Highlights From the Circulation Family of Journals.

Abstract

HomeCirculationVol. 140, No. 23Highlights From the Circulation Family of Journals Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBHighlights From the Circulation Family of Journals Originally published2 Dec 2019https://doi.org/10.1161/CIRCULATIONAHA.119.044691Circulation. 2019;140:1946–1951Circulation: Arrhythmia and ElectrophysiologyMorbid obesity is a known risk factor for recurrent atrial fibrillation after ablation. In this single-center observational cohort study, the arrhythmia recurrence rates of morbidly obese patients who underwent bariatric surgery (BS) are compared with those who did not undergo BS, and with nonobese patients after atrial fibrillation ablation. BS was associated with a reduction in arrhythmia recurrence after ablation, with rates comparable with nonobese patients, raising the hypothesis that morbidly obese patients may benefit from BS before atrial fibrillation ablation for the prevention of recurrent atrial fibrillation.Outcomes of Atrial Fibrillation Ablation in Morbidly Obese Patients Following Bariatric Surgery Compared With a Nonobese CohortEoin Donnellan, MDOussama Wazni, MDMohamed Kanj, MDAyman Hussein, MDBryan Baranowski, MDBruce Lindsay, MDAli Aminian, MDWael Jaber, MDPhilip Schauer, MDWalid Saliba, MDCorrespondence to: Walid Saliba, MD, Department of Cardiac Electrophysiology, Cleveland Clinic, OH. Email [email protected]orgBACKGROUND: Morbid obesity is associated with unacceptable high recurrence rates following atrial fibrillation ablation. The role of risk-factor modification including weight loss and improved glycemic control in reducing arrhythmia recurrence following ablation has been highlighted in recent years. In this study, we compared arrhythmia recurrence rates in morbidly obese patients who underwent prior bariatric surgery (BS) with those of nonobese patients following atrial fibrillation ablation in addition to morbidly obese patients who did not undergo BS.METHODS: This was a single-center observational cohort study. We matched 51 morbidly obese patients [body mass index ≥40 kg/m2] who had undergone prior BS in a 2:1 manner with 102 nonobese patients and 102 morbidly obese patients without prior BS on the basis of age, sex, and timing of atrial fibrillation ablation. Our primary outcome of interest was arrhythmia recurrence.RESULTS: From the time of BS to ablation, BS was associated with a significant reduction in body mass index (47.6±9.3 to 36.7±7; P<0.0001), glycated hemoglobin (6.7±1.5 to 5.8±0.6; P<0.0001), and systolic blood pressure (145±13 to 118±11; P<0.0001). During a mean follow-up of 29±13 months following ablation, recurrent arrhythmia occurred in 10/51 (20%) patients in the BS group compared with 25/102 (24.5%) patients in the nonobese group and 56 (55%) patients in the non-BS morbidly obese group (P<0.0001). No procedural complications were observed in the BS group.CONCLUSIONS: Bariatric surgery is associated with a reduction in arrhythmia recurrence following atrial fibrillation ablation in morbidly obese patients to those of nonobese patients. Morbidly obese patients should be considered for BS before atrial fibrillation ablation.Circ Arrhythm Electrophysiol. 2019;12:e007598. doi: 10.1161/CIRCEP.119.007598.Circulation: Genomic and Precision MedicineThere are currently no effective pharmacotherapies available for calcific aortic valve stenosis (CAVS), which is frequently a surgical disease process. This genome-wide association study meta-analysis sought to identify additional susceptibility genes for CAVS beyond the currently known associations with LPA and PALMD. Three new genes (IL6, ALPL, and NAV1) were implicated in CAVS pathogenesis, constituting novel and potential therapeutic targets for future studies.Genetic Association Analyses Highlight IL6, ALPL, and NAV1 As 3 New Susceptibility Genes Underlying Calcific Aortic Valve StenosisSébastien Thériault, MD, MScChristian Dina, PhDDavid Messika-Zeitoun, MDSolena Le Scouarnec, PhDRomain Capoulade, PhDNathalie Gaudreault, BScSidwell Rigade, MScZhonglin Li, MScFloriane Simonet, MScMaxime Lamontagne, PhDMarie-Annick Clavel, DVM, PhDBenoit J. Arsenault, PhDAnne-Sophie Boureau, MDSimon Lecointe, BScEstelle Baron, BScStéphanie Bonnaud, PhDMatilde Karakachoff, MScEric Charpentier, MScImen Fellah, PhDJean-Christian Roussel, MDJean Philippe Verhoye, MDChristophe Baufreton, MDVincent Probst, MD, PhDRonan Roussel, MD, PhDthe D.E.S.I.R. Study GroupRichard Redon, PhDFrançois Dagenais, MDPhilippe Pibarot, DVM, PhDPatrick Mathieu, MD, MScThierry Le Tourneau, MD, PhDYohan Bossé, PhDJean-Jacques Schott, PhDCorrespondence to: Yohan Bossé, PhD, Institut universitaire de cardiologie et de pneumologie de Québec, Pavillon Marguerite-d’Youville, Y2106, 2725 chemin Sainte-Foy, Quebec City, QC, Canada, G1V 4G5; or Jean-Jacques Schott, PhD, l’Institut du thorax, Unité Inserm UMR 1087, CNRS UMR 6291, IRS-UN, 8 Quai Moncousu, BP 70721, 44007 Nantes cedex 1. Email yohan.[email protected]ulaval.ca or [email protected]frBACKGROUND: Calcific aortic valve stenosis (CAVS) is a frequent and life-threatening cardiovascular disease for which there is currently no medical treatment available. To date, only 2 genes, LPA additional susceptibility genes for CAVS and PALMD, have been identified as causal for CAVS. We aimed to identify additional susceptibility genes for CAVS.METHODS: A GWAS (genome-wide association study) meta-analysis of 4 cohorts, totaling 5115 cases and 354 072 controls of European descent, was performed. A TWAS (transcriptome-wide association study) was completed to integrate transcriptomic data from 233 human aortic valves. A series of post-GWAS analyses were performed, including fine-mapping, colocalization, phenome-wide association studies, pathway, and tissue enrichment as well as genetic correlation with cardiovascular traits.RESULTS: In the GWAS meta-analysis, 4 loci achieved genome-wide significance, including 2 new loci: IL6 (interleukin 6) on 7p15.3 and ALPL (alkaline phosphatase) on 1p36.12. A TWAS integrating gene expression from 233 human aortic valves identified NAV1 (neuron navigator 1) on 1q32.1 as a new candidate causal gene. The CAVS risk alleles were associated with higher mRNA expression of NAV1 in valve tissues. Fine-mapping identified rs1800795 as the most likely causal variant in the IL6 locus. The signal identified colocalizes with the expression of the IL6 RNA antisense in various tissues. Phenome-wide association analyses in the UK Biobank showed colocalized associations between the risk allele at the IL6 lead variant and higher eosinophil count, pulse pressure, systolic blood pressure, and carotid artery procedures, implicating modulation of the IL6 pathways. The risk allele at the NAV1 lead variant colocalized with higher pulse pressure and higher prevalence of carotid artery stenosis. Association results at the genome-wide scale indicated genetic correlation between CAVS, coronary artery disease, and cardiovascular risk factors.CONCLUSIONS: Our study implicates 3 new genetic loci in CAVS pathogenesis, which constitute novel targets for the development of therapeutic agents.Circ Genom Precis Med. 2019;12:e002617. doi: 10.1161/CIRCGEN.119.002617.Circulation: Cardiovascular ImagingThe traditional algorithms used to determine the pretest likelihood of significant coronary artery disease (CAD) may overestimate the prevalence of disease. This single-center cohort study found, when compared with abnormal myocardial perfusion single-photon emission computed tomography, the traditional pretest probability of CAD overestimates its prevalence in stable patients with suspected CAD. These implications should be considered when selecting patients for CAD testing in contemporary clinical practice.Performance of Traditional Pretest Probability Estimates in Stable Patients Undergoing Myocardial Perfusion ImagingOmar Batal, MDSaurabh Malhotra, MD, MPHMatthew Harinstein, MDJeremy Markowitz, MDGavin Hickey, MDSunil Agarwal, MDPamela Douglas, MDPrem Soman, MD, PhDCorrespondence to: Prem Soman, MD, PhD, Division of Cardiology, University of Pittsburgh Medical Center, A-429 Scaife Hall, 200 Lothrop St, Pittsburgh, PA 15213. Email [email protected]eduBACKGROUND: The yield of myocardial perfusion imaging is low in contemporary patients with suspected coronary artery disease (CAD) selected based on American College of Cardiology Foundation/American Heart Association pretest probability estimate. We compared traditional pretest estimates of CAD probability with the prevalence of abnormal myocardial perfusion single-photon emission computed tomography (MPS).METHODS: This was a cohort study from a single academic center. Consecutive stable patients without known CAD referred for stress MPS for suspected CAD between 2004 and 2011 were identified (n=15 777). Angina typicality was determined using standard criteria. Abnormal MPS perfusion was defined as a summed stress score ≥4, ischemia as summed stress score ≥4 and summed difference score ≥2, and extensive ischemia as summed difference score ≥8 using a standard, 17-segment model of the left ventricle. The pretest probability of CAD was determined using the American College of Cardiology Foundation/American Heart Association criteria.RESULTS: Overall, 14% (n=2177) of patients had abnormal MPS of whom 11% (n=1698) had ischemia and 4% (n=684) extensive ischemia. In patients with chest pain who underwent treadmill MPS (n=4764), only 27% reported angina on the treadmill. Typical angina was associated with the highest prevalence for positive MPS (33% in men and 14% in women), ischemia (30% in men and 12% in women), and extensive ischemia (22% in men and 4% in women) when compared with other symptom categories. Prevalence of MPS abnormality was substantially lower than expected based on pretest probability estimates across most sex and age groups. In multivariable analysis, the pretest probability estimate was not an independent predictor of abnormal MPS.CONCLUSIONS: Traditional estimates of pretest probability of CAD are not predictive of MPS perfusion abnormality and overestimate its prevalence in stable patients.Circ Cardiovasc Imaging. 2019;12:e008473. doi: 10.1161/CIRCIMAGING.118.008473.Circulation: Cardiovascular InterventionsIn comparison with infarct-related artery (IRA)–only revascularization, recent studies suggest that complete revascularization in patients with acute ST-segment–elevation myocardial infarction and multivessel disease is associated with better outcomes. This randomized clinical trial enrolled patients with multivessel disease who underwent a successful intervention of the IRA to compare the outcomes of non-IRA lesion stress echocardiography–guided revascularization versus percutaneous treatment of all angiographically significant coronary stenoses before hospital discharge. The composite end point included cardiovascular mortality, nonfatal reinfarction, coronary revascularization, and readmission for heart failure after 12 months of follow-up. A stress echocardiography–guided revascularization strategy did not produce significantly different outcomes to complete angiographically guided revascularization, raising the possibility of reducing elective revascularization procedures before discharge.Angiographically Guided Complete Revascularization Versus Selective Stress Echocardiography–Guided Revascularization in Patients With ST-Segment–Elevation Myocardial Infarction and Multivessel DiseaseThe CROSS-AMI Randomized Clinical TrialRamón Calviño-Santos, MDRodrigo Estévez-Loureiro, MD, PhDJesús Peteiro-Vázquez, MD, PhDJorge Salgado-Fernández, MDAlejandro Rodríguez-Vilela, MDRaúl Franco-Gutiérrez, MDAlberto Bouzas-Mosquera, MD, PhDJosé Ángel Rodríguez Fernández, MDAlejandro Mesías-Prego, MDCarlos González-Juanatey, MD, PhDGuillermo Aldama-López, MDPablo Piñón-Esteban, MDXacobe Flores-Ríos, MD, PhDRita Soler-Martín, PhDTeresa Seoane-Pillado, PhDNicolás Vázquez-González, MDJavier Muñiz, MD, PhDJosé Manuel Vázquez-Rodríguez, MD, PhDCorrespondence to: Ramon Calviño-Santos, MD, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, 84 As Xubias, 15006 A Coruña, Spain. Email [email protected]comBACKGROUND: Recent trials suggest that complete revascularization in patients with acute ST-segment–elevation myocardial infarction and multivessel disease is associated with better outcomes than infarct-related artery (IRA)–only revascularization. There are different methods to select non-IRA lesions for revascularization procedures. We assessed the clinical outcomes of complete angiographically guided revascularization versus stress echocardiography–guided revascularization in patients with ST-segment–elevation myocardial infarction.METHODS: We performed a randomized clinical trial in patients with multivessel disease who underwent a successful percutaneous coronary intervention of the IRA to test differences in prognosis (composite end point included cardiovascular mortality, nonfatal reinfarction, coronary revascularization, and readmission for heart failure after 12 months of follow-up) between complete angiographically guided revascularization (n=154) or stress echocardiography–guided revascularization (n=152) of the non-IRA lesions in an elective procedure before hospital discharge.RESULTS: The trial was prematurely stopped after the inclusion of 77% of the planned study population. As many as 152 (99%) patients in the complete revascularization group and 44 (29%) patients in the selective revascularization group required a percutaneous coronary intervention procedure of a non-IRA lesion before discharge. The primary end point occurred in 21 (14%) patients of the stress echocardiography–guided revascularization group and 22 (14%) patients of the complete angiographically guided revascularization group (hazard ratio, 0.95; 95% CI, 0.52–1.72; P=0.85).CONCLUSIONS: In patients with ST-segment–elevation myocardial infarction and multivessel disease, stress echocardiography–guided revascularization may not be significantly different to complete angiographically guided revascularization, thereby reducing the need for elective revascularization before hospital discharge.CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01179126.Circ Cardiovasc Interv. 2019;12:e007924. doi: 10.1161/CIRCINTERVENTIONS.119.007924.Circulation: Cardiovascular Quality and OutcomesAlthough other studies have shown associations between dog ownership and decreased cardiovascular risk, there have been conflicting results when assessing whether dog ownership is associated with improved survival. This systematic review and meta-analysis of studies published between 1950 and 2019 evaluated the association of dog ownership with all-cause mortality and cardiovascular mortality. Dog ownership was associated with a lower risk of death over the long term, which may be attributable to reductions in cardiovascular mortality, suggesting an opportunity for future studies on lifestyle interventions.Dog Ownership and SurvivalA Systematic Review and Meta-AnalysisCaroline K. Kramer, MD, PhDSadia Mehmood, BScRenée S. SuenCorrespondence to: Caroline K. Kramer, MD, PhD, University of Toronto Leadership Sinai Centre for Diabetes, Mt Sinai Hospital, 60 Murray St, Suite L5-210, Mailbox-21, Toronto, ON, Canada M5T 3L9. Email Caroline.[email protected]caBACKGROUND: Dog ownership has been associated with decreased cardiovascular risk. Recent reports have suggested an association of dog companionship with lower blood pressure levels, improved lipid profile, and diminished sympathetic responses to stress. However, it is unclear if dog ownership is associated with improved survival as previous studies have yielded inconsistent results. Thus, we performed a systematic review and meta-analysis to evaluate the association of dog ownership with all-cause mortality, with and without prior cardiovascular disease, and cardiovascular mortality.METHODS AND RESULTS: Studies published between 1950 and May 24, 2019 were identified by searching Embase and PubMed. Observational studies that evaluated baseline dog ownership and subsequent all-cause mortality or cardiovascular mortality. Two independent reviewers extracted the data. We assessed pooled data using random-effects model. A possible limitation was that the analyses were not adjusted for confounders. Ten studies were included yielding data from 3 837 005 participants (530 515 events; mean follow-up 10.1 years). Dog ownership was associated with a 24% risk reduction for all-cause mortality as compared to nonownership (relative risk, 0.76; 95% CI, 0.67–0.86) with 6 studies demonstrating significant reduction in the risk of death. Notably, in individuals with prior coronary events, living in a home with a dog was associated with an even more pronounced risk reduction for all-cause mortality (relative risk, 0.35; 95% CI, 0.17–0.69; I2, 0%). Moreover, when we restricted the analyses to studies evaluating cardiovascular mortality, dog ownership conferred a 31% risk reduction for cardiovascular death (relative risk, 0.69; 95% CI, 0.67–0.71; I2, 5.1%).CONCLUSIONS: Dog ownership is associated with lower risk of death over the long term, which is possibly driven by a reduction in cardiovascular mortality.Circ Cardiovasc Qual Outcomes. 2019;12:e005554. doi: 10.1161/CIRCOUTCOMES.119.005554.Circulation: Heart FailureUsing the International Society for Heart and Lung Transplantation Registry, this descriptive study compared the long-term posttransplant survival between men and women. After cardiac transplantation, the results show no difference in overall survival between men and women. However, women only represent 1 in 4 heart transplant recipients worldwide and seem to receive hearts from higher-risk donors in comparison with men.Survival Outcomes After Heart TransplantationDoes Recipient Sex Matter?Yasbanoo Moayedi, MDChun Po S. Fan, PhDWida S. Cherikh, PhDJoseph Stehlik, MD, MScJeffrey J. Teuteberg, MDHeather J. Ross, MD, MHScKiran K. Khush, MD, MASCorrespondence to: Kiran K. Khush, MD, MAS, Stanford University, 300 Pasteur Dr, Falk Research Bldg, CA 94305. Email [email protected]eduBACKGROUND: Currently, women represent <25% of heart transplant recipients. Reasons for this female underrepresentation have been attributed to selection and referral bias and potentially poorer outcomes in female recipients. The aim of this study was to compare long-term posttransplant survival between men and women, when matched for recipient and donor characteristics.METHODS AND RESULTS: Using the International Society for Heart and Lung Transplantation Registry, we performed descriptive analyses and estimated overall freedom from posttransplant death stratified by sex using Kaplan-Meier survival methods. Male and female recipients were matched according to the Index for Mortality Prediction After Cardiac Transplantation and Donor Risk Index score using 1:1 propensity score matching. The study cohort comprised 34 198 heart transplant recipients (76.3% men, 23.7% women) between 2004 and 2014. Compared with men, women were more likely younger (51 [39–59] versus 55 [46–61] years; P<0.001) and had a different distribution of heart failure etiology (P<0.001). In general, the prevalence of comorbidities was lower in women than in men. Women were less likely to have diabetes mellitus (19.1% versus 26.2%; P<0.001), hypertension (40.7% versus 47.9%; P<0.001), peripheral vascular disease (2.4% versus 3.3%; P=0.002), tobacco use (36.5% versus 52.3%; P<0.001), and prior cardiovascular surgery (38.6% versus 50.7%; P<0.001). Women were more likely to have a history of malignancy (10.5% versus 5.3%; P<0.001), require intravenous inotropes (41.4% versus 37.2%; P<0.001), and were less likely supported by an intra-aortic balloon pump (3.3% versus 3.8%; P=0.03) or durable ventricular assist device (22% versus 31.5%; P<0.001). Transplanted male recipients had a higher Index for Mortality Prediction After Cardiac Transplantation score (5 [2–7] versus 4 [1–6]; P<0.001). When male and female heart transplant recipients were matched for recipient and donor characteristics, there was no significant survival difference (P=0.57).CONCLUSIONS: Overall survival does not differ between men and women after cardiac transplantation. Women who survive to heart transplantation appear to have lower risk features than male recipients but receive hearts from higher risk donors.Circ Heart Fail. 2019;12:e006218. doi: 10.1161/CIRCHEARTFAILURE.119.006218.Footnoteshttps://www.ahajournals.org/journal/circ Previous Back to top Next FiguresReferencesRelatedDetails December 3, 2019Vol 140, Issue 23 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.119.044691PMID: 31790295 Originally publishedDecember 2, 2019 PDF download Advertisement