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Source: Journal of the American College of Cardiology
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Total 269 results found since Jan 2013.
Age, Ethnicity, and Stroke Risk in Patients With Atrial Fibrillation Another Stitch in the Patchwork ∗
The frequency with which clinicians encounter patients with nonvalvular atrial fibrillation (AF) and its association with ischemic stroke make estimation of the risk borne by individuals a daily issue in contemporary cardiology practice across the globe. In the balance lies the decision to employ long-term anticoagulation therapy with its attendant risk of severe bleeding. A variety of clinical risk scores are available to guide this decision, most prominently the CHA2DS2-VASc score, which cumulates the widely accepted, if unequally validated, clinical risk factors: heart failure (or impaired left ventricular function), hy...
Source: Journal of the American College of Cardiology - September 14, 2015 Category: Cardiology Source Type: research
What Is the Natural Relationship Between Left Atrial Appendage Morphology and History of Stroke?
In a recent issue of the Journal, Di Biase et al. () reported that left atrial appendage (LAA) morphology imaged with computed tomography (CT) or magnetic resonance imaging correlated with a history of stroke in patients that were undergoing catheter ablation for atrial fibrillation. We disagree with their impractical and complicated classification of LAA morphology and their conclusion that patients with non-Chicken Wing LAA morphology are significantly more likely to have an embolic event.
Source: Journal of the American College of Cardiology - February 6, 2013 Category: Cardiology Authors: Jian-Fang Ren, David J. Callans, Francis E. Marchlinski Tags: Letters to the Editor Source Type: research
Stroke, Superior Vena Cava Syndrome, and the Snowman in the Chest Roentgenogram
A 55-year-old man had left hemiparesis 1 month earlier, followed by progressive swelling and dilated nonpulsatile veins over the chest, neck, and upper arm (A, arrows) along with a pulsatile swelling over the right infraclavicular and parasternal area. A chest x-ray (B) showed a widened superior mediastinum with a “figure of 8” appearance. Transthoracic echocardiogram showed a dilated left ventricle (LV) with severe aortic regurgitation (G, Online Video 1). The ascending aorta (AA) was aneurysmally dilated, with a mobile thrombus (asterisk) attached to its wall (E, Online Video 2). Bicaval view (F, Online Video 3) sho...
Source: Journal of the American College of Cardiology - May 28, 2013 Category: Cardiology Authors: Bhupinder Singh, Ravindran Rajendran, Yadvinder Singh, Vivek Singla, Ravindranath K. Shankarappa, Manjunath C. Nanjappa Tags: IMAGES IN 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
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
Left Atrial Appendage Closure for Stroke Prevention in AF The Quest for the Holy Grail ∗
Strokes resulting from embolization of left atrial appendage (LAA) thrombi in patients with atrial fibrillation (AF) account for up to 25% of the 700,000 cerebrovascular accidents occurring annually in the United States. LAA, a complex structure with considerable anatomic variability, has been appropriately described as the “most lethal human attachment” (1). Stasis, hypercoagulability, and endothelial dysfunction (Virchow triad) contribute to LAA thrombus formation in AF patients. This pathophysiological process results in a 5-fold increased risk for cerebral embolization (2). Stroke is currently the major cause of di...
Source: Journal of the American College of Cardiology - December 14, 2015 Category: Cardiology Source Type: research
Considerations When Evaluating Cost-Effectiveness Analyses of Novel Stroke Prevention Therapies
The study by Reddy et al. (1) adds to the growing body of work evaluating the cost effectiveness of stroke prevention therapies from a U.S. perspective. We applaud their use of decision analytical models to inform practitioners and payers. We highlight 3 important considerations for readers of this work.
Source: Journal of the American College of Cardiology - May 3, 2016 Category: Cardiology Source Type: research
Stroke and Bleeding Risks in NOAC- and Warfarin-Treated Patients With Hypertrophic Cardiomyopathy and Atrial Fibrillation
Hypertrophic cardiomyopathy (HCM) affects>600,000 patients in the United States, and approximately 1 in 5 of them have atrial fibrillation (AF) (1). The incidence of stroke in patients with HCM is markedly increased when complicated by AF, with an annualized risk of nearly 4% (2). AF is an indication for warfarin in nearly all patients with HCM (3,4). Non–vitamin K antagonist oral anticoagulants (NOACs) may be reasonable alternatives to warfarin, but there are no explicit data to support their use (3,4).
Source: Journal of the American College of Cardiology - June 21, 2016 Category: Cardiology Source Type: research
Anticoagulation Treatment for Stroke Prevention in Atrial Fibrillation Is Increasing, But Further Improvements Needed
A recent paper by Hsu et al.(1) assessed antithrombotic treatment among atrial fibrillation (AF) patients. The data, from the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) registry between 2008 and 2012, showed that 61.8% of patients with moderate-to-high stroke risk received anticoagulant therapy with either warfarin or newer direct oral anticoagulants (DOACs). The investigators and an editorial commentary noted the alarming prevalence of aspirin-only treatment despite clear evidence that anticoagulants are superior for prevention of thromboembolism in AF (1,2).
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research
Should Atrial Fibrillation Patients With 1 Additional Risk Factor of the CHA 2 DS 2 -VASc Score (Beyond Sex) Receive Oral Anticoagulation?
ConclusionsNot all risk factors in CHA2DS2-VASc score carry an equal risk, with age 65 to 74 years associated with the highest stroke rate. Oral anticoagulation should be considered for AF patients with 1 additional stroke risk factor given their high risk of ischemic stroke.
Source: Journal of the American College of Cardiology - February 16, 2015 Category: Cardiology Source Type: research
Net Clinical Benefit of Antithrombotic Therapy in Patients With Atrial Fibrillation and Chronic Kidney Disease A Nationwide Observational Cohort Study
ConclusionsCKD is associated with a higher risk of stroke/thromboembolism across stroke risk strata in AF patients. High-risk CKD patients (CHA2DS2-VASc ≥2) with AF benefit from warfarin treatment for stroke prevention.
Source: Journal of the American College of Cardiology - December 8, 2014 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
Preserve the Brain: Primary Goal in the Therapy of Atrial Fibrillation∗
Treatment of atrial fibrillation (AF) involves 3 major strategies: prevention of stroke, maintenance of sinus rhythm, and rate control . Stroke is the most dreaded complication of AF, and its prevention is key. Anticoagulation with warfarin and the newer agents dabigatran, rivaroxaban, and apixaban is highly effective in preventing strokes in patients with AF . However, defining the appropriate patient for anticoagulant therapy is not an exact science, and the stroke risk schema CHADS2 (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke/transient ischemic attack) and CHA2DS2-VASc (...
Source: Journal of the American College of Cardiology - May 17, 2013 Category: Cardiology Authors: Eric N. Prystowsky, Benzy J. Padanilam Tags: Heart Rhythm Disorders: Editorial Comment 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
Left Atrial Appendage Closure With the Watchman Device in Patients With a Contraindication for Oral Anticoagulation: The ASAP Study (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology)
Conclusions: LAA closure with the Watchman device can be safely performed without a warfarin transition, and is a reasonable alternative to consider for patients at high risk for stroke but with contraindications to systemic oral anticoagulation. (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology [ASAP]; NCT00851578)
Source: Journal of the American College of Cardiology - April 12, 2013 Category: Cardiology Authors: Vivek Y. Reddy, Sven Möbius-Winkler, Marc A. Miller, Petr Neuzil, Gerhard Schuler, Jens Wiebe, Peter Sick, Horst Sievert Tags: Atrial Fibrillation Source Type: research
