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Source: The American Journal of Cardiology
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Total 715 results found since Jan 2013.
Gender Differences of Thromboembolic Events in Atrial Fibrillation
Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and increases the risk of thromboembolism and stroke; however, these risks are not the same for women and men. This review examines the evidence and clinical significance of increased thromboembolic risk in women with AF. The balance of results from over thirty recent studies suggests that female gender is an independent stroke risk factor in AF, and the inclusion of female gender in stroke risk stratification models, such as CHA2DS2-VASc, has improved risk assessment.
Source: The American Journal of Cardiology - December 31, 2015 Category: Cardiology Authors: Emily Y. Cheng, Melissa H. Kong Source Type: research
Atrial fibrillation after percutaneous patent foramen ovale closure
We read with interest the recent article by Smer et al (1). In a meta-analysis of randomized trials, the authors reported the efficacy and safety of percutaneous patent foramen ovale (PFO) closure for prevention of recurrent stroke, in patients with an index cryptogenic stroke. Among 3440 patients included (five trials), the authors found that PFO closure decreases the risk of stroke compared with medical therapy (2.8% vs 5.8%; RR 0.48, CI 0.27-0.87, p=0.01) but increases risk of atrial fibrillation or flutter (AF) (4.2% vs 0.7%; RR 4.55, CI 2.16-9.6, p=0.0001).
Source: The American Journal of Cardiology - June 5, 2018 Category: Cardiology Authors: Mohammad K. Mojadidi, Akram Y. Elgendy, Islam Y. Elgendy, Ahmed N. Mahmoud, Bernhard Meier Source Type: research
Trends in the Utilization of Left Atrial Appendage Exclusion in the United States
Stroke prevention remains a cornerstone in the management of patients with non-valvular atrial fibrillation (NVAF)1. Oral anticoagulation (OAC) is the main method of stroke prevention in NVAF worldwide. However,>50% of high-risk NVAF patients are not maintained on OAC due to comorbidities, frailty, bleeding complications, or non-compliance2. In 1996, Blackshear proposed Left atrial appendage exclusion (LAAE) as an alternative stroke prevention strategy in NVAF3. Because no randomized data were available to support the routine use of LAAE, its utilization remained initially limited to selected patients undergoing a concomitant cardiac surgery.
Source: The American Journal of Cardiology - April 6, 2020 Category: Cardiology Authors: Safi U. Khan, Muhammad Zia Khan, Mohamad Alkhouli Source Type: research
Real-World Direct Comparison of the Effectiveness and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Medicare Beneficiaries with Atrial Fibrillation
It remains unknown whether the comparative effectiveness of direct oral anticoagulants (DOACs) and warfarin differs between atrial fibrillation (AF) patients with and without a history of stroke or transient ischemic attack (TIA). Using 2012-2014 Medicare claims data, we identified patients newly diagnosed with AF in 2013-2014 who initiated apixaban, dabigatran, rivaroxaban or warfarin. We categorized patients based on a history of stroke or TIA. We constructed Cox proportional hazard models that included indicator variables for treatment groups, a history of stroke or TIA, and the interaction between them, and controlled ...
Source: The American Journal of Cardiology - April 9, 2020 Category: Cardiology Authors: Lanting Yang, Maria M. Brooks, Nancy W. Glynn, Yuting Zhang, Samir Saba, Inmaculada Hernandez Source Type: research
Reader's Comments: Trends in the Utilization of Left Atrial Appendage Exclusion in the United States
Stroke prevention remains a cornerstone in the management of patients with nonvalvular atrial fibrillation (NVAF).1 Oral anticoagulation is the main method of stroke prevention in NVAF worldwide. However,>50% of high-risk NVAF patients are not maintained on oral anticoagulation due to comorbidities, frailty, bleeding complications, or noncompliance.2 In 1996, Blackshear proposed left atrial appendage exclusion (LAAE) as an alternative stroke prevention strategy in NVAF.3 Because no randomized data were available to support the routine use of LAAE, its utilization remained initially limited to selected patients undergoing a...
Source: The American Journal of Cardiology - April 6, 2020 Category: Cardiology Authors: Safi U. Khan, Muhammad Zia Khan, Mohamad Alkhouli Source Type: research
Frequency, Trend, Predictors, and Impact of Gastrointestinal Bleeding in Atrial Fibrillation Hospitalizations
Atrial fibrillation (AF) is associated with a five-fold increased risk of stroke 1. Anticoagulation alone or in combination with other treatment strategies are implemented to reduce the risk of stroke in patients with AF. Gastrointestinal bleeding (GIB) is a common complication of oral anticoagulation (OAC) with a prevalence of 1%-3% in patients on long term OAC2. GIB in AF patients leads to discontinuation of anticoagulation, which can increase the risk of ischemic stroke, subject patients to endoscopic procedures, blood transfusions, and related side effects.
Source: The American Journal of Cardiology - January 30, 2021 Category: Cardiology Authors: Mihir Dav, Ashish Kumar, Monil Majmundar, Devina Adalja, Mariam Shariff, Palak Shah, Rupak Desai, Krunalkumar Patel, Gowthami Sai Kogilathota Jagirdhar, Saraschandra Vallabhajosyula, Nageshwara Gullapalli, Rajkumar Doshi Source Type: research
Meta-Analysis of Usefulness of Cerebral Embolic Protection During Transcatheter Aortic Valve Implantation
One of the most feared complications of transcatheter aortic valve implantation (TAVI) is stroke, with increased mortality and disability observed in patients suffering a stroke after TAVI. There has been no significant decline in stroke rates seen over the last 5 years; attention has therefore been given to strategies for cerebral embolic protection. With the emergence of new randomized trial data, we sought to perform an updated systematic review and meta-analysis to examine the effect of cerebral embolic protection during TAVI both on clinical outcomes and on neuroimaging parameters.
Source: The American Journal of Cardiology - February 4, 2021 Category: Cardiology Authors: Dr Yousif Ahmad, James P. Howard Source Type: research
A Commentary on “Low Utility of Short-Term Rhythm Assessment Before Long-Term Rhythm Monitoring in Patients With Cryptogenic Stroke”
Cryptogenic stroke, defined as acute ischemic stroke without a clear identifiable cause, accounts for approximately 1/3 of acute ischemic stroke cases. Undiagnosed atrial fibrillation (AF) is likely the leading underlying cause of such presentations; hence, cardiac rhythm monitoring is key to the diagnostic work-up. Commonly, long-term monitoring (LTM) using implantable cardiac monitors (ICMs) is indicated after a negative period of short-term monitoring (STM). However, the low diagnostic yield of STM prompts the question: would directly proceeding to LTM represent a more cost-effective approach?
Source: The American Journal of Cardiology - July 22, 2023 Category: Cardiology Authors: Michael Griffin, Gregory Y.H. Lip Tags: Editorial Source Type: research
Transesophageal Echocardiography for Cardiac Thromboembolic Risk Assessment in Patients With Severe, Symptomatic Aortic Valve Stenosis Referred for Potential Transcatheter Aortic Valve Implantation
Stroke is a devastating complication after transcatheter aortic valve implantation (TAVI) and might partially be related to cardiac embolization. The aim of this single-center prospective study was to determine the incidence of intracardiac thrombi and left atrial spontaneous echo contrast (SEC), both known predictors of cardiac embolic stroke, in patients referred for potential TAVI. One hundred four consecutive patients with severe symptomatic aortic valve stenosis and at high or very high risk for surgery were included and underwent transesophageal echocardiography. In 11 patients (10.6%), intracardiac thrombi were dete...
Source: The American Journal of Cardiology - February 25, 2013 Category: Cardiology Authors: Guy D. Lenders, Bernard P. Paelinck, Kristien Wouters, Marc J. Claeys, Inez E. Rodrigus, Paul L. Van Herck, Christiaan J. Vrints, Johan M. Bosmans Tags: Valvular Heart Disease Source Type: research
Dabigatran and Acute Coronary Syndromes
There has been considerable interest in the utility of newer oral anticoagulants for the secondary prevention of myocardial infarction (MI) and acute coronary syndromes (ACS). The direct thrombin inhibitor dabigatran has been approved for stroke prevention in patients with atrial fibrillation. However, as Verheugt discussed, when combined with dual antiplatelet therapy for secondary prevention in patients with ACS, no difference was found between the placebo and dabigatran groups for the composite end point of cardiovascular death, nonfatal MI, or stroke. However, it should also be noted that recent reports have actually ...
Source: The American Journal of Cardiology - May 1, 2013 Category: Cardiology Authors: John R. Kapoor Tags: Readers' Comments Source Type: research
Comparison of In-Hospital Outcomes With Low-Dose Fibrinolytic Therapy Followed by Urgent Percutaneous Coronary Intervention Versus Percutaneous Coronary Intervention Alone for Treatment of ST-Elevation Myocardial Infarction
In patients with acute ST-elevation myocardial infarction (STEMI), a strategy of prehospital reduced dose fibrinolytic administration coupled with urgent percutaneous coronary intervention (PCI), termed FAST-PCI strategy, has been found to be superior to primary PCI (PPCI) alone. A coordinated STEMI system of care that includes FAST-PCI should offer better outcomes than a system in which prehospital diagnosis of STEMI is followed by PPCI alone. The aim of this study was to compare the in-hospital outcomes for patients treated with the FAST-PCI approach with outcomes for patients treated with the PPCI approach in a common s...
Source: The American Journal of Cardiology - March 14, 2013 Category: Cardiology Authors: Neel S. Bhatt, Amirreza Solhpour, Prakash Balan, Armin Barekatain, James J. McCarthy, Stefano Sdringola, Ali E. Denktas, Richard W. Smalling, H. Vernon Anderson Tags: Coronary Artery Disease Source Type: research
Usefulness of Frequent Supraventricular Extrasystoles and a High CHADS2 Score to Predict First-Time Appearance of Atrial Fibrillation
Frequent supraventricular extrasystoles (SVEs) are associated with the subsequent first-time appearance of atrial fibrillation (AF) and ischemic stroke. The aim of this study was to investigate the combined role of SVEs and an AF-related risk score for ischemic stroke, the CHADS2 score, on the occurrence of new AF in patients in sinus rhythm. The Shinken Database 2004–2010 lists 3,263 patients who underwent 24-hour Holter monitoring. A total of 2,589 patients were analyzed, after excluding 674 patients previously diagnosed with AF. Frequent SVEs were defined as ≥102 beats/day (the top quartile) and the presence of a cl...
Source: The American Journal of Cardiology - March 18, 2013 Category: Cardiology Authors: Shinya Suzuki, Koichi Sagara, Takayuki Otsuka, Hiroto Kano, Shunsuke Matsuno, Hideaki Takai, Tokuhisa Uejima, Yuji Oikawa, Akira Koike, Kazuyuki Nagashima, Hajime Kirigaya, Junji Yajima, Hiroaki Tanabe, Hitoshi Sawada, Tadanori Aizawa, Takeshi Yamashita Tags: Arrhythmias and Conduction Disturbances Source Type: research
Effect of Dabigatran on Referrals to and Switching From Warfarin in Two Academic Anticoagulation Management Services
Dabigatran was expected to replace warfarin for stroke prevention in patients with nonvalvular atrial fibrillation (AF) who are warfarin naive, difficult to maintain in therapeutic range, or at risk of warfarin-related bleeding complications. We hypothesized that the number of patients with nonvalvular AF referred to Anticoagulation Management Services would decrease sharply and that most would switch from warfarin to dabigatran. We evaluated the number of patients with nonvalvular AF referred to 2 large services, Anticoagulation Management Service 1 and Anticoagulation Management Service 2, 12 months before and after mark...
Source: The American Journal of Cardiology - May 6, 2013 Category: Cardiology Authors: Julie K. Atay, John Fanikos, Geoffrey D. Barnes, Michael Ehle, John Coatney, Gregory Piazza, James B. Froehlich, Samuel Z. Goldhaber Tags: Arrhythmias and Conduction Disturbances Source Type: research
Hemodynamic Impact and Outcome of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Implantation
In conclusion, PPM implantation after TAVI is associated with reduced LVEF and impaired LV unloading. However, this unfavorable hemodynamic response does not affect the 2-year clinical outcome. The maintenance of clinical benefit appears to be driven by TAVI-related recovery of LV and right ventricular performance that mitigates unfavorable impact of PPM.
Source: The American Journal of Cardiology - November 8, 2013 Category: Cardiology Authors: Simon Biner, Yoav Michowitz, Eran Leshem-Rubinow, Yan Topilsky, Eyal Ben-Assa, Jason Shimiaie, Shmuel Banai, Gad Keren, Arie Steinvil, Ariel Finkelstein Tags: Valvular Heart Disease Source Type: research
Recurrent Myocardial Infarction After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction
In conclusion, recurrent MI after PPCI remains a relatively common complication in contemporary practice and confers a significantly increased risk of death, stroke, and bleeding.
Source: The American Journal of Cardiology - November 4, 2013 Category: Cardiology Authors: Wouter J. Kikkert, Loes P. Hoebers, Peter Damman, Krystien V.V. Lieve, Bimmer E.P.M. Claessen, Marije M. Vis, Jan Baan, Karel T. Koch, Robbert J. de Winter, Jan J. Piek, Jan G.P. Tijssen, Jose P.S. Henriques Tags: Coronary Artery Disease Source Type: research
