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Source: Journal of the American College of Cardiology
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Total 269 results found since Jan 2013.
Incidence of Atrial Fibrillation and Relationship With Cardiovascular Events, Heart Failure, and Mortality A Community-Based Study From the Netherlands
This study investigated the incidence of AF in a contemporary cohort in the Netherlands, together with comorbidities associated with AF and associations of AF with cardiovascular outcomes.MethodsIncident AF was ascertained for hospital and study electrocardiograms in 8,265 participants of the PREVEND (Prevention of Renal and Vascular End-Stage Disease) study in Groningen, the Netherlands.ResultsDuring 9.7 ± 2.3 years of follow-up, 265 participants developed AF, with a resulting overall AF incidence of 3.3 per 1,000 person-years. Advancing age, male sex, antihypertensive drug use, higher body mass index, previous myocardia...
Source: Journal of the American College of Cardiology - August 24, 2015 Category: Cardiology Source Type: research
Orthostatic Hypotension Epidemiology, Prognosis, and Treatment
Orthostatic hypotension (OH) is a common cardiovascular disorder, with or without signs of underlying neurodegenerative disease. OH is diagnosed on the basis of an orthostatic challenge and implies a persistent systolic/diastolic blood pressure decrease of at least 20/10 mm Hg upon standing. Its prevalence is age dependent, ranging from 5% in patients 70 years of age. OH may complicate treatment of hypertension, heart failure, and coronary heart disease; cause disabling symptoms, faints, and traumatic injuries; and substantially reduce quality of life. Despite being largely asymptomatic or with minimal symptoms, the pres...
Source: Journal of the American College of Cardiology - August 10, 2015 Category: Cardiology Source Type: research
Aortic Stenosis Valve Replacement or Valve Implantation? ∗
In this issue of the Journal, Tamburino et al. (1) have published a study that compares the clinical outcomes of aortic valve replacement (AVR) with transcatheter aortic valve replacement (TAVR) at 1 year from the OBSERVANT (Observational Study of Effectiveness of SAVR–TAVR Procedures for Severe Aortic Stenosis Treatment) registry, which investigates the management of aortic stenosis (AS) in 93 institutions in Italy. The registry had 7,618 patients with AS (5,707 treated with AVR and 1,991 with TAVR). The investigators excluded 2,150 patients because of combined procedures, porcelain aortas, “hostile thorax,” nonfem...
Source: Journal of the American College of Cardiology - August 10, 2015 Category: Cardiology Source Type: research
The Challenge of Getting it Just Right Optimizing Long-Term Antithrombotic Therapy After Acute Coronary Syndrome ∗
Acute coronary syndrome (ACS) is associated with substantial morbidity and mortality (1,2). Initial treatment in the hospital consists of intensive antithrombotic therapy combining parenteral anticoagulation with antiplatelet therapy, whereas secondary prevention relies primarily on dual antiplatelet therapy (DAPT), most commonly aspirin and clopidogrel. However, patients with ACS remain at significant risk of recurrent adverse cardiovascular events (3). Mitigation of this risk requires a delicate balance between escalation of antithrombotic therapy to reduce ischemic events, while hoping the increase in bleeding is tolera...
Source: Journal of the American College of Cardiology - August 10, 2015 Category: Cardiology Source Type: research
Apixaban Plus Mono Versus Dual Antiplatelet Therapy in Acute Coronary Syndromes Insights From the APPRAISE-2 Trial
ConclusionsPost-ACS treatment with apixaban versus placebo showed no efficacy, but it increased bleeding regardless of concomitant therapy with aspirin alone or aspirin plus clopidogrel. (Apixaban for Prevention of Acute Ischemic Events 2 [APPRAISE-2]; NCT00831441)
Source: Journal of the American College of Cardiology - August 10, 2015 Category: Cardiology Source Type: research
Glycemic Control in Type 1 Diabetes and Long-Term Risk of Cardiovascular Events or Death After Coronary Artery Bypass Grafting
ConclusionsIn patients with T1DM, poor glycemic control before CABG was associated with increased long-term risk of death or MACE. (HeAlth-data Register sTudies of Risk and Outcomes in Cardiac Surgery [HARTROCS]; NCT02276950)
Source: Journal of the American College of Cardiology - July 27, 2015 Category: Cardiology Source Type: research
Reply Primum Non Nocere: First Do No Harm
Discussion section, the strong correlation shown in Figure 4A would not be possible if variability of afterload was an important consideration.3.If aortic regurgitation were underestimated by MRI, it would lead to an overestimation of mitral regurgitant volume, not an underestimation.4.We do not believe our study shows that pre-surgical left ventricular (LV) volumes predict recovery of LV end-diastolic volume (EDV) post-surgery. For example, in Table 4, patient 29 had mild mitral regurgitation (MR) and an end-diastolic diameter (EDD) of 6.2 cm, whereas patient 38 had severe MR and an EDD of 5.3 cm. Our study shows that ...
Source: Journal of the American College of Cardiology - July 20, 2015 Category: Cardiology Source Type: research
Stent Type and Risk of Late Cerebral Events After Carotid Artery Stenting
We read with great interest the recent paper by Gensicke et al. (1), which reported a 3-fold increased risk of recurrence of stroke or transient ischemic attack at 6 months in symptomatic patients treated with carotid artery stenting (CAS) and who showed new silent ischemic cerebral lesions on diffusion-weighted magnetic resonance imaging after the endovascular procedure. This observation did not apply to patients treated with carotid endoatherectomy (CEA). The investigators discussed the possible role of vulnerable plaques and the potential benefits of longer and more aggressive antiplatelet therapy. The study provided h...
Source: Journal of the American College of Cardiology - July 20, 2015 Category: Cardiology Source Type: research
Direct Catheter-Based Thrombectomy for Acute Ischemic Stroke Outcomes of Consecutive Patients Treated in Interventional Cardiology Centers in Close Cooperation With Neurologists
We sought to evaluate the outcomes of acute stroke patients, who did not undergo thrombolysis, and who were treated by direct catheter-based thrombectomy (CBT) in 3 interventional cardiology centers without pre-existing onsite programs for neurovascular interventions. Neurologists routinely selected patients for intervention. Their selection was on the basis of clinical presentation and computed tomography (CT) imaging. The decision not to use thrombolysis was on the basis of the presence of a contraindication or on a predicted short CT-to-sheath insertion time.
Source: Journal of the American College of Cardiology - July 20, 2015 Category: Cardiology Source Type: research
Net Clinical Benefit for Oral Anticoagulation, Aspirin, or No Therapy in Nonvalvular Atrial Fibrillation Patients With 1 Additional Risk Factor of the CHA 2 DS 2 -VASc Score (Beyond Sex)
Whether to anticoagulate patients with atrial fibrillation (AF) and 1 stroke risk factor (i.e., CHA2DS2-VASc [congestive heart failure, hypertension, age>75 years, diabetes mellitus, stroke, vascular disease, age 65–75 years, and female sex] score = 1 in men, or 2 in women) is controversial, but many studies report ischemic stroke rates of>1.5% per year, even with 1 stroke risk factor (1). We estimated the net clinical benefit (NCB) of aspirin or warfarin compared with no antithrombotic therapy among such patients on the basis of a nationwide Danish cohort, with incident AF diagnosed between 1998 and 2012 (2). Men w...
Source: Journal of the American College of Cardiology - July 20, 2015 Category: Cardiology Source Type: research
The Heart and the Head Neurological Implications of Transcatheter Aortic Valve Replacement ∗
In this issue of the Journal, Bosmans et al. (1) report much-awaited stroke outcomes from the ADVANCE study, a multicenter, prospective, nonrandomized cohort of patients undergoing transcatheter aortic valve replacement (TAVR) with the CoreValve prosthesis (Medtronic Inc., Minneapolis, Minnesota) at 44 mostly European sites between March 2010 and July 2011. In this real-world cohort of patients with severe aortic stenosis, the investigators observed stroke rates of 3.0% at 30 days post-TAVR and 5.6% at 2 years. They reported no significant predictors of periprocedural stroke or transient ischemic attack (TIA) occurring ...
Source: Journal of the American College of Cardiology - July 13, 2015 Category: Cardiology Source Type: research
Revisiting Sex Equality With Transcatheter Aortic Valve Replacement Outcomes A Collaborative, Patient-Level Meta-Analysis of 11,310 Patients
BackgroundThere has been conflicting clinical evidence as to the influence of female sex on outcomes after transcatheter aortic valve replacement.ObjectivesThe aim of this study was to evaluate the impact of sex on early and late mortality and safety end points after transcatheter aortic valve replacement using a collaborative meta-analysis of patient-level data.MethodsFrom the MEDLINE, Embase, and the Cochrane Library databases, data were obtained from 5 studies, and a database containing individual patient-level time-to-event data was generated from the registry of each selected study. The primary outcome of interest was...
Source: Journal of the American College of Cardiology - July 13, 2015 Category: Cardiology Source Type: research
Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation
ConclusionsESVEA was associated with an increased risk of ischemic stroke beyond manifest AF in this middle-aged and older population. Stroke was more often the first clinical presentation, rather than AF, in these study subjects.
Source: Journal of the American College of Cardiology - July 13, 2015 Category: Cardiology Source Type: research
Premature Atrial Contractions A Wolf in Sheep’s Clothing? ∗
Premature atrial contractions (PACs) have long been considered a benign electrophysiological phenomenon unlikely to result in serious clinical consequence. In 1998, Haïssaguerre et al. (1) challenged this notion by demonstrating that targeted ablation of ectopic atrial activity among patients with atrial fibrillation (AF) reduced arrhythmia recurrence. This finding strongly implicated PACs as the acute trigger for AF initiation among patients previously diagnosed with the arrhythmia. Subsequent studies among patients without known AF identified an association between PACs and incident AF, both in cohorts of patients with...
Source: Journal of the American College of Cardiology - July 13, 2015 Category: Cardiology Source Type: research
The Incidence and Predictors of Early- and Mid-Term Clinically Relevant Neurological Events After Transcatheter Aortic Valve Replacement in Real-World Patients
ConclusionsTreatment of high-risk patients with aortic stenosis using a self-expandable system was associated with a low stroke rate at short- and long-term follow-up. Multivariable predictors of clinically relevant neurological events differed on the basis of the timing after TAVR. (CoreValve Advance International Post Market Study; NCT01074658)
Source: Journal of the American College of Cardiology - July 13, 2015 Category: Cardiology Source Type: research
