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Recent items - Journal of the American College of Cardiology

The New Cholesterol Guidelines Finally More Light Than Heat ∗
25/08/2014 23:32
I cannot remember practice guidelines more delayed, groundbreaking, and controversial than the 2013 American College of Cardiology/American Heart Association cholesterol guidelines (1). They are groundbreaking for using a new race-specific [...]
Short Versus Long Duration of DAPT After DES Implantation: A Meta-Analysis
25/08/2014 23:32
The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has not been determined. Current American College of Cardiology Foundation/American Heart Association (AC [...]
Cardiac Intensivism A View From a Fellow-in-Training
25/08/2014 23:32
In a true and perfect form, imperturbability is indissolubly associated with wide experience and an intimate knowledge of the varied aspects of disease. With such advantages he is so equipped that no eventuality can disturb the mental equil [...]
Translating Stem Cell Research to Cardiac Disease Therapies Pitfalls and Prospects for Improvement
25/08/2014 23:32
Over the past 2 decades, there have been numerous stem cell studies focused on cardiac diseases, ranging from proof-of-concept to phase 2 trials. This series of papers focuses on the legacy of these studies and the outlook for future treatm [...]
Percutaneous Mitral Valve Edge-to-Edge Repair In-Hospital Results and 1-Year Follow-Up of 628 Patients of the 2011–2012 Pilot European Sentinel Registry
25/08/2014 23:32
BackgroundThe use of transcatheter mitral valve repair (TMVR) has gained widespread acceptance in Europe, but data on immediate success, safety, and long-term echocardiographic follow-up in real-world patients are still limited.ObjectivesTh [...]
Accuracy of Statin Assignment Using the 2013 AHA/ACC Cholesterol Guideline Versus the 2001 NCEP ATP III Guideline Correlation With Atherosclerotic Plaque Imaging
25/08/2014 23:32
BackgroundAccurate assignment of statin therapy is a major public health issue.ObjectivesThe American Heart Association and the American College of Cardiology released a new guideline on the assessment of cardiovascular risk (GACR) to repla [...]
Electrocardiographic Changes Improve Risk Prediction in Asymptomatic Persons Age 65 Years or Above Without Cardiovascular Disease
25/08/2014 23:32
BackgroundRisk prediction in elderly patients is increasingly relevant due to longer life expectancy.ObjectivesThis study sought to examine whether electrocardiographic (ECG) changes provide prognostic information incremental to current ris [...]
Reply Immortal Time Bias and the Use of IVC Filters
25/08/2014 23:32
We thank Drs. Fernandes and White for their thoughtful comments about our registry-based retrospective cohort study of patients with acute venous thromboembolism (1). We agree that the start time of follow-up and treatment status in the des [...]
Aspirin Treatment and Outcomes in Patients Undergoing Percutaneous Coronary Intervention Is There a Role for Pharmacodynamic Testing? ∗
25/08/2014 23:32
Aspirin is an irreversible inhibitor of the platelet cyclooxygenase (COX)-1 enzyme, which in adjunct to a P2Y12 receptor antagonist, represents the cornerstone of treatment for patients undergoing percutaneous coronary interventions (PCI) ( [...]
The Murky World of Effective Dose for Cardiovascular CT
25/08/2014 23:32
We read with interest the excellent report by Einstein et al. (1) and the accompanying pragmatic editorial (2). We support the laudable aim of involving patients in the discussion of radiation exposure as part of the clinical decision proce [...]
Reply The Murky World of Effective Dose for Cardiovascular CT
25/08/2014 23:32
We thank Drs. Castellano and Nicol for their interest in our paper (1) and their many insightful comments, which focus specifically on the radiation dose for patients undergoing cardiovascular computed tomography (CT). The central themes of [...]
Sex-Specific Mortality Risk by QRS Morphology and Duration in Patients Receiving CRT Results From the NCDR
25/08/2014 23:32
BackgroundPrior studies have suggested that women have better outcomes than men after cardiac resynchronization therapy-defibrillator (CRT-D) implantation.ObjectivesThe purpose of this study was to compare mortality after CRT-D implantation [...]
Leaning Toward a Better Understanding of CRT in Women ∗
25/08/2014 23:32
Cardiac resynchronization-defibrillation therapy (CRT-D) is now a well-established treatment for patients with symptomatic heart failure unresponsive to optimized pharmacological therapy, including an angiotensin-converting enzyme inhibitor [...]
Is Lp(a) Ready for Prime Time? ∗
25/08/2014 23:32
Despite the established benefits of randomized controlled trials in the primary and secondary prevention settings, atherosclerotic cardiovascular disease continues to present a major public health challenge throughout the world. Beyond the [...]
Aspirin Treatment and Outcomes After Percutaneous Coronary Intervention Results of the ISAR-ASPI Registry
25/08/2014 23:32
BackgroundAspirin administration, as part of a dual antiplatelet treatment regimen, is essential for patients undergoing percutaneous coronary intervention (PCI). Although the correlation between high on-clopidogrel treatment platelet react [...]
Time to Bring the “Electrocardio-ome” Into Modern Cardiovascular Epidemiology? ∗
25/08/2014 23:32
More than 50 years have passed since the Framingham Heart Study investigators published their first major report on “risk factors” for coronary heart disease (1). Kannel et al. (1) discovered 3 risk factors, namely elevated blood pressure, [...
Using Basic and Clinical Research in Cardiology to Achieve Personalized Medicine Is it a Maze or Math?
25/08/2014 23:32
Personalized medicine will be integral in further driving down the global impact of cardiovascular disease. Basic and clinical research in cardiovascular medicine has rapidly progressed over the last several decades, causing decreases in mo [...]
Snake Eyes ∗
25/08/2014 23:32
Analogous to transcatheter aortic valve replacement, the assessment and treatment of mitral insufficiency have assumed more central importance, primarily driven by 4 major factors: 1) The recognition that the disease is complex, consisting [...]
Discrimination and Net Reclassification of Cardiovascular Risk With Lipoprotein(a) Prospective 15-Year Outcomes in the Bruneck Study
25/08/2014 23:32
BackgroundRecent studies showed that lipoprotein(a) [Lp(a)] is a causal risk factor for cardiovascular disease (CVD). However, whether Lp(a) modifies clinical risk assessment was not established.ObjectivesThis study was conducted to determi [...]
Reply The Murky World of Effective Dose for Cardiovascular CT
25/08/2014 23:32
The letter by Drs. Castellano and Nicol in response to my editorial introduces an additional complexity regarding radiation exposure from cardiovascular computed tomography (CT), namely the difficulty in measuring the actual dose that any g [...]
Prevention of Anthracycline-Induced Cardiotoxicity Challenges and Opportunities
25/08/2014 23:32
Anthracycline compounds are major culprits in chemotherapy-induced cardiotoxicity, which is the chief limiting factor in delivering optimal chemotherapy to cancer patients. Although extensive efforts have been devoted to identifying strateg [...]
Immortal Time Bias and the Use of IVC Filters
25/08/2014 23:32
We commend the RIETE (Computerized Registry of Patients with Venous Thromboembolism) group for attempting to analyze the benefits of use of an inferior vena cava (IVC) filter after acute pulmonary embolism (PE) using their large prospective [...]
MicroRNA-29a Is a Friend or Foe for Cardiac Hypertrophy?
18/08/2014 23:24
MicroRNAs (miRNAs) play an important role in the pathogenesis of structural alterations of cardiac hypertrophy (1). However, the precise mechanisms of miRNA-29a in cardiac hypertrophy are still unclear. A recent report in the Journal by Ron [...]
Ion Channel Dysfunction Associated With Arrhythmia, Ventricular Noncompaction, and Mitral Valve Prolapse A New Overlapping Phenotype ∗
18/08/2014 23:24
In this issue of the Journal, 2 elegant papers report the association of arrhythmia, primarily sinus bradycardia, left ventricular noncompaction (LVNC), and mitral valve prolapse (MVP) (1,2), demonstrating that the underlying cause is mutat [...]
Blood Transfusion in Myocardial Infarction Opening Old Wounds for Comparative-Effectiveness Research ∗
18/08/2014 23:24
The treatment of anemia in the general population of medical or surgical patients has long been an area of uncertainty, particularly with regard to the transfusion of red blood cells. A multitude of studies, conducted over >4 decades and in [...]
Atrial Fibrillation Ablation Translating Basic Mechanistic Insights to the Patient
18/08/2014 23:24
Atrial fibrillation (AF) ablation is widely performed and is progressively supplanting drug therapy. Catheter-based AF ablation modalities have evolved progressively in parallel to our understanding of underlying mechanisms. Initial attempt [...]
Clinical Effectiveness of CRT and ICD Therapy in Heart Failure Patients by Racial/Ethnic Classification Insights From the IMPROVE HF Registry
18/08/2014 23:24
BackgroundClinical trials have demonstrated benefit for cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) therapies in patients with heart failure with reduced ejection fraction (HFrEF); yet, questions [...]
Inspiring Possibility
18/08/2014 23:24
In July 2014, I began work as a cardiologist. It happens routinely and without fanfare, but there is something worthy of pause during one’s transition to faculty from fellowship training. The world of health care that I now enter as a cardi [...]
A Roadmap to Investigate the Genetic Basis of Bicuspid Aortic Valve and its Complications Insights From the International BAVCon (Bicuspid Aortic Valve Consortium)
18/08/2014 23:24
Bicuspid aortic valve (BAV) is the most common adult congenital heart defect and is found in 0.5% to 2.0% of the general population. The term “BAV” refers to a heterogeneous group of disorders characterized by diverse aortic valve malformat [...
HCN4 Mutations in Multiple Families With Bradycardia and Left Ventricular Noncompaction Cardiomyopathy
18/08/2014 23:24
BackgroundFamilial forms of primary sinus bradycardia have sometimes been attributed to mutations in HCN4, SCN5A, and ANK2. In these studies, no structural cardiac alterations were reported in mutation carriers. However, a cluster of report [...]
Knowing Plasma Concentrations Improves Management of the Effects of Dabigatran
18/08/2014 23:24
With interest we read the report by Reilly et al. (1) in a recent issue of the Journal regarding the effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in patients w [...]
The Symptom Complex of Familial Sinus Node Dysfunction and Myocardial Noncompaction Is Associated With Mutations in the HCN4 Channel
18/08/2014 23:24
BackgroundInherited arrhythmias were originally considered isolated electrical defects. There is growing evidence that ion channel dysfunction also contributes to myocardial disorders, but genetic overlap has not been reported for sinus nod [...]
The Power of Resilience
18/08/2014 23:24
Disappointment can be crippling, but only if the individual allows himself or herself to be emotionally conquered by the defeat. This can be particularly devastating in the young. As an alternate path, I recommend finding refuge in the powe [...]
Disparities in Heart Failure Care Now Is the Time to Focus on Health Care Delivery ∗
18/08/2014 23:24
Over the past 3 decades, heart failure patients have enjoyed major improvements in survival and quality of life. Well-conducted clinical trials have proven the effectiveness of neurohormonal antagonists, cardiac resynchronization therapy (C [...]
Blood Transfusion During Acute Myocardial Infarction Association With Mortality and Variability Across Hospitals
18/08/2014 23:24
BackgroundBlood transfusion is controversial for anemic patients with acute myocardial infarction (AMI), with some previous studies reporting increased risk of transfusion-associated mortality.ObjectivesThe goal of this study was to examine [...]
Accuracy of Coronary CT Angiography Using a Submillisievert Fraction of Radiation Exposure Comparison With Invasive Coronary Angiography
18/08/2014 23:24
BackgroundCoronary computed tomography angiography (CTA) is increasingly being used for evaluation of coronary artery disease (CAD). As a result of the widely reported potential of carcinogenic risk from x-ray based examinations, many strat [...]
Lack of Negative Interaction Between Use of Beta-Blockers and Statins on Cardiovascular Outcomes Among Patients With or At Risk for Atherothrombosis
18/08/2014 23:24
For many years, some have suggested that beta-blockers modify the metabolic profile of patients treated for high blood pressure. A pre-specified analysis of ASCOTAnglo-SCandinavian Outcomes Trial) (1) assessing the synergistic effects of li [...]
Optimal Blood Pressure Targets in Older Adults How Low Is Low Enough? ∗
18/08/2014 23:24
The study by Bangalore et al. (1) that appears in this issue of the Journal addresses the most pressing topic in antihypertensive therapy today: determining the optimal thresholds and targets for treatment in various segments of the hyperte [...]
Minimizing CT Angiography Radiation Burden While Maintaining Accuracy Through Noise Reduction Is Lower Always Better? ∗
18/08/2014 23:24
In this issue of the Journal, Stehli et al. (1) report on the feasibility of a novel approach to reduce patient radiation exposure with coronary computed tomography angiography (CTA) 
2014 Eighth Joint National Committee Panel Recommendation for Blood Pressure Targets Revisited Results From the INVEST Study
18/08/2014 23:24
BackgroundThe 2014 Eighth Joint National Committee panel recommendations for management of high blood pressure (BP) recommend a systolic BP threshold for initiation of drug therapy and a therapeutic target of 
Pro-Inflammatory Interleukin Genotypes Potentiate Early and Advanced Atherosclerosis Differently
18/08/2014 23:24
We read with interest the paper by Tsimikas et al. (1) in a recent issue of the Journal, which reported that genetic differences in the interleukin (IL)-1 gene cluster, known to be associated with inflammatory responsiveness, strongly influ [...]
Would a Modified Lewis Index Be More Specific, Without Marked Reduction of Sensitivity, in ECG Diagnosis of RVH?
12/08/2014 03:15
Whitman et al. (1) should be congratulated for their important contribution on the electrocardiogram (ECG) diagnosis of right ventricular hypertrophy (RVH). The authors’ database comprised 3,719 patients with normal left ventricular morphol [...]
Pregnancy in Fellowship Building a Career and Family
12/08/2014 03:15
Women remain underrepresented among U.S. cardiologists. The past 40 years have seen a growth in the percentage of female physicians from 10% in 1970 to 32% in 2010 (1). However, cardiology is notable for its continued imbalance in the male- [...]
Carotid Artery Stenting
12/08/2014 03:15
Carotid artery stenting (CAS) has achieved clinical equipoise with carotid endarterectomy (CEA), as evidenced by 2 large U.S. randomized clinical trials, multiple pivotal registry trials, and 2 multispecialty guideline documents endorsed by [...]
Urinary Hyaluronic Acid as an Early Predictor of Acute Kidney Injury After Cardiac Surgery
12/08/2014 03:15
Cardiac surgery–associated acute kidney injury (CSA-AKI) is a frequent, complex clinical problem in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). CSA-AKI is an important predictor of morbidity and mortality after ca [...]
Coronary CT Angiography Again Results in Better Patient Outcomes
12/08/2014 03:15
The SPARC (Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in Coronary Artery Disease) Study by Hlatky et al. (1) is the latest of multiple studies showing improved outcomes with use of computed tomography angiography (CTA) [...]
Rhythm Control in Heart Failure Patients With Atrial Fibrillation Contemporary Challenges Including the Role of Ablation
12/08/2014 03:15
Because nonpharmacological interventions likely alter the risks and benefits associated with rhythm control, this paper reviews the role of current rhythm control strategies in atrial fibrillation. This report also focuses on the specific l [...]
Reply Would a Modified Lewis Index Be More Specific, Without Marked Reduction of Sensitivity, in ECG Diagnosis of RVH?
12/08/2014 03:15
We thank Dr. Madias for his interest in our paper (1) regarding the American Heart Association–recommended criteria for the screening of right ventricular hypertrophy (2). Dr. Madias proposes that a ratio, rather than an absolute difference [...]
The Fermi Paradox and Coronary Artery Disease ∗
12/08/2014 03:15
“Where is everybody?”—Enrico Fermi (1)
Glycogen Synthase Kinase–3 and the Heart ∗
12/08/2014 03:15
Over the past decade, optimism has been high for the potential clinical significance of glycogen synthase kinase–3 (GSK-3) as a pharmacological target for ischemia and heart failure, as well as diabetes, Parkinson’s disease, and Alzheimer’s [..
Revolutionizing Cardiology and Health Care A Shared Purpose Makes All the Difference
12/08/2014 03:15
I am a self-proclaimed business and management philosophy junkie. My shelves are full of books on achieving flawless execution, innovative strategies for modern business, and examples of empowered organizations. These rich sources of case s [...]
A Commentary on the SPARC Study
12/08/2014 03:15
We read with interest the recent report by members of the SPARC (Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in Coronary Artery Disease) Study (1). The authors found, on the basis of their interpretation of the results, [...]
Cardiomyocyte-Specific Deletion of Gsk3α  Mitigates Post–Myocardial Infarction Remodeling, Contractile Dysfunction, and Heart Failure
12/08/2014 03:15
BackgroundInjury due to myocardial infarction (MI) is largely irreversible. Once an infarct has occurred, the clinical goal becomes limiting remodeling, preserving left ventricular function, and preventing heart failure. Although traditiona [...]
Reply A Commentary on the SPARC Study
12/08/2014 03:15
We appreciate the interest of Drs. Lundbye and Heller in our paper (1). They are concerned about the selection of patients for computed tomography angiography, positron emission tomography, and single-photon emission computed tomography, be [...]