MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Journal of the American College of Cardiology' source. Wed, 08 Feb 2012 09:32:51 +0100 http://www.medworm.com/index.php?rid=5647430&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109712000769%2Fabstract%3Frss%3Dyes 553 Andrew J. Einstein (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647430 Thu, 02 Feb 2012 13:55:34 +0100 5647430 http://www.medworm.com/index.php?rid=5647429&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049928%2Fabstract%3Frss%3Dyes In an elegant study, Fischell et al. () employed an implantable intracardiac ischemia detection device for continuous surveillance for ST-segmental shifts as a warning system. During a median follow-up of 1.5 years, shifts exceeding 3 SDs were an accurate marker for thrombotic coronary occlusion, allowing for a median alert-to-door time of (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647429 Thu, 02 Feb 2012 13:55:34 +0100 5647429 http://www.medworm.com/index.php?rid=5647428&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049916%2Fabstract%3Frss%3Dyes To the Editor: Ethnic disparities in contemporary ST-segment elevation myocardial infarction (STEMI) management have not been well characterized (). The National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcome Network–Get With The Guidelines Registry (ACTION Registry–GWTG) is the largest national database including consecutive acute coronary syndrome patients from all U.S. geographic regions and therefore provides a unique opportunity to compare contemporary treatment patterns and outcomes between Hispanic and non-Hispanic white STEMI patients. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647428 Thu, 02 Feb 2012 13:55:34 +0100 5647428 http://www.medworm.com/index.php?rid=5647427&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109712000083%2Fabstract%3Frss%3Dyes Irrespective of the field, be it religion (the 3 main Abrahamic religions, Hinduism, or Buddhism), philosophy (Hegel's dialectic), physics (baryon), chemistry (atomic constituents), or anatomy (human light perception), the underlying structure of 3's has been accorded considerable attention. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647427 Thu, 02 Feb 2012 13:55:34 +0100 5647427 http://www.medworm.com/index.php?rid=5647426&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049874%2Fabstract%3Frss%3Dyes A 34-year-old man with recent mitral valve replacement (Sorin Bicarbon prosthesis, Milan, Italy) was referred as the result of an abnormal color flow signal localized in only 1 hemidisc with a significantly increased gradient across the prosthesis during routine transthoracic echocardiography (A). He was asymptomatic, and oral anticoagulation was not adequate. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647426 Thu, 02 Feb 2012 13:55:34 +0100 5647426 http://www.medworm.com/index.php?rid=5647425&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049850%2Fabstract%3Frss%3Dyes A 56-year-old man who was admitted with acute myocardial infarction developed severe heart failure following stent placement in the left anterior descending artery. Ventricular septal perforation (VSP) was diagnosed. Conventional septal closure was considered high risk due to severe heart and multiple organ failure. We decided to place a stent graft in the left ventricle to exclude the VSP (A and B). The stent was placed retrograde from the ascending aorta through the aortic valve into the left ventricle, and the tip was stabilized to the apex. After stent placement, right ventricular free-wall bulging decreased markedly. Cardiac catheterization showed reduction of shunting to 20%. Three years after the procedure, no increase in shunting was observed. Chest radiograph and computed tomograp... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647425 Thu, 02 Feb 2012 13:55:34 +0100 5647425 http://www.medworm.com/index.php?rid=5647424&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049862%2Fabstract%3Frss%3Dyes Conclusions: This study demonstrates that biocompatible multimodal Mn-based molecular imaging probes detect OSE within atherosclerotic plaques and may facilitate clinical translation of noninvasive imaging of human atherosclerosis. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647424 Thu, 02 Feb 2012 13:55:34 +0100 5647424 http://www.medworm.com/index.php?rid=5647423&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049199%2Fabstract%3Frss%3Dyes Objectives: The purpose of this study was to establish the incidence of and risk factors for sudden cardiac death (SCD) in pediatric dilated cardiomyopathy (DCM). Background: The incidence of SCD in children with DCM is unknown. The ability to predict patients at high risk of SCD will help to define who may benefit most from implantable cardioverter-defibrillators. Methods: The cohort was 1,803 children in the PCMR (Pediatric Cardiomyopathy Registry) with a diagnosis of DCM from 1990 to 2009. Cumulative incidence competing-risks event rates were estimated. We achieved risk stratification using Classification and Regression Tree methodology. Results: The 5-year incidence rates were 29% for heart transplantation, 12.1% non-SCD, 4.0% death from unknown cause, and 2.4% for SCD. Of 280 d... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647423 Thu, 02 Feb 2012 13:55:34 +0100 5647423 http://www.medworm.com/index.php?rid=5647422&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049205%2Fabstract%3Frss%3Dyes Conclusions: Acceleration-dependent slowing of atrial conduction (CV restitution) precedes AF initiation, whereas absence of CV restitution identifies inability to induce AF. Conduction restitution, but not fractionated electrograms, may thus track the functional milieu enabling AF initiation and has implications for guiding AF ablation and pharmacological therapy. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647422 Thu, 02 Feb 2012 13:55:34 +0100 5647422 http://www.medworm.com/index.php?rid=5647421&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049886%2Fabstract%3Frss%3Dyes In 1984, Warren and Marshall () presented indirect evidence of a putative microbial etiology for peptic ulcer disease. In the decades to follow, >37,000 scholarly articles have been published on Helicobacter pylori (). Unlike the discovery of the role of H pylori in peptic ulcer disease, enthusiasm for infectious causes of all manner of cardiovascular disease has been largely unsubstantiated (). Nevertheless, the robust relationship between inflammation and cardiovascular events lends biological plausibility to the possible association between infectious processes and cardiovascular disease, particularly heart failure (). Tumor necrosis factor (TNF)-α, interleukin (IL)-6, and other inflammatory cytokines have been recognized as correlates of heart failure disease progression and severity,... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647421 Thu, 02 Feb 2012 13:55:34 +0100 5647421 http://www.medworm.com/index.php?rid=5647420&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049849%2Fabstract%3Frss%3Dyes This study sought to assess the effects of ursodeoxycholic acid (UDCA) on endothelial function and inflammatory markers in patients with chronic heart failure (CHF). Background: Endothelial dysfunction is commonly observed in patients with CHF, and it contributes to the limitation in exercise capacity that accompanies this condition. Bacterial lipopolysaccharide may trigger proinflammatory cytokine release and promote further endothelial dysfunction. UDCA, a bile acid used in the treatment of cholestatic liver disease, has anti-inflammatory and cytoprotective properties and may contribute to the formation of mixed micelles around lipopolysaccharide. These properties may help to improve peripheral blood flow in patients with CHF. Methods: We performed a prospective, single-center, doubl... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647420 Thu, 02 Feb 2012 13:55:34 +0100 5647420 http://www.medworm.com/index.php?rid=5647419&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049904%2Fabstract%3Frss%3Dyes If statistics is a science of probability then Sir William Osler expressed the limitations of its applications when he articulated “Medicine is a science of uncertainty and an art of probability” (). Despite widespread consensus about statin use for the secondary prevention of cardiovascular disease (CVD) in both sexes, there has been substantial debate with regard to the use of statins for primary prevention among women. Much of the discourse has centered on the fact that women have not participated in primary prevention trials to that extent that men have; therefore, less-definitive conclusions can be drawn about the likelihood of benefits and risks among women. The short-term absolute risk of a future cardiovascular event among women is substantially lower than men in a primary prev... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647419 Thu, 02 Feb 2012 13:55:34 +0100 5647419 http://www.medworm.com/index.php?rid=5647418&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049898%2Fabstract%3Frss%3Dyes Conclusions: Statin therapy is associated with significant decreases in cardiovascular events and in all-cause mortality in women and men. Statin therapy should be used in appropriate patients without regard to sex. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647418 Thu, 02 Feb 2012 13:55:34 +0100 5647418 http://www.medworm.com/index.php?rid=5647417&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049175%2Fabstract%3Frss%3Dyes Conclusions: Female sex is associated with better baseline clinical characteristics and improved survival, and is identified as a predictor of midterm survival after TAVI. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647417 Thu, 02 Feb 2012 13:55:34 +0100 5647417 http://www.medworm.com/index.php?rid=5647416&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049217%2Fabstract%3Frss%3Dyes Concerns about medical exposure to ionizing radiation have become heightened in recent years as a result of rapid growth in procedure volumes and the high radiation doses incurred from some procedures. This paper summarizes the evidence base undergirding concerns about radiation exposure in cardiac imaging. After classifying radiation effects, explaining terminology used to quantify the radiation received by patients, and describing typical doses from cardiac imaging procedures, this paper will address the major epidemiological studies having bearing on radiation effects at doses comparable to those received by patients undergoing cardiac imaging. These include studies of atomic bomb survivors, nuclear industry workers, and children exposed in utero to x-rays, all of which have evidenced i... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647416 Thu, 02 Feb 2012 13:55:34 +0100 5647416 http://www.medworm.com/index.php?rid=5647415&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109712000319%2Fabstract%3Frss%3Dyes (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5647415 Thu, 02 Feb 2012 13:55:34 +0100 5647415 http://www.medworm.com/index.php?rid=5628248&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109712000307%2Fabstract%3Frss%3Dyes 435 C. Richard Conti, Anthony A. Bavry, John W. Petersen (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628248 Thu, 26 Jan 2012 13:57:11 +0100 5628248 http://www.medworm.com/index.php?rid=5628247&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971105368X%2Fabstract%3Frss%3Dyes Feinstein JA, Benson DW, Dubin AM, et al. Hypoplastic Left Heart Syndrome: Current Considerations and Expectations. J Am Coll Cardiol 2012;59 Suppl S:S1–S42. The affiliations for the following authors contained the wrong city. The correct affiliation is listed below. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628247 Thu, 26 Jan 2012 13:57:11 +0100 5628247 http://www.medworm.com/index.php?rid=5628246&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048510%2Fabstract%3Frss%3Dyes We read with great interest the recent article in the Journal by Cannizzaro et al. (). The researchers provided a great overview of various trials in the use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy in patients with chronic kidney disease (CKD) and congestive heart failure (CHF). (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628246 Thu, 26 Jan 2012 13:57:11 +0100 5628246 http://www.medworm.com/index.php?rid=5628245&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048522%2Fabstract%3Frss%3Dyes We thank Dr. Tsioufis and colleagues for their recent letter regarding the Rheos Pivotal Trial (). We provide the following clarifications based on their original comments. 1. Was blood pressure (BP) adequately characterized in the Rheos Pivotal Trial? The BpTRU (BpTRU Medical Devices, Coquitlam, British Columbia, Canada) repeated-measures protocol () was used throughout the trial to measure BP. BpTRU was selected for its correlation with and low bias in estimating daytime ambulatory BP (). Trial qualification requirements summarized in our paper are correct but incomplete: systolic blood pressure (SBP) ≥160 mm Hg according to the BpTRU protocol was mandatory, along with 2 office cuff readings of SBP ≥160 mm Hg within 3 months of enrollment. Resistant hypertension was assured by requi... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628245 Thu, 26 Jan 2012 13:57:11 +0100 5628245 http://www.medworm.com/index.php?rid=5628244&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048479%2Fabstract%3Frss%3Dyes We read with interest the elegantly written paper by Bisognano et al. () relating to the double-blind, randomized, placebo-controlled Rheos Pivotal Trial, which demonstrated that over the long-term, baroreflex activation therapy (BAT) can safely reduce systolic blood pressure (SBP) in patients with resistant hypertension. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628244 Thu, 26 Jan 2012 13:57:11 +0100 5628244 http://www.medworm.com/index.php?rid=5628243&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048741%2Fabstract%3Frss%3Dyes In preclinical animal models of acute myocardial infarction (AMI), administration of freshly isolated adipose tissue–derived regenerative cells (ADRCs) immediately after the AMI improved left ventricular (LV) function and myocardial perfusion (). The predominant working mechanism of ADRC therapy in AMI is believed to be through paracrine release of antiapoptotic, immunomodulatory, and proangiogenic factors. These factors evoke cardiomyocyte salvage and stimulate neoangiogenesis in the infarct border zone and eventually result in reduced infarct scar formation and adverse cardiac remodeling (). ADRCs comprise, among other cells, immune-competent cells, endothelial progenitor cells, and mesenchymal stem cells. The amount of these mesenchymal stem cells in freshly isolated adipose tissue di... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628243 Thu, 26 Jan 2012 13:57:11 +0100 5628243 http://www.medworm.com/index.php?rid=5628242&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048765%2Fabstract%3Frss%3Dyes Transthoracic echocardiography (TTE) performed on a 52-year-old man for an abnormal electrocardiogram (A) demonstrated severe midventricular hypertrophy (30 mm) (Online Videos 1 and 2), a left ventricular apical pouch (B, pink arrow, Online Videos 3 and 4), and a midventricular systolic gradient of 40 mm Hg (C, white arrows). Characteristic diastolic velocity profile of the pouch was noted (C, white arrowheads), with mitral inflow and apical pouch flow colliding “head-on” in the midventricle, producing a vivid color display (D and inset, white arrows, Online Video 5). Strain analysis revealed decreased peak systolic strain limited to the apicolateral wall (E). Cardiac magnetic resonance imaging confirmed TTE findings (F, pink arrow) but did not reveal delayed hyperenhancement (Online V... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628242 Thu, 26 Jan 2012 13:57:11 +0100 5628242 http://www.medworm.com/index.php?rid=5628241&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048777%2Fabstract%3Frss%3Dyes A 58-year-old man presented with anterior non–ST-segment elevation myocardial infarction. Echocardiography showed a large pericardial effusion that was drained and found to be hemorrhagic. Angiography revealed “unobstructed” coronary arteries, whereas contrast-enhanced computed tomography (CT) showed some extravasation of contrast suggestive of a ruptured sinus of Valsalva aneurysm (A, arrows). Cardiovascular magnetic resonance (CMR) was performed, visualizing a structure adjacent to the anterior wall. First-pass perfusion demonstrated its communication with the aortic root but no extravasation of contrast into the pericardial space (C, arrow, Online Video 1). There was also a small anterior transmural scar. During cardiac surgery, a small, closed dimple deep in a recess immediately ... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628241 Thu, 26 Jan 2012 13:57:11 +0100 5628241 http://www.medworm.com/index.php?rid=5628240&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711053691%2Fabstract%3Frss%3Dyes As in past years, this Highlights paper takes the place of the Editor's Page and was assembled by the Associate Editors based on the papers that they perceived had or would have the greatest impact on cardiology. Space constraints result in omitting many excellent papers, and we apologize in advance to those authors. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628240 Thu, 26 Jan 2012 13:57:11 +0100 5628240 http://www.medworm.com/index.php?rid=5628239&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048455%2Fabstract%3Frss%3Dyes It has now been >30 years since the implantable cardioverter-defibrillator (ICD) was introduced to the cardiovascular community for the prevention of sudden cardiac death (). Perhaps it is no longer common knowledge that the defibrillator was conceived and initially developed >40 years ago by Drs. Michel Mirowski and Morton Mower, not in an eminent medical institution with the robust support of industry and the National Institutes of Health, but rather in the basement of a small, private hospital (Sinai Hospital, Baltimore, Maryland), initially with no formal funding. This entirely novel concept was initially met with substantial skepticism and even antagonism (), but eventually moved forward, driven by the vision of Mirowski and Mower, until it became the acknowledged treatment to prevent... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628239 Thu, 26 Jan 2012 13:57:11 +0100 5628239 http://www.medworm.com/index.php?rid=5628238&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048443%2Fabstract%3Frss%3Dyes Objectives: The purpose of this study was to determine risk factors that predict malignant ventricular arrhythmias (MVA) in Lamin A/C (LMNA) mutation carriers. Background: LMNA mutations cause a variety of clinical phenotypes, including dilated cardiomyopathy and conduction disease. Many LMNA mutation carriers have a poor prognosis, because of a high frequency of MVA and progression to end-stage heart failure. However, it is unclear how to identify mutation carriers that are at risk for MVA. Methods: In this multicenter cohort of 269 LMNA mutation carriers, we evaluated risk factors for MVA, defined as sudden cardiac death, resuscitation, and appropriate implantable cardioverter-defibrillator (ICD) treatment. Results: In a median follow-up period of 43 months (interquartile range: 1... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628238 Thu, 26 Jan 2012 13:57:11 +0100 5628238 http://www.medworm.com/index.php?rid=5628237&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048546%2Fabstract%3Frss%3Dyes The current indications for measurement of cardiac troponin T (cTnT) and cardiac troponin I (cTnI) primarily focus on diagnosis and risk stratification in patients with suspected myocardial infarction (MI). Recently, highly sensitive assays for cTnT and cTnI have been developed that can detect troponin concentrations ∼10-fold lower than is possible with assays currently in use in the United States. These assays improve sensitivity for the detection of MI, particularly early after symptom onset, at a cost of decreased specificity (). Importantly, the ability to detect very low circulating troponin levels with these assays has opened the door for many additional potential applications for troponin measurement, both for clinical and for research purposes. With the highly sensitive cTnT (hs-... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628237 Thu, 26 Jan 2012 13:57:11 +0100 5628237 http://www.medworm.com/index.php?rid=5628236&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048558%2Fabstract%3Frss%3Dyes We examined the association between baseline glycated hemoglobin (HbA1c) and high-sensitivity cardiac troponin T (hs-cTnT) in 9,661 participants free of CHD and heart failure in the ARIC (Atherosclerosis Risk in Communities) study. Multivariable logistic regression models characterized the association between clinical categories of HbA1c ( (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628236 Thu, 26 Jan 2012 13:57:11 +0100 5628236 http://www.medworm.com/index.php?rid=5628235&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048509%2Fabstract%3Frss%3Dyes Objectives: The goal of this study was to examine the progression of central arterial pulse pressure (cPP) in women and the degree to which this can be reversed by nitrovasodilation. Background: cPP can be partitioned into height of the first systolic shoulder (P1), generated by a forward pressure wave and related to arterial stiffness, and augmentation pressure (AP), thought to be influenced by pressure wave reflection from muscular arteries and/or aortic reservoir. Methods: Using a longitudinal cohort design, cPP, P1, and AP were estimated (using the SphygmoCor System [AtCor Medical Pty Ltd., West Ryde, Australia]) in 411 female twins over a mean follow-up of 10.8 years. In a subsample (n = 42), cPP, arterial stiffness (using pulse wave velocity [PWV]) and arterial diameters (using ... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628235 Thu, 26 Jan 2012 13:57:11 +0100 5628235 http://www.medworm.com/index.php?rid=5628234&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048753%2Fabstract%3Frss%3Dyes Conclusions: Overall, noninvasive testing had only a modest impact on clinical management of patients referred for clinical testing. Although post-imaging use of cardiac catheterization and medical therapy increased in proportion to the degree of abnormality findings, the frequency of catheterization and medication change suggests possible undertreatment of higher risk patients. Patients were more likely to undergo cardiac catheterization after computed tomography angiography than after single-photon emission computed tomography or positron emission tomography after normal/nonobstructive and mildly abnormal study findings. (Study of Perfusion and Anatomy's Role in Coronary Artery [CAD] [SPARC]; NCT00321399) (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628234 Thu, 26 Jan 2012 13:57:11 +0100 5628234 http://www.medworm.com/index.php?rid=5628233&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048534%2Fabstract%3Frss%3Dyes Conclusions: In HFpEF patients, moderate exercise leads to a steep increase in proximal afterload that is underestimated at rest and is associated with unfavorable ventriculoarterial coupling and exercise intolerance. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628233 Thu, 26 Jan 2012 13:57:11 +0100 5628233 http://www.medworm.com/index.php?rid=5628232&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048492%2Fabstract%3Frss%3Dyes The term heart failure with preserved ejection fraction (HFpEF) has evolved to describe the broad clinical syndrome characterized by signs and symptoms of heart failure in patients in whom the ejection fraction (EF) falls within the low normal to normal range. This terminology is essentially descriptive, and implies neither etiology nor pathophysiology, although both continue to fuel vigorous debate. One of the most fundamental of these debates has been whether HFpEF is a truly distinct pathophysiologic entity from heart failure with reduced ejection fraction (HFrEF). While most would agree that the etiologic conditions that lead to heart failure differ between these 2 groups in the majority of cases, whether the pathophysiologic derangements that underlie the nearly identical signs and sy... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628232 Thu, 26 Jan 2012 13:57:11 +0100 5628232 http://www.medworm.com/index.php?rid=5628231&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048467%2Fabstract%3Frss%3Dyes Conclusions: As compared to patients with HFrEF, patients with HFpEF experience greater blood pressure reduction, less enhancement in cardiac output, and greater likelihood of stroke volume drop with vasodilators. These findings emphasize fundamental differences in the 2 HF phenotypes and suggest that more pathophysiologically targeted therapies are needed for HFpEF. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628231 Thu, 26 Jan 2012 13:57:10 +0100 5628231 http://www.medworm.com/index.php?rid=5628230&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034504%2Fabstract%3Frss%3Dyes Myocardial ischemia can occur without overt symptoms. In fact, asymptomatic (or silent) ST-segment depression during ambulatory electrocardiogram monitoring occurs more often than symptomatic ST-segment depression in patients with coronary artery disease. Initial studies documented that silent ischemia provided independent prediction of adverse outcomes in patients with known and unknown coronary artery disease. The ACIP (Asymptomatic Cardiac Ischemia Pilot Study) enrolled patients in the 1990s and found that revascularization was better than medical therapy in reducing silent ischemic episodes and possibly cardiovascular (CV) events. However, the more recent COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial found similar CV event rates between pa... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5628230 Thu, 26 Jan 2012 13:57:10 +0100 5628230 http://www.medworm.com/index.php?rid=5608421&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971200023X%2Fabstract%3Frss%3Dyes 359 Andreas Schuster, Geraint Morton, Amedeo Chiribiri, Divaka Perera, Jean-Louis Vanoverschelde, Eike Nagel (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608421 Fri, 20 Jan 2012 13:57:13 +0100 5608421 http://www.medworm.com/index.php?rid=5608420&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711052788%2Fabstract%3Frss%3Dyes The “ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring by Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain: A Report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography)” (J Am Coll Cardiol 2007;49:378–402) is no longer considered official policy of the American College of Cardiology Foundation because it has been superseded by the following article: (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608420 Fri, 20 Jan 2012 13:57:13 +0100 5608420 http://www.medworm.com/index.php?rid=5608417&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048261%2Fabstract%3Frss%3Dyes We welcome Drs. Kalra and Fenster's interest in our work delineating the association between renal function–based contrast dose and the risk of renal complications in patients undergoing percutaneous coronary intervention (). They argued that in high-risk patients, and especially among patients with cardiogenic shock, the incidence of contrast-induced nephropathy (CIN) is unacceptably high, even when the ratio of contrast volume to creatinine clearance is (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608417 Fri, 20 Jan 2012 13:57:13 +0100 5608417 http://www.medworm.com/index.php?rid=5608416&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971104825X%2Fabstract%3Frss%3Dyes The observational study by Gurm et al. () showed that the ratio of contrast volume to creatinine clearance (CV/CCC) is a simple tool that can help reduce the risk of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention. The most important preventive measure is reducing the CV, and this article focused on defining the dose range that would optimize patient safety. However, the proposed formula has several shortcomings in high-risk patients. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608416 Fri, 20 Jan 2012 13:57:13 +0100 5608416 http://www.medworm.com/index.php?rid=5608415&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048212%2Fabstract%3Frss%3Dyes We thank Drs. McCabe and Armstrong for their valuable comment in regards to our paper (). In general, we tend to agree with them but also want to mention that we clearly stated in the article that despite the best propensity-controlled analysis and given the risk of residual confounding, a randomized trial is required to definitively address this issue. We also agree that the results of patients in the single-treatment multivessel arm may be “biased” because of peri-procedural complications; however, as we also pointed out in the article, some of these procedures may have been instigated by a more complex and lengthy single procedure, such as contrast nephropathy, which might have been avoided with a more judiciously staged procedure strategy. Thus, these data were consistent with the ... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608415 Fri, 20 Jan 2012 13:57:13 +0100 5608415 http://www.medworm.com/index.php?rid=5608414&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048169%2Fabstract%3Frss%3Dyes Kornowski et al. () should be commended for attempting to validate the current guidelines regarding staged versus “one-time” stenting in the setting of an acute ST-segment elevation myocardial infarction. Their recent article in the Journal was a prespecified secondary analysis of the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) cohort. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608414 Fri, 20 Jan 2012 13:57:13 +0100 5608414 http://www.medworm.com/index.php?rid=5608413&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711047656%2Fabstract%3Frss%3Dyes A 14-year-old boy complained of intermittent palpitations and syncope. He also had mild mental retardation. His electrocardiogram showed type B Wolff-Parkinson-White (WPW) syndrome and left ventricular hypertrophy (LVH) (A). He underwent successful ablation, and his echocardiography (B, Online Videos 1, 3, and 4) and cardiovascular magnetic resonance imaging (C, Online Video 2) confirmed the concentric LVH; the thickness of the left ventricular posterior wall and septum were 15 mm and 14 mm, respectively. Serum creatine kinase was 2,301 U/l (normal range (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608413 Fri, 20 Jan 2012 13:57:13 +0100 5608413 http://www.medworm.com/index.php?rid=5608412&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711047668%2Fabstract%3Frss%3Dyes A 48-year-old Caucasian woman presented with 2 weeks of myalgias, arthralgias, headache, and neck stiffness. Total peripheral leukocyte count was 80.2 × 109/l with 72% eosinophils. A diagnosis of FIP1L1/PDGFRA-negative hypereosinophilic syndrome was made. The 12-lead electrocardiogram demonstrated inferolateral repolarization abnormalities (A). Serum troponin T was 0.25 ng/ml. Electrocardiography-gated cardiac magnetic resonance imaging demonstrated anterior, anterolateral, inferolateral, and inferior left ventricular (LV) wall thickening, with corresponding abnormal subendocardial T2 signal (C, white arrows) and delayed gadolinium enhancement (E, white arrows). The posterior mitral valve leaflet was tethered. The LV wall motion, right ventricle, and pericardium were normal. Subcutaneous ... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608412 Fri, 20 Jan 2012 13:57:13 +0100 5608412 http://www.medworm.com/index.php?rid=5608411&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048182%2Fabstract%3Frss%3Dyes Conclusions: IL-17A mainly produced by γδT cells plays a pathogenic role in myocardial I/R injury by inducing cardiomyocyte apoptosis and neutrophil infiltration. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608411 Fri, 20 Jan 2012 13:57:13 +0100 5608411 http://www.medworm.com/index.php?rid=5608410&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049096%2Fabstract%3Frss%3Dyes In recent years, much attention and controversy have surrounded the question of estrogen's role in heart disease prevention and/or progression in women. It is clear that cardiovascular risk increases as estrogen levels decrease in women. Conversely, in men there is an inverse relationship between androgen levels, which decrease with age, and the risk of cardiovascular disease (CVD). Whereas some attribute the increased risk in men and women to aging coincident with decreasing sex steroid levels, there is convincing evidence from animal and human studies that both androgens and estrogens affect the cardiovascular system and blood lipid profiles that contribute to the risk of CVD. Sex differences in pathology that may reflect differential sex steroid action include the fact that the incidenc... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608410 Fri, 20 Jan 2012 13:57:13 +0100 5608410 http://www.medworm.com/index.php?rid=5608409&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711047371%2Fabstract%3Frss%3Dyes Conclusions: E2 directly influences cardiac gene regulation, and E2 actions may be different between the sexes. Since E2 levels rise in older and/or obese men, pharmacological targeting of MYLIP in men with elevated E2 levels could possibly decrease their risk for the development or progression of cardiovascular disease. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608409 Fri, 20 Jan 2012 13:57:13 +0100 5608409 http://www.medworm.com/index.php?rid=5608408&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711047383%2Fabstract%3Frss%3Dyes In recent years, we have come a long way from categorizing all ankle-brachial indices (ABIs) above 0.90 as normal. Both borderline low and high ABIs present significant risk (). In this issue of the Journal, Arain et al. () at the Mayo Clinic document the risk of a high ABI with the largest such study to date. The authors provide us with remarkable data, presented clearly and concisely, on patients with “poorly compressible arteries” (PCA). The more common term for PCA is “high ABI,” since the ratio of the pressure at the ankle to the arm is falsely elevated by selective stiffening of the ankle, but not the brachial, arteries by medial arterial calcinosis (MAC). Such falsely elevated ABI levels may occur at ABI levels of 1.30, although 1.40, the cut point used by the authors, is a ... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608408 Fri, 20 Jan 2012 13:57:13 +0100 5608408 http://www.medworm.com/index.php?rid=5608407&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711047395%2Fabstract%3Frss%3Dyes Conclusions: Patients identified by noninvasive vascular testing to have poorly compressible leg arteries have poor survival, worse than those with a normal ABI or those with PAD. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608407 Fri, 20 Jan 2012 13:57:13 +0100 5608407 http://www.medworm.com/index.php?rid=5608404&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048170%2Fabstract%3Frss%3Dyes In this issue of the Journal, Arbab-Zadeh et al. () report on the influence of calcification and the pre-test likelihood of disease on the diagnostic accuracy of coronary computed tomography angiography (CTA) in a small multicenter study (CORE-64 [Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography]). Their report provides valuable insights into the importance of coronary calcification as an unresolved limitation of CTA. The original CORE-64 report pre-specified exclusion of patients with a calcium score >600 Agatston units, a criterion that eliminated 89 of 405 patients (22%) from the analysis (). In the current paper (), the authors have appropriately included such patients, documenting an important limitation in the diagnostic accuracy of CTA when appli... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608404 Fri, 20 Jan 2012 13:57:13 +0100 5608404 http://www.medworm.com/index.php?rid=5608403&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048194%2Fabstract%3Frss%3Dyes Objectives: The purpose of this study was to assess the impact of patient population characteristics on accuracy by computed tomography angiography (CTA) to detect obstructive coronary artery disease (CAD). Background: The ability of CTA to exclude obstructive CAD in patients of different pre-test probabilities and in presence of coronary calcification remains uncertain. Methods: For the CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) study, 371 patients underwent CTA and cardiac catheterization for the detection of obstructive CAD, defined as ≥50% luminal stenosis by quantitative coronary angiography (QCA). This analysis includes 80 initially excluded patients with a calcium score ≥600. Area under the receiver-operating characterist... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608403 Fri, 20 Jan 2012 13:57:13 +0100 5608403 http://www.medworm.com/index.php?rid=5608402&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048200%2Fabstract%3Frss%3Dyes Conclusions: According to our study, baseline anemia was not an independent predictor of all-cause mortality in outpatients with heart failure and accompanied severe renal dysfunction or advanced heart disease. Sustained anemia after optimizing heart failure treatment might imply worse prognosis independently of renal function and New York Heart Association functional class. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608402 Fri, 20 Jan 2012 13:57:13 +0100 5608402 http://www.medworm.com/index.php?rid=5608401&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711047644%2Fabstract%3Frss%3Dyes Heart failure of ischemic origin has become increasingly common over the last decade because of the improved survival of patients with acute myocardial infarction. Revascularization with coronary bypass grafting or percutaneous coronary intervention plays a pivotal role in patients with ischemic cardiomyopathy, although these interventions are often associated with relatively high peri-procedural risk. The pathophysiological substrate of ischemic cardiomyopathy is heterogeneous, varying from predominantly hibernating myocardium to irreversible scarring. There is evidence to suggest that patients with hibernating myocardium benefit most from revascularization, whereas medical therapy is associated with an adverse prognosis. Therefore, noninvasive testing is recommended by relevant guideline... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608401 Fri, 20 Jan 2012 13:57:13 +0100 5608401 http://www.medworm.com/index.php?rid=5581219&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711052661%2Fabstract%3Frss%3Dyes 197 Cédric Delhaye, Michael Mahmoudi, Ron Waksman (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581219 Fri, 13 Jan 2012 13:52:06 +0100 5581219 http://www.medworm.com/index.php?rid=5581217&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046675%2Fabstract%3Frss%3Dyes We enjoyed reading the systematic review and meta-analysis by Vlaar et al. () on the most appropriate percutaneous coronary intervention (PCI) strategy in patients with acute myocardial infarction (AMI) and concomitant multivessel disease (MVD). Despite the Bayesian analyses, this study is potentially limited by the chosen methodological approach. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581217 Fri, 13 Jan 2012 13:52:06 +0100 5581217 http://www.medworm.com/index.php?rid=5581216&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046584%2Fabstract%3Frss%3Dyes We thank Drs. Ren and Marchlinski for their interest in our paper. Their comments open 2 topics for further discussion. The first concerns the use of simulators for electrophysiology training. Indeed, it would be desirable to have a simulated procedure as realistic and complete as possible with several degrees of freedom within the simulation to render the device adaptable to the different methodologies that different centers may employ. In the case of transseptal catheterization, it should certainly include a large number of anatomic variants. The addition of intracardiac ultrasound (ICE) as an imaging tool that can also be used during simulated procedures would be valuable as well. In fact, it has been recommended that trainees become familiar with ICE for this and other procedures duri... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581216 Fri, 13 Jan 2012 13:52:06 +0100 5581216 http://www.medworm.com/index.php?rid=5581215&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046638%2Fabstract%3Frss%3Dyes In a recent issue of the Journal, De Ponti et al. () reported the results of comparing the transseptal catheterization (TSC) performance of electrophysiology fellows after simulator training (Sim-T) with those undergoing conventional training (Conv-T). The authors found better performance in the fellows who underwent Sim-T. In the Sim-T, the imaging technique was only fluoroscopy. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581215 Fri, 13 Jan 2012 13:52:06 +0100 5581215 http://www.medworm.com/index.php?rid=5581214&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046651%2Fabstract%3Frss%3Dyes We read with interest the thoughtful review by Downing and Balady () describing in detail the pathophysiology of exercise impairment in heart failure (HF) and the beneficial role of exercise training in this population. The authors outline the many pathophysiological effects of exercise but fail to include the salutary effects of exercise on behavioral conditions, including depression and depressive symptoms, which are estimated to occur in 24% to 42% of HF patients (). When present, depression and depressive symptoms are associated with poorer survival and greater use of healthcare services, including hospitalization, emergency room visits, and outpatient services. We and others have demonstrated the beneficial effects of exercise in the treatment of depression in the general population, ... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581214 Fri, 13 Jan 2012 13:52:06 +0100 5581214 http://www.medworm.com/index.php?rid=5581213&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046572%2Fabstract%3Frss%3Dyes Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited cardiomyopathy characterized by fibrofatty replacement of the ventricular myocardium, right ventricular (RV) dysfunction, and ventricular arrhythmias. The Johns Hopkins ARVD Program Registry, which was established in 1995 to provide clinical care for patients with ARVD/C and to study this disease, currently consists of over 1,000 patients, family members, and borderline phenotypes. From this registry, we sought to define the clinical characteristics, pre-transplant course, and indications for and outcomes of those who underwent cardiac transplantation. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581213 Fri, 13 Jan 2012 13:52:06 +0100 5581213 http://www.medworm.com/index.php?rid=5581212&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046559%2Fabstract%3Frss%3Dyes An 85-year-old man with chronic kidney disease and cardiomegaly presented with atrial fibrillation. Echocardiography revealed a large spherical structure adjacent to the anterolateral left ventricular wall (A). Thoracic magnetic resonance imaging confirmed that the structure was anterior and superior to the left ventricle (B and C, Online Videos 1 and 2). Cardiac magnetic resonance imaging revealed a large (85 × 100 × 83 mm) coronary artery aneurysm close to the main pulmonary artery (C, Online Video 3). Although the left main coronary artery had a normal origin, its course was displaced posteriorly. The aneurysm arose from the proximal left anterior descending artery. It was separate from the left ventricle and main pulmonary artery, which appeared normal (D, Online Video 3). (Source: J... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581212 Fri, 13 Jan 2012 13:52:06 +0100 5581212 http://www.medworm.com/index.php?rid=5581211&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046663%2Fabstract%3Frss%3Dyes A 68-year-old woman with severe functional mitral regurgitation was referred for a percutaneous transvenous mitral annuloplasty (PTMA) procedure. Multislice computed tomography was performed with 3-dimensional reconstruction and color rendering (A). Three rods were inserted inside the 7-F 3-lumen Viacor PTMA device to produce significant pressure on the posterolateral part of the mitral annulus (C, arrows). As evaluated by transoesophageal echocardiography, mitral regurgitation was acutely reduced (B to D). However, control angiography revealed complete occlusion of the circumflex artery (E to G). Occlusion persisted until removal of the 3 rods (H). The PTMA procedure was aborted, and the patient was continued on medical therapy. The circumflex artery courses between the mitral annulus and... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581211 Fri, 13 Jan 2012 13:52:06 +0100 5581211 http://www.medworm.com/index.php?rid=5581209&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046298%2Fabstract%3Frss%3Dyes In the United States, nearly 13% of adults aged 20 years and older have type 2 diabetes mellitus (T2DM), and its prevalence is still increasing (). Microvascular and macrovascular abnormalities are common in patients with T2DM and are related to the severity and duration of hyperglycemia (). Thus, treatment of hyperglycemia is an important way to prevent or delay diabetic vascular complications. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581209 Fri, 13 Jan 2012 13:52:06 +0100 5581209 http://www.medworm.com/index.php?rid=5581208&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046304%2Fabstract%3Frss%3Dyes Conclusions: A DPP-4 inhibitor, DFS, exhibited antiatherogenic effects through augmenting GLP-1 activity in macrophages and endothelium. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581208 Fri, 13 Jan 2012 13:52:06 +0100 5581208 http://www.medworm.com/index.php?rid=5581207&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046687%2Fabstract%3Frss%3Dyes Conclusions: Intramyocardial injection of autologous platelet gel ameliorated cardiac dysfunction after myocardial infarction. The striking functional benefits, the simplicity of manufacturing, and the potentially autologous nature of this biomaterial provide impetus for further translation. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581207 Fri, 13 Jan 2012 13:52:06 +0100 5581207 http://www.medworm.com/index.php?rid=5581206&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046547%2Fabstract%3Frss%3Dyes Conclusions: Urinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581206 Fri, 13 Jan 2012 13:52:06 +0100 5581206 http://www.medworm.com/index.php?rid=5581205&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046560%2Fabstract%3Frss%3Dyes Management of patients with asymptomatic severe aortic stenosis (AS) and preserved ejection fraction (EF) continues to puzzle cardiologists. The open questions begin with the very definition of the lesion. American guidelines require a valve area 40 mm Hg (), but on the basis of the landmark report of Otto et al. (), a peak velocity >4 m/s is also regarded as a marker of severe stenosis. However, mean gradients are usually approximately one-half of peak gradients in aortic stenosis, and thus a 4-m/s peak gradient predicts a peak gradient of 64 mm Hg, which typically will correspond to a mean gradient lower than 40 mm Hg, the cutoff for severe AS cited in the preceding text. The European guidelines, in turn, use an even higher >50-mm Hg cutoff for mean gradient in severe AS (). Thus the cut... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581205 Fri, 13 Jan 2012 13:52:06 +0100 5581205 http://www.medworm.com/index.php?rid=5581204&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046614%2Fabstract%3Frss%3Dyes Conclusions: The use of the new proposed AS grading classification integrating valve area and flow-gradient patterns allows a better characterization of the clinical outcome of patients with asymptomatic severe AS. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581204 Fri, 13 Jan 2012 13:52:06 +0100 5581204 http://www.medworm.com/index.php?rid=5581203&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046596%2Fabstract%3Frss%3Dyes Until recently, the diagnosis of pulmonary arterial hypertension (PAH) heralded a uniformly poor prognosis. However, improvement in quality of life and survival has ensued on the backbone of development of carefully targeted therapeutics (). A similar recognition that the development of pulmonary hypertension (PH) in left heart disease (LHD) signals poor prognosis has led to a flurry of investigational activity in this arena (). Indeed, various etiologic substrates such as left ventricular dysfunction, mitral regurgitation, and diastolic dysfunction, all appear to exhibit pulmonary venous hypertension, presumably by sharing a common pathophysiological pathway. It is commonly thought that an increased left ventricular (LV) filling pressure results in elevated left atrial and pulmonary venou... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581203 Fri, 13 Jan 2012 13:52:06 +0100 5581203 http://www.medworm.com/index.php?rid=5581202&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046602%2Fabstract%3Frss%3Dyes Conclusions: Among community patients with HF, PASP strongly predicts death and provides incremental and clinically relevant prognostic information independently of known predictors of outcomes. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581202 Fri, 13 Jan 2012 13:52:06 +0100 5581202 http://www.medworm.com/index.php?rid=5581201&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971104664X%2Fabstract%3Frss%3Dyes Conclusions: The modified procedural strategy of transapical TAVI with a balloon-expandable prosthesis was associated with a low incidence of relevant prosthetic regurgitation. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581201 Fri, 13 Jan 2012 13:52:06 +0100 5581201 http://www.medworm.com/index.php?rid=5581200&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046626%2Fabstract%3Frss%3Dyes Due to its protective effect on the brain and the myocardium, hypothermia therapy (HT) has been extensively studied in cardiac arrest patients with coma as well as in patients presenting with acute myocardial infarction (MI). In the setting of cardiac arrest, randomized studies have shown that HT decreases mortality and improves neurological outcomes. Subsequent guidelines have therefore recommended cooling (32°C to 34°C) for 12 to 24 h in unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest due to ventricular fibrillation. Observational studies have also confirmed the feasibility of this therapy in clinical practice and support its early application in patients with nonventricular fibrillation cardiac arrest and in post-resuscitation circulatory s... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581200 Fri, 13 Jan 2012 13:52:06 +0100 5581200 http://www.medworm.com/index.php?rid=5559722&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711051965%2Fabstract%3Frss%3Dyes 97 Anh L. Bui, Gregg C. Fonarow (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559722 Wed, 04 Jan 2012 18:27:40 +0100 5559722 http://www.medworm.com/index.php?rid=5559721&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711051126%2Fabstract%3Frss%3Dyes Duivenvoorden R, Holleboom AG, van den Bogaard B, et al. Cholesterol Acyltransferase Gene Mutations Have Accelerated Atherogenesis as Assessed by Carotid 3.0-T Magnetic Resonance Imaging: Carriers of Lecithin. J Am Coll Cardiol 2011;58:2481–7. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559721 Wed, 04 Jan 2012 18:27:40 +0100 5559721 http://www.medworm.com/index.php?rid=5559720&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046201%2Fabstract%3Frss%3Dyes We did not test the HAS-BLED score in our report () because there was no internal validation in its original report (). Risk prediction models are prone to overconfidence; for >25 years, the reporting standard has been internal validation through split-sample testing, bootstrapping, or other techniques (). Further, the Euro Heart Survey, on which HAS-BLED was based, is problematic for follow-up studies of bleeds due to a relatively small number of outcome events, missing follow-up in >30% of patients, and incomplete information on longitudinal warfarin use (). Incorporation of HAS-BLED into guidelines is not a substitute for good methodologic practice. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559720 Wed, 04 Jan 2012 18:27:40 +0100 5559720 http://www.medworm.com/index.php?rid=5559719&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046225%2Fabstract%3Frss%3Dyes Fang et al. () describe their bleeding risk scheme for anticoagulated patients with atrial fibrillation (AF), which includes 5 weighted risk factors: anemia, severe renal disease, age 75 years and older, previous hemorrhage, and diagnosed hypertension (). (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559719 Wed, 04 Jan 2012 18:27:40 +0100 5559719 http://www.medworm.com/index.php?rid=5559718&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046237%2Fabstract%3Frss%3Dyes We read with interest the report of all-cause mortality in patients with Fidelis leads as compared with those with nonadvisory leads (). Among 1,030 Fidelis patients (Minneapolis, Minnesota) and 1,641 Quattro patients (Minneapolis, Minnesota) over a mean follow-up period of 34.4 and 39.9 months, respectively, there was no difference in adjusted survival rates. The authors contend that their data support the current manufacturer's strategy of “continued clinical follow-up with the addition of the Lead Integrity Alert (LIA)” and conclude that this “argues against prophylactic removal of a normally functioning Fidelis lead” (). In the accompanying editorial, Faddis () states that these data by Morrison et al. () “provide valuable guidance” with respect to lead management strategie... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559718 Wed, 04 Jan 2012 18:27:40 +0100 5559718 http://www.medworm.com/index.php?rid=5559717&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046171%2Fabstract%3Frss%3Dyes Real-time magnetic resonance imaging (rtMRI) is considered attractive for guiding transarterial aortic valve implantation (TAVI). Compared with X-ray fluoroscopy, rtMRI offers unrestricted scan plane orientation and an unsurpassed soft-tissue contrast with simultaneous device visualization, potentially allowing enhanced positioning accuracy together with online monitoring of cardiac function and immediate detection of complications. Additionally, MRI offers noninvasive assessment of cardiovascular anatomy and function for preinterventional screening as well as immediate morphologic and functional assessment of the implanted prothesis and may, thus, be envisioned as a single comprehensive imaging modality for TAVI. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559717 Wed, 04 Jan 2012 18:27:40 +0100 5559717 http://www.medworm.com/index.php?rid=5559716&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046110%2Fabstract%3Frss%3Dyes A 47-year-old man presented with dyspnea and anasarca, and was found to have jugular venous distension, pleural effusions, and ascites. Three years earlier, he had undergone surgery and radiotherapy for esophageal cancer. Computed tomography revealed pericardial thickening (A). Echocardiography revealed a septal bounce (Online Video 1), plethoric inferior vena cava, dynamic variation in hepatic vein (B) and transmitral flow velocities and prominent mid-diastolic flow or L-wave during expiration (C). Radical pericardiectomy was performed for relief of constrictive pericarditis. Post-operatively, respirophasic Doppler variation was not observed (D). (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559716 Wed, 04 Jan 2012 18:27:40 +0100 5559716 http://www.medworm.com/index.php?rid=5559715&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046250%2Fabstract%3Frss%3Dyes A 54-year-old man presented with acute coronary syndrome. Left heart catheterization found significant left anterior descending (LAD) artery disease and a critical lesion of the distal right coronary artery. Ventriculogram revealed extravasation of dye into a large cavity lateral to the left ventricle (LV) (A, Online Video 1). A stent was placed in the right coronary artery, resolving the presenting symptoms. An echocardiogram confirmed normal left ventricular systolic function and visualized a muscular, saccular structure communicating with the LV (B, Online Video 2). Magnetic resonance imaging demonstrated prominent trabeculation without thrombus (C, Online Video 3). Delayed enhancement images did not suggest scar. The man subsequently underwent elective mammary graft to the LAD artery a... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559715 Wed, 04 Jan 2012 18:27:40 +0100 5559715 http://www.medworm.com/index.php?rid=5559711&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046195%2Fabstract%3Frss%3Dyes During the last decades, intensive investigation has revealed diverse pathophysiological mechanisms of adverse remodeling after myocardial infarction (MI), leading to several therapeutic approaches in clinical care of patients after MI. As a consequence, improved clinical management has significantly lowered morbidity and mortality. Despite major advances in pharmacological treatment of remodeling, such as the introduction of angiotensin-converting enzyme inhibitors () and beta-blockers (), patients surviving an MI are still facing the development of heart failure. Most basic and clinical science heart failure studies have focused so far on the remodeling phase, neglecting the importance of early wound healing after MI for the development of a competent infarct scar and subsequently for cl... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559711 Wed, 04 Jan 2012 18:27:40 +0100 5559711 http://www.medworm.com/index.php?rid=5559710&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046006%2Fabstract%3Frss%3Dyes Conclusions: This study shed light on the innate inflammatory response in remote myocardium after MI. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559710 Wed, 04 Jan 2012 18:27:39 +0100 5559710 http://www.medworm.com/index.php?rid=5559709&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046183%2Fabstract%3Frss%3Dyes Atrial fibrillation (AF) ablation has offered the promise to free patients of symptoms of palpitations, dyspnea, and fatigue, as well as eliminate the need for use of chronic drug therapy with agents that sometimes have significant risks, cost, and inconvenience for the patient. The belief among many is that elimination of symptomatic AF with ablative procedures will also restore patients to the AF-free natural history curve, with reduction in stroke and mortality long term. These advantages are compelling, and they explain the wide adoption of a procedure that is technically challenging and has results that can be characterized as mediocre at best. Despite the fact that reports have claimed procedural success rates of 76% to 91% (), carefully monitored clinical trials performed by experie... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559709 Wed, 04 Jan 2012 18:27:39 +0100 5559709 http://www.medworm.com/index.php?rid=5559708&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971104602X%2Fabstract%3Frss%3Dyes Conclusions: Periprocedural complications occurred in 1 of 20 patients undergoing AF ablation, and all-cause and arrhythmia-related rehospitalizations were common. Older age, female sex, prior AF hospitalizations, and recent hospital procedure experience were associated with a higher risk of complications and/or 30-day readmission after AF ablation. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559708 Wed, 04 Jan 2012 18:27:39 +0100 5559708 http://www.medworm.com/index.php?rid=5559707&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046213%2Fabstract%3Frss%3Dyes The past 2 years have seen the culmination of a number of important pivotal trials in percutaneous structural heart disease intervention, including PARTNER A and B (Placement of AoRTic TraNscathetER Valve Trial), EVEREST II (Endovascular Valve Edge-in-Edge REpair STudy), CLOSURE I, and PROTECT AF (Embolic Protection of Patients in Atrial Fibrillation Trial), all attempting to provide a high-level evidence base for selected patients with aortic stenosis, mitral regurgitation (MR), patent foramen ovale, and atrial fibrillation, respectively. In general, these studies have yielded more nuanced results than their predecessor registries and have dampened some of the enthusiasm within the cardiology community for their major innovations. The outcomes did not produce undisputed winners. The EVERE... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559707 Wed, 04 Jan 2012 18:27:39 +0100 5559707 http://www.medworm.com/index.php?rid=5559706&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046018%2Fabstract%3Frss%3Dyes Conclusions: The MitraClip device reduced MR in a majority of patients deemed at high risk of surgery, resulting in improvement in clinical symptoms and significant left ventricular reverse remodeling over 12 months. (Pivotal Study of a Percutaneous Mitral Valve Repair System [EVEREST II]; NCT00209274) (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559706 Wed, 04 Jan 2012 18:27:39 +0100 5559706 http://www.medworm.com/index.php?rid=5559705&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046146%2Fabstract%3Frss%3Dyes Percutaneous aortic valve replacement (PAVR) is an exceptionally innovative procedure that will undoubtedly alter the way we treat patients with severe aortic stenosis. A procedure once reliant on the operative visual information and feedback afforded to the cardiovascular surgeon is now supplanted by a multitude of imaging technologies available to the interventional cardiologist. Already since the advent of this technology, interventionists have become more cognizant of the intricate anatomopathological relationships of the aortic valve complex. Unfortunately to date, no single imaging modality provides all of the necessary anatomical and functional information needed for safe and effective transcatheter valve implantation. It is now more imperative for us to be aware of the many differe... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559705 Wed, 04 Jan 2012 18:27:39 +0100 5559705 http://www.medworm.com/index.php?rid=5559704&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046134%2Fabstract%3Frss%3Dyes Conclusions: The aortic annulus, generally elliptic, assumes a more round shape in systole, thus increasing CSA without substantial change in perimeter. Perimeter changes are negligible in patients with calcified valves, because tissue properties allow very little expansion. Aortic annulus perimeter appears therefore ideally suited for accurate sizing in transcatheter aortic valve implantation. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559704 Wed, 04 Jan 2012 18:27:39 +0100 5559704 http://www.medworm.com/index.php?rid=5559703&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971104616X%2Fabstract%3Frss%3Dyes Conclusions: Vascular complications occur more often if the minimal artery diameter is smaller than the external sheath diameter, in the presence of moderate or severe calcification, and in patients with peripheral vascular disease. With careful patient selection, advanced interventional techniques, and a fully percutaneous procedure, marked reductions in vascular and bleeding complications can be achieved. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559703 Wed, 04 Jan 2012 18:27:39 +0100 5559703 http://www.medworm.com/index.php?rid=5559702&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046249%2Fabstract%3Frss%3Dyes This study assessed the comparative effectiveness of drug-eluting stents (DES) versus bare-metal stents (BMS) among patients ≥85 years of age. Background: Despite an aging population, little is known about the comparative effectiveness of DES versus BMS among patients age ≥85 years undergoing percutaneous coronary intervention (PCI). Methods: We examined 471,006 PCI patients age ≥65 years at 947 hospitals in the National Cardiovascular Data Registry between 2004 and 2008 and linked to Medicare claims data. Long-term outcomes (median follow-up 640.8 ± 423.5 days) were compared between users of DES and BMS. Results: Patients age ≥85 years comprise an increasing proportion of PCIs performed among elderly subjects, yet rates of DES use declined the most in this age group. Compar... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559702 Wed, 04 Jan 2012 18:27:39 +0100 5559702 http://www.medworm.com/index.php?rid=5559701&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046122%2Fabstract%3Frss%3Dyes With a prevalence of 5.8 million in the United States alone, heart failure (HF) is a common syndrome associated with substantial morbidity, mortality, and healthcare expenditures. Close to 1 million HF hospitalizations occur annually in the United States, with the majority of these resulting from worsening congestion in patients previously diagnosed with HF. An estimated $37.2 billion is spent each year on HF in the United States. These statistics emphasize the need to develop and implement more effective strategies to assess, monitor, and treat HF. It has also become increasingly apparent that interventions geared toward identifying and monitoring subclinical congestion would be of value in the home management of chronic HF. Earlier identification and treatment of congestion together with... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559701 Wed, 04 Jan 2012 18:27:39 +0100 5559701 http://www.medworm.com/index.php?rid=5581210&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048297%2Fabstract%3Frss%3Dyes Conclusions: The results of this study demonstrate an important paradigm shift toward the selection of lower surgical risk patients for TAVI. Significantly better clinical outcomes can be expected in lower than in higher surgical risk patients undergoing TAVI. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581210 Mon, 26 Dec 2011 05:00:00 +0100 5581210 http://www.medworm.com/index.php?rid=5524305&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711050480%2Fabstract%3Frss%3Dyes 9 Bryan G. Schwartz, Laurence A. Levine, Gary Comstock, Vera J. Stecher, Robert A. Kloner (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524305 Thu, 22 Dec 2011 02:25:47 +0100 5524305 http://www.medworm.com/index.php?rid=5524304&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971104993X%2Fabstract%3Frss%3Dyes Giugliano RP, Braunwald E. The Year in Non–ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2011;58:2342–54. The quality of on the final printed version was distorted and poor quality. A revised version is printed below along with the complete legend. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524304 Thu, 22 Dec 2011 02:25:47 +0100 5524304 http://www.medworm.com/index.php?rid=5524303&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045311%2Fabstract%3Frss%3Dyes Dr. Abela and colleagues correctly point out that the use of ethanol, a dehydrating agent, in the preparation of the coronary thrombi samples for scanning electron microscopy may have dissolved cholesterol crystals and led to an underestimation of the true content of cholesterol crystals in the coronary thrombi retrieved by thromboaspiration. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524303 Thu, 22 Dec 2011 02:25:47 +0100 5524303 http://www.medworm.com/index.php?rid=5524302&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045335%2Fabstract%3Frss%3Dyes In a recent study, Silvain et al. () evaluated extracted thrombi obtained by thromboaspiration in 44 samples from consecutive patients with ST-segment elevation myocardial infarction using scanning electron microscopy. Also, various plasma biomarkers (troponin I, ultrasensitive C-reactive protein, interleukin-6, plasminogen activator inhibitor-1, soluble CD40 ligand, and tumor necrosis factor-alpha) and plasma fibrin clot viscoelastic properties were measured in peripheral blood. Coronary thrombi were composed mainly of fibrin (55.9 ± 18%), with platelets (16.8 ± 18%), erythrocytes (11.5 ± 9%), cholesterol crystals (5.2 ± 8.4%), and leukocytes (1.3 ± 2.0%). Also, the investigators demonstrated that fibrin content increased with ischemia duration and that ischemic time was the primary ... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524302 Thu, 22 Dec 2011 02:25:47 +0100 5524302 http://www.medworm.com/index.php?rid=5524301&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045323%2Fabstract%3Frss%3Dyes To the Editor: The sympathetic nervous system plays an important role in ventricular arrhythmogenesis. Left cardiac sympathetic denervation (LCSD) decreases the incidence of ventricular arrhythmias (VAs) and sudden cardiac death in patients with severe VAs (). However, when LCSD is ineffective in suppressing VAs, adjunctive right cardiac sympathetic denervation may be an option. In humans, the safety and feasibility of bilateral cardiac sympathetic denervation (BCSD) in the management of VAs remains unclear. The present study was undertaken to assess the benefit of BCSD for the acute management of persistent VAs. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524301 Thu, 22 Dec 2011 02:25:47 +0100 5524301 http://www.medworm.com/index.php?rid=5524300&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045220%2Fabstract%3Frss%3Dyes A previously healthy 38-year-old man presented to our hospital with sudden-onset dyspnea, sharp, stabbing chest pain, and a clinical picture of cardiogenic shock. Echocardiography revealed a severely dilated ascending aorta beyond the sinotubular junction (A, Online Video 1), with moderate aortic insufficiency (Online Video 2). There was a large pericardial effusion with thrombus inside (Online Videos 1 and 3). Computed tomographic angiography was performed, with a presumptive diagnosis of aortic dissection with rupture into the pericardium, and demonstrated a dilated ascending aorta 100 mm in diameter (B, C) compressing the right atrium, with no visible intimal tear or flap. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524300 Thu, 22 Dec 2011 02:25:47 +0100 5524300 http://www.medworm.com/index.php?rid=5524299&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045207%2Fabstract%3Frss%3Dyes A 6-year-old female with tetralogy of Fallot whose echocardiogram and cardiac catheterization showed pulmonary atresia, ventricular septal defect, aortopulmonary collaterals, and collaterals from the coronary arteries to the main pulmonary artery. Computed tomography (2 × 64-slice, 0.75-mm reconstruction; Online Video) with prospective electrocardiographic gating showed a large collateral from the right coronary artery ostium and another collateral arising from the left coronary artery ostium supplying a small main pulmonary artery (A and B). There was severe hypoplasia and isolation of the right pulmonary artery before bifurcation into upper and lower lobe branches, which were supplied by multiple aortopulmonary collaterals (A and C). This rare variant of tetralogy of Fallot has been pre... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524299 Thu, 22 Dec 2011 02:25:47 +0100 5524299 http://www.medworm.com/index.php?rid=5524298&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711050388%2Fabstract%3Frss%3Dyes While the answer to the question “What do San Jose, Phoenix, Dallas, and San Diego have in common?” may not be uppermost in your mind, it has great relevance to our mission. We have become inured to the rather ubiquitous notion of zeroes—lots of zeroes. Most recently, our politicians have struggled to understand the enormity of $1,500,000,000,000—a struggle which at this time appears to have rendered them paralyzed. The threat that we can be swamped by the enormity of zeroes is very real. The chance to make a difference in zeroes, however, is also very real. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524298 Thu, 22 Dec 2011 02:25:47 +0100 5524298 http://www.medworm.com/index.php?rid=5524297&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711044573%2Fabstract%3Frss%3Dyes This article outlines Section efforts to date and highlights significant successes to date. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524297 Thu, 22 Dec 2011 02:25:47 +0100 5524297 http://www.medworm.com/index.php?rid=5524296&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045244%2Fabstract%3Frss%3Dyes Conclusions: The relationship between BP and overall CV risk had a similar pattern in diabetic and nondiabetic patients over a wide range of baseline and in-treatment BP values although, for the same systolic BP, a higher risk is observed in diabetic patients. (Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial [ONTARGET]; NCT00153101) (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524296 Thu, 22 Dec 2011 02:25:47 +0100 5524296 http://www.medworm.com/index.php?rid=5524295&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045281%2Fabstract%3Frss%3Dyes In addition to lowering low-density lipoprotein cholesterol, statins improve vascular function by cholesterol-independent effects in experimental models. These extrahepatic effects are often called “pleiotropic”; however, specific underlying molecular mechanisms have been identified in animal and cell culture studies. They relate to the inhibition of isoprenylation of small G proteins. Inhibition of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase blocks the synthesis of isoprenoids, which are upstream of cholesterol (). Therefore, statins inhibit isoprenoid and cholesterol synthesis at the same time, making it difficult to assess the relative contribution of the 2 for the reduction of vascular events. One could speculate that their importance may depend on the clinical situat... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524295 Thu, 22 Dec 2011 02:25:47 +0100 5524295 http://www.medworm.com/index.php?rid=5524294&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045268%2Fabstract%3Frss%3Dyes Conclusions: There is a strong independent association between myocardial O2−/ONOO− and in-hospital complications after cardiac surgery. Both myocardial O2− and ONOO− are reduced by pre-operative statin treatment, through a Rac1-mediated suppression of NADPH oxidase activity. These findings suggest that inhibition of myocardial NADPH oxidases may contribute to the beneficial effect of statins in patients undergoing cardiac surgery. (Effects of Atorvastatin on Endothelial Function, Vascular and Myocardial Redox State in High Cardiovascular Risk Patients; NCT01013103) (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524294 Thu, 22 Dec 2011 02:25:47 +0100 5524294 http://www.medworm.com/index.php?rid=5524293&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045293%2Fabstract%3Frss%3Dyes Atrial fibrillation is the most common cardiac arrhythmia, affecting about 3 million adults in the United States and costing over 26 million dollars annually to treat (). As a common cause of symptoms and precipitant of decompensated heart failure, atrial fibrillation contributes greatly to cardiovascular morbidity and disability. Many of the symptoms and adverse outcomes associated with untreated atrial fibrillation may be attributed to the typically rapid ventricular rate, and therefore, a cornerstone of management is rate control. Rate control for atrial fibrillation can ameliorate symptoms and improve outcomes, and in prospective, randomized testing, shows no disadvantage compared with rhythm control (Atrial Fibrillation Follow-Up Investigation of Rhythm Management [AFFIRM]) (). Nevert... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524293 Thu, 22 Dec 2011 02:25:47 +0100 5524293 http://www.medworm.com/index.php?rid=5524292&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045256%2Fabstract%3Frss%3Dyes Conclusions: We have identified a common β1-AR polymorphism, G389R, that is associated with adequate response to rate-control therapy in AF patients. Gly389 is a loss-of-function variant; consequently, for the same adrenergic stimulation, it produces reduced levels of adenyl cyclase, and hence, attenuates the β-adrenergic cascade. Mechanistically, the effect of rate-control drugs will be synergistic with that of the Gly389 variant, which could possibly explain our findings. These findings represent a step forward in the development of a long-term strategy of selecting treatment options in AF based on genotype. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524292 Thu, 22 Dec 2011 02:25:47 +0100 5524292 http://www.medworm.com/index.php?rid=5524291&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045232%2Fabstract%3Frss%3Dyes Brugada syndrome (BrS) is a rare inheritable disorder identified by characteristic abnormalities in the anterior electrocardiographic (ECG) leads (). The main clinical problem is sudden cardiac death (SCD). The only accepted form of SCD prevention is an implantable cardioverter defibrillator (ICD). However, the patient who undergoes ICD implantation is exposed to pain, inconvenience, and a wide variety of serious mechanical and psychological complications that might have a major negative impact on quality of life, and result in considerable cost to healthcare systems. The clinician must decide whether or not to recommend ICD insertion and must justify the decision and reassure all those concerned—not only the patient but also family, friends, and other healthcare providers—that that th... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524291 Thu, 22 Dec 2011 02:25:47 +0100 5524291 http://www.medworm.com/index.php?rid=5524290&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971104530X%2Fabstract%3Frss%3Dyes Objectives: The PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) prospective registry was designed to assess the predictive accuracy of sustained ventricular tachycardia/ventricular fibrillation (VTs/VF) inducibility and to identify additional predictors of arrhythmic events in Brugada syndrome patients without history of VT/VF. Background: Brugada syndrome is a genetic disease associated with increased risk of sudden cardiac death. Even though its value has been questioned, inducibility of VTs/VF is widely used to select candidates to receive a prophylactic implantable defibrillator, and its accuracy has never been addressed in prospective studies with homogeneous enrolling criteria. Methods: Patients with a spontaneous or drug-induced type I electrocardiogram (ECG) and w... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524290 Thu, 22 Dec 2011 02:25:47 +0100 5524290 http://www.medworm.com/index.php?rid=5524289&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711045219%2Fabstract%3Frss%3Dyes Objectives: The aim of this study was to determine renal outcomes after left ventricular assist device (LVAD) implantation. Background: Renal dysfunction before LVAD placement is frequent, and it is unclear whether it is due to primary renal disease or to poor perfusion. Methods: A retrospective single-center analysis was conducted in 83 consecutive patients implanted with HeartMate II continuous-flow LVADs (Thoratec Corp., Pleasanton, California). Calculated glomerular filtration rate (GFR) was assessed on admission and 1, 3, and 6 months after implantation. To define predictors for improvement in GFR, clinical variables were examined in patients with decreased renal function (GFR (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524289 Thu, 22 Dec 2011 02:25:47 +0100 5524289 http://www.medworm.com/index.php?rid=5524288&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711044597%2Fabstract%3Frss%3Dyes Femoropopliteal in-stent restenosis (ISR) remains one of the most frustrating problems for the endovascular specialist. It is relatively common, occurring in 18% to 40% of patients within the first year after femoropopliteal artery stenting ( ). Femoropopliteal ISR is even more common after stenting of longer lesions (>15 cm) and may occur in association with femoropopliteal stent fracture ( ). Despite the frequent occurrence of femoropopliteal ISR in clinical practice, there are few data available regarding the effectiveness of endovascular interventions for this condition ( ). Experience to date suggests that restenotic lesions can be treated with high immediate procedural success, but durable long-term patency remains elusive. Dick et al. ( ) compared balloon angioplasty to cutting ball... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524288 Thu, 22 Dec 2011 02:25:47 +0100 5524288 http://www.medworm.com/index.php?rid=5524287&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711044585%2Fabstract%3Frss%3Dyes Conclusions: Restenotic patterns after FP stenting are important predictors of recurrent ISR and occlusion. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524287 Thu, 22 Dec 2011 02:25:47 +0100 5524287 http://www.medworm.com/index.php?rid=5524286&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971104527X%2Fabstract%3Frss%3Dyes Phosphodiesterase-5 inhibitors (PDE5Is) improve erectile function by enhancing nitric oxide availability in the penis and its supplying vasculature, resulting in vasodilation and increased blood flow. PDE5Is might benefit cardiovascular diseases because phosphodiesterase-5 is also located elsewhere in the body, including the pulmonary and systemic vasculature and in hypertrophied myocardium. PDE5Is are approved for pulmonary arterial hypertension, given that they improved several hemodynamic and clinical parameters in large randomized trials. Initial evidence suggests that PDE5Is benefit patients with congestive heart failure and secondary pulmonary hypertension. PDE5Is seem to improve hemodynamic and clinical parameters in patients with high-altitude pulmonary edema (HAPE) and high-altitu... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524286 Thu, 22 Dec 2011 02:25:47 +0100 5524286 http://www.medworm.com/index.php?rid=5524285&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711050376%2Fabstract%3Frss%3Dyes (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5524285 Thu, 22 Dec 2011 02:25:47 +0100 5524285 http://www.medworm.com/index.php?rid=5559714&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048303%2Fabstract%3Frss%3Dyes The paper by Amat-Santos et al. () in this issue of the Journal deserves attention because of its originality and its potential implications concerning the post-procedural management of patients undergoing transcatheter aortic valve implantation (TAVI). (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559714 Mon, 19 Dec 2011 05:00:00 +0100 5559714 http://www.medworm.com/index.php?rid=5559713&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048315%2Fabstract%3Frss%3Dyes Conclusions: NOAF occurred in about one-third of the patients with no prior history of AF undergoing TAVI and its incidence was increased in patients with larger LA size and those undergoing transapical TAVI. NOAF was associated with a higher rate of stroke/systemic embolism, but not a higher mortality, at 30 days and at 1-year follow-up. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559713 Mon, 19 Dec 2011 05:00:00 +0100 5559713 http://www.medworm.com/index.php?rid=5559712&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711046158%2Fabstract%3Frss%3Dyes Conclusions: Hb is a stimulus for macrophage differentiation in human atherosclerotic plaques. A decrease in macrophage intracellular iron plays an important role in this nonfoam cell phenotype by reducing ROS, which drives transcription of ABC transporters through activation of LXRα. Reduction of macrophage intracellular iron may be a promising avenue to increase macrophage reverse cholesterol transport. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5559712 Mon, 12 Dec 2011 05:00:00 +0100 5559712 http://www.medworm.com/index.php?rid=5486588&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711049126%2Fabstract%3Frss%3Dyes 2615 Aboli A. Rane, Karen L. Christman (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486588 Sat, 10 Dec 2011 02:32:49 +0100 5486588 http://www.medworm.com/index.php?rid=5486585&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034711%2Fabstract%3Frss%3Dyes We thank Dr. Jeong and colleagues for their comments with regard to our study (). We well know that previous studies investigated on-clopidogrel platelet reactivity (PR) through follow-up (). Nevertheless, these findings were observations in studies planned for other aims. Our study is the first investigating the incidence of clopidogrel poor response at baseline versus that at 1 month as the primary endpoint and assessing the different influence over time of genetic and environmental PR determinants. Principally, 3 points were raised: the first concerns the timing of measurements with respect to the last dose administration, the second refers to the occurrence of adverse events, and the third touches on the independent determinants of bleeding. Firstly, in our study, the maintenance dose ... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486585 Sat, 10 Dec 2011 02:32:49 +0100 5486585 http://www.medworm.com/index.php?rid=5486584&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971103470X%2Fabstract%3Frss%3Dyes We read with interest the study of Campo et al. (). Their observation that P2Y12 reaction units (PRU) decreased at 1 month compared to baseline in patients receiving clopidogrel undergoing percutaneous coronary intervention (PCI) is similar to our report in 2003 (), where ∼30% of patients were resistant at 1 and 5 days post-PCI, and 15% were resistant at 30 days. Similar observation of lower prevalence of 30-day high platelet reactivity compared to 12 to 24 h post-stenting was also reported recently (). We further presented similar PRU levels at 24 h after 600 mg loading and just before the last maintenance dose at 6 weeks (). Mean PRUs at 8 h after last maintenance dose decreased by ∼25. These findings indicate the “booster” effect of the last maintenance dose by new active metabo... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486584 Sat, 10 Dec 2011 02:32:49 +0100 5486584 http://www.medworm.com/index.php?rid=5486583&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034462%2Fabstract%3Frss%3Dyes We appreciate the comments of Dr. Joshi and colleagues regarding our report on the cardiovascular risk assessment of candidates for liver transplantation (). We agree that liver transplantation in patients with severe left ventricular systolic dysfunction carries a higher risk for cardiovascular complications and mortality. These patients should be thoroughly evaluated, as we have described, and would benefit from referral to higher volume transplantation centers with experience in caring for such patients. As noted in our report, and by Joshi et al., there have been case reports of successful transplantation in such patients, often requiring combined liver and heart transplantation (). Several potential etiologies of systolic dysfunction in patients with end-stage liver disease have been... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486583 Sat, 10 Dec 2011 02:32:49 +0100 5486583 http://www.medworm.com/index.php?rid=5486582&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034516%2Fabstract%3Frss%3Dyes We read with great interest the report by Raval et al. () on cardiovascular risk assessment of candidates for liver transplantation (LT) and would like to congratulate the investigators on a comprehensive and thorough review. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486582 Sat, 10 Dec 2011 02:32:49 +0100 5486582 http://www.medworm.com/index.php?rid=5486581&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034395%2Fabstract%3Frss%3Dyes Breast cancer and cardiovascular disease are major public health concerns worldwide. The 2 diseases are intricately linked as treatment with established chemotherapeutic agents and monoclonal antibodies, including doxorubicin and trastuzumab, may lead to breast cancer remission, but alternatively, may also lead to significant cardiotoxicity. In the emerging field of cardio-oncology, early indices of left ventricular (LV) systolic dysfunction would be useful for addressing the cardiac safety profile of trastuzumab, potentially avoiding the detrimental effects of heart failure. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486581 Sat, 10 Dec 2011 02:32:49 +0100 5486581 http://www.medworm.com/index.php?rid=5486580&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034450%2Fabstract%3Frss%3Dyes Cardiac monitoring and managing of patients receiving antineoplastic therapy is an actual issue. We agree with the interesting article by Fallah-Rad et al. (): new, sensitive indexes of cardiac function are needed to predict cardiac dysfunction before ejection fraction (EF) is compromised. Normal hearts have enormous recruitable contractile capacity, and to show a decrease in EF, the myocardium must have undergone enough damage to exceed its ability to compensate. The authors conclude that both tissue velocity and strain imaging could detect pre-clinical changes in cardiac function, before EF decreases, in patients receiving adjuvant trastuzumab. Notably, they found no change in plasma biomarkers (troponin T, C-reactive protein, and brain natriuretic peptide); troponin I (TnI) was not eval... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486580 Sat, 10 Dec 2011 02:32:49 +0100 5486580 http://www.medworm.com/index.php?rid=5486579&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034486%2Fabstract%3Frss%3Dyes I read with great interest the recent publication by Fallah-Rad et al. () on chemotherapy-induced cardiac dysfunction. I applaud the authors for this integrated research in cardio-oncology utilizing a multi-imaging modality, including cardiovascular magnetic resonance as I advocated in a previous publication (). (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486579 Sat, 10 Dec 2011 02:32:49 +0100 5486579 http://www.medworm.com/index.php?rid=5486578&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034474%2Fabstract%3Frss%3Dyes We read with great interest the report by Fallah-Rad et al. () regarding echocardiography, biomarkers, and cardiac magnetic resonance (CMR) in patients with trastuzumab-induced heart failure. Cardiotoxicity after chemotherapy remains a clinical challenge. There is great interest in early detection of myocardial damage before left ventricular (LV) function deteriorates, and CMR is a good candidate to deliver this information. CMR is known to differentiate transient and permanent myocardial injury in various systemic and inflammatory diseases using specific techniques (). We would like to focus on the late gadolinium enhancement (LGE) CMR findings. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486578 Sat, 10 Dec 2011 02:32:49 +0100 5486578 http://www.medworm.com/index.php?rid=5486577&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034449%2Fabstract%3Frss%3Dyes To the Editor: Catheter ablation is increasingly being offered for the curative treatment of atrial fibrillation (AF). Generally, the procedure is safe and effective (), but the intense intraprocedural and post-procedural anticoagulation regimen used, together with extensive catheter manipulation and application of radiofrequency energy, may expose patients to an excessive risk for bleeding. Although intraprocedural tamponade has been reported (), little is known about the incidence of delayed cardiac tamponade (DCT). We investigated the incidence, modes of presentation, and outcomes of DCT in a large population of patients undergoing this procedure. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486577 Sat, 10 Dec 2011 02:32:49 +0100 5486577 http://www.medworm.com/index.php?rid=5486576&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711035285%2Fabstract%3Frss%3Dyes The DynaCT system with prototype software (Siemens AG, Forchheim, Germany) allows for computed tomography-like imaging of the aortic root in the operative theater (hybrid suite) during transcatheter transapical aortic valve implantation. Image acquisition is performed by rotational angiography (200° in 5 s) with diluted contrast dye (25 ml total, injected at a rate of 15 ml/s). To minimize blood flow and motion, rapid ventricular pacing is performed (180 to 220 beats/min), and ventilation is stopped. The raw dataset is then automatically segmented, and specific landmarks—coronary ostia (blue = left; green = right) and the lowest point of each coronary sinus (red = nadir)—are automatically identified (A, Online Video 1). The red reference points are utilized to project a circle (yellow... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486576 Sat, 10 Dec 2011 02:32:49 +0100 5486576 http://www.medworm.com/index.php?rid=5486575&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711035273%2Fabstract%3Frss%3Dyes An 80-year-old man, known for years to have chronic renal failure due to retroperitoneal fibrosis, was referred for worsening dyspnea. The cardiac magnetic resonance showed moderate pericardial effusion and a right atrial wall thickness of approximately 2 cm, sparing the fossa ovalis (A, Online Video 1). The poor contrast uptake of the atrial wall was suggestive for an infiltrative disease. Cardiac Erdheim-Chester disease, a non-Langherans cells histiocytosis, was confirmed by the finding of CD 68+ histiocytes on a previous perirenal tissue biopsy specimen (B, labeled in orange), and of the peculiar radiographic long bones osteosclerosis (C). (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486575 Sat, 10 Dec 2011 02:32:49 +0100 5486575 http://www.medworm.com/index.php?rid=5486574&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034565%2Fabstract%3Frss%3Dyes For the increasing number of patients who survive an acute myocardial infarction, infarct size is the main determinant of further prognosis (). Timely reperfusion is mandatory to reduce infarct size, and for all conditioning strategies—ischemic pre-conditioning, delayed ischemic pre-conditioning, ischemic post-conditioning, and remote pre-conditioning—reperfusion is a prerequisite to reduce infarct size (i.e., they delay rather than ultimately prevent infarct development) (). The pioneering experiments demonstrating reduction of infarct size by timely reperfusion are only 40 years old (), and infarct size reduction by a variety of experimental interventions immediately became an attractive target then (). However, the initial enthusiasm for all sorts of interventions to reduce infarct ... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486574 Sat, 10 Dec 2011 02:32:49 +0100 5486574 http://www.medworm.com/index.php?rid=5486573&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034553%2Fabstract%3Frss%3Dyes Conclusions: Our results indicate that beta3-AR agonists protect against MI/R injury. Furthermore, the cardioprotective effects of beta3-AR agonists are mediated by rapid eNOS and nNOS activation and increased NO bioavailability. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486573 Sat, 10 Dec 2011 02:32:49 +0100 5486573 http://www.medworm.com/index.php?rid=5486572&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034413%2Fabstract%3Frss%3Dyes Conclusions: Our results illustrate the consistency and differences in the determinants of genetic susceptibility to CHD in diabetic patients and the general populations. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486572 Sat, 10 Dec 2011 02:32:49 +0100 5486572 http://www.medworm.com/index.php?rid=5486571&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034401%2Fabstract%3Frss%3Dyes Conclusions: Stent patients had significantly lower acute complications compared with surgery patients or BA patients, although they were more likely to require a planned reintervention. At short-term and intermediate follow-up, stent and surgical patients achieved superior hemodynamic and integrated aortic arch imaging outcomes compared with BA patients. Because of the nonrandomized nature of this study, these results should be interpreted with caution. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486571 Sat, 10 Dec 2011 02:32:49 +0100 5486571 http://www.medworm.com/index.php?rid=5486570&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034425%2Fabstract%3Frss%3Dyes In this issue of the Journal, Cristell et al. () performed a novel study to test the prevalence of elevated circulating high-sensitivity C-reactive protein (CRP) immediately prior to ST-segment elevation myocardial infarction (STEMI). This was accomplished in 887 patients with STEMI as well as 887 control patients from urban areas in 3 regions: Italy, Scotland, and China. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486570 Sat, 10 Dec 2011 02:32:49 +0100 5486570 http://www.medworm.com/index.php?rid=5486569&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034437%2Fabstract%3Frss%3Dyes This study sought to assess the prevalence of normal levels of high sensitivity C-reactive protein (hsCRP) at the very onset of ST-segment elevation myocardial infarction (STEMI).Background: Levels of hsCRP ≥2 mg/l identify individuals who benefit from lipid lowering and possibly anti-inflammatory agents, but how many patients develop infarction in spite of hsCRP levels (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486569 Sat, 10 Dec 2011 02:32:49 +0100 5486569 http://www.medworm.com/index.php?rid=5486568&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034541%2Fabstract%3Frss%3Dyes Overweight and obesity are increasing in epidemic proportions both in the United States and throughout the world (). Alarmingly, the proportion of patients with severe and morbid obesity is increasing even more so than are overweight and obesity per se. Almost all of the major coronary heart disease (CHD) risk factors, including lipid disorders (especially elevated triglycerides and low levels of high-density lipoprotein cholesterol), glucose abnormalities, the metabolic syndrome, and diabetes mellitus, hypertension or left ventricular hypertrophy, and physical inactivity, are all adversely affected by overweight and obesity. Additionally, overweight and obesity may be independent risk factors for CHD and have adverse impacts on other cardiovascular (CV) disorders that may accompany CHD, i... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486568 Sat, 10 Dec 2011 02:32:49 +0100 5486568 http://www.medworm.com/index.php?rid=5486567&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034528%2Fabstract%3Frss%3Dyes Objectives: The aim of this study was to assess the impact of extreme (class III) obesity (body mass index [BMI] ≥40 kg/m2) on care and outcomes in patients with ST-segment elevation myocardial infarction (STEMI).Background: Although its prevalence is increasing rapidly, little is known about the impact of extreme obesity on STEMI presentation, treatments, complication rates, and outcomes.Methods: The relationship between BMI and baseline characteristics, treatment patterns, and risk-adjusted in-hospital outcomes was quantified for 50,149 patients with STEMI from the National Cardiovascular Data Registry (NCDR) ACTION Registry–GWTG.Results: The proportions of patients with STEMI by BMI category were as follows: underweight (BMI (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486567 Sat, 10 Dec 2011 02:32:49 +0100 5486567 http://www.medworm.com/index.php?rid=5486566&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971103453X%2Fabstract%3Frss%3Dyes Recent advances in genetics and proteonomics have great potential to help tailor treatment to individual patients in remarkable ways. A focus of intense research is on “clopidogrel nonresponders,” who despite treatment with conventional-dose clopidogrel still demonstrate high on-treatment platelet reactivity (HTPR), which has been associated with in-stent thrombosis and recurrent cardiovascular events (). This decreased response to clopidogrel is thought to affect roughly one-third of patients (). Several genetic polymorphisms have been linked to reduced hepatic metabolism of clopidogrel (the most prevalent of which is CYP2C19), leading to a lower concentration of the active metabolite (). This pathophysiological explanation lends itself to clinical applications, because targeting thos... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486566 Sat, 10 Dec 2011 02:32:49 +0100 5486566 http://www.medworm.com/index.php?rid=5486565&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034498%2Fabstract%3Frss%3Dyes Conclusions: We failed to identify that HTPR measured by VerifyNow P2Y12 assay was significantly associated with long-term atherothrombotic risks in patients receiving DES. However, elevated CRP levels were significantly associated with worse outcomes and had incremental predictive values over conventional risk factors. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486565 Sat, 10 Dec 2011 02:32:49 +0100 5486565 http://www.medworm.com/index.php?rid=5486564&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711047401%2Fabstract%3Frss%3Dyes The first review on biomaterials for the treatment of myocardial infarction (MI) was written in 2006. In the last 5 years, the general approaches for biomaterial treatment of MI and subsequent left ventricular remodeling remain the same, namely, left ventricular restraints, epicardial patches, and injectable therapies. Nonetheless, there have been significant developments in this field, including advancement of biomaterial therapies to large animal pre-clinical studies and, more recently, to clinical trials. This review focuses on the progress made in the field of cardiac biomaterial treatments for MI over the last 5 years. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5486564 Sat, 10 Dec 2011 02:32:49 +0100 5486564 http://www.medworm.com/index.php?rid=5581218&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711047322%2Fabstract%3Frss%3Dyes Robert C. Hendel, MD, FACC, FAHA, Chair; Biykem Bozkurt, MD, PhD, FACC, FAHA; Gregg C. Fonarow, MD, FACC, FAHA; Jeffrey P. Jacobs, MD, FACC; Pamela N. Peterson, MD, FACC; Véronique L. Roger, MD, MPH, FACC, FAHA; Eric E. Smith, MD, MPH, FAHA; James E. Tcheng, MD, FACC, FSCAI; Tracy Wang, MD, FACC, FAHA; William S. Weintraub, MD, FACC, FAHA (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5581218 Thu, 08 Dec 2011 05:00:00 +0100 5581218 http://www.medworm.com/index.php?rid=5608406&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048157%2Fabstract%3Frss%3Dyes Mitral regurgitation (MR) is a common cardiac problem that increases dramatically with age. The consequences of MR are left ventricular volume overload, cardiac hypertrophy, and the eventual development of left ventricular dilation and dysfunction. Compensated or decompensated MR can result in a number of molecular changes in the myocardium that may be either adaptive or maladaptive. Tissue hypoxia is one of the manifestations that can occur in MR. This presence of hypoxia can have significant consequences on organ function, one of which is related to marked changes in cardiac energy metabolism. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608406 Fri, 02 Dec 2011 05:00:00 +0100 5608406 http://www.medworm.com/index.php?rid=5608405&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048145%2Fabstract%3Frss%3Dyes Conclusions: Results suggest that post-transcriptional events determine Kir6.2 protein expression in the left ventricle of patients with severe mitral dysfunction and low venous PO2. Mechanical stress mainly affects transcription of HIF-1α and Kir6.2. This study implies that new therapies could aim at the proteasome for stabilizing the left ventricular Kir6.2 protein. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5608405 Fri, 02 Dec 2011 05:00:00 +0100 5608405 http://www.medworm.com/index.php?rid=5457200&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711048273%2Fabstract%3Frss%3Dyes 2455 Robert S. Bonser, Aaron M. Ranasinghe, Mahmoud Loubani, Jonathan D. Evans, Nassir M. A. Thalji, Jean E. Bachet, Thierry P. Carrel, Martin Czerny, Roberto Di Bartolomeo, Martin Grabenwoger, Lars Lonn, Carlos A. Mestres, Marc A. A. M. Schepens, Ernst Weigang (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5457200 Thu, 01 Dec 2011 02:26:22 +0100 5457200 http://www.medworm.com/index.php?rid=5457195&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711033304%2Fabstract%3Frss%3Dyes We thank Drs. Halbe and Sweitzer for their interest in our paper (). We appreciate the commendations from Drs. Halbe and Sweitzer, who are knowledgeable investigators of heart failure with preserved ejection fraction (HFpEF). We agree with their premise that understanding the pathophysiology of reduced exercise capacity requires measurement of key variables during peak exercise, which can be challenging and has not been commonly done. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5457195 Thu, 01 Dec 2011 02:26:22 +0100 5457195 http://www.medworm.com/index.php?rid=5457194&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711033341%2Fabstract%3Frss%3Dyes The article by Haykowsky et al. () is a comprehensive examination of contributors to the reduced exercise capacity universally found in elderly patients with heart failure with preserved ejection fraction (HFpEF). This work is important given the lack of understanding of the pathophysiology of this disease or proven therapies. The group is particularly to be commended for their open-minded approach to potential contributors to the disease. We do, however, take issue with the method by which their primary conclusion was reached. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5457194 Thu, 01 Dec 2011 02:26:22 +0100 5457194 http://www.medworm.com/index.php?rid=5457193&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711033353%2Fabstract%3Frss%3Dyes We thank Drs. Chatterjee and Maitra for their interest in our paper regarding impaired fasting glucose and the risk of incident diabetes mellitus and cardiovascular events in MESA (Multi-Ethnic Study of Atherosclerosis) (). (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5457193 Thu, 01 Dec 2011 02:26:22 +0100 5457193 http://www.medworm.com/index.php?rid=5457192&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711033377%2Fabstract%3Frss%3Dyes We read with great interest the paper by Yeboah et al. () regarding the effect of impaired fasting glucose (IFG) and incident diabetes, as well as diagnosed diabetes mellitus on cardiovascular events after a mean follow-up duration of 7.5 years, and its conclusion of IFG not being independently associated with an increased short-term risk for incident cardiovascular events (whereas diabetes mellitus type 2 was). The well-written paper attempts to answer a pertinent debate on whether IFG is an independent risk factor for incident cardiovascular events—the data thus far has been variable and heterogeneous (). However, a few interesting points arise from the analysis, which we feel, may require clarification. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5457192 Thu, 01 Dec 2011 02:26:22 +0100 5457192 http://www.medworm.com/index.php?rid=5457191&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034243%2Fabstract%3Frss%3Dyes We cordially appreciate the valuable comments from Dr. Schachner and colleagues on our study () assessing the relationship between cerebral atherosclerosis and post-coronary artery bypass graft (CABG) stroke. Cerebral atherosclerosis was both an independent risk factor for and the cause of a significant (45%) proportion of post-CABG strokes (). Thus, as rightfully noted by Dr. Schachner and colleagues, awareness and careful management may be mandatory for those patients with cerebral atherosclerosis who are undergoing CABG. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5457191 Thu, 01 Dec 2011 02:26:22 +0100 5457191 http://www.medworm.com/index.php?rid=5457190&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS0735109711034280%2Fabstract%3Frss%3Dyes We read with interest the paper by Lee et al. () on the influence of cerebral atherosclerosis and stroke after coronary artery bypass surgery (CABG). Interestingly, they demonstrated that two-thirds of the patients undergoing CABG (65.4%) had steno-occlusive lesions in the intracranial and/or extracranial cerebral arteries. Thus, the issue of cerebrovascular disease and postoperative neurological complications is very important in these patients, and awareness is mandatory for the cardiac surgeons. At our institution, we perform ultrasound of the carotid arteries as a routine checkup before CABG surgery. If we have evidence of neurovascular disease, we modify the anesthesiological management (e.g., keep mean arterial pressure higher during extracorporeal circulation), the patient monitorin... Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5457190 Thu, 01 Dec 2011 02:26:22 +0100 5457190 http://www.medworm.com/index.php?rid=5457189&cid=s_29157_7_f&fid=29157&url=http%3A%2F%2Fwww.jaccjournaloftheacc.com%2Farticle%2FPIIS073510971103422X%2Fabstract%3Frss%3Dyes The mainstay of clinical surveillance for the unoperated patient with Marfan syndrome (MFS) is echocardiography. Because the aorta is not routinely imaged beyond its ascending component, the overall incidence of distal or peripheral arterial disease in MFS is unknown. We sought to determine the incidence of such disease in adults (age >18 years) with MFS. (Source: Journal of the American College of Cardiology) Journal of the American College of Cardiology journals http://www.medworm.com/rss/comments.php?id=5457189 Thu, 01 Dec 2011 02:26:22 +0100 5457189