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As in past years, the Associate Editors have assembled this highlights article. We included those papers published in the Journal in the past 12 months that we perceived as having the greatest impact on cardiology. Space constraints resulted in omitting many excellent papers, for which we apologize

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).The main findings of the TNT Trial were published in 2005 (1). Since that time, members of the Steering Committee and other investigators have published 32 papers based upon additional analyses of TNT. The data for these papers were derived from analyses of the TNT clinical database, managed by Pfizer. The clinical database has been crosschecked many times and the data in it is valid. During the trial, blood samples were drawn from the patients at regular intervals for subsequent analysis. We performed a nested case-control study that included 507 patients who experienced a CV event and 1,020 control patients in the main biomarker analysis, and 496 patients who experienced a CV event and 1,117 control patients in the PCSK9 analysis. The biomarker database was separate from the clinical database. An anonymization code was run in 2007 to link patients from one database to the other.In late 2012, the TNT frozen blood samples were integrated into a large automated biobank that includes samples from other Pfizer trials. At that time discrepancies were noted among the samples, indicating that an error had occurred when the samples were anonymized in 2007. Further investigation revealed that the code created to manually anonymize the data was accidentally run twice. During the first run, anonymized subject identifiers were successfully assigned to both biosamples and clinical data. However, after this first run had passed quality control checks, the anonymization code was re-run inadvertently, replacing the first correct set of identifiers with a random and incorrect set. We do not understand how or why the code was re-run. The study team, who were blinded as to patient identity, thus reported on mismatched clinical and biomarker data. The investigators of the biomarkers study were puzzled that none of the 18 biomarkers were predictive of cardiovascular events. However we were reassured because on-treatment LDL-cholesterol, HDL-cholesterol and triglyceride levels were all strongly predictive of events, and we reported this in the paper. These lipid levels were part of the clinical database, and thus were not subject to the error that occurred with the biomarkers. In the PCSK9 analysis, PCSK9 levels were predictive of events in the atorvastatin 10-mg group (p = 0.039) but not in the 80-mg group. This finding, which we now realize is totally spurious, was not unexpected and raised no red flags. Similarly, the failure of vitamin D levels to predict events, as reported in the AHJ paper, was not surprising.Since the error was discovered, we have created a new anonymized clinical and biomarker database by restoring the original set of anonymized identifiers. We are currently reanalyzing the data according to our original study plans. However, the nested case-control feature of the original study design has been lost because the patient selection for biomarker sampling was random. Only approximately one tenth of patients now had an event, compared to one third in the original study design. Thus, the power to detect a difference in the level of a biomarker between patients with and without events has been attenuated.All authors of these manuscripts are anguished to have made this mistake and publishing incorrect information.

Objectives The purpose of this study was to evaluate feasibility of using real-time, high-fidelity, intracardiac electrogram monitoring from a permanently implantable ischemia detection system (IIDS), with long-range telemetry capability to detect ST-segment shifts associated with acute or subacute coronary occlusion in a porcine model. Background Early identification of coronary occlusion with ST-segment elevation could profoundly accelerate the timing of revascularization and improve clinical outcomes. Methods This paper reports the first investigation using real-time, high-fidelity, intracardiac electrogram monitoring from a permanently IIDS, with long-range telemetry capability. This IIDS was tested in an ambulatory porcine model, with acute coronary occlusion precipitated by stent thrombosis. Two overlapping copper stents were implanted in the left anterior descending (n = 3), the circumflex (n = 3), or the right coronary artery (n = 2) of juvenile farm pigs. Monitoring was carried using telemetry from the IIDS. Results All stented pigs had acute ST-segment elevation event(s) triggering the alerting thresholds of the IIDS. All triggered events were confirmed to be caused by thrombosis of the copper stent(s), and well correlated to infarct age and location. Four of the 8 pigs died from ventricular fibrillation, recorded by the IIDS at a mean time of 70 ± 121 h after ST-segment alert. The sensitivity and specificity of alerting for ST-segment shift, associated with thrombotic coronary occlusion, were 100% and 100%, respectively. Conclusions This study demonstrates the ability of an implantable ischemia detection system to detect ST-segment elevation from coronary occlusion in a porcine model of ST-segment elevation myocardial infarction. ST-segment elevation was sufficient to trigger alerting thresholds in all 3 epicardial coronary distributions. Such a system, with real-time alerting capability, could advance the time frame of reperfusion therapy and potentially prevent, rather than interrupt, acute myocardial infarction in patients with coronary artery disease.

The concept of depressor reflexes originating in the heart was introduced by von Bezold in 1867 and was later revived by Jarisch. The Bezold-Jarisch reflex originates in cardiac sensory receptors with nonmyelinated vagal afferent pathways. The left ventricle, particularly the inferoposterior wall, is a principal location for these sensory receptors. Stimulation of these inhibitory cardiac receptors by stretch, chemical substances or drugs increases parasympathetic activity and inhibits sympathetic activity. These effects promote reflex bradycardia, vasodilation and hypotension (Bezold-Jarisch reflex) and also modulate renin release and vasopressin secretion. Conversely, decreases in the activity of these inhibitory sensory receptors reflexly increase sympathetic activity, vascular resistance, plasma renin activity and vasopressin.Long regarded as pharmacologic curiosities, it is now clear that reflexes originating in these inhibitory cardiac sensory receptors are important to the pathophysiology of many cardiovascular disorders. This paper reviews the role of inhibitory cardiac sensory receptors in several clinical states including 1) bradycardia, hypotension and gastrointestinal disorders with inferoposterior myocardial ischemia and infarction, 2) bradycardia and hypotension during coronary arteriography, 3) exertional syncope in aortic stenosis, 4) vasovagal syncope, 5) neurohumoral excitation in chronic heart failure, and 6) the therapeutic effects of digitalis.

The “state-of-the art” paper written by Taggart et al. ([1][1]) calls into question the current evidence in support of percutaneous coronary intervention (PCI) for the treatment of unprotected left main stem disease. In view of the fact that current guidelines still indicate coronary artery

There is an expanded need for implantable cardioverter-defibrillators and cardiac resynchronization pacemakers as part of the treatment of patients with left ventricular dysfunction. A large number of such patients present to heart failure (HF) specialists for recommendations related to their care. In this paper, a pathway is presented that would combine training in HF/transplantation and cardiac implantable electrical devices.

We read with great interest the paper by Grant et al. ([1][1]) in which they provide an analysis to support the use of strain imaging as a unique echocardiographic measure to predict right ventricular (RV) failure in patients undergoing left ventricular assist device (LVAD) placement. In their study

Given the relative paucity of data regarding tako-tsubo cardiomyopathy (TC) and the risk of heart failure, Madhavan et al. ([1][1]) are to be commended for their work recently published in the Journal . However, we wish to raise one issue not mentioned in their paper. It is recognized that TC can

We read with great interest the paper by Montalescot et al. [(1)][1] and the editorial by Ibanez and Dangas [(2)][2] about prasugrel in non–ST-segment myocardial infarction (NSTEMI), and we appreciate the research on this interesting issue. The ACCOAST (A Comparison of Prasugrel at PCI or Time of

We read with great interest the recent paper by Patarroyo et al. ([1][1]) regarding the possible lack of association between hemodynamic and renal function improvement in refractory heart failure patients treated with slow continuous ultrafiltration (SCUF). The authors pointed out that their

We read with interest the article by Felker et al. [(1)][1] regarding the effect of serelaxin on the mode of death prevention in acute heart failure. This paper was a subgroup analysis of the RELAX-AHF (Efficacy and Safety of Relaxin for the Treatment of Acute Heart Failure) study intended to

We read with interest the paper of Law et al. ([1][1]) regarding the accuracy of B-type natriuretic peptide (BNP) to diagnose significant cardiovascular disease in children. In their prospective study the authors enrolled 100 children (including 42 neonates) presenting with signs and symptoms that

We would like to add a letter to our paper previously published by Uriel et al. [(1)][1]. We are honored to have been contacted by many centers nationally and internationally about our ramp test. However, it has come to our attention that some centers performing the test are unfortunately having

In their excellent paper, Anderson et al. ([1][1]) showed that cellular metabolism correlated better with treadmill exercise results than estimation of muscle perfusion in patients with peripheral artery disease (PAD). Anderson et al. ([1][1]) suggested that factors independent of blood flow and

We read with interest the paper by Koo et al. ([1][1]) regarding the diagnostic accuracy of noninvasive measurement of fractional flow reserve (FFR) from coronary computed tomography angiography data (FFRCT). We do recognize the potential clinical and economic relevance of the validation of a

We read with great interest the paper by Yeboah et al. ([1][1]) regarding the effect of impaired fasting glucose (IFG) and incident diabetes, as well as diagnosed diabetes mellitus on cardiovascular events after a mean follow-up duration of 7.5 years, and its conclusion of IFG not being

We read with interest the paper by Nicholls et al. ([1][1]) investigating the relationship between intravascular ultrasound (IVUS)–derived measures of atherosclerosis (baseline and change in percent atheroma volume) and cardiovascular outcomes (death, myocardial infarction, and coronary

We read with great interest both the research paper by Tsujioka et al. ([1][1]) and the editorial comment by Shantsila and Lip ([2][2]) outlining the role of monocytes in myocardial infarction (MI). We agree that understanding the role of different monocyte population subsets during acute coronary

We read the paper by Sen et al. [(1)][1] with great interest; the study was designed to explore whether the instantaneous wave-free ratio (iFR) was an adenosine-free alternative to fractional flow reserve (FFR) for the assessment of coronary stenosis. Hyperemic stenosis resistance (HSR) was used as

The paper by Taylor et al. [(1)][1] on a new method for the calculation of fractional flow reserve (FFR) from cardiac computed tomography (CTA) images of the coronary arteries is elegant and interesting, with some striking pictures, and it offers the possibility of calculating this important

The recent paper by Berger et al. ([1][1]) brings to light an important point that we think affects a majority of cardiologists and cardiac surgeons alike. The use of clopidogrel is now widespread, and the American College of Cardiology/American Heart Association (ACC/AHA) guidelines ([2][2])

The recent paper by Diamond et al. ([1][1]) comparing costs and effectiveness of using myocardial perfusion scintigraphy (MPS) as a screening strategy against an unconditional treatment strategy for the prevention of cardiovascular events in asymptomatic diabetic patients using a “back of the

Screening for critical congenital heart disease with pulse oximetry requires healthcare providers to decipher a previously published algorithm, a feature that raises concerns about quality of interpretation of pulse oximetry results. We hypothesized that this method would be prone to error and a computer-based tool would lead to a more accurate interpretation of the screening results.In this randomized crossover study, healthcare providers with prior experience using pulse oximetry received 2 sets of 10 mock screening scenarios and were asked to interpret the results of each scenario as "pass," "fail," or "retest." Participants were randomized to use either the paper algorithm or computer-based tool for the first set of 10 scenarios and the alternative method for the second set. We used Wilcoxon rank sum tests to compare the accuracy of interpretation using the 2 methods.The 102 participants answered 81.6% of the scenarios correctly when manually interpreting the algorithm vs 98.3% correct when using the computer-based tool (P.001). These differences were most pronounced for the "fail" scenarios (65.4% manual vs 96.7% computer, P.001) and the "retest" scenarios (80.7% manual vs 98.7% computer, P.001), but were also significant for the "pass" scenarios (94.1% manual vs 99.0% computer, P.001).Use of a manual algorithm for the interpretation of results in screening for critical congenital heart disease with pulse oximetry is susceptible to human error. Implementation of a computer-based tool to aid in the interpretation of the results may lead to improved accuracy and quality.

I read with interest the paper by Thuny et al. ([1][1]) published in the June 12, 2012, issue of the Journal . The authors adequately demonstrated the effectiveness of a post-conditioning strategy in decreasing the degree of myocardial edema as assessed by cardiac magnetic resonance and hypothesized

In the paper by George et al. [(1)][1], regarding the clinical outcome after chronic total occlusion (CTO) percutaneous coronary intervention (PCI), the methods have been described with insufficient details and no data are provided about the indication to PCI and the viability of the myocardial