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Am Heart J 2022 May 21. Epub 2022 May 21.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.

Background: Anxiety is a common comorbidity in patients with coronary heart disease (CHD) and is associated with worse prognosis. However, effective treatment for anxiety in CHD patients is uncertain. The UNWIND randomized clinical trial showed that 12-week treatment of escitalopram was better than exercise training or placebo in reducing anxiety in anxious CHD patients. Read More

Am Heart J 2022 May 20. Epub 2022 May 20.

The Leon H Charney Division of Cardiology and The Center for the Prevention of Cardiovascular Disease New York University Grossman School of Medicine Translational Research Building 227 E. 30th St., Ste. 853, NY, NY 10016.

A polygenic risk score (PGS) is associated with obstructive coronary artery disease (CAD) independent of traditional risk factors. Coronary computed tomography angiography (CTA) can characterize coronary plaques, including features of high-risk CAD. However, it is unknown if a PGS is associated with obstructive CAD and high-risk CAD phenotypes in patients with symptoms suggestive of CAD. Read More

Am Heart J 2022 May 19. Epub 2022 May 19.

Duke Clinical Research Institute, Duke University, Durham, NC.

The Trial to Assess Chelation Therapy 2 (TACT2) is an NIH-sponsored, randomized, 2x2 factorial, double masked, placebo-controlled, multicenter clinical trial testing 40 weekly infusions of a multi-component edetate disodium (disodium ethylenediamine tetra-acetic acid, or NaEDTA)-based chelation solution and twice daily oral, high-dose multivitamin and mineral supplements in patients with diabetes and a prior myocardial infarction (MI). TACT2 completed enrollment of 1000 subjects in December 2020, and infusions in December 2021. Subjects are being followed for 2. Read More

Am Heart J 2022 May 17. Epub 2022 May 17.

Baylor Scott and White Research Institute, Dallas Tx; Department of Medicine, University of Mississippi, Jackson, MS. Electronic address:

Background: Patients with acute myocardial infarction (MI) are at risk for developing heart failure (HF) and subsequently are at an increased risk of mortality. Sodium-glucose cotransporter-2 inhibitors have been proven to improve outcomes in patients with HF with reduced ejection fraction, and, in the case of empagliflozin, in HF with preserved ejection fraction even without diabetes, but their efficacy and safety in the post-MI population has not yet been evaluated.

Methods: The EMPACT-MI trial will evaluate the safety and efficacy of empagliflozin compared with placebo in patients hospitalized for MI with or at high risk of new onset HF, in addition to standard care. Read More

Am Heart J 2022 May 16. Epub 2022 May 16.

Center for Thrombosis and Heamostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Greece. Electronic address:

Background: Due to the bleeding risk of full-dose systemic thrombolysis and the lack of major trials focusing on the clinical benefits of catheter-directed treatment, heparin antiocoagulation remains the standard of care for patients with intermediate-high-risk pulmonary embolism (PE).

Methods: The Higher-Risk Pulmonary Embolism Thrombolysis (HI-PEITHO) study (ClinicalTrials.gov Identifier: NCT04790370) is a multinational multicenter randomized controlled parallel-group comparison trial. Read More

Am Heart J 2022 May 6. Epub 2022 May 6.

TIMI Study Group, Brigham and Women's Hospital, Boston MA.

Background: Data support lipoprotein(a) [Lp(a)] being a risk factor for atherogenesis. Olpasiran is a small interfering RNA molecule that markedly reduces Lp(a) production in hepatocytes.

Study Design: The OCEAN(a)-DOSE trial is a multicenter, randomized, double-blind, placebo-controlled dose-finding study in 281 subjects with established atherosclerotic disease and Lp(a) >150 nmol/L. Read More

Am Heart J 2022 May 12. Epub 2022 May 12.

Department of Medical Sciences, Cardiology, Uppsala University, Sweden; Uppsala Clinical Research Center, Uppsala University, Sweden.

Background: Atrial fibrillation (AF) and heart failure (HF) often coexist. We investigated the prognostic impact of biomarkers on the development of HF and death in patients with AF and different left ventricular systolic function considering the influence of competing events.

Methods: The study included 11,818 patients with AF from the ARISTOTLE trial who at entry had information on history of HF, an estimate of left ventricular function and plasma samples for determination of biomarkers representing cardiorenal dysfunction (NT-proBNP, troponin T, cystatin C) and inflammation (GDF-15, IL-6, CRP). Read More

Am Heart J 2022 May 11. Epub 2022 May 11.

Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan.

Background: B-type natriuretic peptide (BNP) is a risk factor for stroke and cardiac death in patients with atrial fibrillation. We hypothesized the prognostic outcomes of very elderly non-valvular atrial fibrillation (NVAF) patients ineligible for standard anticoagulation treatment would vary according to BNP stratification.

Methods: In this subanalysis of the ELDERCARE-AF trial, patients were stratified by BNP levels at enrollment, and clinical outcomes compared among BNP subgroups. Read More

Am Heart J 2022 May 11. Epub 2022 May 11.

Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: Few studies have compared the efficacy of single-lead implantable cardioverter-defibrillator (ICD) with atrial sensing dipole (VDD-ICD) and conventional single-chamber ICD from the aspect of atrial fibrillation (AF) detection or inappropriate ICD therapy reduction. In the SMART-CONTROL trial (NCT03932604), we primarily aim to investigate whether the atrial sensing capability of VDD-ICD is useful in AF detection and inappropriate therapy reduction by randomly activating or deactivating the atrial sensing function.

Methods And Design: This study was designed as a prospective, multicenter, open-label, randomized trial to enroll 640 patients with no history of clinical AF or rhythm control for AF within one year who were undergoing the implantation of VDD-ICD system. Read More

Am Heart J 2022 May 7. Epub 2022 May 7.

Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom. Electronic address:

Am Heart J 2022 May 7. Epub 2022 May 7.

St. Antonius Hospital, Cardiology Department, Koekoekslaan 1, 3455 CM, Nieuwegein, the Netherlands; Amsterdam University Medical Center, location AMC, Cardiology Department, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.

Background: Left atrial appendage occlusion (LAAO) provides an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). In patients with a long-term or permanent contraindication for OAC randomized controlled trial (RCT) data is lacking.

Study Objectives: To assess the efficacy and safety of LAAO in AF patients who are ineligible to use OAC. Read More

Am Heart J 2022 May 6. Epub 2022 May 6.

Canadian Heart Research Centre (CHRC) and Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Background: Morphine is commonly used to relieve pain, anxiety and dyspnea in STEMI but it lowers blood pressure and delays the activity of oral antiplatelet agents. The impact of morphine on clinical outcomes remains unknown. This analysis was performed to determine if morphine use was associated with increased risk of adverse clinical events among STEMI patients treated with fibrinolytic therapy and clopidogrel or ticagrelor. Read More

Am Heart J 2022 May 6. Epub 2022 May 6.

Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands. Electronic address:

Background: Multiple biomarkers have been investigated in the risk stratification of patients with pulmonary arterial hypertension (PAH). This systematic review and meta-analysis is the first to investigate the prognostic value of (NT-pro)BNP in patients with PAH.

Methods: A systematic literature search was performed using MEDLINE, Embase, Web of Science, the Cochrane Library and Google scholar to identify studies on the prognostic value of baseline (NT-pro)BNP levels in PAH. Read More

Am Heart J 2022 May 5. Epub 2022 May 5.

The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address:

Genetic risk for coronary artery disease (CAD) is commonly measured with polygenic risk scores (PRS); yet, the relationship of atherosclerotic burden with PRS in healthy individuals not at high clinical risk for CAD (i.e., without a high pooled cohort equations [PCE] score) is unknown. Read More

Am Heart J 2022 May 5. Epub 2022 May 5.

Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY.

Background: For patients with symptomatic atrial fibrillation (AF), physicians typically offer AF ablation for symptom relief; however, patients often anticipate/expect a life free from anticoagulation. This belief puts patients at increased risk of stroke due to the potential for asymptomatic AF post-ablation if anticoagulation is ceased contrary to clinical guidelines. Although the WATCHMAN device has been FDA-approved to decrease the risk of thromboembolism from the left atrial appendage (LAA) in patients with an appropriate rationale to avoid oral anticoagulation, it has not been well-studied following AF ablation. Read More

Am Heart J 2022 May 5. Epub 2022 May 5.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC; Department of Gynecology and Obstetrics, The Johns Hopkins School of Medicine, Baltimore, MD.

Objective: To compare rates of severe maternal morbidity (SMM) for pregnant patients with a cardiac diagnosis classified by the modified World Health Organization (mWHO) classification to those without a cardiac diagnosis.

Study Design: This retrospective study using the 2015-2019 Nationwide Readmissions Database identified hospitalizations, comorbidities, and outcomes using diagnosis and procedure codes. The primary exposure was cardiac diagnosis, classified into low-risk (mWHO class I and II) and moderate-to-high-risk (mWHO class II/III, III, or IV). Read More

Am Heart J 2022 May 4. Epub 2022 May 4.

Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China. Electronic address:

Background: For ST-segment elevation myocardial infarction (STEMI) patients presenting 24-48 hours from symptom onset, whether early invasive strategy should be performed still remains controversial.

Methods: This is a prospective, open-label, multicenter, investigator initiated, randomised controlled trial (NCT04962178) to evaluate the efficacy of early invasive strategy for STEMI patients within 24-48h of symptom onset. A total of 366 patients will be included from 10 hospitals in mainland China. Read More

Am Heart J 2022 May 4. Epub 2022 May 4.

The Dartmouth Institute for Health Policy and Clinical Practice, Hanover NH.

Background: In clinical trials, sacubitril/valsartan has demonstrated significant survival benefits compared to angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEi/ARB). Whether older patients with heart failure with reduced ejection fraction (HFrEF) benefit as much, due to higher rates of comorbidities, frailty and drug discontinuation, is unknown.

Methods And Results: Using a cohort of Medicare beneficiaries hospitalized with HFrEF between 2016 and 2018, we determined all-cause mortality and HF-readmission rates among patients not given ACEi/ARB or sacubitril/valsartan at hospital discharge, by age. Read More

Am Heart J 2022 May 2. Epub 2022 May 2.

Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark (DK); Department of Clinical Medicine, University of Copenhagen, Copenhagen, DK. Electronic address:

Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve cardiac structure but most studies suggest no change in left ventricular (LV) systolic function at rest. Whether SGLT2 inhibitors improve LV contractile reserve is unknown. We investigated the effect of empagliflozin on LV contractile reserve in patients with heart failure (HF) and reduced ejection fraction (HFrEF). Read More

Am Heart J 2022 Jun;248:166-168

Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. Electronic address:

Am Heart J 2022 Jun;248:165

Director of Echocardiography, Center for Structural Heart Disease, Division of Cardiovascular Diseases, Henry Ford Hospital, Detroit, MI. Electronic address:

Am Heart J 2022 Jun;248:163-164

Professor Emeritus of Medicine, Columbia Univeristy, New York, NY. Electronic address:

Am Heart J 2022 Jul 25;249:76-85. Epub 2022 Apr 25.

Bristol Myers Squibb, Inc., NJ.

Background: Screening for atrial fibrillation (AF) is attractive because AF independently raises the risk of ischemic stroke, this risk is largely reversible by long-term oral anticoagulant therapy (OAC), and many patients with AF remain undiagnosed and untreated. Recent trials of one-time brief screening for AF have not produced a significant increase in the proportion of patients diagnosed with AF. Trials of longer-term screening have demonstrated an increase in AF diagnoses, primarily paroxysmal AF. Read More

Am Heart J 2022 Jul 15;249:66-75. Epub 2022 Apr 15.

Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.

Study Objective: The added value of computed tomography (CT) follow-up after elective proximal aortic surgery is unclear. We evaluated the benefit of CT follow-up by assessing the incidence of aorta-related complications and reinterventions detected during routine CT follow-up.

Methods: Data on 314 patients undergoing first time elective proximal aortic surgery between 2000 and 2015 were collected. Read More

Am Heart J 2022 Apr 15;250:1-10. Epub 2022 Apr 15.

Division of Cardiology, Duke Clinical Research Institute, Durham, NC.

Background: Optimal dual antiplatelet therapy (DAPT) duration in patients at high bleeding risk (HBR) is not fully defined. We aimed to compare the safety and effectiveness of short-term DAPT (S-DAPT) with longer duration DAPT (L-DAPT) after percutaneous coronary intervention (PCI) with drug eluting stents (DES) in patients at HBR.

Methods: We searched for studies comparing S-DAPT (≤3 months) followed by aspirin or P2Y 12 inhibitor monotherapy against L-DAPT (6-12 months) after PCI in HBR patients. Read More

Am Heart J 2022 Jun 9;248:178. Epub 2022 Apr 9.

Critical Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. Electronic address:

Am Heart J 2022 Jul 8;249:57-65. Epub 2022 Apr 8.

Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Reduced venous return is an important trigger of vasovagal syncope (VVS). Elastic compression stockings (ECS) can modify venous return and be of therapeutic interest; however, evidence for ECS efficacy in VVS is scarce. This randomized controlled trial was designed to address the issue. Read More

Am Heart J 2022 Jul 8;249:86-97. Epub 2022 Apr 8.

D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Programa de Pós-Graduação em Medicina Translacional, Universidade Federal de São Paulo, São Paulo, Brazil; Brazilian Clinical Research Institute, São Paulo, Brazil; Rede D'Or São Luiz (RDSL), São Paulo, Brazil; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. Electronic address:

Background: We explored the effect of discontinuing versus continuing angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) on clinical outcomes in patients with COVID-19 according to baseline disease severity.

Methods: We randomized 659 patients with a confirmed diagnosis of COVID-19 and classified them as having mild or moderate COVID-19 disease severity at hospital presentation using blood oxygen saturation and lung imaging. The primary outcome was the mean ratio of number of days alive and out of the hospital at 30 days according to disease severity. Read More

Am Heart J 2022 Jul 24;249:34-44. Epub 2022 Mar 24.

Duke Clinical Research Institute, Cardiovascular Division, Department of Medicine, Duke University, Durham, NC.

Background: Little is known about the prevalence and prognostic impact of preexisting frailty on acute care and in-hospital outcomes in older adults in the setting of acute myocardial infarction (AMI).

Methods: Preexisting frailty was assessed at baseline in consecutive AMI patients ≥65 years of age treated at 778 hospitals participating in the NCDR ACTION Registry between January 1, 2015 to December 31, 2016. Three domains of preexisting frailty (cognition, ambulation, and functional independence) were abstracted from chart review and summed in 2 ways: an ACTION Frailty Scale based on responses to 6 groups adapted from the Canadian Study of Health and Aging Clinical Frailty Scale and an ACTION Frailty Score derived by summing a rank score of 0-2 assigned for each grade (total ranged between 0 to 6). Read More

Am Heart J 2022 Jul 20;249:23-33. Epub 2022 Mar 20.

Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France; Imperial College, Royal Brompton Hospital, London, UK. Electronic address:

Background: The THEMIS trial demonstrated that in high-risk patients with stable coronary artery disease and diabetes without previous myocardial infarction or stroke, ticagrelor, in addition to aspirin, reduced the incidence of ischemic events but increased major bleeding. Identification of patients who could derive the greatest net benefit from the addition of ticagrelor appears important. We used the CRUSADE bleeding risk score to risk stratify the THEMIS population. Read More