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Early Surgery for Mixed Aortic Valve Disease A Precocious or Premature Proposition?
We read with interest the recent paper by Egbe et al.(1) investigating the outcomes of patients with moderate mixed aortic valve disease (MAVD). Although the paper provides valuable insight, we would temper the recommendation for especially close follow-up and consideration of early aortic valve replacement (AVR), given limitations in data collection and analysis of the primary combined endpoint. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

Reply T1 and T2 Mapping in Nonischemic Cardiomyopathies and Agreement With Endomyocardial Biopsy
With great interest we read Drs. Puntmann and Nagel ’s observations and interpretation of the results of the MyoRacer (Comprehensive Cardiac Magnetic Resonance Imaging in Patients With Suspected Myocarditis) trial(1), which highlight a couple of important considerations in this field. Cardiac magnetic resonance findings are believed to depend on the severity of myocarditis and the time imaging is performed along the course of disease. We(2) and the Puntmann group(3) have therefore grouped patients according to symptoms, presuming that this will result in a more acute and a more chronic myocarditis cohort. The study by Hi...
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

T1 and T2 Mapping in  Nonischemic Cardiomyopathies and Agreement With Endomyocardial Biopsy
With interest we read the study by Lurz et  al.(1), investigating concordance between quantitative tissue characterization techniques and Lake Louise criteria in patients with myocarditis and endomyocardial biopsy. We would like to congratulate the authors for contributing an increasingly rare piece of evidence, as well as for performing multiple contrasts and contributing the histological correlate in a large number of patients. We would like to share a few further observations drawn from the presented data. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

Cardio-Oncology The Carney Complex Type I
Cardio-oncology is an important, expanding discipline. Although most developing programs address the cardiotoxicity of old and novel anticancer drugs, cardio-oncology expertise and experience are also needed for rare multiorgan diseases, which require interdisciplinary evaluation to provide optimal, timely care for patients and families. Carney complex type I is the paradigmatic example that cardiologists should consider when diagnosing cardiac myxoma and oncologists should consider when diagnosing endocrine, cutaneous, and neural myxomatous neoplasms, especially in patients demonstrating pigmented lesions of the skin and ...
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

Single Antiplatelet Therapy Following Left Atrial Appendage Closure in Patients With Contraindication to Anticoagulation
Left atrial appendage closure (LAAC) has emerged as an alternative to warfarin for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). Optimal antithrombotic therapy following LAAC is  an unresolved issue and current anticoagulation and antiplatelet strategies after LAAC remain empirical. In the PROTECT-AF (Watchman left atrial appendage system for embolic protection in patients with atrial fibrillation) trial, patients received short-term (45 days) anticoagulation followed by d ual antiplatelet therapy (DAPT) for a period of 6 months and then lifelong aspirin(1). In patients with a contraindication...
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

Managing Pregnancy as an  Interventional Cardiologist Fellow-in-Training My Experience With a Simulator
The aim of this paper is to present an innovative learning process for fellows-in-training in interventional cardiology, particularly for those who are managing pregnancies while pursuing their careers. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

Overcoming the Challenges of Conducting  Early Feasibility Studies of Medical Devices in the United States
Initial clinical studies of new medical technologies involve a complex balance of research participant benefits versus risks and costs of uncertainty when novel concepts are tested. The Food and Drug Administration Center for Devices and Radiological Health has recently introduced the Early Feasibility Study (EFS) Program for facilitating the conduct of these studies under the Investigational Device Exemption regulations. However, a systematic approach is needed to successfully implement this program while affording appropriate preservation of the rights and interests of patients. For this to succeed, a holistic reform of ...
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

The Changing Landscape of Randomized Clinical Trials in Cardiovascular Disease
Large randomized clinical trials in cardiovascular disease have proliferated over the past 3 decades, with results that have influenced every aspect of cardiology practice. Despite these advances, there remains a substantial need for more high-quality evidence to inform cardiovascular clinical practice, given the increasing prevalence of cardiovascular disease around the world. Traditional clinical trials are increasingly challenging due to rising costs, increasing complexity and length, and burdensome institutional and regulatory requirements. This review will examine the current landscape of cardiovascular clinical trial...
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

Toward Translation of Genomic  Discovery to Clinical Efficacy in Atrial Fibrillation ∗
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Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

PITX2 Modulates Atrial Membrane Potential and the Antiarrhythmic Effects  of Sodium-Channel Blockers
ConclusionsPITX2 mRNA modulates atrial resting membrane potential and thereby alters the effectiveness of Na-channel blockers. PITX2 and ion channels regulating the resting membrane potential may provide novel targets for antiarrhythmic drug development and companion therapeutics in AF. (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

What We Are Learning From Transcatheter  Aortic Valve Replacement Risk Prediction Models ∗
Image 1 (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

Prediction of Poor Outcome After Transcatheter Aortic Valve Replacement
This study examined the performance of the previously developed TAVR Poor Outcome risk models in an external dataset and explored the incremental contribution of geriatric domains to model performance.MethodsPoor outcome after TAVR was defined as death, poor quality of life (QOL), or decline in QOL, as assessed using the Kansas City Cardiomyopathy Questionnaire. We tested 4 TAVR Poor Outcome risk models: 6-month and 1-year full and clinical (reduced) models. We examined each model ’s discrimination and calibration in the CoreValve trial dataset, and then tested the incremental contribution of frailty and disability marke...
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

Selecting the Duration of Antiplatelet  Therapy Following Percutaneous Coronary Intervention A Complex Decision or Not? ∗
Image 1 (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

Efficacy and Safety of Dual Antiplatelet Therapy After Complex PCI
This study investigated the efficacy and safety of long-term ( ≥12 months) versus short-term (3 or 6 months) DAPT with aspirin and clopidogrel according to PCI complexity.MethodsThe authors pooled patient-level data from 6 randomized controlled trials investigating DAPT durations after PCI. Complex PCI was defined as having at least 1 of the following features: 3 vessels treated,  ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length>60 mm, or chronic total occlusion. The primary efficacy endpoint was major adverse cardiac events (MACE), defined as the composite of card...
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

Aortic Valve-Sparing Surgery Yes, But Not for Every Patient and Select the Center Very Carefully ∗
Image 1 (Source: Journal of the American College of Cardiology)
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research