Reply Ectopic Fat Deposition and Diabetes Mellitus
We thank Drs. Gaborit and Dutour for their interest in our paper(1). We acknowledge the lack of assessment of epicardial adipose tissue (EAT) volumes in healthy control subjects, which was due to concerns regarding unnecessary ionizing radiation exposure with coronary computed tomographic angiography. We agree that magnetic resonance imaging (MRI) is highly suitable for adipose tissue imaging. Dark blood prepared, T1-weighted, multislice turbo spin-echo pulse sequence with a water suppression pre-pulse is an established MRI technique for reliable volumetric measurement of EAT volumes(2). Fat quantification on the basis of ...
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Ectopic Fat Deposition and Diabetes Mellitus
We read with interest the paper by Levelt et  al.(1) in a recent issue of theJournal, which deciphered the parameters that give rise to ectopic fat deposition in insulin-resistant states, such as type 2 diabetes (T2D). One of the strengths of this study is the use of multiparametric cardiovascular and liver magnetic resonance imaging (MRI), and proton and phosphorus magnetic resonance spectroscopy, allowing a comparison of epicardial adipose tissue (EAT), myocardial and hepatic triglyceride content, hepatic fibroinflammatory changes, but also cardiac function and energetics between lean healthy and lean and obese subj...
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Reply Is There a Prevention Effect of Fludrocortisone on Vasovagal Syncope?
We thank Dr. Zhu and colleagues for their kind interest and insightful comments on our paper(1). They first question whether we sought a sex-specific interaction with the investigational treatment. As noted in the legend for Table  2 of our paper(1), sex itself was not a significant, independent variable associated with outcome. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Is There a Prevention Effect of Fludrocortisone on Vasovagal Syncope?
We read with great interest the paper by Sheldon et  al.(1) in a recent issue of theJournal. Although this research did not meet its primary objective of demonstrating that fludrocortisone reduced the likelihood of vasovagal syncope by the specified risk reduction of 40%, this study indicated a prevention effect of fludrocortisone for vasovagal syncope. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Cardiovascular Adverse Events After Aortic Valve Replacement in Mixed Aortic Valve Disease Beyond Ejection Fraction
There are limited data about outcomes after aortic valve replacement (AVR) in patients with mixed aortic valve disease (MAVD)(1). We conducted a retrospective review of all adults with moderate-to-severe MAVD who underwent AVR at Mayo Clinic from January 1, 1994 to December 31, 2014 to determine the occurrence of cardiovascular adverse events (CAE). Moderate-to-severe MAVD was defined as the combination of greater than or moderate aortic stenosis and greater than or moderate aortic regurgitation. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Long Noncoding RNA Meg3 Controls Endothelial Cell Aging and Function Implications for Regenerative Angiogenesis
The majority of transcribed ribonucleic acid (RNA) does not encode proteins, but it may function as regulatory RNA. Long noncoding RNA (lncRNA) have been described as playing an important role in  many biological processes, including epigenetic regulation of gene expression. To determine the expression and functional role of lncRNA in endothelial cells, we recently performed RNA deep sequencing of human umbilical venous endothelial cells (HUVECs)(1). Aging is known to induce endothelial dysfunction(2), and we hypothesized that lncRNA contribute to aging-associated decline in endothelial function. (...
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

The Effects of Secondary Cardiovascular Prevention on Cancer Risk in Patients With Manifest Vascular  Disease
In this study, we evaluated the effects of meeting cardiovascular treatment goals, as defined in the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for secondary cardiovascular prevention, on cancer risk in patients with manifest vascular disease. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Finding Mentorship Among Your Peers Sharing the Wealth
“If you want to go fast, go alone. If you want to go far, go with others.”—African Proverb (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

MicroRNAs in Cardiovascular Disease
Micro-ribonucleic acids (miRNAs) are in the spotlight as post-transcriptional regulators of gene expression. More than 1,000 miRNAs are encoded in the human genome. In this review, we provide an introduction to miRNA biology and research methodology, and highlight advances in cardiovascular research to date. This includes the potential of miRNAs as therapeutic targets in cardiac and vascular disease, and their use as novel biomarkers. Although some miRNA therapies are already undergoing clinical evaluation, we stress the importance of integrating current knowledge of miRNA biology into a systemic context. Discovery studies...
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Alcohol and Atrial Fibrillation A Sobering Review
Alcohol is popular in Western culture, supported by a perception that modest intake is cardioprotective. However, excessive drinking has detrimental implications for cardiovascular disease. Atrial fibrillation (AF) following an alcohol binge or the “holiday heart syndrome” is well characterized. However, more modest levels of alcohol intake on a regular basis may also increase the risk of AF. The pathophysiological mechanisms responsible for the relationship between alcohol and AF may include direct toxicity and alcohol’s contribution t o obesity, sleep-disordered breathing, and hypertension. We...
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

GLA-Ring Opportunities and Challenges for Fabry Disease ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Later Onset Fabry Disease, Cardiac Damage Progress in Silence Experience With a Highly Prevalent Mutation
ConclusionsSignificant cardiomyocyte substrate accumulation in IVS4 patients led to severe and irreversible cardiac fibrosis before development of LVH or other significant cardiac manifestations. Thus, it might be too late to start enzyme replacement therapy after the occurrence of LVH or other significant cardiac manifestations in patients with later onset FD. This study also indicated the importance of newborn screening for early detection of the insidious, ongoing, irreversible cardiac damage in patients with later onset FD. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Further Progress in Predicting Life-Threatening Arrhythmias in Patients  With Arrhythmogenic Right Ventricular Cardiomyopathy ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Arrhythmogenic Right Ventricular Cardiomyopathy Clinical Course and Predictors of Arrhythmic Risk
This study sought to describe the clinical course of ARVC and occurrence of life-threatening arrhythmic events (LAE) and cardiovascular mortality; identify risk factors associated with increased LAE risk; and define the response to therapy.MethodsWe determined the clinical course of 301 consecutive patients with ARVC using the Kaplan-Meier method adjusted to avoid the bias of delayed entry. Predictors of LAE over 5.8 years of follow-up were determined with Cox multivariable analysis. Treatment efficacy was assessed comparing LAE rates during matched time intervals.ResultsA first LAE occurred in 1.5 per 100 person-years bet...
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Biological Phenotyping of Combined Post-Capillary and Pre-Capillary Pulmonary Hypertension Focus on Pulmonary Vascular Remodeling ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Clinical and Biological Insights Into Combined Post- and Pre-Capillary Pulmonary Hypertension
ConclusionsPatients with Cpc-PH develop pulmonary vascular disease similar to patients with PAH, despite younger age and similar prevalence of obesity, diabetes mellitus, and left heart disease compared with patients with Ipc-PH. An exploratory genetic analysis in Cpc-PH identified genes and biological pathways in the lung known to contribute to PAH pathophysiology, suggesting that Cpc-PH may be a distinct and highly morbid PH subphenotype. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Anticoagulant-Related Bleeding and Mortality ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Causes of Death in Anticoagulated Patients With Atrial Fibrillation
ConclusionsIn contemporary AF trials, most deaths were cardiac-related, whereas stroke and bleeding represented  only a small subset of deaths. Interventions beyond anticoagulation are needed to further reduce mortality in AF. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Surgical Weight Loss and Atrial Fibrillation A Convenient Paradigm to Evaluate a Complex Problem ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Bariatric Surgery and the Risk of New-Onset Atrial Fibrillation in Swedish  Obese Subjects
BackgroundObesity is a risk factor for atrial fibrillation, which in turn is associated with stroke, heart failure, and increased all-cause mortality.ObjectivesThe authors investigated whether weight loss through bariatric surgery may reduce the risk of new-onset atrial fibrillation.MethodsSOS (Swedish Obese Subjects) is a prospective matched cohort study conducted at 25 surgical departments and 480 primary healthcare centers in Sweden. The cohort was recruited between 1987 and 2001. Among 4,021 obese  individuals with sinus rhythm and no history of atrial fibrillation, 2,000 underwent bariatric surgery (surgery group...
Source: Journal of the American College of Cardiology - December 5, 2016 Category: Cardiology Source Type: research

Etiology of Sudden Cardiac Death in Athletes Can Autopsy Clarify All the Issues?
The report by Finocchiaro et  al.(1) provides a valuable occasion for revisiting the difficult task of assigning a potential primary cause and determining the etiology in cases of sudden cardiac death (SCD). Assigning a primary cause usually involves guesswork, and determining the etiology can be even more complex if it is assumed that the etiology is the ultimate nature (e.g., genetic defect) of the immediate cause. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Reply Should Histologic Determination of Amyloid Load Determine Management Decisions in Light-Chain Amyloidosis?
Thank you for giving us the opportunity to respond to the comments of Dr. Ruberg and colleagues regarding our paper(1). They raise some concerns and propose that cardiac magnetic resonance (CMR) with extracellular volume (ECV) determination yields a “truer average” of amyloid load of the entire heart, and that ECV has been shown to strongly correlate with N-terminal pro−brain natriuretic peptide. However, these data were not shown in the referenced paper(2). Dr. Ruberg and colleagues also failed to mention that ECV is based on only 1 short- and 1 long-axis view. Thus, ECV does not reflect the entire heart...
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Should Histologic Determination of Amyloid  Load Determine Management Decisions in Light-Chain Amyloidosis?
We read with interest the report of Kristen et  al.(1), in which the prognostic usefulness of histologic amyloid load quantification by endomyocardial biopsy was described. Although the investigators stated that no significant variation was observed between biopsy sites, this observation was not quantified. Our collective experience is that Congo red staining of different biopsy specimens from within the same organ in the same patient can vary greatly in the so-called amyloid load, reflecting the patchy nature of amyloid deposition, which is well described(2) and introduces the likelihood of sampling error. Furthermor...
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Reply Anticoagulation Treatment for Stroke Prevention in Atrial Fibrillation Is Increasing, But Further Improvements Needed
We are appreciative of Dr. Brown and colleagues and their interest in our recent paper in theJournal(1) regarding prescription of aspirin instead of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) who are at intermediate-to-high thromboembolic risk in the American College of Cardiology National Cardiovascular Data Registry ’s PINNACLE (Practice Innovation and Clinical Excellence) Registry. They appropriately highlight some of our main findings, including that OAC prescription was selected in 61.8% of patients with a CHADS2 score  ≥2 (meaning 38.2% of patients were treated with aspirin alo...
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Anticoagulation Treatment for Stroke Prevention in Atrial Fibrillation Is Increasing, But Further Improvements Needed
A recent paper by Hsu et  al.(1) assessed antithrombotic treatment among atrial fibrillation (AF) patients. The data, from the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) registry between 2008 and 2012, showed that 61.8% of patients with moderate-to-high stroke risk received anticoagulant therapy with either warfarin or newer direct oral anticoagulants (DOACs). The investigators and an editorial commentary noted the alarming prevalence of aspirin-only treatment despite clear evidence that anticoagulants are superior for prevention of thromboembolism in AF (1,2). (Source: Journ...
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Effect of Remote Ischemic  Preconditioning on Coronary Procedure-Related Impairment of Vascular Dilator Function
In this study we assessed whether RIPC protects against abnormalities of vascular function during coronary procedures. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Treatment With Dalcetrapib Modifies the Relationship Between High-Density Lipoprotein Cholesterol and C-Reactive Protein
Epidemiological data associate higher concentrations of high-density lipoprotein cholesterol (HDL-C) with lower cardiovascular risk. HDL-C isolated from healthy subjects exhibits potentially protective properties, including anti-inflammatory effects(1). However, some evidence suggests that cholesterol-overloaded HDL-C particles may lose protective properties(2), and drugs that raise HDL-C and particle size have thus far not reduced cardiovascular events in patients with established heart disease. Among these agents are inhibitors of cholesteryl ester transfer protein (CETP). These findings raise the question whether HDL-C ...
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Obesity Contributes to Exercise Intolerance in Heart Failure With Preserved Ejection Fraction
In this study, we measured aerobic exercise capacity in patients with HFpEF in relation to indices of obesity and adiposity. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

A Test in Context Hemoglobin A 1c and Cardiovascular Disease
Measurement of glycated hemoglobin (HbA1c), the most widely accepted indicator of long-term glycemic exposure, is central for the diagnosis and management of diabetes mellitus. Levels of HbA1c track epidemiologically with diabetic complications, and glycemic control, as reflected by HbA1c reduction, results in decreased risk of microvascular complications, including diabetic kidney disease, neuropathy, and retinopathy. The relationship between HbA1c reduction and cardiovascular disease prevention in patients with diabetes is more complex, with data from large randomized trials published over the past decade providing clear...
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

The Risk Continuum of Atherosclerosis and  its Implications for Defining CHD by Coronary Angiography
Patients undergoing coronary angiography for suspected coronary heart disease who are found to have coronary atherosclerotic disease with   (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Pim1 Overexpressing ckit + Cardiac Stem  Cells in Cardiac Regeneration Preconditioning as Next-Generation Stem Cell Therapy? ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Pim1 Kinase Overexpression Enhances ckit + Cardiac Stem Cell Cardiac Repair Following Myocardial Infarction in Swine
BackgroundPim1 kinase plays an important role in cell division, survival, and commitment of precursor cells towards a myocardial lineage, and overexpression of Pim1 in ckit+ cardiac stem cells (CSCs) enhances their cardioreparative properties.ObjectivesThe authors sought to validate the effect of Pim1-modified CSCs in a translationally relevant large animal preclinical model of myocardial infarction (MI).MethodsHuman cardiac stem cells (hCSCs, n  = 10), hckit+ CSCs overexpressing Pim1 (Pim1+; n = 9), or placebo (n = 10) were delivered by intramyocardial injection to immunosuppressed Yorkshire swine (n&n...
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Truncating Variants in Filamin C The Challenges of Genotype-Phenotype Correlations in  Cardiomyopathies ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Truncating FLNC Mutations Are Associated With High-Risk Dilated and Arrhythmogenic Cardiomyopathies
ConclusionsTruncating mutations in FLNC caused an overlapping phenotype of dilated and left-dominant arrhythmogenic cardiomyopathies complicated by frequent premature sudden death. Prompt implantation of a cardiac defibrillator should be considered in affected patients harboring truncating mutations in FLNC. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

NT-proBNP The Gold Standard Biomarker in Heart Failure ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Prognostic Implications of Changes in N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Heart Failure
ConclusionsPatients who attained a significant reduction in NT-proBNP had a lower subsequent rate of cardiovascular death or HF hospitalization independent of the treatment group. Treatment with sacubitril/valsartan was  nearly twice as likely as enalapril to reduce NT-proBNP to values ≤1,000 pg/ml. (Prospective Comparison of ARNI [Angiotensin Receptor–Neprilysin Inhibitor] with ACEI [Angiotensin-Converting–Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial) [PARA DIGM-HF]; NCT01035255.) (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Bringing Structure to the Art of Lipid-Lowering Therapy ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Determining When to Add Nonstatin Therapy A Quantitative Approach
ConclusionsAdding ezetimibe or PCSK9 monoclonal antibodies to maximally tolerated statin therapy may  be cost effective in very high-risk and high-risk patients, depending on baseline LDL-C levels. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

The Head and the Heart The Alzheimer ’s Connection ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

A β Amyloid Pathology Affects the Hearts of Patients With Alzheimer’s Disease Mind the Heart
ConclusionsHere, the authors provide the first report of the presence of compromised myocardial function and intramyocardial deposits of A β in AD patients. The findings depict a novel biological framework in which AD may be viewed either as a systemic disease or as a metastatic disorder leading to heart, and possibly multiorgan failure. AD and HF are both debilitating and life-threatening conditions, affecting enormous patient pop ulations. Our findings underline a previously dismissed problem of a magnitude that will require new diagnostic approaches and treatments for brain and he...
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Reply Risk Scores From PARIS Registry: Are They Useful in a Contemporary Cohort of ACS Patients?
We appreciate the comments and concerns raised by Dr. Raposeiras-Roubin and colleagues regarding the PARIS (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) risk scores for coronary thrombosis and major bleeding following percutaneous coronary intervention (PCI) with drug eluting stents that we recently reported in theJournal(1). We agree with the authors that evaluating model performance in patients with acute coronary syndrome or sustaining early events within the first year are important considerations. Accordingly, we have provided metrics of model performance according to these parameters inTab...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Risk Scores From PARIS  Registry Are They Useful in a Contemporary Cohort of ACS Patients?
We have read the recently published paper from Baber et  al.(1). We would like to congratulate the authors for their excellent work, with the aim to integrate both risks (ischemic and hemorrhagic) in the  same population. However, we have several concerns: (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Reply Why to Replace an ACE or ARB With  an ARB/Neprilysin Inhibitor?
The American College of Cardiology (ACC) and American Heart Association (AHA) welcome letters to inform its ongoing work and encourage such correspondence about its clinical policy statements. Because the ACC/AHA guideline development process is rigorous and involves several layers of review by the writing committee, external peer reviewers, and participating organizations endorsing the document, there is limited editorial control over the content after publication. The information, however, gleaned from questions such as this is forwarded to the writing committee chairs and oversight Task Force for review. If any issues a...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Why to Replace an ACE  or ARB With an ARB/Neprilysin Inhibitor?
In the 2016 American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Failure Society of America (HFSA) Focused Update on New Pharmacological Therapy for Heart Failure(1), there is a new recommendation: in patients with chronic symptomatic heart failure with reduced ejection fraction New York Heart Association functional class II or III who tolerate an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, replacement by an ARNI is recommended to further reduce morbidity and mortality, where ARNI stands for Valsartan/Sacubitril (Novartis Pharmaceuticals, East Hanover, New Jersey), an ...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Cardiac Phenotype and Long-Term Follow-Up of Patients With Mutations in NKX2-5 Gene
One of the essential homeobox transcription factors orchestrating cardiac embryologic development isNKX2-5(1). Mutations inNKX2-5 were initially discovered in inherited atrial septal defect (ASD) associated with atrioventricular block (AVB)(2), but were further found linked to other congenital heart  defects and cardiomyopathies. However, it remains difficult to have a clear idea of the cardiac abnormalities caused byNKX2-5 mutations in large populations. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Reported Versus “Real” Incidence of New Pacemaker Implantation Post-Transcatheter Aortic Valve Replacement
Cardiac conduction disturbances requiring permanent pacemaker (PPM) implantation remain the most frequent complication of transcatheter aortic valve replacement (TAVR). PPM rates of approximately 6% (ranging from 2% to 14%) for the balloon-expandable valve system (BEV, Edwards Lifesciences, Irvine, California), and 28% (ranging from 16% to 51%) for the self-expanding valve system (SEV, Corevalve, Medtronic, Minneapolis, Minnesota) have been reported(1). Rates of new PPM implantation are also reportedly higher with certain newer-generation transcatheter valve systems(1). However, to date, most studies have reported the PPM ...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

“Off-Hours” Versus “On-Hours” Presentation in ST-Segment Elevation Myocardial Infarction CHAMPION PHOENIX Findings
Timely percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) is a cornerstone of therapy. Several analyses have demonstrated worse outcomes for patients presenting with STEMI during off-hours compared with during the workday(1). The etiology of this difference is likely multifactorial, including changes in staffing, delays in intervention, and higher procedural complications(2). Most available data derive from registries with retrospective collection of clinical characteristics and outcomes, whereas few data are available from randomized, controlled trials (1,3). There continues to ...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

The Quest to Become a Master Teacher One Cardiologist ’s Story and Recommendations for Others
“Education is the most powerful weapon which you can use to change the world.”—Nelson Mandela(1) (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Fellowship Training in  Cardiology Finding Synergies Between Academic Program Clinical Competencies and ACC-Developed Nonclinical Competencies
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Troponin Testing for Clinicians
The analytical performance of troponin assays has improved markedly in the last 2 decades. The variety of assays, their  evolution over time, and their critical importance in influencing care, mandates the need for skills in their use. There are 3 critical elements necessary for optimal use of troponin testing in clinical care, as follows: 1) the analytical performance of the assay; 2) the clinical sensitivity and s pecificity of the test result; and 3) the clinical reasoning for ordering and the proper clinical context for interpreting the test result. This paper provides further explanation that will assist cli...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research