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Summoning STRENGTH to Question the Placebo in REDUCE-IT
John A. Bostrom, Joshua A. Beckman, Jeffrey S. Berger
doi : 10.1161/CIRCULATIONAHA.121.054539
Circulation. 2021;144:407–409
Quantifying and Understanding the Higher Risk of Atherosclerotic Cardiovascular Disease Among South Asian Individuals
Aniruddh P. Patel, Minxian Wang, Uri Kartoun, Kenney Ng, Amit V. Khera
doi : 10.1161/CIRCULATIONAHA.120.052430
Circulation. 2021;144:410–422
Individuals of South Asian ancestry represent 23% of the global population, corresponding to 1.8 billion people, and have substantially higher risk of atherosclerotic cardiovascular disease compared with most other ethnicities. US practice guidelines now recognize South Asian ancestry as an important risk-enhancing factor. The magnitude of enhanced risk within the context of contemporary clinical care, the extent to which it is captured by existing risk estimators, and its potential mechanisms warrant additional study.
The South Asian Enigma
Namratha R. Kandula, Alka M. Kanaya
doi : 10.1161/CIRCULATIONAHA.121.055159
Circulation. 2021;144:423–425
Relationship Between Residual Mitral Regurgitation and Clinical and Quality-of-Life Outcomes After Transcatheter and Medical Treatments in Heart Failure
Saibal Kar, Michael J. Mack, JoAnn Lindenfeld, William T. Abraham, Federico M. Asch, Neil J. Weissman, Maurice Enriquez-Sarano, D. Scott Lim, Jacob M. Mishell, Brian K. Whisenant, Jason H. Rogers, Suzanne V. Arnold, David J. Cohen, Paul A. Grayburn, Gregg W. Stone
doi : 10.1161/CIRCULATIONAHA.120.053061
Circulation. 2021;144:426–437
In the randomized COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation), among 614 patients with heart failure with 3+ or 4+ secondary mitral regurgitation (MR), transcatheter mitral valve repair (TMVr) with the MitraClip reduced MR, heart failure hospitalizations, and mortality and improved quality of life compared with guideline-directed medical therapy (GDMT) alone. We aimed to examine the prognostic relationship between MR reduction and outcomes after TMVr and GDMT alone.
Arrhythmia Mechanism and Dynamics in a Humanized Mouse Model of Inherited Cardiomyopathy Caused by Phospholamban R14del Mutation
Nour Raad, Philip Bittihn, Marine Cacheux, Dongtak Jeong, Zeki Ilkan, Delaine Ceholski, Erik Kohlbrenner, Lu Zhang, Chen-Leng Cai, Evangelia G. Kranias, Roger J. Hajjar, Francesca Stillitano, Fadi G. Akar
doi : 10.1161/CIRCULATIONAHA.119.043502
Circulation. 2021;144:441–454
Arginine (Arg) 14 deletion (R14del) in the calcium regulatory protein phospholamban (hPLNR14del) has been identified as a disease-causing mutation in patients with an inherited cardiomyopathy. Mechanisms underlying the early arrhythmogenic phenotype that predisposes carriers of this mutation to sudden death with no apparent structural remodeling remain unclear.
TET2 Protects Against Vascular Smooth Muscle Cell Apoptosis and Intimal Thickening in Transplant Vasculopathy
Allison C. Ostriker, Yi Xie, Raja Chakraborty, Ashley J. Sizer, Yalai Bai, Min Ding, Wen-Liang Song, Anita Huttner, John Hwa, Kathleen A. Martin
doi : 10.1161/CIRCULATIONAHA.120.050553
Circulation. 2021;144:455–470
Coronary allograft vasculopathy (CAV) is a devastating sequela of heart transplant in which arterial intimal thickening limits coronary blood flow. There are currently no targeted therapies to prevent or reduce this pathology that leads to transplant failure. Vascular smooth muscle cell (VSMC) phenotypic plasticity is critical in CAV neointima formation. TET2 (TET methylcytosine dioxygenase 2) is an important epigenetic regulator of VSMC phenotype, but the role of TET2 in the progression of CAV is unknown.
Myocarditis With COVID-19 mRNA Vaccines
Biykem Bozkurt, Ishan Kamat, Peter J. Hotez
doi : 10.1161/CIRCULATIONAHA.121.056135
Circulation. 2021;144:471–484
Myocarditis has been recognized as a rare complication of coronavirus disease 2019 (COVID-19) mRNA vaccinations, especially in young adult and adolescent males. According to the US Centers for Disease Control and Prevention, myocarditis/pericarditis rates are ?12.6 cases per million doses of second-dose mRNA vaccine among individuals 12 to 39 years of age. In reported cases, patients with myocarditis invariably presented with chest pain, usually 2 to 3 days after a second dose of mRNA vaccination, and had elevated cardiac troponin levels. ECG was abnormal with ST elevations in most, and cardiac MRI was suggestive of myocarditis in all tested patients. There was no evidence of acute COVID-19 or other viral infections. In 1 case, a cardiomyopathy gene panel was negative, but autoantibody levels against certain self-antigens and frequency of natural killer cells were increased. Although the mechanisms for development of myocarditis are not clear, molecular mimicry between the spike protein of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and self-antigens, trigger of preexisting dysregulated immune pathways in certain individuals, immune response to mRNA, and activation of immunologic pathways, and dysregulated cytokine expression have been proposed. The reasons for male predominance in myocarditis cases are unknown, but possible explanations relate to sex hormone differences in immune response and myocarditis, and also underdiagnosis of cardiac disease in women. Almost all patients had resolution of symptoms and signs and improvement in diagnostic markers and imaging with or without treatment. Despite rare cases of myocarditis, the benefit-risk assessment for COVID-19 vaccination shows a favorable balance for all age and sex groups; therefore, COVID-19 vaccination is recommended for everyone ?12 years of age.
From the Literature
Tracy Hampton
doi : 10.1161/CIRCULATIONAHA.121.056358
Circulation. 2021;144:485–486
In-Depth Evaluation of a Case of Presumed Myocarditis After the Second Dose of COVID-19 mRNA Vaccine
Alagarraju Muthukumar, Madhusudhanan Narasimhan, Quan-Zhen Li, Lenin Mahimainathan, Imran Hitto, Franklin Fuda, Kiran Batra, Xuan Jiang, Chengsong Zhu, John Schoggins, James B. Cutrell, Carol L. Croft, Amit Khera, Mark H. Drazner, Justin L. Grodin, Benjamin M. Greenberg, Pradeep P.A. Mammen, Sean J. Morrison, James A. de Lemos
doi : 10.1161/CIRCULATIONAHA.121.056038
Circulation. 2021;144:487–498
Does This Ischemic Pattern Look Right?
Lara Nicole Goldstein, Ming-Tung Wu, Mike Wells
doi : 10.1161/CIRCULATIONAHA.121.055548
Circulation. 2021;144:499–501
Myocarditis Temporally Associated With COVID-19 Vaccination
Carolyn M. Rosner, Leonard Genovese, Behnam N. Tehrani, Melany Atkins, Hooman Bakhshi, Saquib Chaudhri, Abdulla A. Damluji, James A. de Lemos, Shashank S. Desai, Abbas Emaminia, Michael Casey Flanagan, Amit Khera, Alireza Maghsoudi, Girum Mekonnen, Alagarraju Muthukumar, Ibrahim M. Saeed, Matthew W. Sherwood, Shashank S. Sinha, Christopher M. O’Connor, Christopher R. deFilippi
doi : 10.1161/CIRCULATIONAHA.121.055891
Circulation. 2021;144:502–505
Myocarditis After BNT162b2 and mRNA-1273 Vaccination
Kathryn F. Larson, Enrico Ammirati, Eric D. Adler, Leslie T. Cooper Jr, Kimberly N. Hong, Gianluigi Saponara, Daniel Couri, Alberto Cereda, Antonio Procopio, Cristina Cavalotti, Fabrizio Oliva, Tommaso Sanna, Vincenzo Antonio Ciconte, George Onyango, David R. Holmes, Daniel D. Borgeson
doi : 10.1161/CIRCULATIONAHA.121.055913
Circulation. 2021;144:506–508
Letter by Quintão and Cazita Regarding Article, “Inhibition of Cholesteryl Ester Transfer Protein Preserves High-Density Lipoprotein Cholesterol and Improves Survival in Sepsis”
Eder C.R. Quintão, Patricia M. Cazita
doi : 10.1161/CIRCULATIONAHA.120.053079
Circulation. 2021;144:e120–e121
Response by Brunham et al to Letter Regarding Article, “Inhibition of Cholesteryl Ester Transfer Protein Preserves High-Density Lipoprotein Cholesterol and Improves Survival in Sepsis”
Liam R. Brunham, Mark Trinder, Patrick C.N. Rensen, John Boyd
doi : 10.1161/CIRCULATIONAHA.121.055698
Circulation. 2021;144:e122
Diagnosis and Management of Myocarditis in Children
Yuk M. Law, Ashwin K. Lal, Sharon Chen, Daniela ?iháková, Leslie T. Cooper Jr, Shriprasad Deshpande, Justin Godown, Lars Grosse-Wortmann, Joshua D. Robinson, Jeffrey A. Towbin, and on behalf of the American Heart Association Pediatric Heart Failure and Transplantation Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young and Stroke Council
doi : 10.1161/CIR.0000000000001001
Circulation. 2021;144:e123–e135
Myocarditis remains a clinical challenge in pediatrics. Originally, it was recognized at autopsy before the application of endomyocardial biopsy, which led to a histopathology-based diagnosis such as in the Dallas criteria. Given the invasive and low-sensitivity nature of endomyocardial biopsy, its diagnostic focus shifted to a reliance on clinical suspicion. With the advances of cardiac magnetic resonance, an examination of the whole heart in vivo has gained acceptance in the pursuit of a diagnosis of myocarditis. The presentation may vary from minimal symptoms to heart failure, life-threatening arrhythmias, or cardiogenic shock. Outcomes span full resolution to chronic heart failure and the need for heart transplantation with inadequate clues to predict the disease trajectory. The American Heart Association commissioned this writing group to explore the current knowledge and management within the field of pediatric myocarditis. This statement highlights advances in our understanding of the immunopathogenesis, new and shifting dominant pathogeneses, modern laboratory testing, and use of mechanical circulatory support, with a special emphasis on innovations in cardiac magnetic resonance imaging. Despite these strides forward, we struggle without a universally accepted definition of myocarditis, which impedes progress in disease-targeted therapy.
Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association
Carl G. Streed Jr, Lauren B. Beach, Billy A. Caceres, Nadia L. Dowshen, Kerrie L. Moreau, Monica Mukherjee, Tonia Poteat, Asa Radix, Sari L. Reisner, Vineeta Singh, and on behalf of the American Heart Association Council on Peripheral Vascular Disease; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Council on Hypertension; and Stroke Council
doi : 10.1161/CIR.0000000000001003
Circulation. 2021;144:e136–e148
There is growing evidence that people who are transgender and gender diverse (TGD) are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Prior literature has characterized disparities in cardiovascular morbidity and mortality as a result of a higher prevalence of health risk behaviors. Mounting research has revealed that cardiovascular risk factors at the individual level likely do not fully account for increased risk in cardiovascular health disparities among people who are TGD. Excess cardiovascular morbidity and mortality is hypothesized to be driven in part by psychosocial stressors across the lifespan at multiple levels, including structural violence (eg, discrimination, affordable housing, access to health care). This American Heart Association scientific statement reviews the existing literature on the cardiovascular health of people who are TGD. When applicable, the effects of gender-affirming hormone use on individual cardiovascular risk factors are also reviewed. Informed by a conceptual model building on minority stress theory, this statement identifies research gaps and provides suggestions for improving cardiovascular research and clinical care for people who are TGD, including the role of resilience-promoting factors. Advancing the cardiovascular health of people who are TGD requires a multifaceted approach that integrates best practices into research, health promotion, and cardiovascular care for this understudied population.
Correction to: Diagnosis and Management of Myocarditis in Children: A Scientific Statement From the American Heart Association
doi : 10.1161/CIR.0000000000001011
Circulation. 2021;144:e149
Correction to: Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association
doi : 10.1161/CIR.0000000000001009
Circulation. 2021;144:e150
