The following science being presented during AHA 2022 in Chicago was simultaneously published Oct. 31 in JACC, JACC: Clinical Electrophysiology, JACC: Heart Failure, JACC: Cardiovascular Interventions, JACC: CardioOncology, JACC: Basic to Translational Science and JACC: Asia. Access all JACC Journals simultaneous publications on JACC.org.

JACC

Edoxaban in Children With Cardiac Disease: A study by Michael A. Portman, MD, et al., identified edoxaban as a potential alternative mode of thromboprophylaxis in children with cardiac disease. Results of a cohort of 167 children in the ENNOBLE-ATE trial showed low rates of clinically relevant bleeding and thromboembolism with advantages of once daily dosing and infrequent monitoring requirement. Read the full study. In a related editorial comment, Nadine F. Choueiter, MD, writes that while the study provides “exciting and crucial initial evidence” on the subject, “it is neither designed nor powered to test the superiority or inferiority of edoxaban in comparison to anticoagulants.”

Elevated C-Reactive Protein: Lipoprotein(a) [Lp(a)] concentration is associated with the risk of cardiovascular events, reflecting atherogenic, thrombogenic or proinflammatory properties, according to Gregory G. Schwartz, MD, PhD, FACC, et al. A post-hoc analysis of the ODYSSEY OUTCOMES trial concluded that elevated high-sensitivity C-reactive protein amplifies the relationship of Lp(a) with the risk of cardiovascular events after acute coronary syndrome (ACS). Additionally, the clinical benefit of alirocumab after ACS depends on levels of both biomarkers. Read the full study.

Thrombotic Antiphospholipid Syndrome: Candrika D. Khairani, MD, et al., conducted a meta-analysis of four open-label randomized controlled trials involving 472 patients and found that patients with thrombotic antiphospholipid syndrome randomized to direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) appear to have increased risk for arterial thrombotic events. However, no significant differences were observed between patients randomized to DOACs vs VKAs in the risk of subsequent venous thromboembolic events or major bleeding. Read the full study.

High-Sensitivity Cardiac Troponin Implementation: A study by Cian McCarthy, MBBCh, BAO, et al., examined trends in implementation of hs-cTn assays among 500 participating hospitals in ACC’s Chest Pain-MI Registry and assessed the association of their use with in-hospital cardiac testing and outcomes. They found that implementation of hs-cTn is increasing but most U.S. hospitals continue to use less sensitive assays. Additionally, hs-cTn use was associated with modestly shorter length of stay, greater use of echocardiography for NSTE-ACS, and less use of invasive angiography among low-risk patients. Read the full study.

Pediatric CHD Research: A workshop convened by the National Heart, Lung, and Blood Institute in August 2021 identified opportunities in pediatric and congenital cardiovascular research that would improve outcomes in patients with congenital heart disease (CHD) across the lifespan. Alexander R. Opotowsky, MD, MMSc, et al., write that the identified themes “provide a framework to focus our efforts to enhance the impact of clinical research on pediatric and congenital cardiovascular disease,” and that to achieve the field’s shared potential it will be crucial to partner across a broad range of organizers and investigators to fund and perform research. Read the full study.

JACC: Clinical Electrophysiology

Periodontitis and Atrial Fibrosis: New research from Shunsuke Miyauchi, MD, PhD, et al., identified periodontitis as a likely risk factor for atrial fibrillation (AFib). The researchers, who evaluated the relationship between periodontitis and atrial fibrosis by studying resected left atrial appendages (LAA), conducted an oral examination in 76 patients who were scheduled to undergo LAA excision during cardiac surgery. Read the full study. In a related editorial comment, Andreas Goette, MD, adds, “What are the driving factors for the activation of atrial inflammatory pathways or histological atrial changes? Are profibrotic risk factors modifiable?”

Low BMI and Cardiac Tamponade During AFib Ablation: A study by Reina Tonegawa-Kuji, MD, PhD, et al., found low body mass index was independently associated with an increased risk of cardiac tamponage during AFib ablation. The researchers analyzed data from a Japanese nationwide claims database of 59,789 hospitalizations with catheter ablation for AFib between April 1, 2016 and March 31, 2018. Read the full study.

Subcutaneous and Transvenous ICD in ARVC: A study by Weijia Wang, MD, MPH, et al., compared clinical and quality-of-life outcomes between transvenous and subcutaneous ICDs among patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and concluded that in patients with ARVC receiving an ICD, the risk of inappropriate shocks from a subcutaneous ICD should be balanced against the significant vascular complication risk from a transvenous ICD. Read the full study.

Early Mortality After VT Ablation in Reduced LVEF: A retrospective analysis of 503 patients with reduced left ventricular ejection fraction (LVEF) after ventricular tachycardia (VT) ablation showed that the overall early mortality (≤30 days) rate was 5%. The most common primary cause of death was recurrent VT (44%), followed by decompensated heart failure (HF) (28%), according to Justin Z. Lee, MD, et al. Significant predictors of early mortality included nonischemic cardiomyopathy, lower LVEF, electrical storm and ventricular fibrillation. Read the full study.

JACC: Heart Failure

Income and HF Readmission Trends: A study by Nijat Aliyev, MD, et al., examined data of 9,020,742 HF index hospitalizations from the National Readmission Database and compared patient outcomes based on household income quartiles. They found that, between 2010 and 2019, adjusted all-cause and HF-specific 30-day readmission rates increased for patients in the lowest two income quartiles. “The current data suggest that disparities in readmissions by household income status have increased over time,” Aliyev, et al., write. Read the full study.

HF Cardiogenic Shock: In a large, contemporary HF cardiogenic shock cohort, Jaime Hernandez-Montfort, MD, MPH, et al., found a greater incidence of in-hospital death, cardiac arrest, and more rapid escalation to maximum SCAI Stage severity among de novo HF-related cardiogenic shock. In addition, the use of acute mechanical circulatory support in HF-related cardiogenic shock was common with significant heterogeneity among device type. Read the full study.

JACC: Cardiovascular Interventions

Cangrelor Following Ticagrelor Pretreatment: In a prospective, randomized, double-blind, placebo-controlled, cross-over, pharmacokinetic and pharmacodynamic study of patients with coronary artery disease, Francesco Franchi, MD, et al., concluded that the use of cangrelor in patients pretreated with ticagrelor results in enhanced platelet inhibition with no differences in pharmacokinetic/pharmacodynamic profiles after discontinuation of drug infusion, indicating the absence of a drug-drug interaction. Read the full study.

JACC: CardioOncology

Racial Difference in Men With Prostate Cancer: Results from a single-center study by Nickolas Stabellini, BS, et al., found that chronic stress, as measured by the allostatic load, is higher among non-Hispanic Blacks compared with non-Hispanic Whites before a diagnosis of prostate cancer, but both groups experienced a similar increase after diagnosis and treatment with androgen deprivation therapy. Read the full study.  

JACC: Basic to Translational Science

Metabolomic Signatures of MGU on Fluorine-18 FDG-PET: In a crossover trial (KEETO-CROSS), Mahesh K. Vidula, MD, FACC, et al., found that combined markers of enhanced ketone/fatty acid oxidation and BCAA catabolism strongly predicted myocardial glucose suppression (MGS), had robust discriminatory value, and demonstrated utility in measuring before fluorodeoxyglucose positron emission tomography (FDG-PET) to reduce the risk of false-positive scans. “These findings suggest that strategies to enhance these oxidative pathways, rather than augmenting circulating metabolite levels alone, may be more effective in improving MGS,” Vidula, et al., write. Read the full study.

JACC: Asia

Cardiogenic Shock With Temporary MCS: Using data from a nationwide Japanese database of 65,847 patients receiving temporary mechanical circulatory support (MCS) for cardiogenic shock, Toru Kondo, MD, PhD, et al., determined the most common causes of cardiogenic shock were acute myocardial infarction (77.4%) and HF (13.6%). The use and combination patterns of MCS varied according to the causes of cardiogenic shock, and the in-hospital mortality also varied according to the types of MCS used within each specific cause of cardiogenic shock. Read the full study.

Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Pericardial Disease, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Atherosclerotic Disease (CAD/PAD), ACS and Cardiac Biomarkers, Anticoagulation Management and ACS, Anticoagulation Management and Atrial Fibrillation, Anticoagulation Management and Venothromboembolism, Implantable Devices, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Advanced Lipid Testing, Lipid Metabolism, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Angiography, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging, Stress

Keywords: AHA Annual Scientific Sessions, AHA22, Ketones, Glucose, Registries, Vitamin K, Troponin, Oxidative Stress, Hospitals, Fatty Acids, Chest Pain, Biomarkers, Angiography, Periodontitis, Lipoprotein(a), Heart Failure, Hemorrhage, Heart Arrest, Cardiac Surgical Procedures, Fibrosis, Echocardiography, Diagnosis, Oral, Electrophysiology, Drug Interactions, Catheter Ablation, Tachycardia, Ventricular, Positron-Emission Tomography, Risk Factors, Ventricular Function, Left, Venous Thromboembolism, Prostatic Neoplasms, Ventricular Fibrillation, Shock, Cardiogenic, Race Factors, Quality of Life, Incidence, Cross-Over Studies, Cause of Death, Cardiac Tamponade, Atrial Appendage, Arrhythmogenic Right Ventricular Dysplasia, Antiphospholipid Syndrome, Antiphospholipid Syndrome, Allostasis, Acute Coronary Syndrome, Coronary Artery Disease, Cardiovascular Diseases, Prospective Studies, Retrospective Studies, Ticagrelor, Stroke Volume, Patient Readmission, Fluorodeoxyglucose F18, C-Reactive Protein, Body Mass Index, Atrial Fibrillation, Anticoagulants, Androgens, Androgen Antagonists, Hospital Mortality, Child

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