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    Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association.
    Circulation 2017 Sep 18. Epub 2017 Sep 18.
    Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Read More

    Response by Bress et al to Letters Regarding Article, "Potential Deaths Averted and Serious Adverse Events Incurred From Adoption of the SPRINT (Systolic Blood Pressure Intervention Trial) Intensive Blood Pressure Regimen in the United States: Projections from NHANES (National Health and Nutrition Examination Survey)".
    Circulation 2017 Sep;136(12):1174-1175
    From Department of Population Health Sciences, University of Utah, Salt Lake City (A.P.B.); Department of Public Health Sciences, Loyola Medical Center, Maywood, IL (H.K., R.S.C.); and Division of Nephrology and Hypertension, Loyola Medical Center, Maywood, IL (H.K.).

    Letter by Koh Regarding Article, "Potential Deaths Averted and Serious Adverse Events Incurred From Adoption of the SPRINT (Systolic Blood Pressure Intervention Trial) Intensive Blood Pressure Regimen in the United States: Projections From NHANES (National Health and Nutrition Examination Survey)".
    Circulation 2017 Sep;136(12):1172-1173
    From Department of Cardiovascular Medicine, Heart Center, Gachon University Gil Medical Center, Incheon, Korea; and Gachon Cardiovascular Research Institute, Incheon, Korea.


    Acute Coronary Syndromes: The Way Forward From Mechanisms to Precision Treatment.
    Circulation 2017 Sep;136(12):1155-1166
    From Department of Cardiovascular and Thoracic Sciences, Catholic University, Rome, Italy (F.C.); and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.L.).
    Well into the 21st century, we still triage acute myocardial infarction on the basis of the presence or absence of ST-segment elevation, a century-old technology. Meanwhile, we have learned a great deal about the pathophysiology and mechanisms of acute coronary syndromes (ACS) at the clinical, pathological, cellular, and molecular levels. Contemporary imaging studies have shed new light on the mechanisms of ACS. Read More

    Inflammation and Atherosclerosis - The End of a Controversy.
    Circulation 2017 Sep 15. Epub 2017 Sep 15.
    Karolinska Institute, Department of Medicine Solna and Center for Molecular Medicine L8:03, Karolinska University Hospital, Stockholm, Sweden
    Does inflammation matter in coronary artery disease? Is it a driving force in atherosclerosis, or merely an epiphenomenon? And is there space for novel therapies besides those targeting cholesterol? The CANTOS trial, which was presented at the European Society of Cardiology meeting in Barcelona a few weeks ago provides answers to these important questions. Indeed, the results of this trial open up a new avenue for cardiovascular prevention. Read More

    Clinical Profile and Consequences of Atrial Fibrillation in Hypertrophic Cardiomyopathy.
    Circulation 2017 Sep 15. Epub 2017 Sep 15.
    Hypertrophic Cardiomyopathy Institute, Division of Cardiology, Tufts Medical Center, Boston MA.
    Background -Atrial fibrillation (AF), the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), is capable of producing symptoms that impact quality of life and is associated with risk for embolic stroke. However, the influence of AF on clinical course and outcome in HCM remains incompletely resolved. Methods -Records were accessed of 1558 consecutive patients followed at the Tufts Medical Center Hypertrophic Cardiomyopathy Institute for 4. Read More

    Computing Fractional Flow Reserve From Invasive Coronary Angiography: Getting Closer.
    Circ Cardiovasc Interv 2017 Sep;10(9)
    From the Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, and Insigneo Institute for In Silico Medicine, University of Sheffield, United Kingdom (P.D.M., J.P.G.); and Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom (P.D.M., J.P.G.).


    Gait Speed Assessment in Transcatheter Aortic Valve Replacement: A Step in the Right Direction.
    Circ Cardiovasc Interv 2017 Sep;10(9)
    From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada (J.A.); Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada (J.A.); Section of Geriatric Cardiology, University of Pittsburgh Medical Center, PA (D.E.F.); and Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University of Pittsburgh, PA (D.E.F.).


    Coronary Perforation Complicating Percutaneous Coronary Intervention in Patients With a History of Coronary Artery Bypass Surgery: An Analysis of 309 Perforation Cases From the British Cardiovascular Intervention Society Database.
    Circ Cardiovasc Interv 2017 Sep;10(9)
    From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (J.C.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.B.); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (T.W.J.); Department of Biostatistics, Biosensors SA, Morges, Switzerland (S.C.); Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.Z.); Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.Z.); Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Staffordshire, United Kingdom (M.A.M.); and Department of Cardiology, Stoke-on-Trent and Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M.).
    Background: The evidence base for coronary perforation (CP) occurring during percutaneous coronary intervention in patients with a history of coronary artery bypass surgery (PCI-CABG) is limited and the long-term effects unclear. Using a national PCI database, the incidence, predictors, and outcomes of CP during PCI-CABG were defined.

    Methods And Results: Data were analyzed on all PCI-CABG procedures performed in England and Wales between 2005 and 2013. Read More

    Phase 2a Clinical Trial of Mitochondrial Protection (Elamipretide) During Stent Revascularization in Patients With Atherosclerotic Renal Artery Stenosis.
    Circ Cardiovasc Interv 2017 Sep;10(9)
    From the Division of Nephrology and Hypertension (A.S., S.M.S.H., A.E., C.M.F., L.O.L., S.C.T.) and Department of Radiology (J.F.G., H.B., M.A.M., S.M.), Mayo Clinic, Rochester, MN.
    Background: Atherosclerotic renal artery stenosis reduces renal blood flow (RBF) and amplifies stenotic kidney hypoxia. Revascularization with percutaneous transluminal renal angioplasty (PTRA) and stenting often fails to recover renal function, possibly because of ischemia/reperfusion injury developing after PTRA. Elamipretide is a mitochondrial-targeted peptide that binds to cardiolipin and stabilizes mitochondrial function. Read More

    Validation Study of Image-Based Fractional Flow Reserve During Coronary Angiography.
    Circ Cardiovasc Interv 2017 Sep;10(9)
    From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra'anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.).
    Background: Fractional flow reserve (FFR), an index of the hemodynamic severity of coronary stenoses, is derived from invasive measurements and requires a pressure-monitoring guidewire and hyperemic stimulus. Angiography-derived FFR measurements (FFRangio) may have several advantages. The aim of this study is to assess the diagnostic performance and interobserver reproducibility of FFRangio in patients with stable coronary artery disease. Read More

    Gait Speed Can Predict Advanced Clinical Outcomes in Patients Who Undergo Transcatheter Aortic Valve Replacement: Insights From a Japanese Multicenter Registry.
    Circ Cardiovasc Interv 2017 Sep;10(9)
    From the Department of Cardiology, Nagoya Heart Canter, Japan (S.K., M.Y., Y.K., T.K., K.S.); Department of Cardiology, Toyohashi Heart Canter, Japan (M.Y., T.S., A. Kagase, M. Tsuzuki, A. Kodama); Department of Cardiology, Sendai Kosei Hospital, Japan (N.T.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Syonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); Department of Cardiology, Osaka City General Hospital, Japan (K.M.); Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan (M. Tabata); Department of Cardiology, Toyama University Hospital, Japan (H.U.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (K.T.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (A.H.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W.); and Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (K.H.).
    Background: Gait speed reflects an important factor of frailty and is associated with an increased risk of late mortality in patients with cardiac disease. This study sought to assess the prognostic value of gait speed in elderly patients who underwent transcatheter aortic valve replacement.

    Methods And Results: We investigated the 5-m or 15-feet gait speed (m/sec) in 1256 patients who underwent transcatheter aortic valve implantation using data from the OCEAN-TAVI Japanese multicenter registry (Optimized Catheter Valvular Intervention-Transcatheter Aortic Valve Implantation). Read More

    White Blood Cell Count and Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention in the Contemporary Era: Insights From the PARIS Study (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Registry).
    Circ Cardiovasc Interv 2017 Sep;10(9)
    From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine, Durham, NC (M.W.K.); Department of Medicine (Cardiology), Harvard Medical School, Cambridge, MA (C.M.G.); Department of Medicine (Cardiology), Hôpital Bichat-Claude Bernard, Paris, France (P.G.S.); Department of Medicine (Cardiology), Columbia University Medical Center, New York, NY (G.W.); Department of Medicine (Cardiology), HELIOS Amper-Klinikum Dachau, Germany (B.W.); Department of Medicine (Cardiology), Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Department of Medicine (Cardiology), Minneapolis Heart Institute Foundation, University of Minnesota (T.D.H.); Department of Medicine (Cardiology), Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, NC (T.S.); Department of Medicine (Cardiology), St Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Department of Medicine (Cardiology), Onassis Cardiac Surgery Center, Athens, Greece (I.I.); Department of Medicine (Cardiology), San Raffaele Hospital, Milan, Italy (A. Chieffo, A. Colombo); and Department of Medicine (Cardiology), University of Kentucky, Lexington (D.J.M.).
    Background: Elevated white blood cell (WBC) count is associated with increased major adverse cardiovascular events (MACE) in the setting of acute coronary syndrome. The aim of this study was to evaluate whether similar associations persist in an all-comers population of patients undergoing percutaneous coronary intervention in the contemporary era.

    Methods And Results: In the multicenter, prospective, observational PARIS study (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Registry), 4222 patients who underwent percutaneous coronary intervention in the United States and Europe between July 1, 2009, and December 2, 2010, were evaluated. Read More

    Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency: Twelve-Month Results of the DEFINITIVE AR Study.
    Circ Cardiovasc Interv 2017 Sep;10(9)
    From the Universitäts-Herzzentrum Bad Krozingen, Germany (T.Z.); Sankt Getrauden-Krankenhaus, Berlin, Germany (R.L.); Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.J.R.-S.); VasCore-the Vascular Ultrasound Core Laboratory, Massachusetts General Hospital, Boston (M.R.J.); SRH Klinikum Karlsbad-Langensteinbach, Germany (E.B.); Clinic for Angiology, University Hospital Zurich, Switzerland (B.A.-V.); Zakład Leczniczy Angio-Medicus, Krakow, Poland (M.K.); Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium (P.P.); Department of Interventional Angiology, University Hospital Leipzig, Germany (D.S.); University Hospital Muenster, Klinik for Vascular and Endovascular Surgery, Germany (G. Torsello); Swiss Cardiovascular Center, Division of Angiology, University Hospital, Inselspital Bern, Switzerland (S.S.); and Klinikum Rosenheim, Germany (G. Tepe).
    Background: Studies assessing drug-coated balloons (DCB) for the treatment of femoropopliteal artery disease are encouraging. However, challenging lesions, such as severely calcified, remain difficult to treat with DCB alone. Vessel preparation with directional atherectomy (DA) potentially improves outcomes of DCB. Read More

    Failure to Treat Life-Threatening Ventricular Tachyarrhythmias in Contemporary Implantable Cardioverter-Defibrillators: Implications for Strategic Programming.
    Circ Arrhythm Electrophysiol 2017 Sep;10(9)
    From the Department of Cardiology, Aalborg University Hospital, Denmark; Department of Cardiology, Odense University Hospital, Denmark (J.B.J.); Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso (M.A.); and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.).
    Background: In clinical trials, manufacturer-specific, strategic programming of implantable cardioverter-defibrillators (ICDs), including faster detection rates, reduces unnecessary therapy but permits therapy for ventricular tachycardia/ventricular fibrillation (VF). Present consensus recommends a generic rate threshold between 185 and 200 beats per minute, which exceeds the rate tested in clinical trials for some manufacturers. In a case series, we sought to determine the relationship between programmed parameters and failure of modern ICDs to treat VF. Read More

    Outcomes of Telemedicine Video-Conferencing Clinic Versus In-Person Clinic Follow-Up for Implantable Cardioverter-Defibrillator Recipients.
    Circ Arrhythm Electrophysiol 2017 Sep;10(9)
    From the Knight Cardiovascular Institute (K.D., N.G., P.J., K.M., I.G.Z., M.R.), Biostatistics and Design Program (M.L.), Oregon Clinical & Translational Research Institute (OCRTI), Oregon Health and Science University, Portland; and Electrophysiology Department, Portland Veterans Affairs Medical Center, OR (P.J., K.M., I.G.Z., M.R.).
    Background: Implantable cardioverter-defibrillator (ICD) recipients require close follow-up that can be difficult for patients who have to travel long distances for clinic follow-up. We aimed to compare clinical outcomes between ICD patients followed-up in a telemedicine video-conferencing clinic (TMVC) and a conventional in-person clinic (CIC). We hypothesized that outcomes of patients followed in the TMVC are noninferior to the CIC. Read More

    Preprints and Cardiovascular Science: Prescient or Premature?
    Circulation 2017 Sep 14. Epub 2017 Sep 14.
    Departments of Internal Medicine and Molecular Biology, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX.
    Medical journals currently find themselves in the throes of 2 powerful trends: (1) a growing concern for the irreproducibility of scientific reports, and (2) a rising imperative to accelerate dissemination of new knowledge in the digital era. Without question, the individual merit of tackling each issue is readily apparent. Irreproducibility of scientific reports is surprisingly common and contributes to an overall loss of confidence in research by the public and other stakeholders. Read More

    Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure.
    Circ Heart Fail 2017 Sep;10(9)
    From the Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium (R.N., J.-L.V., S.C.); Department of Internal Medicine II, Division of Cardiology, General Hospital of Vienna (AKH-Wien), Medical University of Vienna, Austria (M.G., C.G., I.M.L.); and Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale S. Luca IRCCS Istituto Auxologico Italiano, Milan, Italy (S.C.).
    Increased pulmonary venous pressure secondary to left heart disease is the most common cause of pulmonary hypertension (PH). The diagnosis of PH due to left heart disease relies on a clinical probability assessment followed by the invasive measurements of a mean pulmonary artery pressure (PAP) ≥25 mm Hg and mean wedged PAP (PAWP) >15 mm Hg. A combination of mean PAP and mean PAWP defines postcapillary PH. Read More

    Diastolic Pressure Difference to Classify Pulmonary Hypertension in the Assessment of Heart Transplant Candidates.
    Circ Heart Fail 2017 Sep;10(9)
    From the Institute of Medical Science, Faculty of Medicine, University of Toronto, Ontario, Canada (S.P.W., S.M.); Division of Cardiology, Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada (S.P.W., Y.M., F.F., S.A., G.P., A.C.A., S.M.); and Advanced Heart Failure and Cardiac Transplant Service, Division of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia (J.B.).
    Background: The diastolic pressure difference (DPD) is recommended to differentiate between isolated postcapillary and combined pre-/postcapillary pulmonary hypertension (Cpc-PH) in left heart disease (PH-LHD). However, in usual practice, negative DPD values are commonly calculated, potentially related to the use of mean pulmonary artery wedge pressure (PAWP). We used the ECG to gate late-diastolic PAWP measurements. Read More

    Preoperative Pectoralis Muscle Quantity and Attenuation by Computed Tomography Are Novel and Powerful Predictors of Mortality After Left Ventricular Assist Device Implantation.
    Circ Heart Fail 2017 Sep;10(9)
    From the Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis (L.T., A.J.K., E.M.N., C.P.E.); and Department of Cardiothoracic Surgery, Division of Surgery (R.J.) and Department of Medicine, Division of Cardiology (J.K., C.M., R.C.), University of Minnesota, Minneapolis.
    Background: Skeletal muscle mass decreases in end-stage heart failure and is predictive of clinical outcomes in several disease states. Skeletal muscle attenuation and quantity as quantified on preoperative chest computed tomographic scans may be predictive of mortality after continuous flow (CF) left ventricular assist device (LVAD) implantation.

    Methods And Results: A single-center continuous flow-LVAD database (n=354) was used to identify patients with chest computed tomographies performed in the 3 months before LVAD implantation (n=143). Read More

    Decoupling Between Diastolic Pulmonary Artery Pressure and Pulmonary Capillary Wedge Pressure as a Prognostic Factor After Continuous Flow Ventricular Assist Device Implantation.
    Circ Heart Fail 2017 Sep;10(9)
    From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.).
    Background: A cohort of heart failure (HF) patients receiving left ventricular assist devices (LVADs) has decoupling of their diastolic pulmonary artery pressure and pulmonary capillary wedge pressure. However, the clinical implications of this decoupling remain unclear.

    Methods And Results: In this prospective study, patients with LVADs underwent routine invasive hemodynamic ramp testing with right heart catheterization, during which LVAD speeds were adjusted. Read More

    NOD2 (Nucleotide-Binding Oligomerization Domain 2) Is a Major Pathogenic Mediator of Coxsackievirus B3-Induced Myocarditis.
    Circ Heart Fail 2017 Sep;10(9)
    From the Department of Cardiology and Pneumology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Germany (C.T., Y.X., K.S., F.S., B.P., U.K., S.V.L.); DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany (C.T., I.M., K.P., B.P., S.V.L.); Berlin-Brandenburg Center for Regenerative Therapies, Charité, University Medicine Berlin, Campus Virchow, Germany (C.T., I.M., K.P., K.M., S.V.L.); Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Germany (S.P., H.F.); Institut Kardiale Diagnostik und Therapie (IKDT), Berlin, Germany (D.L., H.-P.S.); Institut für Mikrobiologie und Infektionsmedizin, Campus Benjamin Franklin, Berlin, Germany (M.M.H., S.B.); and Department of Cardiology, Deutsches Herzzentrum Berlin (DHZB), Germany (B.P.).
    Background: The cytoplasmatic pattern recognition receptor, NOD2 (nucleotide-binding oligomerization domain 2), belongs to the innate immune system and is among others responsible for the recognition of single-stranded RNA. With Coxsackievirus B3 (CVB3) being a single-stranded RNA virus, and the recent evidence that the NOD2 target, NLRP3 (NOD-like receptor family, pyrin domain containing 3) is of importance in the pathogenesis of CVB3-induced myocarditis, we aimed to unravel the role of NOD2 in CVB3-induced myocarditis.

    Methods And Results: Endomyocardial biopsy NOD2 mRNA expression was higher in CVB3-positive patients compared with patients with myocarditis but without evidence of persistent CVB3 infection. Read More

    Propagation of Sinus Waves in the Atrial Architecture: When Laminar Electrical Fluxes Turn Turbulent.
    Circ Arrhythm Electrophysiol 2017 Sep;10(9)
    From the Arrhythmia Unit, Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C.); Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, Madrid, Spain (D.F., J.J.); Hospital Clínico Universitario San Carlos, Madrid, Spain (D.F.-R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (D.F., J.J.); and CIBERCV, Madrid, Spain (D.F., J.J.).

    Clinical Yield of Familial Screening After Sudden Death in Young Subjects: The French Experience.
    Circ Arrhythm Electrophysiol 2017 Sep;10(9)
    From the l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes (P.Q., F.K., A.T., B.G., R.R., J.B., J.-J.S., V.P., J.B.G.); Service de cardiologie, CHU de Rennes, (P.M.); Service de cardiologie, CHU de Brest (J.M.); Service de cardiologie, CHU de Tours (D.B.); and Service de cardiologie, Institut Lyric, CHU de Bordeaux, France (F.S.).
    Background: After sudden cardiac death with negative autopsy, clinical screening of relatives identifies a high proportion of inherited arrhythmia syndrome. However, the efficacy of this screening in families not selected by autopsy has never been assessed. We aim to investigate the value of clinical screening in relatives of all subjects who died suddenly before 45 years of age. Read More

    Epicardial Breakthrough Waves During Sinus Rhythm: Depiction of the Arrhythmogenic Substrate?
    Circ Arrhythm Electrophysiol 2017 Sep;10(9)
    From the Department of Cardiology (E.M.J.P.M., E.A.H.L., C.P.T., L.J.M.E.v.d.D., P.K., N.M.S.d.G.) and Department of Cardiothoracic Surgery (E.M.J.P.M., C.K., J.A.B., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, The Netherlands.
    Background: Epicardial breakthrough waves (EBW) during atrial fibrillation are important elements of the arrhythmogenic substrate and result from endo-epicardial asynchrony, which also occurs to some degree during sinus rhythm (SR). We examined the incidence and characteristics of EBW during SR and its possible value in the detection of the arrhythmogenic substrate associated with atrial fibrillation.

    Methods And Results: Intraoperative epicardial mapping (interelectrode distances 2 mm) of the right atrium, Bachmann's bundle, the left atrioventricular groove, and the pulmonary vein area was performed during SR in 381 patients (289 male, 67±10 years) with ischemic or valvular heart disease. Read More

    Blockchain Technology: Applications in Health Care.
    Circ Cardiovasc Qual Outcomes 2017 Sep;10(9)
    From the Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (S.A., H.M.K., W.L.S.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Department of Laboratory Medicine (W.L.S.), Yale School of Medicine, New Haven, CT; and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.).

    Race and Socioeconomic Differences Associated With Changes in Statin Eligibility Under the 2013 American College of Cardiology/American Heart Association Cholesterol Guidelines.
    Circ Cardiovasc Qual Outcomes 2017 Sep;10(9)
    From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael's Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital-McGill University Health Centre, Montreal, Canada (A.D.S.); and Harvard Center for Population and Development Studies, Boston, MA (F.R.).
    Background: The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines expanded eligibility criteria for statins. We examined race and socioeconomic differences associated with these changes.

    Methods And Results: This was an observational study of adults between 40 and 75 years of age using data from the National Health and Nutrition Examination Surveys between 2005 and 2012. Read More

    Development and Validation of Electronic Quality Measures to Assess Care for Patients With Transient Ischemic Attack and Minor Ischemic Stroke.
    Circ Cardiovasc Qual Outcomes 2017 Sep;10(9)
    From the Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Stroke Quality Enhancement Research Initiative (QUERI), Washington, DC (D.M.B., L.J.M., E.C., M.R., T.D., E.J.M., B.M., G.G., L.S.W., G.A.); VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN (D.M.B., L.J.M., T.D., E.J.M., C.A., J.F., B.M., K.S., L.S.W.); Department of Internal Medicine (D.M.B., L.J.M., T.D., E.J.M., C.A.) and Department of Neurology (D.M.B., L.S.W.), and Department of Emergency Medicine (E.J.M.), Indiana University School of Medicine, Indianapolis; Regenstrief Institute, Indianapolis, IN (D.M.B., T.D., E.J.M., L.S.W.); VA Nebraska-Western Iowa Health Care System-Omaha Division, Omaha, NE (J.J.); Department of Surgery, University of Nebraska, Lincoln (J.J.); Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT (J.S.); Departments of Internal Medicine and Neurology, Yale University School of Medicine, New Haven, CT (J.S., J.F.); School of Nursing, Purdue University, West Lafayette, IN (G.A.); Department of Biostatistics, Indiana University School of Medicine, IUPUI, Indianapolis (F.B., Z.Y., S.O.); Department of Neurology, University of Maryland School of Medicine, Baltimore (M.P.); Miami VA Medical Center (S.C.); Department of Neurology, School of Medicine, University of Miami, FL (S.C.); Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN (A.Z.); Department of Epidemiology, Michigan State University, East Lansing (M.R.); Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, CA (E.C.); Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (E.C.); and Department of Veterans Affairs, Office of Analytics and Business Intelligence, In-Patient Evaluation Center (IPEC), Cincinnati, OH (R.R.).
    Background: Despite interest in using electronic health record (EHR) data to assess quality of care, the accuracy of such data is largely unknown. We sought to develop and validate transient ischemic attack and minor ischemic stroke electronic quality measures (eQMs) using EHR data.

    Methods And Results: A random sample of patients with transient ischemic attack or minor ischemic stroke, cared for in Veterans Health Administration facilities (fiscal year 2011), was identified. Read More

    Preprints and Cardiovascular Science: Prescient or Premature?
    Circ Cardiovasc Qual Outcomes 2017 Sep;10(9)
    From Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Department of Internal Medicine, University of Michigan, and the Center for Clinical Management and Research, Ann Arbor VA Medical Center (B.K.N.); and Departments of Internal Medicine and Molecular Biology, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.H.).

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