M, Okumus G
This study aimed to determine the effect of ground-based walking training on exercise capacity, physical activity, quadriceps muscle strength, and quality of life (QoL) in patients with pulmonary hypertension. A total of 24 patients were included in the study. Patients were randomly assigned to 2 groups as the walking group or the control group. The walking group participated in 30-minute supervised ground-based walking training 2 days/week for 8 weeks. Also, they walked unsupervised at least 1 day/week. The control group received no intervention. The number of weekly steps taken in both groups was recorded using a pedometer. In addition to the sociodemographic and clinic characteristics of the patients, the endurance shuttle walk test, incremental shuttle walk test, and 6-minute walk test were used for the evaluation of exercise capacity, and an activity monitor and pedometer for physical activity, a dynamometer for quadriceps muscle strength, and emPHasis-10 for QoL. After 8 weeks, endurance capacity, maximal exercise capacity, and the number of steps significantly improved in the walking group (p <0.05). The 6-minute walk distance, physical activity, quadriceps muscle strength, and QoL were similar in both groups (p >0.05). The results of the study showed that ground-based walking could improve endurance capacity, maximal exercise capacity, and the number of steps. Quadriceps muscle strength also improved in the walking group. No adverse effects were reported during the training period. Ground-based walking training can be performed safely in patients with pulmonary hypertension.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 23 Apr 2022; epub ahead of print
Ertan O, Aslan GK, Akinci B, Bilge AK, Inanc M, Okumus G
Am J Cardiol: 23 Apr 2022; epub ahead of print | PMID: 35473778
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Abstract

Risk Factors for Dementia in Patients With Atrial Fibrillation.

Alam AB, Lutsey PL, Chen LY, MacLehose RF, Shao IY, Alonso A
Although dementia and atrial fibrillation (AF) are common in older adults, risk factors for dementia have not been sufficiently characterized in patients with AF. We studied 621,773 patients with AF without dementia at the time of AF diagnosis who were enrolled in the MarketScan Commercial and Medicare Supplemental databases from 2007 to 2015. Dementia incidence and presence of predictors at the time of AF diagnosis (cardiometabolic conditions, mental and neurologic disorders, and other chronic conditions) were based on International Classification of Diseases, Ninth Revision, Clinical Modification codes in outpatient and inpatient claims, whereas medication usage was based on outpatient pharmacy claims. A frailty score was calculated using a previously established algorithm. The associations between the predictors of interest and dementia were assessed with multivariable Cox models. Patients had a mean age of 68 years (SD 14 years) and 41% were women. During a mean follow-up of 2.0 years, there were 16,073 cases of dementia. The strongest predictors of dementia were frailty (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.40 to 1.45, per 1-SD increase in the score), cognitive impairment (HR 1.50, 95% CI 1.36 to 1.65), mood disorders (HR 1.49, 95% CI 1.32 to 1.70), schizophrenia (HR 1.86, 95% CI 1.75 to 1.98), and substance abuse (HR 1.58, 95% CI 1.39 to 1.80). Among cardiometabolic conditions, only stroke (HR 1.17, 95% CI 1.13 to 1.22) and diabetes mellitus (HR 1.14, 95% CI 1.11 to 1.18) were associated with small increases in dementia risk after adjusting for demographics, frailty, co-morbidities, and medications. We have identified several risk factors for dementia in patients with AF.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 23 Apr 2022; epub ahead of print
Alam AB, Lutsey PL, Chen LY, MacLehose RF, Shao IY, Alonso A
Am J Cardiol: 23 Apr 2022; epub ahead of print | PMID: 35473779
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Abstract

Patient Perceptions of Exertion and Dyspnea With Interleukin-1 Blockade in Patients With Recently Decompensated Systolic Heart Failure.

Mihalick V, Wohlford G, Talasaz AH, Ho AJ, ... Abbate A, Van Tassell B
Interleukin-1 (IL-1) blockade is an anti-inflammatory treatment that may affect exercise capacity in heart failure (HF). We evaluated patient-reported perceptions of exertion and dyspnea at submaximal exercise during cardiopulmonary exercise testing (CPET) in a double-blind, placebo-controlled, randomized clinical trial of IL-1 blockade in patients with systolic HF (REDHART [Recently Decompensated Heart Failure Anakinra Response Trial]). Patients underwent maximal CPET at baseline, 2, 4, and 12 weeks and rated their perceived level of exertion (RPE, on a scale from 6 to 20) and dyspnea on exertion (DOE, on a scale from 0 to 10) every 3 minutes throughout exercise. Patients also answered 2 questionnaires to assess HF-related quality of life: the Duke Activity Status Index and the Minnesota Living with Heart Failure Questionnaire. From baseline to the 12-week follow-up, IL-1 blockade significantly reduced RPE and DOE at 3- and 6-minutes during CPET without changing values for heart rate, oxygen consumption, and cardiac workload at 3- and 6-minutes. Linear regression identified 6-minute RPE to be a strong independent predictor of both physical symptoms (Minnesota Living with Heart Failure Questionnaire; β = 0.474, p = 0.002) and perceived exercise capacity (Duke Activity Status Index; β = -0.443, p = 0.008). In conclusion, patient perceptions of exertion and dyspnea at submaximal exercise may be valuable surrogates for quality of life and markers of response to IL-1 blockade in patients with HF.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 23 Apr 2022; epub ahead of print
Mihalick V, Wohlford G, Talasaz AH, Ho AJ, ... Abbate A, Van Tassell B
Am J Cardiol: 23 Apr 2022; epub ahead of print | PMID: 35473780
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Abstract

Treatment and Outcomes of Acute Myocardial Infarction in Patients With Polymyalgia Rheumatica With and Without Giant Cell Arteritis.

Sokhal BS, Matetić A, Bharadwaj A, Helliwell T, ... Mohamed MO, Mamas MA
This study analyzed the characteristics, management, and outcomes of patients with polymyalgia rheumatica (PMR) hospitalized with acute myocardial infarction (AMI), including sensitivity analysis for presence of giant cell arteritis (GCA). Using the National Inpatient Sample (January 2004 to September 2015) and International Classification of Diseases, Ninth Revision, all AMI hospitalizations were stratified into main groups: PMR and no-PMR; and subsequently, PMR, PMR with GCA, and GCA and no-PMR. Outcomes were all-cause mortality, major adverse cardiovascular/cerebrovascular events (MACCEs), major bleeding, and ischemic stroke as well as coronary angiography (CA) and percutaneous coronary intervention (PCI). Multivariable logistic regression was used to determine adjusted odds ratios with 95% confidence interval (95% CI). A total of 7,622,043 AMI hospitalizations were identified, including 22,597 patients with PMR (0.3%) and 5,405 patients with GCA (0.1%). Patients with PMR had higher rates of mortality (5.8% vs 5.4%, p = 0.013), MACCEs (10.2% vs 9.2%, p <0.001), and stroke (4.6% vs 3.5%, p <0.001) and lower receipt of CA (48.9% vs 62.6%, p <0.001) and PCI (30.6% vs 41.0%, p <0.001) than the no-PMR group. After multivariable adjustment, patients with PMR had decreased odds of mortality (0.75, 95% CI 0.71 to 0.80), MACCEs (0.78, 95% CI 0.74 to 0.81), bleeding (0.79, 95% CI 0.73 to 0.86), and stroke (0.88, 95% CI 0.83 to 0.93); no difference in use of CA (1.01, 95% CI 0.98 to 1.04) and increased odds of PCI (1.07 95% CI 1.03 to 1.10) compared with the no-PMR group. Similar results were observed for patients with concomitant PMR and GCA, whereas patients with GCA only showed increased odds of bleeding (1.51 95% CI 1.32 to 1.72) and stroke (1.31 95% CI 1.16 to 1.47). In conclusion, patients with AMI with PMR have an increased incidence of crude adverse in-hospital outcomes than those without PMR; however, these differences do not persist after adjusting for age and comorbidities.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 23 Apr 2022; epub ahead of print
Sokhal BS, Matetić A, Bharadwaj A, Helliwell T, ... Mohamed MO, Mamas MA
Am J Cardiol: 23 Apr 2022; epub ahead of print | PMID: 35473781
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Abstract

Sex-Specific Differences in Ventricular Remodeling and Response After Cardiac Resynchronization Therapy.

Varrias D, De La Hoz MA, Zhao M, Pujol M, ... Singh J, Das S
In this study, we investigated the baseline characteristics and \"trajectories\" of clinical response in men and women after cardiac resynchronization therapy (CRT) implantation. Although women enjoy improved echocardiographic response after CRT compared with men, the kinetics of this response and its relation to functional performance and outcomes are less clear. We identified 592 patients who underwent CRT implantation at our center between 2004 and 2017 and were serially followed in a multidisciplinary clinic. Longitudinal linear mixed effects regression for cardiac response was specified, including interaction terms between time after CRT and sex , and Cox regression models were used to assess differences in all-cause mortality by gender after CRT. Women in our cohort were younger than men, had less frequent ischemic etiology of heart failure (24% vs 60% in men), a shorter QRS (151 vs 161 ms) and more frequent left bundle branch block (77% vs 52%) at baseline. Women had a greater improvement in left ventricular ejection fraction that was evident starting at approximately 1-month after CRT. We did not observe effect modification by gender in New York Heart Association class or 6-minute walk distance after CRT. Although women had improved mortality after CRT, after adjustment for potential confounders, gender was not associated with mortality after CRT. In conclusion, women were more likely to have CRT implantation for left bundle branch block and exhibited improved echocardiographic but not functional response within the first year after CRT. Clinical outcomes after CRT were not associated with gender in adjusted analysis.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 23 Apr 2022; epub ahead of print
Varrias D, De La Hoz MA, Zhao M, Pujol M, ... Singh J, Das S
Am J Cardiol: 23 Apr 2022; epub ahead of print | PMID: 35473782
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Abstract

Utility of Cardiac Magnetic Resonance Imaging in Predicting Atrial Arrhythmias in Repaired Tetralogy of Fallot.

Pinsker BL, Serfas JD, Awerbach JD, Dizon S, ... Campbell MJ, Krasuski RA
Arrhythmias are the leading cause of morbidity and mortality in repaired tetralogy of Fallot (TOF), and over 20% of these patients will develop a sustained atrial arrhythmia during their lifetimes. Cardiac magnetic resonance imaging (cMRI) is frequently performed in TOF, although its ability to identify patients at risk of atrial arrhythmias is uncertain. Adult TOF patients (n = 175) with no history of atrial arrhythmia who underwent cMRI between 2003 and 2020 at a single tertiary care center were identified. Clinical characteristics and imaging findings were evaluated to identify a predilection for atrial arrhythmias using Kaplan-Meier survival analysis and log-rank testing. Multivariable Cox regression was used to determine independent predictors of atrial arrhythmias. Over a median follow-up of 3.6 years, 29 patients (17%) developed atrial arrhythmias. Independent predictors of atrial arrhythmia included age (hazard ratio [HR] 1.06 per 1-year increase, 95% confidence interval [CI] 1.02 to 1.09, p = 0.002), diabetes mellitus (HR 4.26, 95% CI 1.26 to 14.41, p = 0.020), indexed right ventricular end-diastolic volume (RVEDVi), (HR 1.20 per 10-ml/m2 increase, 95% CI 1.05 to 1.39, p = 0.010), and moderate or greater tricuspid regurgitation (TR) (HR 6.32, 95% CI 2.15 to 18.60, p = 0.001). Utilizing Kaplan-Meier analysis, patients with at least mild right ventricular dilation (RVEDVi >100 ml/m2, p = 0.047) and greater than or equal to moderate TR (p <0.001) were found to be significantly more likely to develop atrial arrhythmias. In conclusion, cMRI can help to identify TOF patients at increased risk for atrial arrhythmia beyond standard clinical and imaging data by better quantifying RVEDVi and degree of TR.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 23 Apr 2022; epub ahead of print
Pinsker BL, Serfas JD, Awerbach JD, Dizon S, ... Campbell MJ, Krasuski RA
Am J Cardiol: 23 Apr 2022; epub ahead of print | PMID: 35473783
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Abstract

Characteristics of Patients With Obstructive Hypertrophic Cardiomyopathy in Real-World Community-Based Cardiovascular Practices.

Butzner M, Sarocco P, Maron MS, Rowin E, ... Tan H, Robertson LA
The clinical profile of patients with obstructive hypertrophic cardiomyopathy (oHC) is not well characterized, with little evidence outside selected referral populations. Using longitudinal medical claims data from a United States nationwide database, we retrospectively identified adults who were newly diagnosed with oHC. Clinical characteristics were compared from 1 year before diagnosis and at the 2-year follow-up. Patients (N = 1,841) with oHC (age 63 ± 15 years; 52% were male) with geographic representation across the United States were identified. Most patients received care within community-based cardiovascular practices and 7% at referral hypertrophic cardiomyopathy (HC) centers. Baseline diagnostic procedures included electrocardiogram (66%), echocardiogram (51%), magnetic resonance imaging (4%), and HC genetic testing (0.7%). Baseline co-morbidities were hypertension (59%), coronary artery disease (30%), diabetes (19%), and atrial fibrillation (19%). For all HC-related medications, use significantly increased after diagnosis. During follow-up, 144 patients (8%) received an implantable cardioverter-defibrillator for sudden death prevention, 99 underwent septal myectomy (5%), and 24 underwent alcohol septal ablation (1%). By the 1-year follow-up, 2% of patients had sudden cardiac arrest and 26% had atrial fibrillation, and heart failure increased from 16% to 27%. In conclusion, in a community-based population of patients with oHC, patients\' age at diagnosis of oHC was older than reported for referral populations and patients had a significant co-morbidity burden. Cardiovascular medication use was appropriate, but the rate of guideline-supported surgical procedures was low.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 23 Apr 2022; epub ahead of print
Butzner M, Sarocco P, Maron MS, Rowin E, ... Tan H, Robertson LA
Am J Cardiol: 23 Apr 2022; epub ahead of print | PMID: 35473784
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Abstract

Gender Differences in the Outcomes of Cardiogenic Shock Requiring Percutaneous Mechanical Circulatory Support.

Bravo-Jaimes K, Mejia MO, Abelhad NI, Zhou Y, ... Nathan S, Dhoble A
There is evidence for the lower use of percutaneous mechanical circulatory support (pMCS) in women. We aimed to determine (1) whether gender differences exist regarding in-hospital mortality, hospital course, and procedures; (2) whether socio-demographic and treatment-related factors were associated with these differences. Using the National Inpatient Sample, we collected the International Classification of Diseases, Ninth Revision, Clinical Modification codes for cardiogenic shock (CS) because of acute myocardial infarction AMI or acutely decompensated advanced heart failure and included intra-aortic balloon pump, Impella or Tandem Heart percutaneous ventricular assist devices (pVADs), extracorporeal membrane oxygenation. Demographics, co-morbidities, in-hospital course and procedures were recorded, and the Charlson Co-morbidity Index was calculated. Multivariable hierarchical logistic regression analysis and additional sensitivity analyses were performed. We identified 376,116 cases of CS because of acute myocardial infarction or acutely decompensated advanced heart failure, of which 113,305 required pMCS. Women were more likely to be older, non-White, insured by Medicare, and have a higher burden of co-morbidities and higher Charlson Co-morbidity Index. pMCS devices were inserted in 35,516 women (24.9%) and 77,789 men (33.3%). Women were less likely to receive pVAD or pulmonary artery (PA) catheters. Blood transfusions and acute respiratory failure were more common in women than men. Women had 15% higher in-hospital mortality and in a multivariate analysis, women, older age, having no insurance, diabetes mellitus, chronic kidney disease, cerebrovascular disease, peripheral arterial disease, longer time to pMCS insertion, receiving PA catheter, pVAD or extracorporeal membrane oxygenation and having cardiac arrest were associated with higher in-hospital mortality. In conclusion, women requiring pMCS support had a higher co-morbidity load, in-hospital mortality, acute respiratory failure, blood transfusions, and lower PA catheter use. Studies addressing early gender-specific interventions in CS are needed to reduce these differences.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 22 Apr 2022; epub ahead of print
Bravo-Jaimes K, Mejia MO, Abelhad NI, Zhou Y, ... Nathan S, Dhoble A
Am J Cardiol: 22 Apr 2022; epub ahead of print | PMID: 35469654
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Abstract

Impact of Small Valve Size on 1-Year Outcomes After Transcatheter Aortic Valve Implantation in Women (from the WIN-TAVI Registry).

Pivato CA, Cao D, Spirito A, Sartori S, ... Dangas G, Mehran R
Although most patients with small aortic annulus are women, there is paucity of data on the prognostic impact of small aortic prosthesis in women who underwent transcatheter aortic valve implantation (TAVI). Therefore, we aimed to evaluate the impact of small valve size on 1-year clinical outcomes after TAVI in women. The Women\'s INternational Transcatheter Aortic Valve Implantation is an all-women registry evaluating patients with severe aortic stenosis who underwent TAVI. Based on the size of the aortic bioprosthesis implanted, women were stratified into small (≤23 mm) and nonsmall (>23 mm) valve. The primary efficacy endpoint was the Valve Academic Research Consortium-2 composite of all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction at 1-year follow-up. Of 934 women who underwent TAVI, 388 (41.5%) received a small valve. Women with a small valve size had a lower body mass index, lower surgical risk scores, were less likely to suffer from atrial fibrillation, less often required postdilation and had a lower rate of residual aortic regurgitation grade ≥2. The occurrence of the Valve Academic Research Consortium-2 efficacy endpoint was similar between women treated with small and nonsmall valve (16.0% vs 16.3%, p = 0.881; adjusted hazard ratio 1.34, 95% confidence interval 0.90 to 2.00). Likewise, there were no significant differences in the occurrence of other secondary endpoints after multivariable adjustment. In conclusion, women with severe aortic stenosis who underwent TAVI with the implantation of a small valve bioprosthesis had similar 1-year outcomes as those receiving a nonsmall bioprosthesis.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 20 Apr 2022; epub ahead of print
Pivato CA, Cao D, Spirito A, Sartori S, ... Dangas G, Mehran R
Am J Cardiol: 20 Apr 2022; epub ahead of print | PMID: 35461697
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Abstract

Clinical Outcomes of Mitral Valve Disease With Mitral Annular Calcification.

Fukui M, Cavalcante JL, Ahmed A, Bae R, ... Enriquez-Sarano M, Sorajja P
The prevalence of mitral valve disease with mitral annular calcification (MAC) and its clinical outcomes remain uncertain. This study sought to evaluate the prevalence of significant mitral disease due to MAC, and the impact of intervention on the clinical outcomes in these patients. All patients who underwent transthoracic echocardiography (TTE) between January 2014 and December 2015 in our health care system were reviewed and identified for having MAC with significant mitral valve disease (i.e., either≥moderate mitral regurgitation (MR) or mitral stenosis (MS)). The primary endpoints of the study were all-cause mortality and a composite outcome of mortality or heart failure hospitalization at 3-year follow-up. Of 41,136 patients who underwent TTE, MAC was identified in 2,855 (6.9%) patients, including 434 (1.1% of total) patients who had significant MR and/or MS (median age [IQR], 80 [73 to 87] years; 63% women). MAC predominately involved the posterior annulus (95%), with the majority having calcification of both trigones (55%), the leaflets (71%), and circumferential involvement (67%). During 3-year follow-up, 59 (14%) patients underwent surgical or transcatheter MV intervention. Patients who did not undergo mitral intervention had higher all-cause mortality (HR 2.80, 95% CI 1.60 to 4.92; p <0.001) and a greater risk of the composite outcome (HR 1.43, 1.00 to 2.04; p = 0.05) than those treated. Survival at 3-year follow-up was markedly greater in those with mitral intervention (78% vs 50%; p <0.001). This survival benefit remained after multivariable adjustment. In conclusion, MAC affects approximately % of patients who undergo echocardiography. Those with significant mitral valve disease due to any degree of MAC have poor survival, which may be ameliorated with transcatheter or surgical intervention.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 18 Apr 2022; epub ahead of print
Fukui M, Cavalcante JL, Ahmed A, Bae R, ... Enriquez-Sarano M, Sorajja P
Am J Cardiol: 18 Apr 2022; epub ahead of print | PMID: 35450733
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Abstract

Ventricular Premature Complexes and Their Associated Factors in a General Population of Japanese Men.

Ahmed S, Hisamatsu T, Kadota A, Fujiyoshi A, ... Miura K, Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) Research Group
Increased ventricular premature complexes (VPCs) are associated with a higher risk of cardiac morbidities. However, little information is available on the risk factors of Western general populations. Therefore, we aimed to assess the frequency and associated factors of VPCs in healthy general Japanese men. We conducted a population-based cross-sectional study in 517 men, aged 40 to 79 years, using 24-hour Holter electrocardiography. Age, body mass index, height, low-density lipoprotein cholesterol, triglycerides, high-density lipoprotein cholesterol, resting heart rate, diabetes mellitus, hypertension, physical activity, smoking, alcohol consumption, lipid-lowering therapy were included in multivariable negative binomial regression to assess independent correlates for the number of VPCs per hour. We observed at least 1 VPC in 1 hour in 429 men (83%). In multivariable negative binomial regression adjusted for all covariates simultaneously, age (risk ratio [95% confidence interval] 1.91 [1.56 to 2.33] per 1-SD increment), height (1.17 [1.04 to 1.49] per 1-SD increment), resting heart rate(1.34 [1.02 to 1.77] per 1-SD increment), diabetes mellitus (2.36 [1.17 to 4.76] ), hypertension (1.90 [1.03 to 3.50]), physical activity (0.67 [0.47 to 0.97] ), current smoking (4.23 [1.86 to 9.60] ), past smoking (2.08 [1.03 to 4.19] ), current light alcohol consumption (0.16 [0.04 to 0.64] ), and lipid-lowering therapy (0.47 [0.23 to 0.96] ) were independently associated with VPCs frequency. In conclusion, VPCs frequency was independently associated with age, height, resting heart rate, diabetes mellitus, hypertension, physical activity, smoking, alcohol consumption, and lipid-lowering therapy.

Copyright © 2021 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 Apr 2022; 169:51-56
Ahmed S, Hisamatsu T, Kadota A, Fujiyoshi A, ... Miura K, Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) Research Group
Am J Cardiol: 15 Apr 2022; 169:51-56 | PMID: 35045928
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Abstract

Late Potential Abolition in Ventricular Tachycardia Ablation.

Roca-Luque I, Quinto L, Sanchez-Somonte P, Garre P, ... Brugada J, Mont L
Ventricular tachycardia (VT) substrate-based ablation has become the gold standard treatment for patients with structural heart disease-related VT. VT is linked to re-entry in relation to myocardial scarring, with areas of conduction block (core scar) and of slow conduction (border zone). Slow conduction areas can be detected in sinus rhythm as late potentials (LPs). LP abolition has been shown to be the best end point to avoid long-term recurrences. Our study aimed to analyze the challenges of LP abolition and the predictors of failure. We analyzed 169 consecutive patients with structural heart disease (61% ischemic cardiomyopathy, left ventricular ejection fraction: 37 ± 13%) who underwent VT ablation between 2013 and 2018. A preprocedural clinical evaluation, including cardiac magnetic resonance, was done in 66% of patients. Electroanatomical mapping with the identification of LPs was performed in all patients. Noninducibility was achieved in 71% (119), and complete LP abolition was achieved in 61% (103) of patients. Incomplete LP abolition was a powerful predictor of VT recurrence (67% vs 33%, hazard ratio 3.19 [2.1 to 4.7]; p <0.001). Lack of use of a high-density mapping catheter (odds ratio 6.2, 1.2 to 38.1; p = 0.028), the septal substrate (odds ratio 9.34, 2.27 to 38.4; p = 0.002), and larger left ventricular mass (190 ± 58 g vs 156 ± 46 g, p = 0.002) were predictors of incomplete LP abolition. The main reasons that contributed to unsuccessful LP abolition were anatomic obstacles (such as the conduction system) and large extension of the LP area. In conclusion, incomplete LP abolition is related to VT recurrence. Lack of use of a high-density mapping catheter, the septal substrate, and larger left ventricular mass are related to incomplete LP abolition.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 Apr 2022; epub ahead of print
Roca-Luque I, Quinto L, Sanchez-Somonte P, Garre P, ... Brugada J, Mont L
Am J Cardiol: 15 Apr 2022; epub ahead of print | PMID: 35437160
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Abstract

Echocardiographic Estimated Pulmonary Systolic Pressure and Outcome After Noncardiac-Obstetrics Surgery in Postcapillary Pulmonary Hypertensive Patients.

Zhou Y, Liu L, Fan F, Ma W
Pulmonary hypertension is associated with increased postoperative risk. This study analyzed the relation between the preoperative echocardiographic estimated blood pressure (estimated pulmonary arterial systolic pressure [ePASP]) of noncardiac patients and postoperative cardiac outcome and tried to identify a clinically meaningful threshold for ePASP in postcapillary pulmonary hypertensive patients. This was a single-center retrospective cohort study with propensity score analysis based on patients who underwent elective noncardiac surgery from June 2012 to December 31, 2018. We evaluated the relation between ePASP and the development of postoperative major adverse cardiac events (MACEs). Multivariate logistic regression models and generalized additive models were used, and the minimum p value approach was used to identify the threshold of ePASP that independently indicated the risk of MACEs. Finally, propensity score matching was used for patients with ePASP above or below the threshold, and the exposure effect was evaluated. Of the 16,210 surgeries, 7.0% experienced postoperative MACEs. The threshold for the ePASP was 47 mm Hg. Adjusted odds ratios for MACEs before and after propensity score matching were 2.03 (1.22 to 2.83) and 1.62 (1.01 to 2.23), respectively. In conclusion, the incidence of postoperative MACEs was 7.0% in patients who underwent elective noncardiac surgery. An ePASP ≥47 mm Hg was significantly associated with an increased risk of postoperative MACEs in postcapillary pulmonary hypertensive patients.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 15 Apr 2022; 169:127-135
Zhou Y, Liu L, Fan F, Ma W
Am J Cardiol: 15 Apr 2022; 169:127-135 | PMID: 35065802
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Abstract

Thigh Intramuscular Fat on Prognosis of Patients With Nonischemic Cardiomyopathy.

Yoshida T, Shibata A, Tanihata A, Hayashi H, ... Izumiya Y, Yoshiyama M
Skeletal muscle atrophy is an independent prognostic predictor for patients with chronic heart failure, and the concept of sarcopenia is drawing attention. Furthermore, the importance of not only muscle mass but also ectopic fat has been pointed out. However, there is a lack of consensus on the implications of ectopic fat for the prognosis in patients with nonischemic cardiomyopathy. We investigated whether ectopic fat in the thigh affects the prognosis of nonischemic cardiomyopathy. This prospective study recruited 145 patients diagnosed with nonischemic cardiomyopathy between September 2017 and January 2020. Finally, 93 patients with a reduced ejection fraction were enrolled. The clinical end points were cardiovascular death or unexpected rehospitalization because of a cardiac event. Using computed tomography, the percentage of intramuscular fat (%IMF) in the thigh was measured in all patients. Patients were divided into 2 groups based on the median %IMF. The results of Spearman\'s correlation coefficient analysis revealed a correlation among %IMF and peak oxygen uptake (Spearman r = -0.221, p = 0.036). Kaplan-Meier analysis results showed significantly higher risk of adverse events in the high %IMF group (log-rank p = 0.013). Multivariate Cox regression analysis results revealed the %IMF as an independent factor for adverse events (hazard ratio 1.361; 95% confidence interval 1.043 to 1.745; p = 0.018). In conclusion, %IMF may have adverse consequences such as increased cardiac events in patients with nonischemic cardiomyopathy with a reduced ejection fraction.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 15 Apr 2022; 169:113-119
Yoshida T, Shibata A, Tanihata A, Hayashi H, ... Izumiya Y, Yoshiyama M
Am J Cardiol: 15 Apr 2022; 169:113-119 | PMID: 35067348
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Abstract

Transcatheter Mitral Valve Implantation In Patients With Chronic Kidney Disease.

Elbadawi A, Abdelghany M, Dang A, Omer MA, ... Paniagua D, Jneid H
There is a paucity of data regarding the outcomes of trans-septal transcatheter mitral valve implantation (TS-TMVI) in patients with chronic kidney disease (CKD). We queried the Nationwide Readmissions Database (2015 to 2018) for patients undergoing TS-TMVI. We identified patients with CKD (Stage III or higher). We conducted propensity score matching analysis to compare the outcomes in patients with CKD versus patients without CKD. The main outcomes were in-hospital mortality and 30-day nonelective readmissions. From 2015 to 2018, there were 2,017 admissions for patients receiving TS-TMVI, of whom 733 (36.34%) had CKD. In the CKD group, 76 (10.4%) required chronic dialysis. During the study years, the number of TS-TMVI procedures increased in patients with CKD (ptrend <0.001). Patients with CKD were older and less likely to be women. There was no difference in in-hospital mortality in those with versus without CKD in the matched cohorts (7.8% vs 7.3%; odds ratio 1.09; 95% confidence interval 0.64 to 1.80). Subgroup analysis showed no interaction between chronic dialysis status and in-hospital mortality after TS-TMVI. In the matched cohort, TS-TMVI in those with CKD was associated with higher rates of cardiogenic shock (12.3% vs 7.6%, p = 0.03), acute kidney injury (35.7% vs 16.7%, p <0.001), hemodialysis (5.4% vs 1.5%, p = 0.01) and longer median length of stay, (7 [12] vs 5 [8] days, p <0.001). Patients with CKD were more likely to have 30-day nonelective readmission (25.8% vs 16.5%, p = 0.01), driven by more readmissions for bleeding/anemia. In conclusion, TS-TMVI in patients with CKD is associated with increased risk for cardiogenic shock, worsening renal function requiring hemodialysis, without increased risk of mortality when compared with patients without CKD. Also, there was a higher length of stay and 30-day readmission rate in patients with CKD versus patients without CKD.

Published by Elsevier Inc.

Am J Cardiol: 15 Apr 2022; 169:100-106
Elbadawi A, Abdelghany M, Dang A, Omer MA, ... Paniagua D, Jneid H
Am J Cardiol: 15 Apr 2022; 169:100-106 | PMID: 35063264
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Abstract

Readmission in Patients With ST-Elevation Myocardial Infarction in 4 Age Groups (<45, >45 to <60, 60 to <75, and >75).

Krittanawong C, Yue B, Mahtta D, Narasimhan B, ... Jneid H, Virani SS
The incidence of ST-elevation myocardial infarction (STEMI) among younger adults is increasing due to an increased prevalence of cardiometabolic risk factors. Readmissions after STEMI in young patients could lead to substantial health care costs and a significant burden on health care resources. Although STEMI readmissions are well studied in elderly patients, limited data are available regarding readmissions after STEMI in young patients and the etiologies remain poorly understood. Because younger patients with STEMI have different sociodemographic profiles th;an older patients with STEMI, one would postulate that the risk factors for readmissions in young patients would differ from that reported in the older patients with STEMI. We performed a contemporary nationwide study using the 2016 and 2017 Nationwide Readmissions Database to identify patterns of readmissions after STEMI in the young adult population. Our analysis of the Nationwide Readmissions Database revealed a total of 243,747 hospitalizations for STEMI between 2016 and 2017. Readmission rates demonstrated a steady increase from discharge, increasing to 7.8% at 30 days and 10.3% at 60 days before relatively plateauing at 12.1% at 90 days. Cardiovascular etiologies were the most common cause of readmission (53.6%). After multivariable analysis, development of cardiogenic shock (adjusted odds ratio 1.48, 95% confidence interval 1.11 to 1.97; p = 0.008) and acute renal failure (adjusted odds ratio 1.46, 95% confidence interval 1.14 to 1.87; p = 0.003) during the index admission were associated with significantly higher rates of readmission. In conclusion, close monitoring in young patients who presented with STEMI and concomitant with cardiogenic shock or acute renal failure, and possibly, aggressive therapy during index admission may be needed. However, this population may be heterogeneous and further research is needed.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 14 Apr 2022; epub ahead of print
Krittanawong C, Yue B, Mahtta D, Narasimhan B, ... Jneid H, Virani SS
Am J Cardiol: 14 Apr 2022; epub ahead of print | PMID: 35431050
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Abstract

Impact of Timing and Treatment Strategy on Coronary Perforation During Percutaneous Coronary Intervention for Chronic Total Occlusion.

Miura K, Tanaka H, Kishi K, Muramatsu T, ... Okamura A, Tsuchikane E
Coronary perforations during chronic total occlusion percutaneous coronary intervention (CTO-PCI) are potential complications and reportedly associated with adverse events. This study aimed to describe the clinical characteristics and timing of perforations during CTO-PCI. Data from the Japanese CTO-PCI expert registry included 8,760 patients who underwent CTO-PCI between January 2014 and January 2019. The major adverse cardiac and cerebrovascular events were defined as death, tamponade, myocardial infarction, stent thrombosis, stroke, and revascularization. The guidewire manipulation time was defined as the time required to cross the CTO without perforation. Among these patients, 333 (3.8%) developed perforation during the CTO crossing attempt. Of the 333 patients, 29 developed cardiac tamponades (8.7%). Perforations more frequently occurred in a retrograde wiring than in an anterograde wiring (6.6% vs 1.7%, p <0.0001). A longer guidewire manipulation time was associated with the occurrence of perforation (median 101 minutes [interquartile range 59 to 150 minutes] in the perforation group vs 54.9 minutes [interquartile range 21.1 to 112.7 minutes] in the nonperforation group, p <0.0001). Risk factors for perforation were age, history of coronary bypass graft, right coronary artery lesion, de novo lesion, use of a stiff guidewire, and guidewire manipulation time of >60 minutes during anterograde wiring and age, non-left anterior descending artery lesion, use of a polymer-jacketed guidewire, and use of epicardial channel during retrograde wiring. In conclusion, risk factors for perforation were different between anterograde and retrograde wirings. A prolonged guidewire manipulation time was associated with the occurrence of perforation, especially during anterograde wiring.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 13 Apr 2022; epub ahead of print
Miura K, Tanaka H, Kishi K, Muramatsu T, ... Okamura A, Tsuchikane E
Am J Cardiol: 13 Apr 2022; epub ahead of print | PMID: 35430083
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Abstract

Effects of Medical Face Masks on Physical Performance in Patients With Coronary Artery Disease or Hypertension.

Fischer P, Blumenauer D, Egger F, Fikenzer S, ... Böhm M, Mahfoud F
In this randomized, prospective monocentric study, 40 subjects with coronary artery disease or hypertension (cardiovascular disease [CVD] group) were assigned to either surgical mask (SM) or class 2 filtering facepiece mask (FFP2). They performed cycle ergometry exercise tests with progressive intensity until exhaustion with the assigned mask and another test with no mask (NM) in random order. A control group of 10 healthy subjects randomly performed 3 exercise tests with NM, SM, and FFP2, respectively. Blood pressure, heart rate, 12-lead electrocardiogram, exertion, shortness of breath, and capillary blood gases from the earlobe were documented. Across all groups, exercise testing with face masks resulted in a significantly reduced peak power output in watts compared with testing with NM (CVD group: SM vs NM: -5.0 ± 7.0%, p = 0.005; FFP2 vs NM: -4.7 ± 14%, p = 0.03; control group: SM vs NM: -6.8 ± 4.4%, p = 0.008; FFP2 vs NM: -8.9 ± 6.3%; p = 0.01) without differences in hemodynamic parameters, such as maximum heart rate and systolic blood pressure. Wearing an FFP2 compared with NM resulted in significant higher carbon dioxide partial pressure (CVD group: FFP2: 36.0 ± 3.2 mm Hg vs NM: 33.3 ± 4.4 mm Hg, p = 0.019; control group: FFP2: 32.6 ± 2.8 mm Hg vs NM: 28.1 ± 1.7 mm Hg, p <0.001) with corresponding differences in hydrogen carbonate and base excess, but not to a clinically critical extent. In conclusion, exercise testing with SM and FFP2 resulted in a significant reduction of peak power output without differences in hemodynamic parameters in subjects with preexisting CVD and in healthy subjects.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 10 Apr 2022; epub ahead of print
Fischer P, Blumenauer D, Egger F, Fikenzer S, ... Böhm M, Mahfoud F
Am J Cardiol: 10 Apr 2022; epub ahead of print | PMID: 35418332
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Abstract

Protective Effect of Catheter Ablation of Atrial Fibrillation on the Renal Function in Patients With Hypertrophic Cardiomyopathy.

Mimuro R, Hayashi H, Iwasaki YK, Hachisuka M, ... Yodogawa K, Shimizu W
Atrial fibrillation (AF) is a common arrhythmia in patients with hypertrophic cardiomyopathy (HCM) and is associated with renal function deterioration. The protective effects of catheter ablation (CA) of AF on renal function in patients with HCM remain unsolved. From 2009 to 2020, a total of 169 consecutive patients with HCM and AF (age 70 ± 12, 87 males) were retrospectively evaluated. The estimated glomerular filtration rate (eGFR) was evaluated at the study enrollment or 1 month before the CA and reevaluated 3 and 12 months later. In the 169 patients, 63 underwent CA of AF (ablation group), and the remaining 106 did not (control group). After propensity score matching, 45 pairs were matched. The baseline eGFR was similar between the 2 groups (p = 0.83). During a mean follow-up period of 34 ± 27 months, sinus rhythm was maintained in 36 patients (80%) after 1.7 ± 0.8 ablation procedures. The eGFR significantly decreased from baseline to 3 months (p <0.01) and from baseline to 1 year (p <0.01) in the control group, whereas the eGFR in the ablation group was maintained both from baseline to 3 months (p = 0.94) and from baseline to 1 year (p = 1.00) after the CA. The change in the eGFR between baseline and 12 months was significantly smaller in the ablation group than in the control group (p <0.01). After logistic regression analysis, CA of AF was the independent predictor of an improvement of eGFR (odds ratio 2.81, 95% confidence interval 1.08 to 7.36, p = 0.04). In conclusion, CA of AF had a protective effect on renal function in patients with HCM.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 06 Apr 2022; epub ahead of print
Mimuro R, Hayashi H, Iwasaki YK, Hachisuka M, ... Yodogawa K, Shimizu W
Am J Cardiol: 06 Apr 2022; epub ahead of print | PMID: 35397868
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Abstract

Meta-Analysis of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Left Main Narrowing.

Chew NWS, Ng CH, Kong G, Lee KS, ... Tan HC, Chan MY
Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) for patients with left main coronary artery disease (LMCAD) have reported conflicting results. We performed a systematic review up to May 23, 2021, and 1-stage reconstructed individual patient data meta-analysis (IPDMA) to compare outcomes between both groups. The primary outcome was 10-year all-cause mortality. Secondary outcomes included myocardial infarction (MI), stroke, and unplanned revascularization at 5 years. We performed individual patient data meta-analysis using published Kaplan-Meier curves to provide individual data points in coordinates and numbers at risk were used to increase the calibration accuracy of the reconstructed data. Shared frailty model or, when proportionality assumptions were not met, a restricted mean survival time model were fitted to compare outcomes between treatment groups. Of 583 articles retrieved, 5 RCTs were included. A total of 4,595 patients from these 5 RCTs were randomly assigned to PCI (n = 2,297) or CABG (n = 2,298). The cumulative 10-year all-cause mortality after PCI and CABG was 12.0% versus 10.6%, respectively (hazard ratio [HR] 1.093, 95% confidence interval [CI] 0.925 to 1.292; p = 0.296). PCI conferred similar time-to-MI (restricted mean survival time ratio 1.006, 95% CI 0.992 to 1.021, p=0.391) and stroke (restricted mean survival time ratio 1.005, 95% CI 0.998 to 1.013, p = 0.133) at 5 years. Unplanned revascularization was more frequent after PCI than CABG (HR 1.807, 95% CI 1.524 to 2.144, p <0.001) at 5 years. This meta-analysis using reconstructed participant-level time-to-event data showed no statistically significant difference in cumulative 10-year all-cause mortality between PCI versus CABG in the treatment of LMCAD.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 04 Apr 2022; epub ahead of print
Chew NWS, Ng CH, Kong G, Lee KS, ... Tan HC, Chan MY
Am J Cardiol: 04 Apr 2022; epub ahead of print | PMID: 35393084
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Abstract

Mitral Valve Infective Endocarditis after Trans-Catheter Aortic Valve Implantation.

Panagides V, Del Val D, Abdel-Wahab M, Mangner N, ... Holzhey D, Rodés-Cabau J
Scarce data exist on mitral valve (MV) infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). This multicenter study included a total of 579 patients with a diagnosis of definite IE after TAVI from the IE after TAVI International Registry and aimed to evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI. A total of 86 patients (14.9%) had MV-IE. These patients were compared with 284 patients (49.1%) with involvement of the transcatheter heart valve (THV) only. Two factors were found to be associated with MV-IE: the use of self-expanding valves (adjusted odds ratio 2.49, 95% confidence interval [CI] 1.23 to 5.07, p = 0.012), and the presence of an aortic regurgitation ≥2 at discharge (adjusted odds ratio 3.33; 95% CI 1.43 to 7.73, p <0.01). There were no differences in IE timing and causative microorganisms between groups, but surgical management was significantly lower in patients with MV-IE (6.0%, vs 21.6% in patients with THV-IE, p = 0.001). All-cause mortality rates at 2-year follow-up were high and similar between patients with MV-IE (51.4%, 95% CI 39.8 to 64.1) and patients with THV-IE (51.5%, 95% CI 45.4 to 58.0) (log-rank p = 0.295). The factors independently associated with increased mortality risk in patients with MV-IE were the occurrence of heart failure (adjusted p <0.001) and septic shock (adjusted p <0.01) during the index hospitalization. One of 6 IE episodes after TAVI is localized on the MV. The implantation of a self-expanding THV and the presence of an aortic regurgitation ≥2 at discharge were associated with MV-IE. Patients with MV-IE were rarely operated on and had a poor prognosis at 2-year follow-up.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 03 Apr 2022; epub ahead of print
Panagides V, Del Val D, Abdel-Wahab M, Mangner N, ... Holzhey D, Rodés-Cabau J
Am J Cardiol: 03 Apr 2022; epub ahead of print | PMID: 35387738
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Abstract

Long-Term Outcomes and Risk Stratification of Patients With Heart Failure With Recovered Ejection Fraction.

Perry AS, Mudigonda P, Huang GS, Qureshi B, ... Levy WC, Li S
This study aimed to understand the long-term outcomes of patients with heart failure with recovered ejection fraction, identify predictors of adverse events, and develop a risk stratification model. From an academic healthcare system, we retrospectively identified 133 patients (median age 66, 38% female, 30% ischemic etiology) who had an improvement in left ventricular ejection fraction (LVEF) from <40% to ≥53%. Significant predictors of all-cause mortality, hospitalization, and future reduction in LVEF were identified through Cox regression analysis. Kaplan-Meier survival was 70% at 5 years. Freedom from hospitalization was 58% at 1 year, and the risk of future LVEF reduction to <40% was 28% at 3 years. Diuretic dose and B-type natriuretic peptide (BNP) at the time of LVEF recovery were the strongest predictors of mortality and hospitalization in multivariate-adjusted analysis (BNP hazard ratio 1.13 per 100 pg/ml increase [p <0.01]; furosemide-equivalent dose hazard ratio 1.19 per 40 mg increase [p = 0.02]). An all-cause mortality Cox proportional hazard risk model incorporating New York Heart Association functional class, BNP and diuretic dose at the time of recovery showed excellent risk discrimination (c-statistic 0.79) and calibration. In conclusion, patients with heart failure with recovered ejection fraction have heterogenous clinical outcomes and are not \"cured.\" A risk model using New York Heart Association functional class, BNP, and diuretic dose can accurately stratify mortality risk.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 02 Apr 2022; epub ahead of print
Perry AS, Mudigonda P, Huang GS, Qureshi B, ... Levy WC, Li S
Am J Cardiol: 02 Apr 2022; epub ahead of print | PMID: 35382925
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Abstract

Incidence, Mortality, and Imaging Outcomes of Atrial Arrhythmias in COVID-19.

Jehangir Q, Lee Y, Latack K, Poisson L, ... Krishnamoorthy G, Sule AA
Atrial arrhythmias (AAs) are common in hospitalized patients with COVID-19; however, it remains uncertain if AAs are a poor prognostic factor in SARS-CoV-2 infection. In this retrospective cohort study from 2014 to 2021, we report in-hospital mortality in patients with new-onset AA and history of AA. The incidence of new-onset congestive heart failure (CHF), hospital length of stay and readmission rate, intensive care unit admission, arterial and venous thromboembolism, and imaging outcomes were also analyzed. We further compared the clinical outcomes with a propensity-matched influenza cohort. Generalized linear regression was performed to identify the association of AA with mortality and other outcomes, relative to those without an AA diagnosis. Predictors of new-onset AA were also modeled. A total of 6,927 patients with COVID-19 were included (626 with new-onset AA, 779 with history of AA). We found that history of AA (adjusted relative risk [aRR] 1.38, confidence interval [CI], 1.11 to 1.71, p = 0.003) and new-onset AA (aRR 2.02, 95% CI 1.68 to 2.43, p <0.001) were independent predictors of in-hospital mortality. The incidence of new-onset CHF was 6.3% in history of AA (odds ratio 1.91, 95% CI 1.30 to 2.79, p <0.001) and 11.3% in new-onset AA (odds ratio 4.01, 95% CI 3.00 to 5.35, p <0.001). New-onset AA was shown to be associated with worse clinical outcomes within the propensity-matched COVID-19 and influenza cohorts. The risk of new-onset AA was higher in patients with COVID-19 than influenza (aRR 2.02, 95% CI 1.76 to 2.32, p <0.0001), but mortality associated with new-onset AA was higher in influenza (aRR 12.58, 95% CI 4.27 to 37.06, p <0.0001) than COVID-19 (aRR 1.86, 95% CI 1.55 to 2.22, p <0.0001). In a subset of the patients with COVID-19 for which echocardiographic data were captured, abnormalities were common, including valvular abnormalities (40.9%), right ventricular dilation (29.6%), and elevated pulmonary artery systolic pressure (16.5%); although there was no evidence of a difference in incidence among the 3 groups. In conclusion, new-onset AAs are associated with poor clinical outcomes in patients with COVID-19.

Copyright © 2022 Elsevier Inc. All rights reserved.

Am J Cardiol: 02 Apr 2022; epub ahead of print
Jehangir Q, Lee Y, Latack K, Poisson L, ... Krishnamoorthy G, Sule AA
Am J Cardiol: 02 Apr 2022; epub ahead of print | PMID: 35382929
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Abstract

Relation of Cigarette Smoking and Heart Failure in Adults ≥65 Years of Age (From the Cardiovascular Health Study).

Gottdiener JS, Buzkova P, Kahn PA, DeFilippi C, ... Psaty B, Gardin JM
Cigarette smoking is associated with adverse cardiac outcomes, including incident heart failure (HF). However, key components of potential pathways from smoking to HF have not been evaluated in older adults. In a community-based study, we studied cross-sectional associations of smoking with blood and imaging biomarkers reflecting mechanisms of cardiac disease. Serial nested, multivariable Cox models were used to determine associations of smoking with HF, and to assess the influence of biochemical and functional (cardiac strain) phenotypes on these associations. Compared with never smokers, smokers had higher levels of inflammation (C-reactive protein and interleukin-6), cardiomyocyte injury (cardiac troponin T [hscTnT]), myocardial \"stress\"/fibrosis (soluble suppression of tumorigenicity 2 [sST2], galectin 3), and worse left ventricle systolic and diastolic function. In models adjusting for age, gender, and race (DEMO) and for clinical factors potentially in the causal pathway (CLIN), smoking exposures were associated with C-reactive protein and interleukin-6, sST2, hscTnT, and with N-terminal pro-brain natriuretic protein (in Whites). In DEMO adjusted models, the cumulative burden of smoking was associated with worse left ventricle systolic strain. Current smoking and former smoking were associated with HF in DEMO models (hazard ratio 1.41, 95% confidence interval 1.22 to 1.64 and hazard ratio 1.14, 95% confidence interval 1.03 to 1.25, respectively), and with current smoking after CLIN adjustment. Adjustment for time-varying myocardial infarction, inflammation, cardiac strain, hscTnT, sST2, and galectin 3 did not materially alter the associations. Smoking was associated with HF with preserved and decreased ejection fraction. In conclusion, in older adults, smoking is associated with multiple blood and imaging biomarker measures of pathophysiology previously linked to HF, and to incident HF even after adjustment for clinical intermediates.

Copyright © 2021 Elsevier Inc. All rights reserved.

Am J Cardiol: 01 Apr 2022; 168:90-98
Gottdiener JS, Buzkova P, Kahn PA, DeFilippi C, ... Psaty B, Gardin JM
Am J Cardiol: 01 Apr 2022; 168:90-98 | PMID: 35045935
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Abstract

Early Resolution of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve.

Isogai T, Dykun I, Agrawal A, Shekhar S, ... Kapadia SR, Puri R
New-onset left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) but can resolve in the post-TAVI period. We sought to examine the incidence, predictors, and outcomes of early resolution of new-onset LBBB among TAVI recipients with a SAPIEN 3 (S3) valve. Among 1,203 S3-TAVI recipients without a pre-existing pacemaker or wide QRS complex at our institution between 2016 and 2019, we identified 143 patients who developed new-onset LBBB during TAVI and divided them according to the resolution or persistence of LBBB by the next day post-TAVI to compare high-degree atrioventricular block (HAVB) and permanent pacemaker (PPM) rates. Patients with resolved LBBB (n = 74, 52%), compared with those with persistent LBBB, were more often women and had a shorter QRS duration at baseline and post-TAVI, with a smaller S3 size and a shallower implantation depth. A multivariable logistic regression model demonstrated significant associations of post-TAVI QRS duration (per 10 ms increase, odds ratio = 0.60 [95% confidence interval = 0.44 to 0.82]) and implantation depth (per 1-mm-depth-increase, 0.77 [0.61 to 0.97]) with a lower likelihood of LBBB resolution. No patient with resolved LBBB developed HAVB within 30 days post-TAVI. Meanwhile, 8 patients (11.6%) with persistent LBBB developed HAVB. The 2-year PPM rate was significantly higher after persistent LBBB than after resolved LBBB (30.3% vs 4.5%, log-rank p <0.001), mainly driven by higher 30-day PPM rate (18.8% vs 0.0%). In conclusion, about half of new-onset LBBBs that occurred during S3-TAVI resolved by the next day post-TAVI without HAVB. In contrast, new-onset persistent LBBB may need follow-up with ambulatory monitoring within 30 days because of the HAVB risk.

Copyright © 2021 Elsevier Inc. All rights reserved.

Am J Cardiol: 01 Apr 2022; 168:117-127
Isogai T, Dykun I, Agrawal A, Shekhar S, ... Kapadia SR, Puri R
Am J Cardiol: 01 Apr 2022; 168:117-127 | PMID: 35045936
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Abstract

Relation of Iron Status to Prognosis After Acute Coronary Syndrome.

Gürgöze MT, Kardys I, Akkerhuis KM, Oemrawsingh RM, ... Manintveld OC, Boersma E
Iron deficiency has been extensively researched and is associated with adverse outcomes in heart failure. However, to our knowledge, the temporal evolution of iron status has not been previously investigated in patients with acute coronary syndrome (ACS). Therefore, we aimed to explore the temporal pattern of repeatedly measured iron, ferritin, transferrin, and transferrin saturation (TSAT) in relation to prognosis post-ACS. BIOMArCS (BIOMarker study to identify the Acute risk of a Coronary Syndrome) is a prospective, multicenter, observational cohort study conducted in The Netherlands between 2008 and 2015. A total of 844 patients with post-ACS were enrolled and underwent high-frequency (median 17) blood sampling during 1 year follow-up. Biomarkers of iron status were measured batchwise in a central laboratory. We analyzed 3 patient subsets, including the case-cohort (n = 187). The primary endpoint (PE) was a composite of cardiovascular mortality and repeat nonfatal ACS, including unstable angina pectoris requiring revascularization. The association between iron status and the PE was analyzed using multivariable joint models. Mean age was 63 years; 78% were men, and >50% had iron deficiency at first sample in the case-cohort. After adjustment for a broad range of clinical variables, 1 SD decrease in log-iron was associated with a 2.2-fold greater risk of the PE (hazard ratio 2.19, 95% confidence interval 1.34 to 3.54, p = 0.002). Similarly, 1 SD decrease in log-TSAT was associated with a 78% increased risk of the PE (hazard ratio 1.78, 95% confidence interval 1.17 to 2.65, p = 0.006). Ferritin and transferrin were not associated with the PE. Repeated measurements of iron and TSAT predict risk of adverse outcomes in patients with post-ACS during 1 year follow-up. Trial Registration: The Netherlands Trial Register. Unique identifiers: NTR1698 and NTR1106. Registered at https://www.trialregister.nl/trial/1614 and https://www.trialregister.nl/trial/1073.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 01 Apr 2022; 168:22-30
Gürgöze MT, Kardys I, Akkerhuis KM, Oemrawsingh RM, ... Manintveld OC, Boersma E
Am J Cardiol: 01 Apr 2022; 168:22-30 | PMID: 35045937
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Abstract

Unraveling the Multitude of Etiologies in Myocardial Infarction With Nonobstructive Coronary Arteries.

Pustjens TFS, Vranken NPA, Hermanides RS, Rasoul S, Ottervanger JP, Van\'t Hof AWJ
Although recent studies revealed suboptimal outcomes in patients with myocardial infarction with nonobstructive coronary arteries (MINOCAs), the underlying etiology remains unknown in most patients. Therefore, adequate treatment modalities have not yet been established. We aimed to assess demographics, treatment strategies, and long-term clinical outcome in MINOCA subgroups. We retrospectively analyzed data from a large, prospective observational study of patients with acute coronary syndrome admitted to the Isala hospital in Zwolle, The Netherlands between 2006 and 2014. Patients with MINOCA were divided into subgroups based on the underlying cause of the event. From 7,693 patients, 402 patients (5%) concerned MINOCA. After the exclusion of missing cases (n = 47), 5 subgroups were distinguished: \"true\" acute myocardial infarction (10%), perimyocarditis (13%), cardiomyopathy (including Takotsubo cardiomyopathy) (19%), miscellaneous causes (21%), and an indeterminate group (38%). Patients with cardiomyopathy were predominantly women (78%) and showed the highest incidence of major adverse cardiovascular events at 30 days follow-up (7%; p = 0.012), 1 year (19%; p = 0.004), and mortality at long-term follow-up (27%; p = 0.010) compared with any other MINOCA subgroup. The cardiomyopathy group was followed by the indeterminate group, with major adverse cardiovascular events rates of 1% and 5%, respectively, and 17% long-term all-cause mortality. In conclusion, long-term prognosis in MINOCA depends on the underlying etiology. Prognosis is worst in the cardiomyopathy group followed by the indeterminate group. This underlines the importance of revealing the diagnosis to ultimately optimize treatment.

Copyright © 2021 Elsevier Inc. All rights reserved.

Am J Cardiol: 01 Apr 2022; 168:17-21
Pustjens TFS, Vranken NPA, Hermanides RS, Rasoul S, Ottervanger JP, Van't Hof AWJ
Am J Cardiol: 01 Apr 2022; 168:17-21 | PMID: 35031111
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Abstract

Validation of Heart Failure-Specific Risk Equations in 1.3 Million Israeli Adults and Usefulness of Combining Ambulatory and Hospitalization Data from a Large Integrated Health Care Organization.

Khan SS, Barda N, Greenland P, Dagan N, ... Balicer R, Rasmussen-Torvik LJ
Heart failure (HF) prevalence is increasing worldwide and is associated with significant morbidity and mortality. Guidelines emphasize prevention in those at-risk, but HF-specific risk prediction equations developed in United States population-based cohorts lack external validation in large, real-world datasets outside of the United States. The purpose of this study was to assess the model performance of the pooled cohort equations to prevent HF (PCP-HF) within a contemporary electronic health record for 5- and 10-year risk. Using a retrospective cohort study design of Israeli residents between 2008 and 2018 with continuous membership until end of follow-up, HF, or death, we quantified 5- and 10-year estimated risks of HF using the PCP-HF equations, which integrate demographics (age, gender, and race) and risk factors (body mass index, systolic blood pressure, glucose, medication use for hypertension or diabetes, and smoking status). Of 1,394,411 patients included, 56% were women with mean age of 49.6 (SD 13.2) years. Incident HF occurred in 1.2% and 4.5% of participants over 5 and 10 years of follow-up. The PCP-HF model had excellent discrimination for 5- and 10-year predictions of incident HF (C Statistic 0.82 [0.82 to 0.82] and 0.84 [0.84 to 0.84]), respectively. In conclusion, HF-specific risk equations (PCP-HF) accurately predict the risk of incident HF in ambulatory and hospitalized patients using routinely available clinical data.

Copyright © 2021 Elsevier Inc. All rights reserved.

Am J Cardiol: 01 Apr 2022; 168:105-109
Khan SS, Barda N, Greenland P, Dagan N, ... Balicer R, Rasmussen-Torvik LJ
Am J Cardiol: 01 Apr 2022; 168:105-109 | PMID: 35031113
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Abstract

Effect of Elevated C-Reactive Protein on Outcomes After Complex Percutaneous Coronary Intervention for Angina Pectoris.

Camaj A, Giustino G, Kocovic N, Cao D, ... Sharma SK, Mehran R
Inflammation and procedural complexity are individually associated with adverse outcomes after percutaneous coronary intervention (PCI). We aimed to evaluate the association of high sensitivity C-reactive protein (hsCRP) with adverse events according to PCI complexity. We included patients with available hsCRP levels who underwent PCI at our center from 2012 to 2017. We compared patients with hsCRP ≥3 versus <3 mg/L. Complex PCI was defined as having ≥1 of the following: ≥3 different target vessels, ≥3 lesions treated, ≥3 stents implanted, bifurcation lesion treated with 2 stents, chronic total occlusion as target lesion, or total stent length >60 mm. The primary end point was major adverse cardiac events (MACEs) (composite of all-cause death, myocardial infarction, or target vessel revascularization) at 1 year. A total of 11,979 patients were included, of which 2,840 (24%) underwent complex PCI. In those, 767 (27%) had hsCRP ≥3 mg/L. The 1-year incidence of MACE was 6% (noncomplex PCI, low hsCRP), 10% (noncomplex PCI, high hsCRP), 10% (complex PCI, low hsCRP), and 15% (complex PCI, high hsCRP). Overall, hsCRP ≥3 mg/L was associated with an increased risk of MACE compared with hsCRP <3 mg/L; this was independent of the number of complex PCI features: 0 (adjusted hazard ratio [HR] 1.53; 95% confidence interval [CI] 1.27 to 1.86), 1 (adjusted HR 1.77; 95% CI 1.21 to 2.60), or ≥2 (adjusted HR 1.21; 95% CI 0.80 to 1.83) (pinteraction = 0.42). In conclusion, in patients who underwent PCI, elevated hsCRP is associated with an increased risk of ischemic events. The effect of elevated hsCRP on cardiovascular risk is consistent regardless of PCI complexity.

Copyright © 2021 Elsevier Inc. All rights reserved.

Am J Cardiol: 01 Apr 2022; 168:47-54
Camaj A, Giustino G, Kocovic N, Cao D, ... Sharma SK, Mehran R
Am J Cardiol: 01 Apr 2022; 168:47-54 | PMID: 35058052
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