Issue Information
(Source: Clinical Cardiology)
Source: Clinical Cardiology - June 13, 2014 Category: Cardiology Tags: Issue Information Source Type: research

Hypoglycemia From a Cardiologist's Perspective
In conclusion, in the current era of DM and its vascular ramifications, hypoglycemia from a cardiologist's perspective deserves due attention. (Source: Clinical Cardiology)
Source: Clinical Cardiology - June 4, 2014 Category: Cardiology Authors: Vani P. Sanon, Saurabh Sanon, Rushit Kanakia, Hu Yu, Faris Araj, Rene Oliveros, Robert Chilton Tags: Review Source Type: research

Impact of Adverse Left Ventricular Remodeling on Sudden Cardiac Death in Patients With Hypertrophic Cardiomyopathy
ConclusionsThis study shows that SCD risk in HCM increases when adverse remodeling occurs. Because cases and controls were similar at baseline, these findings emphasize the importance of vigilant follow‐up of HCM patients and could aid clinical decision making concerning implantable cardioverter‐defibrillator implantation, especially in patients with moderate risk for SCD. (Source: Clinical Cardiology)
Source: Clinical Cardiology - June 1, 2014 Category: Cardiology Authors: Pieter A. Vriesendorp, Arend F.L. Schinkel, Natasja M. S. de Groot, Ron T. van Domburg, Folkert J. ten Cate, Michelle Michels Tags: Clinical Investigation Source Type: research

The Association of Gender to Cardiovascular Outcomes After Coronary Artery Revascularization in Patients With End‐Stage Renal Disease
Abstract BackgroundInadequate recruitment of women and an exclusion of patients with end‐stage renal disease (ESRD) in coronary revascularization trials have led to knowledge gaps of gender‐based outcomes. HypothesisWomen have equivalent cardiovascular outcomes when compared to men. MethodsWe conducted a retrospective observational study utilizing Kaiser Permanente Northern California (KPNC) databases and identified 1015 adults with ESRD who underwent coronary revascularization between 1996 and 2008. We ascertained baseline characteristics, primary (mortality at 5 years) and secondary (myocardial infarction [MI] and re...
Source: Clinical Cardiology - June 1, 2014 Category: Cardiology Authors: Ashok Krishnaswami, Tara I. Chang, James J. Jang, Thomas K. Leong, Alan S. Go Tags: Clinical Investigation Source Type: research

Hyperglycemia in Patients Referred for Cardiac Catheterization Is Associated With Preexisting Diabetes Rather Than a Stress‐Related Phenomenon: A Prospective Cross‐Sectional Study
ABSTRACT BackgroundAn increased serum glucose level in patients with acute coronary syndrome (ACS) is associated with adverse clinical outcome. This hyperglycemia has been attributed, at least in part, to acute stress reaction. Our objective was to determine whether hyperglycemia is a stress‐related phenomenon or whether it represents a more sustained and possibly significant background dysglycemia. HypothesisHyperglycemia in patients undergoing coronary angiography is related to background dysglycemia. MethodsBlood samples were obtained at the time of cardiac catheterization. Patients with hemoglobin A1c>6.5% were ex...
Source: Clinical Cardiology - May 2, 2014 Category: Cardiology Authors: Yaron Arbel, Hezzy Shmueli, Amir Halkin, Shlomo Berliner, Itzhak Shapira, Itzhak Herz, Ofer Havakuk, Yacov Shacham, Itay Rabinovich, Gad Keren, Ariel Finkelstein, Shmuel Banai Tags: Clinical Investigations Source Type: research

Issue Information
(Source: Clinical Cardiology)
Source: Clinical Cardiology - April 11, 2014 Category: Cardiology Tags: Issue Information Source Type: research

Does Low Vitamin D Amplify the Association of COPD With Total and Cardiovascular Disease Mortality?
ABSTRACT BackgroundChronic obstructive pulmonary disease (COPD) has been shown to be associated with lower levels of vitamin D, and the latter has been associated with total and cardiovascular disease (CVD) mortality. HypothesisWe hypothesized that lower vitamin D levels will further enhance the association of COPD and its severity with total and CVD mortality. MethodsWe studied 7746 US adults age ≥40 years without known CVD (mean age, 59.8 years) and followed up through 2006 (8.2 ± 2.5 years) for total and CVD mortality. Serum 25‐hydroxyvitamin D levels were categorized as tertiles: first tertile...
Source: Clinical Cardiology - April 9, 2014 Category: Cardiology Authors: Hwa Mu Lee, Michael Liu, Katherine Lee, Yanting Luo, Nathan D. Wong Tags: Clinical Investigations Source Type: research

Coronary Microvascular Dysfunction Assessed by Intracoronary Acetylcholine Provocation Testing Is a Frequent Cause of Ischemia and Angina in Patients With Exercise‐Induced Electrocardiographic Changes and Unobstructed Coronary Arteries
ConclusionsCoronary microvascular dysfunction is frequently found in patients with exertional angina pectoris and unobstructed coronary arteries. Such a finding is found significantly more often in presence of a pathologic exercise ECG. (Source: Clinical Cardiology)
Source: Clinical Cardiology - April 9, 2014 Category: Cardiology Authors: Peter Ong, Anastasios Athanasiadis, Stephan Hill, Tim Schäufele, Heiko Mahrholdt, Udo Sechtem Tags: Clinical Investigations Source Type: research

Predictors of Long‐term Maintenance of Normal Sinus Rhythm After Successful Electrical Cardioversion
Electrical cardioversion (EC) for atrial fibrillation (AF) is a common procedure performed in an attempt to restore normal sinus rhythm (NSR). Many factors predict long‐term maintenance of NSR and the risk of AF recurrence. The duration of AF, cardiac size and function, rheumatic heart disease, significant mitral valve disease, left atrial enlargement, and older age are among the most common recognized factors. A number of interventions can potentially decrease the AF recurrence rate. Identifying and treating reversible causes and the use of antiarrhythmic medications in certain situations can help decrease the risk of A...
Source: Clinical Cardiology - April 3, 2014 Category: Cardiology Authors: Basil Abu‐El‐Haija, Michael C. Giudici Tags: Review Source Type: research

Lack of Efficacy of Drug Therapy in Preventing Takotsubo Cardiomyopathy Recurrence: A Meta‐analysis
ConclusionsA meta‐analysis of the efficacy of different medications through the clinical TTC registries available showed no clinical evidence for a standard drug treatment in the chronic management of TTC. β‐Blockers, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, statins, and aspirin do not seem to significantly reduce recurrences of TTC. Randomized, adequately powered studies are needed to further assess this issue. (Source: Clinical Cardiology)
Source: Clinical Cardiology - April 3, 2014 Category: Cardiology Authors: Francesco Santoro, Riccardo Ieva, Francesco Musaico, Armando Ferraretti, Giuseppe Triggiani, Nicola Tarantino, Matteo Di Biase, Natale Daniele Brunetti Tags: Review Source Type: research

From Door‐to‐Balloon Time to Contact‐to‐Device Time: Predictors of Achieving Target Times in Patients With ST‐Elevation Myocardial Infarction
This study investigates the impact of prehospital wireless electrocardiogram transmission (PHT) on reperfusion times to assess the impact of the new guidelines. MethodsFrom January 2009 to December 2012, data were collected on STEMI patients who received percutaneous coronary interventions; 245 patients were included for analysis. The primary outcome was median C2D time in the PHT group and the secondary outcome was D2B time. ResultsPrehospital wireless electrocardiogram transmission was associated with reduced C2D times vs no PHT: 80 minutes (interquartile range [IQR], 64–94) vs 96 minutes (IQR, 79&mda...
Source: Clinical Cardiology - April 3, 2014 Category: Cardiology Authors: Robert O. Roswell, Brian Greet, Parin Parikh, Andrea Mignatti, John Freese, Iryna Lobach, Yu Guo, Norma Keller, Martha Radford, Sripal Bangalore Tags: Quality and Outcomes Source Type: research

Clinical Utility and Prognostic Significance of Measuring Troponin I Levels in Patients Presenting to the Emergency Room With Atrial Fibrillation
ConclusionsTroponin levels are routinely checked in a majority of patients presenting to the emergency department with AF. Even mildly elevated TnI is associated with a greater incidence of coronary artery disease on diagnostic testing and a higher 1‐year incidence of MI. (Source: Clinical Cardiology)
Source: Clinical Cardiology - April 2, 2014 Category: Cardiology Authors: Kamal Gupta, Jayasree Pillarisetti, Mazda Biria, Micah Pescetto, Tareq M. Abu‐Salah, Chandra Annapureddy, Kay Ryschon, Buddhadeb Dawn, Dhanunjaya Lakkireddy Tags: Clinical Investigation Source Type: research

Cardiac Platypnea‐Orthodeoxia Syndrome: An Often Unrecognized Malady
Abstract Platypnea‐orthodeoxia syndrome (POS) is a rare but clinically important form of dyspnea. The syndrome is characterized by dyspnea and arterial oxygen desaturation that occurs in the upright position and improves with recumbency. In cardiac POS, an atrial septal defect or patent foramen ovale allows communication between the right‐ and left‐sided circulations. A second defect, such as a dilated aorta, prominent eustachian valve, or pneumonectomy, then contributes to right‐to‐left shunting through the interatrial connection. Diagnosis is made through pulse oximetry to confirm orthodeoxia and through transe...
Source: Clinical Cardiology - April 1, 2014 Category: Cardiology Authors: Joseph T. Knapper, Jason Schultz, Gladwin Das, Laurence S. Sperling Tags: Review Source Type: research

Primary Malignancies of the Heart and Pericardium
ABSTRACT Primary malignancies of the heart and pericardium are rare. All the available data come from autopsy studies, case reports, and, in recent years, from large, specialized, single‐center studies. Nevertheless, if primary malignancy is present, it may have a devastating implication for patients. Malignancies may affect heart function, also causing left‐sided or right‐sided heart failure. In addition, they can be responsible for embolic events or arrhythmias. Today, with the widespread use of noninvasive imaging modalities, heart tumors become evident, even as an incidental finding. A multimodality imaging appro...
Source: Clinical Cardiology - April 1, 2014 Category: Cardiology Authors: Ivana Burazor, Sarit Aviel‐Ronen, Massimo Imazio, Gal Markel, Yoni Grossman, Ady Yosepovich, Yehuda Adler Tags: Review Source Type: research

Unexplained Syncope: Implications of Age and Gender on Patient Characteristics and Evaluation, the Diagnostic Yield of an Implantable Loop Recorder, and the Subsequent Treatment
Abstract BackgroundSyncope is a common clinical problem with a variety of underlying mechanisms, some of which occur more frequently in 1 of the sexes or at a certain age. HypothesisThere may be clinically significant age‐ and gender‐related differences in patients with unexplained syncope. MethodsFive hundred seventy patients (54% women) with unexplained syncope received an implantable loop recorder (ILR) and were followed until diagnosis or for at least 1 year. ResultsWomen were older and more prone to severe trauma during syncope (40.8% vs 29.9%, P = 0.007), and hospitalization was more common at ≥65 years (P = 0...
Source: Clinical Cardiology - April 1, 2014 Category: Cardiology Authors: Nils Edvardsson, Claudio Garutti, Guido Rieger, Nicholas J. Linker, Tags: Clinical Investigation Source Type: research

The Role of Vitamin Supplementation in the Prevention of Cardiovascular Disease Events
ABSTRACT The production, sale, and consumption of multiple vitamins is a multibillion‐dollar industry. Most Americans take some form of supplement ostensibly for prevention of cardiovascular disease. It has been claimed that vitamin A retards atherogenesis. Vitamin C is an antioxidant and is thought to possibly decrease free radical‐induced endothelial injury, which can lead to atherosclerotic plaque formation. Vitamin E has been extensively studied for its possible effects on platelet function as well as inhibition of foam‐cell formation. Low levels of vitamin D have been thought to negatively impact myocardial stru...
Source: Clinical Cardiology - April 1, 2014 Category: Cardiology Authors: Chirag K. Desai, Jennifer Huang, Adil Lokhandwala, Aaron Fernandez, Irbaz Bin Riaz, Joseph S. Alpert Tags: Review Source Type: research

Association Between N‐Terminal Pro‐Brain Natriuretic Peptide Levels and Contrast‐Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome
Abstract BackgroundContrast‐induced nephropathy (CIN) is associated with significantly increased morbidity and mortality after percutaneous coronary intervention (PCI). Patients with acute coronary syndrome (ACS) are at higher risk for CIN. N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) is closely linked to the prognosis as a strong predictor of both short‐ and long‐term mortality in patients with ACS. HypothesisWe hypothesized that NT‐proBNP levels on admission can predict the development of CIN after PCI for ACS. MethodsA total of 436 patients (age 62.27 ± 13.01 years; 64.2% male) with ACS unde...
Source: Clinical Cardiology - April 1, 2014 Category: Cardiology Authors: Alparslan Kurtul, Mustafa Duran, Mikail Yarlioglues, Sani Namik Murat, Muhammed Bora Demircelik, Gokhan Ergun, Sadik Kadri Acikgoz, Baris Sensoy, Mustafa Cetin, Ender Ornek Tags: Clinical Investigation Source Type: research

Adherence to Dual Antiplatelet Therapy After Coronary Stenting: A Systematic Review
ConclusionsDAPT adherence is suboptimal at 12 months, and interventions to increase adherence should focus on reducing bleeding risk and improving communication between patients and physicians. (Source: Clinical Cardiology)
Source: Clinical Cardiology - April 1, 2014 Category: Cardiology Authors: Matthew J. Czarny, Ashwin S. Nathan, Robert W. Yeh, Laura Mauri Tags: Review Source Type: research

Recent Improvement in Coronary Computed Tomography Angiography Diagnostic Accuracy
ABSTRACT Although invasive coronary angiography has been the gold standard for evaluating coronary artery disease (CAD), it should not be routinely performed as an initial test to assess CAD in subjects with suspected CAD by the recent guidelines, due to cost, invasiveness, and measurable risk. Coronary computed tomography angiography (CCTA) is a rapidly growing, noninvasive imaging modality that developed quickly over the last decade, and its role for evaluation of CAD becomes of great promise with high diagnostic accuracy. Although artifact issues have created some challenges for CCTA, recent advances—including the...
Source: Clinical Cardiology - April 1, 2014 Category: Cardiology Authors: Anas Alani, Rine Nakanishi, Matthew J. Budoff Tags: Reviews Source Type: research

Fractional Flow Reserve: An Updated Review
ABSTRACT Revascularization of ischemia‐producing coronary lesions is widely used in the management of coronary artery disease. However, some coronary lesions appear significant on the conventional angiogram when they are truly non–flow limiting. For this reason, it is becoming increasingly important to determine the coronary physiology. Fractional flow reserve (FFR) has emerged as a useful tool to determine the lesions that require revascularization. Measurement of FFR during invasive coronary angiography now has a class IA indication from the European Society of Cardiology for identifying hemodynamically significa...
Source: Clinical Cardiology - March 20, 2014 Category: Cardiology Authors: Islam Y. Elgendy, C. Richard Conti, Anthony A. Bavry Tags: Review Source Type: research

Time‐Trend Analysis on the Framingham Risk Score and Prevalence of Cardiovascular Risk Factors in Patients Undergoing Percutaneous Coronary Intervention Without Prior History of Coronary Vascular Disease Over the Last 17 Years: A Study From the Mayo Clinic PCI Registry
ABSTRACT BackgroundThere is a paucity of data on the temporal trends of cardiovascular risk factors in patients undergoing percutaneous coronary intervention (PCI). We investigated the secular trends of risk profiles of patients undergoing PCI without prior history of cardiovascular disease (CVD). HypothesisCVD risk factors are changed over time. MethodsThis time‐trend analysis from 1994 to 2010 was performed within the Mayo Clinic PCI Registry. Outcome measures were prevalence of CVD risk factors, including the Framingham risk score (FRS), at the time of admission for PCI. ResultsDuring this period, 12,055 patients with...
Source: Clinical Cardiology - March 20, 2014 Category: Cardiology Authors: Moo‐Sik Lee, Andreas J. Flammer, Jing Li, Ryan J. Lennon, Mandeep Singh, David R. Holmes, Charanjit S. Rihal, Amir Lerman Tags: Clinical Investigation Source Type: research

Prevention of Cardiovascular Disease: Highlights for the Clinician of the 2013 American College of Cardiology/American Heart Association Guidelines
ABSTRACT Prevention of cardiovascular disease, undoubtedly an emphasis of clinical care in 2014, will provide both opportunities and challenges to patients and their healthcare providers. The recently‐released ACC/AHA guidelines on assessment of cardiovascular risk, lifestyle management to reduce cardiovascular risk, management of overweight and obesity, and treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk, have introduced new concepts and revised prior conventional strategies. New to risk assessment are the Pooled Cohort Equations, targeting the expanded concept of atherosclerotic cardiovascu...
Source: Clinical Cardiology - March 14, 2014 Category: Cardiology Authors: Nanette K. Wenger Tags: Review Source Type: research

Choice of Vein‐Harvest Technique for Coronary Artery Bypass Grafting: Rationale and Design of the REGROUP Trial
ABSTRACT The Randomized Endo‐vein Graft Prospective (REGROUP) trial (ClinicalTrials.gov NCT01850082) is a randomized, intent‐to‐treat, 2‐arm, parallel‐design, multicenter study funded by the Cooperative Studies Program (CSP No. 588) of the US Department of Veterans Affairs. Cardiac surgeons at 16 Veterans Affairs (VA) medical centers with technical expertise in performing both endoscopic vein harvesting (EVH) and open vein harvesting (OVH) were recruited as the REGROUP surgeon participants. Subjects requiring elective or urgent coronary artery bypass grafting using cardiopulmonary bypass with use of ≥1 sa...
Source: Clinical Cardiology - March 14, 2014 Category: Cardiology Authors: Marco A. Zenati, J. Michael Gaziano, Joseph F. Collins, Kousick Biswas, Jennifer M. Gabany, Jacquelyn A. Quin, Jerene M. Bitondo, Faisal G. Bakaeen, Rosemary F. Kelly, A. Laurie Shroyer, Deepak L. Bhatt Tags: Trial Designs Source Type: research

Issue Information
(Source: Clinical Cardiology)
Source: Clinical Cardiology - March 13, 2014 Category: Cardiology Tags: Issue Information Source Type: research

Clinical Outcomes of Biodegradable Polymer Drug‐Eluting Stents for Percutaneous Coronary Intervention: An Updated Meta‐analysis of Randomized Controlled Trials
ABSTRACT Biodegradable polymer drug‐eluting stents (DES) are innovative concepts in the era of percutaneous coronary intervention. We systematically reviewed the latest randomized evidence on the efficacy and safety of biodegradable polymer DES as compared to durable polymer DES. MEDLINE, Embase, and the Cochrane database were searched in August 2013 for eligible randomized controlled trials (RCTs) comparing biodegradable polymer DES with durable polymer DES. Clinical outcomes of interest were mortality, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent th...
Source: Clinical Cardiology - March 1, 2014 Category: Cardiology Authors: Joey S.W. Kwong, Cheuk‐Man Yu Tags: Review Source Type: research

Utility of Dobutamine Stress Echocardiography as Part of the Pre‐Liver Transplant Evaluation: An Evaluation of Its Efficacy
ConclusionsAlthough widely used, DSE may not always accurately reflect the severity of obstructive CAD in patients undergoing OLT. (Source: Clinical Cardiology)
Source: Clinical Cardiology - March 1, 2014 Category: Cardiology Authors: David Snipelisky, Michael Levy, Brian Shapiro Tags: Clinical Investigations Source Type: research

Improved Rate Control Reduces Cardiac Troponin T Levels in Permanent Atrial Fibrillation
Abstract BackgroundDetectable levels of troponins are often found in serum of patients with atrial fibrillation (AF), and recent reports suggest that Tn concentrations are independently related to patient prognosis. HypothesisWe hypothesized that treatment with common rate‐reducing drugs might lower the levels of cardiac troponin T (TnT) in patients with permanent AF. We also wanted to investigate whether the different drugs would impact the Tn levels differently. MethodsSixty patients were included (mean age 71 ± 9 years, 18 women) in this randomized crossover study. All patients had stable, permanent AF without ...
Source: Clinical Cardiology - March 1, 2014 Category: Cardiology Authors: Sara R. Ulimoen, Steve Enger, Jon Norseth, Are H. Pripp, Michael Abdelnoor, Harald Arnesen, Knut Gjesdal, Arnljot Tveit Tags: Clinical Investigations Source Type: research

Effects of Renal Denervation on Ambulatory Blood Pressure Measurements in Patients With Resistant Arterial Hypertension
Abstract BackgroundThe sympathetic nervous system is an important factor in hypertension. In patients suffering from resistant hypertension, transfemoral renal sympathetic denervation (RDN) reduces office blood pressure (BP) values. HypothesisAmbulatory BP measurement (ABPM) is a better predictor than office BP of cardiovascular morbidity and mortality. We thus believe that ABPM should be added to the systematic evaluation and follow‐up protocol when treating patients with resistant hypertension with RDN. Therefore, we evaluated the effect of RDN on mean 24‐hour BP by the use of ABPM. MethodsPatients with resistant hyp...
Source: Clinical Cardiology - March 1, 2014 Category: Cardiology Authors: Thomas Lambert, Hermann Blessberger, Verena Gammer, Alexander Nahler, Michael Grund, Klaus Kerschner, Gunda Buchmayr, Karim Saleh, Jürgen Kammler, Clemens Steinwender Tags: Clinical Investigation Source Type: research

Cardiac Transplantation in African Americans: A Single‐Center Experience
Abstract BackgroundIn view of limited data on the subject of graft and patient survival differences between African American (AA) and non‐AA heart transplant recipients, we reviewed our experience. HypothesisThere is a higher mortality among AA recipients compared with non‐AA recipients after cardiac transplantation. MethodsThe study included all AA patients who have received a heart transplant in our center since 1983. Stepwise Cox regression was used for covariates affecting the survival. The χ2 test was employed to identify the effects of a mechanical assist device and pretransplant creatinine (Cr) on the out...
Source: Clinical Cardiology - March 1, 2014 Category: Cardiology Authors: Prakash Goutham Suryanarayana, Hannah Copeland, Mark Friedman, Jack G. Copeland Tags: Quality and Outcomes Source Type: research

Management of Patients With Atrial Fibrillation by Primary‐Care Physicians in Germany: 1‐Year Results of the ATRIUM Registry
ConclusionsIn this unselected group of patients with long‐standing AF managed in primary care, hospitalizations and cardiovascular complications including strokes are frequent, illustrating the need to improve management of AF patients. (Source: Clinical Cardiology)
Source: Clinical Cardiology - March 1, 2014 Category: Cardiology Authors: Paulus Kirchhof, Janine Schmalowsky, David Pittrow, Ludger Rosin, Wilhelm Kirch, Karl Wegscheider, Thomas Meinertz, Tags: Quality and Outcomes Source Type: research

Neck Circumference Is Not Associated With Subclinical Atherosclerosis in Retired National Football League Players
ABSTRACT BackgroundNeck circumference (NC) is associated with metabolic syndrome (MetS) in the general population. It is not known if NC is associated with MetS and subclinical atherosclerosis in retired National Football League (NFL) players. HypothesisWe hypothesized that NC is associated with MetS and subclinical atherosclerosis (assessed as coronary artery calcium [CAC] and carotid artery plaque [CAP]) in retired NFL players. MethodsNC was measured midway between the midcervical spine and midanterior neck in 845 retired NFL players. CAC presence was defined as total CAC score>0. CAP was defined as carotid plaque of ...
Source: Clinical Cardiology - March 1, 2014 Category: Cardiology Authors: Yashashwi Pokharel, Francisco Y. Macedo, Vijay Nambi, Seth S. Martin, Khurram Nasir, Nathan D. Wong, Jeffrey Boone, Arthur J. Roberts, Christie M. Ballantyne, Salim S. Virani Tags: Clinical Investigation Source Type: research

Comparison of Prasugrel and Bivalirudin vs Clopidogrel and Heparin in Patients With ST‐Segment Elevation Myocardial Infarction: Design and Rationale of the Bavarian Reperfusion Alternatives Evaluation (BRAVE) 4 Trial
ABSTRACT Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients with ST‐segment elevation myocardial infarction (STEMI). Effective and safe adjunct antithrombotic therapy is a major determinant for short‐ and long‐term outcomes after primary PCI. Two separate studies have shown significant benefits vs conventional therapy for 2 recently approved drugs. In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS‐AMI) trial, bivalirudin after pretreatment with clopidogrel resulted in improved net clinical outcome compared with hep...
Source: Clinical Cardiology - March 1, 2014 Category: Cardiology Authors: Stefanie Schulz, Gert Richardt, Karl‐Ludwig Laugwitz, Roxana Mehran, Anthony H. Gershlick, Tanja Morath, Katharina Mayer, Julia Neudecker, Ralph Tölg, Tareq Ibrahim, Dieter Hauschke, Daniel Braun, Heribert Schunkert, Adnan Kastrati, Julinda Mehilli, Tags: Trial Designs Source Type: research

A Reevaluation of the Costs of Heart Failure and Its Implications for Allocation of Health Resources in the United States
The objective of this analysis is to more accurately assess these costs. Publicly available data sources were used. Cost calculations incorporated relevant factors such as Medicare hospital cost‐to‐charge ratios, reimbursement from both government and private insurance, and out‐of‐pocket expenditures. A recently published Atherosclerosis Risk in Communities (ARIC) HF scheme was used to adjust the HF classification scheme. Costs were calculated with HF as the primary diagnosis (HF in isolation, or HFI) or HF as one of the diagnoses/part of a disease milieu (HF syndrome, or HFS). Total direct costs for HF were calcul...
Source: Clinical Cardiology - February 22, 2014 Category: Cardiology Authors: Jeff Voigt, M. Sasha John, Andrew Taylor, Mitchell Krucoff, Matthew R. Reynolds, C. Michael Gibson Tags: Review Source Type: research

Management of Patients With ST‐Segment Elevation or Non–ST‐Segment Elevation Acute Coronary Syndromes in Cardiac Rehabilitation Centers
ABSTRACT BackgroundCurrent data on the management of patients in cardiac rehabilitation (CR) after an acute hospital stay due to ST‐segment elevation or non–ST segment elevation acute coronary syndromes (STE‐ACS or NSTE‐ACS) are limited. We aimed to describe patient characteristics, risk factor management, and lipid target achievement of patients in CR in Germany and compare the 2 groups. HypothesisWith respect to the risk factor pattern and treatment effects during a CR stay, there are important differences between STE‐ACS and NSTE‐ACS patients. MethodsComparison of 7950 patients by STE‐ACS or NSTE‐ACS...
Source: Clinical Cardiology - February 22, 2014 Category: Cardiology Authors: Rona Reibis, Heinz Völler, Anselm Gitt, Christina Jannowitz, Martin Halle, David Pittrow, Steven Hildemann Tags: Clinical Investigation Source Type: research

Impact of Obstructive Sleep Apnea on Cardiovascular Outcomes in Patients Treated With Percutaneous Coronary Intervention: Rationale and Design of the Sleep and Stent Study
ABSTRACT Elucidating the effects of obstructive sleep apnea (OSA) on cardiovascular outcomes is crucial in risk assessments and therapeutic recommendations for affected individuals. The Sleep and Stent Study is a multicenter observational study investigating the relationships between OSA and cardiovascular outcomes in patients treated with percutaneous coronary intervention (PCI). Eight centers in 5 countries (Singapore, China and Hong Kong, India, Myanmar, and Brazil) are participating in the study, and the recruitment target is 1600 patients. Adult patients age 18 to 80 years who have undergone successful PCI are eligibl...
Source: Clinical Cardiology - February 22, 2014 Category: Cardiology Authors: Germaine Loo, Chieh‐Yang Koo, Junjie Zhang, Ruogu Li, Rithi Sethi, Thun‐How Ong, Bee‐Choo Tai, Chi‐Hang Lee Tags: Trial Designs Source Type: research

Plasma Soluble ST2 Levels Correlate With Disease Severity and Predict Clinical Worsening in Patients With Pulmonary Arterial Hypertension
ConclusionssST2 correlates with disease severity and is a significant predictor of clinical worsening in patients with PAH. (Source: Clinical Cardiology)
Source: Clinical Cardiology - February 22, 2014 Category: Cardiology Authors: Ya‐Guo Zheng, Tao Yang, Jian‐Guo He, Guo Chen, Zhi‐Hong Liu, Chang‐Ming Xiong, Qing Gu, Xin‐Hai Ni, Zhi‐Hui Zhao Tags: Clinical Investigation Source Type: research

Response to Relationship of Race/Ethnicity With Door‐to‐Balloon Time and Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: Findings From Get With the Guidelines–Coronary Artery Diseases
Cavender MA et al. Clin Cardiol. 2013;36:749–756. (Source: Clinical Cardiology)
Source: Clinical Cardiology - February 14, 2014 Category: Cardiology Authors: Theodora Benedek, Monica Chitu, Imre Benedek Tags: Letter to the Editor Source Type: research

Highlights From the 2013 ACCF/AHA Guidelines for the Management of ST‐Elevation Myocardial Infarction and Beyond
Abstract ST‐segment elevation myocardial infarction (STEMI) is considered a cardiology emergency requiring immediate recognition and treatment aimed at successful and early reperfusion to ensure optimal outcomes. The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have issued guidelines for the diagnosis and management of patients with acute myocardial infarction since 1990. These guidelines are based on clinical research exploring reperfusion modalities and adjunctive therapies. They are further supported by expert opinion where randomized trial evidence is lacking. In January 2...
Source: Clinical Cardiology - February 12, 2014 Category: Cardiology Authors: Jacqueline E. Tamis‐Holland, Patrick O'Gara Tags: Review Source Type: research

Issue Information
(Source: Clinical Cardiology)
Source: Clinical Cardiology - February 10, 2014 Category: Cardiology Tags: Issue Information Source Type: research

Authors' Reply
(Source: Clinical Cardiology)
Source: Clinical Cardiology - February 1, 2014 Category: Cardiology Authors: Matthew A. Cavender, Andrew N. Rassi, Lee H. Schwamm, Gregg C. Fonarow, Christopher P. Cannon, W. Frank Peacock, Warren K. Laskey, Adrian F. Hernandez, Eric D. Peterson, Margueritte Cox, Marie Grau‐Sepulveda, Deepak L. Bhatt Tags: Letter to the Editor Source Type: research

Comparison of Clinical Trial Outcome Patterns in Patients Following Acute Coronary Syndromes and in Patients With Chronic Stable Atherosclerosis
ConclusionsPatients with ACS enrolled while in the hospital appear to have different risk profiles for ischemic and bleeding outcomes compared with outpatients enrolled with CSA, including those patients with ACS after the acute phase. (Source: Clinical Cardiology)
Source: Clinical Cardiology - February 1, 2014 Category: Cardiology Authors: Kenneth W. Mahaffey, Daniel M. Wojdyla, Karen S. Pieper, Pierluigi Tricoci, John H. Alexander, A. Michael Lincoff, Danielle M. Brennan, Deepak L. Bhatt, Lars Wallentin, Robert A. Harrington Tags: Clinical Investigation Source Type: research

Reliable Exclusion of Acute Coronary Syndrome Among Hospitalized Patients With Elevated Troponin
ABSTRACT BackgroundElevated cardiac troponin I (cTnI) occurs in acute coronary syndrome (ACS) as well as various scenarios not associated with ACS. HypothesisSimple clinical criteria can reliably exclude ACS among hospitalized patients with elevated cTnI. MethodsRecords for patients hospitalized from January to April 2011 with elevated cTnI (>0.29 ng/dL) and an available echocardiogram were retrospectively reviewed. Patients with ST‐segment elevation myocardial infarction were excluded. Based on available clinical data, patients were classified as having ACS or elevation of cTnI unrelated to ACS (non‐ACS). Median fo...
Source: Clinical Cardiology - February 1, 2014 Category: Cardiology Authors: Melinda B. Davis, Asher Shafton, Aken Desai, David Childers, David S. Bach Tags: Clinical Investigation Source Type: research

Patterns of Long‐term Thienopyridine Therapy and Outcomes in Patients With Acute Coronary Syndrome Treated With Coronary Stenting: Observations From the TIMI‐38 Coronary Stent Registry
ConclusionsPatients stabilized for a year after ACS and stenting have low rates of ST relative to overall cardiovascular events. The decision to continue DAPT maybe associated with stent type (DES vs bare‐metal stent) and region. (Source: Clinical Cardiology)
Source: Clinical Cardiology - February 1, 2014 Category: Cardiology Authors: Marc P. Bonaca, Sabina A. Murphy, Debra Miller, Jean‐Paul R. Herrman, Shmuel Gottlieb, Matyas Keltai, Alberto Menozzi, José C. Nicolau, Petr Widimsky, Elliott M. Antman, Stephen D. Wiviott Tags: Clinical Investigation Source Type: research

Response to Familial Hypercholesterolemia: An Under‐recognized but Significant Concern in Cardiology Practice Foody JM et al. Clin Cardiol. doi: 10.1002/clc.22223.
(Source: Clinical Cardiology)
Source: Clinical Cardiology - February 1, 2014 Category: Cardiology Authors: Damon A. Bell, Gerald F. Watts Tags: Letter to the Editor Source Type: research

One‐Year Outcome of Patients With Atrial Fibrillation Undergoing Coronary Artery Stenting: An Analysis of the AFCAS Registry
ConclusionsIn this large, real‐world population of AF patients undergoing PCI‐S, TT was the antithrombotic regimen most frequently prescribed. Although several limitations need to be acknowledged, in our study the 1‐year efficacy and safety of TT, dual antiplatelet therapy, and VKA plus clopidogrel was comparable. (Source: Clinical Cardiology)
Source: Clinical Cardiology - January 30, 2014 Category: Cardiology Authors: Andrea Rubboli, Axel Schlitt, Tuomas Kiviniemi, Fausto Biancari, Pasi P. Karjalainen, Josè Valencia, Mika Laine, Paulus Kirchhof, Matti Niemelä, Saila Vikman, Gregory Y. H. Lip, K. E. Juhani Airaksinen, Tags: Clinical Investigations Source Type: research

Clinical Features, Use of Evidence‐Based Therapies, and Cardiovascular Outcomes Among Patients With Chronic Kidney Disease Following Non–ST‐Elevation Acute Coronary Syndrome
ABSTRACT BackgroundChronic kidney disease (CKD) is associated with an increased risk of cardiovascular events following acute coronary syndrome (ACS). The underlying pathobiology and optimal treatments for this population continue to be evaluated. HypothesisPatients with CKD will receive fewer evidence‐based therapies and experience high rates of adverse cardiovascular events in both the short‐ and long term. MethodsThe MERLIN‐TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischemia in Non–ST‐Elevation Acute Coronary Syndromes‐Thrombolysis in Myocardial Infarction 36) trial randomized non–ST‐...
Source: Clinical Cardiology - January 30, 2014 Category: Cardiology Authors: June‐Wha Rhee, Stephen D. Wiviott, Benjamin M. Scirica, C. Michael Gibson, Sabina A. Murphy, Marc P. Bonaca, David A. Morrow, Jessica L. Mega Tags: Clinical Investigations Source Type: research

Oxidative Status, Inflammation, and Postoperative Atrial Fibrillation With Metoprolol vs Carvedilol or Carvedilol Plus N‐Acetyl Cysteine Treatment
Abstract BackgroundAtrial fibrillation is associated with inflammation and oxidative stress. HypothesisCarvedilol and N‐acetyl cysteine (NAC) combination decreases inflammation, oxidative stress, and postoperative atrial fibrillation (POAF) rates more than metoprolol or carvedilol. MethodsPreoperative and postoperative total oxidative stress (TOS), total antioxidant capacity (TAC), and white blood cells (WBC) were measured in metoprolol, carvedilol, or carvedilol plus NAC groups, and association with POAF was evaluated. ResultsPreoperative TAC, TOS, and WBC levels were similar among the groups. Postoperative TAC levels w...
Source: Clinical Cardiology - January 29, 2014 Category: Cardiology Authors: Mehmet Ozaydin, Oktay Peker, Dogan Erdogan, Selahaddin Akcay, Habil Yucel, Atilla Icli, Betul M. Ceyhan, Recep Sutcu, Bayram A. Uysal, Ercan Varol, Abdullah Dogan, Huseyin Okutan Tags: Clinical Investigation Source Type: research

Regional Variation Across the United States in Management and Outcomes of ST‐Elevation Myocardial Infarction: Analysis of the 2003 to 2010 Nationwide Inpatient Sample Database
Abstract BackgroundRegional differences in the treatment and outcomes of patients with ST‐elevation myocardial infarction (STEMI) within the United States remain poorly understood. HypothesisTreatment choice and outcomes in patients with STEMI differ between regions within the United States. MethodsWe used the 2003 to 2010 Nationwide Inpatient Sample databases to identify all patients age ≥40 years hospitalized with STEMI. Patients were divided into 4 groups according to region: Northeast, Midwest, South, and West. Multivariable logistic regression was used to identify differences in treatment choice and outcomes (in...
Source: Clinical Cardiology - January 29, 2014 Category: Cardiology Authors: Dhaval Kolte, Sahil Khera, Wilbert S. Aronow, Marjan Mujib, Chandrasekar Palaniswamy, Ali Ahmed, William H. Frishman, Gregg C. Fonarow Tags: Quality and Outcomes Source Type: research

Design and Rationale of the GAUSS‐2 Study Trial: A Double‐Blind, Ezetimibe‐Controlled Phase 3 Study of the Efficacy and Tolerability of Evolocumab (AMG 145) in Subjects With Hypercholesterolemia Who Are Intolerant of Statin Therapy
This article describes the rationale and design of the Goal Achievement After Utilizing an anti‐PCSK9 Antibody in Statin‐Intolerant Subjects 2 (GAUSS‐2) trial, a randomized, double‐blind, ezetimibe‐controlled, multicenter phase 3 study to evaluate the effects of 12 weeks of evolocumab 140 mg every 2 weeks or 420 mg every month in statin‐intolerant patients with hypercholesterolemia. Eligible subjects were unable to tolerate effective doses of ≥2 statins because of myalgia, myopathy, myositis, or rhabdomyolysis that resolved with statin discontinuation. The primary objective of the...
Source: Clinical Cardiology - January 29, 2014 Category: Cardiology Authors: Leslie Cho, Michael Rocco, David Colquhoun, David Sullivan, Robert S. Rosenson, Ricardo Dent, Allen Xue, Rob Scott, Scott M Wasserman, Erik Stroes Tags: Trial Designs Source Type: research

Diagnostic Performance of Copeptin in Patients With Acute Nontraumatic Chest Pain: BWH‐TIMI ED Chest Pain Study
Abstract BackgroundArginine‐vasopressin (AVP) is an acute marker of physiologic stress. Copeptin is the C‐terminal fragment of vasopressin precursor hormone that is more easily measured than AVP. Studies assessing the utility of copeptin in the diagnosis of myocardial infarction (MI) have demonstrated mixed results. HypothesisThe aim of this study was to test the hypothesis that copeptin improves diagnostic performance when added to troponin for detecting MI in patients presenting to the emergency department with nontraumatic chest pain. MethodsWe measured copeptin, local cardiac troponin I (local cTnI), and a contempo...
Source: Clinical Cardiology - January 22, 2014 Category: Cardiology Authors: Devraj Sukul, Marc P. Bonaca, Christian T. Ruff, Joshua Kosowsky, Michael Conrad, Sabina A. Murphy, Marc S. Sabatine, Petr Jarolim, David A. Morrow Tags: Clinical Investigation Source Type: research