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Source: Journal of the American College of Cardiology
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Total 269 results found since Jan 2013.
Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease
This study investigated the association of increased visit-to-visit variability and all-cause mortality, cardiovascular events, and end-stage renal disease (ESRD) in a large cohort of U.S. veterans.MethodsFrom among 3,285,684 U.S. veterans with and without hypertension and normal estimated glomerular filtration rates (eGFR) during 2005 and 2006, we identified 2,865,157 patients who had 8 or more outpatient BP measurements. Systolic blood pressure variability (SBPV) was measured using the SD of all SBP values (normally distributed) in 1 individual. Associations of SD quartiles (
Source: Journal of the American College of Cardiology - September 20, 2016 Category: Cardiology Source Type: research
Thromboembolic, Bleeding, and Mortality Risks of Rivaroxaban and Dabigatran in Asians With Nonvalvular Atrial Fibrillation
BackgroundIt is unclear whether the non –vitamin K antagonist oral anticoagulant agents rivaroxaban and dabigatran are superior to warfarin for efficacy and safety outcomes in Asians with nonvalvular atrial fibrillation (NVAF).ObjectivesThe aim of this study was to compare the risk for thromboembolic events, bleeding, and mortality associated with rivaroxaban and dabigatran versus warfarin in Asians with NVAF.MethodsA nationwide retrospective cohort study was conducted of consecutive patients with NVAF taking rivaroxaban (n = 3,916), dabigatran (n = 5,921), or warfarin (n = 5,251) using data collected from the Taiwan...
Source: Journal of the American College of Cardiology - September 20, 2016 Category: Cardiology Source Type: research
Effect of New Cerebral Ischemic Lesions on the Delirium Occurrence After Transcatheter Aortic Valve Replacement
Although only 2% to 5% of patients develop symptomatic stroke following transcatheter aortic valve replacement (TAVR), new cerebral lesions have been detected among the majority of these patients using diffusion weighted magnetic resonance imaging (DWI-MRI), irrespective of access site strategy(1). According to the published reports, new cerebral DWI lesions have been associated with future neurological and cognitive decline; however, the relationship between these lesions and post-operative delirium (POD) following TAVR remains unknown. By means of this study, we aimed to assess the impact of new cerebral DWI lesions on t...
Source: Journal of the American College of Cardiology - September 20, 2016 Category: Cardiology Source Type: research
The Challenge of Timing Surgery in Degenerative Mitral Regurgitation Is B-Type Natriuretic Peptide the Solution? ∗
Degenerative mitral regurgitation (MR) with prolapse or flail of mitral leaflets has become the most frequent cause of severe primary MR in Europe and North America (1,2). In its chronic stage, even severe MR is tolerated very well for a surprisingly long time, and patients may remain asymptomatic for years. During this compensated stage of disease, pre-load, afterload, and both contractility and ejection fraction of the left ventricle (LV) remain normal, and the total stroke volume is increased as a result of the compensatory enlargement of the end-diastolic LV volume, which is enabled by an adaptive process of the LV myo...
Source: Journal of the American College of Cardiology - September 13, 2016 Category: Cardiology Source Type: research
Thrombotic and Embolic Complications Associated With Atrial Arrhythmia After Fontan Operation Role of Prophylactic Therapy
This study sought to determine the risk of TEC in this population and the role of anticoagulation therapy in TEC prevention.MethodsThis was a retrospective review of adults with atrial arrhythmia after Fontan operation who were evaluated at the Mayo Clinic between 1994 to 2014. TEC was classified into 2 groups: systemic TEC, defined as intracardiac thrombus, ischemic stroke, or systemic arterial embolus; and nonsystemic TEC, defined as Fontan conduit/right atrial thrombus or pulmonary embolus. Patients were divided into 3 groups: anticoagulation, antiplatelet, and no therapy cohorts.ResultsWe followed 278 patients, mean ag...
Source: Journal of the American College of Cardiology - September 13, 2016 Category: Cardiology Source Type: research
Fontan Anticoagulation A Never-Ending Debate? ∗
Thrombus formation is a significant cause of morbidity and mortality after Fontan operations. Intracardiac thrombus formation can lead to chronic pulmonary embolism (e.g., from system veins or subpulmonary ventricle) or stroke (e.g., from pulmonary veins or the systemic ventricle). Those “right-sided” embolisms may result in a ventilation/perfusion mismatch or an elevation of pulmonary vascular resistance, both of which may seriously hamper the cavopulmonary circulation. Preventing thromboembolism after the Fontan procedure and the role of a proper prophylaxis remains an ongoing discussion. The published reports are fr...
Source: Journal of the American College of Cardiology - September 13, 2016 Category: Cardiology Source Type: research
Cerebrovascular Events With Transcatheter Aortic Valve Replacement Can We Identify Those Who Are at Risk? ∗
As interventional technologies evolve, careful assessment of the benefits and risks is urged (1,2). Stroke remains one of the most feared complications of percutaneous interventions(3), but has generally been a rare complication for percutaneous coronary intervention (
Source: Journal of the American College of Cardiology - August 9, 2016 Category: Cardiology Source Type: research
Cerebral Embolism During Transcatheter Aortic Valve Replacement The BRAVO-3 MRI Study
ConclusionsThis study documented cerebral embolization in nearly two-thirds of patients during contemporary TAVR. There were no significant differences in cerebral embolization for bivalirudin versus heparin anticoagulation during TAVR. (Open-Label, Randomized Trial in Patients Undergoing TAVR to Determine Safety and Efficacy of Bivalrudin vs. UFH [BRAVO-2/3]; NCT01651780)
Source: Journal of the American College of Cardiology - August 2, 2016 Category: Cardiology Source Type: research
Cerebral Embolism A Silent Iatrogenic Complication of TAVR That Needs Voiced Consideration ∗
Transcatheter aortic valve replacement (TAVR) has rapidly and definitely changed the way patients with aortic stenosis are treated. Both the number of procedures and the indications have increased worldwide, allowing the inoperable patient to be treated, the high risk patient to be treated less invasively, and the intermediate risk patient to have the choice of an alternative to surgery (1–4). Clinical stroke or transient ischemic attack is not uncommon after aortic stenosis treatment, ranging in the randomized studies from 5% to 6% at 30 days to 8% to 10% at 1 year —one-half of them being major/disabling strokes (Tabl...
Source: Journal of the American College of Cardiology - August 2, 2016 Category: Cardiology Source Type: research
Refining Stroke Prediction in Atrial Fibrillation Patients by Addition of African-American Ethnicity to CHA 2 DS 2 -VASc Score
Conclusions In patients> 65 years of age with newly diagnosed AF, the addition of ethnicity to CHA2DS2-VASc score significantly improved stroke prediction.
Source: Journal of the American College of Cardiology - July 26, 2016 Category: Cardiology Source Type: research
Stroke Prediction in Atrial Fibrillation Is it Black and White? ∗
Atrial fibrillation (AF) is a common arrhythmia that predisposes patients to risk of stroke (1) that can be prevented with anticoagulation (2) . However, a minority of patients with AF and risk of stroke are treated with anticoagulants (3) , with undertreatment being due to a variety of factors. Optimizing treatment depends, in part, on the ability to understand risks, benefits, and personal preferences of individual patients. The CHADS 2 (congestive heart failure, hypertension, age ≥75 years, diabetes, and 2 points for prior stroke or transient ischemic attack) scoring system has been useful for stratifying risk of ...
Source: Journal of the American College of Cardiology - July 26, 2016 Category: Cardiology Source Type: research
Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease A Multicenter Observational Study
Conclusions These observational data from this first multicenter study of HCR suggest that there is no significant difference in MACCE rates over 12 months between patients treated with multivessel PCI or HCR, an emerging modality. A randomized trial with long-term outcomes is needed to definitively compare the effectiveness of these 2 revascularization strategies. (Hybrid Revascularization Observational Study; NCT01121263)
Source: Journal of the American College of Cardiology - July 21, 2016 Category: Cardiology Source Type: research
Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease A Multicenter Observational Study
ConclusionsThese observational data from this first multicenter study of HCR suggest that there is no significant difference in MACCE rates over 12 months between patients treated with multivessel PCI or HCR, an emerging modality. A randomized trial with long-term outcomes is needed to definitively compare the effectiveness of these 2 revascularization strategies. (Hybrid Revascularization Observational Study; NCT01121263)
Source: Journal of the American College of Cardiology - July 18, 2016 Category: Cardiology Source Type: research
Hybrid Coronary Revascularization The Best of 2 Worlds? ∗
As early as 1997, Michael Mack’s essay discussed the outlook for the possibility of hybrid revascularization with the emergence of minimally invasive coronary surgery combining the off-pump and minimally invasive direct coronary artery bypass (MIDCAB) techniques with percutaneous coronary intervention (PCI) to a non-left anterior descending (LAD) artery target (1). Since that time, coronary surgery and PCI technology have evolved even more. Off-pump coronary artery bypass surgery and MIDCAB surgery have been established in clinical practice and, with the development of drug-eluting stents, a new era of PCI was born. Desp...
Source: Journal of the American College of Cardiology - July 18, 2016 Category: Cardiology Source Type: research
Aspirin Instead of Oral Anticoagulant Prescription in Atrial Fibrillation Patients at Risk for Stroke
ConclusionsIn a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC. Specific patient characteristics predicted prescription of aspirin therapy over OAC.
Source: Journal of the American College of Cardiology - June 21, 2016 Category: Cardiology Source Type: research
