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High-Sensitivity Troponin T and Mortality After Elective Percutaneous Coronary Intervention
This study included 5,626 patients undergoing elective PCI who had baseline and peak post-procedural hs-TnT measurements available. The primary outcome was 3-year mortality (with risk estimates calculated per SD increase of the log hs-TnT scale).ResultsPatients were divided into 4 groups: nonelevated baseline and post-procedural hs-TnT levels (hs-TnT ≤0.014 μg/l; n = 742); nonelevated baseline but elevated post-procedural hs-TnT levels (peak post-procedural hs-TnT>0.014  μg/l; n = 2,721); elevated baseline hs-TnT levels (hs-TnT>0.014 μg/l) with no further rise post-procedure (n = 516); and elevated baseline hs-T...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Does the Natural History of Atherosclerosis Follow an Ischemic  Dose-Response Curve? ∗
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

A Prospective Natural History Study of  Coronary Atherosclerosis Using Fractional Flow Reserve
This study sought to investigate the relationship between FFR values and vessel-related clinical outcome.MethodsWe prospectively studied major adverse cardiovascular events (MACE) at 2 years in 607 patients in whom all stenoses were assessed by FFR and who were treated with medical therapy alone. The relationship between FFR and 2-year MACE was assessed as a continuous function. Logistic and Cox proportional hazards regression models were used to calculate the average decrease in the risk of MACE per 0.05-U increase in FFR.ResultsMACE occurred in 272 (26.5%) of 1,029 lesions. Target lesions with diameter stenosis  ≥70% ...
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Cultural Third World War How Economic Disparity Adversely  Affects Health
“When man is viewed in his totality…we are able to have a profound understanding of the poorest, those most in need, and the marginalized. In this way, they will benefit from your care and the support and assistance offered by the public and private health sectors.”—Excerpt from Pope Fran cis’s address to the 2016 European Society of Cardiology Congress in Rome, Italy(1) (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Reply No Evidence for Femoral Pulse Evaluation in Normotensive College Athletes During Sports Preparticipation Examinations
Dr. McGrew makes an excellent point in questioning the rationale for evaluating the femoral pulse in normotensive college student-athletes during the preparticipation evaluation, noting that there have been no documented cases of sudden death in college athletes from coarctation of the aorta. However, as stated in the interassociation document(1), although neither the 14-Element AHA Recommendations nor the Preparticipation Physical Evaluation, 4th Edition, have been validated scientifically to reduce the incidence of sudden cardiac death in college athletes, there is widespread consensus from leading medical and sports med...
Source: Journal of the American College of Cardiology - November 15, 2016 Category: Cardiology Source Type: research

No Evidence for Femoral Pulse Evaluation in Normotensive College Athletes During Sports Preparticipation Examinations
In a recently published consensus statement, Hainline et  al.(1) present a college athlete –specific preparticipation protocol, which states that the “NCAA supports, in concept, preparticipation cardiovascular screening using a comprehensive personal and family history and physical examination, such as the American Heart Association (AHA) 14 point recommendations and/or the Prepartici pation Monograph, Fourth Edition (PPE-4).” Both of these recommended protocols include femoral pulse evaluation to exclude coarctation of the aorta during the preparticipation examination. It is important to note that the 2 largest and...
Source: Journal of the American College of Cardiology - November 15, 2016 Category: Cardiology Source Type: research

Reply Mineralocorticoid Receptor Antagonism in Acute Myocardial Infarction: Who Benefits?
The letter by Drs. Weir and Petrie points to the hypothetic benefit of mineralocorticoid receptor blockade (MRA) in preventing left ventricular remodeling and reducing mortality in patients with myocardial infarction (MI) but preserved left ventricular function. Although the ALBATROSS (Aldosterone Lethal Effects Blockade in Acute Myocardial Infarction Treated With or Without Reperfusion to Improve Outcome and Survival at Six Months Follow-up) study(1) failed to demonstrate a benefit of MRA in the global MI population, it reported a possible reduction of mortality only in the ST-segment elevation MI subgroup (1,229 of 1,603...
Source: Journal of the American College of Cardiology - November 15, 2016 Category: Cardiology Source Type: research

Mineralocorticoid Receptor Antagonism in  Acute Myocardial Infarction Who Benefits?
Beygui et al.(1) deserve credit for demonstrating, through the ALBATROSS (Aldosterone Lethal Effects Blockade in Acute Myocardial Infarction Treated With or Without Reperfusion to Improve Outcome and Survival at Six Months Follow-up) study, that the beneficial effects on cardiovascular outcomes of mineralocorticoid receptor antagonism (MRA) after myocardial infarction (MI) do not extend to patients with preserved left ventricular function and largely without heart failure. This result may seem unsurprising when the baseline left ventricular ejection fraction (LVEF) of patients in ALBATROSS (50% [45 to 60]) is taken into ac...
Source: Journal of the American College of Cardiology - November 15, 2016 Category: Cardiology Source Type: research

Circulating Concentrations of Orexin A Predict Left  Ventricular Myocardial Remodeling
Among pivotal processes in heart failure (HF) progression is remodeling of the myocardium, which involves progressive cardiomyocyte cell death with interstitial fibrosis. On a macroscopic level, myocardial remodeling manifests as progressive increase in left ventricular (LV) volumes and reduction in ejection fraction (LVEF). LV reverse remodeling (LVRR) (i.e., reduction in LV volumes and improvement in LVEF) has been seen to follow initiation and up-titration of guideline-directed medical HF therapy (GDMT) and is associated with favorable outcome(1). (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 15, 2016 Category: Cardiology Source Type: research

Obscurin Variants in  Patients With Left Ventricular Noncompaction
Left ventricular noncompaction (LVNC) is a rare type of cardiomyopathy, occurring less frequently than hypertrophic cardiomyopathy (HCM) and dilated CM (DCM). In our patient population, we identified a possible association between LVNC and variants in the obscurin (OBSCN) gene. Obscurins are giant sarcomeric proteins ( ≈700 to 900 kDa) that play key roles in myofibrillogenesis and cytoskeletal arrangement through interaction with several other binding partners, including the proteins titin, myomesmin, and obscurin-like-1 to generate a complex important for myofibrillar M-band function(1). While disrupting these interacti...
Source: Journal of the American College of Cardiology - November 15, 2016 Category: Cardiology Source Type: research

Fractional Flow Reserve Derived From Routine Coronary Angiograms
Pressure wire-based fractional flow reserve (FFR) has become the standard of reference for decision making regarding coronary revascularization. Deriving FFR from routine angiograms could facilitate the uptake of FFR-based clinical decisions. Several angiography-derived FFR methods have recently been introduced (1,2). These methods are based on computational fluid dynamic simulations. FFRangio is a novel technology providing a functional angiography mapping of the coronaries in 3D  based on a rapid flow analysis of a dynamically derived lumped model that can assess FFR using routine angiograms and hemodynamic data. (Sourc...
Source: Journal of the American College of Cardiology - November 15, 2016 Category: Cardiology Source Type: research

Multicenter Cardiovascular Studies and Trials Lessons Learned From 35 Years of Productive  Collaboration
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 15, 2016 Category: Cardiology Source Type: research

The Next “Chapter” in the ACC’s Chapter System
(Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - November 15, 2016 Category: Cardiology Source Type: research

Heart Failure With Preserved Ejection  Fraction and Atrial Fibrillation Vicious Twins
Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are age-related conditions that are increasing in prevalence, commonly coexist, and share clinical features. This review provides a practical update on the  epidemiology, pathophysiology, diagnosis, and management of patients with concomitant HFpEF and AF. Epidemiological studies highlight the close and complex links between HFpEF and AF, the shared risk factors, the high AF occurrence in the natural history of HFpEF, and the independent contributio n of each condition to poor outcomes. Diagnosis of HFpEF in the setting of AF is challeng...
Source: Journal of the American College of Cardiology - November 15, 2016 Category: Cardiology Source Type: research

Computed Tomography and Cardiac  Magnetic Resonance in Ischemic Heart Disease
Ischemic heart disease is a complex disease process caused by the development of coronary atherosclerosis, with downstream effects on the left ventricular myocardium. It is characterized by a long preclinical phase, abrupt development of myocardial infarction, and more chronic disease states such as stable angina and ischemic cardiomyopathy. Recent advances in computed tomography (CT) and cardiac magnetic resonance (CMR) now allow detailed imaging of each of these different phases of the disease, potentially allowing ischemic heart disease to be tracked during a patient ’s lifetime. In particular, CT has emerged as the n...
Source: Journal of the American College of Cardiology - November 15, 2016 Category: Cardiology Source Type: research