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Source: Journal of the American College of Cardiology

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Total 269 results found since Jan 2013.

Data Strengthen to Support Recommending Anticoagulant Therapy for All Atrial Fibrillation Patients With a CHA 2 DS 2 -VASc Score ≥1 ∗
Management of patients with atrial fibrillation (AF) can be considered a 3-legged stool. Physicians caring for AF patients must consider the issues of rate control, rhythm control, and stroke prevention and then make specific recommendations to their patients that address each of these issues.
Source: Journal of the American College of Cardiology - February 16, 2015 Category: Cardiology Source Type: research

All Aortic Stenoses Are Not Created Equal ∗
With the advent and success of transcatheter aortic valve replacement (TAVR), new emphasis is being placed on patient selection to ensure successful outcomes after aortic valve replacement (AVR). In this regard, clinicians must appreciate that aortic stenosis (AS) is not a simple obstruction but involves a complex pathological interaction among the left ventricle (LV), aortic valve (AV), and peripheral vasculature (1). The most typical form of AS is normal flow high-gradient aortic stenosis (NFHGAS), which is characterized by patients with a normal left ventricular ejection fraction (EF), normal flow (left ventricular stro...
Source: Journal of the American College of Cardiology - February 16, 2015 Category: Cardiology Source Type: research

Ischemic Brain Lesions After Carotid Artery Stenting Increase Future Cerebrovascular Risk
ConclusionsIschemic brain lesions discovered on DWI after CAS seem to be a marker of increased risk for recurrent cerebrovascular events. Patients with periprocedural DWI lesions might benefit from more aggressive and prolonged antiplatelet therapy after CAS. (A Randomised Comparison of the Risks, Benefits and Cost Effectiveness of Primary Carotid Stenting With Carotid Endarterectomy: International Carotid Stenting Study; ISRCTN25337470)
Source: Journal of the American College of Cardiology - February 9, 2015 Category: Cardiology Source Type: research

Systemic Vascular Load in Calcific Degenerative Aortic Valve Stenosis Insight From Percutaneous Valve Replacement
This study sought to characterize the interaction between valvular and vascular functions in patients with AS by using transcatheter aortic valve replacement (TAVR) as a clinical model of isolated intervention.MethodsAortic pressure and flow were measured simultaneously using high-fidelity sensors in 23 patients (mean 79 ± 7 years of age) before and after TAVR. Blood pressure and clinical response were registered at 6-month follow-up.ResultsSystolic and pulse arterial pressures, as well as indices of vascular function (vascular resistance, aortic input impedance, compliance, and arterial elastance), were significantly mo...
Source: Journal of the American College of Cardiology - February 2, 2015 Category: Cardiology Source Type: research

Device-Detected Atrial Fibrillation What to Do With Asymptomatic Patients?
Atrial fibrillation (AF) is the most common clinically significant arrhythmia and conveys an increased risk of stroke, regardless of whether it is symptomatic. Despite multiple studies supporting an association between subclinical atrial tachyarrhythmias (ATs) detected by cardiac implantable electronic devices and increased risk of thromboembolic events, clinical intervention for device-detected AT remains sluggish, with some clinicians delaying treatment and instead opting for continued surveillance for additional or longer episodes. However, the 2014 updated clinical practice guidelines on AF recommend use of the CHA2DS2...
Source: Journal of the American College of Cardiology - January 19, 2015 Category: Cardiology Source Type: research

Adding Rigor to Stroke Risk Prediction in Atrial Fibrillation ∗
Guidelines recommend oral anticoagulant (OAC) therapy for patients with atrial fibrillation (AF) on the basis of ischemic stroke risk. Guidelines from both the United States (American College of Cardiology/American Heart Association/Heart Rhythm Society [AHA/ACC/HRS]) (1) and from Europe (European Society of Cardiology [ESC]) (2) use the CHA2DS2-VASc risk score (3) and recommend a low threshold for OAC use. The ESC guideline proposes anticoagulation therapy for patients with ≥1 risk factor (≥1 point), whereas the AHA/ACC/HRS guideline uses a threshold of 2 points. Because ESC does not consider female sex as a stand-al...
Source: Journal of the American College of Cardiology - January 19, 2015 Category: Cardiology Source Type: research

Benefit of Anticoagulation Unlikely in Patients With Atrial Fibrillation and a CHA 2 DS 2 -VASc Score of 1
ConclusionsThe risk of ischemic stroke in patients with AF and a CHA2DS2-VASc score of 1 seems to be lower than previously reported.
Source: Journal of the American College of Cardiology - January 19, 2015 Category: Cardiology Source Type: research

Patent Foramen Ovale and Paradoxical Systemic Embolism Can We Determine High-Risk Characteristics by Echocardiography?
We read with interest the review paper on paradoxical embolism by Windecker et al. (1). It was suggested, on the basis of available evidence from published reports, that device closure of patent foramen ovale (PFO) should be considered in patients with first-time cryptogenic stroke, particularly in those with high-risk criteria, such as presence of an atrial septal aneurysm (ASA), large PFO, Eustachian valve, or Chiari network. The viewpoints of Windecker et al. on those with high-risk criteria should be discussed and clarified.
Source: Journal of the American College of Cardiology - January 12, 2015 Category: Cardiology Source Type: research

Affinity Proteomics for Phosphatase Interactions in Atrial Fibrillation ∗
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, with an estimated 30 million individuals affected worldwide (1). AF constitutes a major risk factor for stroke and heart failure, resulting in significant morbidity and mortality. Remodeling of the atria is a consequence as well as a substrate for perpetuation of AF. The remodeling process occurs at various levels, including atrial fibrosis, cardiomyocyte contractibility, and electrical coupling. During electrical remodeling, an unbalanced calcium (Ca2+) transport exposes cardiomyocytes locally to increased Ca2+ levels. Ca2+ overload i...
Source: Journal of the American College of Cardiology - January 12, 2015 Category: Cardiology Source Type: research

Management of Paradoxical Low-Flow, Low-Gradient Aortic Stenosis Need for an Integrated Approach, Including Assessment of Symptoms, Hypertension, and Stenosis Severity ∗
In 2007, we reported that a substantial proportion of patients with severe aortic stenosis may have a low flow (LF) (i.e., reduced stroke volume), and thus, often have a low transvalvular pressure gradient (LG), despite a preserved left ventricular ejection fraction (LVEF) (1). The 2014 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines (2) classified this “paradoxical” LF/LG entity as a D3 stage of aortic stenosis, which is defined as an aortic valve area (AVA) of 
Source: Journal of the American College of Cardiology - January 5, 2015 Category: Cardiology Source Type: research

Low-Gradient, Low-Flow Severe Aortic Stenosis With Preserved Left Ventricular Ejection Fraction Characteristics, Outcome, and Implications for Surgery
ConclusionsIn this study, the outcome of severe LG/LF aortic stenosis with preserved EF was similar to that of mild-to-moderate aortic stenosis and was not favorably influenced by aortic surgery. Further research is needed to better understand the natural history and the progression of LG/LF aortic stenosis.
Source: Journal of the American College of Cardiology - January 5, 2015 Category: Cardiology Source Type: research

Bivalirudin Versus Heparin With or Without Glycoprotein IIb/IIIa Inhibitors in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention Pooled Patient-Level Analysis From the HORIZONS-AMI and EUROMAX Trials
BackgroundIn the HORIZONS-AMI (Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction) trial, 3,602 patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) treated with bivalirudin had lower bleeding and mortality rates, but higher acute stent thrombosis rates compared with heparin + a glycoprotein IIb/IIIa inhibitor (GPI). Subsequent changes in primary PCI, including the use of potent P2Y12 inhibitors, frequent radial intervention, and pre-hospital medication administration, were incorporated into the EUROMAX (European Ambu...
Source: Journal of the American College of Cardiology - January 5, 2015 Category: Cardiology Source Type: research

Coronary Artery Bypass Graft Surgery Versus Drug-Eluting Stents for Patients With Isolated Proximal Left Anterior Descending Disease
ConclusionsDespite the higher rating in current guidelines of CABG (Class IIa vs. Class IIb) for patients with isolated PLAD disease, there were no differences in mortality or mortality, MI, and/or stroke, although CABG patients had significantly lower repeat revascularization rates.
Source: Journal of the American College of Cardiology - December 22, 2014 Category: Cardiology Source Type: research

Proximal Aortic Distensibility Is an Independent Predictor of All-Cause Mortality and Incident CV Events The MESA Study
ConclusionsDecreased proximal aorta distensibility significantly predicted all-cause mortality and hard CV events among individuals without overt CVD. AAD may help refine risk stratification, especially among asymptomatic, low- to intermediate-risk individuals.
Source: Journal of the American College of Cardiology - December 15, 2014 Category: Cardiology Source Type: research

Effect of Prasugrel Pre-Treatment Strategy in Patients Undergoing Percutaneous Coronary Intervention for NSTEMI The ACCOAST-PCI Study
ConclusionsThese findings support deferring treatment with prasugrel until a decision is made about revascularization in patients with NSTEMI undergoing angiography within 48 h of admission. (A Comparison of prasugrel at the time of percutaneous Coronary intervention Or as pre-treatment At the time of diagnosis in patients with non—ST-segment elevation myocardial infarction [ACCOAST]; NCT01015287)
Source: Journal of the American College of Cardiology - December 15, 2014 Category: Cardiology Source Type: research