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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 clinicians ...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

The Quest for New Approaches in  Myocarditis and Inflammatory Cardiomyopathy
Myocarditis is a diverse group of heart-specific immune processes classified by clinical and histopathological manifestations. Up to 40% of dilated cardiomyopathy is associated with inflammation or viral infection. Recent experimental studies revealed complex regulatory roles for several microribonucleic acids and T-cell and macrophage subtypes. Although the prevalence of myocarditis remained stable between 1990 and 2013 at about 22 per 100,000 people, overall mortality from cardiomyopathy and myocarditis has decreased since 2005. The diagnostic and prognostic value of cardiac magnetic resonance has increased with new, hig...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Differentiation of Constriction and Restriction Complex Cardiovascular Hemodynamics
We present a contemporary review of the pathophysiology, hemodynamics, diagnostic assessment, and therapeutic approach to patients presenting with CP and RCM. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Complicated Pericarditis Understanding Risk Factors and Pathophysiology to  Inform Imaging and Treatment
Most patients with acute pericarditis have a benign course and a good prognosis. However, a minority of patients develop complicated pericarditis, and the care of these patients is the focus of this review. Specifically, we address risk factors, multimodality imaging, pathophysiology, and novel treatments. The authors conclude that: 1) early high-dose corticosteroids, a  lack of colchicine, and an elevated high-sensitivity C-reactive protein are associated with the development of complicated pericarditis; 2) in select cases, cardiovascular magnetic resonance imaging may aid in the assessment of pericardial inflammation an...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

The Significant Arrhythmia and Cardiomyopathy Burden of Lamin A/C Mutations ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Long-Term Arrhythmic and Nonarrhythmic Outcomes of Lamin A/C Mutation Carriers
This study sought to describe the arrhythmic and nonarrhythmic outcomes of LMNA mutation carriers and to assess the prognostic significance of the index cardiac phenotype.MethodsThe incidence of AVB, AA, sustained VA, left ventricular systolic dysfunction (LVD)  (= left ventricular ejection fraction ≤50%), and end-stage heart failure (HF) was retrospectively determined in 122 consecutive LMNA mutation carriers followed at 5 referral centers for a median of 7 years from first clinical contact. Predictors of VA and end-stage HF or death were determined.ResultsThe prevalence of clinical manifestations increased broadly fr...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Machine Learning for Echocardiographic Imaging Embarking on Another Incredible Journey ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Machine-Learning Algorithms to Automate Morphological and Functional Assessments in 2D Echocardiography
This study investigated the diagnostic value of a machine-learning framework that incorporates speckle-tracking echocardiographic data for automated discrimination of hypertrophic cardiomyopathy (HCM) from physiological hypertrophy seen in athletes (ATH).MethodsExpert-annotated speckle-tracking echocardiographic datasets obtained from 77 ATH and 62 HCM patients  were used for developing an automated system. An ensemble machine-learning model with 3 different machine-learning algorithms (support vector machines, random forests, and artificial neural networks) was developed and a majority voting method was used for conclus...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Anticoagulant-Related Nephropathy Is an AKI Elephant Hiding in Plain View? ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Acute Kidney Injury in Asians  With Atrial Fibrillation Treated With Dabigatran or Warfarin
BackgroundWhether dabigatran is associated with a lower risk of acute kidney injury (AKI) in patients with nonvalvular atrial fibrillation (NVAF) remains unknown.ObjectivesThe authors compared the risk of AKI in Asians with NVAF who were prescribed dabigatran versus  warfarin.MethodsThe authors analyzed patients enrolled in the Taiwan nationwide retrospective cohort study from June 1, 2012, to December 31, 2013. Dabigatran and warfarin were taken by 7,702 and 7,885 NVAF patients without a history of chronic kidney disease (CKD) and 2,256 and 2,089 NVAF patients with a history of CKD, respectively. A propensity-score weigh...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Should We Measure Biomarkers for Myonecrosis Before and After PCI? ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research