Journal: J Am Coll Cardiol

Sorted by: date / impact
Abstract
<div><h4>Comparative Risk of Angioedema With Sacubitril-Valsartan vs Renin-Angiotensin-Aldosterone Inhibitors.</h4><i>Eworuke E, Welch EC, Haug N, Horgan C, ... Zhao Y, Huang TY</i><br /><b>Background</b><br />Data on angioedema risk among sacubitril-valsartan (SV) users in real-world settings are limited.<br /><b>Objectives</b><br />We sought to evaluate the risk of angioedema among SV new users compared with angiotensin-converting enzyme (ACE) inhibitor and angiotensin-receptor-blocker (ARB) new users separately.<br /><b>Methods</b><br />We conducted a propensity score-matched cohort study, comparing SV new users (no use of SV, ACE inhibitor, ARB 6 months before) and SV new users with prior use (within 183 or 14 days) of ACE inhibitor or ARB (ACE inhibitor-SV and ARB-SV users; recent ACE inhibitor-SV and recent ARB-SV users, respectively) vs ACE inhibitor and ARB new users separately.<br /><b>Results</b><br />Compared with ACE inhibitor, SV new (HR: 0.18; 95% CI: 0.11-0.29) and ACE inhibitor-SV users (HR: 0.31; 95% CI: 0.23-0.43) showed lower risk of angioedema. On the other hand, there was no difference in angioedema risk when SV new users (HR: 0.59; 95% CI: 0.35-1.01) or ARB-SV users (HR: 0.85; 95% CI: 0.58-1.26) were compared with ARB new users. Compared with SV new users, ACE inhibitor-SV users (HR: 1.62; 95% CI: 0.91-2.89) trended toward higher angioedema risk, which intensified when the ACE inhibitor to SV switch occurred within 14 days (recent ACE inhibitor-SV) (HR: 1.98; 95% CI: 1.11-3.53). Similarly, ARB-SV users (HR: 2.03; 95% CI: 1.16-3.54) experienced an increased risk compared with SV new users, which intensified for the more recent switchers (recent ARB-SV) (HR: 2.45; 95% CI: 1.36-4.43).<br /><b>Conclusions</b><br />We did not observe an increased risk of angioedema among SV new users compared with ACE inhibitor or ARB users. However, there was an increased risk of angioedema among SV users who recently switched from ACE inhibitor or ARB compared with SV new users.<br /><br />Published by Elsevier Inc.<br /><br /><small>J Am Coll Cardiol: 31 Jan 2023; 81:321-331</small></div>
Eworuke E, Welch EC, Haug N, Horgan C, ... Zhao Y, Huang TY
J Am Coll Cardiol: 31 Jan 2023; 81:321-331 | PMID: 36697132
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Somatostatin Receptor PET/MR Imaging of Inflammation in Patients With Large Vessel Vasculitis and Atherosclerosis.</h4><i>Ćorović A, Wall C, Nus M, Gopalan D, ... Mason JC, Tarkin JM</i><br /><b>Background</b><br />Assessing inflammatory disease activity in large vessel vasculitis (LVV) can be challenging by conventional measures.<br /><b>Objectives</b><br />We aimed to investigate somatostatin receptor 2 (SST<sub>2</sub>) as a novel inflammation-specific molecular imaging target in LVV.<br /><b>Methods</b><br />In a prospective, observational cohort study, in vivo arterial SST<sub>2</sub> expression was assessed by positron emission tomography/magnetic resonance imaging (PET/MRI) using <sup>68</sup>Ga-DOTATATE and <sup>18</sup>F-FET-βAG-TOCA. Ex vivo mapping of the imaging target was performed using immunofluorescence microscopy; imaging mass cytometry; and bulk, single-cell, and single-nucleus RNA sequencing.<br /><b>Results</b><br />Sixty-one participants (LVV: n = 27; recent atherosclerotic myocardial infarction of ≤2 weeks: n = 25; control subjects with an oncologic indication for imaging: n = 9) were included. Index vessel SST<sub>2</sub> maximum tissue-to-blood ratio was 61.8% (P < 0.0001) higher in active/grumbling LVV than inactive LVV and 34.6% (P = 0.0002) higher than myocardial infarction, with good diagnostic accuracy (area under the curve: ≥0.86; P < 0.001 for both). Arterial SST<sub>2</sub> signal was not elevated in any of the control subjects. SST<sub>2</sub> PET/MRI was generally consistent with <sup>18</sup>F-fluorodeoxyglucose PET/computed tomography imaging in LVV patients with contemporaneous clinical scans but with very low background signal in the brain and heart, allowing for unimpeded assessment of nearby coronary, myocardial, and intracranial artery involvement. Clinically effective treatment for LVV was associated with a 0.49 ± 0.24 (standard error of the mean [SEM]) (P = 0.04; 22.3%) reduction in the SST<sub>2</sub> maximum tissue-to-blood ratio after 9.3 ± 3.2 months. SST<sub>2</sub> expression was localized to macrophages, pericytes, and perivascular adipocytes in vasculitis specimens, with specific receptor binding confirmed by autoradiography. SSTR2-expressing macrophages coexpressed proinflammatory markers.<br /><b>Conclusions</b><br />SST<sub>2</sub> PET/MRI holds major promise for diagnosis and therapeutic monitoring in LVV. (PET Imaging of Giant Cell and Takayasu Arteritis [PITA], NCT04071691; Residual Inflammation and Plaque Progression Long-Term Evaluation [RIPPLE], NCT04073810).<br /><br />Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 31 Jan 2023; 81:336-354</small></div>
Ćorović A, Wall C, Nus M, Gopalan D, ... Mason JC, Tarkin JM
J Am Coll Cardiol: 31 Jan 2023; 81:336-354 | PMID: 36697134
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Revascularization Strategies for Patients With Femoropopliteal Peripheral Artery Disease.</h4><i>Farhan S, Enzmann FK, Bjorkman P, Kamran H, ... Bosiers M, Krishnan P</i><br /><b>Background</b><br />No adequately powered studies exist to compare major clinical outcomes after endovascular therapy (EVT) with stent implantation vs bypass surgery (BSx) for symptomatic femoropopliteal peripheral artery disease.<br /><b>Objectives</b><br />This study sought to perform a pooled analysis of individual patient data from all randomized controlled trials comparing EVT vs BSx.<br /><b>Methods</b><br />Principal investigators of 5 of 6 available randomized controlled trials agreed to pool individual patient data. The primary endpoint was major adverse limb events, a composite of all-cause death, major amputation, or target limb reintervention. Secondary endpoints included amputation-free survival, individual major adverse limb event components, and primary patency. Early complications were bleeding, infection, or all-cause death within 30 days.<br /><b>Results</b><br />A total of 639 patients were analyzed with a mean age of 68.1 ± 9.1 years and 29.0% women. Baseline characteristics were comparable between groups. At 2 years, there were no significant differences between patients who received EVT and those who received BSx regarding major adverse limb events (40.1% vs 36.4%; log-rank P = 0.447; adjusted HR [aHR]: 1.04; 95% CI: 0.80-1.36), amputation-free survival (88.1% vs 90.0%; log-rank P = 0.455; aHR for death or amputation: 1.04; 95% CI: 0.63-1.71) and the other secondary endpoints except for primary patency, which was lower in patients who received EVT vs those who received BSx (51.2% vs 61.3%; log-rank P = 0.024; aHR for loss of primary patency: 1.31; 95% CI: 1.02-1.69). EVT was associated with significantly lower rates of early complications (6.8% vs 22.6%; P < 0.001) and shorter hospital stay (3.1 ± 4.2 days vs 7.4 ± 4.9 days; P < 0.001).<br /><b>Conclusions</b><br />These findings further support the efficacy and safety of EVT as an alternative to BSx in patients with symptomatic femoropopliteal peripheral artery disease.<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 31 Jan 2023; 81:358-370</small></div>
Farhan S, Enzmann FK, Bjorkman P, Kamran H, ... Bosiers M, Krishnan P
J Am Coll Cardiol: 31 Jan 2023; 81:358-370 | PMID: 36697136
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Thromboprophylaxis in Patients With Fontan Circulation.</h4><i>Van den Eynde J, Possner M, Alahdab F, Veldtman G, ... Feingold B, Alsaied T</i><br /><b>Background</b><br />The optimal strategy for thromboprophylaxis in patients with a Fontan circulation is unknown.<br /><b>Objectives</b><br />The aim of this study was to compare the efficacy and safety of aspirin, warfarin, and nonvitamin K oral anticoagulants (NOACs) in a network meta-analysis.<br /><b>Methods</b><br />Relevant studies published by February 2022 were included. The primary efficacy outcome was thromboembolic events; major bleeding was a secondary safety outcome. Frequentist network meta-analyses were conducted to estimate the incidence rate ratios (IRRs) of both outcomes. Ranking of treatments was performed based on probability (P) score.<br /><b>Results</b><br />A total of 21 studies were included (26,546 patient-years). When compared with no thromboprophylaxis, NOAC (IRR: 0.11; 95% CI: 0.03-0.40), warfarin (IRR: 0.23; 95% CI: 0.14-0.37), and aspirin (IRR: 0.24; 95% CI: 0.15-0.39) were all associated with significantly lower rates of thromboembolic events. However, the network meta-analysis revealed no significant differences in the rates of major bleeding (NOAC: IRR: 1.45 [95% CI: 0.28-7.43]; warfarin: IRR: 1.38 [95% CI: 0.41-4.69]; and aspirin: IRR: 0.72 [95% CI: 0.20-2.58]). Rankings, which simultaneously analyze competing interventions, suggested that NOACs have the highest P score to prevent thromboembolic events (P score 0.921), followed by warfarin (P score 0.582), aspirin (P score 0.498), and no thromboprophylaxis (P score 0.001). Aspirin tended to have the most favorable overall profile.<br /><b>Conclusions</b><br />Aspirin, warfarin, and NOAC are associated with lower risk of thromboembolic events. Recognizing the limited number of patients and heterogeneity of studies using NOACs, the results support the safety and efficacy of NOACs in patients with a Fontan circulation.<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 31 Jan 2023; 81:374-389</small></div>
Van den Eynde J, Possner M, Alahdab F, Veldtman G, ... Feingold B, Alsaied T
J Am Coll Cardiol: 31 Jan 2023; 81:374-389 | PMID: 36697138
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Infective Endocarditis After Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review.</h4><i>Del Val D, Panagides V, Mestres CA, Miró JM, Rodés-Cabau J</i><br /><AbstractText>Infective endocarditis (IE) is a rare but serious complication following transcatheter aortic valve replacement (TAVR). Despite substantial improvements in the TAVR procedure (less invasive) and its expansion to younger and healthier patients, the incidence of IE after TAVR remains stable, with incidence rates similar to those reported after surgical aortic valve replacement. Although IE after TAVR is recognized as a subtype of prosthetic valve endocarditis, this condition represents a particularly challenging scenario given its unique clinical and microbiological profile, the high incidence of IE-related complications, the uncertain role of cardiac surgery, and the dismal prognosis in most patients with TAVR-IE. The number of TAVR procedures is expected to grow exponentially in the coming years, increasing the number of patients at risk of developing this life-threatening complication. Therefore, a detailed understanding of this disease and its complications will be essential to improve clinical outcomes.</AbstractText><br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 31 Jan 2023; 81:394-412</small></div>
Del Val D, Panagides V, Mestres CA, Miró JM, Rodés-Cabau J
J Am Coll Cardiol: 31 Jan 2023; 81:394-412 | PMID: 36697140
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Worsening Heart Failure: Nomenclature, Epidemiology, and Future Directions: JACC Review Topic of the Week.</h4><i>Greene SJ, Bauersachs J, Brugts JJ, Ezekowitz JA, ... Zieroth S, Butler J</i><br /><AbstractText>Heart failure (HF) is a progressive disease characterized by variable durations of symptomatic stability often punctuated by episodes of worsening despite continued therapy. These periods of clinical worsening are increasingly recognized as a distinct phase in the history of HF, termed worsening HF (WHF). The definition of WHF continues to evolve from a historical focus solely on hospitalization to now include nonhospitalization events (eg, need for intravenous diuretic therapy in the emergency or outpatient setting). Most HF clinical trials to date have had HF hospitalization and death as primary endpoints, and only recently, some studies have included other WHF events regardless of location of care. This article reviews the evolution of the WHF definition, highlights the importance of considering the onset of WHF as an event that marks a new phase of HF, summarizes the latest clinical trials investigating novel therapies, and outlines unmet needs regarding identification and treatment of WHF.</AbstractText><br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 31 Jan 2023; 81:413-424</small></div>
Greene SJ, Bauersachs J, Brugts JJ, Ezekowitz JA, ... Zieroth S, Butler J
J Am Coll Cardiol: 31 Jan 2023; 81:413-424 | PMID: 36697141
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>PCSK9 Inhibition During the Inflammatory Stage of SARS-CoV-2 Infection.</h4><i>Navarese EP, Podhajski P, Gurbel PA, Grzelakowska K, ... Andreotti F, Kubica J</i><br /><b>Background</b><br />The intensity of inflammation during COVID-19 is related to adverse outcomes. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is involved in low-density lipoprotein receptor homeostasis, with potential influence on vascular inflammation and on COVID-19 inflammatory response.<br /><b>Objectives</b><br />The goal of this study was to investigate the impact of PCSK9 inhibition vs placebo on clinical and laboratory outcomes in patients with severe COVID-19.<br /><b>Methods</b><br />In this double-blind, placebo-controlled, multicenter pilot trial, 60 patients hospitalized for severe COVID-19, with ground-glass opacity pneumonia and arterial partial oxygen pressure to fraction of inspired oxygen ratio ≤300 mm Hg, were randomized 1:1 to receive a single 140-mg subcutaneous injection of evolocumab or placebo. The primary endpoint was death or need for intubation at 30 days. The main secondary endpoint was change in circulating interleukin (IL)-6 at 7 and 30 days from baseline.<br /><b>Results</b><br />Patients randomized to receive the PCSK9 inhibitor had lower rates of death or need for intubation within 30 days vs placebo (23.3% vs 53.3%, risk difference: -30%; 95% CI: -53.40% to -6.59%). Serum IL-6 across time was lower with the PCSK9 inhibitor than with placebo (30-day decline: -56% vs -21%). Patients with baseline IL-6 above the median had lower mortality with PCSK9 inhibition vs placebo (risk difference: -37.50%; 95% CI: -68.20% to -6.70%).<br /><b>Conclusions</b><br />PCSK9 inhibition compared with placebo reduced the primary endpoint of death or need for intubation and IL-6 levels in severe COVID-19. Patients with more intense inflammation at randomization had better survival with PCSK9 inhibition vs placebo, indicating that inflammatory intensity may drive therapeutic benefits. (Impact of PCSK9 Inhibition on Clinical Outcome in Patients During the Inflammatory Stage of the COVID-19 [IMPACT-SIRIO 5]; NCT04941105).<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 24 Jan 2023; 81:224-234</small></div>
Navarese EP, Podhajski P, Gurbel PA, Grzelakowska K, ... Andreotti F, Kubica J
J Am Coll Cardiol: 24 Jan 2023; 81:224-234 | PMID: 36653090
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Declining Incidence of Postoperative Neonatal Brain Injury in Congenital Heart Disease.</h4><i>Peyvandi S, Xu D, Barkovich AJ, Gano D, ... Miller SP, McQuillen P</i><br /><b>Background</b><br />Brain injury is common in neonates with complex neonatal congenital heart disease (CHD) and affects neurodevelopmental outcomes.<br /><b>Objectives</b><br />Given advancements in perioperative care, we sought to determine if the rate of preoperative and postoperative brain injury detected by using brain magnetic resonance imaging (MRI) and associated clinical risk factors have changed over time in complex CHD.<br /><b>Methods</b><br />A total of 270 term newborns with complex CHD were prospectively enrolled for preoperative and postoperative brain MRIs between 2001 and 2021 with a total of 466 MRI scans. Brain injuries in the form of white matter injury (WMI) or focal stroke and clinical factors were compared across 4 epochs of 5-year intervals with logistic regression.<br /><b>Results</b><br />Rates of preoperative WMI and stroke did not change over time. After adjusting for timing of the postoperative MRI, site, and cardiac group, the odds of newly acquired postoperative WMI were significantly lower in Epoch 4 compared with Epoch 1 (OR: 0.29; 95% CI: 0.09-1.00; P = 0.05). The adjusted probability of postoperative WMI declined significantly by 18.7% from Epoch 1 (24%) to Epoch 4 (6%). Among clinical risk factors, lowest systolic, mean, and diastolic blood pressures in the first 24 hours after surgery were significantly higher in the most recent epoch.<br /><b>Conclusions</b><br />The prevalence of postoperative WMI has declined, whereas preoperative WMI rates remain constant. More robust postoperative blood pressures may explain these findings by minimizing periods of ischemia and supporting cerebral perfusion. These results suggest potential modifiable clinical targets in the postoperative time period to minimize the burden of WMI.<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 24 Jan 2023; 81:253-266</small></div>
Peyvandi S, Xu D, Barkovich AJ, Gano D, ... Miller SP, McQuillen P
J Am Coll Cardiol: 24 Jan 2023; 81:253-266 | PMID: 36653093
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Albuminuria and Heart Failure: JACC State-of-the-Art Review.</h4><i>Khan MS, Shahid I, Anker SD, Fonarow GC, ... Bakris GL, Butler J</i><br /><AbstractText>Although chronic kidney disease is characterized by low glomerular filtration rate (GFR) or albuminuria, estimated GFR (eGFR) is more widely utilized as a marker of risk profile in cardiovascular diseases, including heart failure (HF). The presence and magnitude of albuminuria confers a strong prognostic association in forecasting risk of incident HF as well as its progression, irrespective of eGFR. Despite the high prevalence of albuminuria in HF, whether it adds incremental prognostic information in clinical practice and serves as an independent risk marker, and whether there are any therapeutic implications of assessing albuminuria in patients with HF is less well-established. In this narrative review, we assess the potential role of albuminuria in risk profiling for development and progression of HF, strengths and limitations of utilizing albuminuria as a risk marker, its ability to serve in HF risk prediction models, and the implications of adopting albuminuria as an effective parameter in cardiovascular trials and practice.</AbstractText><br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 24 Jan 2023; 81:270-282</small></div>
Khan MS, Shahid I, Anker SD, Fonarow GC, ... Bakris GL, Butler J
J Am Coll Cardiol: 24 Jan 2023; 81:270-282 | PMID: 36653095
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Survival After Septal Reduction in Patients >65 Years Old With Obstructive Hypertrophic Cardiomyopathy.</h4><i>Mentias A, Smedira NG, Krishnaswamy A, Reed GW, ... Kapadia SR, Desai MY</i><br /><b>Background</b><br />Obstructive hypertrophic cardiomyopathy (oHCM) is increasingly being diagnosed in elderly patients.<br /><b>Objectives</b><br />The authors sought to study long-term outcomes of septal reduction therapies (SRT) in Medicare patients with oHCM, and hospital volume-outcome relation.<br /><b>Methods</b><br />Medicare beneficiaries aged >65 years who underwent SRT, septal myectomy (SM) or alcohol septal ablation (ASA), from 2013 through 2019 were identified. Primary outcome was all-cause mortality, and secondary outcomes included heart failure (HF) readmission and need for redo SRT in follow-up. Overlap propensity score weighting was used to adjust for differences between both groups. Relation between hospital SRT volume and short-term and long-term mortality was studied.<br /><b>Results</b><br />The study included 5,679 oHCM patients (SM = 3,680 and ASA = 1,999, mean age 72.9 vs 74.8 years, women 67.2% vs 71.1%; P < 0.01). SM patients had fewer comorbidities, but after adjustment, both groups were well balanced. At 4 years (IQR: 2-6 years), although there was no difference in long-term mortality between SM and ASA (HR: 0.87; 95% CI: 0.74-1.03; P = 0.1), on landmark analysis, SM was associated with lower mortality after 2 years of follow-up (HR: 0.72; 95% CI: 0.60-0.87; P < 0.001) and had lower need for redo SRT. Both reduced HF readmissions in follow-up vs 1 year pre-SRT. Higher-volume centers had better outcomes vs lower-volume centers, but 70% of SRT were performed in low-volume centers.<br /><b>Conclusions</b><br />SRT reduced HF readmission in Medicare patients with oHCM. SM is associated with lower redo and better long-term survival compared with ASA. Despite better outcomes in high-volume centers, 70% of SRT are performed in low-volume U.S.<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 17 Jan 2023; 81:105-115</small></div>
Mentias A, Smedira NG, Krishnaswamy A, Reed GW, ... Kapadia SR, Desai MY
J Am Coll Cardiol: 17 Jan 2023; 81:105-115 | PMID: 36631204
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Regional Antibiotic Delivery for Implanted Cardiovascular Electronic Device Infections.</h4><i>Topaz M, Chorin E, Schwartz AL, Hochstadt A, ... Rosso R, Viskin S</i><br /><b>Background</b><br />Present guidelines endorse complete removal of cardiovascular implantable electronic devices (pacemakers/defibrillators), including extraction of all intracardiac electrodes, not only for systemic infections, but also for localized pocket infections.<br /><b>Objectives</b><br />The authors evaluated the efficacy of delivering continuous, in situ-targeted, ultrahigh concentration of antibiotics (CITA) into the infected subcutaneous device pocket, obviating the need for device/lead extraction.<br /><b>Methods</b><br />The CITA group consisted of 80 patients with pocket infection who were treated with CITA during 2007-2021. Of them, 9 patients declined lead extraction because of prohibitive operative risk, and 6 patients had questionable indications for extraction. The remaining 65 patients with pocket infection, who were eligible for extraction, but opted for CITA treatment, were compared with 81 patients with pocket infection and similar characteristics who underwent device/lead extraction as primary therapy.<br /><b>Results</b><br />A total of 80 patients with pocket infection were treated with CITA during 2007-2021. CITA was curative in 85% (n = 68 of 80) of patients, who remained free of infection (median follow-up 3 years [IQR: 1.0-6.8 years]). In the case-control study of CITA vs device/lead extraction, cure rates were higher after device/lead extraction than after CITA (96.2% [n = 78 of 81] vs 84.6% [n = 55 of 65]; P = 0.027). However, rates of serious complications were also higher after extraction (n = 12 [14.8%] vs n = 1 [1.5%]; P = 0.005). All-cause 1-month and 1-year mortality were similar for CITA and device/lead extraction (0.0% vs 3.7%; P = 0.25 and 12.3% vs 13.6%; P = 1.00, respectively). Extraction was avoided in 90.8% (n = 59 of 65) of extraction-eligible patients treated with CITA.<br /><b>Conclusions</b><br />CITA is a safe and effective alternative for patients with pocket infection who are unsuitable or unwilling to undergo extraction. (Salvage of Infected Cardiovascular Implantable Electronic Devices [CIED] by Localized High-Dose Antibiotics; NCT01770067).<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 17 Jan 2023; 81:119-133</small></div>
Topaz M, Chorin E, Schwartz AL, Hochstadt A, ... Rosso R, Viskin S
J Am Coll Cardiol: 17 Jan 2023; 81:119-133 | PMID: 36631206
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Elevated LDL Triglycerides and Atherosclerotic Risk.</h4><i>Balling M, Afzal S, Davey Smith G, Varbo A, ... Kamstrup PR, Nordestgaard BG</i><br /><b>Background</b><br />It is unclear whether elevated low-density lipoprotein (LDL) triglycerides are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD).<br /><b>Objectives</b><br />This study tested the hypothesis that elevated LDL triglycerides are associated with an increased risk of ASCVD and of each ASCVD component individually.<br /><b>Methods</b><br />The study investigators used the Copenhagen General Population Study, which measured LDL triglycerides in 38,081 individuals with a direct automated assay (direct LDL triglycerides) and in another 30,208 individuals with nuclear magnetic resonance (NMR) spectroscopy (NMR LDL triglycerides). Meta-analyses aggregated the present findings with previously reported results.<br /><b>Results</b><br />During a median follow-up of 3.0 and 9.2 years, respectively, 872 and 5,766 individuals in the 2 cohorts received a diagnosis of ASCVD. Per 0.1 mmol/L (9 mg/dL) higher direct LDL triglycerides, HRs were 1.26 (95% CI: 1.17-1.35) for ASCVD, 1.27 (95% CI: 1.16-1.39) for ischemic heart disease, 1.28 (95% CI: 1.11-1.48) for myocardial infarction, 1.22 (95% CI: 1.08-1.38) for ischemic stroke, and 1.38 (95% CI: 1.21-1.58) for peripheral artery disease. Corresponding HRs for NMR LDL triglycerides were 1.26 (95% CI: 1.20-1.33), 1.33 (95% CI: 1.25-1.41), 1.41 (95% CI: 1.31-1.52), 1.13 (95% CI: 1.05-1.23), and 1.26 (95% CI: 1.10-1.43), respectively. The foregoing results were not entirely statistically explained by apolipoprotein B levels. In meta-analyses for the highest quartile vs the lowest quartile of LDL triglycerides, random-effects risk ratios were 1.50 (95% CI: 1.35-1.66) for ASCVD (4 studies; 71,526 individuals; 8,576 events), 1.62 (95% CI: 1.37-1.93) for ischemic heart disease (6 studies; 107,538 individuals; 9,734 events), 1.30 (95% CI: 1.13-1.49) for ischemic stroke (4 studies; 78,026 individuals; 4,273 events), and 1.53 (95% CI: 1.29-1.81) for peripheral artery disease (4 studies; 107,511 individuals; 1,848 events).<br /><b>Conclusions</b><br />Elevated LDL triglycerides were robustly associated with an increased risk of ASCVD and of each ASCVD component individually in 2 prospective cohort studies and in meta-analyses of previous and present studies combined.<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 17 Jan 2023; 81:136-152</small></div>
Balling M, Afzal S, Davey Smith G, Varbo A, ... Kamstrup PR, Nordestgaard BG
J Am Coll Cardiol: 17 Jan 2023; 81:136-152 | PMID: 36631208
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Improving Risk Stratification for Patients With Type 2 Myocardial Infarction.</h4><i>Taggart C, Monterrubio-Gómez K, Roos A, Boeddinghaus J, ... Vallejos CA, Chapman AR</i><br /><b>Background</b><br />Despite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction.<br /><b>Objectives</b><br />The goal of this study was to derive and validate a risk stratification tool for the prediction of death or future myocardial infarction in patients with type 2 myocardial infarction.<br /><b>Methods</b><br />The T2-risk score was developed in a prospective multicenter cohort of consecutive patients with type 2 myocardial infarction. Cox proportional hazards models were constructed for the primary outcome of myocardial infarction or death at 1 year using variables selected a priori based on clinical importance. Discrimination was assessed by area under the receiving-operating characteristic curve (AUC). Calibration was investigated graphically. The tool was validated in a single-center cohort of consecutive patients and in a multicenter cohort study from sites across Europe.<br /><b>Results</b><br />There were 1,121, 250, and 253 patients in the derivation, single-center, and multicenter validation cohorts, with the primary outcome occurring in 27% (297 of 1,121), 26% (66 of 250), and 14% (35 of 253) of patients, respectively. The T2-risk score incorporating age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration had good discrimination (AUC: 0.76; 95% CI: 0.73-0.79) for the primary outcome and was well calibrated. Discrimination was similar in the consecutive patient (AUC: 0.83; 95% CI: 0.77-0.88) and multicenter (AUC: 0.74; 95% CI: 0.64-0.83) cohorts. T2-risk provided improved discrimination over the Global Registry of Acute Coronary Events 2.0 risk score in all cohorts.<br /><b>Conclusions</b><br />The T2-risk score performed well in different health care settings and could help clinicians to prognosticate, as well as target investigation and preventative therapies more effectively. (High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome [High-STEACS]; NCT01852123).<br /><br />Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 17 Jan 2023; 81:156-168</small></div>
Taggart C, Monterrubio-Gómez K, Roos A, Boeddinghaus J, ... Vallejos CA, Chapman AR
J Am Coll Cardiol: 17 Jan 2023; 81:156-168 | PMID: 36631210
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Risk of Surgical Mitral Valve Repair for Primary Mitral Regurgitation.</h4><i>Badhwar V, Chikwe J, Gillinov AM, Vemulapalli S, ... Shahian DM, Habib RH</i><br /><b>Background</b><br />Risk estimation for surgical intervention is an essential component of heart team shared decision-making. However, current mitral valve (MV) surgery risk models used in practice lack etiologic or procedural specificity.<br /><b>Objectives</b><br />The purpose of this study was to establish a comprehensive method for assessment of operative risk of MV repair of primary mitral regurgitation (MR).<br /><b>Methods</b><br />A novel etiology and procedure-specific algorithm identified 53,462 consecutive (July 2014 to June 2020) intention-to-treat MV repair patients with primary MR from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Risk models were fit for 30-day operative mortality, mortality and/or major morbidity, and conversion-to-replacement (CONV). As-treated mortality and morbidity models were derived separately.<br /><b>Results</b><br />Event rates for mortality (n = 619; 1.16%), mortality plus morbidity (n = 4,746; 8.88%), and CONV (n = 3,399; 6.36%) were low. Mortality was higher in CONV patients vs repair (3.18% vs 1.02%). All event rates were lower with increasing program volumes. The mortality risk model had excellent discrimination (AUC: 0.807) and calibration and confirmed very low mortality risk for isolated MV repair for primary MR, with mean mortality risk of 1.16% and median of 0.55% (IQR: 0.30%-1.17%) with 90th and 95th percentiles 2.48% and 3.99%, respectively. The mortality risk was <0.5% in patients <65 years of age, with 97% of the total population across age groups having a risk of <3%. Only 1 in 4 patients age 75 or older had >3% estimated risk of mortality.<br /><b>Conclusions</b><br />This etiologic and procedure-specific risk model establishes that the contemporary mortality risk of MV repair for primary MR is <1% for the vast majority of patients.<br /><br />Copyright © 2023 American College of Cardiology and the society of thoracic surgeons. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 10 Jan 2023; epub ahead of print</small></div>
Badhwar V, Chikwe J, Gillinov AM, Vemulapalli S, ... Shahian DM, Habib RH
J Am Coll Cardiol: 10 Jan 2023; epub ahead of print | PMID: 36669958
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Phase 2 Study of Aficamten in Patients With Obstructive Hypertrophic Cardiomyopathy.</h4><i>Maron MS, Masri A, Choudhury L, Olivotto I, ... Abraham T, REDWOOD-HCM Steering Committee and Investigators</i><br /><b>Background</b><br />Left ventricular outflow tract (LVOT) obstruction is a major determinant of heart failure symptoms in obstructive hypertrophic cardiomyopathy (oHCM). Aficamten, a next-in-class cardiac myosin inhibitor, may lower gradients and improve symptoms in these patients.<br /><b>Objectives</b><br />This study aims to evaluate the safety and efficacy of aficamten in patients with oHCM.<br /><b>Methods</b><br />Patients with oHCM and LVOT gradients ≥30 mm Hg at rest or ≥50 mm Hg with Valsalva were randomized 2:1 to receive aficamten (n = 28) or placebo (n = 13) in 2 dose-finding cohorts. Doses were titrated based on gradients and ejection fraction (EF). Safety and changes in gradient, EF, New York Heart Association functional class, and cardiac biomarkers were assessed over a 10-week treatment period and after a 2-week washout.<br /><b>Results</b><br />From baseline to 10 weeks, aficamten reduced gradients at rest (mean difference: -40 ± 27 mm Hg, and -43 ± 37 mm Hg in Cohorts 1 and 2, P = 0.0003 and P = 0.0004 vs placebo, respectively) and with Valsalva (-36 ± 27 mm Hg and -53 ± 44 mm Hg, P = 0.001 and <0.0001 vs placebo, respectively). There were modest reductions in EF (-6% ± 7.5% and -12% ± 5.9%, P = 0.007 and P < 0.0001 vs placebo, respectively). Symptomatic improvement in ≥1 New York Heart Association functional class was observed in 31% on placebo, and 43% and 64% on aficamten in Cohorts 1 and 2, respectively (nonsignificant). With aficamten, N-terminal pro-B-type natriuretic peptide was reduced (62% relative to placebo, P = 0.0002). There were no treatment interruptions and adverse events were similar between treatment arms.<br /><b>Conclusions</b><br />Aficamten resulted in substantial reductions in LVOT gradients with most patients experiencing improvement in biomarkers and symptoms. These results highlight the potential of sarcomere-targeted therapy for treatment of oHCM.<br /><br />Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 03 Jan 2023; 81:34-45</small></div>
Maron MS, Masri A, Choudhury L, Olivotto I, ... Abraham T, REDWOOD-HCM Steering Committee and Investigators
J Am Coll Cardiol: 03 Jan 2023; 81:34-45 | PMID: 36599608
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Outcomes of Percutaneous Intervention in Patients With Takayasu Arteritis.</h4><i>Joseph G, Thomson VS, Attumalil TV, Mathen PG, ... Mathew J, Danda D</i><br /><b>Background</b><br />The status of vascular lesion treatment using percutaneous intervention (PI) in Takayasu arteritis (TAK) remains unresolved.<br /><b>Objectives</b><br />This study sought to develop PI strategies appropriate for TAK.<br /><b>Methods</b><br />A prospectively maintained single-center database of TAK PI procedures from 1996 to 2022 was analyzed retrospectively. Obstructive lesions were treated by elective stenting (using bare or covered stents), balloon angioplasty (BA), or cutting-balloon angioplasty (CBA), with adjunctive stenting for suboptimal BA or CBA results. PIs were repeated in restenotic lesions until sustained success was obtained. Aortic or peripheral aneurysms and spontaneous aortic dissections were treated with covered stents or endografts. Immunosuppressive therapy, started before PI, was continued long term.<br /><b>Results</b><br />A total of 942 patients underwent PI to treat 2,450 arterial lesions (2,365 stenoses or occlusions, 85 aneurysms or dissections) in 630 subclavian or axillary, 586 renal, 463 aortic, 333 carotid, 188 mesenteric, 116 iliac, 71 coronary, and 63 other arteries; 3,805 PIs were performed (1.55 PIs per lesion; range 1-7 PIs per lesion). Early success was obtained in 2,262 (92.3%), and late success in 1,460 (84.5%) of 1,727 lesions with a median of 39 months (IQR: 15-85 months) of follow-up. Repeated PIs increased late success in obstructive lesions from 48.6% to 83.3%. A total of 1,687 elective stenting lesions achieved 88% late success with 1.49 PIs per lesion; covered stents (1.18 PIs per lesion) restenosed less than bare stents (1.51 PIs per lesion; P < 0.001). A total of 183 (36%) of 513 BA-treated lesions had good outcomes without adjunctive stenting; 122 CBA-treated lesions had 19% dissections and 8% ruptures or pseudoaneurysm formations. Aneurysms or dissections had 91.3% late success after PI. A total of 472 complications occurred in 415 (17%) lesions; 375 (79%) were resolved.<br /><b>Conclusions</b><br />Most vascular lesions in TAK can be effectively, safely, and durably treated using predominantly stent-based PI strategies.<br /><br />Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 03 Jan 2023; 81:49-64</small></div>
Joseph G, Thomson VS, Attumalil TV, Mathen PG, ... Mathew J, Danda D
J Am Coll Cardiol: 03 Jan 2023; 81:49-64 | PMID: 36599610
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Infections and Cardiovascular Disease: JACC Focus Seminar 1/4.</h4><i>Farina JM, Liblik K, Iomini P, Miranda-Arboleda AF, ... Sosa-Liprandi A, Baranchuk A</i><br /><AbstractText>The burden of cardiovascular diseases is sharply rising in low- and middle-income countries (LMICs). Along with the increasing rates of cardiovascular risk factors in these regions, there is a growing recognition of the contribution of neglected tropical diseases and other infections. Several cardiac implications of these infections have been reported but have not yet been validated by robust population data. This is in part due to limited access to health care and insufficient data collection infrastructure in many LMICs. Therefore, the true impact of these infections on the cardiovascular system may be underestimated, because of both underdiagnosis and underreporting bias. There is an urgent need to thoroughly delineate the cardiac impact of these conditions with elevated prevalence in LMICs and to propose strategies to reduce the negative consequences of these diseases in health systems with limited resources.</AbstractText><br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 03 Jan 2023; 81:71-80</small></div>
Farina JM, Liblik K, Iomini P, Miranda-Arboleda AF, ... Sosa-Liprandi A, Baranchuk A
J Am Coll Cardiol: 03 Jan 2023; 81:71-80 | PMID: 36599613
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Rheumatic Heart Disease: JACC Focus Seminar 2/4.</h4><i>Dougherty S, Okello E, Mwangi J, Kumar RK</i><br /><AbstractText>It is a sad reality that although eminently preventable, and despite possessing such knowledge for >70 years, rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and early mortality in young people worldwide. A disease of the poor, RHD is one of the most neglected diseases. Several challenges are unique to the acute rheumatic fever/RHD continuum and contribute to its persistence, including its sequestration among the poorest, its protracted natural history, the erratic availability of penicillin, and the lack of a concerted effort in endemic regions. However, there is cause for optimism following a resurgence in scientific interest over the last 15 years. This review presents the latest advancements in epidemiology, diagnosis, and management. It also discusses pressing research questions on disease pathophysiology, the barriers to implementation of effective management strategies, and pragmatic policy solutions required for translation of current knowledge into meaningful action.</AbstractText><br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 03 Jan 2023; 81:81-94</small></div>
Dougherty S, Okello E, Mwangi J, Kumar RK
J Am Coll Cardiol: 03 Jan 2023; 81:81-94 | PMID: 36599614
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Prevalence and Professional Impact of Mental Health Conditions Among Cardiologists.</h4><i>Sharma G, Rao SJ, Douglas PS, Rzeszut A, ... Summers RF, Mehta LS</i><br /><b>Background</b><br />Mental illness among physicians is an increasingly recognized concern. Global data on mental health conditions (MHCs) among cardiologists are limited.<br /><b>Objectives</b><br />The purpose of this study was to investigate the global prevalence of MHCs among cardiologists and its relationships to professional life.<br /><b>Methods</b><br />The American College of Cardiology conducted an online survey with 5,931 cardiologists globally in 2019. Data on demographics, practice, MHC, and association with professional activities were analyzed. The P values were calculated using the chi-square, Fischer exact, and Mann-Whitney U tests. Univariate and multivariate logistic regression analysis determined the association of characteristics with MHC.<br /><b>Results</b><br />Globally, 1 in 4 cardiologists experience any self-reported MHC, including psychological distress, or major or other psychiatric disorder. There is significant geographic variation in MHCs, with highest and lowest prevalences in South America (39.3%) and Asia (20.1%) (P < 0.001). Predictors of MHCs included experiencing emotional harassment (OR: 2.81; 95% CI: 2.46-3.20), discrimination (OR: 1.85; 95% CI: 1.61-2.12), being divorced (OR: 1.85; 95% CI: 1.27-2.36), and age <55 years (OR: 1.43; 95% CI: 1.24-1.66). Women were more likely to consider suicide within the past 12 months (3.8% vs 2.3%), but were also more likely to seek help (42.3% vs 31.1%) as compared with men (all P < 0.001). Nearly one-half of cardiologists reporting MHCs (44%) felt dissatisfied on at least one professional metric including feeling valued, treated fairly, and adequate compensation.<br /><b>Conclusions</b><br />More than 1 in 4 cardiologists experience self-reported MHCs globally, and the association with adverse experiences in professional life is substantial. Dedicated efforts toward prevention and treatment are needed to maximize the contributions of affected cardiologists.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 20 Dec 2022; epub ahead of print</small></div>
Sharma G, Rao SJ, Douglas PS, Rzeszut A, ... Summers RF, Mehta LS
J Am Coll Cardiol: 20 Dec 2022; epub ahead of print | PMID: 36585350
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Prognosis of Myocarditis Developing After mRNA COVID-19 Vaccination Compared With Viral Myocarditis.</h4><i>Lai FTT, Chan EWW, Huang L, Cheung CL, ... Yiu KH, Wong ICK</i><br /><b>Background</b><br />Association between messenger RNA (mRNA) COVID-19 vaccines and myocarditis has aroused public concern over vaccine safety.<br /><b>Objectives</b><br />The goal of this study was to compare the prognosis of this condition with viral infection-related myocarditis over 180 days.<br /><b>Methods</b><br />A territory-wide electronic public health care database in Hong Kong linked with population-based vaccination records was used to conduct a retrospective cohort study. Since the roll-out of BNT162b2 (Pfizer-BioNTech), patients aged ≥12 years hospitalized with myocarditis within 28 days after BNT162b2 vaccination were compared against viral infection-related myocarditis recorded before the pandemic (2000-2019), over a 180-day follow-up period (starting from diagnosis of myocarditis). All-cause mortality, heart failure, dilated cardiomyopathy, heart transplant, and postdischarge health care utilization were examined with Cox proportional hazards models.<br /><b>Results</b><br />A total of 866 patients were included for analysis. Over the follow-up period, 1 death (1.0%) of 104 patients with postvaccination myocarditis and 84 deaths (11.0%) of 762 patients with viral infection-related myocarditis were identified. One case (1.0%) of dilated cardiomyopathy and 2 cases (1.9%) of heart failure were identified in the postvaccination group, compared with 28 (3.7%) and 93 (12.2%) in the viral infection-related myocarditis group, respectively. Adjusted analysis showed that the postvaccination myocarditis group had a 92% lower mortality risk (adjusted HR: 0.08; 95% CI: 0.01-0.57). No significant differences in other prognostic outcomes were seen.<br /><b>Conclusions</b><br />This study found a significantly lower rate of mortality among individuals with myocarditis after mRNA vaccination compared with those with viral infection-related myocarditis. Prognosis of this iatrogenic condition may be less severe than naturally acquired viral infection-related myocarditis.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 13 Dec 2022; 80:2255-2265</small></div>
Lai FTT, Chan EWW, Huang L, Cheung CL, ... Yiu KH, Wong ICK
J Am Coll Cardiol: 13 Dec 2022; 80:2255-2265 | PMID: 36480967
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Micronutrient Supplementation to Reduce Cardiovascular Risk.</h4><i>An P, Wan S, Luo Y, Luo J, ... Ren F, Liu S</i><br /><b>Background</b><br />Healthy dietary patterns are rich in micronutrients, but their influence on cardiovascular disease (CVD) risks has not been systematically quantified.<br /><b>Objectives</b><br />The goal of this study was to provide a comprehensive and most up-to-date evidence-based map that systematically quantifies the impact of micronutrients on CVD outcomes.<br /><b>Methods</b><br />This study comprised a systematic review and meta-analysis of randomized controlled intervention trials of micronutrients on CVD risk factors and clinical events.<br /><b>Results</b><br />A total of 884 randomized controlled intervention trials evaluating 27 types of micronutrients among 883,627 participants (4,895,544 person-years) were identified. Supplementation with n-3 fatty acid, n-6 fatty acid, l-arginine, l-citrulline, folic acid, vitamin D, magnesium, zinc, α-lipoic acid, coenzyme Q10, melatonin, catechin, curcumin, flavanol, genistein, and quercetin showed moderate- to high-quality evidence for reducing CVD risk factors. Specifically, n-3 fatty acid supplementation decreased CVD mortality (relative risk [RR]: 0.93; 95% CI: 0.88-0.97), myocardial infarction (RR: 0.85; 95% CI: 0.78-0.92), and coronary heart disease events (RR: 0.86; 95% CI: 0.80-0.93). Folic acid supplementation decreased stroke risk (RR: 0.84; 95% CI: 0.72-0.97), and coenzyme Q10 supplementation decreased all-cause mortality events (RR: 0.68; 95% CI: 0.49-0.94). Vitamin C, vitamin D, vitamin E, and selenium showed no effect on CVD or type 2 diabetes risk. β-carotene supplementation increased all-cause mortality (RR: 1.10; 95% CI: 1.05-1.15), CVD mortality events (RR: 1.12; 95% CI: 1.06-1.18), and stroke risk (RR: 1.09; 95% CI: 1.01-1.17).<br /><b>Conclusions</b><br />Supplementation of some but not all micronutrients may benefit cardiometabolic health. This study highlights the importance of micronutrient diversity and the balance of benefits and risks to promote and maintain cardiovascular health in diverse populations. (Antioxidant Supplementation in the Prevention and Treatment of Cardiovascular Diseases; CRD42022315165).<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 13 Dec 2022; 80:2269-2285</small></div>
An P, Wan S, Luo Y, Luo J, ... Ren F, Liu S
J Am Coll Cardiol: 13 Dec 2022; 80:2269-2285 | PMID: 36480969
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Takayasu Arteritis: JACC Focus Seminar 3/4.</h4><i>Joseph G, Goel R, Thomson VS, Joseph E, Danda D</i><br /><AbstractText>Takayasu arteritis is a rare idiopathic large-vessel vasculitis that typically affects young women. An early \"prepulseless\" stage is often missed, associated with nonspecific constitutional symptoms (fever, malaise, and weight loss) and elevated inflammatory markers. Unchecked disease progression leads to the \"pulseless\" stage, manifest clinically by missing pulses, vascular tenderness, and ischemic symptoms (limb claudication, dizziness, angina, and renovascular hypertension), and is characterized pathologically by arterial wall thickening and stenotic/occlusive lesions or aneurysm formation. Vascular complications (stroke, blindness, heart failure, and aneurysm rupture) could follow unless disease progression is halted by immunosuppressive therapy and critical lesions are palliated by timely endovascular therapy or open surgery. Early diagnosis, effective therapy, and lifelong surveillance for disease activity relapses and vascular disease progression are critical to successful long-term outcomes. The outlook for patients has improved significantly in recent years with the establishment of diagnostic and classification criteria, better investigational modalities, and more effective medical and invasive therapy.</AbstractText><br /><br />Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 13 Dec 2022; epub ahead of print</small></div>
Joseph G, Goel R, Thomson VS, Joseph E, Danda D
J Am Coll Cardiol: 13 Dec 2022; epub ahead of print | PMID: 36599755
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Incidence and Burden of Tricuspid Regurgitation in Patients With Atrial Fibrillation.</h4><i>Patlolla SH, Schaff HV, Nishimura RA, Stulak JM, ... Pislaru SV, Nkomo VT</i><br /><b>Background</b><br />Atrial fibrillation (AF) is considered a risk factor for isolated tricuspid valve regurgitation (TR) in the absence of other known etiologies.<br /><b>Objectives</b><br />This study sought to identify the incidence of clinically significant isolated TR and its impact in patients with AF.<br /><b>Methods</b><br />A population-based record linkage system was used to identify adult patients with new-onset AF. Patients with evidence of moderate or greater tricuspid valve disease, left-sided valve disease, pulmonary hypertension, prior cardiac surgery, impaired left ventricular systolic/diastolic function at baseline were excluded. The remaining patients (n = 691) were followed over time to identify development of moderate or greater TR and assess its impact on subsequent survival.<br /><b>Results</b><br />A total of 232 patients (33.6%) developed moderate or greater TR. Among these, 73 patients (10.6%) had isolated TR without significant underlying structural heart disease. Incidence rate of any moderate or greater TR was 3.9 cases and that of isolated TR was 1.3 cases per 100 person-years. Permanent/persistent AF and female sex were associated with increased risk of developing TR, whereas rhythm control was associated with lower risk of TR. Over a median clinical follow-up of 13.3 years (IQR: 10.0-15.9 years), development of any moderate or greater TR (HR: 2.92; 95% CI: 2.29-3.73; P < 0.001) and isolated significant TR (HR: 1.51; 95% CI: 1.03-2.22; P = 0.03) were associated with an adjusted increased risk of subsequent mortality.<br /><b>Conclusions</b><br />In this population-based cohort of patients with AF, nearly one-third developed moderate or greater TR over time. Incident significant TR and incident isolated significant TR portend a worse survival in patients with AF.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 13 Dec 2022; 80:2289-2298</small></div>
Patlolla SH, Schaff HV, Nishimura RA, Stulak JM, ... Pislaru SV, Nkomo VT
J Am Coll Cardiol: 13 Dec 2022; 80:2289-2298 | PMID: 36480971
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Pathophysiology, Echocardiographic Diagnosis, and Treatment of Atrial Functional Mitral Regurgitation: JACC State-of-the-Art Review.</h4><i>Farhan S, Silbiger JJ, Halperin JL, Zhang L, ... Sharma S, Lerakis S</i><br /><AbstractText>The conventional view holds that functional mitral regurgitation (MR) is caused by restriction of leaflet motion resulting from displacement of the papillary muscle-bearing segments of the left ventricle. In the past decade, evidence has accrued suggesting functional MR can also be caused by left atrial enlargement. This underrecognized cause of secondary MR-atrial functional MR (AF-MR)-is mechanistically linked to annular enlargement, perturbations of annular contraction, and atriogenic leaflet tethering. AF-MR has been described in patients with atrial fibrillation and heart failure with preserved ejection fraction. Preliminary data suggest rhythm control may decrease MR severity in patients with atrial fibrillation. Additionally, several studies have reported reductions in MR and symptomatic improvement with restrictive annuloplasty and transcatheter edge-to-edge repair. This review discusses the pathophysiology, echocardiographic diagnosis, and treatment of AF-MR. AF-tricuspid regurgitation is also discussed.</AbstractText><br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 13 Dec 2022; 80:2314-2330</small></div>
Farhan S, Silbiger JJ, Halperin JL, Zhang L, ... Sharma S, Lerakis S
J Am Coll Cardiol: 13 Dec 2022; 80:2314-2330 | PMID: 36480974
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Research Opportunities in the Treatment of Mitral Valve Prolapse: JACC Expert Panel.</h4><i>Delling FN, Noseworthy PA, Adams DH, Basso C, ... Enriquez-Sarano M, Levine RA</i><br /><AbstractText>In light of the adverse prognosis related to severe mitral regurgitation, heart failure, or sudden cardiac death in a subset of patients with mitral valve prolapse (MVP), identifying those at higher risk is key. For the first time in decades, researchers have the means to rapidly advance discovery in the field of MVP thanks to state-of-the-art imaging techniques, novel omics methodologies, and the potential for large-scale collaborations using web-based platforms. The National Heart, Lung, and Blood Institute recently initiated a webinar-based workshop to identify contemporary research opportunities in the treatment of MVP. This report summarizes 3 specific areas in the treatment of MVP that were the focus of the workshop: 1) improving management of degenerative mitral regurgitation and associated left ventricular systolic dysfunction; 2) preventing sudden cardiac death in MVP; and 3) understanding the mechanisms and progression of MVP through genetic studies and small and large animal models, with the potential of developing medical therapies.</AbstractText><br /><br />Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 13 Dec 2022; 80:2331-2347</small></div>
Delling FN, Noseworthy PA, Adams DH, Basso C, ... Enriquez-Sarano M, Levine RA
J Am Coll Cardiol: 13 Dec 2022; 80:2331-2347 | PMID: 36480975
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Effect of Dapagliflozin on Health Status in Patients With Preserved or Mildly Reduced Ejection Fraction.</h4><i>Kosiborod MN, Bhatt AS, Claggett BL, Vaduganathan M, ... McMurray JJV, Solomon SD</i><br /><b>Background</b><br />Patients with heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) experience a high burden of symptoms, physical limitations, and poor quality of life; improving health status is a key goal of management.<br /><b>Objectives</b><br />In a prespecified analysis of the DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trial, we examine effects of dapagliflozin on health status using the Kansas City Cardiomyopathy Questionnaire (KCCQ).<br /><b>Methods</b><br />The DELIVER trial randomized patients with symptomatic HFmrEF/HFpEF to dapagliflozin 10 mg or placebo. KCCQ was evaluated at randomization, 1, 4, and 8 months; KCCQ Total Symptom Score (TSS) was a key secondary endpoint. Patients were stratified by KCCQ-TSS tertiles; Cox models examined effects of dapagliflozin on clinical outcomes. We evaluated the effects of dapagliflozin on KCCQ-TSS, Physical Limitations (PLS), Clinical Summary (CSS), and Overall Summary (OSS) domains. Responder analyses compared proportions of dapagliflozin vs placebo-treated patients with clinically meaningful changes in KCCQ.<br /><b>Results</b><br />A total of 5,795 patients had baseline KCCQ (median KCCQ-TSS 72.9). The effects of dapagliflozin on reducing cardiovascular death/worsening HF appeared more pronounced in patients with greater baseline symptom burden (lowest-to-highest KCCQ-TSS tertile: HR: 0.70 [95% CI: 0.58-0.84]; 0.81 [95% CI: 0.65-1.01]; 1.07 [95% CI: 0.83-1.37]; P<sub>interaction</sub> = 0.026). Dapagliflozin improved KCCQ-TSS, -PLS, -CSS, and -OSS at 8 months (2.4, 1.9, 2.3, and 2.1 points higher vs placebo; P < 0.001 for all). Dapagliflozin-treated patients experienced improvements in KCCQ-TSS regardless of EF (P<sub>interaction</sub> = 0.85). Fewer dapagliflozin-treated patients had deterioration, and more had improvements in all KCCQ domains at 8 months.<br /><b>Conclusions</b><br />The clinical benefits of dapagliflozin in HFmrEF/HFpEF appear especially pronounced in those with greater baseline symptom impairment. Dapagliflozin improved all KCCQ domains and the proportion of patients experiencing clinically meaningful changes in health status. (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213).<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Coll Cardiol: 09 Dec 2022; epub ahead of print</small></div>
Kosiborod MN, Bhatt AS, Claggett BL, Vaduganathan M, ... McMurray JJV, Solomon SD
J Am Coll Cardiol: 09 Dec 2022; epub ahead of print | PMID: 36526515
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Nutritional Heart Disease and Cardiomyopathies: JACC Focus Seminar 4/4.</h4><i>Sliwa K, Viljoen CA, Hasan B, Ntusi NAB</i><br /><AbstractText>This JACC Focus Seminar provides an overview of and highlights recently published research on cardiomyopathies and nutritional heart disease that have a higher prevalence in tropical regions. The development of tropical cardiomyopathies and nutritional cardiovascular disease (CVD) is complicated by high rates of poverty, fragmented health care systems, and suboptimal access to health care because of socioeconomic inequalities, leading to the fact that children, adolescents, and young adults are disproportionally affected. Such tropical cardiomyopathies and nutritional CVD that have not been prevalent in high-income countries in the past decades are now reemerging. When treating migrants or refugees, it is important for attending physicians to consider the burden of endemic diseases in the countries of origin and the likelihood that such patients might be affected. In this review, the authors propose an approach for adequate diagnostic work-up leading to appropriate care for those with suspected or confirmed tropical cardiomyopathies and nutritional CVD.</AbstractText><br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 07 Dec 2022; epub ahead of print</small></div>
Sliwa K, Viljoen CA, Hasan B, Ntusi NAB
J Am Coll Cardiol: 07 Dec 2022; epub ahead of print | PMID: 36599756
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Adding Salt to Foods and Risk of Cardiovascular Disease.</h4><i>Ma H, Wang X, Li X, Heianza Y, Qi L</i><br /><b>Background</b><br />We recently found that the frequency of adding salt to foods could reflect a person\'s long-term salt taste preference and sodium intake, and was significantly related to life expectancy.<br /><b>Objective</b><br />We analyzed whether the frequency of adding salt to foods was associated with incident cardiovascular disease (CVD) risk.<br /><b>Methods</b><br />This study included 176,570 adults in UK Biobank who were initially free of CVD. Cox proportional hazards models were used to estimate the association between the frequency of adding salt to foods and incident CVD events.<br /><b>Results</b><br />During a median of 11.8 years of follow-up, 9,963 total CVD events, 6,993 ischemic heart disease (IHD) cases, 2,007 stroke cases, and 2,269 heart failure cases were documented. Lower frequency of adding salt to foods was significantly associated with lower risk of total CVD events after adjustment for covariates and the DASH (Dietary Approaches to Stop Hypertension) diet (a modified DASH score was used without considering sodium intake). Compared with the group of always adding salt to foods, the adjusted HRs were 0.81 (95% CI: 0.73-0.90), 0.79 (95% CI: 0.71-0.87), and 0.77 (95% CI: 0.70-0.84) across the groups of usually, sometimes, and never/rarely, respectively (P trend < 0.001). Among the subtypes of CVD, adding salt showed the strongest association with heart failure (P trend <0.001), followed by IHD (P trend < 0.001), but was not associated with stroke. We found that participants who combined a DASH-style diet with the lowest frequency of adding salt had the lowest CVD risk.<br /><b>Conclusions</b><br />Our findings indicate that lower frequency of adding salt to foods is associated with lower risk of CVD, particularly heart failure and IHD.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 06 Dec 2022; 80:2157-2167</small></div>
Ma H, Wang X, Li X, Heianza Y, Qi L
J Am Coll Cardiol: 06 Dec 2022; 80:2157-2167 | PMID: 36456045
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>2-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Annular Calcification, Rings, and Bioprostheses.</h4><i>Eleid MF, Wang DD, Pursnani A, Kodali SK, ... Rihal CS, Guerrero ME</i><br /><b>Background</b><br />The MITRAL (Mitral Implantation of Transcatheter Valves) trial is the first prospective study for valve-in-mitral annular calcification (ViMAC), mitral valve-in-ring (MViR), and mitral valve-in-valve (MViV) using balloon-expandable aortic transcatheter heart valves. Procedural outcomes beyond 1 year are not well described.<br /><b>Objectives</b><br />This study evaluated 2-year outcomes in ViMAC, MViR, and MViV in the MITRAL trial.<br /><b>Methods</b><br />This multicenter prospective study enrolled patients with severe MAC, prior failed mitral annuloplasty ring repair, or prior failed bioprosthetic MV replacement who were at high surgical risk at 13 U.S. sites.<br /><b>Results</b><br />Between February 1, 2015, and December 31, 2017, 91 patients were enrolled (31 with ViMAC, 30 with MViR, and 30 with MViV). In the ViMAC group, 2-year all-cause mortality was 39.3%, 66.7% were New York Heart Association (NYHA) functional class I-II, and mean MV gradient was 5.6 ± 2.0 mm Hg. In the MViR group, 2-year all-cause mortality was 50%, 65% were NYHA functional class I-II, and mean MV gradient was 6.5 ± 2.7 mm Hg. In the MViV group, 2-year all-cause mortality was 6.7%, 85% were NYHA functional class I-II, and mean MV gradient was 6.9 ± 2.4 mm Hg. At 2 years, all patients had ≤mild mitral regurgitation and survivors in all 3 arms showed sustained improvement in Kansas City Cardiomyopathy Questionnaire scores compared to baseline.<br /><b>Conclusions</b><br />Use of balloon-expandable aortic transcatheter heart valves in selected patients with severe MAC, failed annuloplasty ring, and bioprosthetic MV dysfunction is associated with improvements in symptoms, quality of life, and stable prosthesis function at 2-year follow-up. Between 1 and 2 years, the MViR group experienced higher mortality rates than the MViV and ViMAC groups.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 06 Dec 2022; 80:2171-2183</small></div>
Eleid MF, Wang DD, Pursnani A, Kodali SK, ... Rihal CS, Guerrero ME
J Am Coll Cardiol: 06 Dec 2022; 80:2171-2183 | PMID: 36456047
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Ultrasonic Texture Features for Assessing Cardiac Remodeling and Dysfunction.</h4><i>Hathaway QA, Yanamala N, Siva NK, Adjeroh DA, Hollander JM, Sengupta PP</i><br /><b>Background</b><br />Changes in cardiac size, myocardial mass, cardiomyocyte appearance, and, ultimately, the function of the entire organ are interrelated features of cardiac remodeling that profoundly affect patient outcomes.<br /><b>Objectives</b><br />This study proposes that the application of radiomics for extracting cardiac ultrasonic textural features (ultrasomics) can aid rapid, automated assessment of left ventricular (LV) structure and function without requiring manual measurements.<br /><b>Methods</b><br />This study developed machine-learning models using cardiac ultrasound images from 1,915 subjects in 3 clinical cohorts: 1) an expert-annotated cardiac point-of-care-ultrasound (POCUS) registry (n = 943, 80% training/testing and 20% internal validation); 2) a prospective POCUS cohort for external validation (n = 275); and 3) a prospective external validation on high-end ultrasound systems (n = 484). In a type 2 diabetes murine model, echocardiography of wild-type (n = 10) and Leptr<sup>-/-</sup> (n = 8) mice were assessed longitudinally at 3 and 25 weeks, and ultrasomics features were correlated with histopathological features of hypertrophy.<br /><b>Results</b><br />The ultrasomics model predicted LV remodeling in the POCUS and high-end ultrasound external validation studies (area under the curve: 0.78 [95% CI: 0.68-0.88] and 0.79 [95% CI: 0.73-0.86], respectively). Similarly, the ultrasomics model predicted LV remodeling was significantly associated with major adverse cardiovascular events in both cohorts (P < 0.0001 and P = 0.0008, respectively). Moreover, on multivariate analysis, the ultrasomics probability score was an independent echocardiographic predictor of major adverse cardiovascular events in the high-end ultrasound cohort (HR: 8.53; 95% CI: 4.75-32.1; P = 0.0003). In the murine model, cardiomyocyte hypertrophy positively correlated with 2 ultrasomics biomarkers (R<sup>2</sup> = 0.57 and 0.52, Q < 0.05).<br /><b>Conclusions</b><br />Cardiac ultrasomics-based biomarkers may aid development of machine-learning models that provide an expert-level assessment of LV structure and function.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 06 Dec 2022; 80:2187-2201</small></div>
Hathaway QA, Yanamala N, Siva NK, Adjeroh DA, Hollander JM, Sengupta PP
J Am Coll Cardiol: 06 Dec 2022; 80:2187-2201 | PMID: 36456049
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Enhanced Mitochondrial Calcium Uptake Suppresses Atrial Fibrillation Associated With Metabolic Syndrome.</h4><i>Fossier L, Panel M, Butruille L, Colombani S, ... Montaigne D, Fauconnier J</i><br /><b>Background</b><br />Patients with metabolic syndrome (MetS) have an increased risk of atrial fibrillation (AF). Impaired Ca<sup>2+</sup> homeostasis and mitochondrial dysfunction have emerged as an arrhythmogenic substrate in both patients and animal models of MetS. Whether impaired mitochondrial Ca<sup>2+</sup> handling underlies AF associated with MetS remains poorly explored.<br /><b>Objectives</b><br />The aim of this study was to determine the initial mechanisms related to AF susceptibility and mitochondrial dysfunction encountered in metabolic cardiomyopathy.<br /><b>Methods</b><br />A total of 161 mice and 34 patients were studied. Mitochondrial Ca<sup>2+</sup> and mitochondrial Ca<sup>2+</sup> uniporter complex (MCUC) were investigated in right atrial tissue of patients with (n = 18) or without (n = 16) MetS and of C57Bl/6J mice fed with a high-fat sucrose diet (HFS) for 2 (n = 42) or 12 (n = 39) weeks. Susceptibility to AF was evaluated in isolated sinoatrial tissue and in vivo in mice.<br /><b>Results</b><br />Increased expression of the MICUs subunits of the MCUC (1.00 ± 0.33 AU vs 1.29 ± 0.23 AU; P = 0.034) was associated with impaired mitochondrial Ca<sup>2+</sup> uptake in patients (168.7 ± 31.3 nmol/min/mg vs 127.3 ± 18.4 nmol/min/mg; P = 0.026) and HFS mice (0.10 ± 0.04 ΔF/F0 × ms<sup>-1</sup> vs 0.06 ± 0.03 ΔF/F0 × ms<sup>-1</sup>; P = 0.0086, and 0.15 ± 0.07 ΔF/F0 × ms<sup>-1</sup> vs 0.046 ± 0.03 ΔF/F0 × ms<sup>-1</sup>; P = 0.0076 in 2- and 12-week HFS mice, respectively). HFS mice elicited a 70% increased susceptibility to AF. The MCUC agonist kaempferol restored MCUC activity in vitro and abolished the occurrence of AF in HFS mice.<br /><b>Conclusions</b><br />Impaired MCUC activity and mitochondrial Ca<sup>2+</sup> homeostasis from the early stage of metabolic cardiomyopathy in mice lead to AF. Given that similar defects in cardiac mitochondrial Ca<sup>2+</sup> handling are present in MetS patients, the modulation of the MCUC activity represents an attractive antiarrhythmic strategy.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 06 Dec 2022; 80:2205-2219</small></div>
Fossier L, Panel M, Butruille L, Colombani S, ... Montaigne D, Fauconnier J
J Am Coll Cardiol: 06 Dec 2022; 80:2205-2219 | PMID: 36456051
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Management of Heart Failure With Arrhythmia in Adults With Congenital Heart Disease: JACC State-of-the-Art Review.</h4><i>Moore JP, Marelli A, Burchill LJ, Chubb H, ... Vehmeijer JT, Cohen MI</i><br /><AbstractText>Together, heart failure and arrhythmia represent the most important cardiovascular sources of morbidity and mortality among adults with congenital heart disease (ACHDs). Although traditionally conceptualized as operating within 2 distinct clinical silos, these scenarios frequently coexist within the same individual; consequently the mechanistic, therapeutic, and prognostic overlap between them demands increased recognition. In fact, given the near ubiquity of heart failure and arrhythmia among ACHDs, there is perhaps no other arena within cardiology where this critical intersection is more frequently observed. Optimal care for ACHDs therefore requires a heightened awareness of the relevant interactions as well as the pharmacologic and interventional resources that are increasingly available to the treating cardiologist. This review explores and highlights the overlap between these 2 fields to recommend a parallel, yet interactive, multidisciplinary approach to clinical management. Congenital heart disease categories are broken down into their archetypal subtypes to highlight subtleties of the pathophysiology, evaluation, and therapeutic approach.</AbstractText><br /><br />Published by Elsevier Inc.<br /><br /><small>J Am Coll Cardiol: 06 Dec 2022; 80:2224-2238</small></div>
Moore JP, Marelli A, Burchill LJ, Chubb H, ... Vehmeijer JT, Cohen MI
J Am Coll Cardiol: 06 Dec 2022; 80:2224-2238 | PMID: 36456053
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Pediatric and Congenital Cardiovascular Disease Research Challenges and Opportunities: JACC Review Topic of the Week.</h4><i>Opotowsky AR, Allen KY, Bucholz EM, Burns KM, ... Pearson GD, Miyamoto SD</i><br /><AbstractText>The National Heart, Lung, and Blood Institute convened a workshop in August 2021 to identify opportunities in pediatric and congenital cardiovascular research that would improve outcomes for individuals with congenital heart disease across the lifespan. A subsidiary goal was to provide feedback on and visions for the Pediatric Heart Network. This paper summarizes several key research opportunities identified in the areas of: data quality, access, and sharing; aligning cardiovascular research with patient priorities (eg, neurodevelopmental and psychological impacts); integrating research within clinical care and supporting implementation into practice; leveraging creative study designs; and proactively enriching diversity of investigators, participants, and perspectives throughout the research process.</AbstractText><br /><br />Copyright © 2022 American College of Cardiology Foundation. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 06 Dec 2022; 80:2239-2250</small></div>
Opotowsky AR, Allen KY, Bucholz EM, Burns KM, ... Pearson GD, Miyamoto SD
J Am Coll Cardiol: 06 Dec 2022; 80:2239-2250 | PMID: 36456054
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Concealed Cardiomyopathy in Autopsy-Inconclusive Cases of Sudden Cardiac Death and Implications for Families.</h4><i>Isbister JC, Nowak N, Yeates L, Singer ES, ... Bagnall RD, Semsarian C</i><br /><b>Background</b><br />Genetic testing following sudden cardiac death (SCD) is currently guided by autopsy findings, despite the inherent challenges of autopsy examination and mounting evidence that malignant arrhythmia may occur before structural changes in inherited cardiomyopathy, so-called \"concealed cardiomyopathy\" (CCM).<br /><b>Objectives</b><br />The authors sought to identify the spectrum of genes implicated in autopsy-inconclusive SCD and describe the impact of identifying CCM on the ongoing care of SCD families.<br /><b>Methods</b><br />Using a standardized framework for adjudication, autopsy-inconclusive SCD cases were identified as having a structurally normal heart or subdiagnostic findings of uncertain significance on autopsy. Genetic variants were classified for pathogenicity using the American College of Medical Genetics and Genomics guidelines. Family follow-up was performed where possible.<br /><b>Results</b><br />Twenty disease-causing variants were identified among 91 autopsy-inconclusive SCD cases (mean age 25.4 ± 10.7 years) with a similar rate regardless of the presence or absence of subdiagnostic findings (25.5% vs 18.2%; P = 0.398). Cardiomyopathy-associated genes harbored 70% of clinically actionable variants and were overrepresented in cases with subdiagnostic structural changes at autopsy (79% vs 21%; P = 0.038). Six of the 20 disease-causing variants identified were in genes implicated in arrhythmogenic cardiomyopathy. Nearly two-thirds of genotype-positive relatives had an observable phenotype either at initial assessment or subsequent follow-up, and 27 genotype-negative first-degree relatives were released from ongoing screening.<br /><b>Conclusions</b><br />Phenotype-directed genetic testing following SCD risks under recognition of CCM. Comprehensive evaluation of the decedent should include assessment of genes implicated in cardiomyopathy in addition to primary arrhythmias to improve diagnosis of CCM and optimize care for families.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 29 Nov 2022; 80:2057-2068</small></div>
Isbister JC, Nowak N, Yeates L, Singer ES, ... Bagnall RD, Semsarian C
J Am Coll Cardiol: 29 Nov 2022; 80:2057-2068 | PMID: 36423990
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Race-Dependent Association of High-Density Lipoprotein Cholesterol Levels With Incident Coronary Artery Disease.</h4><i>Zakai NA, Minnier J, Safford MM, Koh I, ... Howard VJ, Pamir N</i><br /><b>Background</b><br />Plasma lipids are risk factors for coronary heart disease (CHD) in part because of race-specific associations of lipids with CHD.<br /><b>Objectives</b><br />The purpose of this study was to understand why CHD risk equations underperform in Black adults.<br /><b>Methods</b><br />Between 2003 and 2007, the REGARDS (REasons for Geographic and Racial Differences in Stroke) cohort recruited 30,239 Black and White individuals aged ≥45 years from the contiguous United States. We used Cox regression models adjusted for clinical and behavioral risk factors to estimate the race-specific hazard of plasma lipid levels with incident CHD (myocardial infarction or CHD death).<br /><b>Results</b><br />Among 23,901 CHD-free participants (57.8% White and 58.4% women, mean age 64 ± 9 years) over a median 10 years of follow-up, 664 and 951 CHD events occurred among Black and White adults, respectively. Low-density lipoprotein cholesterol and triglycerides were associated with increased risk of CHD in both races (P interaction by race >0.10). For sex-specific clinical HDL-C categories: low HDL-C was associated with increased CHD risk in White (HR: 1.22; 95% CI: 1.05-1.43) but not in Black (HR: 0.94; 95% CI: 0.78-1.14) adults (P interaction by race = 0.08); high HDL-C was not associated with decreased CHD events in either race (HR: 0.96; 95% CI: 0.79-1.16 for White participants and HR: 0.91; 95% CI: 0.74-1.12 for Black adults).<br /><b>Conclusions</b><br />Low-density lipoprotein cholesterol and triglycerides modestly predicted CHD risk in Black and White adults. Low HDL-C was associated with increased CHD risk in White but not Black adults, and high HDL-C was not protective in either group. Current high-density lipoprotein cholesterol-based risk calculations could lead to inaccurate risk assessment in Black adults.<br /><br />Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 29 Nov 2022; 80:2104-2115</small></div>
Zakai NA, Minnier J, Safford MM, Koh I, ... Howard VJ, Pamir N
J Am Coll Cardiol: 29 Nov 2022; 80:2104-2115 | PMID: 36423994
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>A Practical Approach to Left Main Coronary Artery Disease: JACC State-of-the-Art Review.</h4><i>Davidson LJ, Cleveland JC, Welt FG, Anwaruddin S, ... Taha RA, Malaisrie SC</i><br /><AbstractText>The treatment of left main (LM) coronary artery disease (CAD) requires complex decision-making. Recent clinical practice guidelines provide clinicians with guidance; however, decisions regarding treatment for individual patients can still be difficult. The American College of Cardiology\'s Cardiac Surgery Team and Interventional Council joined together to develop a practical approach to the treatment of LM CAD, taking into account randomized clinical trial, meta-analyses, and clinical practice guidelines. The various presentations of LM CAD based on anatomy and physiology are presented. Recognizing the complexity of LM CAD, which rarely presents isolated and is often in combination with multivessel disease, a treatment algorithm with medical therapy alone or in conjunction with percutaneous coronary intervention or coronary artery bypass grafting is proposed. A heart team approach is recommended that accounts for clinical, procedural, operator, and institutional factors, and features shared decision-making that meets the needs and preferences of each patient and their specific clinical situation.</AbstractText><br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Coll Cardiol: 29 Nov 2022; 80:2119-2134</small></div>
Davidson LJ, Cleveland JC, Welt FG, Anwaruddin S, ... Taha RA, Malaisrie SC
J Am Coll Cardiol: 29 Nov 2022; 80:2119-2134 | PMID: 36423996
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>2-Year Outcomes of Angiographic Quantitative Flow Ratio-Guided Coronary Interventions.</h4><i>Song L, Xu B, Tu S, Guan C, ... Stone GW, FAVOR III China Study Group</i><br /><b>Background</b><br />In the multicenter, randomized, sham-controlled FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial, quantitative flow ratio (QFR)-based lesion selection improved 1-year clinical outcomes compared with conventional angiographic guidance for percutaneous coronary intervention (PCI).<br /><b>Objectives</b><br />The purpose of this study was to determine whether the benefits of QFR guidance persist at 2 years, particularly for patients in whom QFR changed the revascularization strategy.<br /><b>Methods</b><br />Eligible patients were randomized to a QFR-guided strategy (PCI performed only if QFR ≤0.80) or a standard angiography-guided strategy. Major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), or ischemia-driven revascularization occurring within 2 years were analyzed in the intention-to-treat population.<br /><b>Results</b><br />Among 3,825 randomized participants, 2-year MACE occurred in 161 of 1,913 (8.5%) patients in the QFR-guided group and in 237 of 1,912 (12.5%) patients in the angiography-guided group (HR: 0.66; 95% CI: 0.54-0.81; P < 0.0001), driven by fewer MIs (4.0% vs 6.8%; HR: 0.58; 95% CI: 0.44-0.77; P = 0.0002) and ischemia-driven revascularizations (4.2% vs 5.8%; HR: 0.71; 95% CI: 0.53-0.95; P = 0.02) in the QFR-guided group. Landmark analysis showed consistent results within the first year and between 1-2 years (P<sub>int</sub> = 0.99). Although the 2-year MACE rate was lower in the QFR-guided group in both patients with and without revascularization strategy changes, the extent of outcome improvement was greater (P<sub>int</sub> = 0.009) among those patients in whom the preplanned PCI strategy was modified by QFR.<br /><b>Conclusions</b><br />QFR-guided lesion selection improved 2-year clinical outcomes compared with standard angiography guidance. The benefits were most pronounced among patients in whom QFR assessment altered the planned revascularization strategy. (FAVOR III China Study [The Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease] NCT03656848).<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 29 Nov 2022; 80:2089-2101</small></div>
Song L, Xu B, Tu S, Guan C, ... Stone GW, FAVOR III China Study Group
J Am Coll Cardiol: 29 Nov 2022; 80:2089-2101 | PMID: 36424680
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Coronary Calcium Scoring Improves Risk Prediction in Patients With Suspected Obstructive Coronary Artery Disease.</h4><i>Winther S, Schmidt SE, Foldyna B, Mayrhofer T, ... Knuuti J, Bøttcher M</i><br /><b>Background</b><br />In patients with suspected obstructive coronary artery disease (CAD), the risk factor-weighted clinical likelihood (RF-CL) model and the coronary artery calcium score-weighted clinical likelihood (CACS-CL) model improves the identification of obstructive CAD compared with basic pretest probability (PTP) models.<br /><b>Objectives</b><br />The aim of this study was to assess the prognostic value of the new models.<br /><b>Methods</b><br />The incidences of myocardial infarction and death were stratified according to categories by the RF-CL and CACS-CL and compared with categories by the PTP model. We used cohorts from a Danish register (n = 41,177) and a North American randomized study (n = 3,952). All patients were symptomatic and were referred for diagnostic testing because of clinical indications.<br /><b>Results</b><br />Despite substantial down-reclassification of patients to a likelihood ≤5% of CAD with either the RF-CL (45%) or CACS-CL (60%) models compared with the PTP (18%), the annualized event rates of myocardial infarction and death were low using all 3 models; RF-CL 0.51% (95% CI: 0.46-0.56), CACS-CL 0.48% (95% CI: 0.44-0.56), and PTP 0.37% (95% CI: 0.31-0.44), respectively. Overall, comparison of the predictive power of the 3 models using Harrell\'s C-statistics demonstrated superiority of the RF-CL (0.64 [95% CI: 0.63-0.65]) and CACS-CL (0.69 [95% CI: 0.67-0.70]) compared with the PTP model (0.61 [95% CI: 0.60-0.62]).<br /><b>Conclusions</b><br />The simple clinical likelihood models that include classical risk factors or risk factors combined with CACS provide improved risk stratification for myocardial infarction and death compared with the standard PTP model. Hence, the optimized RF-CL and CACS-CL models identify 2.5 and 3.3 times more patients, respectively, who may not benefit from further diagnostic testing.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 22 Nov 2022; 80:1965-1977</small></div>
Winther S, Schmidt SE, Foldyna B, Mayrhofer T, ... Knuuti J, Bøttcher M
J Am Coll Cardiol: 22 Nov 2022; 80:1965-1977 | PMID: 36396197
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Prognostic Prediction of Genotype vs Phenotype in Genetic Cardiomyopathies.</h4><i>Paldino A, Dal Ferro M, Stolfo D, Gandin I, ... Mestroni L, Sinagra G</i><br /><b>Background</b><br />Diverse genetic backgrounds often lead to phenotypic heterogeneity in cardiomyopathies (CMPs). Previous genotype-phenotype studies have primarily focused on the analysis of a single phenotype, and the diagnostic and prognostic features of the CMP genotype across different phenotypic expressions remain poorly understood.<br /><b>Objectives</b><br />We sought to define differences in outcome prediction when stratifying patients based on phenotype at presentation compared with genotype in a large cohort of patients with CMPs and positive genetic testing.<br /><b>Methods</b><br />Dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy, left-dominant arrhythmogenic cardiomyopathy, and biventricular arrhythmogenic cardiomyopathy were examined in this study. A total of 281 patients (80% DCM) with pathogenic or likely pathogenic variants were included. The primary and secondary outcomes were: 1) all-cause mortality (D)/heart transplant (HT); 2) sudden cardiac death/major ventricular arrhythmias (SCD/MVA); and 3) heart failure-related death (DHF)/HT/left ventricular assist device implantation (LVAD).<br /><b>Results</b><br />Survival analysis revealed that SCD/MVA events occurred more frequently in patients without a DCM phenotype and in carriers of DSP, PKP2, LMNA, and FLNC variants. However, after adjustment for age and sex, genotype-based classification, but not phenotype-based classification, was predictive of SCD/MVA. LMNA showed the worst trends in terms of D/HT and DHF/HT/LVAD.<br /><b>Conclusions</b><br />Genotypes were associated with significant phenotypic heterogeneity in genetic cardiomyopathies. Nevertheless, in our study, genotypic-based classification showed higher precision in predicting the outcome of patients with CMP than phenotype-based classification. These findings add to our current understanding of inherited CMPs and contribute to the risk stratification of patients with positive genetic testing.<br /><br />Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 22 Nov 2022; 80:1981-1994</small></div>
Paldino A, Dal Ferro M, Stolfo D, Gandin I, ... Mestroni L, Sinagra G
J Am Coll Cardiol: 22 Nov 2022; 80:1981-1994 | PMID: 36396199
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Equivalent Impact of Elevated Lipoprotein(a) and Familial Hypercholesterolemia in Patients With Atherosclerotic Cardiovascular Disease.</h4><i>Hedegaard BS, Bork CS, Kaltoft M, Klausen IC, ... Langsted A, Nordestgaard BG</i><br /><b>Background</b><br />Genetically elevated plasma lipoprotein(a) and familial hypercholesterolemia each result in premature atherosclerotic cardiovascular disease (ASCVD); however, a direct comparison in the same population is needed of these 2 genetic traits on the risk of ASCVD.<br /><b>Objectives</b><br />We determined the level of plasma lipoprotein(a) that is equivalent to low-density lipoprotein (LDL) cholesterol in clinically and genetically diagnosed familial hypercholesterolemia on risk of myocardial infarction and ASCVD.<br /><b>Methods</b><br />We examined the CGPS (Copenhagen General Population Study) with determination of lipoprotein(a) and familial hypercholesterolemia in 69,644 individuals followed for 42 years, during which time, 4,166 developed myocardial infarction and 11,464, ASCVD.<br /><b>Results</b><br />For risk of myocardial infarction, the plasma lipoprotein(a) level equivalent to LDL cholesterol in clinical familial hypercholesterolemia was 67 mg/dL (142 nmol/L) for MEDPED (Make Early Diagnosis to Prevent Early Death), 110 mg/dL (236 nmol/L) for Simon Broome, 256 mg/dL (554 nmol/L) for possible DLCN (Dutch Lipid Clinic Network), and 402 mg/dL (873 nmol/L) for probable+definite DLCN, whereas it was 180 mg/dL (389 nmol/L) for genetic familial hypercholesterolemia. Corresponding values for ASCVD were 130 mg/dL (280 nmol/L), 150 mg/dL (323 nmol/L), 227 mg/dL (491 nmol/L), 391 mg/dL (849 nmol/L), and 175 mg/dL (378 nmol/L), respectively. Individuals with both elevated lipoprotein(a) and either familial hypercholesterolemia or a family history of premature myocardial infarction had a higher risk of myocardial infarction and ASCVD compared with individuals with only 1 of these genetic traits, with the highest HRs being for lipoprotein(a) upper 20% vs lower 50% of 14.0 (95% CI: 9.15-21.3) for myocardial infarction and 5.05 (95% CI: 3.41-7.48) for ASCVD.<br /><b>Conclusions</b><br />Lipoprotein(a) levels equivalent to LDL cholesterol in clinical and genetic familial hypercholesterolemia were 67 to 402 mg/dL and 180 mg/dL, respectively, for myocardial infarction and 130 to 391 mg/dL and 175 mg/dL, respectively, for ASCVD.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 22 Nov 2022; 80:1998-2010</small></div>
Hedegaard BS, Bork CS, Kaltoft M, Klausen IC, ... Langsted A, Nordestgaard BG
J Am Coll Cardiol: 22 Nov 2022; 80:1998-2010 | PMID: 36396201
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Outcomes of Pregnancy in Women With Bioprosthetic Heart Valves With or Without Valve Dysfunction.</h4><i>Wichert-Schmitt B, Grewal J, Malinowski AK, Pfaller B, ... Siu SC, Silversides CK</i><br /><b>Background</b><br />Although pregnancy outcomes in women with normally functioning bioprosthetic valves (BPVs) are often good, structural valve dysfunction (SVD) may adversely affect pregnancy outcomes, but this has not been studied.<br /><b>Objectives</b><br />The aim of this study was to examine outcomes in pregnant women with BPVs and the association with SVD.<br /><b>Methods</b><br />Pregnancy outcomes in women with BPVs were prospectively collected. Adverse maternal cardiac events (CEs) included cardiac death or arrest, sustained arrhythmia, heart failure, thromboembolism, and stroke. Adverse fetal events were also studied. Determinants of adverse events were examined using logistic regression.<br /><b>Results</b><br />Overall, 125 pregnancies in women with BPVs were included, 27% with left-sided and 73% with right-sided BPV. SVD was present in 27% of the pregnancies (44% with left-sided BPVs vs 21% with right-sided BPVs; P = 0.009). CEs occurred in 13% of pregnancies and were more frequent in women with SVD compared with those with normally functioning BPVs (26% vs 8%; P = 0.005). CEs were more common in women with left-sided BPVs with SVD vs normally functioning BPVs (47% vs 5%; P = 0.01) but not in women with right-sided BPVs (11% in those with SVD vs 8% in those without SVD; P = 0.67). Left-sided SVD (P = 0.007), maternal age >35 years (P = 0.001), and a composite variable of \"high-risk\" features (P = 0.006) were predictors of CEs. Fetal events occurred in 28% of pregnancies.<br /><b>Conclusions</b><br />In this cohort of young women with BPVs, SVD was present in 27% at the first antenatal visit and negatively affected pregnancy outcomes. In particular, SVD of left-sided BPVs was associated with high rates of adverse outcomes.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 22 Nov 2022; 80:2014-2024</small></div>
Wichert-Schmitt B, Grewal J, Malinowski AK, Pfaller B, ... Siu SC, Silversides CK
J Am Coll Cardiol: 22 Nov 2022; 80:2014-2024 | PMID: 36396203
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Randomized Trials of Percutaneous Microaxial Flow Pump Devices: JACC State-of-the-Art Review.</h4><i>Pahuja M, Johnson A, Kabir R, Bhogal S, ... Sheikh FH, Waksman R</i><br /><AbstractText>The use of mechanical circulatory support devices in cardiovascular practice has risen exponentially over the past decade. These devices are currently used for hemodynamic support in patients with cardiogenic shock, high-risk percutaneous coronary intervention, left ventricular unloading, protection of kidneys, and right ventricular failure. The Impella (Abiomed) percutaneous microaxial flow pump devices are rapidly gaining popularity. However, despite their increasing use, there are limited randomized clinical trials (RCTs) to support the benefits of the therapy and growing concern regarding complication rates. Vascular problems, including bleeding and acute limb ischemia, are associated with the devices, but published reports also highlight risks for cardiac perforations, mitral chordae rupture, and stroke. In this review, we summarize the history, mechanism of action, previously published RCT data, and upcoming RCTs on these devices.</AbstractText><br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 22 Nov 2022; 80:2028-2049</small></div>
Pahuja M, Johnson A, Kabir R, Bhogal S, ... Sheikh FH, Waksman R
J Am Coll Cardiol: 22 Nov 2022; 80:2028-2049 | PMID: 36396205
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure: The COAPT Trial.</h4><i>Giustino G, Camaj A, Kapadia SR, Kar S, ... Mack MJ, Stone GW</i><br /><b>Background</b><br />The impact of transcatheter edge-to-edge repair (TEER) on the rate and prognostic impact of hospitalizations in patients with heart failure (HF) and severe secondary mitral regurgitation is unknown.<br /><b>Objectives</b><br />This study sought to evaluate the effect of the MitraClip percutaneous edge-to edge repair system on fatal and nonfatal hospitalizations and their relationship with mortality in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial.<br /><b>Methods</b><br />Patients with HF (n = 614) with severe secondary mitral regurgitation were randomized to TEER plus guideline-directed medical therapy (GDMT) versus GDMT alone. Hospitalizations were classified as fatal if death occurred during that hospitalization or nonfatal if the patient was discharged alive.<br /><b>Results</b><br />At 2 years, TEER treatment, compared with GDMT alone, resulted in lower time-to-first-event rates of any heart failure hospitalization (HFH) (34.8% vs 56.4%; HR: 0.51; 95% CI: 0.39-0.66) and fatal HFH (6.5% vs 12.6%; HR: 0.47; 95% CI: 0.26-0.85). TEER also resulted in lower rates of all-cause nonfatal and fatal hospitalizations. During the 2-year follow-up period, patients who underwent TEER spent an average of 2 more months alive and out of the hospital than did patients treated with GDMT alone (581 ± 27 days vs 519 ± 26 days; P = 0.002). All HFHs (adjusted HR: 6.37; 95% CI: 4.63-8.78) and nonfatal HFHs (adjusted HR: 1.78; 95% CI: 1.27-2.49) were consistently independently associated with increased 2-year mortality in both the TEER and GDMT groups (P<sub>interaction</sub> = 0.34 and 0.39, respectively).<br /><b>Conclusions</b><br />In the COAPT trial, compared with GDMT alone, patients with HF and severe secondary mitral regurgitation undergoing TEER with the percutaneous edge-to edge repair system had lower 2-year rates of fatal and nonfatal all-cause hospitalizations and HFH and spent more time alive and out of the hospital. HFHs were strongly associated with mortality, irrespective of treatment. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] and COAPT CAS [COAPT]; NCT01626079).<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 15 Nov 2022; 80:1857-1868</small></div>
Giustino G, Camaj A, Kapadia SR, Kar S, ... Mack MJ, Stone GW
J Am Coll Cardiol: 15 Nov 2022; 80:1857-1868 | PMID: 36357085
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Cardiovascular Risk Reduction After Renal Denervation According to Time in Therapeutic Systolic Blood Pressure Range.</h4><i>Mahfoud F, Mancia G, Schmieder RE, Ruilope L, ... Fahy M, Böhm M</i><br /><b>Background</b><br />Renal denervation (RDN) has been shown to lower blood pressure (BP), but its effects on cardiovascular events have only been preliminarily evaluated. Time in therapeutic range (TTR) of BP is associated with cardiovascular events.<br /><b>Objectives</b><br />This study sought to assess the impact of catheter-based RDN on TTR and its association with cardiovascular outcomes in the GSR (Global SYMPLICITY Registry).<br /><b>Methods</b><br />Patients with uncontrolled hypertension were enrolled and treated with radiofrequency RDN. Office and ambulatory systolic blood pressure (OSBP and ASBP) were measured at 3, 6, 12, 24, and 36 months postprocedure and used to derive TTR. TTR through 6 months was assessed as a predictor of cardiovascular events from 6 to 36 months using a Cox proportional hazard regression model.<br /><b>Results</b><br />As of March 1, 2022, 3,077 patients were enrolled: 42.2% were female; mean age was 60.5 ± 12.2 years; baseline OSBP was 165.6 ± 24.8 mm Hg; and baseline ASBP was 154.3 ± 18.7 mm Hg. Patients were prescribed 4.9 ± 1.7 antihypertensive medications at baseline and 4.8 ± 1.9 at 36 months. At 36 months, mean changes were -16.7 ± 28.4 and -9.0 ± 20.2 mm Hg for OSBP and ASBP, respectively. TTR through 6 months was 30.6%. A 10% increase in TTR after RDN through 6 months was associated with significant risk reductions from 6 to 36 months of 15% for major adverse cardiovascular events (P < 0.001), 11% cardiovascular death (P = 0.010), 15% myocardial infarction (P = 0.023), and 23% stroke (P < 0.001).<br /><b>Conclusions</b><br />There were sustained BP reductions and higher TTR through 36 months after RDN. A 10% increase in TTR through 6 months was associated with significant risk reductions in major cardiovascular events from 6 to 36 months. (Global SYMPLICITY Registry [GSR] DEFINE; NCT01534299).<br /><br />Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 15 Nov 2022; 80:1871-1880</small></div>
Mahfoud F, Mancia G, Schmieder RE, Ruilope L, ... Fahy M, Böhm M
J Am Coll Cardiol: 15 Nov 2022; 80:1871-1880 | PMID: 36357087
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Neurometabolism and Ventricular Dyssynchrony in Patients With Heart Failure and Reduced Ejection Fraction.</h4><i>Bai Y, Yun M, Nie B, Shan L, ... Zhang X, Li X</i><br /><b>Background</b><br />The brain coordinates the heart through the autonomic nervous system (ANS). Numerous mediator signals along the brain-heart axis interact with the neuronal-metabolic system in heart failure (HF). Disturbances in cardio-neural interactions influence the disease progression in patients with HF.<br /><b>Objectives</b><br />The purpose of this study was to investigate the interactome between ANS-associated neurometabolism and ventricular dyssynchrony in patients with heart failure with reduced ejection fraction (HFrEF). Further, we studied the association of neurometabolism with major arrhythmic events (MAEs).<br /><b>Methods</b><br />A total of 197 patients with HFrEF who underwent gated single-photon emission computed tomography myocardial perfusion imaging and the brain <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/computed tomography were prospectively enrolled. Relationships between the brain metabolism and MAEs were assessed using Cox models and mediation analyses. Finally, metabolic central autonomic networks were constructed and statistically compared between patients with and without MAEs.<br /><b>Results</b><br />In total, 35 (17.8%) patients experienced MAEs during a median follow-up of 3.1 years. In patients with HFrEF (age 58 years [IQR: 50-64 years], left ventricular ejection fraction: 20.0% [IQR: 15.0%-25.0%]), glucose hypometabolism in the insula, hippocampus, amygdala, cingulate gyrus, and caudate nucleus were independent predictors for MAEs (all P < 0.05). Cerebral hypometabolism was related to ventricular dyssynchrony, which was the predominant risk factor of MAEs. Additionally, patients who experienced MAEs presented hypoconnectivity in the metabolic central autonomic network compared with those without MAEs (P < 0.05).<br /><b>Conclusions</b><br />We found an interaction of the neuronal metabolic-ventricular dyssynchronization axis in HF, which might be related to MAEs. This new brain-heart axis could expand our understanding of the distinct pathomechanisms of HFrEF.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 15 Nov 2022; 80:1884-1896</small></div>
Bai Y, Yun M, Nie B, Shan L, ... Zhang X, Li X
J Am Coll Cardiol: 15 Nov 2022; 80:1884-1896 | PMID: 36357089
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Comparative Risk of Myocarditis/Pericarditis Following Second Doses of BNT162b2 and mRNA-1273 Coronavirus Vaccines.</h4><i>Naveed Z, Li J, Wilton J, Spencer M, ... Janjua NZ, Canadian Immunization Research Network (CIRN) Provincial Collaborative Network (PCN) Investigators</i><br /><b>Background</b><br />Postmarketing evaluations have linked myocarditis to COVID-19 mRNA vaccines. However, few population-based analyses have directly compared the safety of the 2 mRNA COVID-19 vaccines.<br /><b>Objectives</b><br />This study aimed to compare the risk of myocarditis, pericarditis, and myopericarditis between BNT162b2 and mRNA-1273.<br /><b>Methods</b><br />We used data from the British Columbia COVID-19 Cohort (BCC19C), a population-based cohort study. The exposure was the second dose of an mRNA vaccine. The outcome was diagnosis of myocarditis, pericarditis, or myopericarditis during a hospitalization or an emergency department visit within 21 days of the second vaccination dose. We performed multivariable logistic regression to assess the association between vaccine product and the outcomes of interest.<br /><b>Results</b><br />The rates of myocarditis and pericarditis per million second doses were higher for mRNA-1273 (n = 31, rate 35.6; 95% CI: 24.1-50.5; and n = 20, rate 22.9; 95% CI: 14.0-35.4, respectively) than BNT162b2 (n = 28, rate 12.6; 95% CI: 8.4-18.2 and n = 21, rate 9.4; 95% CI: 5.8-14.4, respectively). mRNA-1273 vs BNT162b2 had significantly higher odds of myocarditis (adjusted OR [aOR]: 2.78; 95% CI: 1.67-4.62), pericarditis (aOR: 2.42; 95% CI: 1.31-4.46) and myopericarditis (aOR: 2.63; 95% CI: 1.76-3.93). The association between mRNA-1273 and myocarditis was stronger for men (aOR: 3.21; 95% CI: 1.77-5.83) and younger age group (18-39 years; aOR: 5.09; 95% CI: 2.68-9.66).<br /><b>Conclusions</b><br />Myocarditis/pericarditis following mRNA COVID-19 vaccines is rare, but we observed a 2- to 3-fold higher odds among individuals who received mRNA-1273 vs BNT162b2. The rate of myocarditis following mRNA-1273 receipt is highest among younger men (age 18-39 years) and does not seem to be present at older ages. Our findings may have policy implications regarding the choice of vaccine offered.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 15 Nov 2022; 80:1900-1908</small></div>
Naveed Z, Li J, Wilton J, Spencer M, ... Janjua NZ, Canadian Immunization Research Network (CIRN) Provincial Collaborative Network (PCN) Investigators
J Am Coll Cardiol: 15 Nov 2022; 80:1900-1908 | PMID: 36357091
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Risk Factors for In-Hospital Cardiac Arrest in Patients With ST-Segment Elevation Myocardial Infarction.</h4><i>Gong W, Yan Y, Wang X, Zheng W, ... Nie S, CCC-ACS Investigators</i><br /><b>Background</b><br />In-hospital cardiac arrest (IHCA) is one of the most deleterious complications of ST-segment elevation myocardial infarction (STEMI).<br /><b>Objectives</b><br />We systematically analyzed the clinical characteristics of STEMI patients with IHCA, as well as predictors and treatments associated with risk of IHCA, using a nationwide database.<br /><b>Methods</b><br />In the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project (2014-2019), we stratified patients presenting with STEMI within 24 hours after symptom onset according to IHCA or no IHCA during the index hospitalization. We analyzed patients\' clinical characteristics, mortality, and independent correlates of IHCA.<br /><b>Results</b><br />Of 40,670 STEMI patients, 2.2% (95% CI: 2.1%-2.4%) experienced IHCA. Among IHCA patients, the in-hospital mortality was 53.0% (95% CI: 49.7%-56.3%). IHCA represents 55.0% (95% CI: 51.6%-58.4%) of inpatient deaths. Age ≥75 years, female, nonsmoker, prior diabetes mellitus, prior renal failure, out-of-hospital cardiac arrest, heart rate >100 beats/min, systolic blood pressure <90 mm Hg, and Killip IV were identified as predictors of IHCA. IHCA patients were less likely to receive β-blockers and ticagrelor during the first 24 hours after first medical contact and were less likely to undergo primary percutaneous coronary intervention. After adjustment, primary percutaneous coronary intervention (adjusted HR: 0.82; 95% CI: 0.71-0.95), β-blockers (adjusted HR: 0.63; 95% CI: 0.47-0.86), and ticagrelor (adjusted HR: 0.57; 95% CI: 0.42-0.76) were associated with a reduced risk of IHCA.<br /><b>Conclusions</b><br />IHCA is rare in STEMI but is associated with high mortality. Multiple modifiable and unmodifiable factors are associated with its occurrence, suggesting that early intervention and rational drug treatment may improve its prognosis. (CCC Project- Acute Coronary Syndrome; NCT02306616).<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 08 Nov 2022; 80:1788-1798</small></div>
Gong W, Yan Y, Wang X, Zheng W, ... Nie S, CCC-ACS Investigators
J Am Coll Cardiol: 08 Nov 2022; 80:1788-1798 | PMID: 36328690
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Coronary Artery Bypass Surgery Without Saphenous Vein Grafting: JACC Review Topic of the Week.</h4><i>Royse A, Ren J, Royse C, Tian DH, ... Canty D, Bellomo R</i><br /><AbstractText>Approximately 95% of patients of any age undergoing contemporary, coronary bypass surgery will receive at least 1 saphenous vein graft (SVG). It is recognized that SVG will develop progressive and accelerated atherosclerosis, resulting in a stenosis, and in occlusion that occurs in 50% by 10 years postoperatively. For arterial conduits, there is little evidence of progressive failure as for SVG. Could avoidance of SVG (total arterial revascularization [TAR]) lead to a different late (>5 year) survival? A literature review of 23 studies (N = 100,314 matched patients) at a mean 8.8 years postoperative found reduced all-cause mortality for TAR (HR: 0.77; 95% CI: 0.71-0.84; P < 0.001). An expanded analysis with a new unpublished data set (N = 63,288 matched patients) was combined with the literature review (N = 127,565). It found reduced all-cause mortality for TAR (HR: 0.78; 95% CI: 0.72-0.85; P < 0.001). Additional Bayesian analysis found a very high probability of a TAR-associated reduction all-cause mortality.</AbstractText><br /><br />Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 08 Nov 2022; 80:1833-1843</small></div>
Royse A, Ren J, Royse C, Tian DH, ... Canty D, Bellomo R
J Am Coll Cardiol: 08 Nov 2022; 80:1833-1843 | PMID: 36328694
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Cardiovascular Effects of Canagliflozin in Relation to Renal Function and Albuminuria.</h4><i>Sarraju A, Bakris G, Cannon CP, Cherney D, ... Perkovic V, Mahaffey KW</i><br /><b>Background</b><br />People with type 2 diabetes mellitus (T2DM) have elevated cardiovascular (CV) risk, including for hospitalization for heart failure (HHF). Canagliflozin reduced CV and kidney events in patients with T2DM and high CV risk or nephropathy in the CANVAS (CANagliflozin cardioVascular Assessment Study) Program and the CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) trial.<br /><b>Objectives</b><br />The aim of this study was to assess the effects of canagliflozin on CV outcomes according to baseline estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (UACR) in pooled patient-level data from the CANVAS Program and CREDENCE trial.<br /><b>Methods</b><br />Canagliflozin effects on CV death or HHF were assessed by baseline eGFR (<45, 45-60, and >60 mL/min/1.73 m<sup>2</sup>) and UACR (<30, 30-300, and >300 mg/g). HRs and 95% CIs were estimated by using Cox regression models overall and according to subgroups.<br /><b>Results</b><br />A total of 14,543 participants from the CANVAS Program (N = 10,142) and the CREDENCE (N = 4,401) trial were included, with a mean age of 63 years, 35% female, 75% White, 13.2% with baseline eGFR <45 mL/min/1.73 m<sup>2</sup>, and 31.9% with UACR >300 mg/g. Rates of CV death or HHF increased as eGFR declined and/or UACR increased. Canagliflozin significantly reduced CV death or HHF compared with placebo (19.4 vs 28.0 events per 1,000 patient-years; HR: 0.70; 95% CI: 0.62-0.79), with consistent results across eGFR and UACR categories (all P interaction >0.40).<br /><b>Conclusions</b><br />Risk of CV death or HHF was higher in those with lower baseline eGFR and/or higher UACR. Canagliflozin consistently reduced CV death or HHF in participants with T2DM and high CV risk or nephropathy regardless of baseline renal function or level of albuminuria. (Canagliflozin Cardiovascular Assessment Study [CANVAS], NCT01032629; A Study of the Effects of Canagliflozin [JNJ-24831754] on Renal Endpoints in Adult Participants With Type 2 Diabetes Mellitus [CANVAS-R], NCT01989754; and Evaluation of the Effects of Canagliflozin on Renal and Cardiovascular Outcomes in Participants With Diabetic Nephropathy [CREDENCE], NCT02065791).<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Coll Cardiol: 01 Nov 2022; 80:1721-1731</small></div>
Sarraju A, Bakris G, Cannon CP, Cherney D, ... Perkovic V, Mahaffey KW
J Am Coll Cardiol: 01 Nov 2022; 80:1721-1731 | PMID: 36302584
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Biomarker-Based Prediction of Recurrent Ischemic Events in Patients With Acute Coronary Syndromes.</h4><i>Batra G, Lindbäck J, Becker RC, Harrington RA, ... Siegbahn A, Wallentin L</i><br /><b>Background</b><br />In patients with acute coronary syndrome (ACS), there is residual and variable risk of recurrent ischemic events.<br /><b>Objectives</b><br />This study aimed to develop biomarker-based prediction models for 1-year risk of cardiovascular (CV) death and myocardial infarction (MI) in patients with ACS undergoing percutaneous coronary intervention.<br /><b>Methods</b><br />We included 10,713 patients from the PLATO (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome) trial in the development cohort and externally validated in 3,508 patients from the TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trial. Variables contributing to risk of CV death/MI were assessed using Cox regression models, and a score was derived using subsets of variables approximating the full model.<br /><b>Results</b><br />There were 632 and 190 episodes of CV death/MI in the development and validation cohorts. The most important predictors of CV death/MI were the biomarkers, growth differentiation factor 15, and N-terminal pro-B-type natriuretic peptide, which had greater prognostic value than all candidate variables. The final model included 8 items: age (A), biomarkers (B) (growth differentiation factor 15 and N-terminal pro-B-type natriuretic peptide), and clinical variables (C) (extent of coronary artery disease, previous vascular disease, Killip class, ACS type, P2Y<sub>12</sub> inhibitor). The model, named ABC-ACS ischemia, was well calibrated and showed good discriminatory ability for 1-year risk of CV death/MI with C-indices of 0.71 and 0.72 in the development and validation cohorts, respectively. For CV death, the score performed better, with C-indices of 0.80 and 0.84 in the development and validation cohorts, respectively.<br /><b>Conclusions</b><br />An 8-item score for the prediction of CV death/MI was developed and validated for patients with ACS undergoing percutaneous coronary intervention. The ABC-ACS ischemia score showed good calibration and discrimination and might be useful for risk prediction and decision support in patients with ACS. (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome [PLATO]; NCT00391872; Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Participants With Acute Coronary Syndrome [TRACER]; NCT00527943).<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 01 Nov 2022; 80:1735-1747</small></div>
Batra G, Lindbäck J, Becker RC, Harrington RA, ... Siegbahn A, Wallentin L
J Am Coll Cardiol: 01 Nov 2022; 80:1735-1747 | PMID: 36302586
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Relationship of Circulating Vegetable Omega-3 to Prognosis in Patients With Heart Failure.</h4><i>Lázaro I, Lupón J, Cediel G, Codina P, ... Sala-Vila A, Bayés-Genís A</i><br /><b>Background</b><br />There is an urgent need for cost-effective strategies to promote quality of life in patients with heart failure (HF). Several studies reported benefits in HF prognosis for marine omega-3 fatty acids and plant-based dietary patterns.<br /><b>Objectives</b><br />The aim of this study was to explore whether dietary alpha-linolenic acid (ALA), the main plant omega-3, relates to a better HF prognosis.<br /><b>Methods</b><br />ALA was determined in serum phospholipids (which reflect long-term dietary ALA intake and metabolism) by gas chromatography in 905 ambulatory patients with HF caused by different etiologies.<br /><b>Results</b><br />After a median follow-up of 2.4 years (range: 0.02-3 years), 140 all-cause deaths, 85 cardiovascular (CV) deaths, and 141 first HF hospitalizations (composite of all-cause death and first HF hospitalization, n = 238) were documented. Using Cox regression analyses, we observed that, compared with patients at the lowest quartile of ALA in serum phospholipids (Q1), those at the 3 upper quartiles (Q2-Q4) exhibited a reduction in the risk of composite of all-cause death and first HF hospitalization (HR: 0.61; 95% CI: 0.46-0.81). Statistically significant reductions were observed for all-cause death (HR: 0.58; 95% CI: 0.41-0.82), CV death (HR: 0.51; 95% CI: 0.32-0.80), first HF hospitalization (HR: 0.58; 95% CI: 0.40-0.84), and the composite of CV death and HF hospitalization (HR: 0.58; 95% CI: 0.42-0.79).<br /><b>Conclusions</b><br />HF patients with bottom 25% ALA levels in serum phospholipids had a worse prognosis during a mid-term follow-up compared with those with the highest levels. This might be a target population in whom to test dietary ALA-rich interventions to promote quality of life.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 01 Nov 2022; 80:1751-1758</small></div>
Lázaro I, Lupón J, Cediel G, Codina P, ... Sala-Vila A, Bayés-Genís A
J Am Coll Cardiol: 01 Nov 2022; 80:1751-1758 | PMID: 36302588
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Eliminating Disparities in Cardiovascular Disease for Black Women: JACC Review Topic of the Week.</h4><i>Ogunniyi MO, Mahmoud Z, Commodore-Mensah Y, Fleg JL, ... Hayes SN, American College of Cardiology Cardiovascular Disease in Women Committee and the American College of Cardiology Health Equity Taskforce</i><br /><AbstractText>Black women are disproportionately affected by cardiovascular disease with an excess burden of cardiovascular morbidity and mortality. In addition, the racialized structure of the United States shapes cardiovascular disease research and health care delivery for Black women. Given the indisputable evidence of the disparities in health care delivery, research, and cardiovascular outcomes, there is an urgent need to develop and implement effective and sustainable solutions to advance cardiovascular health equity for Black women while considering their ethnic diversity, regions of origin, and acculturation. Innovative and culturally tailored strategies that consider the differential impact of social determinants of health and the unique challenges that shape their health-seeking behaviors should be implemented. A patient-centered framework that involves collaboration among clinicians, health care systems, professional societies, and government agencies is required to improve cardiovascular outcomes for Black women. The time is \"now\" to achieve health equity for all Black women.</AbstractText><br /><br />Copyright © 2022 American College of Cardiology Foundation. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 01 Nov 2022; 80:1762-1771</small></div>
Ogunniyi MO, Mahmoud Z, Commodore-Mensah Y, Fleg JL, ... Hayes SN, American College of Cardiology Cardiovascular Disease in Women Committee and the American College of Cardiology Health Equity Taskforce
J Am Coll Cardiol: 01 Nov 2022; 80:1762-1771 | PMID: 36302590
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:

This program is still in alpha version.