Journal of the American Heart Association

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Current Perspectives on Coronavirus Disease 2019 and Cardiovascular Disease: A White Paper by the JAHA Editors
Journal of the American Heart Association - Tập 9 Số 12 - 2020
Ajay Gupta, Hani Jneid, Daniel Addison, Hossein Ardehali, Amelia K. Boehme, Sanket Borgaonkar, Romain Boulestreau, Kevin J. Clerkin, Nicolas Delarche, Holli A. DeVon, Isabella M. Grumbach, José Gutierrez, Daniel A. Jones, Vikas Kapil, Carmela Maniero, Amgad Mentias, Pamela S. Miller, Sher May Ng, Jai Parekh, Reynaldo H. Sanchez, Konrad Teodor Sawicki, Anneline S.J.M. te Riele, Carol Ann Remme, Barry London
Short‐Term Exposure to Air Pollution and Biomarkers of Oxidative Stress: The Framingham Heart Study
Journal of the American Heart Association - Tập 5 Số 5 - 2016
Wenyuan Li, Elissa H. Wilker, Kirsten Dorans, Mary B. Rice, Joel Schwartz, Brent A. Coull, Petros Koutrakis, Diane R. Gold, John F. Keaney, Honghuang Lin, Ramachandran S. Vasan, Emelia J. Benjamin, Murray A. Mittleman
Background Short‐term exposure to elevated air pollution has been associated with higher risk of acute cardiovascular diseases, with systemic oxidative stress induced by air pollution hypothesized as an important underlying mechanism. However, few community‐based studies have assessed this association.

Methods and Results Two thousand thirty‐five Framingham Offspring Cohort participants living within 50 km of the Harvard Boston Supersite who were not current smokers were included. We assessed circulating biomarkers of oxidative stress including blood myeloperoxidase at the seventh examination (1998–2001) and urinary creatinine‐indexed 8‐epi‐prostaglandin F 2α (8‐epi‐ PGF 2α ) at the seventh and eighth (2005–2008) examinations. We measured fine particulate matter ( PM 2.5 ), black carbon, sulfate, nitrogen oxides, and ozone at the Supersite and calculated 1‐, 2‐, 3‐, 5‐, and 7‐day moving averages of each pollutant. Measured myeloperoxidase and 8‐epi‐ PGF 2α were log e transformed. We used linear regression models and linear mixed‐effects models with random intercepts for myeloperoxidase and indexed 8‐epi‐ PGF 2α , respectively. Models were adjusted for demographic variables, individual‐ and area‐level measures of socioeconomic position, clinical and lifestyle factors, weather, and temporal trend. We found positive associations of PM 2.5 and black carbon with myeloperoxidase across multiple moving averages. Additionally, 2‐ to 7‐day moving averages of PM 2.5 and sulfate were consistently positively associated with 8‐epi‐ PGF 2α . Stronger positive associations of black carbon and sulfate with myeloperoxidase were observed among participants with diabetes than in those without.

Conclusions Our community‐based investigation supports an association of select markers of ambient air pollution with circulating biomarkers of oxidative stress.

Associations Between Ambient Particle Radioactivity and Blood Pressure: The NAS (Normative Aging Study)
Journal of the American Heart Association - Tập 7 Số 6 - 2018
Marguerite M. Nyhan, Brent A. Coull, Annelise J. Blomberg, C Vieira, Eric Garshick, Abdulaziz Aba, Pantel Vokonas, Diane R. Gold, Joel Schwartz, Petros Koutrakis
Background The cardiovascular effects of low‐level environmental radiation exposures are poorly understood. Although particulate matter ( PM ) has been linked to cardiovascular morbidity and mortality, and elevated blood pressure ( BP ), the properties promoting its toxicity remain uncertain. Addressing a knowledge gap, we evaluated whether BP increased with higher exposures to radioactive components of ambient PM , herein referred to as particle radioactivity ( PR ).

Methods and Results We performed a repeated‐measures analysis of 852 men to examine associations between PR exposure and BP using mixed‐effects regression models. As a surrogate for PR , we used gross β activity, measured by the US Environmental Protection Agency's radiation monitoring network. Higher PR exposure was associated with increases in both diastolic BP and systolic BP , for exposures from 1 to 28 days. An interquartile range increase in 28‐day PR exposure was associated with a 2.95–mm Hg increase in diastolic BP (95% confidence interval, 2.25–3.66; P <0.001) and a 3.94–mm Hg increase in systolic BP (95% confidence interval, 2.62–5.27; P <0.001). For models including both PR and PM ≤2.5 µm, the PR ‐ BP associations remained stable and significant. For models including PR and black carbon or PR and particle number, the PR ‐ BP associations were attenuated; however, they remained significant for many exposure durations.

Conclusions This is the first study to demonstrate the potential adverse effects of PR on both systolic and diastolic BP s. These were independent and similar in magnitude to those of PM ≤2.5 µm, black carbon, and particle number. Understanding the effects of particle‐bound radionuclide exposures on BP may have important implications for environmental and public health policy.

Arrhythmogenic Right Ventricular Cardiomyopathy: Characterization of Left Ventricular Phenotype and Differential Diagnosis With Dilated Cardiomyopathy
Journal of the American Heart Association - Tập 9 Số 5 - 2020
Alberto Cipriani, Barbara Bauce, Manuel De Lazzari, Ilaria Rigato, Riccardo Bariani, Samuele Meneghin, Kalliopi Pilichou, Raffaella Motta, Camillo Aliberti, Gaetano Thiene, William J. McKenna, Alessandro Zorzi, Sabino Iliceto, Cristina Basso, Martina Perazzolo Marra, Domenico Corrado
Background This study assessed the prevalence of left ventricular ( LV ) involvement and characterized the clinical, electrocardiographic, and imaging features of LV phenotype in patients with arrhythmogenic right ventricular cardiomyopathy ( ARVC ). Differential diagnosis between ARVC ‐ LV phenotype and dilated cardiomyopathy ( DCM ) was evaluated.

Methods and Results The study population included 87 ARVC patients (median age 34 years) and 153 DCM patients (median age 51 years). All underwent cardiac magnetic resonance with quantitative tissue characterization. Fifty‐eight ARVC patients (67%) had LV involvement, with both LV systolic dysfunction and LV late gadolinium enhancement ( LGE ) in 41/58 (71%) and LV ‐ LGE in isolation in 17 (29%). Compared with DCM , the ARVC ‐ LV phenotype was statistically significantly more often characterized by low QRS voltages in limb leads, T‐wave inversion in the inferolateral leads and major ventricular arrhythmias. LV ‐ LGE was found in all ARVC patients with LV systolic dysfunction and in 69/153 (45%) of DCM patients. Patients with ARVC and LV systolic dysfunction had a greater amount of LV ‐ LGE (25% versus 13% of LV mass; P <0.01), mostly localized in the subepicardial LV wall layers. An LV ‐ LGE ≥20% had a 100% specificity for diagnosis of ARVC ‐ LV phenotype. An inverse correlation between LV ejection fraction and LV ‐ LGE extent was found in the ARVC ‐ LV phenotype ( r =−0.63; P <0.01), but not in DCM ( r =−0.01; P =0.94).

Conclusions LV involvement in ARVC is common and characterized by clinical and cardiac magnetic resonance features which differ from those seen in DCM . The most distinctive feature of ARVC ‐ LV phenotype is the large amount of LV ‐ LGE /fibrosis, which impacts directly and negatively on the LV systolic function.

Prognostic Value of Minimal Left Atrial Volume in Heart Failure With Preserved Ejection Fraction
Journal of the American Heart Association - Tập 10 Số 15 - 2021
Sung‐Hee Shin, Brian Claggett, Riccardo M. Inciardi, Ângela Barreto Santiago Santos, Sanjiv J. Shah, Michael R. Zile, Marc A. Pfeffer, Amil M. Shah, Scott D. Solomon
Background Maximal left atrial (LA) volume is reported by most echocardiography laboratories and is associated with clinical outcomes in patients with heart failure (HF). Recent studies suggest that minimal LA volume may better reflect left ventricular filling pressure and may be more prognostic than maximal LA volume. This study assessed the prognostic value of indexed minimal LA volume (LAVImin) in patients with HF with preserved ejection fraction.

Methods and Results We assessed the relationship of LAVImin with a primary composite end point of cardiovascular death, aborted cardiac death, or HF hospitalization in 347 patients with HF with preserved ejection fraction enrolled from the Americas region in TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial). We compared LAVImin with indexed maximal LA volume with respect to their prognostic values. In addition, we assessed if LA functional parameters provide additional prognostic information over LAVImin. During a median follow‐up of 2.5 years, 107 patients (31%) experienced a primary composite end point. LAVImin was associated with increased risk of a primary composite outcome (hazard ratio [HR], 1.35; 95% CI, 1.12–1.61) and HF hospitalization alone (HR, 1.42; 95% CI, 1.17–1.71) after adjusting for clinical confounders and ejection fraction. In contrast, indexed maximal LA volume was not related to the primary composite outcome, but related to HF alone (HR, 1.25; 95% CI, 1.02–1.54). In comparison with indexed maximal LA volume, LAVImin was significantly more prognostic for primary composite outcome ( P for comparison=0.032). Both LA emptying fraction and LA strain were prognostic of primary outcome independent of LAVImin (all P <0.05).

Conclusions In patients with HF with preserved ejection fraction, LAVImin was more predictive of cardiovascular outcome than indexed maximal LA volume, suggesting this measure may be more physiologically relevant and might better identify patients at high risk for cardiovascular events. LA functional parameters provide prognostic information independent of LAVImin.

Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00094302.

Systematic Review and Network Meta‐Analysis on the Efficacy of Evolocumab and Other Therapies for the Management of Lipid Levels in Hyperlipidemia
Journal of the American Heart Association - Tập 6 Số 10 - 2017
Peter P. Tóth, Gillian Worthy, Shravanthi R. Gandra, Naveed Sattar, Sarah Bray, Lung‐I Cheng, Ian Bridges, Gavin Worth, Ricardo Dent, Carol Forbes, Sohan Deshpande, Janine Ross, Jos Kleijnen, Erik S.G. Stroes
Background The proprotein convertase subtilisin/kexin type 9 ( PCSK 9) inhibitors evolocumab and alirocumab substantially reduce low‐density lipoprotein cholesterol ( LDL ‐C) when added to statin therapy in patients who need additional LDL ‐C reduction.

Methods and Results We conducted a systematic review and network meta‐analysis of randomized trials of lipid‐lowering therapies from database inception through August 2016 (45 058 records retrieved). We found 69 trials of lipid‐lowering therapies that enrolled patients requiring further LDL ‐C reduction while on maximally tolerated medium‐ or high‐intensity statin, of which 15 could be relevant for inclusion in LDL ‐C reduction networks with evolocumab, alirocumab, ezetimibe, and placebo as treatment arms. PCSK 9 inhibitors significantly reduced LDL ‐C by 54% to 74% versus placebo and 26% to 46% versus ezetimibe. There were significant treatment differences for evolocumab 140 mg every 2 weeks at the mean of weeks 10 and 12 versus placebo (−74.1%; 95% credible interval −79.81% to −68.58%), alirocumab 75 mg (−20.03%; 95% credible interval −27.32% to −12.96%), and alirocumab 150 mg (−13.63%; 95% credible interval −22.43% to −5.33%) at ≥12 weeks. Treatment differences were similar in direction and magnitude for PCSK 9 inhibitor monthly dosing. Adverse events were similar between PCSK 9 inhibitors and control. Rates of adverse events were similar between PCSK 9 inhibitors versus placebo or ezetimibe.

Conclusions PCSK 9 inhibitors added to medium‐ to high‐intensity statin therapy significantly reduce LDL ‐C in patients requiring further LDL ‐C reduction. The network meta‐analysis showed a significant treatment difference in LDL ‐C reduction for evolocumab versus alirocumab.

Mức hsCRP và Nguy Cơ Tử Vong hoặc Sự Kiện Tim Mạch Tái Phát ở Bệnh Nhân Nhồi Máu Cơ Tim: một Nghiên Cứu Dựa trên Dịch Vụ Y Tế Dịch bởi AI
Journal of the American Heart Association - Tập 8 Số 11 - 2019
Juan Jesús Carrero, Mikael Andersson, Achim Obergfell, Anders Gabrielsen, Tomas Jernberg
Thông Tin Nền Ngoài các điều kiện kiểm soát trong các thử nghiệm, thông tin về gánh nặng, các yếu tố dự đoán và kết quả liên quan đến mức hs CRP (protein phản ứng C nhạy cảm cao) ở những bệnh nhân "thực tế" mắc bệnh nhồi máu cơ tim ( MI ) còn hạn chế.

Phương Pháp và Kết Quả Chúng tôi đã bao gồm tất cả các bệnh nhân sống sót sau MI tham gia kiểm tra hs CRP sau 30 ngày kể từ khi MI trong quá trình chăm sóc sức khỏe thông thường tại Stockholm, Thụy Điển (2006–2011). Các xét nghiệm hs CRP được thực hiện trong thời gian nhập viện/khám cấp cứu, tiếp theo là kháng sinh hoặc biểu hiện của bệnh cấp tính, đã bị loại trừ, cùng với những bệnh nhân có ung thư đang diễn ra/gần đây, nhiễm trùng mãn tính, hoặc suy giảm miễn dịch. Viêm được xác định trong khoảng thời gian 3 tháng cơ bản và được liên kết với cái chết sau đó và các sự kiện tim mạch bất lợi nghiêm trọng (tổng hợp bao gồm MI, đột quỵ do thiếu máu cục bộ, hoặc tử vong do tim mạch). Có 17.464 bệnh nhân được đưa vào (63% nam giới; tuổi trung bình, 72.6 năm) với mức hs CRP trung vị là 2.2 (phạm vi giữa các phần tư, 1.0–6.0) mg/L và trung vị thời gian từ khi xảy ra MI là 2.2 (phạm vi giữa các phần tư, 0.8–4.9) năm. Hầu hết (66%) có mức hs CRP ≥2 mg/L, và 40% có hs CRP >3 mg/L. Nồng độ hemoglobin thấp hơn, tỷ lệ lọc cầu thận ước tính thấp hơn, và các bệnh đi kèm (ví dụ: suy tim, bệnh mạch máu ngoại vi, đột quỵ, rung nhĩ, tiểu đường, và các bệnh thấp khớp) có liên quan đến xác suất cao hơn của hs CRP ≥2 mg/L. Ngược lại, can thiệp động mạch corona qua da trước đó, đang điều trị bằng thuốc chẹn renin-angiotensin, và statin có liên quan đến xác suất thấp hơn của hs CRP ≥2 mg/L. Những bệnh nhân có hs CRP ≥2 mg/L có nguy cơ cao hơn về các sự kiện tim mạch bất lợi nghiêm trọng (n=3900; tỷ lệ rủi ro điều chỉnh, 1.28; 95% CI, 1.18–1.38) và tử vong (n=4138; tỷ lệ rủi ro điều chỉnh, 1.42; 95% CI, 1.31–1.53). Kết quả này vững chắc trong các phân nhóm bệnh nhân và sau khi loại trừ các sự kiện xảy ra trong 6 đến 12 tháng đầu tiên. Trên thang đo liên tục, mối liên hệ giữa hs CRP và các kết quả là tuyến tính cho đến mức hs CRP >5 mg/L, sau đó ổn định.

Kết Luận Hầu hết bệnh nhân mắc MI đều có mức hs CRP cao. Ngoài việc xác định các nhóm có nguy cơ viêm nhiễm cao, nghiên cứu này mở rộng tính hợp lệ dự đoán của sinh học đánh dấu này từ chứng cứ thử nghiệm đến các điều kiện chăm sóc sức khỏe thực tế.

Can a Novel Clinical Risk Score Improve Pneumonia Prediction in Acute Stroke Care? A UK Multicenter Cohort Study
Journal of the American Heart Association - Tập 4 Số 1 - 2015
Craig J. Smith, Benjamin Bray, Alex Hoffman, Andreas Meisel, Peter U. Heuschmann, Charles Wolfe, Pippa Tyrrell, Anthony G. Rudd
Background Pneumonia frequently complicates stroke and has a major impact on outcome. We derived and internally validated a simple clinical risk score for predicting stroke‐associated pneumonia (SAP), and compared the performance with an existing score (A 2 DS 2 ).

Methods and Results We extracted data for patients with ischemic stroke or intracerebral hemorrhage from the Sentinel Stroke National Audit Programme multicenter UK registry. The data were randomly allocated into derivation (n=11 551) and validation (n=11 648) samples. A multivariable logistic regression model was fitted to the derivation data to predict SAP in the first 7 days of admission. The characteristics of the score were evaluated using receiver operating characteristics (discrimination) and by plotting predicted versus observed SAP frequency in deciles of risk (calibration). Prevalence of SAP was 6.7% overall. The final 22‐point score ( ISAN : prestroke I ndependence [modified Rankin scale], S ex, A ge, N ational Institutes of Health Stroke Scale) exhibited good discrimination in the ischemic stroke derivation (C‐statistic 0.79; 95% CI 0.77 to 0.81) and validation (C‐statistic 0.78; 95% CI 0.76 to 0.80) samples. It was well calibrated in ischemic stroke and was further classified into meaningful risk groups (low 0 to 5, medium 6 to 10, high 11 to 14, and very high ≥15) associated with SAP frequencies of 1.6%, 4.9%, 12.6%, and 26.4%, respectively, in the validation sample. Discrimination for both scores was similar, although they performed less well in the intracerebral hemorrhage patients with an apparent ceiling effect.

Conclusions The ISAN score is a simple tool for predicting SAP in clinical practice. External validation is required in ischemic and hemorrhagic stroke cohorts.

Risk of Death Following Application of Paclitaxel‐Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
Journal of the American Heart Association - Tập 7 Số 24 - 2018
Konstantinos Katsanos, Stavros Spiliοpoulos, Panagiotis Kitrou, Μiltiadis Krokidis, Dimitrios Karnabatidis
Background Several randomized controlled trials ( RCT s) have already shown that paclitaxel‐coated balloons and stents significantly reduce the rates of vessel restenosis and target lesion revascularization after lower extremity interventions.

Methods and Results A systematic review and meta‐analysis of RCT s investigating paclitaxel‐coated devices in the femoral and/or popliteal arteries was performed. The primary safety measure was all‐cause patient death. Risk ratios and risk differences were pooled with a random effects model. In all, 28 RCT s with 4663 patients (89% intermittent claudication) were analyzed. All‐cause patient death at 1 year (28 RCT s with 4432 cases) was similar between paclitaxel‐coated devices and control arms (2.3% versus 2.3% crude risk of death; risk ratio, 1.08; 95% CI, 0.72–1.61). All‐cause death at 2 years (12 RCT s with 2316 cases) was significantly increased in the case of paclitaxel versus control (7.2% versus 3.8% crude risk of death; risk ratio, 1.68; 95% CI, 1.15–2.47; —number‐needed‐to‐harm, 29 patients [95% CI , 19–59]). All‐cause death up to 5 years (3 RCT s with 863 cases) increased further in the case of paclitaxel (14.7% versus 8.1% crude risk of death; risk ratio, 1.93; 95% CI , 1.27–2.93; —number‐needed‐to‐harm, 14 patients [95% CI , 9–32]). Meta‐regression showed a significant relationship between exposure to paclitaxel (dose‐time product) and absolute risk of death (0.4±0.1% excess risk of death per paclitaxel mg‐year; P <0.001). Trial sequential analysis excluded false‐positive findings with 99% certainty (2‐sided α, 1.0%).

Conclusions There is increased risk of death following application of paclitaxel‐coated balloons and stents in the femoropopliteal artery of the lower limbs. Further investigations are urgently warranted.

Clinical Trial Registration URL : www.crd.york.ac.uk/PROSPERO . Unique identifier: CRD 42018099447.

Using Mobile Technology for Cardiac Rehabilitation: A Review and Framework for Development and Evaluation
Journal of the American Heart Association - Tập 2 Số 6 - 2013
Alexis L. Beatty, Yoshimi Fukuoka, Mary A. Whooley
Tổng số: 85   
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