The American Journal of Cardiology

BackgroundSpontaneous coronary artery dissection (SCAD) is an understudied cause of acute coronary syndrome (ACS), particularly in women. Heart muscle damage may result from spontaneous dissection of coronary arteries. There is no clear consensus regarding the optimum antiplatelet medication regimen and treatment duration for SCAD despite current American Heart Association (AHA) consensus guidelines recommending 12-month regimen of dual antiplatelet therapy (DAPT) consisting of a P2Y12 inhibitor...

BackgroundTakotsubo Syndrome (TTS) generally presents like a form of acute coronary syndrome, with variable extents of coronary flow retardation and concomitant release of markers from damaged endothelial glycocalyx (eGC). Whilst systemic hypotension often develops early, there is also rapid emergence and slow resolution of left ventricular (LV) dysfunction. It remains uncertain whether these hypotensive and LV functional complications reflect severity of early coronary vasculitis. Methods284 p...

BackgroundMyocardial metabolism plays an important role in maintaining cardiac function. Patients with dilated cardiomyopathy (DCMP) exhibit alterations in myocardial metabolism characterized by increased myocardial glucose metabolism. This study aimed to evaluate effects on myocardial metabolism of angiotensin-II receptor blockers, olmesartan and valsartan, in patients with DCMP. MethodsOVOID (a comparison study of Olmesartan and Valsartan effects on myocardial metabolism in patients with Dila...

BACKGROUNDLeft ventricular hypertrophy (LVH) is a strong predictor of adverse outcomes. Although normalizing LV mass (LVM) to height exponents reduced variability from body size, specific recommendations for height exponents are lacking due to a scarcity of normal cohorts to define appropriate height exponents. We aimed to demonstrate the diagnostic and prognostic implications of establishing height exponents specific to sex, ethnicity and imaging modality. METHODSNon-overweight/non-obese Asian...

BackgroundLeft ventricular pseudoaneurysm (LVPA) is a rare but life-threatening complication of myocardial infarction (MI). Given the similarities in the clinical presentations and the appearance of the cardiac imaging, differentiation of LVPA from left ventricular aneurysm (LVA) remains a challenge but is imperative for timely management. We summarized and compared clinical and imaging findings of post-MI LVPA and LVA. MethodWe performed a comprehensive search of the literature in PubMed and S...

BackgroundCoronary artery tortuosity (CAT) is often viewed as a benign angiographic finding; however, emerging evidence suggests its potential hemodynamic significance, particularly in non-atherosclerotic cardiomyopathies such as Takotsubo syndrome (TS). ObjectivesThis study aimed to investigate the prevalence and hemodynamic implications of CAT in patients diagnosed with Takotsubo cardiomyopathy (TCM) and to evaluate the association between the severity of tortuosity and myocardial injury mark...

BackgroundRapid diagnostic screening is an unmet need in patients with suspected cardiomyopathy. We recently demonstrated that magnetocardiography (MCG) might be a suitable tool to detect cardiomyopathies. We now tested diagnostic accuracy of MCG prospectively. MethodsMCG uses a superconducting quantum interference device (SQUID) to detect the electromagnetic field of the heart. In our recent retrospective study, a T-beg-Tmax (MCG Score) > 0.051 identified patients with non-ischemic cardiomyopa...

ObjectivesTo conduct a systematic review and meta-analysis to assess the evidence of cardiovascular magnetic resonance imaging (CMR) in patients with suspected myocardial infarction and nonobstructive coronary arteries (MINOCA), and how time to CMR influences diagnosis. BackgroundCMR is indicated in patients with suspected MINCOA but it is unclear when is best to perform the CMR and how this timing can influence diagnosis. MethodsWe systematically conducted a comprehensive literature search to...

Backgrounds20-30% atrial fibrillation (AF) may result in heart failure (HF). Noninvasive left ventricle myocardial work (LVMW) is a fairly new method for detecting LV function. We aimed to evaluate whether LVMW could detect the LV change function in paroxysmal atrial fibrillation (PAF) and predict HF incident. MethodsIn this prospective cohort study, 146 PAF subjects and 63 non-PAF subjects matched by age and gender set as the controls were enrolled. Noninvasive LVMW parameters, including globa...

BackgroundThe predictive value of atrial conduction abnormalities, reflected by P-wave indices (PWI), and their association with biomarkers signaling fibrosis for the development of atrial fibrillation (AF) in patients with heart failure (HF) remains underexplored. To address this gap, we investigated the associations between PWI, fibrotic biomarkers, and the risk of incident AF in a cohort of HF patients. MethodsA total of 475 patients with new-onset or worsening HF, were followed for 5 years....

BackgroundElevated B-type- and NT-pro-beta natriuretic peptide (BNP and NT-pro-BNP) after transcatheter aortic valve replacement (TAVR) may be associated with worse outcomes. ObjectiveWe performed a systematic review and meta-analysis to investigate the association of post-TAVR BNP and NT-pro BNP levels on all-cause mortality and heart failure hospitalization. MethodsSeven retrospective studies (n=4143) were included, with a mean follow-up of 32 months. Lower BNP and NT-pro BNP was defined as ...

BackgroundEarly recognition of left atrial (LA) and left ventricular (LV) remodelling may improve prognosis of patients with hypertension. MethodsLeft heart coupling indices were studied to investigate the adaptive effect of hypertension on cardiac remodelling. The ratio of LV to LA volumes was measured at selected phases of a cardiac cycle using computed tomography (CT) coronary angiography and transthoracic echocardiogram (TTE). A group of 180 patients was divided into Group 1 (no hypertensio...

BackgroundScreening for atherosclerosis focuses on identifying Standard Modifiable Risk Factors (SMuRFs), including diabetes, hypertension, hyperlipidaemia, and smoking. PurposeTo compare the extracardiac thoracoabdominal atherosclerotic plaque burden, as measured by computed tomography angiography (CTA), among heart transplant candidates with ischemic or non-ischemic cardiomyopathy (ICM, NICM), and evaluate potential associations between plaque burden and SMuRFs. MethodsThis retrospective stu...

BackgroundCoronavirus disease 2019 (COVID-19) can lead to long-term cardiopulmonary symptoms and is associated to coronary microvascular dysfunction (CMD). However, long-term data on CMD following severe COVID-19 are lacking. ObjectiveTo determine long-term left ventricular (LV) function and presence of CMD after severe COVID-19, utilizing cardiovascular magnetic resonance (CMR) and stress perfusion mapping. MethodsHospitalized COVID-19 patients underwent CMR at 10 months follow-up (1.5T Aera,...

BackgroundBoth ischemia and scar can contribute to arrhythmogenesis in patients with ischemic left ventricular dysfunction (ILVD); coronary revascularization is frequently undertaken to modify the former. Whether modulation of ischemia affects the substrate for ventricular arrhythmia is unclear. ObjectivesTo assess the mechanistic effects of ischemia modulation via revascularization on the arrhythmic substrate in patients with ILVD. MethodsPatients were eligible for enrolment if they had a lef...

Backround and aimsProlonged QRS duration ([≥] 110 ms) and coronary artery disease are risk factors for sudden cardiac death (SCD). We explored the SCD risk associated with intraventricular conduction disorders - a prolonged QRS duration of 110-119 ms, right bundle branch block (RBBB), left bundle branch block (LBBB), and a nonspecific intraventricular conduction delay (NIVCD) - in patients with acute coronary syndrome (ACS). MethodsThis is a retrospective study of 9,700 consecutive, invasive...

AimsLeft bundle branch block (LBBB) is associated with mechanical dyssynchrony, heterogeneous perfusion, and adverse left ventricular (LV) remodeling. However, not all patients with LBBB develop cardiomyopathy, and dyssynchrony can occur without conduction defects. The role of microvascular dysfunction remains uncertain. We aimed to assess how mechanical dyssynchrony and perfusion heterogeneity relate to LV remodeling and function in patients with and without LBBB. Methods and resultsWe retrosp...

Background: Acute heart failure (AHF) exhibits marked heterogeneity in diastolic hemodynamics, yet comprehensive echocardiographic assessment of diastolic function (DF) and filling pressure (FP) is often infeasible. We evaluated whether artificial intelligence-enabled electrocardiography (AI-ECG) could provide scalable DF grading and FP estimation in hospitalized AHF patients. Methods: We retrospectively studied adults hospitalized for AHF across Mayo Clinic sites (2013-2023) who received 1 dose...

BACKGROUNDPeak oxygen uptake (pVO2) is a strong, independent predictor of adverse cardiovascular outcomes, supporting cardiopulmonary exercise testing as a primary end point assessing efficacy of novel drug therapies in obstructive hypertrophic cardiomyopathy (oHCM) clinical trials. However, characterizing changes in pVO2 that patients perceive as beneficial or meaningful (ie, minimal important difference [MID]) has not been determined. METHODSData from patients with symptomatic oHCM enrolled i...

Background and AimsThe H2FPEF score is a widely used prediction tool used during the diagnostic work-up of heart failure with preserved ejection fraction (HFpEF). However, having angina symptoms is not included in the score, despite being common in patients with HFpEF. We hypothesize that incorporating angina in the H2FPEF score may improve its performance. Given the known sex differences in HFpEF, sex-specific analyses are warranted. MethodsWe included 1,266 individuals suspected HFpEF, with 5...