Rhythm Control of Atrial Fibrillation

Anne M. Gillis, Stephen B. Wilton

doi : 10.1161/CIRCULATIONAHA.120.051383

Circulation. 2021 | Volume 143, Issue 17: 1639–1641

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Fruit and Vegetable Intake and Mortality

Dong D. Wang, Yanping Li, Shilpa N. Bhupathiraju, Bernard A. Rosner, Qi Sun, Edward L. Giovannucci, Eric B. Rimm, JoAnn E. Manson, Walter C. Willett, Meir J. Stampfer, Frank B. Hu

doi : 10.1161/CIRCULATIONAHA.120.048996

Circulation. 2021 | Volume 143, Issue 17: 1642–1654

The optimal intake levels of fruit and vegetables for maintaining long-term health are uncertain.

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More Evidence for 5-a-Day for Fruit and Vegetables and a Greater Need for Translating Dietary Research Evidence to Practice

Naveed Sattar, Nita G. Forouhi

doi : 10.1161/CIRCULATIONAHA.121.053293

Circulation. 2021 | Volume 143, Issue 17: 1655–1658

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Diagnostic Performance of High-Sensitivity Cardiac Troponin T Strategies and Clinical Variables in a Multisite US Cohort

Brandon R. Allen, Robert H. Christenson, Scott A. Cohen, Richard Nowak, R. Gentry Wilkerson, Bryn Mumma, Troy Madsen, James McCord, Maite Huis in’t Veld, Michael Massoomi, Jason P. Stopyra, Cindy Montero, Michael T. Weaver, Kai Yang, Simon A. Mahler

doi : 10.1161/CIRCULATIONAHA.120.049298

Circulation. 2021 | Volume 143, Issue 17: 1659–1672

European data support the use of low high-sensitivity troponin (hs-cTn) measurements or a 0/1-hour (0/1-h) algorithm for myocardial infarction to exclude major adverse cardiac events (MACEs) among patients in the emergency department with possible acute coronary syndrome. However, modest US data exist to validate these strategies. This study evaluated the diagnostic performance of an initial hs-cTnT measure below the limit of quantification (LOQ: 6 ng/L), a 0/1-h algorithm, and their combination with history, ECG, age, risk factors, and initial troponin (HEART) scores for excluding MACE in a multisite US cohort.

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Empagliflozin Effects on Pulmonary Artery Pressure in Patients With Heart Failure

Michael E. Nassif, Mohammed Qintar, Sheryl L. Windsor, Rita Jermyn, David M. Shavelle, Fengming Tang, Sumant Lamba, Kunjan Bhatt, John Brush, Andrew Civitello, Robert Gordon, Orvar Jonsson, Brent Lampert, Jamie Pelzel, Mikhail N. Kosiborod

doi : 10.1161/CIRCULATIONAHA.120.052503

Circulation. 2021 | Volume 143, Issue 17: 1673–1686

Sodium glucose cotransporter 2 inhibitors (SGLT2 inhibitors) prevent heart failure (HF) hospitalizations in patients with type 2 diabetes and improve outcomes in those with HF and reduced ejection fraction, regardless of type 2 diabetes. Mechanisms of HF benefits remain unclear, and the effects of SGLT2 inhibitor on hemodynamics (filling pressures) are not known. The EMBRACE-HF trial (Empagliflozin Evaluation by Measuring Impact on Hemodynamics in Patients With Heart Failure) was designed to address this knowledge gap.

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Excessive O-GlcNAcylation Causes Heart Failure and Sudden Death

Priya Umapathi, Olurotimi O. Mesubi, Partha S. Banerjee, Neha Abrol, Qinchuan Wang, Elizabeth D. Luczak, Yuejin Wu, Jonathan M. Granger, An-Chi Wei, Oscar E. Reyes Gaido, Liliana Florea, C. Conover Talbot Jr, Gerald W. Hart, Natasha E. Zachara, Mark E. Anderson

doi : 10.1161/CIRCULATIONAHA.120.051911

Circulation. 2021 | Volume 143, Issue 17: 1687–1703

Heart failure is a leading cause of death worldwide and is associated with the rising prevalence of obesity, hypertension, and diabetes. O-GlcNAcylation (the attachment of O-linked ?-N-acetylglucosamine [O-GlcNAc] moieties to cytoplasmic, nuclear, and mitochondrial proteins) is a posttranslational modification of intracellular proteins and serves as a metabolic rheostat for cellular stress. Total levels of O-GlcNAcylation are determined by nutrient and metabolic flux, in addition to the net activity of 2 enzymes: O-GlcNAc transferase (OGT) and O-GlcNAcase (OGA). Failing myocardium is marked by increased O-GlcNAcylation, but whether excessive O-GlcNAcylation contributes to cardiomyopathy and heart failure is unknown.

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Single Nuclei Sequencing Reveals Novel Insights Into the Regulation of Cellular Signatures in Children With Dilated Cardiomyopathy

Luka Nicin, Wesley T. Abplanalp, Anne Sch?nzer, Anke Sprengel, David John, Hannah Mellentin, Lukas Tombor, Matthias Keuper, Evelyn Ullrich, Karin Klingel, Reinhard B. Dettmeyer, Jedrzej Hoffmann, Hakan Akintuerk, Christian Jux, Dietmar Schranz, Andreas M. Zeiher, Stefan Rupp, Stefanie Dimmeler

doi : 10.1161/CIRCULATIONAHA.120.051391

Circulation. 2021 | Volume 143, Issue 17: 1704–1719

Dilated cardiomyopathy (DCM) is a leading cause of death in children with heart failure. The outcome of pediatric heart failure treatment is inconsistent, and large cohort studies are lacking. Progress may be achieved through personalized therapy that takes age- and disease-related pathophysiology, pathology, and molecular fingerprints into account. We present single nuclei RNA sequencing from pediatric patients with DCM as the next step in identifying cellular signatures.

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Highlights From the Circulation Family of Journals

doi : 10.1161/CIRCULATIONAHA.121.055032

Circulation. 2021 | Volume 143, Issue 17: 1720–1724

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Dual-Chamber Pacemaker After Sinus Node Dysfunction and Enlarged Right Atrium

Emilio Arbas-Redondo, ?lvaro Montes-Mu?iz, Carlos A. ?lvarez-Ortega

doi : 10.1161/CIRCULATIONAHA.121.054510

Circulation. 2021 | Volume 143, Issue 17: 1725–1728

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Serial Versus Single Cardiovascular Screening of Adolescent Athletes

Patrizio Sarto, Alessandro Zorzi, Laura Merlo, Teresina Vessella, Cinzia Pegoraro, Flaviano Giorgiano, Alessandro Patti, Martino Crosato, Gaetano Thiene, Jonathan A. Drezner, Cristina Basso, Domenico Corrado

doi : 10.1161/CIRCULATIONAHA.120.053168

Circulation. 2021 | Volume 143, Issue 17: 1729–1731

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Letter by Zhang and Liu Regarding Article, “Genetic Architecture of Abdominal Aortic Aneurysm in the Million Veteran Program”

Kaijie Zhang, Zhenjie Liu

doi : 10.1161/CIRCULATIONAHA.120.052263

Circulation. 2021 | Volume 143, Issue 17: e872

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Response by Pan and Tsao to Letter Regarding Article, “Genetic Architecture of Abdominal Aortic Aneurysm in the Million Veteran Program”

Cuiping Pan, Philip S. Tsao

doi : 10.1161/CIRCULATIONAHA.121.053669

Circulation. 2021 | Volume 143, Issue 17: e873–e874

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Reducing Nontraumatic Lower-Extremity Amputations by 20% by 2030: Time to Get to Our Feet: A Policy Statement From the American Heart Association

Mark A. Creager, Kunihiro Matsushita, Shipra Arya, Joshua A. Beckman, Sue Duval, Philip P. Goodney, J. Antonio T. Gutierrez, John A. Kaufman, Karen E. Joynt Maddox, Amy W. Pollak, Aruna D. Pradhan, Laurie P. Whitsel and On behalf of the American Heart Association Advocacy Coordinating Committee

doi : 10.1161/CIR.0000000000000967

Circulation. 2021 | Volume 143, Issue 17: e875–e891

Nontraumatic lower-extremity amputation is a devastating complication of peripheral artery disease (PAD) with a high mortality and medical expenditure. There are ?150?000 nontraumatic leg amputations every year in the United States, and most cases occur in patients with diabetes. Among patients with diabetes, after an ?40% decline between 2000 and 2009, the amputation rate increased by 50% from 2009 to 2015. A number of evidence-based diagnostic and therapeutic approaches for PAD can reduce amputation risk. However, their implementation and adherence are suboptimal. Some racial/ethnic groups have an elevated risk of PAD but less access to high-quality vascular care, leading to increased rates of amputation. To stop, and indeed reverse, the increasing trends of amputation, actionable policies that will reduce the incidence of critical limb ischemia and enhance delivery of optimal care are needed. This statement describes the impact of amputation on patients and society, summarizes medical approaches to identify PAD and prevent its progression, and proposes policy solutions to prevent limb amputation. Among the actions recommended are improving public awareness of PAD and greater use of effective PAD management strategies (eg, smoking cessation, use of statins, and foot monitoring/care in patients with diabetes). To facilitate the implementation of these recommendations, we propose several regulatory/legislative and organizational/institutional policies such as adoption of quality measures for PAD care; affordable prevention, diagnosis, and management; regulation of tobacco products; clinical decision support for PAD care; professional education; and dedicated funding opportunities to support PAD research. If these recommendations and proposed policies are implemented, we should be able to achieve the goal of reducing the rate of nontraumatic lower-extremity amputations by 20% by 2030.

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Correction to: Excessive O-GlcNAcylation Causes Heart Failure and Sudden Death

doi : 10.1161/CIR.0000000000000976

Circulation. 2021 | Volume 143, Issue 17: e892

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