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    A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure with Preserved Ejection Fraction.
    Circulation 2018 May 23. Epub 2018 May 23.
    The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
    -Diagnosis of heart failure with preserved ejection fraction (HFpEF) is challenging in euvolemic patients with dyspnea, and no evidence-based criteria are available. We sought to develop and then validate non-invasive diagnostic criteria that could be used to estimate the likelihood that HFpEF is present among patients with unexplained dyspnea in order to guide further testing. -Consecutive patients with unexplained dyspnea referred for invasive hemodynamic exercise testing were retrospectively evaluated. Read More

    #Me_Who: Anatomy of Scholastic, Leadership, and Social Isolation of Underrepresented Minority Women in Academic Medicine.
    Circulation 2018 May 22. Epub 2018 May 22.
    CeNter for the StUdy of AdveRsity and CardiovascUlaR Disease (NURTURE Center), Division of Cardiology, Department of Medicine, University of California at San Francisco, San Francisco CA
    In academic medicine, under-represented minority women physician-scientists (URMWP)* are uncommon, particularly in leadership positions. Data from the American Association of Medical Colleges (AAMC) show that among internal medicine chairs, there are 12 Asian males, 10 African/American (blacks; 9 men), 7 Hispanics (2 females) and 137 whites (21 females). In the top 40 ranked cardiology programs, there are no female cardiology chiefs, whereas there are at least 10, 2, 1 and 24 Asian, black, Hispanic and white males respectively. Read More

    Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Single-Vessel Coronary Artery Disease: Physiology-Stratified Analysis of ORBITA.
    Circulation 2018 May 22. Epub 2018 May 22.
    National Heart and Lung Institute, Imperial College London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom.
    : There are no data on how fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are associated with the placebo-controlled efficacy of percutaneous coronary intervention (PCI) in stable single-vessel coronary artery disease. : We report the association between prerandomization invasive physiology within ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina), a placebo-controlled trial of patients who have stable angina with angiographically severe single-vessel coronary disease clinically eligible for PCI. Patients underwent prerandomization research FFR and iFR assessment. Read More

    ORBITA: Bringing Some Oxygen Back to PCI in Stable Ischemic Heart Disease?
    Circulation 2018 May 22. Epub 2018 May 22.
    Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
    With the presentation and publication of the ORBITA trial in late 2017, for the first time the cardiology community had the results of a blinded randomized trial examining the efficacy of percutaneous coronary intervention (PCI) for stable ischemic heart disease (SIHD). ORBITA was a mechanistic trial, carefully examining a host of endpoints in order to determine potentially measurable effects of PCI vs. a sham comparator at 6 weeks of follow-up. Read More

    Use of Intracardiac Echocardiography in Interventional Cardiology: Working With the Anatomy Rather Than Fighting It.
    Circulation 2018 May;137(21):2278-2294
    Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
    The indications for catheter-based structural and electrophysiological procedures have recently expanded to more complex scenarios, in which an accurate definition of the variable individual cardiac anatomy is key to obtain optimal results. Intracardiac echocardiography (ICE) is a unique imaging modality able to provide high-resolution real-time visualization of cardiac structures, continuous monitoring of catheter location within the heart, and early recognition of procedural complications, such as pericardial effusion or thrombus formation. Additional benefits are excellent patient tolerance, reduction of fluoroscopy time, and lack of need for general anesthesia or a second operator. Read More

    Effect of 2 Psoriasis Treatments on Vascular Inflammation and Novel Inflammatory Cardiovascular Biomarkers: A Randomized Placebo-Controlled Trial.
    Circ Cardiovasc Imaging 2018 Jun;11(6):e007394
    Department of Dermatology, Perelman School of Medicine (D.B.S., Z.C.F., J.T., S.B.V., J.M.G.)
    Background: Psoriasis is a chronic inflammatory disease associated with dyslipidemia, cardiovascular events, and mortality. We aimed to assess and compare the effect of treatment of moderate-to-severe psoriasis with adalimumab or phototherapy on vascular inflammation and cardiovascular biomarkers.

    Methods And Results: Randomized, double-blind, trial of adalimumab, phototherapy, and placebo (1:1:1) for 12 weeks, with crossover to adalimumab for 52 weeks total. Read More

    Seafood Long-Chain n-3 Polyunsaturated Fatty Acids and Cardiovascular Disease: A Science Advisory From the American Heart Association.
    Circulation 2018 May 17. Epub 2018 May 17.
    Since the 2002 American Heart Association scientific statement "Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease," evidence from observational and experimental studies and from randomized controlled trials continues to emerge to further substantiate the beneficial effects of seafood long-chain n-3 polyunsaturated fatty acids and cardiovascular disease. A recent American Heart Association science advisory addressed the specific effect of n-3 polyunsaturated fatty acid supplementation on clinical cardiovascular events. This American Heart Association science advisory extends that review and offers further support to include n-3 polyunsaturated fatty acids from seafood consumption. Read More

    Right Ventricular Dysfunction and Long-Term Risk of Sudden Cardiac Death in Patients With and Without Severe Left Ventricular Dysfunction.
    Circ Arrhythm Electrophysiol 2018 Jun;11(6):e006091
    Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
    Background: Right ventricular systolic dysfunction (RVD) often coexists with various cardiopulmonary diseases. However, the association between RVD and risk of sudden cardiac death (SCD) has not been well studied. This study examined the risk of SCD associated with RVD in patients with heterogeneous underlying cardiac diseases. Read More

    Comprehensive Multicenter Study of the Common Isthmus in Post-Atrial Fibrillation Ablation Multiple-Loop Atrial Tachycardia.
    Circ Arrhythm Electrophysiol 2018 Jun;11(6):e006019
    Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, France (M.T., N.D., R.M., A.D., A.F., K.V., T.K., G.C., G.M., N.T., C.A.M., M.W., X.P., J.D., N.K., T.P., F.S., H.C., M. Hocini, M. Hai.ssaguerre, P.J.).
    Background: Characteristics of multiple-loop atrial tachycardia (AT) circuits have never precisely examined.

    Methods: In 193 consecutive post-atrial fibrillation ablation patients with AT, 44 multiple-loop ATs including 42 dual-loop AT and 2 triple-loop AT in 41 (21.2%) were diagnosed with the high-resolution mapping system and analyzed off-line. Read More

    Transient Outward K Current (I) Underlies the Right Ventricular Initiation of Polymorphic Ventricular Tachycardia in a Transgenic Rabbit Model of Long-QT Syndrome Type 1.
    Circ Arrhythm Electrophysiol 2018 Jun;11(6):e005414
    Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence (B.-R.C., W.L., D.T., A.Y.K., R.T., T.Y.K., G.K.).
    Background: Sudden death in long-QT syndrome type 1 (LQT1), an inherited disease caused by loss-of-function mutations in KCNQ1, is triggered by early afterdepolarizations (EADs) that initiate polymorphic ventricular tachycardia (pVT). We investigated ionic mechanisms that underlie pVT in LQT1 using a transgenic rabbit model of LQT1.

    Methods: Optical mapping, cellular patch clamping, and computer modeling were used to elucidate the mechanisms of EADs in transgenic LQT1 rabbits. Read More

    Clinical Presentation and Outcome in a Contemporary Cohort of Patients with Acute Myocarditis: The Multicenter Lombardy Registry.
    Circulation 2018 May 15. Epub 2018 May 15.
    Vita Salute University and San Raffaele Hospital, Milan, Italy.
    -There is controversy regarding outcome of patients with acute myocarditis (AM), and lack of data on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management and long-term outcome of patients with AM based on a retrospective multi-center registry from 19 Italian hospitals. -A total of 684 patients with suspected AM and recent onset of symptoms (<30 days) were screened between May 2001 and February 2017. Read More

    Diagnostic Yield of Genetic Testing in Young Athletes with T-wave Inversion.
    Circulation 2018 May 15. Epub 2018 May 15.
    St. George's University of London, London, UK
    -T-wave inversion (TWI) is common in patients with cardiomyopathy. However, up to 25% of athletes of African/Afro-Caribbean descent (black athletes) and 5% of white athletes also have TWI of unclear clinical significance despite comprehensive clinical evaluation and long-term follow-up. The aim of this study was to determine the diagnostic yield from genetic testing, beyond clinical evaluation, when investigating athletes with TWI. Read More

    Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions.
    Circulation 2018 May;137(20):2166-2178
    Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
    Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. Read More

    Common Coding Variants in Are Associated With the Nav1.8 Late Current and Cardiac Conduction.
    Circ Genom Precis Med 2018 May;11(5):e001663
    Cardiovascular Research Center, Massachusetts General Hospital, Charlestown (V.M., W.J.H., R.W.M., S.A.L., E.V.D., S.L.P., C.N.-C., D.J.M., P.T.E.).
    Background: Genetic variants at the / locus are strongly associated with electrocardiographic PR and QRS intervals. While is the canonical cardiac sodium channel gene, the role of in cardiac conduction is less well characterized.

    Methods: We sequenced the locus in 3699 European-ancestry individuals to identify variants associated with cardiac conduction, and replicated our findings in 21,000 individuals of European ancestry. Read More

    Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes.
    Circulation 2018 May 11. Epub 2018 May 11.
    Icahn School of Medicine at Mount Sinai, New York, NY
    -In patients with atrial fibrillation (AF), left atrial appendage closure (LAAC) with the Watchman device prevents thromboembolism from the LAA; however, thrombus may form on the left atrial face of the device, and then potentially embolize. Herein, we studied the incidence, predictors and clinical outcome of device-related thrombus (DRT) using a large series of clinical trial cohorts of patients undergoing Watchman implantation. -We studied the device arms of 4 prospective FDA trials: PROTECT-AF (n=463); PREVAIL (n=269); CAP (n=566); CAP2 (n=578). Read More

    Cardiac Structural Remodeling, Longitudinal Systolic Strain, and Torsional Mechanics in Lean and Nonlean Dysglycemic Chinese Adults.
    Circ Cardiovasc Imaging 2018 May;11(5):e007047
    National Yang-Ming University, Taipei, Taiwan. National Heart Centre Singapore (C.S.P.L.).
    Background: Diabetes mellitus and pre-diabetes mellitus are associated with lower body mass indices and increased risk of cardiovascular events (including heart failure) at lower glucose thresholds in Chinese compared with Western cohorts. However, the extent of cardiac remodeling and regulation on cardiac mechanics in lean and nonlean dysglycemic Chinese adults is understudied.

    Methods And Results: We studied 3950 asymptomatic Chinese (aged 49. Read More

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