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1. A Randomized, double-blind, dose ranging clinical trial of intravenous FDY-5301 in acute STEMI patients undergoing primary PCI

Author: István Édes, Andrew S.P. Sharp, Neal G. Uren, Michael A Insko, János Tomcsányi, Shahzad Munir, Leong L. Ng, Ben Haber, Azfar Zaman, Keith M. Channon, Mario J. Garcia, Géza Lupkovics, Keith G. Oldroyd, David Adlam, John Irving, Piotr Musialek, Róbert Gábor Kiss, Hussain Contractor, Stephen Hill, Mark B. Roth, Simon Tulloch, Paweł Ptaszyński, P A Quinn, Lori Siegel, Cheerag Shirodaria, Joseph B. Selvanayagam, Maciej Zarębiński, Gergely Nagy, and Joanna Szachniewicz
Subjects: medicine.medical_specialty, medicine.medical_treatment, Placebo, Chest pain, Percutaneous Coronary Intervention, Double-Blind Method, Cardiac magnetic resonance imaging, Internal medicine, medicine, Humans, Myocardial infarction, Anterior Wall Myocardial Infarction, Ejection fraction, medicine.diagnostic_test, business.industry, Percutaneous coronary intervention, Arrhythmias, Cardiac, medicine.disease, Clinical trial, Treatment Outcome, Conventional PCI, Cardiology, ST Elevation Myocardial Infarction, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: Background Ischemia-reperfusion injury remains a major clinical problem in patients with ST-elevation myocardial infarction (STEMI), leading to myocardial damage despite early reperfusion by primary percutaneous coronary intervention (PPCI). There are no effective therapies to limit ischemia-reperfusion injury, which is caused by multiple pathways activated by rapid tissue reoxygenation and the generation of reactive oxygen species (ROS). FDY-5301 contains sodium iodide, a ubiquitous inorganic halide and elemental reducing agent that can act as a catalytic anti-peroxidant. We tested the feasibility, safety and potential utility of FDY-5301 as a treatment to limit ischemia-reperfusion injury, in patients with first-time STEMI undergoing emergency PPCI. Methods STEMI patients (n = 120, median 62 years) presenting within 12 h of chest pain onset were randomized at 20 PPCI centers, in a double blind Phase 2 clinical trial, to receive FDY-5301 (0.5, 1.0 or 2.0 mg/kg) or placebo prior to reperfusion, to evaluate the feasibility endpoints. Participants underwent continuous ECG monitoring for 14 days after PPCI to address pre-specified cardiac arrhythmia safety end points and cardiac magnetic resonance imaging (MRI) at 72 h and at 3 months to assess exploratory efficacy end points. Results Intravenous FDY-5301 was delivered before re-opening of the infarct-related artery in 97% participants and increased plasma iodide levels ~1000-fold within 2 min. There was no significant increase in the primary safety end point of incidence of cardiac arrhythmias of concern. MRI at 3 months revealed median final infarct sizes in placebo vs. 2.0 mg/kg FDY-5301-treated patients of 14.9% vs. 8.5%, and LV ejection fractions of 53.9% vs. 63.2%, respectively, although the study was not powered to detect statistical significance. In patients receiving FDY-5301, there was a significant reduction in the levels of MPO, MMP2 and NTproBNP after PPCI, but no reduction with placebo. Conclusions Intravenous FDY-5301, delivered immediately prior to PPCI in acute STEMI, is feasible, safe, and shows potential efficacy. A larger trial is justified to test the effects of FDY-5301 on acute ischemia-reperfusion injury and clinical outcomes. Clinical Trial Registration: CT.gov NCT03470441 ; EudraCT 2017-000047-41
Published: 2022
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2. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author: Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C Quinn, Maria A Alfonso, Maria Antonieta Pereira Moraes, María Dolores Martínez-Ruíz, María Fernanda Canales, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Victoria Actis, Maria Aguirre, Maria Andreasson, Maria Aprile, Maria Colton, Maria Eugenia Martin, Maria Lasala, Maria Lorenzo, Maria Posada, Maria Shier, Maria Thottam, Mariana V Furtado, Mariana Yumi Okada, Marianna D A Dracoulakis, Marianne De Andrade, Mariano Rubio, Marie Essermark, Marielle Scherrer-Crosbie, Marija T Petrovic, Marija Zdravkovic, Marilyn Black, Marina Garcia, Mario J Garcia, Mariola Szulik, Marisa Orgera, Mark A de Belder, Mark Harbinson, Mark Hyun, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Marcinkiewicz-Siemion, Marta Swiderek, Martha Meyer, Martina Ceseri, Martina Tricoli, Marvin Kronenberg, Mary Williams, Mary Ann Champagne, Mary Colleen Rogge, Mary R Soltau, Mary Streif, Massimo Villella, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Wall Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Mona Bhatia, Monica Rosca, Monika Laukyte, Montserrat Gracida Blanca, Montserrat Vila Perales, Mouaz H Al-Mallah, Moysés de Oliveira Filho, Mpiko Ntsekhe, Muhamed Saric, Mulei Chen, Myriam Brousseau, Myrthes Emy Takiuti, Nada Cemerlic-Adjic, Nadia Asif, Nadia Gakou, Nafisa Hussain, Nana O Katamadze, Nancy L Clapp, Nancy Aedy, Nandita Nataraj, Nanette K Wenger, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Natalie Spitzer, Natasha C Putnam, Naved Aslam, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Nevena Garcevic, Ngaire Meadows, Nhi N Tran, Nicholas Danchin, Nicki Lakeman, Nicola Johnston, Nicolas W Shammas, Nicole Saint Vrestil, Nicole Deming, Nier Zhong, Niket Patel, Nikola N Boskovic, Nikolaos Karogiannis, Nikos Werner, Nina Johnston, Ning Zhang, Ning Zhou, Niree Hindoyan, Nirmal Kumar, Nitika Chadha, Nitish Naik, Nodira Aripova, Noloyiso Mtana, Nona A Eskelson, Noor Syamira 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Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona 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Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits
Subjects: Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract: BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
Published: 2020
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3. Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation

Author: Nurilign Bulcha, Omar Saeed, Ying Xian, Mario J. Garcia, Tanush Gupta, Lee H. Schwamm, Ulrich P. Jorde, Shreyansh Shah, Eric E. Smith, Gregg C. Fonarow, Roland A. Matsouaka, Shuaiqi Zhang, and Snehal R. Patel
Subjects: Aging, medicine.medical_specialty, Adverse outcomes, Clinical Sciences, Hemorrhage, Nursing, Cardiorespiratory Medicine and Haematology, 030204 cardiovascular system & hematology, Cardiovascular, Medicare, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Clinical Research, Internal medicine, Atrial Fibrillation, medicine, Humans, 030212 general & internal medicine, Mortality, Adverse effect, Stroke, Oral anticoagulation, Aged, Ischemic Stroke, Heart Failure, business.industry, Hazard ratio, Anticoagulants, Atrial fibrillation, medicine.disease, United States, Brain Disorders, Heart Disease, Cardiovascular System & Hematology, Heart failure, Ischemic stroke, Cardiology, Oral Anticoagulation, Cardiology and Cardiovascular Medicine, business
Abstract: BackgroundThe safety and effectiveness of oral anticoagulation (OAC) after an ischemic stroke in older patients with heart failure (HF) without atrial fibrillation remains uncertain.MethodsUtilizing Get With The Guidelines Stroke national clinical registry data linked to Medicare claims from 2009-2014, we assessed the outcomes of eligible patients with a history of HF who were initiated on OAC during a hospitalization for an acute ischemic stroke. The cumulative incidences of adverse events were calculated using Kaplan-Meier curves and adjusted Cox proportional hazard ratios were compared between patients discharged on or off OAC.ResultsA total of 8,261 patients from 1,370 sites were discharged alive after an acute ischemic stroke and met eligibility criteria. Of those, 747 (9.0%) were initiated on OAC. Patients on OAC were younger (77.2±8.0 vs. 80.5±8.9 years, p
Published: 2021
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4. Incidence of new-onset atrial fibrillation in COVID-19 is associated with increased epicardial adipose tissue

Author: Alison Schonberger, Ulrich P. Jorde, Mario J. Garcia, Francesco Castagna, Jeffrey M. Levsky, Luigi Di Biase, Damini Dey, Eitan Novogrodsky, and Leandro Slipczuk
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Population, Coronary artery calcium, Article, Coronary artery disease, COVID-19 Testing, Risk Factors, Physiology (medical), Diabetes mellitus, Internal medicine, Epicardial adipose tissue, Post-hoc analysis, Humans, Medicine, Intubation, education, Aged, Retrospective Studies, education.field_of_study, business.industry, Incidence, Incidence (epidemiology), COVID-19, Atrial fibrillation, Middle Aged, medicine.disease, Adipose Tissue, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Pericardium
Abstract: Purpose Coronary artery calcium (CAC) and epicardial adipose tissue (EAT) can predict AF in the general population. We aimed to determine if CAC and EAT measured by computed tomographic (CT) scanning can predict new-onset AF in patients admitted with COVID-19 disease. Methods We performed a retrospective, post hoc analysis of all patients admitted to Montefiore Medical Center with a confirmed COVID-19 diagnosis from March 1st to June 23rd, 2020, who had a non-contrast CT of the chest within 5 years prior to admission. We determined ordinal CAC scores and quantified the EAT volume and examined their relationship with inpatient mortality. Results A total of 379 patients were analyzed. There were 16 events of new-onset AF (4.22%). Patients who developed AF during the index admission were more likely to be male (75 vs 47%, p
Published: 2021
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5. Coronary artery calcification and epicardial adipose tissue as independent predictors of mortality in COVID-19

Author: Mario J. Garcia, Eitan Novogrodsky, Leandro Slipczuk, Ulrich P. Jorde, Jeffrey M. Levsky, Richard Sekerak, Alison Schonberger, Damini Dey, and Francesco Castagna
Subjects: medicine.medical_specialty, Population, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary artery calcium, Covid, 030218 nuclear medicine & medical imaging, Coronary artery disease, 03 medical and health sciences, COVID-19 Testing, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Internal medicine, Epicardial adipose tissue, Epidemiology, medicine, Humans, Pericardium, Radiology, Nuclear Medicine and imaging, Mortality, Vascular Calcification, education, Cardiac imaging, Retrospective Studies, Original Paper, education.field_of_study, SARS-CoV-2, business.industry, COVID-19, Retrospective cohort study, medicine.disease, Coronary Vessels, medicine.anatomical_structure, Adipose Tissue, Predictive value of tests, Cohort, Cardiology, Cardiology and Cardiovascular Medicine, business
Abstract: Recent epidemiological studies have demonstrated that common cardiovascular risk factors are strongly associated with adverse outcomes in COVID-19. Coronary artery calcium (CAC) and epicardial fat (EAT) have shown to outperform traditional risk factors in predicting cardiovascular events in the general population. We aim to determine if CAC and EAT determined by Computed Tomographic (CT) scanning can predict all-cause mortality in patients admitted with COVID-19 disease. We performed a retrospective, post-hoc analysis of all patients admitted to Montefiore Medical Center with a confirmed COVID-19 diagnosis from March 1st, 2020 to May 2nd, 2020 who had a non-contrast CT of the chest within 5 years prior to admission. We determined ordinal CAC scores and quantified the epicardial (EAT) and thoracic (TAT) fat volume and examined their relationship with inpatient mortality. A total of 493 patients were analyzed. There were 197 deaths (39.95%). Patients who died during the index admission had higher age (72, [64–80] vs 68, [57–76]; p
Published: 2021
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6. T-wave inversion as a manifestation of COVID-19 infection: a case series

Author: Mario J. Garcia, Andrea Natale, Eric D. Braunstein, Sutopa Purkayastha, Kavisha Patel, Xiao-Dong Zhang, Juan Carlos Diaz, Michael K. Parides, Alejandro Velasco, Dalvert Polanco, Ulrich P. Jorde, Sanghamitra Mohanty, Domenico G. Della Rocca, Jorge Romero, Juan Bello, David F. Briceno, Maria T. Gamero, Mohamed Gabr, Carolina R. Valencia, Isabella Alviz, Ruike Yang, Nicola Tarantino, and Luigi Di Biase
Subjects: Male, Sars‐Cov‐2, medicine.medical_specialty, Myocarditis, medicine.medical_treatment, electrocardiogram, 030204 cardiovascular system & hematology, Sudden cardiac death, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, COVID‐19, prolonged QTc, Physiology (medical), T wave, Internal medicine, medicine, Humans, Ventricular Function, ST segment, 030212 general & internal medicine, Aged, Retrospective Studies, Mechanical ventilation, biology, SARS-CoV-2, business.industry, Mortality rate, COVID-19, medicine.disease, Respiration, Artificial, mortality, Troponin, Electrophysiology, Heart failure, Cardiology, biology.protein, Female, New York City, Cardiology and Cardiovascular Medicine, business
Abstract: Background Coronavirus disease‐2019 (COVID‐19) causes severe illness and multi‐organ dysfunction. An abnormal electrocardiogram is associated with poor outcome, and QT prolongation during the illness has been linked to pharmacological effects. This study sought to investigate the effects of the COVID‐19 illness on the corrected QT interval (QTc). Method For 293 consecutive patients admitted to our hospital via the emergency department for COVID‐19 between 01/03/20 ‐18/05/20, demographic data, laboratory findings, admission electrocardiograph and clinical observations were compared in those who survived and those who died within 6 weeks. Hospital records were reviewed for prior electrocardiograms for comparison with those recorded on presentation with COVID‐19. Results Patients who died were older than survivors (82 vs 69.8 years, p 455 ms (males) and >465 ms (females) (p = 0.028, HR 1.49 [1.04‐2.13]), as predictors of mortality. QTc prolongation beyond these dichotomy limits was associated with increased mortality risk (p = 0.0027, HR 1.78 [1.2‐2.6]). Conclusion QTc prolongation occurs in COVID‐19 illness and is associated with poor outcome.
Published: 2020
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7. An Overlap Presentation of Pericardial Decompression Syndrome and Stress Cardiomyopathy Following Therapeutic Pericardiocentesis

Author: Ahmad Alkhalil, Syed Muhammad Ibrahim Rashid, James M. Tauras, Roberto C. Cerrud-Rodriguez, Jay J. Chudow, Hussein Shaqra, Mohammed Algodi, Mario J. Garcia, and Giora Weisz
Subjects: musculoskeletal diseases, 0301 basic medicine, SCM, stress cardiomyopathy, medicine.medical_specialty, Decompression, medicine.medical_treatment, Cardiomyopathy, Case Report, 030105 genetics & heredity, Pericardial effusion, 03 medical and health sciences, 0302 clinical medicine, Clinical Case, Internal medicine, LVEF, left ventricular ejection fraction, PDS, pericardial decompression syndrome, pericardial decompression syndrome, Diseases of the circulatory (Cardiovascular) system, Medicine, LV, left ventricular, business.industry, systolic dysfunction, Pulmonary edema, medicine.disease, pericardial effusion, TTE, transthoracic echocardiography, Pericardiocentesis, RC666-701, stress cardiomyopathy, Cardiology, Cardiac enzymes, Presentation (obstetrics), Cardiology and Cardiovascular Medicine, Complication, business, cardiomyopathy, 030217 neurology & neurosurgery
Abstract: Pericardial decompression syndrome, defined as paradoxical hypotension and pulmonary edema after pericardiocentesis, is a rare complication of pericardiocentesis. Stress cardiomyopathy, caused by excess catecholamine response resulting in left ventricular dysfunction and elevated cardiac enzymes, can overlap with pericardial decompression syndrome, and both might belong to the same spectrum of disease. (Level of Difficulty: Intermediate.), Graphical abstract, Pericardial decompression syndrome, defined as paradoxical hypotension and pulmonary edema after pericardiocentesis, is a rare complication of…
Published: 2020
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8. Mapping and localization of the left phrenic nerve during left atrial appendage electrical isolation to avoid inadvertent injury in patients undergoing catheter ablation of atrial fibrillation

Author: Mario J. Garcia, Juan Carlos Diaz, Dhanunjaya Lakkireddy, Saul Rios, Vito Grupposo, Jorge Romero, Isabella Alviz, Roberto C. Cerrud-Rodriguez, Elizabeth Chernobelsky, Luis Cerna, Luigi Di Biase, Andrea Natale, and Mohamed Gabr Elsayed
Subjects: Male, medicine.medical_specialty, Left phrenic nerve, Radiofrequency ablation, medicine.medical_treatment, Catheter ablation, 030204 cardiovascular system & hematology, law.invention, Electrical isolation, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Left atrial, law, Physiology (medical), Internal medicine, Atrial Fibrillation, medicine, Humans, Atrial Appendage, 030212 general & internal medicine, Aged, Retrospective Studies, Appendage, business.industry, Body Surface Potential Mapping, Atrial fibrillation, medicine.disease, Phrenic Nerve, Ostium, Echocardiography, Catheter Ablation, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Background A significant role of the left atrial appendage (LAA) in the genesis of atrial fibrillation (AF) has been described. Left atrial appendage electrical isolation (LAAEI) confers substantial long-term clinical benefits. Nevertheless, the left phrenic nerve (LPN) is in the vicinity of the LAA and can be injured during radiofrequency ablation at the ostial level. Objective The purpose of this study was to describe our experience mapping the LPN, its anatomic relationships to the LAA and alternative approaches to isolate this structure when the LPN is located at the LAA ostium. Methods Patients undergoing LAAEI for nonparoxysmal AF were included in this study. We attempted to localize the LPN with high-output pacing (20 mA/2 ms). Cases were classified into 4 groups (distal, middle, proximal segment and unmappable) based on the position of the LPN in electroanatomic mapping in the posterior wall of the LAA. Results A total of 66 cases were included in this study. The LPN was mapped in the distal segment in 27 cases (40.9%); in the middle segment in 22 (33.3%); and at the proximal segment/ostium in 3 (4.5%); the LPN was unmappable in 14 cases (21.2%). In the 3 patients in whom the LPN was at the ostial level or crossing the ostium, segmental LAAEI was attempted in 2, with successful LAAEI achieved in 1 case. There was no LPN injury. Conclusion LPN mapping is feasible and should be routinely performed to prevent LPN injury during LAAEI.
Published: 2020
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9. An Overview of the ABIM Cardiovascular Disease Maintenance of Certification Examination

Author: Mario J. Garcia, Kelli Samonte, and Suzanne de la Cruz
Subjects: Medical education, Certification, business.industry, health care facilities, manpower, and services, education, Cardiology, Disease, 030204 cardiovascular system & hematology, Maintenance of Certification, 03 medical and health sciences, 0302 clinical medicine, Cardiovascular Diseases, Humans, Medicine, Educational Measurement, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, health care economics and organizations
Abstract: In the earlier part of the 20th century, the American Board of Internal Medicine (ABIM) was created as a physician-led, nonprofit, independent evaluation organization with the purpose of establishing uniform standards and helping the public obtain evidence-based care by qualified physicians. In 1936
Published: 2020
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10. The Prognostic Role of Late Gadolinium Enhancement in Aortic Stenosis

Author: Christos A. Papanastasiou, Evangelos Oikonomou, Theodoros D. Karamitsos, Iosif Bikakis, Polydoros N. Kampaktsis, John P Greenwood, Daniela K. Cunha, Damianos G. Kokkinidis, and Mario J. Garcia
Subjects: medicine.medical_specialty, business.industry, Hazard ratio, Odds ratio, 030204 cardiovascular system & hematology, medicine.disease, Random effects model, Confidence interval, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Stenosis, 0302 clinical medicine, Fibrosis, Meta-analysis, Internal medicine, embryonic structures, medicine, Cardiology, Late gadolinium enhancement, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business
Abstract: Objectives The aim of this systematic review was to explore the prognostic value of late gadolinium enhancement (LGE) in patients with aortic stenosis (AS). Background Myocardial fibrosis is a common feature of many cardiac diseases. Cardiac magnetic resonance (CMR) has the ability to noninvasively detect regional fibrosis by using the LGE technique. Several studies have explored whether LGE is associated with adverse outcome in patients with AS. Methods Electronic databases were searched to identify studies investigating the ability of LGE to predict all-cause mortality in patients with AS. A random effects model meta-analysis was conducted. Heterogeneity was assessed with the I2 statistic. Results Six studies comprising 1,151 patients met our inclusion criteria. LGE was present in 49.1% of patients with AS. In the pooled analysis, LGE was found to be a strong univariate predictor of all-cause mortality (pooled unadjusted odds ratio: 2.56; 95% confidence interval: 1.83 to 3.57; I2 = 0%). Four of the included studies reported adjusted hazard ratios for mortality. LGE was independently associated with mortality, even after adjusting for baseline characteristics (pooled adjusted hazard ratio: 2.50; 95% confidence interval: 1.64 to 3.83; I2 = 0%). Conclusions Fibrosis on LGE-CMR is a powerful predictor of all-cause mortality in patients with AS and may serve as a novel marker for risk stratification. Future studies should explore whether LGE-CMR can also be used to optimize timing of AS-related interventions.
Published: 2020
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11. Health status after invasive or conservative care in coronary and advanced kidney disease

Author: Spertus J. A., Jones P. G., Maron D. J., Mark D. B., O'Brien S. M., Fleg J. L., Reynolds H. R., Stone G. W., Sidhu M. S., Chaitman B. R., Chertow G. M., Hochman J. S., Bangalore S, ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic, Spertus J.A., Jones P.G., Maron D.J., Mark D.B., O'Brien S.M., Fleg J.L., Reynolds H.R., Stone G.W., Sidhu M.S., Chaitman B.R., Chertow G.M., Hochman J.S., Bangalore S, and ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic
Subjects: Male, Intention to Treat Analysi, medicine.medical_treatment, Health Status, Myocardial Ischemia, 030204 cardiovascular system & hematology, Coronary Angiography, law.invention, Health Statu, 0302 clinical medicine, Randomized controlled trial, law, Surveys and Questionnaires, Odds Ratio, Surveys and Questionnaire, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, medicine.diagnostic_test, General Medicine, Middle Aged, Intention to Treat Analysis, Cardiology, Female, Human, medicine.medical_specialty, Revascularization, Follow-Up Studie, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, cardiovascular diseases, Healthy Lifestyle, Renal Insufficiency, Chronic, Proportional Hazards Models, Aged, Intention-to-treat analysis, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Odds ratio, medicine.disease, Angiography, Exercise Test, Proportional Hazards Model, business, Kidney disease, Follow-Up Studies
Abstract: BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of
Published: 2020

12. Meta-Analysis of Transthoracic Echocardiography Versus Cardiac Magnetic Resonance for the Assessment of Aortic Regurgitation After Transcatheter Aortic Valve Implantation

Author: Saul G. Myerson, Mario J. Garcia, Christos A. Papanastasiou, Damianos G. Kokkinidis, Theodoros D. Karamitsos, Evangelos Oikonomou, Anil Kumar Jonnalagadda, and Polydoros N. Kampaktsis
Subjects: medicine.medical_specialty, Transcatheter aortic, Aortic Valve Insufficiency, Magnetic Resonance Imaging, Cine, Regurgitation (circulation), 030204 cardiovascular system & hematology, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Cohen's kappa, Internal medicine, medicine, Humans, 030212 general & internal medicine, medicine.diagnostic_test, Receiver operating characteristic, business.industry, Reproducibility of Results, Magnetic resonance imaging, Aortic Valve Stenosis, Confidence interval, body regions, Echocardiography, Meta-analysis, Cardiology, Cardiology and Cardiovascular Medicine, Cardiac magnetic resonance, business
Abstract: Residual aortic regurgitation (AR) is a major complication after transcatheter aortic valve implantation (TAVI). Although the echocardiographic assessment of post-TAVI AR remains challenging, cardiac magnetic resonance (CMR) allows direct quantification of AR. The aim of this study was to review the level of agreement between 2-dimensional transthoracic echocardiography (2D TTE) and CMR on grading the severity of AR after TAVI, and determine the accuracy of TTE in detecting moderate or severe AR. Electronic databases were searched in order to identify studies comparing 2D TTE to CMR for post-TAVI AR assessment. Kappa coefficient was used to determine the level of agreement between the 2 imaging modalities. CMR was used as the reference standard in order to assess the diagnostic accuracy of 2D TTE. Seven studies were included in this systematic review. Six studies reported a low correlation between 2D TTE and CMR (kappa coefficient ranging from -0.02 to 0.41), whereas one study showed good agreement with a kappa coefficient of 0.72. Given the heterogeneity in the included studies the diagnostic accuracy of TTE was evaluated by estimating the hierarchical summary receiver operator characteristic curve. The area under the curve for detection of moderate or severe AR with TTE was 0.83 (95% confidence interval 0.79 to 0.86). In conclusion, despite the reported significant disconcordance between TTE and CMR grading of AR, TTE has sufficient ability to discriminate moderate or severe AR from mild or none AR after TAVI in the clinical setting. CMR should be considered when TTE results are equivocal.
Published: 2019
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13. Oral anticoagulation after catheter ablation of atrial fibrillation and the associated risk of thromboembolic events and intracranial hemorrhage: A systematic review and meta‐analysis

Author: Mario J. Garcia, Roberto C. Cerrud-Rodriguez, Samiullah Arshad, Luis Cerna, Sangamitra Monhanty, Saul Rios, Andrea Natale, Isabella Alviz, Luigi Di Biase, Juan Carlos Diaz, Jorge Romero, and Daniel Rodriguez
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Administration, Oral, Catheter ablation, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Thromboembolism, Physiology (medical), Internal medicine, Atrial Fibrillation, Humans, Medicine, In patient, 030212 general & internal medicine, Oral anticoagulation, Aged, business.industry, Anticoagulants, Atrial fibrillation, Middle Aged, medicine.disease, Confidence interval, Treatment Outcome, Meta-analysis, Relative risk, Cohort, Catheter Ablation, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Intracranial Hemorrhages
Abstract: Aims We sought to examine whether continuing oral anticoagulation (OAC) after catheter ablation (CA) for atrial fibrillation (AF) is associated with improved outcomes. OAC reduces morbidity and mortality in patients with AF. However, the continuation of OAC following the blanking period of CA is controversial due to conflicting published data. Methods A systematic review of Medline, Cochrane, and Embase was performed for studies comparing patients who were continued on OAC (ON-OAC) vs those in which OAC was discontinued (OFF-OAC). CHA2 DS2 VASc score had to be available for the classification of patients into high- or low-risk cohorts (CHA2 DS2 VASc ≥ 2 and ≤ 1, respectively). The primary efficacy outcome was thromboembolic events (TE). Intracranial hemorrhage (ICH) was the primary safety outcome. Results Five studies comprising 3956 patients were included (mean age, 61.1 ± 2.9 years; 72.4% male, CHA2 DS2 VASc ≤ 1 50.1%; CHA2 DS2 VASc ≥ 2 49.9%). After a mean follow-up of 39.6 ± 11.7 months, OAC-continuation was associated with a significant decrease in risk of TE in the high-risk cohort (CHA2 DS2 VASc ≥ 2) (risk ratio [RR] 0.41, 95% confidence interval [CI] 0.21-0.82, P = .01) with a RR reduction of 59%. ICH was significantly higher in the ON-OAC group (RR, 5.78; 95% CI, 1.33-25.08; P = .02). No significant benefit was observed in the low-risk cohort ON-OAC after the blanking period. Conclusion Continuation of OAC after CA of AF with CHA2 DS2 VASc ≥ 2 is associated with a significant decreased TE risk and a favorable net clinical benefit in spite of ICH being significantly increased in the ON-OAC group. Continued OAC offers no benefit with CHA2 DS2 VASC ≤ 1.
Published: 2019
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14. Pericarditis constrictiva: multimodalidad

Author: Renato Quispe, Mario J. Garcia, and Pedro A. Villablanca
Subjects: Constrictive pericarditis, Gynecology, medicine.medical_specialty, business.industry, Cardiac catheterisation, 030204 cardiovascular system & hematology, medicine.disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Pericarditis, 0302 clinical medicine, RC666-701, medicine, Diseases of the circulatory (Cardiovascular) system, Cardiology and Cardiovascular Medicine, business
Abstract: Resumen: La pericarditis constrictiva es una entidad clínica que se manifiesta con signos y síntomas de insuficiencia cardiaca diastólica, causada por un pericardio anormalmente engrosado y rígido, o ambos, y disminución consecuente del llenado ventricular debido a menor distensibilidad. Dentro de las causas de pericarditis constrictiva está la inflamación por infección (viral, micobacterial o fúngica), enfermedades del tejido conectivo o cirugía cardiaca, entre otros. La ecocardiografía transtorácica de dos dimensiones (2 D) y el modo Doppler constituyen la primera herramienta diagnóstica en la evaluación de insuficiencia cardiaca y pueden identificar pericarditis constrictiva en la mayoría de pacientes mediante técnicas en movimiento real y hallazgos hemodinámicos. Asimismo, la tomografía computarizada y la resonancia magnética proveen información adicional para el diagnóstico y manejo de la pericarditis constrictiva, y son particularmente útiles cuando los hallazgos ecocardiográficos no son concluyentes. La evaluación hemodinámica por cateterismo cardíaco ocasionalmente puede aportar información adicional en casos en los que las imágenes no-invasivas demuestran hallazgos sugerentes o no concluyentes de pericarditis constrictiva. Abstract: Constrictive pericarditis is a clinical condition that demonstrates signs and symptoms of diastolic heart failure, caused by an abnormally enlarged and rigid pericardium, and a subsequent decrease in ventricular filling due to lower distensibility. Among the causes of constrictive pericarditis are the inflammation due to infection (viral, mycobacterial, or fungal), connective tissue diseases, or cardiac surgery. Two-dimensional (2-D) transthoracic ultrasound and in the Doppler mode is the main diagnostic tool in the evaluation of heart failure. It can also identify constrictive pericarditis in the majority of patients by means of real-time movement techniques and haemodynamic findings. Likewise, computed tomography and magnetic resonance provide additional information for the diagnosis and management of constrictive pericarditis, and are particularly useful when the cardiac ultrasound findings are inconclusive. The haemodynamic evaluation by cardiac catheterisation can occasionally provide additional information in cases in which the non-invasive images show suggestive of inconclusive findings of constrictive pericarditis. : Pericarditis constrictiva, Insuficiencia cardiaca diastólica, Cateterismo cardíaco, Keywords: Constrictive pericarditis, Diastolic heart failure, Cardiac catheterisation
Published: 2019
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15. Speckle-Tracking Echocardiography with Novel Imaging Technique of Higher Frame Rate

Author: Yun Xing, Cynthia C. Taub, Kana Fujikura, Muhammad Farooq, Mario J. Garcia, Wayne Humphrey, Mohammed Makkiya, and Mohammad Hashim Mustehsan
Subjects: Tachycardia, left ventricle, Speckle tracking echocardiography, 030204 cardiovascular system & hematology, Article, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Heart rate, medicine, echocardiography, Normal left ventricular systolic function, frame rate, business.industry, General Medicine, Frame rate, Temporal resolution, Myocardial strain, Medicine, Imaging technique, speckle-tracking, medicine.symptom, Nuclear medicine, business, global longitudinal strain
Abstract: Background: The accuracy of speckle-tracking echocardiography (STE) depends on temporal resolution. The goal of this study was to demonstrate the feasibility of relatively high frame rate (rHi-FR) (~200 fps) for STE. Methods: In this prospective study, echocardiographic images were acquired using clinical scanners on patients with normal left ventricular systolic function using rHi-FR and conventional frame rate (Reg-FR) (~50 FPS). GLS values were evaluated on apical 4-, 2- and 3-chamber images acquired in both rHi-FR and Reg-FR. Inter-observer and intra-observer variabilities were assessed in rHi-FR and Reg-FR. Results: There were 143 echocardiograms evaluated in this study. The frame rate of rHi-FR was 190 ± 25 and Reg-FR was 50 ± 3, and the heart rate was 71 ± 13. Absolute strain values measured in rHi-FR were significantly higher than those measured in Reg-FR (all p &lt, 0.001). Inter-observer and intra-observer correlations were strong in both rHi-FR and Reg-FR. Conclusions: We demonstrated that absolute strain values were significantly higher using rHi-FR when compared with Reg-FR. It is plausible that higher temporal resolution enabled the measurement of myocardial strain at desired time point. Further investigations are necessary to evaluate the value of rHi-FR to assess myocardial strain in the setting of tachycardia.
Published: 2021
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16. Speckle-Tracking Echocardiography With Novel High Frame-Rate Imaging

Author: Mohammed Makkiya, Humphrey W, Kana Fujikura, Mario J. Garcia, Mohammad Hashim Mustehsan, Muhammad Farooq, Cynthia C. Taub, and Xing Y
Subjects: Text mining, business.industry, Computer science, allergology, Computer vision, Speckle tracking echocardiography, Artificial intelligence, High frame rate, business, Frame rate
Abstract: Background: global longitudinal strain (GLS) measures myocardial deformation and is a sensitive modality for detecting subclinical myocardial dysfunction and predicting cardiac outcomes. The accuracy of speckle-tracking echocardiography (STE) is dependent on temporal resolution. A novel software enables relatively high frame rate (Hi-FR) (~200 fps) echocardiographic images acquisition which empowers us to investigate the impact of Hi-FR imaging on GLS analysis. The goal of this pilot study was to demonstrate the feasibility of Hi-FR for STE. Methods: In this prospective study, we acquired echocardiographic images using clinical scanners on patients with normal left ventricular systolic function using Hi-FR and conventional frame rate (Reg-FR) (~50 FPS). GLS values were evaluated on apical 4-, 2- and 3-chamber images acquired in both Hi-FR and Reg-FR. Inter-observer and intra-observer variabilities were assessed in Hi-FR and Reg-FR. Results: There were 143 resting echocardiograms with normal LVEF included in this study. The frame rate of Hi-FR was 190 ± 25 and Reg-FR was 50 ± 3, and the heart rate was 71 ± 13. Strain values measured in Hi-FR were significantly higher than those measured in Reg-FR (all p < 0.001). Inter-observer and intra-observer correlations were strong in both Hi-FR and Reg-FR. Conclusions: We demonstrated that strain values were significantly higher using Hi-FR when compared with Reg-FR in patients with normal LVEF. It is plausible that higher temporal resolution enabled the measurement of myocardial strain at desired time point. The result of this study may inform clinical adoption of the novel technology. Further investigations are necessary to evaluate the value of Hi-FR to assess myocardial strain in stress echocardiography in the setting of tachycardia.
Published: 2021
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17. HIV, HCV and risk of new-onset left ventricular dysfunction

Author: Jason M. Lazar, Mario J. Garcia, Kathryn Anastos, David B. Hanna, Phyllis C. Tien, Ryung S. Kim, Sanyog G. Shitole, Jorge R. Kizer, Robert C. Kaplan, and Joao A.C. Lima
Subjects: medicine.medical_specialty, business.industry, Immunology, Confounding, Diastole, virus diseases, Women's Interagency HIV Study, medicine.disease, New onset, Infectious Diseases, Risk Estimate, Increased risk, Lv dysfunction, Internal medicine, Coinfection, Immunology and Allergy, Medicine, business
Abstract: BACKGROUND HIV and HCV have each been linked with cardiac dysfunction. Studies of HIV have often lacked appropriate controls and primarily involved men, whereas data for HCV are sparse. METHODS We performed repeat echocardiography over a median interval of 12 years in participants from the Women's Interagency HIV Study in order to evaluate the relationships of HIV and HCV with incident left ventricular (LV) dysfunction (systolic or diastolic). RESULTS Of the 311 women included (age 39 ± 9), 70% were HIV-positive and 20% HCV-positive. Forty three participants (13.8%) developed LV dysfunction, of which 79.1% was diastolic. Compared with participants with neither infection, the group with HIV--HCV coinfection showed a significantly increased risk of incident LV dysfunction after adjustment for risk factors [RR = 2.96 (95% CI = 1.05-8.31)], but associations for the HCV monoinfected and HIV monoinfected groups were not statistically significant [RR = 2.54 (0.83-7.73) and RR = 1.66 (0.65-4.25), respectively]. Comparison of HCV-positive and HCV-negative women showed a significantly increased risk independent of covariates [RR = 1.96 (1.02-3.77)] but this was not the case for HIV-positive vs. HIV-negative women [RR = 1.43 (0.76-2.69)]. There was no evidence of HCV-by-HIV interaction. A more restrictive definition of LV diastolic dysfunction led to fewer incident cases, but a similar, though nonsignificant, risk estimate for HCV. CONCLUSION Among mostly middle-aged women, HCV but not HIV infection was associated with a pronounced risk of incident LV dysfunction. Although the influence of residual confounding cannot be excluded, these findings bolster the potential benefits that could be realized by adopting recent recommendations for expanding HCV screening and treatment.
Published: 2021
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18. Evidence of systemic endothelial injury and microthrombosis in hospitalized COVID-19 patients at different stages of the disease

Author: Mario J. Garcia, Isabella Alviz, Nicola Tarantino, Andrea Natale, Domenico G. Della Rocca, Cristina Chimenti, Luigi Di Biase, Giovanni B. Forleo, Jorge Romero, Carlo Lavalle, Michele Magnocavallo, and Maria T. Gamero
Subjects: Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Erythrocytes, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), MEDLINE, Disease, Article, Cohort Studies, Internal medicine, medicine, Humans, Aged, Inpatients, Hematology, business.industry, aged, COVID-19, cohort studies, endothelium, vascular, erythrocytes, female, humans, inpatients, male, middle aged, thrombosis, Thrombosis, Middle Aged, medicine.disease, Female, Endothelium, Vascular, business, Cardiology and Cardiovascular Medicine, Cohort study
Published: 2021

19. Statin Use and In‐Hospital Mortality in Patients With Diabetes Mellitus and COVID‐19

Author: Francesco Castagna, Omar Saeed, Chikezie Alvarez, Rachna Kataria, Snehal R. Patel, Yogita Rochlani, Mercedes Rivas-Lasarte, Ilir Agalliu, Ulrich P. Jorde, Daniel B. Sims, Sasa Vukelic, Mario J. Garcia, and Xiaonan Xue
Subjects: Male, medicine.medical_specialty, Time Factors, Statin, medicine.drug_class, New York, 030204 cardiovascular system & hematology, Single Center, Lower risk, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, COVID‐19, Interquartile range, Diabetes mellitus, Internal medicine, Diabetes Mellitus, medicine, Humans, Hospital Mortality, 030212 general & internal medicine, Preventive Cardiology, Survival analysis, Aged, Dyslipidemias, Retrospective Studies, Original Research, Aged, 80 and over, Inflammation, business.industry, Hazard ratio, statin, nutritional and metabolic diseases, COVID-19, Middle Aged, Protective Factors, Prognosis, medicine.disease, Primary Prevention, Propensity score matching, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Mortality/Survival, Cardiology and Cardiovascular Medicine, business, hospitalization
Abstract: Background Severe coronavirus disease 2019 (COVID‐19) is characterized by a proinflammatory state with high mortality. Statins have anti‐inflammatory effects and may attenuate the severity of COVID‐19. Methods and Results An observational study of all consecutive adult patients with COVID‐19 admitted to a single center located in Bronx, New York, was conducted from March 1, 2020, to May 2, 2020. Patients were grouped as those who did and those who did not receive a statin, and in‐hospital mortality was compared by competing events regression. In addition, propensity score matching and inverse probability treatment weighting were used in survival models to examine the association between statin use and death during hospitalization. A total of 4252 patients were admitted with COVID‐19. Diabetes mellitus modified the association between statin use and in‐hospital mortality. Patients with diabetes mellitus on a statin (n=983) were older (69±11 versus 67±14 years; P P P P =0.82). Propensity score matching (hazard ratio, 0.88; 95% CI, 0.83–0.94; P P Conclusions Statin use was associated with reduced in‐hospital mortality from COVID‐19 in patients with diabetes mellitus. These findings, if validated, may further reemphasize administration of statins to patients with diabetes mellitus during the COVID‐19 era.
Published: 2020
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20. Abstract 16489: Comparison of Severity of Illness at Presentation and Outcomes for Patients With Acute Cardiovascular Syndromes Before and During Covid-19 Pandemic

Author: Luigi DiBiase, Jose Wiley, Cristina Sanina, Mohamed Gabr, and Mario J. Garcia
Subjects: medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Executive order, business.industry, Psychological intervention, medicine.disease, Physiology (medical), Emergency medicine, Pandemic, Severity of illness, medicine, Presentation (obstetrics), Cardiology and Cardiovascular Medicine, business, Stroke
Abstract: Introduction: The New York Governor Andrew M. Cuomo’s executive order N202.25 on March 7, 2020, canceled all elective, semi-urgent procedures, including cardiovascular interventions such as coronary angiography and angioplasty due to SARS- Cov2 (COVID 19) pandemic. New York City was devastated by COVID 19 infection carrying the highest incidence, prevalence, and mortality rates in the US. Importantly, a 4. 4.83-fold increase in death rate at home was reported. We hypothesized that the COVID19 surge postponed the patient's decision to seek medical attention leading to an increase in cardiovascular-related hospital mortality. Methods: We conducted a retrospective observational study examining the incidence, prevalence, complication rate, and mortality from cardiovascular diseases in hospitalized patients during COVID 19 surge. We performed a patient chart review of a cohort with acute cardiovascular events (STEMI, NSTEMI, Stroke, CHF) during the COVID 19 surge who were hospitalized at Montefiore Medical Center between March 7, 2020, and April 21, 2020, and compared it to a similar cohort from the preceding year (March 7, 2019 and April 21, 2019). Results: During the dates (March 7- April 21, 2020), there was a significant decrease in NSTEMI, stroke, and CHF admissions (P Conclusions: Montefiore Medical Center admitted and treated significantly fewer patients with acute cardiovascular syndromes during the COVID19 surge. Non-COVID patients presented with delayed MI. All HF patients (COVID+Non-COVID) carried a significantly higher mortality rate.
Published: 2020
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21. Abstract 12964: Complete Revascularization of Stable Patients Presenting With STEMI is Associated With Decreased Cardiovascular Death and Reinfarction If Performed During Index Percutaneous Coronary Intervention, but Not If Complete Revascularization is Staged

Author: Azeem Latib, Syed Muhammad Ibrahim Rashid, Mario J. Garcia, Ioanna Katsa, and Roberto C. Cerrud-Rodriguez
Subjects: medicine.medical_specialty, Index (economics), business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Revascularization, behavioral disciplines and activities, Cardiovascular death, Physiology (medical), Internal medicine, Cardiology, Medicine, Cardiology and Cardiovascular Medicine, business
Abstract: Introduction: Recent evidence suggests that complete revascularization (CR) of stable patients presenting with STEMI improves outcomes, but the appropriate timing of said CR has not been clearly established (CR during index PCI [iCR] versus staged CR [sCR]). sCR is defined as CR within a mean of 31.5±24.6 days after the STEMI. Objective: To determine the appropriate timing of CR for it to be beneficial (iCR versus sCR). Methods: A systematic review of Medline, Cochrane, and Embase was performed for randomized control trials (RCTs) that reported outcomes of stable patients presenting with STEMI and whose culprit lesion received PCI, who were subsequently randomized into culprit-lesion only and CR cohorts. Only RCTs with at least a 12-month follow-up were included. The timing of CR, for the subdivision of CR cohort into iCR and sCR, had to be stated. Seven RCTs comprising 6647 patients (mean age: 62.9±1.4 years, male sex: 79.4%) met this criteria and were included. Results: After a mean follow-up of 25.1±9.4 months, iCR, when compared to a culprit-lesion only strategy, was associated with a significant cardiovascular mortality benefit (Risk Ratio [RR] 0.48 95% Confidence Interval [CI] 0.26-0.90 p=0.02, Relative Risk Reduction [RRR] 52%) and a significant decrease in reinfarctions (RR 0.42 95% CI 0.25-0.70 p=0.001 RRR: 58%). sCR showed no significant benefit for any of the studied outcomes when compared to a culprit-lesion only strategy. There was no significant difference in all-cause mortality or in the composite safety outcome of contrast-induced nephropathy nor stroke in either the iCR or the sCR groups when compared to the culprit-lesion only group. Conclusion: Complete revascularization during index PCI of stable patients presenting with STEMI, but not staged CR, is associated with a statistically significant decrease in cardiovascular death and non-fatal reinfarctions. There is no difference between groups in all-cause mortality or in the composite safety outcome.
Published: 2020
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22. Abstract 17334: Effects of Alcohol Consumption on Fiver-Year Change in Cardiac Structure and Function: In the Echocardiographic Study of Latinos

Author: Mayank M Kansal, Un Jung Lee, Carlos J. Rodriguez, Mario J. Garcia, Greg Talavera, Cristian Zamora, Robert C. Kaplan, and Barry E. Hurwitz
Subjects: medicine.medical_specialty, business.industry, Physiology (medical), Internal medicine, Cardiology, Medicine, Cardiac structure, Cardiology and Cardiovascular Medicine, business, Alcohol consumption
Abstract: Background: The relationship between alcohol consumption and clinical heart failure has been extensively studied. There have been little longitudinal data documenting alcohol effects on cardiac structure and function in a community-based population. Methods: The second Echocardiographic Study of Latinos (ECHO-SOL2) was designed to provide echocardiographic parameters that characterized longitudinal cardiac structure and function in a random and representative sample of 1,818 participants ≥45 years old. Participants underwent to serial echocardiograms at 2011-2014 (exam 1) and ~5-6 years later at 2016-2019 (exam 2). Quantification of alcohol was created on a gender-specific basis. Multiple linear regression models were adjusted for age and sex. Results: The mean age at enrollment was 56.4 years old, 57% were women. At baseline, impaired left ventricular (LV) systolic function and increased right ventricular (RV) function were associated with binge drinkers (P = 0.01). At 5-6 years later, heavy drinkers had a significant decrease in LV ejection fraction (P = 0.01). Moderate and binge drinkers demonstrated worsening diastolic function over time (P ≤ 0.01). Binge drinkers demonstrated a progressive decrease in LV mass index (P = 0.02), decrease in LV stroke volume (P = 0.01) and further reduction in RV function (P < 0.01). Conclusion: Alcohol consumption was associated with longitudinal changes in cardiac structure and function, mostly among binge drinkers, which can lead to impaired myocardial contractility compared to nondrinkers.
Published: 2020
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23. State of the Art: Imaging for Myocardial Viability: A Scientific Statement From the American Heart Association

Author: Robert O. Bonow, Parham Eshtehardi, Marielle Scherrer-Crosbie, Ron Blankstein, Mario J. Garcia, John P. Bois, Cynthia C. Taub, Raymond Y. Kwong, and Joao A.C. Lima
Subjects: Adult, Male, medicine.medical_specialty, Clinical Decision-Making, Myocardial Ischemia, Context (language use), Risk Assessment, Sudden cardiac death, Coronary artery disease, Necrosis, Myocardial perfusion imaging, Predictive Value of Tests, Risk Factors, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Myocardial infarction, Intensive care medicine, Aged, Tissue Survival, Myocardial stunning, Ischemic cardiomyopathy, medicine.diagnostic_test, business.industry, Myocardium, Reproducibility of Results, American Heart Association, Prognosis, medicine.disease, Fibrosis, United States, Cardiac Imaging Techniques, Heart failure, Female, Cardiology and Cardiovascular Medicine, business
Abstract: A substantial proportion of patients with acute myocardial infarction develop clinical heart failure, which remains a common and major healthcare burden. It has been shown that in patients with chronic coronary artery disease, ischemic episodes lead to a global pattern of cardiomyocyte remodeling and dedifferentiation, hallmarked by myolysis, glycogen accumulation, and alteration of structural proteins. These changes, in conjunction with an impaired global coronary reserve, may eventually become irreversible and result in ischemic cardiomyopathy. Moreover, noninvasive imaging of myocardial scar and hibernation can inform the risk of sudden cardiac death. Therefore, it would be intuitive that imaging of myocardial viability is an essential tool for the proper use of invasive treatment strategies and patient prognostication. However, this notion has been challenged by large-scale clinical trials demonstrating that, in the modern era of improved guideline-directed medical therapies, imaging of myocardial viability failed to deliver effective guidance of coronary bypass surgery to a reduction of adverse cardiac outcomes. In addition, current available imaging technologies in this regard are numerous, and they target diverse surrogates of structural or tissue substrates of myocardial viability. In this document, we examine these issues in the current clinical context, collect current evidence of imaging technology by modality, and inform future directions.
Published: 2020
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24. Determination of Sensitivity and Specificity of Electrocardiography for Left Ventricular Hypertrophy in a Large, Diverse Patient Population

Author: Andrew Krumerman, John D. Fisher, Ythan Goldberg, Mario J. Garcia, Alon Y. Mazori, Eric Shulman, Jay J. Chudow, Kevin J. Ferrick, Maxwell Bressman, and Luigi Di Biase
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Patient characteristics, 030204 cardiovascular system & hematology, Overweight, Left ventricular hypertrophy, Sensitivity and Specificity, Left ventricular mass, 03 medical and health sciences, Electrocardiography, Young Adult, 0302 clinical medicine, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Patient population, Echocardiography, Cohort, Cardiology, Female, Hypertrophy, Left Ventricular, medicine.symptom, business
Abstract: Background Electrocardiography (ECG) is poorly sensitive, but highly specific for the diagnosis of left ventricular hypertrophy. However, previous studies documenting this were small and lacked patient diversity. Furthermore, little is known about the impact of patient characteristics on the sensitivity and specificity of ECG for left ventricular hypertrophy. To address this issue, the present study was conducted to ascertain the sensitivity and specificity of ECG for left ventricular hypertrophy in a large, diverse patient population. Methods We performed a retrospective cohort study using ECG and echocardiography (ECHO) data from a large metropolitan health system. All patients had one ECG and ECHO on file, obtained within 1 week of each other. Sensitivity and specificity of ECG for left ventricular hypertrophy were determined by comparing results from the MUSE® 12-SL (GE Healthcare, Chicago, IL) computer-generated algorithm for ECG to ECHO left ventricular mass index. Subgroup analyses of individual patient characteristics were performed with corresponding chi-squared analyses to determine significance. Results A total of 13,960 subjects were included in the study. The typical subject was 60 years of age or older, female, overweight, and hypertensive, and demonstrated low socioeconomic status. The sensitivity and specificity of ECG for left ventricular hypertrophy in the overall cohort were 30.7% and 84.4%, respectively, with multiple patient characteristics influencing these results. Conclusions This is the first study to confirm the sensitivity and specificity of ECG for left ventricular hypertrophy in a large, diverse patient population with significant minority representation. Furthermore, although these statistical measures are influenced by patient characteristics, such differences are likely not clinically significant.
Published: 2020

25. Reduced global longitudinal strain is associated with increased risk of cardiovascular events or death after kidney transplant

Author: Ally B. Dinhofer, Hye Gi Shim, Kana Fujikura, Jorge R. Kizer, Sanyog G. Shitole, Bradley Peltzer, Mario J. Garcia, and Nidhish Tiwari
Subjects: Adult, Male, medicine.medical_specialty, Diastole, Disease, 030204 cardiovascular system & hematology, Article, Cohort Studies, Coronary artery disease, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Diabetes mellitus, Internal medicine, medicine, Humans, 030212 general & internal medicine, Retrospective Studies, business.industry, Medical record, Middle Aged, medicine.disease, Kidney Transplantation, Death, Transplantation, Cardiovascular Diseases, Heart failure, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract: Background Patients with chronic kidney disease are at increased risk of cardiovascular disease (CVD). Even after kidney transplant, the rate of CVD events and death remain elevated. Early detection of patients at risk would be helpful for guiding aggressive preventive therapy. The purpose of this study was to evaluate global longitudinal strain (GLS) as a predictor of CVD events and death after kidney transplant. Method Among patients with successful kidney transplant between 3/2009 and 12/2012 at our institution, 111 individuals had an echocardiogram within 6 months of the transplant. Medical records were evaluated for demographics and patient characteristics. Echocardiograms were analyzed for conventional measurements, and GLS was assessed using speckle-tracking analysis. Results The median age of the study sample was 54 years. Overall, 60% were men; 35% were non-Hispanic black, and 50% Hispanic. After a mean follow-up of 3.8 ± 0.5 years, there were 21 cardiovascular events or deaths. Patients who experienced an event were older, more frequently had a history of coronary artery disease, and had higher LV filling/longitudinal diastolic annular velocity (E/e') than those who did not. GLS was significantly associated with event-free survival even after adjusting for age, sex, race-ethnicity, hypertension, diabetes, history of coronary artery disease or heart failure, and E/e'. Conclusion Reduced GLS peri-transplant is significantly associated with increased CVD events or death after kidney transplant. Larger studies are required to determine the incremental predictive value of GLS over clinical and other echocardiographic parameters for adverse CVD events following renal transplantation.
Published: 2018
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26. Three-dimensional echocardiography demonstrates a skewered left ventricular thrombus in a patient with a heart transplant

Author: Mario J. Garcia, Sean Pinney, Benjamin Hirsh, Michael P. Gannon, Martin E. Goldman, Shahryar G. Saba, and Jonathan L. Halperin
Subjects: Heart Defects, Congenital, Male, 0301 basic medicine, medicine.medical_specialty, Heart Diseases, Heart Ventricles, medicine.medical_treatment, Echocardiography, Three-Dimensional, Magnetic Resonance Imaging, Cine, 03 medical and health sciences, Internal medicine, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Clinical significance, cardiovascular diseases, Thrombus, False tendon, Heart transplantation, business.industry, Ventricular wall, nutritional and metabolic diseases, Thrombosis, Three dimensional echocardiography, Middle Aged, Left ventricular thrombus, medicine.disease, 030104 developmental biology, Serial imaging, cardiovascular system, Cardiology, Heart Transplantation, Cardiology and Cardiovascular Medicine, business
Abstract: A left ventricular (LV) false tendon is a frequently visualized structure in echocardiography with unclear clinical significance. We present the case of a false tendon serving as a nidus for thrombus in a post-orthotopic heart transplantation patient. Three-dimensional transthoracic echocardiography (3DTTE) was utilized to visualize a LV mass and facilitate its identification as a thrombus as well as the surrounding structures. Using datasets from 3DTTE, the lack of ventricular wall attachment and circumferential formation of the thrombus around the false tendon was identified. Serial imaging demonstrated resolution of the thrombus with anticoagulation.
Published: 2018
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27. Starfish in the heart: Congenital anomaly of the papillary muscles

Author: Mario J. Garcia, Linda B. Haramati, Ali N. Zaidi, Jonathan R. Walker, Mohammed Makkiya, Pedro A. Villablanca, and Cynthia C. Taub
Subjects: medicine.medical_specialty, business.industry, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Internal medicine, Heart failure, Mitral valve, Cardiology, Medicine, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Chordae tendineae, Cardiology and Cardiovascular Medicine, business, Pediatric population
Abstract: Most common congenital anatomical abnormalities of the subvalvular apparatus (papillary muscles and chordae tendineae) are parachute or parachute like mitral valve. This is more commonly reported among the pediatric population as they develop heart failure symptoms shortly after birth. Reports of adult cases are rare and incidental. Multimodality imaging has an important role in evaluating such anatomical abnormalities, and identification of possible related complications. We are describing a rare atypical variant of parachute like mitral valve.
Published: 2018
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28. Coronary Computed Tomography Angiography Versus Stress Echocardiography in Acute Chest Pain

Author: Rikah Lerer, Samantha Selesny, Cynthia C. Taub, Mark Menegus, Durline Brown-Manhertz, Jeffrey M. Levsky, Sarah Mizrachi, Jonathan N. Tobin, Linda B. Haramati, Daniel M. Spevack, Terence Chen, Deborah White, and Mario J. Garcia
Subjects: medicine.medical_specialty, biology, business.industry, Emergency department, 030204 cardiovascular system & hematology, Chest pain, Triage, Troponin, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Interquartile range, law, Internal medicine, medicine, Clinical endpoint, biology.protein, Cardiology, Stress Echocardiography, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: Objectives This study sought to compare early emergency department (ED) use of coronary computed tomography angiography (CTA) and stress echocardiography (SE) head-to-head. Background Coronary CTA has been promoted as the early ED chest pain triage imaging method of choice, whereas SE is often overlooked in this setting and involves no ionizing radiation. Methods The authors randomized 400 consecutive low- to intermediate-risk ED acute chest pain patients without known coronary artery disease and a negative initial serum troponin level to immediate coronary CTA (n = 201) or SE (n = 199). The primary endpoint was hospitalization rate. Secondary endpoints were ED and hospital length of stay. Safety endpoints included cardiovascular events and radiation exposure. Results Mean patient age was 55 years, with 43% women and predominantly ethnic minorities (46% Hispanics, 32% African Americans). Thirty-nine coronary CTA patients (19%) and 22 SE patients (11%) were hospitalized at presentation (difference 8%; 95% confidence interval: 1% to 15%; p = 0.026). Median ED length of stay for discharged patients was 5.4 h (interquartile range [IQR]: 4.2 to 6.4 h) for coronary CTA and 4.7 h (IQR: 3.5 to 6.0 h) for SE (p Conclusions The use of SE resulted in the hospitalization of a smaller proportion of patients with a shorter length of stay than coronary CTA and was safe. SE should be considered an appropriate option for ED chest pain triage (Stress Echocardiography and Heart Computed Tomography [CT] Scan in Emergency Department Patients With Chest Pain; NCT01384448).
Published: 2018
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29. Clinical outcomes in patients with atrial fibrillation receiving amiodarone on NOACs vs. warfarin

Author: Andrea Natale, Andrew Krumerman, Renato Quispe, Anjani Golive, Jorge Romero, Florentino Lupercio, Ricardo Avendano, Juan Carlos Diaz, Mario J. Garcia, and Luigi Di Biase
Subjects: Male, medicine.medical_specialty, Administration, Oral, Amiodarone, 030204 cardiovascular system & hematology, Risk Assessment, Severity of Illness Index, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Thromboembolism, Physiology (medical), Internal medicine, Atrial Fibrillation, medicine, Humans, In patient, 030212 general & internal medicine, Stroke, Aged, Randomized Controlled Trials as Topic, business.industry, Warfarin, Atrial fibrillation, Middle Aged, Prognosis, medicine.disease, Confidence interval, Survival Rate, Treatment Outcome, Relative risk, Female, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents, medicine.drug
Abstract: Amiodarone is a potent inhibitor of the CYP450:3A4 and inhibitor of the P-glycoprotein, both of which metabolize new oral anticoagulants (NOACs). Patients who are on NOACs and are concomitantly treated with amiodarone may have a higher risk of major bleeding according to recent retrospective trials. Whether this increased risk outweighs the benefits of NOACs compared to warfarin is unknown. We aimed to compare clinical outcomes between NOACs and warfarin in patients with atrial fibrillation (AF) being treated with amiodarone. We performed a systematic review of MEDLINE, Cochrane, and Embase for randomized controlled trials that compared NOACs to warfarin for prophylaxis of ischemic stroke/thromboembolic events (TEs) in patients with AF and reported outcomes on TE, major bleeding, and intracranial bleeding (ICB). Risk ratio (RR) and 95% confidence intervals were measured using the Mantel-Haenszel method. Fixed effects model was used, and if heterogeneity (I2) was > 25%, effects were analyzed using a random model. A total of four studies comparing NOACs to warfarin were included in the analysis. The total number of patients on amiodarone was 6197. Mean follow up was 23 ± 5 months. No statistically significant difference for TE prevention (RR, 0.73; 95% CI 0.50–1.07), major bleeding (RR, 1.02; 95% CI 0.68–1.53), or ICB outcomes (RR, 0.58; 95% CI 0.22–1.51) between patients on NOACs + amiodarone when compared to patients on warfarin + amiodarone. Among patients with AF taking amiodarone, there is no increased risk of stroke, major bleeding, or ICB with NOACs compared to warfarin.
Published: 2018
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30. Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset

Author: Jean Pierre Laissy, Gianluca Pontone, Jörg Hausleiter, Juhani Knuuti, Lily Honoris, Mario J. Garcia, Hiroyuki Niinuma, Jonathan Leipsic, Harald Brodoefel, Daniele Andreini, Matthijs F.L. Meijs, R.R. Buechel, Eugenio Martuscelli, Jean-Claude Tardif, Lin Yang, Ashraf Hamdan, Thorsten R. C. Johnson, Robert Haase, Said Ghostine, Simone Muraglia, Peter Schlattmann, U. Joseph Schoepf, Shona M.M. Jenkins, Michael Laule, Koen Nieman, Philipp A. Kaufmann, Bjørn Arild Halvorsen, Carlos E. Rochitte, Robert Roehle, David A. Halon, Hans Mickley, Viktoria Wieske, Sebastian Leschka, Konstantin Nikolaou, Marc Dewey, David E. Bush, Axel Cosmus Pyndt Diederichsen, Abbas Arjmand Shabestari, Bernhard Gerber, Bjarne L. Nørgaard, Yung-Liang Wan, Arthur J.H.A. Scholte, Kristian A. Øvrehus, Johannes Rixe, Christoph Langer, John Hoe, Zhaoqi Zhang, Reda Jakamy, Benjamin J.W. Chow, Mehraj Sheikh, Hatem Alkadhi, Geir R. Ulimoen, Melvin E. Clouse, Pascal Gueret, Roy P. Marcus, Georg M. Schuetz, Albert de Roos, Narinder Paul, Akira Sato, Willem B. Meijboom, David Maintz, Vladimir Mendoza Rodriguez, Elke Zimmermann, Bernhard A. Herzog, Nuno Bettencourt, Kai Sun, Cardiology, Radiology & Nuclear Medicine, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, and UCL - (SLuc) Service de pathologie cardiovasculaire
Subjects: Adult, Male, medicine.medical_specialty, Chest Pain, education, Clinical Decision-Making, Nice, Mistake, Pretest probability, 030204 cardiovascular system & hematology, Chest pain, Coronary artery disease, Duke clinical score, Multidetector computed tomography, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, Medical physics, 030212 general & internal medicine, Recent onset, health care economics and organizations, computer.programming_language, Aged, Probability, business.industry, Chest Pain/diagnostic imaging, Published Erratum, General Medicine, Guideline, Middle Aged, humanities, Pre- and post-test probability, Cardiac Imaging Techniques, Practice Guidelines as Topic, NICE clinical guideline, Female, Radiology, Guideline Adherence, medicine.symptom, business, Tomography, X-Ray Computed, computer
Abstract: Objectives: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. Methods: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). Results: 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. Conclusions: Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. Key Points: • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.
Published: 2018
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31. Trends in Utilization of Surgical and Transcatheter Mitral Valve Repair in the United States⋆

Author: Tanush Gupta, Azeem Latib, Giora Weisz, Dhaval Kolte, Charanjit S. Rihal, Gregg C. Fonarow, J. Dawn Abbott, Mario J. Garcia, Kashish Goel, Deepak L. Bhatt, Sahil Khera, and Pedro A. Villablanca
Subjects: Aged, 80 and over, Heart Valve Prosthesis Implantation, Male, Cardiac Catheterization, medicine.medical_specialty, business.industry, Incidence, Incidence (epidemiology), MEDLINE, Mitral Valve Insufficiency, United States, Internal medicine, Cardiology, medicine, Humans, Mitral Valve, Female, Transcatheter mitral valve repair, Cardiology and Cardiovascular Medicine, business, Mitral valve surgery, Aged
Published: 2019
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32. Multimodality imaging: Bird’s eye view from The American College of Cardiology Annual Scientific Meeting 2017, Washington DC March 17 to 19, 2017

Author: Mario J. Garcia, Ron Blankstein, William A. Van Decker, and Steven G. Lloyd
Subjects: Gerontology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, Medicine, Radiology, Nuclear Medicine and imaging, Medical physics, 030212 general & internal medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Multimodality
Published: 2017
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33. Regional Variation in Utilization, In-hospital Mortality, and Health-Care Resource Use of Transcatheter Aortic Valve Implantation in the United States

Author: Ankur Kalra, Julio A. Panza, Deepak L. Bhatt, Michael J. Reardon, Wilbert S. Aronow, Sahil Khera, Cynthia C. Taub, David P. Slovut, Tanush Gupta, Kashish Goel, Anna E. Bortnick, Gregg C. Fonarow, Neal S. Kleiman, Dhaval Kolte, J. Dawn Abbott, Mario J. Garcia, Pedro A. Villablanca, and Charanjit S. Rihal
Subjects: Male, medicine.medical_specialty, Time Factors, Transcatheter aortic, 030204 cardiovascular system & hematology, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Health care, Humans, Medicine, Hospital Mortality, 030212 general & internal medicine, Hospital Costs, Retrospective Studies, Aged, 80 and over, Inpatients, In hospital mortality, business.industry, Aortic Valve Stenosis, Odds ratio, medicine.disease, Patient Discharge, United States, Surgery, Survival Rate, Regional variation, Aortic valve stenosis, Cardiology, Health Resources, Resource use, Female, Skilled Nursing Facility, Cardiology and Cardiovascular Medicine, business, Demography
Abstract: We queried the National Inpatient Sample database from 2012 to 2014 to identify all patients aged ≥18 years undergoing transcatheter aortic valve implantation (TAVI) in the United States. Regional differences in TAVI utilization, in-hospital mortality, and health-care resource use were analyzed. Of 41,025 TAVI procedures in the United States between 2012 and 2014, 10,390 were performed in the Northeast, 9,090 in the Midwest, 14,095 in the South, and 7,450 in the West. Overall, the number of TAVI implants per million adults increased from 24.8 in 2012 to 63.2 in 2014. The utilization of TAVI increased during the study period in all 4 geographic regions, with the number of implants per million adults being highest in the Northeast, followed by the Midwest, South, and West, respectively. Overall in-hospital mortality was 4.2%. Compared with the Northeast, risk-adjusted in-hospital mortality was higher in the Midwest (adjusted odds ratio [aOR] 1.26 [1.07 to 1.48]) and the South (aOR 1.61 [1.40 to 1.85]) and similar in the West (aOR 1.00 [0.84 to 1.18]). Average length of stay was shorter in all other regions compared with the Northeast. Among patients surviving to discharge, disposition to a skilled nursing facility or home health care was most common in the Northeast, whereas home discharge was most common in the West. Average hospital costs were highest in the West. In conclusion, we observed significant regional differences in TAVI utilization, in-hospital mortality, and health-care resource use in the United States. The findings of our study may have important policy implications and should provide an impetus to understand the source of this regional variation.
Published: 2017
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34. Direct Xa inhibitors in addition to antiplatelet therapy in acute coronary syndrome

Author: Robert Pyo, David F. Briceño, David R. Holmes, Mark Menegus, Farouk Mookadam, Tanush Gupta, Jorge R. Kizer, Faraj Kargoli, Harish Ramakrishna, Mario J. Garcia, Divyanshu Mohananey, Anna E. Bortnick, Jose Wiley, Pedro A. Villablanca, and Iván Núñez Gil Md
Subjects: medicine.medical_specialty, Acute coronary syndrome, medicine.medical_treatment, Myocardial Infarction, Hemorrhage, 030204 cardiovascular system & hematology, Risk Assessment, law.invention, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Coronary thrombosis, Randomized controlled trial, Risk Factors, law, Internal medicine, Odds Ratio, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, Aged, Randomized Controlled Trials as Topic, Chi-Square Distribution, business.industry, Coronary Thrombosis, Percutaneous coronary intervention, General Medicine, Odds ratio, Middle Aged, medicine.disease, Treatment Outcome, Linear Models, Number needed to treat, Platelet aggregation inhibitor, Stents, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, Factor Xa Inhibitors
Abstract: Objective We carried out a meta-analysis summarizing the efficacy and safety of direct factor Xa inhibitor (DXI) in patients receiving guideline-based antiplatelet therapy (GBAT) after an acute coronary syndrome. Background Randomized-controlled trials have shown that the addition of a DXI to GBAT after acute coronary syndrome can reduce ischemic events, the trade-off being an increase in major bleeding complications. Methods PubMed, Central, Embase, The Cochrane Register, Google Scholar databases, and the scientific session abstracts were searched for eligible randomized trials from 1 January 1990 through 31 December 2016. Results Nine randomized-controlled trials were included in this meta-analysis enrolling a total of 45651 patients. There was a significant reduction in major adverse cardiovascular events with DXIs/GBAT compared with GBAT alone [odds ratio (OR): 0.88; 95% confidence interval (CI): 0.82-0.94, number needed to treat=52]. There were also significant reductions in two individual components of major adverse cardiovascular events: myocardial infarction (OR: 0.89; 95% CI: 0.81-0.98) and stent thrombosis (OR: 0.73; 95% CI: 0.59-0.90), favoring the DXI/GBAT group. There was an increased risk of major bleeding (OR: 2.51; 95% CI: 1.82-3.46) and intracranial hemorrhage (OR: 3.47; 95% CI: 1.76-6.86) compared with GBAT. Conclusion In acute coronary syndromes, the addition of a DXI to GBAT results in a significant reduction of major adverse cardiovascular events, myocardial infarction, and stent thrombosis, offset by an increased risk of bleeding.
Published: 2017
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35. Association of Obesity With In-Hospital Mortality of Cardiogenic Shock Complicating Acute Myocardial Infarction

Author: Dhaval Kolte, Gregg C. Fonarow, Tanush Gupta, Anusha Shanbhag, Kavisha Patel, Nikhil Meena, Pedro A. Villablanca, Mark Menegus, Kshitij Chatterjee, Sahil Khera, Wilbert S. Aronow, Deepak L. Bhatt, Abhinav Goyal, Nayan Agarwal, and Mario J. Garcia
Subjects: Male, medicine.medical_specialty, Myocardial Infarction, Shock, Cardiogenic, 030204 cardiovascular system & hematology, Coronary Angiography, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Odds Ratio, medicine, Humans, Hospital Mortality, Obesity, Registries, 030212 general & internal medicine, Myocardial infarction, Aged, Retrospective Studies, business.industry, Incidence, ST elevation, Cardiogenic shock, Retrospective cohort study, Odds ratio, Middle Aged, medicine.disease, United States, Survival Rate, Shock (circulatory), Cardiology, Myocardial infarction complications, Female, Myocardial infarction diagnosis, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: Several previous studies have shown obesity to be counterintuitively associated with more favorable mortality in patients with acute myocardial infarction (AMI); however, the association of obesity with in-hospital mortality of cardiogenic shock complicating AMI has not been previously examined. We queried the 2004 to 2013 National Inpatient Sample databases to identify all patients ≥18 years hospitalized with the principal diagnosis of AMI. Multivariable regression models adjusting for demographics, hospital characteristics, and co-morbidities were used to examine differences in incidence and in-hospital mortality of cardiogenic shock complicating AMI between obese and nonobese patients. Of 6,097,817 patients with AMI, 290,894 (4.8%) had cardiogenic shock. There was no difference in risk-adjusted incidence of cardiogenic shock between obese and nonobese patients (adjusted odds ratio 1.00, 95% CI 0.98 to 1.01; p = 0.46). Of the patients with cardiogenic shock complicating AMI, 8.9% had a documented diagnosis of obesity. Obese patients were on average 6 years younger and had higher prevalence of most cardiovascular co-morbidities. Obese patients were more likely to receive revascularization (73.0% vs 63.4%, p
Published: 2017
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36. Comparison Between Anatomical and Functional Imaging Modalities for Evaluation of Chest Pain in the Emergency Department

Author: Anjani Golive, Faraj Kargoli, Cynthia C. Taub, Durline Brown-Manhertz, Mohammed Makkiya, Linda B. Haramati, Nurilign Bulcha, Mario J. Garcia, Dalvert Polanco, Jeffrey M. Levsky, Mohammad Hashim Mustehsan, Sarah Mizrachi, and Andrea Furlani
Subjects: Male, medicine.medical_specialty, Chest Pain, Computed Tomography Angiography, 030204 cardiovascular system & hematology, Chest pain, Coronary Angiography, 03 medical and health sciences, Myocardial perfusion imaging, Electrocardiography, 0302 clinical medicine, Internal medicine, Stress Echocardiography, Medicine, Humans, 030212 general & internal medicine, Computed tomography angiography, Retrospective Studies, medicine.diagnostic_test, business.industry, Myocardial Perfusion Imaging, Retrospective cohort study, Emergency department, Length of Stay, Middle Aged, Functional imaging, Cardiology, Female, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Emergency Service, Hospital, Echocardiography, Stress
Abstract: Evaluation of chest pain in the emergency department (ED) frequently employs a noninvasive strategy, including coronary computed tomography angiography (CCTA), stress echocardiography (SE), or myocardial perfusion imaging (MPI). We sought to report the real-world experience of utilizing CCTA compared with SE and MPI at an urban hospital ED. We conducted a retrospective cohort study of consecutively enrolled patients presenting with chest pain who had normal or nondiagnostic electrocardiogram (ECG), negative initial troponin-T, at least intermediate risk based on modified Diamond-Forrester criteria, and who underwent CCTA, SE, or MPI based on their individual test eligibility criteria. The primary outcome was ED discharge time. Secondary outcomes included test utilization and 30-days rehospitalization rates. The 2,143 patients who were included (mean age was 56 ± 12 years; 55% women) utilization rate (test performed/eligible) was lower for CCTA (n = 354/1,329) and MPI (n = 530/1,435) compared with SE (n = 1,259/1,650), p0.001. Mean ED discharge times for both CCTA and SE were 12.5 ± 7.4 versus 16 ± 7.3 hours for MPI (p0.0001). Patients with SE and CCTA were less likely to undergo coronary angiography (29%, 25%, vs 52% for MPI). There was a 1% cardiac-related 30-days rehospitalization rate in the CCTA group versus 1% in SE and 3% in the MPI group (p0.01). In conclusion, CCTA and SE were associated with faster ED discharge and lower frequency of diagnostic coronary angiography. Notwithstanding its clinical utility, CCTA was underutilized at our large urban ED setting.
Published: 2019

37. Comparison of Incidence and Outcomes of Cardiogenic Shock Complicating Posterior (Inferior) Versus Anterior ST-Elevation Myocardial Infarction

Author: Dhaval Kolte, Michael Weinreich, Anna E. Bortnick, Mark Menegus, Mario J. Garcia, Pedro A. Villablanca, Deepak L. Bhatt, Jose Wiley, Azeem Latib, Giora Weisz, Sahil Khera, Tanush Gupta, and Ajay J. Kirtane
Subjects: Male, medicine.medical_specialty, Percutaneous, Time Factors, medicine.medical_treatment, Shock, Cardiogenic, 030204 cardiovascular system & hematology, Revascularization, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Myocardial Revascularization, Humans, 030212 general & internal medicine, Myocardial infarction, Hospital Mortality, Registries, Anterior Wall Myocardial Infarction, Aged, Retrospective Studies, business.industry, Cardiogenic shock, Incidence (epidemiology), Incidence, Percutaneous coronary intervention, medicine.disease, Confidence interval, United States, Concomitant, Cardiology, ST Elevation Myocardial Infarction, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Cardiogenic shock (CS) is a catastrophic consequence of ST-elevation myocardial infarction (STEMI). CS has been reported to be associated less often with inferior wall (IWMI) than anterior wall STEMI (AWMI). We queried the National Inpatient Sample databases from January 2010 to September 2015 to identify all patients aged ≥18 years admitted with AWMI or IWMI. Patients with a concomitant diagnosis of CS were then identified. Complex samples multivariable logistic regression models were used to compare the incidence, management, and in-hospital mortality of CS complicating IWMI versus AWMI. The incidence of CS was lower in IWMI (9.5%) versus AWMI (14.1%), adjusted OR (aOR) 0.84 (95% confidence interval [CI] 0.81 to 0.87). Revascularization rates with either percutaneous coronary intervention or coronary artery bypass grafting were similar in CS complicating IWMI versus AWMI (80.9% vs 80.3%; aOR 1.05; 95% CI 0.97 to 1.14). The reported use of percutaneous mechanical circulatory support devices was lower in patients with CS-IWMI versus CS-AWMI (44.7% vs 61.0%; aOR 0.55; 95% CI 0.52 to 0.59). In-hospital mortality was modestly lower in patients with CS complicating IWMI versus AWMI (30.3% vs 31.9%; aOR, 0.80; 95% CI 0.75 to 0.86). Use of percutaneous mechanical circulatory support was not associated with lower in-hospital mortality in either CS-AWMI (30.0% vs 34.7; aOR 1.04; 95% CI 0.94 to 1.14) or CS-IWMI (31.0% vs 29.8%; aOR 1.20; 95% CI 1.08 to 1.33). In conclusion, the incidence of CS in the contemporary era is lower in patients with IWMI compared with those with AWMI. CS complicating STEMI is associated with higher in-hospital mortality in AWMI versus IWMI, and outcomes were not different with or without percutaneous circulatory support.
Published: 2019

38. Therapeutic management of hyperlipoproteinemia (a)

Author: Eliscer Guzman, Constantine E Kosmas, Andreas Sourlas, Delia Silverio, Gordon Mallarkey, Domingo Y Ynoa, Mario J. Garcia, and Peter D Montan
Subjects: Oncology, cardiovascular risk, medicine.medical_specialty, Disease, Review, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, cardiovascular disease, Internal medicine, medicine, 030212 general & internal medicine, hyperlipoproteinemia (a), Risk factor, Cause of death, Pharmacology, Aspirin, biology, business.industry, PCSK9, lcsh:RM1-950, lipoprotein (a), nutritional and metabolic diseases, General Medicine, Lipoprotein(a), therapeutic management, Clinical trial, lcsh:Therapeutics. Pharmacology, biology.protein, Molecular Medicine, business, Niacin, medicine.drug
Abstract: Cardiovascular disease (CVD) has consistently been the leading cause of death worldwide. Several clinical and epidemiological studies have demonstrated that an elevated plasma concentration of lipoprotein (a) [Lp(a)] is a causative and independent major risk factor for the development of CVD, as well as calcific aortic valve stenosis. Thus, the therapeutic management of hyperlipoproteinemia (a) has received much attention, as significant reductions in Lp(a) levels may, potentially, favorably affect cardiovascular risk. Aspirin, niacin, estrogens, and statins, which act on different molecular pathways, may be prescribed to patients with mild or modest elevations of Lp(a) levels. Other therapeutic interventions, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, Lp(a) apheresis, and the novel antisense oligonucleotides APO(a)-Rx and APO(a)-LRx, which are being evaluated in ongoing clinical trials, have provided some promising results and can potentially be used in severe cases of hyperlipoproteinemia (a). This review aims to present and discuss the current clinical and scientific data pertaining to the therapeutic options for the management of hyperlipoproteinemia (a).
Published: 2019

39. The changing landscape of aortic valve replacement in the USA

Author: Tanush, Gupta, Dhaval, Kolte, Sahil, Khera, Kashish, Goel, Pedro A, Villablanca, Ankur, Kalra, J Dawn, Abbott, Sammy, Elmariah, Gregg C, Fonarow, Charanjit S, Rihal, Mario J, Garcia, Giora, Weisz, Deepak L, Bhatt, and Poonam, Velagapudi
Subjects: Aortic valve, Adult, Male, medicine.medical_specialty, Adolescent, Treatment outcome, 030204 cardiovascular system & hematology, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Aortic valve replacement, Age groups, Risk Factors, Internal medicine, Medicine, Humans, In patient, 030212 general & internal medicine, National data, Aged, Aged, 80 and over, Absolute number, business.industry, Aortic Valve Stenosis, medicine.disease, United States, medicine.anatomical_structure, Treatment Outcome, Aortic valve stenosis, Aortic Valve, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: AIMS The aim of this study was to analyse the real-world national data on parallel utilisation of transcatheter (TAVR) and surgical (SAVR) aortic valve replacement. METHODS AND RESULTS We queried an all-payer, administrative United States in-patient database to identify all AVR hospitalisations in patients aged ≥18 years from January 2012 to December 2016 and examined the temporal changes in the number of AVR procedures and in-hospital mortality. A total of 463,675 AVRs were performed - 363,275 (78.4%) SAVR and 100,400 (21.6%) TAVR. AVR linearly increased (from 78,985 in 2012 to 103,415 in 2016; +30.9%; ptrend
Published: 2019

40. 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee

Author: Susan E. Wiegers, Thomas Ryan, James A. Arrighi, Samuel M. Brown, Barry Canaday, Julie B. Damp, Jose L. Diaz-Gomez, Vincent M. Figueredo, Mario J. Garcia, Linda D. Gillam, Brian P. Griffin, James N. Kirkpatrick, Kyle W. Klarich, George K. Lui, Scott Maffett, Tasneem Z. Naqvi, Amit R. Patel, Marie-France Poulin, Geoffrey A. Rose, Madhav Swaminathan, Lisa A. Mendes, Jesse E. Adams, John E. Brush, G. William Dec, Ali Denktas, Susan Fernandes, Rosario Freeman, Rebecca T. Hahn, Jonathan L. Halperin, Susan D. Housholder-Hughes, Sadiya S. Khan, C. Huie Lin, Joseph E. Marine, John A. McPherson, Khusrow Niazi, Michael A. Solomon, Robert L. Spicer, Marty Tam, Andrew Wang, Gaby Weissman, Howard H. Weitz, and Eric S. Williams
Subjects: Medical education, Consensus, business.industry, Statement (logic), Cardiology, United States, Echocardiography, Education, Medical, Graduate, Specialty Boards, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Education, Medical, Continuing, Level iii, Clinical Competence, Curriculum, Educational Measurement, Clinical competence, Fellowships and Scholarships, Cardiology and Cardiovascular Medicine, business, Fellowship training, Societies, Medical
Published: 2019

41. 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee

Author: Jose L. Diaz-Gomez, Vincent M. Figueredo, Julie B. Damp, Marie-France Poulin, Madhav Swaminathan, Brian P. Griffin, Geoffrey A. Rose, Tasneem Z. Naqvi, Mario J. Garcia, Barry Canaday, Kyle W. Klarich, Scott Maffett, George K. Lui, Susan E. Wiegers, Samuel M. Brown, James N. Kirkpatrick, James A. Arrighi, T.P. Ryan, Amit R. Patel, and Linda D. Gillam
Subjects: medicine.medical_specialty, Consensus, Statement (logic), Library science, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Cardiologists, 0302 clinical medicine, Predictive Value of Tests, Humans, Medicine, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Fellowship training, business.industry, General Medicine, Cardiovascular Diseases, Echocardiography, Education, Medical, Graduate, Family medicine, Clinical Competence, Curriculum, Level iii, Clinical competence, Cardiology and Cardiovascular Medicine, business
Abstract: James A. Arrighi, MD, FACC, Chair Lisa A. Mendes, MD, FACC, Co-Chair Jesse E. Adams III, MD, FACC John E. Brush Jr, MD, FACC[#][1] G. William Dec Jr, MD, FACC Ali Denktas, MD, FACC Susan Fernandes, LPD, PA-C Rosario Freeman, MD, MS, FACC[#][1] Rebecca T. Hahn, MD, FACC Jonathan L.
Published: 2019
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42. Imaging Integration to Localize and Protect the Left Coronary Artery in Patients Undergoing LAAEI

Author: Dhanunjaya Lakkireddy, Luis Cerna, Andrea Natale, Mario J. Garcia, Jorge Romero, Juan Carlos Diaz, Isabella Alviz, Saul Rios, Luigi Di Biase, Nestor Lopez Cabanillas, Vito Grupposo, and Elizabeth Chernobelsky
Subjects: Male, medicine.medical_specialty, Radiofrequency ablation, medicine.medical_treatment, Catheter ablation, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Left coronary artery, law, Internal medicine, medicine.artery, Atrial Fibrillation, medicine, Humans, Atrial Appendage, 030212 general & internal medicine, Aged, Retrospective Studies, business.industry, Atrial fibrillation, Middle Aged, Vascular System Injuries, medicine.disease, Ablation, Coronary Vessels, Coronary arteries, Ostium, Cardiac Imaging Techniques, medicine.anatomical_structure, Surgery, Computer-Assisted, cardiovascular system, Cardiology, Catheter Ablation, Female, business, Tomography, X-Ray Computed, Artery
Abstract: Objectives This study sought to determine the distance between the anterior wall of the left atrial appendage (LAA) ostium to the left main coronary artery (LMCA) and the left circumflex artery (LCx) in patients undergoing left atrial appendage electrical isolation (LAAEI). Background LAAEI improves outcomes in nonparoxysmal atrial fibrillation ablation. There is a potential risk of damaging the LMCA and the LCx during LAAEI. Methods Patients undergoing LAAEI during the period between January 1, 2017 and October 31, 2018, were included in this study. Patients underwent cardiac computed tomography prior to ablation. The position of the LAA was analyzed. The closest distances between the LMCA, its bifurcation, LCx, and the anterior wall of the LAA ostium were measured. Additionally, imaging integration was performed to localize these vessels and catheter ablation was performed at least 5 mm away. Results A total of 74 patients (mean age: 68 ± 9.5 years; male 54%) who underwent LAAEI were included. The mean distance from the anterior wall of the LAA ostium to the LMCA was 7.88 ± 2.8 mm, to the LMCA bifurcation was 9.24 ± 4.40 mm, and to the LCx was 10.03 ± 4.56 mm. The LCx artery was found along the LAA ostium in 98% of the cases, whereas the LMCA was found in only 48.6%. No coronary damage or vasospasm was observed after performing LAAEI. Conclusions A detailed imaging integration with cardiac computed tomography, electroanatomic mapping, and CARTOSOUND reconstructions to accurately define the anatomical relationship between the LMCA and LCx and the anterior edge of the LAA ostium should be performed prior to delivering radiofrequency energy during LAAEI. When the distance on cardiac computed tomography between the LAA ostium and left coronary arteries is >10 mm, intraprocedural localization of these vessels may be not necessary.
Published: 2019

43. Significant Benefit of Uninterrupted DOACs Versus VKA During Catheter Ablation of Atrial Fibrillation

Author: Isabella Alviz, Jose Taveras, Mario J. Garcia, Luis Cerna, Samiullah Arshad, Andrea Natale, Juan Carlos Diaz, Luigi Di Biase, Daniel Rodriguez, Jorge Romero, Roberto C. Cerrud-Rodriguez, and Vito Grupposo
Subjects: Male, medicine.medical_specialty, Vitamin K, medicine.medical_treatment, Administration, Oral, Catheter ablation, Hemorrhage, 030204 cardiovascular system & hematology, Lower risk, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Thromboembolism, Atrial Fibrillation, medicine, Humans, 030212 general & internal medicine, Aged, Randomized Controlled Trials as Topic, business.industry, Cerebral infarction, Warfarin, Anticoagulants, Atrial fibrillation, Middle Aged, medicine.disease, Confidence interval, Stroke, Relative risk, Cardiology, Catheter Ablation, Female, business, medicine.drug
Abstract: Objectives This study assessed the incremental benefit of uninterrupted direct oral anticoagulants (DOACs) versus uninterrupted vitamin K antagonists (VKAs) for catheter ablation (CA) of nonvalvular atrial fibrillation (NVAF) on 3 primary outcomes: major bleeding events (MBEs), minor bleeding events, and thromboembolic events (TEs). The secondary outcome was post-procedural silent cerebral infarction (SCI) as detected by brain cardiac magnetic resonance. Background As a class, evidence of the benefits of DOACs versus VKAs during CA of AF is scant. Methods A systematic review of Medline, Cochrane, and Embase was done to find all randomized controlled trials in which uninterrupted DOACs were compared against uninterrupted VKAs for CA of NVAF. A fixed-effect model was used, except when I2 was ≥25, in which case, a random effects model was used. Results The benefit of uninterrupted DOACs over VKAs was analyzed from 6 randomized control trials that enrolled a total of 2,256 patients (male: 72.7%) with NVAF, finding significant benefit in MBEs (relative risk [RR]: 0.45; 95% confidence interval [CI]: 0.20 to 0.99; p = 0.05). No significant differences were found in minor bleeding events (RR: 1.12; 95% CI: 0.87 to 1.43; p = 0.39), TEs (RR: 0.75; 95% CI: 0.26 to 2.14; p = 0.59), or post-procedural SCI (RR: 1.09; 95% CI: 0.80 to 1.49; p = 0.58). Conclusions An uninterrupted DOACs strategy for CA of AF appears to be safer than uninterrupted VKAs with a decreased rate of major bleeding events. There are no significant differences among the other outcomes. DOACs should be offered as a first-line therapy to patients undergoing CA of AF, due to their lower risk of major bleeding events, ease of use, and fewer interactions.
Published: 2019

44. Prevalence of Unexplained Left Ventricular Hypertrophy by Cardiac Magnetic Resonance Imaging in MESA

Author: Robyn L. McClelland, David S. Owens, Kihei Yoneyama, Jorge R. Kizer, Mario J. Garcia, Antoinette S. Gomes, W. Gregory Hundley, Bharath Ambale-Venkatesh, David A. Bluemke, Mark V. Sherrid, Daniele Massera, Joao A.C. Lima, and Nadine Kawel-Boehm
Subjects: Male, medicine.medical_specialty, Cardiomyopathy, Epidemiology, Population, Magnetic Resonance Imaging (MRI), Cardiac-Gated Imaging Techniques, 030204 cardiovascular system & hematology, Left ventricular hypertrophy, Muscle hypertrophy, Imaging, Cohort Studies, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Cardiac magnetic resonance imaging, Internal medicine, Prevalence, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, education, Aged, Original Research, 2. Zero hunger, education.field_of_study, medicine.diagnostic_test, business.industry, Hypertrophic cardiomyopathy, Magnetic resonance imaging, Hypertrophy, Cardiomyopathy, Hypertrophic, Middle Aged, medicine.disease, hypertrophic cardiomyopathy, Magnetic Resonance Imaging, United States, 3. Good health, Population based study, Cardiology, Female, Hypertrophy, Left Ventricular, Cardiology and Cardiovascular Medicine, business, Wall thickness, population‐based study
Abstract: Background Hypertrophic cardiomyopathy is defined as unexplained left ventricular ( LV ) hypertrophy (wall thickness ≥15 mm) and is prevalent in 0.2% of adults (1:500) in population‐based studies using echocardiography. Cardiac magnetic resonance imaging ( MRI ) allows for more accurate wall thickness measurement across the entire ventricle than echocardiography. The prevalence of unexplained LV hypertrophy by cardiac MRI is unknown. MESA (Multi‐Ethnic Study of Atherosclerosis) recruited individuals without overt cardiovascular disease 45 to 84 years of age. Methods and Results We studied 4972 individuals who underwent measurement of regional LV wall thickness by cardiac MRI as part of the MESA baseline exam. American Heart Association criteria were used to define LV segments. We excluded participants with hypertension, LV dilation (≥95% predicted end‐diastolic volume) or dysfunction (ejection fraction ≤50%), moderate‐to‐severe left‐sided valve lesions by cardiac MRI , severe aortic valve calcification by cardiac computed tomography (aortic valve Agatston calcium score >1200 in women or >2000 in men), obesity (body mass index >35 kg/m 2 ), diabetes mellitus, and current smoking. Sixty‐seven participants (aged 64±10 years, 9% female) had unexplained LV hypertrophy (wall thickness ≥15 mm in at least 2 adjacent LV segments), representing 1.4% (1 in 74) participants, 2.6% of men and 0.2% of women. Prevalence was similar across categories of race/ethnicity. Hypertrophy was focal in 17 (25.4%), intermediate in 44 (65.7%), and diffuse in 5 (7.5%) participants. Conclusions The prevalence of unexplained LV hypertrophy in a population‐based cohort using cardiac MRI was 1.4%. This may have implications for the diagnosis of patients with hypertrophic cardiomyopathy and will require further study.
Published: 2019

45. Image-based Risk Stratification for Stroke in Atrial Fibrillation

Author: Jorge Romero, Sanghamitra Mohanty, Mario J. Garcia, Andrea Natale, Luigi Di Biase, Carola Gianni, and David Briceno
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, Anticoagulation management, Atrial fibrillation, Transesophageal echocardiogram, medicine.disease, Internal medicine, Risk stratification, medicine, Cardiology, business, Stroke, Image based
Published: 2019
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46. Right Ventricular Strain

Author: Andrea Furlani and Mario J. Garcia
Subjects: medicine.medical_specialty, business.industry, Strain (injury), medicine.disease, Tricuspid Valve Insufficiency, Internal medicine, Heart failure, Rv function, Cardiology, medicine, Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine, business, Cardiac imaging, Valve disease
Published: 2019
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47. Culprit-lesion only versus complete multivessel percutaneous intervention in ST-elevation myocardial infarction: A systematic review and meta-analysis of randomized trials

Author: David F. Briceno, Michela Faggioni, Mario J. Garcia, Jose Wiley, Marissa Lombardo, George Dangas, Pedro A. Villablanca, Robert Pyo, Ota Hlinomaz, Harish Ramakrishna, Anna E. Bortnick, Mark Menegus, Farouk Mookadam, and Daniele Massera
Subjects: medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Revascularization, Severity of Illness Index, law.invention, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Myocardial Revascularization, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Randomized Controlled Trials as Topic, business.industry, Patient Selection, Percutaneous coronary intervention, medicine.disease, Coronary Vessels, Treatment Outcome, Conventional PCI, Cardiology, Number needed to treat, ST Elevation Myocardial Infarction, Cardiology and Cardiovascular Medicine, business, Mace
Abstract: Background ST-segment elevation myocardial infarction (STEMI) in patients with concomitant multivessel (MV) coronary artery disease (CAD) is associated with poor outcomes. Percutaneous coronary intervention (PCI) of the culprit-lesion only (CLO) as compared with a MV PCI approach to revascularization remains uncertain. Our objective is to gain a better understanding of the efficacy and safety of CLO as compared with MV PCI in patients with STEMI by conducting an updated meta-analysis. Methods A comprehensive search of PubMed, CENTRAL, EMBASE, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar databases of randomized controlled trials (RCTs) was performed. Results Seven RCTs were included, enrolling a total of 2006 patients. We found that there was a significant reduction in major adverse cardiovascular events (MACE) (OR, 0.62; 95% CI, 0.43–0.90), cardiovascular mortality (OR, 0.46; 95% CI, 0.27–0.80), and repeat revascularization (RRV) (OR, 0.39; 95% CI, 0.30–0.51) favoring MV over the CLO approach for patients undergoing primary PCI. The number needed to treat in order to prevent one CV mortality, RRV, or MACE event is 47, 11, and 16 patients, respectively. No differences were observed between MV vs. CLO PCI for subsequent myocardial infarction (OR, 0.74; 95% CI, 0.40–1.39), all-cause mortality (OR, 0.78; 95% CI, 0.53–1.15), non-cardiovascular mortality (OR, 1.35; 95% CI, 0.74–2.48), all-bleeding events (OR, 0.82; 95% CI, 0.40–1.65), contrast-induced nephropathy (OR, 0.72; 95% CI, 0.33–1.54), and stroke (OR, 1.28; 95% CI, 0.47–3.46). Conclusions MV PCI significantly reduces the rate of MACE, CV mortality, and RRV without significant harm as compared to CLO PCI.
Published: 2016
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48. Multimodality Imaging: Bird’s-Eye View from the 65th Annual Scientific Sessions of the American College of Cardiology, Chicago, Ill, April 2–4, 2016

Author: Farooq A. Chaudhry, Ron Blankstein, William A. VanDecker, Jeroen J. Bax, Mario J. Garcia, and Steven G. Lloyd
Subjects: Gerontology, Medical education, business.industry, Cardiology, 030204 cardiovascular system & hematology, Coronary Angiography, Multimodal Imaging, Multimodality, 03 medical and health sciences, 0302 clinical medicine, Echocardiography, Humans, Medicine, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business
Published: 2016
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49. The prevalence of metabolic syndrome among law enforcement officers who responded to the 9/11 World Trade Center attacks

Author: Cynara Maceda, Mario J. Garcia, Lori B. Croft, Martin E. Goldman, Mary Ann McLaughlin, Jacqueline Moline, Simonette T Sawit, Mark Woodward, and Rupa L Iyengar
Subjects: Gerontology, High rate, education.field_of_study, business.industry, Population, Public Health, Environmental and Occupational Health, World trade center, Law enforcement, Disease, 030204 cardiovascular system & hematology, medicine.disease, 030210 environmental & occupational health, 03 medical and health sciences, 0302 clinical medicine, Increased risk, medicine, Metabolic syndrome, medicine.symptom, business, education, Abdominal obesity, Demography
Abstract: Background Law enforcement officers (LEOs) experience high rates of cardiovascular events compared with the general US population. Metabolic syndrome (MetS) confers an increased risk of cardiovascular disease and all-cause mortality. Data regarding MetS among LEOs are limited. Methods We sought to determine the prevalence of MetS and its associated risk factors as well as gender differences among LEOs who participated in the World Trade Center (WTC) Law Enforcement Cardiovascular Screening (LECS) Program from 2008 to 2010. We evaluated a total of 2,497 participants, 40 years and older, who responded to the 9/11 WTC attacks. Results The prevalence of MetS was 27%, with abdominal obesity and hypertension being the most frequently occurring risk factors. MetS and its risk factors were significantly higher among male compared to female LEOs, except for reduced HDL-cholesterol levels. Conclusions MetS is a rising epidemic in the United States, and importantly, approximately one in four LEOs who worked at the WTC site after 9/11 are affected. Am. J. Ind. Med. 59:752–760, 2016. © 2016 Wiley Periodicals, Inc.
Published: 2016
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50. Therapeutic hypothermia in ST elevation myocardial infarction: a systematic review and meta-analysis of randomised control trials

Author: Gaurav Rao, Marissa Lombardo, David F. Briceno, Mark Menegus, Farouk Mookadam, Pedro A. Villablanca, Harish Ramakrishna, Mohammed Makkiya, Anna E. Bortnick, Mario J. Garcia, and Daniel B. Sims
Subjects: medicine.medical_specialty, business.industry, 030204 cardiovascular system & hematology, Hypothermia, medicine.disease, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Meta-analysis, Heart failure, Epidemiology, medicine, Cardiology, Anterior Wall Myocardial Infarction, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Mace
Abstract: Objective Our objective is to gain a better understanding of the efficacy and safety of therapeutic hypothermia (TH) in patients with acute ST elevation myocardial infarction (STEMI) through an analysis of randomised controlled trials (RCTs). Background Several RCTs have suggested a positive outcome with the use of TH in the prevention of myocardial injury in the setting of an acute STEMI. However, there are currently no clinical trials that have conclusively shown any significant benefit. Methods Electronic databases were used to identify RCTs of TH in the patient population with STEMI. The primary efficacy end point was major adverse cardiovascular event (MACE). Secondary efficacy end points included all-cause mortality, infarct size, new myocardial infarction and heart failure/pulmonary oedema (HF/PO). All-bleeding, ventricular arrhythmias and bradycardias were recorded as the safety end points. Results Six RCTs were included in this meta-analysis, enrolling a total of 819 patients. There was no significant benefit from TH in preventing MACE (OR, 01.04; 95% CI 0.37 to 2.89), all-cause mortality (OR, 1.48; 95% CI 0.68 to 3.19), new myocardial infarction (OR, 0.99; 95% CI 0.20 to 4.94), HF/PO (OR, 0.52; 95% CI 0.15 to 1.77) or infarct size (standard difference of the mean (SDM), −0.1; 95% CI −0.23 to 0.04). However, a significant reduction of infarct size was observed with TH utilisation in anterior wall myocardial infarction (SDM, −0.23; 95% CI −0.45 to −0.02). There was no significant difference seen for the safety end points all-bleeding (OR 1.32; 95% CI 0.77 to 2.24), ventricular arrhythmias (OR, 0.85; 95% CI 0.54 to 1.36) or bradycardias (OR, 1.16; 95% CI 0.74 to 1.83). Conclusions Although TH appears to be safe in patients with STEMI, meta-analysis of published RCTs indicates that benefit is limited to reduction of infarct size in patients with anterior wall involvement with no demonstrable effect on all-cause mortality, recurrent myocardial infarction or HF/PO.
Published: 2016
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