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Source: Journal of the American College of Cardiology
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Total 269 results found since Jan 2013.
2-Year Outcomes in Patients Undergoing Surgical or Self-Expanding Transcatheter Aortic Valve Replacement
BackgroundThe U.S. pivotal trial for the self-expanding valve found that among patients with severe aortic stenosis at increased risk for surgery, the 1-year survival rate was 4.9 percentage points higher in patients treated with a self-expanding transcatheter aortic valve bioprosthesis than in those treated with a surgical bioprosthesis.ObjectivesLonger-term clinical outcomes were examined to confirm if this mortality benefit is sustained.MethodsPatients with severe aortic stenosis who were at increased surgical risk were recruited. Eligible patients were randomly assigned in a 1:1 ratio to transcatheter aortic valve repl...
Source: Journal of the American College of Cardiology - July 6, 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
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
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
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
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
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
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
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
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
Measuring Blood microRNAs to Provide Personalized Advice to Sleep Apnea Patients With Resistant Hypertension Dreaming the Future ∗
Obstructive sleep apnea (OSA; defined as>15 episodes of obstructive apnea and hypopnea per hour of sleep) was recently estimated to affect 13% of men and 6% of women (1), the prevalence having increased substantially over the last 2 decades in parallel with rising rates of obesity. OSA is associated with a 2- to 3-fold increase in the risk of stroke, ischemic heart disease, heart failure, and sudden death (2). One of the main putative mechanisms for increased OSA-related cardiovascular risk is systemic hypertension. Epidemiological studies have shown an independent association between OSA and prevalent and incident hyper...
Source: Journal of the American College of Cardiology - August 24, 2015 Category: Cardiology Source Type: research
Clinical Benefit of Warfarin in Dialysis Patients With Atrial Fibrillation
Patients with atrial fibrillation (AF) and end-stage chronic kidney disease (CKD) receiving dialysis are at higher risk of stroke (1). Warfarin has been shown to reduce the frequency of strokes by 64.0% in patients with AF; however, its use in dialysis patients has not received consensus owing to the lack of randomized controlled trial data and associated increased bleeding risk.
Source: Journal of the American College of Cardiology - September 7, 2015 Category: Cardiology Source Type: research
Coronary Calcium Score and the New Guidelines Back to Square One? ∗
Previous guidelines for cardiovascular risk assessment recommended the use of a modified Framingham score to estimate the 10-year risk of hard coronary heart disease (CHD) events, defined as myocardial infarction and CHD death (1). Coronary artery calcium (CAC) scoring for refined stratification received Class IIa or IIb recommendations for those at intermediate (10% to 20%) or low to intermediate (6% to 10%) risk, respectively (2). In 2013, the American College of Cardiology (ACC) and American Heart Association (AHA) released guidelines (3,4) endorsing new sex- and race-specific predictive equations derived from 5 large p...
Source: Journal of the American College of Cardiology - October 5, 2015 Category: Cardiology Source Type: research
Sodium Nitrite Improves Exercise Hemodynamics and Ventricular Performance in Heart Failure With Preserved Ejection Fraction
This study sought to determine whether acute nitrite administration improves exercise hemodynamics and cardiac reserve in HFpEF.MethodsIn a double-blind, randomized, placebo-controlled, parallel-group trial, subjects with HFpEF (N = 28) underwent invasive cardiac catheterization with simultaneous expired gas analysis at rest and during exercise, before and 15 min after treatment with either sodium nitrite or matching placebo.ResultsBefore the study drug infusion, HFpEF subjects displayed an increase in PCWP with exercise from 16 ± 5 mm Hg to 30 ± 7 mm Hg (p
Source: Journal of the American College of Cardiology - October 5, 2015 Category: Cardiology Source Type: research
Next Steps in Primary Prevention of Coronary Heart Disease Rationale for and Design of the ECAD Trial
Atherosclerotic cardiovascular disease (ASCVD) events, including coronary heart disease and stroke, are the most frequent cause of death and major disability in the world. Current American College of Cardiology/American Heart Association primary prevention guidelines are mainly on the basis of randomized controlled trials of statin-based low-density lipoprotein cholesterol (LDL-C)–lowering therapy for primary prevention of ASCVD events. Despite the clear demonstration of statin-based LDL-C lowering, substantial 10-year and lifetime risks of incident ASCVD continue. Although the 10-year risk is low in young and middle-age...
Source: Journal of the American College of Cardiology - October 12, 2015 Category: Cardiology Source Type: research
