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- Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term: A Randomized Trial
- Long-Term Nationwide Follow-Up Study of Simple Congenital Heart Disease Diagnosed in Otherwise Healthy Children
- Atrial Fibrillation Begets Heart Failure and Vice Versa: Temporal Associations and Differences in Preserved Versus Reduced Ejection Fraction
- Unplanned Inpatient and Observation Rehospitalizations After Acute Myocardial Infarction: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study
- Significance of Intermediate Values of Fractional Flow Reserve in Patients With Coronary Artery Disease
- Relation of Nailfold Capillaries and Autoantibodies to Mortality in Patients With Raynaud Phenomenon
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Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term: A Randomized Trial
Exercise training is an effective treatment for important atrial fibrillation (AF) comorbidities, and risk factor interventions have recently been shown to reduce AF burden. On the other hand, high levels of endurance exercise have been associated with an increased prevalence of AF. The effects of exercise training on arrhythmic burden in AF patients are uncertain, and there are currently no specific recommendations for exercise training in AF patients. In this randomized study, aerobic interval training for 12 weeks reduced the time in AF in patients with paroxysmal or persistent AF. It was associated with significant improvements in AF symptoms, exercise capacity, left atrial and ventricular function, lipid levels, and quality of life. These results support the growing evidence of a favorable effect on AF burden and disease progression by modulating cardiovascular risk factors and AF substrate. The reduction of time in AF, reduced AF symptoms, and improved quality of life induced by exercise training imply an important clinical benefit and support the concept that interventions aimed at lifestyle and risk factors should be central in the management and prevention of AF. Exercise intervention in the study is within the intensity, duration, and frequency recommended in guidelines for the prevention and treatment of cardiovascular disease. Further studies are needed to assess the safety of exercise training in AF patients and to find the optimal intensity and amount of exercise training over a longer period of time. See p 466.
Long-Term Nationwide Follow-Up Study of Simple Congenital Heart Disease Diagnosed in Otherwise Healthy Children
Sudden unexpected death has long been known as a substantial risk in adult congenital heart disease patients. Our contribution to this problem is to present a nationwide population study of patients with simple congenital heart disease in otherwise healthy children, with 50 years of follow-up. Our patients were prospectively registered from 1963 through 1973, and can be followed through Danish public registries concerning death, emigration, and hospital admission. Further, we can compare the fate of the patients with a control population in a ratio of 1:10, matched for sex and age. There were 1241 patients, followed for a total of 58 422 patient-years. Mortality was increased compared with the general population, hazard ratio 1.9 (95% confidence interval, 1.5–2.4). Mode of death was in 40% sudden unexpected death, which was 3 to 5 times higher than in the control population. Among patient not followed in the specialist hospital, there was a hazard ratio of death of 1.7 (95% confidence interval, 1.3–2.2). Back in the 1960s, when these patients were diagnosed, their parent were encouraged to let the child live without thinking of the disease. This was very sensible then. Today there are treatments to prevent sudden death. Thus, we now must do our best to identify and possibly treat the patients at risk among the simple congenital heart disease. It can be a difficult task to find these patients, who in childhood were urged to forget about the disease. There is a need for prospective studies, to prevent sudden death in simple adult congenital heart disease patients. See p 474.
Atrial Fibrillation Begets Heart Failure and Vice Versa: Temporal Associations and Differences in Preserved Versus Reduced Ejection Fraction
Atrial fibrillation (AF) and heart failure (HF) frequently coexist and together confer an adverse prognosis. However, the association of AF with HF subtypes has not been well-described. We studied the temporal association of new-onset AF and HF with preserved versus reduced ejection fraction in participants of the Framingham Heart Study. We show that AF occurs in more than half of individuals with HF and that HF occurs in more than one third of individuals with AF at some point of time. We found that AF precedes and follows both HF with preserved ejection fraction and HF with reduced ejection fraction, with some differences in temporal association: Prevalent AF was more strongly associated with incident HF with preserved ejection fraction. Lastly, AF and HF conjointly portend a poor prognosis, with a higher risk among those with reduced ejection fraction. These findings shed light on the complex association of AF and HF, and future studies focused on underlying mechanisms of these dual conditions and potential therapeutic strategies are warranted. See p 484.
Unplanned Inpatient and Observation Rehospitalizations After Acute Myocardial Infarction: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study
Each year, ≈1 million Americans are hospitalized for acute myocardial infarction, and after discharge from the index hospitalization, almost 1 in 5 Medicare patients is readmitted within 30 days. Previous studies examining early readmission after acute myocardial infarction have focused exclusively on inpatient readmissions; however, from a patient’s perspective, any unplanned inpatient or observation rehospitalization after acute myocardial infarction may represent a significant event. In this study of >12 000 patients with myocardial infarction treated with percutaneous coronary intervention at 233 hospitals in Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS), we found that ≈10% of patients had at least 1 unplanned rehospitalization within 30 days of discharge. One third of these rehospitalizations were classified as observation status, and the majority were for cardiovascular reasons. We observed that hospitals varied considerably (5.4%–20.0%) in their rates of 30-day unplanned rehospitalization. Although patient comorbidities, presentation characteristics, and procedural features were all related to unplanned rehospitalization, the 2 factors most strongly associated with increased risk of unplanned rehospitalization were baseline lower quality of life and the presence of depression. Predischarge and postdischarge assessments of overall, not just cardiovascular, health and strategies to optimize patient functional status may help to reduce unplanned rehospitalizations. See p 493.
Significance of Intermediate Values of Fractional Flow Reserve in Patients With Coronary Artery Disease
A fractional flow reserve (FFR) value ≤0.75 is almost uniformly associated with signs of ischemia, whereas an FFR >0.80 is usually associated with the absence of ischemia. Based on numerous randomized trials and registries, the threshold value of 0.80 has been widely accepted and recommended to guide clinical decision making. Yet, the best treatment strategy for intermediate stenosis with FFR in the narrow gray zone of values between 0.76 and 0.80 has been questioned. Our study focused on treatment strategies and related outcomes of patients presenting with an isolated coronary stenosis and FFR value within the gray zone of 0.76 to 0.80. The main findings of the study are: (1) Patients with single-vessel disease and a coronary stenosis with FFR within the gray zone have a numeric trend toward twice as much risk of combined death or myocardial infarction and overall death if treated with medical therapy only. (2) In these latter patients, the risk of a major adverse cardiovascular event progressively and independently decreased with increasing FFR stratum, suggesting an incremental risk of the gray-zone patients in comparison with patients with coronary stenosis and FFR >0.80. (3) This increased risk was only observed in patients with proximal location of the coronary stenoses. These data confirm the value of the 0.80 FFR threshold, and favor a revascularization strategy of coronary stenoses with FFR ≤0.80. See p 502.
Relation of Nailfold Capillaries and Autoantibodies to Mortality in Patients With Raynaud Phenomenon
Raynaud phenomenon is a widespread but still understudied condition. Data on survival prediction in patients with Raynaud phenomenon are scarce. To detect an emerging connective tissue disease, patients with incipient Raynaud phenomenon routinely undergo nailfold capillaroscopy and laboratory tests for antinuclear antibodies and antinuclear antibody subsets, as well. In this observational study we assessed the relation of these measures to all-cause mortality over a median follow-up of 9.3 years in patients with Raynaud phenomenon without previously known connective tissue disease. The present study reveals that survival was worse in male patients than in female patients with incipient Raynaud phenomenon. Apart from patients’ age, renal function was related to mortality. In female patients with Raynaud phenomenon, abnormal nailfold capillaries and antinuclear antibodies and anti-Scl-70 antibodies, as well, were associated with an increase in all-cause mortality. Highest mortality rates were found in patients with a conjoint presence of abnormal nailfold capillaries and autoantibodies. In male patients with Raynaud phenomenon, nailfold capillaries and autoantibodies were not related to survival. In summary, the present study demonstrates that, especially in female patients with Raynaud phenomenon, nailfold capillaroscopy and immunologic tests are of high clinical relevance, not only to detect an emerging connective tissue disease, but also to identify patients at risk of an increased mortality. See p 509.
- © 2016 American Heart Association, Inc.
This Issue
Jump to
- Article
- Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term: A Randomized Trial
- Long-Term Nationwide Follow-Up Study of Simple Congenital Heart Disease Diagnosed in Otherwise Healthy Children
- Atrial Fibrillation Begets Heart Failure and Vice Versa: Temporal Associations and Differences in Preserved Versus Reduced Ejection Fraction
- Unplanned Inpatient and Observation Rehospitalizations After Acute Myocardial Infarction: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study
- Significance of Intermediate Values of Fractional Flow Reserve in Patients With Coronary Artery Disease
- Relation of Nailfold Capillaries and Autoantibodies to Mortality in Patients With Raynaud Phenomenon
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- eLetters
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