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6-Month Effects of Fingolimod on Indexes of Cardiovascular Autonomic Control in Multiple Sclerosis
Fingolimod, the first oral agent for treatment of multiple sclerosis (MS), exerts its main action through the engagement of sfingosine-1-phosphate receptors (S1Pr)(1) at the lymphocyte level. However, S1Pr are also expressed in the atrial myocytes and endothelial cells, and their activation may frequently cause a nonharmful bradycardia following the first dose. The drug is generally well tolerated, although some cardiovascular adverse effects have been reported, including first- or second-degree atrioventricular blocks(1) and a moderate reduction in the left ventricular systolic function(2). In a very limited number of pat...
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

HIV-Related Myocardial Vulnerability to Infarction and Coronary Artery Disease
Human immunodeficiency virus-infected (HIV+) persons have significantly greater risks for myocardial infarction (MI), heart failure, and sudden death than the general population (1–3). HIV-related inflammation and immune dysfunction have been implicated in atherogenesis and MI, but the extent to which these processes potentiate myocardial ischemic scarring in HIV is unknown. Emerging data suggest that CD4+ T regulatory (Treg) cells —which are often depleted and dysfunctional in HIV—reduce infarct size and attenuate adverse remodeling following MI(4). Accordingly, it is plausible that HIV-related inflammation and immu...
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

Regression to the Mean in SYMPLICITY  HTN-3 Implications for Design and Reporting of Future Trials
Regression to the mean (RTM) describes the tendency for an extreme measurement on 1 occasion to become less extreme when measured again. RTM may affect clinical trial data interpretation when the outcome measure has high variability. We investigated RTM in the SYMPLICITY HTN-3 (Renal Denervation in Patients With Uncontrolled Hypertension) trial of renal denervation versus a sham procedure. Analysis of covariance was performed on the 6-month change in systolic blood pressure, estimating a mean treatment difference of  −4.11 mm Hg (95% confidence interval: −8.44 to 0.22 mm Hg; p = 0.064), which was similar to the u...
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

Critical Limb Ischemia An Expert Statement
Critical limb ischemia (CLI), the most advanced form of peripheral artery disease, is associated with significant morbidity, mortality, and health care resource utilization. It is also associated with physical, as well as psychosocial, consequences such as amputation and depression. Importantly, after a major amputation, patients are at heightened risk of amputation on the contralateral leg. However, despite the technological advances to manage CLI with minimally invasive technologies, this condition often remains untreated, with significant disparities in revascularization and amputation rates according to race, socioecon...
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

Arrhythmia Substrate Ablation for Nonischemic Cardiomyopathy All or Some? ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

Scar Homogenization Versus Limited-Substrate Ablation in Patients With  Nonischemic Cardiomyopathy and Ventricular Tachycardia
BackgroundScar homogenization improves long-term ventricular arrhythmia –free survival compared with standard limited-substrate ablation in patients with post-infarction ventricular tachycardia (VT). Whether such benefit extends to patients with nonischemic cardiomyopathy and scar-related VT is unclear.ObjectivesThe aim of this study was to assess the long-term efficacy of an endoepicardial scar homogenization approach compared with standard ablation in this population.MethodsConsecutive patients with dilated nonischemic cardiomyopathy (n  = 93), scar-related VTs, and evidence of low-voltage regions on the basis of pre-...
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

Subclinical Myocardial Dysfunction in Asymptomatic Mitral Regurgitation “Watchful Waiting 2.0” ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

Strain Echocardiography and Functional  Capacity in Asymptomatic Primary Mitral Regurgitation With Preserved Ejection Fraction
BackgroundThe potential additive utility of baseline resting left ventricular global longitudinal strain (LV-GLS) and exercise stress testing in risk stratification of patients with significant mitral regurgitation (MR) has not been studied.ObjectivesThe goal of this study was to determine whether resting LV-GLS and exercise testing provide incremental prognostic utility in asymptomatic patients with  ≥3+ primary MR and preserved left ventricular ejection fraction.MethodsBetween 2000 and 2011, resting and exercise echocardiography data, Society of Thoracic Surgeons (STS) scores, and death were recorded in 737 patients (...
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

In the Country of the Blind, the One-Eyed Man  Is King
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

The Hybrid Algorithm for Treating Chronic  Total Occlusions in Europe The RECHARGE Registry
BackgroundThe hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to improve procedural outcomes. Large, prospective studies validating the algorithm in a broad multicenter setting with operators of different experience levels are lacking.ObjectivesThe RECHARGE (REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom) registry aims to report achievable results using the hybrid algorithm.MethodsBetween January 2014 and October 2015, consecutive patients undergoing hybrid CTO-PCI were prospectively enrolled in 17 centers. Procedu...
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

On the Endovascular Climb to the Type A Dissection Summit, Reaching a New Base Camp ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

Outcomes of Endovascular Repair of Ascending Aortic Dissection in Patients Unsuitable for Direct Surgical Repair
ConclusionsOur results with the novel endovascular procedure appear acceptable. Additional evidence and studies  with larger sample size and longer follow-up are needed to support the durability of this new technique. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

What Should We Believe About Electrical  Isolation of the Left Atrial Appendage? ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

Left Atrial Appendage Isolation in Patients  With Longstanding Persistent AF Undergoing Catheter Ablation BELIEF Trial
ConclusionsThis randomized study showed that both after a single procedure and after redo procedures in patients with LSPAF, empirical electrical isolation of the LAA improved long-term freedom from atrial arrhythmias without increasing complications. (Effect of Empirical Left Atrial Appendage Isolation on Long-term Procedure Outcome in Patients With Persistent or Longstanding Persistent Atrial Fibrillation Undergoing Catheter Ablation [BELIEF]; NCT01362738) (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

Reply Early Surgery for Mixed Aortic  Valve Disease: A Precocious or Premature Proposition?
We thank Dr. Cremer and colleagues for their letter  regarding our recent paper about the outcomes in patients with moderate mixed aortic valve disease (MAVD)(1). We agree with Cremer and colleagues that we cannot make strong recommendations based on a single-center retrospective study, and we clearly highlighted this limitation in the paper. Let us address the concerns raised in their letter. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research