Minneapolis Heart Institute Foundation Research Articles

Research frontiers and hotspots of coronary chronic total occlusion: A bibliometric analysis.

By analyzing the relevant literature, we can accurately grasp the current status of diagnosis and treatment of chronic total occlusion of coronary artery, and clarify the development trend, research frontiers and hotspots of this disease. A literature search with "chronic total occlusion" as the title was performed in the Web of Science database. The title, author, abstract, keywords, institution, publication, country, reference, and other endnotes of the selected literature were exported in the form of text. The author, country, institution, and keywords of the literature were analyzed through Citespace and VOSviewer. The United States has the highest proportion of articles. The institution with the largest number of publications in this field is the Minneapolis Heart Institute Foundation. Brilakis Emmanouil S is the author with the most published articles. The journal system with the largest number of articles in this field is Cardiac Cardiovascular Systems. The keywords with the highest frequency are "chronic total occlusion," "percutaneous coronary intervention," "recanalization," and "revascularization." The burst detection analysis of hot keywords shows that "algorithm," "management," and "mortality" are the research hotspots in this field in recent years. At present, the research on this disease mainly focuses on the opening of occluded coronary arteries through various treatment methods. In the near future and the next few years, the research hotspots may be the scoring system algorithms for the treatment of chronic total occlusion of coronary artery and the management strategies for patients.

Global status and trends in coronary chronic total occlusion over the period 2000–2023: a bibliometric analysis

Background and purpose: Chronic total occlusion (CTO) affects 25% to 30% of individuals with coronary heart disease (CHD), posing significant challenges in percutaneous revascularization. This study investigates the advancement sand research trends in CTO by analyzing publication contributions from diverse countries, institutions, journals, and authors. Methods: We conducted a comprehensive literature review of CTO publications spanning from 2000 to 2023, utilizing the Web of Science Core Collection (WoSCC). Articles included were limited to those published in English. Research trends in the field were analyzed using CiteSpace 6.2.R4 (Chaomei Chen, Drexel University, Philadelphia, PA, USA) and VOSviewer 1.6.19 (Leiden University, Leiden, The Netherlands). Results: A total of 2,202 articles related to CTO were identified. The United States (US) emerged as the top contributor with 438 papers, followed by China with 305 papers, and Italy with 185 papers. Leading institutions included the US Department of Veterans Affairs with 353 publications, and Minneapolis Heart Institute Foundation with 217 publications. The Journal of the American College of Cardiology was the journal with the most publications in the field of CTO. Emmanouil S. Brilakis was identified as the most prolific author, while Gerald S. Werner had the highest average citation count. Cluster analysis highlighted chronic total occlusion percutaneous coronary intervention (CTO-PCI) as a focal area of research attention, indicating a promising trajectory for the field. Conclusions: This study provides a comprehensive analysis of the global research trends of CTO. The substantial increase in high-quality publications over the past 24 years highlights a promising future for the research and advancement of CTO-PCI.

Simple Maneuver to Improve TriClip Eligibility in Patients With Cardiac Implantable Electronic Device Leads.

HomeCirculation: Cardiovascular InterventionsVol. 16, No. 6Simple Maneuver to Improve TriClip Eligibility in Patients With Cardiac Implantable Electronic Device Leads No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessCase ReportRequest AccessFull TextSimple Maneuver to Improve TriClip Eligibility in Patients With Cardiac Implantable Electronic Device Leads Paul Sorajja, Yashasvi Chugh, Marcus Burns, Nadira Hamid and Richard Bae Paul SorajjaPaul Sorajja Correspondence to: Paul Sorajja, MD, Roger and Lynn Headrick Family Chair, Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th St, Ste 200, Minneapolis, MN, 55417. Email E-mail Address: [email protected] https://orcid.org/0000-0001-6401-854X Valve Science Center, Minneapolis Heart Institute Foundation, MN. Allina Health Minneapolis Heart Institute at AbbottNorthwestern Hospital, MN. Search for more papers by this author , Yashasvi ChughYashasvi Chugh https://orcid.org/0000-0001-9724-9088 Valve Science Center, Minneapolis Heart Institute Foundation, MN. Allina Health Minneapolis Heart Institute at AbbottNorthwestern Hospital, MN. Search for more papers by this author , Marcus BurnsMarcus Burns Valve Science Center, Minneapolis Heart Institute Foundation, MN. Allina Health Minneapolis Heart Institute at AbbottNorthwestern Hospital, MN. Search for more papers by this author , Nadira HamidNadira Hamid Valve Science Center, Minneapolis Heart Institute Foundation, MN. Allina Health Minneapolis Heart Institute at AbbottNorthwestern Hospital, MN. Search for more papers by this author and Richard BaeRichard Bae Valve Science Center, Minneapolis Heart Institute Foundation, MN. Allina Health Minneapolis Heart Institute at AbbottNorthwestern Hospital, MN. Search for more papers by this author Originally published20 Jun 2023https://doi.org/10.1161/CIRCINTERVENTIONS.123.012950Circulation: Cardiovascular Interventions. 2023;16FootnotesFor Sources of Funding and Disclosures, see page 400.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCINTERVENTIONS.123.012950.Correspondence to: Paul Sorajja, MD, Roger and Lynn Headrick Family Chair, Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th St, Ste 200, Minneapolis, MN, 55417. Email paul.[email protected]com Previous Back to top Next FiguresReferencesRelatedDetails June 2023Vol 16, Issue 6 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.123.012950PMID: 37339235 Originally publishedJune 20, 2023 KeywordsinterferencecatheterheartfemaleelectronicsPDF download Advertisement SubjectsCatheter-Based Coronary and Valvular Interventions

North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality.

BackgroundIn-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is higher in those with COVID-19 than in those without COVID-19. The factors that predispose to this mortality rate and their relative contribution are poorly understood. This study developed a risk score inclusive of clinical variables to predict in-hospital mortality in patients with COVID-19 and STEMI.MethodsBaseline demographic, clinical, and procedural data from patients in the North American COVID-19 Myocardial Infarction registry were extracted. Univariable logistic regression was performed using candidate predictor variables, and multivariable logistic regression was performed using backward stepwise selection to identify independent predictors of in-hospital mortality. Independent predictors were assigned a weighted integer, with the sum of the integers yielding the total risk score for each patient.ResultsIn-hospital mortality occurred in 118 of 425 (28%) patients. Eight variables present at the time of STEMI diagnosis (respiratory rate of >35 breaths/min, cardiogenic shock, oxygen saturation of <93%, age of >55 ​years, infiltrates on chest x-ray, kidney disease, diabetes, and dyspnea) were assigned a weighted integer. In-hospital mortality increased exponentially with increasing integer risk score (Cochran-Armitage χ2, P ​< ​.001), and the model demonstrated good discriminative power (c-statistic ​= ​0.81) and calibration (Hosmer-Lemeshow, P ​= ​.40). The increasing risk score was strongly associated with in-hospital mortality (3.6%-60% mortality for low-risk and very high–risk score categories, respectively).ConclusionsThe risk of in-hospital mortality in patients with COVID-19 and STEMI can be accurately predicted and discriminated using readily available clinical information.

Abstract 17423: Impact of Hypertriglyceridemia on ST-Elevation Myocardial Infarction Outcomes

Introduction: There has been conflicting data regarding the impact of hypertriglyceridemia (HTG) on STEMI outcomes, including reports of a “lipid paradox” defined as lower event rates in patients with HTG. Therefore, the association between HTG and outcomes in STEMI deserves further investigation especially given the results of REDUCE-IT trial. Methods: A prospective, multicenter database of the Midwest STEMI Consortium was examined. The Midwest STEMI Consortium is a unique association of 4 large STEMI systems of care: Iowa Heart Center, Minneapolis Heart Institute Foundation, Prairie Cardiovascular, and The Christ Hospital. We included all consecutive STEMI patients between age of 40 and 75. Those with missing TG levels were excluded (23%). We compared 3 groups of TG levels: normal (&lt;150 mg/dl), moderate (150 to 499 mg/dl), and severe (&gt;500 mg/dl) for MACE (death, MI, or stroke) and all-cause mortality. Results: Of 6492 consecutive STEMI patients from 03/2003 to 01/2020, 3760 (58%) met inclusion criteria. The mean (SD) age was 59.1 ± 9.2 and male gender was predominant (76%). A little over one-third of the study participants had moderate HTG (35%). Patients with higher TG levels had lower HDL levels and increased rates of history of premature CAD, DM, and HTN (Table). Moderate HTG was not a risk factor for MACE or all-cause mortality. Severe HTG was significantly associated with increased in-hospital (p=0.016) but not 1-year all-cause mortality (p=0.21) (Figure). Conclusions: In STEMI patients, higher TG levels were associated with increased in-hospital but not 1-year all-cause mortality.

Abstract 17305: Frequency, Predictors and Outcomes of Unplanned Coronary Angiography Following Successful Primary Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction Patients

Introduction: There is limited data regarding the frequency, predictors and impact of repeat, unplanned coronary angiography following successful reperfusion with primary PCI in STEMI pts. Methods: We used the prospective, multicenter Midwest STEMI Consortium database, which was created by unique consolidation of 4 large STEMI systems of care: Iowa Heart Center, Minneapolis Heart Institute Foundation, Prairie Cardiovascular, and The Christ Hospital. Each center has similar, well-established standardized STEMI protocols with collaboration over 100 non-PCI-capable hospitals in Midwest. We included all consecutive STEMI pts who underwent repeat, unplanned coronary angiography within 48-hour of successful primary PCI. We excluded pts who underwent a planned or staged coronary angiography. We compared pts with repeat, unplanned coronary angiography to a propensity-score matched (1:2) pts without repeat coronary angiography within 48-hour. Results: Among 6507 STEMI pts treated with primary PCI from 03/2003 to 01/2020, only 136 (2.1%) underwent repeat, unplanned coronary angiography. These pts had higher rates of LAD culprit, history of prior MI, poor pre-PCI TIMI flow (0 or 1) and lower EF. Nearly half of the repeat, unplanned coronary angiographies revealed patent stent (63/136). There were only 32 (24%) in-stent thrombosis and 30 (22%) new occlusions. Compare to the control group, pts with repeat, unplanned coronary angiography were more likely to have major bleeding and longer LOS (p=&lt;0.001) but similar MI, stroke, CV- or all-cause mortality up to 1-year follow-up. Of note, in-hospital MI, which was significantly higher reported in pts with repeat, unplanned coronary angiography, occurred basically prior to repeat coronary angiography (Table). Conclusions: Repeat, unplanned coronary angiography is relatively uncommon after contemporary primary PCI for STEMI pts and is more common with larger, anterior MIs.

Frequency and clinical impact of different definitions of moderate aortic stenosis

Abstract Background Current echocardiographic guidelines recommend five parameters to define severity of aortic stenosis (AS): peak velocity (PV), mean gradient (MG), aortic valve area (AVA), index AVA (AVAi), and dimensionless index (DI). However, the clinical utility of these parameters for patients with moderate AS largely remain unknown. Objective To investigate the clinical profiles and outcomes of patients with moderate AS according to five different definitions for severity. Methods Using standard echocardiographic definitions, we identified patients with moderate AS who were evaluated in our health care system from 2011 to 2012. Patient demographics, morbidities, and adverse events were reviewed, including death, heart failure (HF) admission, and aortic valve replacement (AVR). Results We enrolled 1,042 patients (age, 75±12 yrs; 40% women). Very few patients (4%) met all five criteria for moderate AS, while 49% had only one or two criteria met. DI was the most common parameter for defining moderate AS, employed in 93% of patients. Patients with area-based indices (i.e., AVA, AVAi, DI) had lower stroke volume index, lower mean gradients, lower peak velocities, and more morbidities in comparison to those flow-based definitions of severity (i.e., PV, MG). During a median follow-up of 5.7 years, overall survival was poor with all-cause mortality of 62.8%. Notably, there was no difference in the rates of mortality (range, 56.4 to 63.3%) or HF hospitalization (range, 28.9 to 32.2%) for groups defined by the five parameters, though patients with flow-based definitions more likely had AVR in follow-up. Conclusions Most patients with moderate AS meet the definition for severity with one or few criteria. Regardless of the method of definition for severity, a high rate of mortality and morbidity can occur in patients with moderate AS. Further study to optimize the clinical outcomes of patients with moderate AS is warranted. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Minneapolis Heart Institute Foundation

The Midwest ST-Elevation Myocardial Infarction Consortium: Design and Rationale

BackgroundOver the past 20 years, the development of regional ST-elevation myocardial infarction (STEMI) care systems has led to remarkable progress in achieving timely coronary reperfusion with attendant improvement in clinical outcomes, including survival. Despite this progress, contemporary STEMI care does not consistently meet the national guideline-recommended goals, which offers an opportunity for further improvement in STEMI outcomes. The lack of single, comprehensive, national STEMI registry complicates our ability to improve STEMI outcomes in particular for high-risk STEMI subsets such as cardiac arrest (CA) and/or cardiogenic shock (CS). ObjectivesTo address this need, the Midwest STEMI Consortium (MSC) was created as a collaboration of 4 large, regional STEMI care systems to provide a comprehensive, multicenter, and prospective STEMI registry without any exclusionary criteria. MethodsThe MSC is a collaboration of 4 large, regional STEMI care systems: Iowa Heart Center in Des Moines, IA; Minneapolis Heart Institute Foundation in Minneapolis, MN; Prairie Heart Institute in Springfield, IL; and The Christ Hospital in Cincinnati, OH. Each has similar standardized STEMI protocol and together include 6 percutaneous coronary intervention (PCI)-capable hospitals and over 100 non-PCI-capable hospitals. Each center had a prospective database that was transferred to a data coordinating center to create the multicenter database. The comprehensive database includes traditional risk factors, cardiovascular history, medications, time to treatment data, detailed angiographic characteristics, and short- and long-term clinical outcomes up to 5-year for myocardial infarction, stroke, and cardiovascular and all-cause mortality. Ten-year mortality rates were assessed by using national death index. ResultsCurrently, the comprehensive database (03/2003–01/2020) includes 14,911 consecutive STEMI patients with mean age of 62.3 ± 13.6 years, female gender (29%), and left anterior descending artery as the culprit vessel (34%). High risk features included: Age >75 years (19%), left ventricular ejection fraction <35% (15%), CA (10%), and CS (8%). ConclusionThis collaboration of 4 large, regional STEMI care systems with broad entry criteria including high-risk STEMI subsets such as CA and/or CS provides a unique platform to conduct clinical research studies to optimize STEMI care.

P1077Late gadolinium enhancement with cardiac magnetic resonance imaging demonstrates left ventricular involvement is under-recognized in arrhythmogenic right ventricular cardiomyopathy

Abstract Funding Acknowledgements The study is partially funded by Medtronic and the Minneapolis Heart Institute Foundation. Background/Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by replacement of the myocardium with fibrous and fatty tissue that may lead to an increased risk of ventricular arrhythmias and heart failure. Although left ventricular (LV) and biventricular forms have been identified post-mortem resulting in the increased use of the term arrhythmogenic cardiomyopathy, there is only inclusion of right ventricular wall motion abnormalities in the taskforce diagnostic criteria. Purpose The aim of our study was to examine the utility of cardiac magnetic resonance (CMR) imaging in characterizing LV or biventricular involvement with late gadolinium enhancement (LGE) in a large cohort of patients with suspected ARVC. Methods Retrospective, single-institution, chart review of 76 patients diagnosed with ARVC between January 2009 and July 2019. Data collection and analysis included baseline demographics and parameters specific to diagnosis (definite, borderline, or possible) and risk stratification of ARVC based on 2019 modified taskforce criteria, as well as detailed CMR evaluation. Results Of the 76 patients with ARVC, 66 (87%) had at least one CMR with gadolinium administered. In that subset of patients, 27 (41%) had LGE. Of those with LGE, LV involvement was identified in 23 (85%) patients. The pattern of LGE was not localized to one myocardial region but demonstrated variable LV enhancement patterns including anterior, inferior, lateral, septal, basal, mid, apical, and from the sub-epicardium into the mid-myocardium. Conclusions Left ventricular involvement reflected by LGE was identified in a high percentage of patients with suspected ARVC, and there was significant variation in the pattern of distribution in terms of region and depth of myocardial involvement. While post-mortem examination of patients with ARVC demonstrates a high prevalence of left ventricular involvement, this study shows that CMR can consistently detect late gadolinium enhancement, and ARVC should be considered in the differential diagnosis for biventricular cardiomyopathy. The identification of variable locations of LGE within the LV suggests there is more than one phenotype, and this imaging modality may help to clarify the implications of left ventricular involvement in disease progression.

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

P302Prediction of long-term success with global longitudinal strain in patients treated with transcatheter mitral repair

Abstract Background Transcatheter mitral valve repair with MitraClip is effective for patients with mitral regurgitation (MR) and high or prohibitive surgical risk. Global longitudinal strain (GLS) allows evaluation of subclinical myocardial dysfunction, but its incremental clinical utility is unknown in patients treated with MitraClip. Purpose To evaluate the relation of baseline GLS and 1-year combined endpoint of all-cause death and heart failure hospitalization in patients treated with MitraClip. Methods We analyzed all patients who underwent MitraClip in our hospital between 2012 and 2018. Baseline LV GLS was obtained by 2D speckle tracking echocardiography, averaging the 18-segments from 3 apical views. Receiver operating characteristic (ROC) analyses were used to assess GLS cut-point associated with mortality. Multivariate models with Cox regression tested its relationship after adjustment of baseline characteristics. Results We examined 155 patients (mean age 83±7 years, 52% men; mean LVEF 56±10%, the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) for repair 6.62±5.22%). At one-year, there were 30 deaths and 9 of heart failure hospitalizations, totalizing a composite outcome rate of 25.2%. Baseline GLS (per 1% increase) was associated with 1-year combined endpoint before (HR 1.10, 95% CI 1.02–1.19, p=0.02) and after (HR 1.10, 95% CI 1.01–1.20, p=0.04, respectively) adjustment for baseline characteristics. The optimal value of GLS for discriminating mortality at 1-year was −14.5% (AUC, 0.60; sensitivity 40%, specificity 76%). After accounting for baseline characteristics, patients with reduced GLS (&gt;−14.5%) had worse 1-year combined endpoint than those with preserved GLS (≤−14.5%) (p&lt;0.001; Figure). Conclusions Baseline GLS is independently associated with 1-year combined endpoint of all-cause mortality and/or heart failure hospitalization in patients who received transcatheter mitral valve repair. Detection of subclinical myocardial dysfunction by GLS may improve risk stratification and long-term success in these patients. Acknowledgement/Funding Valve Science Center, Minneapolis Heart Institute Foundation

The Case for Takotsubo Cardiomyopathy (Syndrome) as a Variant of Acute Myocardial Infarction

The Case for Takotsubo Cardiomyopathy (Syndrome) as a Variant of Acute Myocardial Infarction

Meet the First Authors.

Meet the First Authors.

Death and Cardiac Arrest in U.S. Triathlon Participants, 1985 to 2016: A Case Series.

Reports of race-related triathlon fatalities have raised questions regarding athlete safety. To describe death and cardiac arrest among triathlon participants. Case series. United States. Participants in U.S. triathlon races from 1985 to 2016. Data on deaths and cardiac arrests were assembled from such sources as the U.S. National Registry of Sudden Death in Athletes (which uses news media, Internet searches, LexisNexis archival databases, and news clipping services) and USA Triathlon (USAT) records. Incidence of death or cardiac arrest in USAT-sanctioned races from 2006 to 2016 was calculated. A total of 135 sudden deaths, resuscitated cardiac arrests, and trauma-related deaths were compiled; mean (±SE) age of victims was 46.7±12.4 years, and 85% were male. Most sudden deaths and cardiac arrests occurred in the swim segment (n= 90); the others occurred during bicycling (n= 7), running (n= 15), and postrace recovery (n= 8). Fifteen trauma-related deaths occurred during the bike segment. Incidence of death or cardiac arrest among USAT participants (n= 4776443) was 1.74 per 100000 (2.40 in men and 0.74 in women per 100000; P < 0.001). In men, risk increased substantially with age and was much greater for those aged 60 years and older (18.6 per 100000 participants). Death or cardiac arrest risk was similar for short, intermediate, and long races (1.61 vs. 1.41 vs. 1.92 per 100000 participants). At autopsy, 27 of 61 decedents (44%) had clinically relevant cardiovascular abnormalities, most frequently atherosclerotic coronary disease or cardiomyopathy. Case identification may be incomplete and may underestimate events, particularly in the early study period. In addition, prerace medical history is unknown in most cases. Deaths and cardiac arrests during the triathlon are not rare; most have occurred in middle-aged and older men. Most sudden deaths in triathletes happened during the swim segment, and clinically silent cardiovascular disease was present in an unexpected proportion of decedents. Minneapolis Heart Institute Foundation.

Correction to: 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.

In the article by Yancy et al, “2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America,” which published online May 20, 2016, and appeared in the September 27, 2016, issue of the journal ( Circulation. 2016;134:e282–e293. DOI: 10.1161/CIR.0000000000000435), several corrections were needed. 1. On page e282, …

How gold is the gold standard? How gold does it need to be?

Catheterization and Cardiovascular InterventionsVolume 79, Issue 7 p. 1099-1100 Coronary Artery Disease How gold is the gold standard? How gold does it need to be?† Timothy D. Henry MD, Corresponding Author Timothy D. Henry MD [email protected] Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota Tel.: +612-863-7372. Fax: +612-863-3801Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100; Minneapolis, MN 55407Search for more papers by this authorScott W. Sharkey MD, Scott W. Sharkey MD Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MinnesotaSearch for more papers by this author Timothy D. Henry MD, Corresponding Author Timothy D. Henry MD [email protected] Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota Tel.: +612-863-7372. Fax: +612-863-3801Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100; Minneapolis, MN 55407Search for more papers by this authorScott W. Sharkey MD, Scott W. Sharkey MD Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MinnesotaSearch for more papers by this author First published: 04 June 2012 https://doi.org/10.1002/ccd.24463 † Conflict of interest: Nothing to report. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume79, Issue71 June 2012Pages 1099-1100 SCAI Member Sign in RelatedInformation

Hypertrophic Cardiomyopathy With Longevity to 90 Years or Older

Hypertrophic cardiomyopathy (HC) is the most common cause of sudden death in the young, but survival to particularly advanced age is less well appreciated. The investigators report the prevalence, clinical features, and demographics of patients with HC surviving to ≥90 years of age. Of 1,297 patients with HC in the Hypertrophic Cardiomyopathy Center database (Minneapolis Heart Institute Foundation), 26 (2.0%) were identified who had achieved the age of ≥90 years; 18 (69%) were women. HC diagnosis came late in life, at 61 to 92 years (mean 80 ± 8; ≥75 years in 21 patients), recognized fortuitously by the detection of a heart murmur or during family screening (n = 6) or after onset of new symptoms (n = 20). At most recent evaluation (or death) patients were aged 90 to 96.7 years (mean 92.2 ± 2), with 6 presently alive at 91 to 96 years of age; HC did not appear to be the primary cause of death in any patient. Left ventricular wall thicknesses were 15 to 31 mm (mean 20 ± 3); 8 patients (31%) had obstruction to left ventricular outflow at rest (peak instantaneous gradients, 38 to 135 mm Hg). Significant HC-related complications occurred in 13 patients (50%), including progressive heart failure symptoms, atrial fibrillation, and nonfatal embolic stroke. Although no patient died suddenly, 13 (50%) nevertheless carried conventional HC risk markers. A greater proportion of cohort patients reached ≥90 years of age (2.0%) than expected in the general population (0.8%) (p <0.001). In conclusion, HC may be unrecognized until late in life and is consistent with survival to particularly advanced age into the 10th decade of life without the need for major HC-related treatment interventions, and with demise ultimately largely unrelated to this disease. This principle regarding the natural history of HC can afford a measure of reassurance to many patients.

Eliminating untimely deaths of women from heart disease: Highlights from the Minnesota Women's Heart Summit

Despite national campaigns to increase awareness and reduce cardiovascular disease (CVD) mortality in women, CVD remains their leading cause of death, annually killing more women than men. Although some progress has been made in our understanding and treatment of CVD in women, the causes, extent, and demographic trends of observed sex differences and disparities remain uncertain, and the growing burden of CVD and its risk factors among younger women is concerning. The Minnesota Women's Heart Summit was convened to chart a course to eliminate premature deaths of women from heart disease. The multidisciplinary summit was hosted by the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, University of Minnesota, and Mayo Clinic. Presentations highlighted sex-based differences in symptoms, treatment, and outcomes, and panel experts provided commentary. Invited faculty and summit participants worked in small-group sessions to identify strategies to dissolve barriers, improve primary and secondary prevention, and enhance women's care and outcomes. This report summarizes strategies identified during the conference to serve as springboards for more substantive future initiatives. These include, for example, standardized data collection and use of existing data sets to inform perspectives on sex-related cardiovascular issues, mandatory reporting of sex-specific data, and increased attention to underserved/high-risk women. Participants acknowledged that implementing these ideas would be challenging and recommended key priorities/next action steps such as providing services close to "point-of-life" rather than "point-of-care" and creation of policies and regulations so that resources and environmental modifications encouraging healthier lifestyle choices are promoted. Additional research is needed to improve identification, treatment, and health behaviors and to address continued lack of awareness, symptom recognition delays, barriers to care, and outcome disparities-especially in diverse populations.

Is it time to “Rescue” Rescue PCI?

Catheterization and Cardiovascular InterventionsVolume 77, Issue 5 p. 605-607 Coronary Artery Disease Is it time to “Rescue” Rescue PCI?† Timothy D. Henry MD, Corresponding Author Timothy D. Henry MD [email protected] Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital Minneapolis, MinnesotaMinneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN 55407Search for more papers by this author Timothy D. Henry MD, Corresponding Author Timothy D. Henry MD [email protected] Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital Minneapolis, MinnesotaMinneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN 55407Search for more papers by this author First published: 23 March 2011 https://doi.org/10.1002/ccd.23000 † Conflict of interest: Nothing to report. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume77, Issue51 April 2011Pages 605-607 SCAI Member Sign in RelatedInformation

Electrocardiography and Preparticipation Screening of Competitive High School Athletes

Letters20 July 2010Electrocardiography and Preparticipation Screening of Competitive High School AthletesBarry J. Maron, MDBarry J. Maron, MDFrom Minneapolis Heart Institute Foundation, Minneapolis, MN 55407.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-2-201007200-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:I read with interest Dr. Marek's reaction to my editorial. Unfortunately, my comments seem to have been largely misunderstood. First, the disparity cited between U.S. and Italian physicians performing screening examinations relates specifically to the unique cadre of sports medicine physicians solely dedicated to this program in Italy—a crucial resource that simply does not exist in the United States, making national mandatory ECG screening exceedingly difficult, if not impractical. Second, the sudden death of any young athlete is tragic, but these events are uncommon (1–3). Third, Dr. Marek's characterization of the Sudden Death in Athletes Registry (1) as ...