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  • Comparing Primary Prevention Recommendations
    Circulation (IF 23.054) Pub Date : 2020-04-06
    Neil J. Stone; Roger S. Blumenthal; Donald Lloyd-Jones; Scott M. Grundy

    This brief review of recent United States and European guideline recommendations for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) through the management of dyslipidemia/cholesterol compares the evaluation and treatment set forth in both guidelines (see the Table). The US 2018 American Heart Association/American College of Cardiology Multisociety Guideline (AHA/ACC)1 emphasizes

  • Secondary Prevention for Atherosclerotic Cardiovascular Disease
    Circulation (IF 23.054) Pub Date : 2020-04-06
    Salim S. Virani; Sidney C. Smith Jr; Neil J. Stone; Scott M. Grundy

    The 2018 American Heart Association (AHA)/American College of Cardiology (ACC) Multisociety Guideline on the Management of Blood Cholesterol1 divides patients with clinical atherosclerotic cardiovascular disease (ASCVD) into high-risk and very high-risk categories. The high-risk group includes those with stable ASCVD who are treated with high-intensity statins. Very high-risk patients are those with

  • Cardiovascular Medicine in Sweden
    Circulation (IF 23.054) Pub Date : 2020-04-06
    Annika Rosengren; Lars Wallentin

    Sweden has a total population of just >10 million, mostly (85%) in urban areas, and almost one-third with at least one parent born abroad. A mainly publicly financed healthcare system is in place, with low out-of-pocket costs for hospitalizations, procedures, and prescription drugs, also covering treatment that cannot be deferred for asylum seekers and migrants without papers. Medical education in

  • Isoflavone Intake and the Risk of Coronary Heart Disease in US Men and Women
    Circulation (IF 23.054) Pub Date : 2020-03-23
    Le Ma; Gang Liu; Ming Ding; Geng Zong; Frank B. Hu; Walter C. Willett; Eric B. Rimm; JoAnn E. Manson; Qi Sun

    Background:Whether soy products confer health benefits related to coronary heart disease (CHD) remains controversial because of inconsistent evidence.Methods:A total of 74 241 women from the NHS (Nurses’ Health Study; 1984–2012), 94 233 women from the NHSII (Nurses’ Health Study II; 1991–2013), and 42 226 men from the Health Professionals Follow-Up Study (1986–2012), who were free of cardiovascular

  • A Feast of Observations About Diet
    Circulation (IF 23.054) Pub Date : 2020-04-06
    Mercedes R. Carnethon; Sadiya S. Khan

    Article, see p 1127 The scientific community has devoted considerable effort in identifying how food and nutrition influence health. In 2019, the key words foods, nutrition, and diet patterns appeared 101 661 times in PubMed—markedly more often than other health behavior–related terms, including physical activity (36 590 records) and sleep (15 018 records). The lay public is eagerly seeking guidance

  • Rivaroxaban Plus Aspirin Versus Aspirin Alone in Patients With Prior Percutaneous Coronary Intervention (COMPASS-PCI)
    Circulation (IF 23.054) Pub Date : 2020-03-17
    Kevin R. Bainey; Robert C. Welsh; Stuart J. Connolly; Tamara Marsden; Jackie Bosch; Keith A.A. Fox; P. Gabriel Steg; Dragos Vinereanu; Derek L. Connolly; Scott D. Berkowitz; JoAnne M. Foody; Jeffrey L. Probstfield; Kelley R. Branch; Basil S. Lewis; Rafael Diaz; Eva Muehlhofer; Petr Widimsky; Salim Yusuf; John W. Eikelboom; Deepak L. Bhatt; On behalf of the COMPASS Investigators

    Background:The COMPASS trial (Cardiovascular Outcomes for People using Anticoagulation Strategies) demonstrated that dual pathway inhibition (DPI) with rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily versus aspirin 100 mg once daily reduced the primary major adverse cardiovascular event (MACE) outcome of cardiovascular death, myocardial infarction, or stroke, as well as, mortality, in

  • Myocardial Energetics in Obesity
    Circulation (IF 23.054) Pub Date : 2020-03-06
    Jennifer J. Rayner; Mark A. Peterzan; William D. Watson; William T. Clarke; Stefan Neubauer; Christopher T. Rodgers; Oliver J. Rider

    Background:Obesity is strongly associated with exercise intolerance and the development of heart failure. Whereas myocardial energetics and diastolic function are impaired in obesity, systolic function is usually preserved. This suggests that the rate of ATP delivery is maintained, but this has never been explored in human obesity. We hypothesized that ATP transfer rate through creatine kinase (CK)

  • Energetic Adaptations and Stress Reserve in the Obese Heart
    Circulation (IF 23.054) Pub Date : 2020-04-06
    Barry A. Borlaug; Craig R. Malloy

    Article, see p 1152 The human race is dealing with an epidemic of obesity the likes of which has never been seen on planet earth. In the United States alone, the prevalence of obesity is projected to rise to 50% in just 10 years, a staggering increase from 15% in the mid-1970s.1 Obesity is a major risk factor for a number of cardiovascular disorders, including heart failure, and particularly heart

  • Orphan G-Protein-Coupled Receptor GPRC5B Controls Smooth Muscle Contractility and Differentiation by Inhibiting Prostacyclin Receptor Signaling.
    Circulation (IF 23.054) Pub Date : 2020-01-16
    Jorge Carvalho,Ramesh Chennupati,Rui Li,Stefan Günther,Harmandeep Kaur,Wencai Zhao,Sarah Tonack,Michael Kurz,Nadja Mößlein,Moritz Bünemann,Stefan Offermanns,Nina Wettschureck

    Background: G-protein-coupled receptors (GPCRs) are important regulators of contractility and differentiation in vascular smooth muscle cells (SMC), but the specific function of SMC-expressed orphan GPCR GPRC5B is unclear. Methods: We studied the role of GPRC5B in the regulation of contractility and dedifferentiation in human and murine SMC in vitro as well as in tamoxifen-inducible, SMC-specific knockout

  • Value of Hemodynamic Monitoring in Patients With Cardiogenic Shock Undergoing Mechanical Circulatory Support
    Circulation (IF 23.054) Pub Date : 2020-04-06
    Abhinav Saxena; A. Reshad Garan; Navin K. Kapur; William W. O’Neill; JoAnn Lindenfeld; Sean P. Pinney; Nir Uriel; Daniel Burkhoff; Morton Kern

    The recent widespread availability and use of mechanical circulatory support is transforming the management and outcomes of cardiogenic shock (CS). Clinical decision-making regarding the optimization of therapies for patients with CS can be guided effectively by hemodynamic monitoring with a pulmonary artery catheter (PAC). Because several studies regarding the benefit of PACs are ambiguous, the use

  • Getting to the Heart of Sex Differences
    Circulation (IF 23.054) Pub Date : 2020-04-06
    Bridget M. Kuehn

    Women experience a steeper rise in blood pressure than men and this trend begins as early as the third decade of life, suggests a study published in JAMA Cardiology. The results suggest that women may experience more rapid vascular aging, which may make them more vulnerable to cardiovascular risk factors at earlier stages in life, said senior author Susan Cheng, MD, Erika J. Glazer Chair in Women’s

  • The Hidden Reveals the Hidden
    Circulation (IF 23.054) Pub Date : 2020-04-06
    Miguel A. Arias; Marta Pachón; Pedro Brugada

    A 59-year-old man with no history of cardiovascular disease was admitted to the emergency department with sudden onset of rapid palpitations and dizziness 2 hours before admission. ECG (Figure 1) revealed a rapid irregular wide QRS complex tachycardia with right bundle-branch block morphology and alternating QRS width. Because the patient was hemodynamically unstable, immediate direct current cardioversion

  • Association of Parkinson Disease With Risk of Cardiovascular Disease and All-Cause Mortality
    Circulation (IF 23.054) Pub Date : 2020-04-06
    Joo-Hyun Park; Do-Hoon Kim; Yong-Gyu Park; Do-Young Kwon; Moonyoung Choi; Jin-Hyung Jung; Kyungdo Han

    Parkinson disease (PD) is the second most common neurodegenerative disorder and affects 1% to 3% of people aged >65 years. As life expectancy increases, the prevalence and burden of PD increase worldwide.1 Although epidemiologic studies have consistently reported high PD-associated mortality,2 the relationship between PD and cardiovascular diseases (CVDs), the leading cause of death, remains unclear

  • Molecular Signatures of Beneficial Class Effects of Statins on Human Induced Pluripotent Stem Cell–Derived Cardiomyocytes
    Circulation (IF 23.054) Pub Date : 2020-04-06
    Lei Tian; Angelos Oikonomopoulos; Chun Liu; Tomoya Kitani; Rajani Shrestha; Christopher L. Chen; Sang-Ging Ong; Mark Smeets; Ioannis Karakikes; Nazish Sayed; Joseph C. Wu

    Statins prevent cardiac diseases via inhibition of cholesterol biosynthesis and exert pleiotropic effects on the cardiovascular system.1 Statins may also act as antihypertrophic and antiapoptotic agents to prevent cardiomyocyte injury. However, the effects of clinically relevant concentrations of statins (ie, serum peak concentration) on cardiomyocytes remain largely unknown. In the current study,

  • Reduced Apolipoprotein M and Adverse Outcomes Across the Spectrum of Human Heart Failure
    Circulation (IF 23.054) Pub Date : 2020-04-02
    Julio A. Chirinos; Lei Zhao; Yi Jia; Cecilia Frej; Luigi Adamo; Douglas Mann; Swapnil V. Shewale; John S. Millar; Daniel J. Rader; Benjamin French; Jeff Brandimarto; Kenneth B. Margulies; John S. Parks; Zhaoqing Wang; Dietmar A. Sieffert; James Fang; Nancy Sweitzer; Christina Christoffersen; Björn Dahlbäck; Bruce D. Car; David A. Gordon; Thomas P. Cappola; Ali Javaheri

    Background: Apolipoprotein M (APOM) mediates the physical interaction between high-density lipoprotein (HDL) particles and sphingosine-1-phosphate (S1P). APOM exerts anti-inflammatory and cardio-protective effects in animal models.Methods: In a subset of Penn-HF study (PHFS) participants (n=297), we measured APOM by ELISA. We also measured total S1P by liquid chromatography-mass spectrometry and isolated

  • Coronary Artery Calcium for Personalized Allocation of Aspirin in Primary Prevention of Cardiovascular Disease in 2019: The Multi-Ethnic Study of Atherosclerosis (MESA)
    Circulation (IF 23.054) Pub Date : 2020-04-01
    Miguel Cainzos-Achirica; Michael D. Miedema; John W. McEvoy; Mahmoud Al Rifai; Philip Greenland; Zeina Dardari; Matthew Budoff; Roger S. Blumenthal; Joseph Yeboah; Daniel A. Duprez; Martin Bødtker Mortensen; Omar Dzaye; Jonathan Hong; Khurram Nasir; Michael J. Blaha

    Background: Recent American College of Cardiology/American Heart Association (ACC/AHA) Primary Prevention Guidelines recommended considering low-dose aspirin therapy only among adults 40-70 years of age who are at higher atherosclerotic cardiovascular disease (ASCVD) risk but not at high risk of bleeding. However, it remains unclear how these patients are best identified. The present study aimed to

  • Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association
    Circulation (IF 23.054) Pub Date : 2020-03-31
    Dhanunjaya R. Lakkireddy; Mina K. Chung; Rakesh Gopinathannair; Kristen K. Patton; Ty J. Gluckman; Mohit Turagam; Jim Cheung; Parin Patel; Jaun Sotomonte; Rachel Lampert; Janet K. Han; Bharath Rajagopalan; Lee Eckhardt; Jose Joglar; Kristin Sandau; Brian Olshansky; Elaine Wan; Peter A. Noseworthy; Miguel Leal; Elizabeth Kaufman; Alejandra Gutierrez; Joseph M. Marine; Paul J. Wang; Andrea M. Russo

    Covid-19 is a global pandemic that is wreaking havoc with the health and economy of much of human civilization. Electrophysiologists have been impacted personally and professionally by this global catastrophe. In this joint document from representatives of the HRS, ACC and AHA we identify the potential risks of exposure to patients, allied health care staff, industry representatives and hospital administrators

  • Hypertrophic Cardiomyopathy with Left Ventricular Systolic Dysfunction: Insights from the SHaRe Registry
    Circulation (IF 23.054) Pub Date : 2020-03-31
    Peter Marstrand; Larry Han; Sharlene M. Day; Iacopo Olivotto; Euan A. Ashley; Michelle Michels; Alexandre C. Pereira; Samuel G. Wittekind; Adam Helms; Sara Saberi; Daniel Jacoby; James S. Ware; Steven D. Colan; Christopher Semsarian; Jodie Ingles; Neal K. Lakdawala; Carolyn Y. Ho

    Background: The terminology "end-stage" has been used to describe hypertrophic cardiomyopathy (HCM) with left ventricular systolic dysfunction (herein referred to as HCM-LVSD), defined when left ventricular ejection fraction (LVEF) <50% is present. The prognosis of HCM-LVSD has reportedly been poor, but due to its relative rarity, natural history remains incompletely characterized.Methods: Data from

  • Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017
    Circulation (IF 23.054) Pub Date : 2020-03-29
    Simon Yadgir; Catherine Owens Johnson; Victor Aboyans; Oladimeji M. Adebayo; Rufus Adesoji Adedoyin; Mohsen Afarideh; Fares Alahdab; Alaa Alashi; Vahid Alipour; Jalal Arabloo; Samad Azari; Celine M. Barthelemy; Catherine P. Benziger; Adam E. Berman; Ali Bijani; Juan J. Carrero; Félix Carvalho; Ahmad Daryani; Andre R. Durães; Alireza Esteghamati; Talha A. Farid; Farshad Farzadfar; Eduarda Fernandes;

    Background: Non-rheumatic valvular heart diseases (NRVDs) are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease (GBD) 2017 study, mortality, prevalence, and disability-adjusted life years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease (DMVD), and other NRVD were estimated for 195 countries and territories

  • The Effect of PCSK9 Inhibition on the Risk of Venous Thromboembolism
    Circulation (IF 23.054) Pub Date : 2020-03-29
    Nicholas A. Marston; Yared Gurmu; Giorgio E. M. Melloni; Marc Bonaca; Baris Gencer; Peter S. Sever; Terje R. Pedersen; Anthony C. Keech; Carolina Roselli; Steven A. Lubitz; Patrick T. Ellinor; Michelle L. O'Donoghue; Robert P. Giugliano; Christian T. Ruff; Marc S. Sabatine

    Background: The relationship between cholesterol levels and risk of venous thromboembolism (VTE) is uncertain. We set out to determine the effect of PCSK9 inhibition on the risk of VTE, explore potential mechanisms, and examine the efficacy in clinically and genetically defined risk subgroups.Methods: We performed a post-hoc analysis of the FOURIER trial testing whether evolocumab reduces the risk

  • Peripheral Artery Disease and Venous Thromboembolic Events After Acute Coronary Syndrome: Role of Lipoprotein(a) and Modification by Alirocumab: Prespecified Analysis of a Randomized Clinical Trial
    Circulation (IF 23.054) Pub Date : 2020-03-29
    Gregory G. Schwartz; Ph. Gabriel Steg; Michael Szarek; Vera A. Bittner; Rafael Diaz; Shaun G. Goodman; Yong-Un Kim; J. Wouter Jukema; Robert Pordy; Matthew T. Roe; Harvey D. White; Deepak L. Bhatt

    Background: Patients with acute coronary syndrome (ACS) are at risk for peripheral artery disease (PAD) events and venous thromboembolism (VTE). Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduce lipoprotein(a) and low-density lipoprotein cholesterol (LDL-C) levels. Our objective was to ascertain whether PCSK9 inhibition reduces the risk of PAD events or VTE after ACS, and if such

  • The Risk / Benefit Tradeoff of Antithrombotic Therapy in Patients with Atrial Fibrillation Early and Late After an Acute Coronary Syndrome or Percutaneous Coronary Intervention: Insights from AUGUSTUS
    Circulation (IF 23.054) Pub Date : 2020-03-29
    John H. Alexander; Daniel Wojdyla; Amit N. Vora; Laine Thomas; Christopher B. Granger; Shaun G. Goodman; Ronald Aronson; Stephan Windecker; Roxana Mehran; Renato D. Lopes

    Background: In AUGUSTUS, patients with atrial fibrillation (AF) and a recent acute coronary syndrome (ACS) and/or those undergoing percutaneous coronary intervention (PCI) had less bleeding with apixaban than vitamin K antagonist (VKA) and with placebo than aspirin, however, the number of ischemic events was numerically higher with placebo. The aim of this analysis is to assess the tradeoff of risk

  • First in Human Experience with Peritoneal Direct Sodium Removal Using a Zero Sodium Solution: A New Candidate Therapy for Volume Overload.
    Circulation (IF 23.054) Pub Date : 2020-01-08
    Veena S Rao,Jeffrey M Turner,Matthew Griffin,Devin Mahoney,Jennifer Asher,Sangchoon Jeon,Peter S Yoo,Nabil Boutagy,Attila Feher,Albert Sinusas,F Perry Wilson,Fredric Finkelstein,Jeffrey M Testani

    Background: Loop diuretics have well described toxicities and loss of response to these agents is common. Alternative strategies are needed for the maintenance of euvolemia in heart failure (HF). Non-renal removal of sodium directly across the peritoneal membrane (direct sodium removal, DSR) using a sodium free osmotic solution should result in extraction of large quantities of sodium with limited

  • Preventive or Deferred Ablation of Ventricular Tachycardia in Patients with Ischemic Cardiomyopathy and Implantable Defibrillator (BERLIN VT): A Multicenter Randomized Trial.
    Circulation (IF 23.054) Pub Date : 2020-01-31
    Stephan Willems,Roland Richard Tilz,Daniel Steven,Stefan Kääb,Karl Wegscheider,László Geller,Christian Meyer,Christian-Hendrik Heeger,Andreas Metzner,Moritz F Sinner,Michael Schlüter,Peter Nordbeck,Lars Eckardt,Harilaos Bogossian,Arian Sultan,Beate Wenzel,Karl-Heinz Kuck,

    Background: Catheter ablation for ventricular tachycardia (VT) reduces the recurrence of VT in patients with implanted cardioverter-defibrillators (ICDs). The appropriate timing of VT ablation and its effects on mortality and heart failure progression remain a matter of debate. In patients with life-threatening arrhythmias necessitating ICD implantation, we compared outcomes of preventive VT ablation

  • Outcomes of Transcatheter Aortic Valve Replacement in Patients with Bicuspid Aortic Valve Disease: A Report from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
    Circulation (IF 23.054) Pub Date : 2020-02-26
    Sharif A Halim,Fred H Edwards,David Dai,Zhuokai Li,Michael J Mack,David R Holmes,E Murat Tuzcu,Vinod H Thourani,J Kevin Harrison,J Matthew Brennan

    Background: Patients with bicuspid aortic valve (AV) stenosis were excluded from the pivotal evaluations of transcatheter AV replacement (TAVR) devices. We sought to evaluate the outcomes of TAVR in patients with bicuspid AV stenosis compared with those with tricuspid AV. Methods: We used data from the Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry

  • Neutrophil-Derived S100A8/A9 Amplify Granulopoiesis Following Myocardial Infarction.
    Circulation (IF 23.054) Pub Date : 2020-01-16
    Gopalkrishna Sreejit,Ahmed Abdel-Latif,Baskaran Athmanathan,Rahul Annabathula,Ashish Dhyani,Sunil K Noothi,Gregory A Quaife-Ryan,Annas Al-Sharea,Gerard Pernes,Dragana Dragoljevic,Hind Lal,Kate Schroder,Beatriz Y Hanaoka,Chander Raman,Maria B Grant,James E Hudson,Susan Smyth,Enzo R Porrello,Andrew J Murphy,Prabhakara R Nagareddy

    Background: Myocardial infarction (MI) triggers myelopoiesis resulting in heightened production of neutrophils. However, the mechanisms that sustain their production and recruitment to the injured heart are unclear. Methods: Using a mouse model of the permanent ligation of the left anterior descending (LAD) artery and flow cytometry, we first characterized the temporal and spatial effects of MI on

  • Prospective Associations of Accelerometer-Measured Physical Activity and Sedentary Time With Incident Cardiovascular Disease, Cancer, and All-Cause Mortality
    Circulation (IF 23.054) Pub Date : 2020-03-30
    Paddy C. Dempsey; Tessa Strain; Kay-Tee Khaw; Nicholas J. Wareham; Søren Brage; Katrien Wijndaele

    Both insufficient moderate-to-vigorous intensity physical activity (MVPA) and high volumes of sedentary time (ST) have been associated with increased risk of all-cause mortality, cardiovascular disease (CVD), and some cancers.1 However, epidemiological evidence has relied mostly on self-reported physical activity (PA) and ST measures, which are prone to reporting bias and measurement error. Cohort

  • Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective-An Update: A Scientific Statement From the American Heart Association.
    Circulation (IF 23.054) Pub Date : 2020-02-26
    Barry A Franklin,Paul D Thompson,Salah S Al-Zaiti,Christine M Albert,Marie-France Hivert,Benjamin D Levine,Felipe Lobelo,Kushal Madan,Anjail Z Sharrief,Thijs M H Eijsvogels,

    Epidemiological and biological plausibility studies support a cause-and-effect relationship between increased levels of physical activity or cardiorespiratory fitness and reduced coronary heart disease events. These data, plus the well-documented anti-aging effects of exercise, have likely contributed to the escalating numbers of adults who have embraced the notion that "more exercise is better." As

  • The Role of Combination Antiplatelet and Anticoagulation Therapy in Diabetes and Cardiovascular Disease: Insights from the COMPASS Trial
    Circulation (IF 23.054) Pub Date : 2020-03-28
    Deepak L. Bhatt; John W. Eikelboom; Stuart J. Connolly; Ph. Gabriel Steg; Sonia S. Anand; Subodh Verma; Kelley R. H. Branch; Jeffrey Probstfield; Jackie Bosch; Olga Shestakovska; Michael Szarek; Aldo Pietro Maggioni; Petr Widimský; Alvaro Avezum; Rafael Diaz; Basil S. Lewis; Scott D. Berkowitz; Keith A.A. Fox; Lars Ryden; Salim Yusuf

    Background: Patients with established coronary artery disease (CAD) or peripheral artery disease (PAD) often have diabetes mellitus. These patients are at high risk of future vascular events.Methods: In a prespecified analysis of the COMPASS trial, we compared the effects of rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg daily) versus placebo plus aspirin in patients with diabetes versus without

  • Branched-Chain Amino Acid Catabolism Promotes Thrombosis Risk by Enhancing Tropomodulin-3 Propionylation in Platelets
    Circulation (IF 23.054) Pub Date : 2020-03-23
    Yanyan Xu; Haojie Jiang; Li Li; Fengwu Chen; Yunxia Liu; Meiyi Zhou; Ji Wang; Jingjing Jiang; Xiaoying Li; Xuemei Fan; Lin Zhang; Junfeng Zhang; Junqiang Qiu; Yi Wu; Chao Fang; Haipeng Sun; Junling Liu

    Background: Branched-chain amino acids (BCAAs), essential nutrients including leucine, isoleucine and valine, serve as a resource for energy production and the regulator of important nutrient and metabolic signals. Recent studies have suggested that dysfunction of BCAA catabolism is associated with a risk of cardiovascular disease. Platelets play an important role in cardiovascular disease, but the

  • Improving National Outcomes in Congenital Heart Surgery: The Time Has Come for Regionalization of Care.
    Circulation (IF 23.054) Pub Date : 2020-02-12
    Carl L Backer,Sara K Pasquali,Joseph A Dearani

    Recently there have been several high-profile articles in the national media reporting on US congenital heart surgery programs, which have led in part to closure or curtailing of surgical services of at least 5 programs. These articles stemmed from concerns raised by families and practitioners regarding program outcomes and lack of transparency, which led to news media investigations and reported findings

  • Variation in Ultrasound Diagnostic Thresholds for Carotid Stenosis in the United States.
    Circulation (IF 23.054) Pub Date : 2020-01-16
    Jesse A Columbo,Robert M Zwolak,Edward J Arous,Philip P Goodney,Michael P Lilly,H Gilbert Welch

    Background: Individuals with carotid stenosis enter surveillance or are considered for surgery based upon disease severity assessed by ultrasound. However, there is variation in the ultrasound diagnostic thresholds used to determine disease severity. Our objective was to describe this variation and its potential impact on patients. Methods: To describe the variation in carotid ultrasound diagnostic

  • Variation in Ultrasound Diagnostic Thresholds for Carotid Stenosis in the United States
    Circulation (IF 23.054) Pub Date : 2020-03-23
    Esther S.H. Kim; R. Eugene Zierler

    Article, see p 946 Consider the case of C.S., a 69-year-old man who has a moderately severe 50% to 69% left internal carotid stenosis, which has been followed for years by his physician with serial duplex scans at accredited Vascular Laboratory A. When that physician retired, C.S. transitioned his care to another physician, who ordered his annual carotid duplex scan to be performed at accredited Vascular

  • Racial Differences in Malignant Left Ventricular Hypertrophy and Incidence of Heart Failure: A Multi-Cohort Study.
    Circulation (IF 23.054) Pub Date : 2020-01-14
    Alana A Lewis,Colby R Ayers,Elizabeth Selvin,Ian Neeland,Christie Ballantyne,Vijay Nambi,Ambarish Pandey,Tiffany M Powell-Wiley,Mark H Drazner,Mercedes R Carnethon,Jarett D Berry,Stephen L Seliger,Christopher R deFilippi,James A de Lemos

    Background: A "malignant" subphenotype of left ventricular hypertrophy (LVH) has been described, in which minimal elevations in cardiac biomarkers identify individuals with LVH at high risk for developing heart failure (HF). We tested the hypothesis that a higher prevalence of malignant LVH among blacks may contribute to racial disparities in HF risk. Methods: Participants (n=15, 710) without prevalent

  • Small Extracellular Microvesicles Mediated Pathological Communications between Dysfunctional Adipocytes and Cardiomyocytes as a Novel Mechanisms Exacerbating Ischemia/Reperfusion Injury in Diabetic Mice.
    Circulation (IF 23.054) Pub Date : 2020-01-10
    Lu Gan,Dina Xie,Jing Liu,Wayne Bond Lau,Theodore A Christopher,Bernard Lopez,Ling Zhang,Erhe Gao,Walter Koch,Xin-Liang Ma,Yajing Wang

    Background: Diabetes exacerbates myocardial ischemia/reperfusion (MI/R) injury by incompletely understood mechanisms. Adipocyte dysfunction contributes to remote organ injury. However, the molecular mechanisms linking dysfunctional adipocytes to increased MI/R injury remain unidentified. The current study attempted to clarify whether and how small extracellular vesicles (sEV) may mediate pathological

  • S-Nitrosylation of Muscle LIM Protein Facilitates Myocardial Hypertrophy Through Toll-Like Receptor 3-Mediated Receptor-Interacting Protein Kinase 3 and NLRP3 Inflammasome Activation.
    Circulation (IF 23.054) Pub Date : 2020-01-06
    Xin Tang,Lihong Pan,Shuang Zhao,Feiyue Dai,Menglin Chao,Hong Jiang,Xuesong Li,Zhe Lin,Zhengrong Huang,Guoliang Meng,Chun Wang,Chan Chen,Jin Liu,Xin Wang,Albert Ferro,Hong Wang,Hongshan Chen,Yuanqing Gao,Qiulun Lu,Liping Xie,Yi Han,Yong Ji

    Background: S-nitrosylation (SNO), a prototypic redox-based posttranslational modification, is involved in the pathogenesis of cardiovascular disease. The aim of this study was to determine the role of S-nitrosylation of muscle LIM protein (MLP) in myocardial hypertrophy, as well as the mechanism by which SNO-MLP modulates hypertrophic growth in response to pressure overload. Methods: Myocardial samples

  • Research Priorities for Heart Failure With Preserved Ejection Fraction
    Circulation (IF 23.054) Pub Date : 2020-03-23
    Sanjiv J. Shah; Barry A. Borlaug; Dalane W. Kitzman; Andrew D. McCulloch; Burns C. Blaxall; Rajiv Agarwal; Julio A. Chirinos; Sheila Collins; Rahul C. Deo; Mark T. Gladwin; Henk Granzier; Scott L. Hummel; David A. Kass; Margaret M. Redfield; Flora Sam; Thomas J. Wang; Patrice Desvigne-Nickens; Bishow B. Adhikari

    Heart failure with preserved ejection fraction (HFpEF), a major public health problem that is rising in prevalence, is associated with high morbidity and mortality and is considered to be the greatest unmet need in cardiovascular medicine today because of a general lack of effective treatments. To address this challenging syndrome, the National Heart, Lung, and Blood Institute convened a working group

  • Two Sides of the Same Coin in Myotonic Dystrophy Type 1
    Circulation (IF 23.054) Pub Date : 2020-03-23
    Miguel A. Arias; Marta Pachón; Gerard Loughlin

    A 25-year-old man with myotonic muscular dystrophy type 1 presented to the emergency department complaining of palpitations and chest discomfort. A regular wide QRS complex tachycardia with right bundle-branch block (RBBB) morphology (Figure 1) was recorded on electrocardiogram (ECG), being treated with direct electrical cardioversion. An echocardiogram revealed normal biventricular cardiac systolic

  • Impact of Low-Flow Duration on Favorable Neurological Outcomes of Extracorporeal Cardiopulmonary Resuscitation After Out-of-Hospital Cardiac Arrest
    Circulation (IF 23.054) Pub Date : 2020-03-23
    Tasuku Matsuyama; Taro Irisawa; Tomoki Yamada; Koichi Hayakawa; Kazuhisa Yoshiya; Kazuo Noguchi; Tetsuro Nishimura; Takuya Ishibe; Yoshiki Yagi; Takeyuki Kiguchi; Masafumi Kishimoto; Hiroshi Shintani; Yasuyuki Hayashi; Taku Sogabe; Takaya Morooka; Haruko Sakamoto; Keitaro Suzuki; Fumiko Nakamura; Norihiro Nishioka; Yohei Okada; Satoshi Matsui; Junya Sado; Takeshi Shimazu; Bon Ohta; Taku Iwami; Tetsuhisa

    Extracorporeal cardiopulmonary resuscitation (ECPR) is expected to benefit the rescue of selected patients, particularly those who are refractory to conventional cardiopulmonary resuscitation (CPR).1 Considering its invasive procedure and considerable resources, establishing a helpful criterion for initiating ECPR remains crucial. Low-flow duration (LFD) is one of the most common criteria to identify

  • Disparities in Congenital Heart Disease Mortality Based on Proximity to a Specialized Pediatric Cardiac Center.
    Circulation (IF 23.054) Pub Date : 2020-02-10
    Jonathan R Kaltman,Kristin M Burns,Gail D Pearson,David C Goff,Frank Evans

  • Cardiac Cell Therapy Rejuvenates the Infarcted Rodent Heart via Direct Injection but Not by Vascular Infusion
    Circulation (IF 23.054) Pub Date : 2020-03-23
    Ronald J. Vagnozzi; Michelle A. Sargent; Jeffery D. Molkentin

    Cardiac cell therapy using adult cells with stem- or progenitor-like properties has been under clinical investigation for more than 15 years. However, the cumulative results from dozens of trials suggest a slight, transient benefit at best.1,2 The underlying rationale for these trials was derived from studies in small and large animals where a more consistent functional benefit has been observed,3

  • Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association.
    Circulation (IF 23.054) Pub Date : 2020-02-12
    Kelly N Sawyer,Teresa R Camp-Rogers,Pavitra Kotini-Shah,Marina Del Rios,Michelle R Gossip,Vivek K Moitra,Kirstie L Haywood,Cynthia M Dougherty,Steven A Lubitz,Alejandro A Rabinstein,Jon C Rittenberger,Clifton W Callaway,Benjamin S Abella,Romergryko G Geocadin,Michael C Kurz,

    Cardiac arrest systems of care are successfully coordinating community, emergency medical services, and hospital efforts to improve the process of care for patients who have had a cardiac arrest. As a result, the number of people surviving sudden cardiac arrest is increasing. However, physical, cognitive, and emotional effects of surviving cardiac arrest may linger for months or years. Systematic recommendations

  • Telecommunicator Cardiopulmonary Resuscitation: A Policy Statement From the American Heart Association.
    Circulation (IF 23.054) Pub Date : 2020-02-24
    Michael Christopher Kurz,Bentley J Bobrow,Julie Buckingham,Jose G Cabanas,Mickey Eisenberg,Peter Fromm,Micah J Panczyk,Tom Rea,Kevin Seaman,Christian Vaillancourt,

    Every year in the United States, >350 000 people have sudden cardiac arrest outside of a hospital environment. Sudden cardiac arrest is the unexpected loss of heart function, breathing, and consciousness and is commonly the result of an electric disturbance in the heart. Unfortunately, only ≈1 in 10 victims survives this dramatic event. Early access to 9-1-1 and early cardiopulmonary resuscitation

  • Novel Mutations and Decreased Expression of the Epigenetic Regulator TET2 in Pulmonary Arterial Hypertension
    Circulation (IF 23.054) Pub Date : 2020-03-20
    François Potus; Michael W. Pauciulo; Elina K. Cook; Na Zhu; Alexander Hsieh; Carrie L. Welch; Yufeng Shen; Lian Tian; Patricia Lima; Jeffrey Mewburn; Christine L. D'Arsigny; Katie A. Lutz; Anna W. Coleman; Rachel Damico; Brooke Snetsinger; Ashley Y. Martin; Paul M. Hassoun; William C. Nichols; Wendy K. Chung; Michael J. Rauh; Stephen L. Archer

    Background: Pulmonary arterial hypertension (PAH) is a lethal vasculopathy. Hereditary cases are associated with germline mutations in BMPR2 and 16 other genes. However, these mutations occur in under 25% of idiopathic PAH patients (IPAH) and are rare in PAH associated with connective tissue diseases (APAH). Preclinical studies suggest epigenetic dysregulation, including altered DNA methylation, promotes

  • Reducing Hypermuscularization of the Transitional Segment between Arterioles and Capillaries Protects Against Spontaneous Intracerebral Hemorrhage
    Circulation (IF 23.054) Pub Date : 2020-03-18
    Julien Ratelade; Nicholas R. Klug; Damiano Lombardi; Monara Kaelle Servulo Cruz Angelim; Fabrice Dabertrand; Valérie Domenga-Denier; Rustam Al-Shahi Salman; Colin Smith; Jean-Frédéric Gerbeau; Mark T. Nelson; Anne Joutel

    Background: Spontaneous deep intracerebral hemorrhage (ICH) is a devastating subtype of stroke without specific treatments. It has been thought that smooth muscle cell (SMC) degeneration at the site of arteriolar wall rupture may be sufficient to cause hemorrhage. However, deep ICHs are rare in some aggressive small vessel diseases that are characterized by significant arteriolar SMC degeneration.

  • LDL-Cholesterol Lowering Strategies and Population Health - Time to Move to a Cumulative Exposure Model.
    Circulation (IF 23.054) Pub Date : 2020-01-20
    Julia Brandts,Kausik K Ray

    Lifetime medication burden from current approaches to LDL-cholesterol (LDL-C) lowering is reliant on small molecules requiring daily dosing with the burden of responsibility placed upon patients. Patient-related factors (risk perception, health literacy) impact adherence and persistence. Adherence to statins and ezetimibe correlate with LDL-C reduction and risk, potentially accounting for approximately

  • Improved Survival with Extracorporeal Cardiopulmonary Resuscitation Despite Progressive Metabolic Derangement Associated with Prolonged Resuscitation.
    Circulation (IF 23.054) Pub Date : 2020-01-03
    Jason A Bartos,Brian Grunau,Claire Carlson,Sue Duval,Adrian Ripeckyj,Rajat Kalra,Ganesh Raveendran,Ranjit John,Marc Conterato,Ralph J Frascone,Alexander Trembley,Tom P Aufderheide,Demetris Yannopoulos

    Background: Likelihood of neurologically favorable survival declines with prolonged resuscitation. However, the ability of extracorporeal cardiopulmonary resuscitation (ECPR) to modulate this decline is unknown. We aimed to examine the effects of resuscitation duration on survival and metabolic profile in patients who undergo ECPR for refractory ventricular fibrillation/ventricular tachycardia out-of-hospital

  • Extracorporeal Cardiopulmonary Resuscitation for Adults With Refractory Out-of-Hospital Cardiac Arrest
    Circulation (IF 23.054) Pub Date : 2020-03-16
    Romain Sonneville; Matthieu Schmidt

    Article, see p 877 Treatment of out-of-hospital cardiac arrest (OHCA) implies a multidisciplinary approach, including the immediate provision of high-quality cardiopulmonary resuscitation, targeted temperature management, consideration of immediate coronary angiography, and early neurological evaluation for prognostication. It is a common condition, with an incidence of 360 000 cases in the United

  • Long-Term Safety and Efficacy of Durable Polymer Cobalt-Chromium Everolimus-Eluting Stents in Patients at High Bleeding Risk: A Patient-Level Stratified Analysis from Four Post-Approval Studies.
    Circulation (IF 23.054) Pub Date : 2020-01-29
    Sabato Sorrentino,Bimmer E Claessen,Rishi Chandiramani,Paul Guedeney,Birgit Vogel,Usman Baber,Vinuta Rau,Jin Wang,Mitchell Krucoff,Ken Kozuma,Junbo Ge,Ashok Seth,Raj Makkar,Yuqi Liu,Sripal Bangalore,Deepak L Bhatt,Dominick J Angiolillo,Shigeru Saito,Franz-Josef Neumann,James Hermiller,Marco Valgimigli,Roxana Mehran

    Background: Long-term outcomes in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) with a drug-eluting stent are unclear. Therefore, we aimed to evaluate long-term adverse events in HBR patients undergoing PCI with cobalt-chromium (CoCr) everolimus-eluting stent implantation. Methods: We analyzed stratified data from four all-comers post-approval registries.

  • Microtubules Increase Diastolic Stiffness in Failing Human Cardiomyocytes and Myocardium.
    Circulation (IF 23.054) Pub Date : 2020-01-16
    Matthew A Caporizzo,Christina Yingxian Chen,Ken Bedi,Kenneth B Margulies,Benjamin L Prosser

    Background: Diastolic dysfunction is a prevalent and therapeutically intractable feature of heart failure (HF). Increasing ventricular compliance can improve diastolic performance, but the viscoelastic forces that resist diastolic filling and become elevated in human HF are poorly defined. Having recently identified post-translationally detyrosinated microtubules as a source of viscoelasticity in cardiomyocytes

  • Altering Sphingolipid Metabolism Attenuates Cell Death and Inflammatory Response after Myocardial Infarction.
    Circulation (IF 23.054) Pub Date : 2020-01-29
    Yoav Hadas,Adam S Vincek,Elias Youssef,Magdalena M Żak,Elena Chepurko,Nishat Sultana,Mohammad Tofael Kabir Sharkar,Ningning Guo,Rinat Komargodski,Ann Anu Kurian,Keerat Kaur,Ajit Magadum,Anthony Fargnoli,Michael G Katz,Nadia Hossain,Ephraim Kenigsberg,Nicole C Dubois,Eric Schadt,Roger Hajjar,Efrat Eliyahu,Lior Zangi

    Background: Sphingolipids have recently emerged as a biomarker of recurrence and mortality after myocardial infarction (MI). The increased ceramide levels in mammalian heart tissues during acute MI, as demonstrated by several groups, is associated with higher cell death rates in the left ventricle (LV) and deteriorated cardiac function. Ceramidase, the only enzyme known to hydrolyze pro-apoptotic ceramide

  • New Onset Recurrent Syncope Triggered by Fever
    Circulation (IF 23.054) Pub Date : 2020-03-16
    Miguel A. Arias; Marta Pachón; Gerard Loughlin

    A 51-year-old woman with a medical history of treated primary hypothyroidism was admitted to the emergency department because of a syncopal episode preceded by palpitations with no other prodromal symptoms. The patient experienced occasional episodes of palpitations in the past without loss of consciousness that coincided with febrile episodes and were resolved once the fever was controlled. Upon arrival

  • Suicide Attempts Among LVAD Recipients
    Circulation (IF 23.054) Pub Date : 2020-03-10
    Marion Charton; Erwan Flécher; Christophe Leclercq; Clément Delmas; Camille Dambrin; Céline Goeminne; André Vincentelli; Magali Michel; Laurence Lehelias; Constance Verdonk; Marylou Para; Matteo Pozzi; Jean-François Obadia; Aude Boignard; Olivier Chavanon; Laurent Barandon; Karine Nubret; Michel Kindo; Tam Hoang Minh; Philippe Gaudard; Edeline Pelcé; Vlad Gariboldi; Pierre-Yves Litzler; Frédéric Anselme;

    Left ventricular assist device (LVAD) implantation is an alternative therapy for end-stage heart failure. Numerous complications are associated with LVADs, including psychiatric disorders such as anxiety and depression. Data regarding the suicide risk in this population are lacking. We aimed at describing the incidence of suicide in LVAD recipients included in the multicenter ASSIST-ICD observational

  • Trends in Antiarrhythmic Drug Use Among Patients in the United States Between 2004 and 2016
    Circulation (IF 23.054) Pub Date : 2020-03-16
    Timothy M. Markman; Zhi Geng; Andrew E. Epstein; Saman Nazarian; Rajat Deo; Francis E. Marchlinski; Peter W. Groeneveld; David S. Frankel

    Antiarrhythmic drugs (AADs) are widely prescribed to treat both ventricular and supraventricular arrhythmias. Although the efficacy of catheter ablation is often superior to AADs, medical rhythm control remains an important treatment modality.1,2 The choice of AAD is affected by efficacy for treatment of the specific arrhythmia, comorbidities including structural heart disease and chronic kidney disease

  • Identifying the Cardiac Dyad Proteome In Vivo by a BioID2 Knock-In Strategy
    Circulation (IF 23.054) Pub Date : 2020-03-16
    Wei Feng; Canzhao Liu; Simone Spinozzi; Li Wang; Sylvia M. Evans; Ju Chen

    Increasing evidence demonstrates that perturbation of excitation-contraction coupling in cardiomyocytes leads to cardiac dysfunction and heart failure.1 Critical to excitation-contraction coupling are cardiac dyads, microdomains at membrane contact sites between transverse-tubules and junctional sarcoplasmic reticulum membranes.1,2 Junctophilin 2 (JPH2), spanning the cleft from the transverse-tubule

  • Role of Deranged Energy Deprivation Signaling in the Pathogenesis of Cardiac and Renal Disease in States of Perceived Nutrient Overabundance
    Circulation (IF 23.054) Pub Date : 2020-03-13
    Milton Packer

    Sodium-glucose cotransporter 2 inhibitors reduce the risk of serious heart failure and adverse renal events, but the mechanisms that underlie this benefit are not understood. Treatment with SGLT2 inhibitors is distinguished by two intriguing features — ketogenesis and erythrocytosis. Both reflect the induction of a fasting-like and hypoxia-like transcriptional paradigm that is capable of restoring

  • Apixaban versus Warfarin in Patients with Atrial Fibrillation and Advanced Chronic Kidney Disease
    Circulation (IF 23.054) Pub Date : 2020-03-12
    John W. Stanifer; Sean D. Pokorney; Glenn M. Chertow; Stefan H. Hohnloser; Daniel M. Wojdyla; Samira Garonzik; Wonkyung Byon; Ziad Hijazi; Renato D. Lopes; John H. Alexander; Lars Wallentin; Christopher B. Granger

    Background: Compared with the general population, patients with advanced chronic kidney disease (CKD) have a >10-fold higher burden of atrial fibrillation (AF). Limited data are available guiding the use of non-vitamin K antagonist oral anticoagulants in this population.Methods: We compared the safety of apixaban with warfarin in 269 patients with AF and advanced CKD (defined as creatinine clearance

  • Heart-Specific Immune Responses in an Animal Model of AutoimmuneRelated Myocarditis Mitigated by an Immunoproteasome Inhibitor and Genetic Ablation
    Circulation (IF 23.054) Pub Date : 2020-03-12
    Mariella Bockstahler; Andrea Fischer; Carl Christoph Goetzke; Hannah Louise Neumaier; Martina Sauter; Meike Kespohl; Anna-Maria Müller; Christin Meckes; Christian Salbach; Mirjam Schenk; Arnd Heuser; Ulf Landmesser; January Weiner; Benjamin Meder; Lorenz Lehmann; Adelheid Kratzer; Karin Klingel; Hugo A Katus; Ziya Kaya; Antje Beling

    Background: Immune checkpoint inhibitor (ICI) therapy is often accompanied by immune-related pathology, with an increasing occurrence of high-risk ICI-related myocarditis. Understanding the mechanisms involved in this side effect could enable the development of management strategies. In mouse models, immune checkpoints, such as PD-1, control the threshold of self-antigen responses directed against

  • Time Trends in Cardiovascular Disease Mortality Across the BRICS: An Age-Period-Cohort Analysis of Key Nations with Emerging Economies Using the Global Burden of Disease Study 2017.
    Circulation (IF 23.054) Pub Date : 2020-01-16
    Zhiyong Zou,Karly Cini,Bin Dong,Yinghua Ma,Jun Ma,David P Burgner,George C Patton

    Background: Brazil, Russia, India, China and South Africa (BRICS) are emerging economies making up almost half the global population. We analyzed trends in cardiovascular disease (CVD) mortality across the BRICS, and associations with age, period and birth cohort. Methods: Mortality estimates were derived from the Global Burden of Disease Study 2017. We used age-period-cohort modeling to estimate cohort

  • The Effect of Coconut Oil Consumption on Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Clinical Trials.
    Circulation (IF 23.054) Pub Date : 2020-01-13
    Nithya Neelakantan,Jowy Yi Hoong Seah,Rob M van Dam

    Background: Coconut oil is high in saturated fat and may, therefore, raise serum cholesterol concentrations, but beneficial effects on other cardiovascular risk factors have also been suggested. Therefore, we conducted a systematic review of the effect of coconut oil consumption on blood lipids and other cardiovascular risk factors compared with other cooking oils using data from clinical trials. Methods:

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全球疫情及响应:BMC Medicine专题征稿