HomeCirculationVol. 138, No. 6Highlights From the Circulation Family of Journals Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBHighlights From the Circulation Family of Journals Originally published6 Aug 2018https://doi.org/10.1161/CIRCULATIONAHA.118.036699Circulation. 2018;138:636–641Circulation: Arrhythmia and ElectrophysiologyThis nationwide Danish study investigated the incidence of sudden cardiac death in young people with congenital heart defects. The authors found that the incidence of sudden cardiac death–congenital heart defects in infants declined after the implementation of nationwide fetal ultrasound screening, the proportion of sudden cardiac death–congenital heart defects in the young was higher than previously reported, and the incidence rate of sudden cardiac death during physical activity among young people with congenital heart defects was low.Nationwide Study of Sudden Cardiac Death in People With Congenital Heart Defects Aged 0 to 35 YearsThomas Hadberg Lynge, MDAlexander Gade Jeppesen, BMBo Gregers Winkel, MD, PhDCharlotte Glinge, MDMichael Rahbek Schmidt, MD, PhDLars Søndergaard, MD, DMScBjarke Risgaard, MD, PhDJacob Tfelt-Hansen, MD, DMScCorrespondence to: Thomas Hadberg Lynge, MD, Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. Email [email protected]BACKGROUND: Congenital heart defects (CHD) are among the leading causes of sudden cardiac death (SCD) in the young. Nationwide incidence of SCD in people with CHD (SCD-CHD) has not been established in the young general population. The aims of this study were to investigate incidence of SCD-CHD and whether incidence of SCD-CHD in infants declined after implementation of nationwide fetal ultrasound screening in Denmark.METHODS: All deaths (n=11 451) among people aged 0 to 35 years in Denmark in 2000 to 2009 (24.4 million person-years) were included. Danish death certificates, autopsy reports, records from hospitals and general practitioners, and data from nationwide Danish registries were used to identify SCD-CHD cases.RESULTS: We identified 90 (11%) cases of SCD-CHD from 809 SCD. The incidence rate of SCD-CHD was 0.4 per 100 000 person-years among people aged 0 to 35 years. In total, 53 (59%) were diagnosed with CHD before death. Incidence of SCD was 9.6× higher among patients with CHD compared with people without CHD (P<0.01). Annual incidence of physical activity–related SCD-CHD among patients aged 2 to 35 years diagnosed with CHD was 0.9 per 100 000. The annual incidence rate of SCD-CHD in infants declined after implementation of nationwide fetal ultrasound screening (incidence rate ratio, 3.8; P<0.01).CONCLUSIONS: The proportion of SCD-CHD in the young was 11%, which is higher than previously reported. Physical activity–related SCD-CHD was a rare event among patients with CHD. We observed an ≈4-fold lower incidence of SCD-CHD among infants born after implementation of nationwide screening.Circ Arrhythm Electrophysiol. 2018;11:e005757. doi: 10.1161/CIRCEP.117.005757Circulation: Genomic and Precision MedicineBlack Americans experience significant health disparities for kidney and cardiovascular disease, and much excess risk for chronic and end-stage kidney disease in black Americans is attributable in part to 2 coding variants in the apolipoprotein L1 gene (APOL1). The association between APOL1 renal risk variants and cardiovascular disease is unresolved, and conflicting results have been reported. This study examined associations of APOL1 with incident cardiovascular disease from black participants of the REGARDS study. The study found that APOL1 high-risk status is associated with cardiovascular disease events in community-dwelling black adults without diabetes mellitus. The findings may provide insight into reasons for the higher incidence rate of ischemic stroke among blacks.APOL1 Nephropathy Risk Variants and Incident Cardiovascular Disease Events in Community-Dwelling Black AdultsOrlando M. Gutiérrez, MD, MMScMarguerite R. Irvin, PhDNinad S. Chaudhary, MBBS, MPHMary Cushman, MDNeil A. Zakai, MDVictor A. David, MScSophie Limou, PhDNathalie Pamir, PhDAlex P. Reiner, MDRakhi P. Naik, MDMichele M. Sale, PhDMonika M. Safford, MDHyacinth I. Hyacinth, MD, PhDSuzanne E. Judd, PhDJeffrey B. Kopp, MDCheryl A. Winkler, PhDCorrespondence to: Cheryl A. Winker, PhD, Basic Research Laboratory, National Institute of Cancer Research, Leidos Biomedical Research, National Laboratory for Cancer Research at Frederick, 8560 Progress Dr, Frederick, MD 21702; or Jeffrey B. Kopp, MD, Kidney Section, National Institute of Diabetes and Digestive and Kidney Diseases, 10 Center Dr, Bethesda, MD 20892. Email [email protected] or [email protected]BACKGROUND:APOL1 renal risk variants are strongly associated with chronic kidney disease in Black adults, but reported associations with cardiovascular disease (CVD) have been conflicting.METHODS: We examined associations of APOL1 with incident coronary heart disease (n=323), ischemic stroke (n=331), and the composite CVD outcome (n=500) in 10 605 Black participants of the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Primary analyses compared individuals with APOL1 high-risk genotypes to APOL1low-risk genotypes in Cox proportional hazards models adjusted for CVD risk factors and African ancestry.RESULTS:APOL1 high-risk participants were younger and more likely to have albuminuria at baseline than APOL1 low-risk participants. The risk of incident stroke, coronary heart disease, or composite CVD end point did not significantly differ by APOL1 genotype status in multivariable models. The association of APOL1 genotype with incident composite CVD differed by diabetes mellitus status (Pinteraction=0.004). In those without diabetes mellitus, APOL1 high-risk genotypes associated with greater risk of incident composite CVD (hazard ratio, 1.67; 95% confidence interval, 1.12–2.47) compared with those with APOL1 low-risk genotypes in multivariable adjusted models. This latter association was driven by ischemic strokes (hazard ratio, 2.32; 95% confidence interval, 1.33–4.07), in particular, those related to small vessel disease (hazard ratio, 5.10; 95% confidence interval, 1.55–16.56). There was no statistically significant association of APOL1 genotypes with incident CVD in subjects with diabetes mellitus. The APOL1 high-risk genotype was associated with higher stroke risk in individuals without but not those with chronic kidney disease in fully adjusted models.CONCLUSIONS:APOL1 high-risk status is associated with CVD events in community-dwelling Black adults without diabetes mellitus.Circ Genom Precis Med. 2018;11:e002098. doi: 10.1161/CIRCGEN.117.002098Circulation: Cardiovascular ImagingThis multicenter register study of 351 patients compared the diagnostic performance of machine-learning–based computed tomographic fractional flow reserve (FFR) with a combination of computed tomographic angiography and computational fluid dynamics–based computed tomographic FFR for detection of functionally obstructive coronary artery disease. Using invasive FFR as the standard, the authors found that the diagnostic performance of computed tomographic angiography can be improved with machine-learning–based computed tomographic FFR that was similar to computational fluid dynamics–based computed tomographic FFR, potentially reducing the number of unnecessary referrals for invasive coronary angiography.Diagnostic Accuracy of a Machine-Learning Approach to Coronary Computed Tomographic Angiography–Based Fractional Flow ReserveResult From the MACHINE ConsortiumAdriaan Coenen, MDYoung-Hak Kim, MD, PhDMariusz Kruk, MD, PhDChristian Tesche, MDJakob De Geer, MD, PhDAkira Kurata, MD, PhDMarisa L. Lubbers, MDJoost Daemen, MD, PhDLucian Itu, PhDSaikiran Rapaka, PhDPuneet Sharma, PhDChris Schwemmer, MSAnders Persson, MD, PhDU. Joseph Schoepf, MDCezary Kepka, MD, PhDDong Hyun Yang, MD, PhDKoen Nieman, MD, PhDCorrespondence to: Adriaan Coenen, MD, Department of Cardiology, Erasmus University Medical Center, Room Ca-207, ‘s-Gravendijkwal 230, Rotterdam 3015 CE, Netherlands. Email [email protected]BACKGROUND: Coronary computed tomographic angiography (CTA) is a reliable modality to detect coronary artery disease. However, CTA generally overestimates stenosis severity compared with invasive angiography, and angiographic stenosis does not necessarily imply hemodynamic relevance when fractional flow reserve (FFR) is used as reference. CTA-based FFR (CT-FFR), using computational fluid dynamics (CFD), improves the correlation with invasive FFR results but is computationally demanding. More recently, a new machine-learning (ML) CT-FFR algorithm has been developed based on a deep learning model, which can be performed on a regular workstation. In this large multicenter cohort, the diagnostic performance ML-based CT-FFR was compared with CTA and CFD-based CT-FFR for detection of functionally obstructive coronary artery disease.METHODS AND RESULTS: At 5 centers in Europe, Asia, and the United States, 351 patients, including 525 vessels with invasive FFR comparison, were included. ML-based and CFD-based CT-FFR were performed on the CTA data, and diagnostic performance was evaluated using invasive FFR as reference. Correlation between ML-based and CFD-based CT-FFR was excellent (R=0.997). ML-based (area under curve, 0.84) and CFD-based CT-FFR (0.84) outperformed visual CTA (0.69; P<0.0001). On a per-vessel basis, diagnostic accuracy improved from 58% (95% confidence interval, 54% to 63%) by CTA to 78% (75% to 82%) by ML-based CT-FFR. The per-patient accuracy improved from 71% (66% to 76%) by CTA to 85% (81% to 89%) by adding ML-based CT-FFR as 62 of 85 (73%) false-positive CTA results could be correctly reclassified by adding ML-based CT-FFR.CONCLUSIONS: On-site CT-FFR based on ML improves the performance of CTA by correctly reclassifying hemodynamically nonsignificant stenosis and performs equally well as CFD-based CT-FFR.Circ Cardiovasc Imaging. 2018;11:e007217. doi: 10.1161/CIRCIMAGING.117.007217Circulation: Cardiovascular InterventionsThe clinical benefit of fractional flow reserve–guided coronary artery bypass graft in comparison with angiography-guided coronary artery bypass graft is unclear. This retrospective analysis suggests that fractional flow reserve–guided coronary artery bypass graft surgery is associated with a significant reduction in the rate of overall death or myocardial infarction and a higher graft patency rate at 6 years.Six-Year Follow-Up of Fractional Flow Reserve–Guided Versus Angiography-Guided Coronary Artery Bypass Graft SurgeryStephane Fournier, MDGabor G. Toth, MD, PhDBernard De Bruyne, MD, PhDNils P. Johnson, MD, MSGiovanni Ciccarelli, MDPanagiotis Xaplanteris, MD, PhDAnastasios Milkas, MDTeresa Strisciuglio, MDJozef Bartunek, MD, PhDMarc Vanderheyden, MD, PhDEric Wyffels, MDFilip Casselman, MD, PhDFrank Van Praet, MDBernard Stockman, MDIvan Degrieck, MDEmanuele Barbato, MD, PhDCorrespondence to: Emanuele Barbato, MD, PhD, FESC, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, B-9300 Aalst, Belgium. Email [email protected]BACKGROUND: Fractional flow reserve (FFR)-guided coronary artery bypass graft (CABG) surgery has been associated with lower number of graft anastomoses, lower rate of on-pump surgery, and higher graft patency rate as compared with angiography-guided CABG surgery. However, no clinical benefit has been reported to date.METHODS AND RESULTS: Consecutive patients (n=627) treated by CABG between 2006 and 2010 were retrospectively included. In 198 patients, at least 1 stenosis was grafted according to FFR (FFR-guided group), whereas in 429 patients all stenoses were grafted based on angiography (angiography-guided group). The 2 coprimary end points were overall death or myocardial infarction and major adverse cardiovascular events (composite of overall death, myocardial infarction, and target vessel revascularization) up to 6-year follow-up. In the FFR-guided group, patients were significantly younger (66 [57–73] versus 70 [63–76]; P<0.001), more often male (82% versus 72%; P=0.008), and less often diabetic (21% versus 30%; P=0.023). Clinical follow-up (median, 85 [66–104] months) was analyzed in 396 patients after 1:1 propensity-score matching for these 3 variables. The rate of overall death or myocardial infarction was significantly lower in the FFR-guided (n=31 [16%] versus n=49 [25%]; hazard ratio, 0.59 [95% confidence interval, 0.38–0.93]; P=0.020) as compared with the angiography-guided group. Major adverse cardiovascular events rate was also numerically lower in the FFR-guided than in the angiography-guided group (n=42 [21%] versus n=52 [26%]; hazard ratio, 0.77 [95% confidence interval, 0.51–1.16]; P=0.21).CONCLUSIONS: FFR-guided CABG is associated with a significant reduction in the rate of overall death or myocardial infarction at 6-year follow-up as compared with angiography-guided CABG.Circ Cardiovasc Interv. 2018;11:e006368. doi: 10.1161/CIRCINTERVENTIONS.117.006368Circulation: Heart FailureThis study examined the unclear associations of proteins from different food sources with risk of heart failure. Evaluating patients from the Kuopio Ischemic Heart Disease Risk Factor Study, the authors found that higher protein intake was marginally associated with increased risk of heart failure in middle-aged men. These results suggest that, despite the popularity of high-protein diets, they may not be the optimal dietary strategy in the prevention of heart failure.Intake of Different Dietary Proteins and Risk of Heart Failure in MenThe Kuopio Ischemic Heart Disease Risk Factor StudyHeli E.K. Virtanen, MScSari Voutilainen, PhDTimo T. Koskinen, MScJaakko Mursu, PhDTomi-Pekka Tuomainen, MD, PhDJyrki K. Virtanen, PhDCorrespondence to: Jyrki K. Virtanen, PhD, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Yliopistonranta 1 C, PO Box 1627, 70211 Kuopio, Finland. Email [email protected]BACKGROUND: Animal and plant protein intakes have indicated opposite associations with cardiovascular mortality risk. Whether dietary proteins are associated with risk of heart failure (HF) is unclear. Thus, we examined the associations of proteins from different food sources with risk of HF.METHODS AND RESULTS: The study included 2441 men aged 42 to 60 years at the baseline examinations in 1984 to 1989 in the Kuopio Ischemic Heart Disease Risk Factor Study. Protein intakes at baseline were assessed with 4-day dietary records. Data on incident HF cases were obtained from national registers. HF risk according to protein intake was estimated by Cox proportional hazard ratios. During the mean follow-up of 22.2 years, 334 incident HF cases occurred. Higher intake of total protein indicated a trend toward increased risk of HF (multivariable-adjusted hazard ratio in the highest versus lowest quartile=1.33; 95% confidence interval: 0.95–1.85; P-trend=0.05). The associations between specific types and sources of protein with incident HF were consistent with this overall finding although not all associations reached statistical significance. For example, the hazard ratio in the highest versus lowest quartile was 1.43 (95% confidence interval: 1.00–2.03; P-trend=0.07) for total animal protein and 1.17 (95% confidence interval: 0.72–1.91; P-trend=0.35) for total plant protein.CONCLUSIONS: In middle-aged men, higher protein intake was marginally associated with increased risk of HF.CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03221127.Circ Heart Fail. 2018;11:e004531. doi: 10.1161/CIRCHEARTFAILURE.117.004531Circulation: Cardiovascular Quality and OutcomesInvolving pharmacists in team-based care improves on usual care of chronic cardiovascular risk factors, but is challenging to implement in primary care offices in rural and small community settings. This study cluster randomized 12 family medicine offices to investigate whether a centralized, remote, clinical pharmacy service could improve guideline adherence and secondary measures of cardiovascular risk. The results show higher than expected baseline guideline adherence and modest but significant improvements in overall guideline adherence and several individual criteria.Cluster-Randomized Trial to Evaluate a Centralized Clinical Pharmacy Service in Private Family Medicine OfficesBarry L. Carter, PharmDBarcey Levy, MD, PhDBrian Gryzlak, MSW, MAYinghui Xu, MSElizabeth Chrischilles, PhDJeffrey Dawson, ScDMark Vander Weg, PhDAlan Christensen, PhDPaul James, MDLinnea Polgreen, PhDCorrespondence to: Barry L. Carter, PharmD, Department of Pharmacy Practice and Science College of Pharmacy, University of Iowa, Rm 527, Iowa City, IA 52242. Email [email protected]BACKGROUND: The use of clinical pharmacists in primary care has improved the control of several chronic cardiovascular conditions. However, many private physician practices lack the resources to implement team-based care with pharmacists. The purpose of this study was to evaluate whether a centralized, remote, clinical pharmacy service could improve guideline adherence and secondary measures of cardiovascular risk in primary care offices in rural and small communities.METHODS AND RESULTS: This study was a prospective trial in 12 family medicine offices cluster randomized to either the intervention or usual care. The intervention was delivered for 12 months, and subjects had research visits at baseline and 12 months. The primary outcome was adherence to guidelines, and secondary outcomes included changes in key cardiovascular risk factors and preventative health measures. We enrolled 302 subjects. There was no improvement in the Guideline Advantage score from baseline to 12 months in the control group (64.7% versus 63.1%, respectively; P=0.21). There was a statistically significant improvement in the intervention group from 63.3% at baseline to 67.8% at 12 months (P=0.02). The estimated benefit of the intervention was 5.0%±2.4% (95% confidence interval=−0.5% to 10.4%; P=0.07). Several criteria were significantly better for intervention subjects, including appropriate statin therapy (P<0.001), body mass index, screening (P<0.001), and alcohol screening (P<0.001). Only 13.7% of subjects with diabetes mellitus had hemoglobin A1c at goal at baseline, and this increased to 30.8% and 21.0% in the intervention and control group, respectively, at 12 months (P=0.10).CONCLUSIONS: The centralized, remote pharmacist intervention was successfully implemented. The improvements in outcomes were modest, in part because of higher than expected baseline guideline adherence. Future studies of this model should focus on patients with uncontrolled conditions at high risk for cardiovascular events.CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT 01983813.Circ Cardiovasc Qual Outcomes. 2018;11:e004188. doi: 10.1161/CIRCOUTCOMES.117.004188.Footnoteshttps://www.ahajournals.org/journal/circ Previous Back to top Next FiguresReferencesRelatedDetails August 7, 2018Vol 138, Issue 6 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.118.036699PMID: 30354626 Originally publishedAugust 6, 2018 PDF download Advertisement