Background: Among patients with diabetes mellitus (diabetes) and chronic coronary disease (CCD), it is unclear if invasive management improves outcomes when added to medical therapy.Methods: The ISCHEMIA Trials (ISCHEMIA and ISCHEMIA CKD) randomized CCD patients to an invasive (medical therapy + angiography and revascularization if feasible) or a conservative approach (medical therapy alone with revascularization

Background:Even on optimal therapy, many patients with heart failure and atrial fibrillation experience cardiovascular complications. Additional treatments are needed to reduce these events, especially in patients with heart failure and preserved left ventricular ejection fraction.Methods:This prespecified subanalysis of the randomized EAST-AFNET4 trial (Early Treatment of Atrial Fibrillation for Stroke

Background:Inflammation is a key factor of myocardial damage in reperfused ST-segment–elevation myocardial infarction. We hypothesized that colchicine, a potent anti-inflammatory agent, may reduce infarct size (IS) and left ventricular (LV) remodeling at the acute phase of ST-segment–elevation myocardial infarction.Methods:In this double-blind multicenter trial, we randomly assigned patients admitted

Background:Current paradigms suggest that nitric oxide (NO) produced by endothelial cells (ECs) through endothelial nitric oxide synthase (eNOS) in the vessel wall is the primary regulator of blood flow and blood pressure. However, red blood cells (RBCs) also carry a catalytically active eNOS, but its role is controversial and remains undefined. This study aimed to elucidate the functional significance

Background:Ischemic and hemorrhagic cerebrovascular accidents remain common among patients with centrifugal-flow left ventricular assist devices, despite improvements in survival and device longevity. We compared the incidence of neurologic adverse events (NAEs) associated with 2 contemporary centrifugal-flow left ventricular assist devices: the Abbott HeartMate3 (HM3) and the Medtronic HeartWare HVAD

Among the estimated 6.2 million Americans living with heart failure (HF), ≈5%/y may progress to advanced, or stage D, disease. Advanced HF has a high morbidity and mortality, such that early recognition of this condition is important to optimize care. Delayed referral or lack of referral in patients who are likely to derive benefit from an advanced HF evaluation can have important adverse consequences

Background: Doxycycline was demonstrated in a retrospective study to be associated with greater survival in patients with light chain (AL) amyloidosis. Therefore, we prospectively compared the efficacy of bortezomib-cyclophosphamide-dexamethasone (CyBorD) and CyBorD combined with doxycycline for cardiac AL amyloidosis.Methods: This was a multicenter, open-label randomized controlled trial. Patients

Background: The ISCHEMIA trial postulated that patients with stable coronary artery disease (CAD) and moderate or severe ischemia would benefit from revascularization. We investigated the relationship between severity of CAD and that of ischemia and trial outcomes, overall and by management strategy.Methods: 5,179 patients with moderate or severe ischemia were randomized to an initial invasive or conservative

The United States has the highest maternal mortality rates among developed countries, and cardiovascular disease is the leading cause. Therefore, the American Heart Association has a unique role in advocating for efforts to improve maternal health and to enhance access to and delivery of care before, during, and after pregnancy. Several initiatives have shaped the time course of major milestones in

Background:Ischemic and hemorrhagic cerebrovascular accidents remain common among patients with centrifugal-flow left ventricular assist devices, despite improvements in survival and device longevity. We compared the incidence of neurologic adverse events (NAEs) associated with 2 contemporary centrifugal-flow left ventricular assist devices: the Abbott HeartMate3 (HM3) and the Medtronic HeartWare HVAD

Background:The non–ST-segment–elevation myocardial infarction (NSTEMI) guidelines of the European Society of Cardiology (ESC) recommend a 3h cardiac troponin determination in patients triaged to the observe-zone of the ESC 0/1h-algorithm; however, no specific cutoff for further triage is endorsed. Recently, a specific cutoff for 0/3h high-sensitivity cardiac troponin T (hs-cTnT) change (7 ng/L) was

Polymorphic ventricular tachyarrhythmias are highly lethal arrhythmias. Several types of polymorphic ventricular tachycardia have similar electrocardiographic characteristics but have different modes of therapy. In fact, medications considered the treatment of choice for one form of polymorphic ventricular tachycardia, are contraindicated for the other. Yet confusion about terminology, and thus diagnosis

In the article by Cho et al, “Cerebrovascular Events in Patients With Centrifugal-Flow Left Ventricular Assist Devices,” which published online on July 28, 2021, and appears in the September 7, 2021, issue of the journal (Circulation.2021;144:763–772. 10.1161/CIRCULATIONAHA.121.055716), a correction is needed. In the text, 2 data points for HVAD and HM3 were swapped: The first line of the results section

Background: Acute kidney injury (AKI) affects up to 30% of cardiac surgery patients, leading to increased in-hospital and long-term morbidity and mortality. Teprasiran is a novel small interfering RNA (siRNA) that temporarily inhibits p53-mediated cell death, which underlies AKI.Methods: This prospective, multicenter, double-blind, randomized, controlled Phase 2 trial evaluated the efficacy and safety

Background: Angiogenesis is a dynamic process that involves expansion of a pre-existing vascular network that can occur in a number of physiologic and pathologic settings. Despite its importance, the origin of the new angiogenic vasculature is poorly defined. In particular, the primary subtype of endothelial cells (capillary, venous, arterial) driving this process remains undefined.Methods: Endothelial

Background: Acute cellular rejection is a major determinant of mortality and re-transplantation after heart transplantation. We sought to evaluate prognostic implications of coronary microcirculatory dysfunction assessed by index of microcirculatory resistance (IMR) for risk of acute cellular rejection after heart transplantation.Methods: The current study prospectively enrolled 154 heart transplant

Background:Effective screening for term preeclampsia is provided by a combination of maternal factors with measurements of mean arterial pressure, serum placental growth factor, and serum soluble fms-like tyrosine kinase-1 at 35 to 37 weeks of gestation, with a detection rate of ≈75% at a screen-positive rate of 10%. However, there is no known intervention to reduce the incidence of the disease.Methods:In

Background:Obesity may accelerate age-related increases in aortic stiffness. Although aerobic exercise training generally has favorable effects on aortic structure and function, exercise alone may not be sufficient to improve aortic stiffness in older adults with obesity. We determined the effects of aerobic exercise training with and without moderate- to high-caloric restriction (CR) on the structure

Saphenous vein grafts (SVGs) remain the most frequently used conduits in coronary artery bypass graft surgery (CABG). Despite advances in surgical techniques and pharmacotherapy, SVG failure rates remain high, often leading to repeat coronary revascularization. The no-touch SVG harvesting technique (minimal graft manipulation with preservation of vasa vasorum and nerves) reduces the risk of SVG failure

A 39-year-old male patient presented to our emergency department with complaints of chest discomfort for the past 6 hours. His chest pain was a dull aching type, retrosternal, and was not radiating elsewhere. He was diagnosed with systemic hypertension 1 year back and was on regular medication since then. A 12-lead ECG was taken, which is shown in Figure 1. What is the electrocardiographic diagnosis

Hypertrophic cardiomyopathy (HCM) represents one of the most common inherited cardiac conditions. It is genetically and clinically heterogeneous and is most commonly caused by variants in sarcomere-encoding genes, including MYH7, which represents the second most common cause of familial HCM.1 Missense variants in MYH7 are believed to cause HCM through gain-of-function actions: Variants produce an abnormal

Lower extremity peripheral artery disease (PAD) affects >230 million adults worldwide and is associated with increased risk of various adverse clinical outcomes (other cardiovascular diseases such as coronary heart disease and stroke and leg outcomes such as amputation). Despite its prevalence and clinical importance, PAD has been historically underappreciated by health care professionals and patients

In the article by Wilson et al, “Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association,” which published ahead of print on April 15, 2021, and appeared in the May 18, 2021, issue of the journal (Circulation. 2021;143:e963–e978. DOI: 10.1161/CIR.0000000000000969), corrections were needed. On page e972, left column, last paragraph

In the article by Criqui et al, “Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association,” which published ahead of print on July 28, 2021, and appeared in the August 31, 2021, issue of the journal (Circulation. 2021;144:e171–e191. DOI: 10.1161/CIR.0000000000001005), corrections were needed

Background: The relative cardiovascular safety of gonadotropin-releasing hormone (GnRH) antagonists compared with GnRH agonists in men with prostate cancer and known atherosclerotic cardiovascular disease (ASCVD) remains controversial.Methods: In this international, multicenter, prospective, randomized, open-label trial, men with prostate cancer and concomitant ASCVD were randomized 1:1 to receive

Background: Observational and small randomized studies suggest that influenza vaccine may reduce future cardiovascular events in patients with cardiovascular disease.Methods: We conducted an investigator-initiated, randomized, double-blind trial to compare inactivated influenza vaccine with saline placebo administered shortly after myocardial infarction (MI) (99.7% of patients) or high-risk stable

Background: Percutaneous closure of the left atrial appendage (LAA) is an alternative to chronic oral anticoagulation to reduce stroke risk in patients with non-valvular atrial fibrillation (NVAF). The Amplatzer™ Amulet™ LAA Occluder IDE Trial (Amulet IDE Trial) was designed to evaluate the safety and effectiveness of the dual-seal mechanism of the Amulet LAA occluder compared with the Watchman™ device

Background: The optimal duration of antiplatelet therapy (APT) in patients at high bleeding risk with or without oral anticoagulation (OAC) after coronary stenting remains unclear.Methods: In the investigator-initiated, randomized, open-label MASTER DAPT trial, 4579 patients at high bleeding risk were randomized after 1-month dual APT (DAPT) to abbreviated or nonabbreviated APT strategies. Randomization

Background: Empagliflozin reduces the risk of cardiovascular death or hospitalization for heart failure in patients with heart failure and a preserved ejection fraction, but additional data are needed about its effect on inpatient and outpatient heart failure events.Methods: We randomly assigned 5988 patients with class II-IV heart failure with an ejection fraction of >40% to double-blind treatment

Background: There remain major uncertainties regarding disease activity within the retained native aortic valve as well as bioprosthetic valve durability following transcatheter aortic valve implantation (TAVI). We aimed to assess native aortic valve disease activity and bioprosthetic valve durability in patients with TAVI in comparison to subjects with bioprosthetic surgical aortic valve replacement

Background: High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative (NSSRI) proposed government supported voluntary national sugar reduction targets. This intervention's potential health and equity impacts, and cost-effectiveness are unclear.Methods: A validated microsimulation model, CVD-PREDICT, coded in C++, was used

Background: In the VICTORIA trial, anemia occurred more often in patients treated with vericiguat (7.6%) than placebo (5.7%). We explored the association between vericiguat, randomization hemoglobin, development of anemia and whether the benefit of vericiguat related to baseline hemoglobin.Methods: Anemia was defined as hemoglobin <13.0 g/dL in men and <12.0 g/dL in women (World Health Organization

“Choices are the hinges of destiny” —Edwin Markham Established more than a century ago, and buttressed by 1962 legislation, the United States Food and Drug Administration (FDA) plays a central role in advancing patient care. The FDA’s impressive global reputation has been deservedly earned by providing independent, critically appraised, evidence-based assessments of new therapies before their approval

The Russian Federation has 146.6 million inhabitants and the largest territory in the world. Cardiovascular mortality in the country is unacceptably high, and cardiovascular disease is the leading cause of death, accounting for ≈1 million (46%) of all fatalities per year. During the late 20th century and early 2000s, Russia faced a profound socioeconomic crisis with a dramatic increase in cardiovascular

Background:Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is the gold standard for noninvasive myocardial tissue characterization but requires intravenous contrast agent administration. It is highly desired to develop a contrast agent–free technology to replace LGE for faster and cheaper CMR scans.Methods:A CMR virtual native enhancement (VNE) imaging technology was

Article, see p 589 Noninvasive cardiovascular imaging is fundamental to diagnosis, surveillance, risk stratification, and management of patients with hypertrophic cardiomyopathy (HCM). Although transthoracic echocardiography more frequently identifies or confirms the presence of HCM, cardiovascular magnetic resonance (CMR) is increasingly recommended to exclude phenocopies, screen family members, and

Background:Abdominal aortic aneurysm (AAA) can occur in patients who are ineligible for routine ultrasound screening. A simple AAA risk score was derived and compared with current guidelines used for ultrasound screening of AAA.Methods:United Kingdom Biobank participants without previous AAA were split into a derivation cohort (n=401 820, 54.6% women, mean age 56.4 years, 95.5% White race) and validation

Background:Many patients with heart failure with preserved ejection fraction have metabolic syndrome and develop exercise-induced pulmonary hypertension (EIPH). Increases in pulmonary vascular resistance in patients with heart failure with preserved ejection fraction portend a poor prognosis; this phenotype is referred to as combined precapillary and postcapillary pulmonary hypertension (CpcPH). Therapeutic

A 33-years old female patient was transferred to the emergency department after out-of-hospital cardiac arrest. The prehospital ECG showed a regular bradycardia with wide QRS complex (see Figure 1) that subsequently converted into ventricular fibrillation requiring cardiopulmonary resuscitation. The patient was intubated and sedated. The medical history of the patient was negative for chronic disease

Genome-wide association studies have led to identification of >160 variants with significant association to coronary artery disease (CAD).1 One of the variants identified (rs7678555) is located on chromosome 4q27 in proximity of PDE5A and linked to enhanced PDE5A mRNA levels in aorta.2 The mechanisms by which the variant affects CAD risk remain unclear. In an extended family with high prevalence of

In the article by Docherty et al, “Effect of Neprilysin Inhibition on Left Ventricular Remodeling in Patients With Asymptomatic Left Ventricular Systolic Dysfunction Late After Myocardial Infarction” which appears in the July 20, 2021, issue of the journal (Circulation. 2021;144:199–209. DOI: 10.1161/CIRCULATIONAHA.121.054892), corrections are needed. The lower bound of the 95% confidence interval