Importance High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural

Importance Appropriate regimens of antithrombotic therapy for patients with atrial fibrillation (AF) and coronary artery disease (CAD) have not yet been established. Objective To compare the total number of thrombotic and/or bleeding events between rivaroxaban monotherapy and combined rivaroxaban and antiplatelet therapy in such patients. Design, Setting, and Participants This was a post hoc secondary

Importance Intimal hyperplasia and subsequent saphenous vein graft failure may have significant adverse clinical effects in patients undergoing coronary artery bypass surgery. External support of saphenous vein grafts has the potential to prevent vein graft dilation and hence slow the rate of intimal hyperplasia and increase long-term vein patency. Objective To determine efficacy, as measured by intimal

Importance Early detection and characterization of increased left ventricular (LV) wall thickness can markedly impact patient care but is limited by under-recognition of hypertrophy, measurement error and variability, and difficulty differentiating causes of increased wall thickness, such as hypertrophy, cardiomyopathy, and cardiac amyloidosis. Objective To assess the accuracy of a deep learning workflow

This narrative review provides an overview of coronary artery calcium testing as a tool for risk assessment in the prevention of atherosclerotic cardiovascular disease.

This Viewpoint discusses the challenges of cardiovascular imaging in patients with breast cancer after reconstruction.

This cohort study evaluates the use of guideline-directed medical therapy and implantable cardioverter-defibrillator as well as mortality rates over a 6-year period among patients with heart failure with reduced ejection fraction in the US Department of Veterans Affairs health care system.

This cohort study investigates outcomes associated with ventricular tachycardia ablation in patients with cardiac sarcoidosis.

This national cross-sectional analysis examines the association between zip code–level racial, ethnic, and socioeconomic composition and rates of transcatheter aortic valve replacement among Medicare patients living within large metropolitan areas in the US.

Despite breakthrough science and innovative procedures, cardiovascular disease is rife with evidence-based racial disparities. Adopting quality initiatives, raising awareness, and inciting discussions about unconscious bias are recommended steps intended to narrow cardiovascular disease disparities. Progress is noted but a new challenge emerges. The implementation of transcatheter aortic valve replacement

This randomized clinical trial tests the hypothesis that n-of-1 trials of self-selected atrial fibrillation triggers would enhance atrial fibrillation–related quality of life.

This cohort study examines metabolites associated with incident coronary heart disease and coronary artery calcium among African American participants in the Jackson Heart Study and seeks to replicate coronary heart disease findings among multiethnic participants in the Women’s Health Initiative.

Clinical guideline evidence matters. Recent 2018 American Heart Association/American College of Cardiology/Multisociety guidelines present strong evidence to support maximally tolerated statin therapy as a first step in patients aged 20 to 75 years with primary severe elevations of low-density lipoprotein cholesterol (LDL-C) of 190 mg/dL (to convert to millimoles per liter, multiply by 0.0259) or greater

This secondary analysis of a randomized clinical trial’s economic outcomes reports the cumulative medical resource use and costs during the 6-month follow-up period for patients randomized to an intervention or control condition for acute decompensated heart failure.

This case series examines the prevalence of fibromuscular dysplasia and other extracoronary events in patients who develop spontaneous coronary artery dissection.

This randomized clinical trial evaluates the effect of high-intensity interval training and intensive lower extremity resistance training compared with standard moderate intensity continuous training on peak oxygen uptake among women in cardiac rehabilitation.

This cohort study assesses whether and to what extent differences in treatment intensification, scheduled follow-up interval, and missed visits are associated with racial and ethnic disparities in blood pressure control among adults with hypertension.

This cohort study evaluates the predictive utility of adding former smoking status, pack-years smoked, and years since quitting to the American College of Cardiology/American Heart Association 2013 pooled cohort equations for more accurate atherosclerotic cardiovascular disease risk prediction.

In the Editorial titled, “The Potential and Pitfalls of Coronary Artery Calcium Scoring,” which published online October 27, 2021, the following sentence is incorrect: “Beyond this recommendation, however, some investigators have called for even more aggressive de-risking of patients with a CAC score of 0, suggesting that even those with familial hypercholesterolemia and a CAC score of 0 may not need

In Reply We appreciate the letter by Senter and colleagues highlighting the important implications of socioeconomic deprivation on clinical outcomes. As our research highlighted, neighborhood-level socioeconomic disadvantage is associated with increasing all-cause and cardiovascular mortality in individuals 50 years and younger who experienced a first myocardial infarction over an 11-year follow-up

To the Editor We appreciate the work of Berman and colleagues, who investigated the association between socioeconomic disadvantage and mortality after a myocardial infarction (MI). The authors found that among people who had an MI before age 50 years, patients who lived in the most disadvantaged neighborhoods had a higher risk of all-cause and cardiovascular mortality. These findings suggest that addressing

This Patient Page describes the causes, symptoms, diagnosis, genetic testing, and treatment of amyloidogenic transthyretin.

To do nothing is sometimes a good remedy.Hippocrates

A man in his 40s with a 20-year history of bilateral sensorineural hearing loss was referred for evaluation of left ventricular hypertrophy detected by echocardiography. On physical examination, he was 154 cm tall and weighed 38 kg and neurological examination showed mild cognitive impairment, poor coordination, and muscle weakness of the bilateral lower limbs. What would you do next?

This Viewpoint discusses how the rapid rise of the gig economy has resulted in a fast-growing workforce segment with unique health vulnerabilities.

IMPORTANCE Diagnosis of cancer therapy-related cardiac dysfunction (CTRCD) remains a challenge. Cardiovascular magnetic resonance (CMR) provides accurate measurement of left ventricular ejection fraction (LVEF), but access to repeated scans is limited. OBJECTIVE To develop a diagnostic model for CTRCD using echocardiographic LVEF and strain and biomarkers, with CMR as the reference standard. DESIGN

IMPORTANCE The outcome and interpretation of noninferiority trials depend on the magnitude of the noninferiority margin and whether a relative or absolute noninferiority margin is used and may be affected by imprecision in event rate estimation. OBJECTIVE To assess the consequence of imprecise event rate estimations on interpretation of peer-reviewed randomized clinical trials. DATA SOURCES PubMed/MEDLINE

IMPORTANCE Distinct plaque locations and vessel geometric features predispose to altered coronary flow hemodynamics. The association between these lesion-level characteristics assessed by coronary computed tomographic angiography (CCTA) and risk of future acute coronary syndrome (ACS) is unknown. OBJECTIVE To examine whether CCTA-derived adverse geometric characteristics (AGCs) of coronary lesions

IMPORTANCE Hypertensive disorders of pregnancy are associated with future cardiovascular disease, perhaps because of subclinical cardiac dysfunction before pregnancy leading to impaired adaptation to pregnancy. Natriuretic peptides are promising biomarkers for detecting subclinical cardiac dysfunction outside of pregnancy. OBJECTIVE To investigate whether higher concentrations of N-terminal pro-brain

IMPORTANCE Wide state-level variability in waiting list outcomes have been noted for patients listed for heart transplant in the US, but little is known regarding center-level transplant rates since the heart allocation policy change. OBJECTIVE To evaluate center-level transplant rates following the recent allocation policy change for heart transplant. DESIGN, SETTING, AND PARTICIPANTS This cohort

Importance Although myocardial injury can occur with acute COVID-19, there is limited understanding of changes with myocardial metabolism in recovered patients. Objective To examine myocardial metabolic changes early after recovery from COVID-19 using fluorodeoxyglucose–positron emission tomography (PET) and associate these changes to abnormalities in cardiac magnetic resonance imaging (MRI)–based

Importance The use of sacubitril/valsartan is not endorsed by practice guidelines for use in patients with New York Heart Association class IV heart failure with a reduced ejection fraction because of limited clinical experience in this population. Objective To compare treatment with sacubitril/valsartan treatment with valsartan in patients with advanced heart failure and a reduced ejection fraction

Importance Heart failure with reduced ejection fraction is a progressive clinical syndrome, and many patients’ condition worsen over time despite treatment. Patients with more severe disease are often intolerant of available medical therapies. Objective To evaluate the efficacy and safety of omecamtiv mecarbil for the treatment of patients with severe heart failure (HF) enrolled in the Global Approach

Importance The diagnostic value is unclear of a 0 coronary artery calcium (CAC) score to rule out obstructive coronary artery disease (CAD) and near-term clinical events across different age groups. Objective To assess the diagnostic value of a CAC score of 0 for reducing the likelihood of obstructive CAD and to assess the implications of such a CAC score and obstructive CAD across different age groups

Importance Smoking is a key modifiable risk factor in the development and progression of peripheral artery disease, which often manifests as intermittent claudication (IC). Smoking cessation is a first-line therapy for IC, yet a minority of patients quit smoking prior to elective revascularization. Objective To assess if preprocedural smoking is associated with an increased risk of early postprocedural

Importance The balance between the potential long-term clinical benefits and harms associated with genetic cholesteryl ester transfer protein (CETP) deficiency, mimicking pharmacologic CETP inhibition, is unknown. Objective To assess the relative benefits and harms associated with genetic CETP deficiency. Design, Setting, and Participants This study examined 2 similar prospective cohorts of the Danish

Importance Preterm delivery has been associated with future cardiometabolic disorders in women. However, the long-term risks of chronic hypertension associated with preterm delivery and whether such risks are attributable to familial confounding are unclear. Such knowledge is needed to improve long-term risk assessment, clinical monitoring, and cardiovascular prevention strategies in women. Objective

Importance Respiratory fluoroquinolone antibiotics are some of the most common medications with QT interval–prolonging potential prescribed to patients with hemodialysis-dependent kidney failure—individuals who have a very high risk of sudden cardiac death (SCD). To date, there have been no large-scale, population-specific studies evaluating the cardiac safety of respiratory fluoroquinolones in the

Importance Calcium-release deficiency syndrome (CRDS), which is caused by loss-of-function variants in cardiac ryanodine receptor 2 (RyR2), is an emerging cause of ventricular fibrillation. However, the lack of complex polymorphic/bidirectional ventricular tachyarrhythmias during exercise stress testing (EST) may distinguish it from catecholaminergic polymorphic ventricular tachycardia (CPVT). Recently

Importance Impaired myocardial flow reserve (MFR) and stress myocardial blood flow (MBF) on positron emission tomography (PET) myocardial perfusion imaging may identify adverse myocardial characteristics, including myocardial stress and injury in aortic stenosis (AS). Objective To investigate whether MFR and stress MBF are associated with LV structure and function derangements, and whether these parameters

Importance Enhanced ventricular interdependence is a highly sensitive and specific criterion for the diagnosis of constrictive pericarditis (CP), but simultaneous ventricular measurements can be challenging at cardiac catheterization. Ejection times (ETs) correlate with stroke volumes and can be easily measured from arterial pressure tracings. Objective To assess respirophasic changes in pulmonary

Importance The recognition of the pulmonary circulation is a complex evolution in medical history and draws on theories across eras and cultures. Observations This narrative review summarizes evidence suggesting that the recognition of pulmonary circulation is older than the time of Ibn Nafis. The theory of pulmonary circulation originated in ancient Persia (ad 224-637), was overshadowed by Greek theory

In the Original Investigation titled “Long-term Benefits and Harms Associated With Genetic Cholesteryl Ester Transfer Protein Deficiency in the General Population,”1 published online October 6, 2021, 3 of the 8 bars in the left graph of Figure 4 representing myocardial infarction, age-related macular degeneration (AMD), and dry AMD, respectively, and all 3 bars in the right graph of Figure 4 representing

In the Original Investigation titled “Effect of a Self-care Intervention on 90-Day Outcomes in Patients With Acute Heart Failure Discharged From the Emergency Department: A Randomized Clinical Trial,”1 published in the February 2021 issue, an affiliation was omitted. A second affiliation for Sean P. Collins, MD, MSc, and Jin H. Han, MD, should have been given as “Geriatric Research, Education, and

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