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  • JAMA August 14, 2013

    Figure 1: Survival After Diagnosis of Mitral Regurgitation Due to Flail Mitral Leaflet According to Initial Treatment Strategy

    Long-term survival following early surgery vs initial medical management overall population (A) and in the propensity score–matched cohort (B).
  • JAMA August 14, 2013

    Figure 2: Heart Failure Incidence After Diagnosis of Mitral Regurgitation Due to Flail Mitral Leaflet According to Initial Treatment Strategy

    Long-term heart failure risk following early surgery vs initial medical management overall (A) and in the propensity score–matched cohort (B).
  • JAMA June 7, 2006

    Figure 2: Kaplan-Meier Long-term Survival of All Patients and Those Discharged Alive Following Hospitalization

    Among all patients, the survival rates in the early revascularization (ERV) and initial medical stabilization (IMS) groups, respectively, were 41.4% vs 28.3% at 3 years and 32.8% vs 19.6% at 6 years. With exclusion of 8 patients with aortic dissection, tamponade, or severe mitral regurgitation identified shortly after randomization, the survival curves remained significantly different (P = .02), with a 14.0% absolute difference at 6 years. Among hospital survivors, the survival rates in the ERV and IMS groups, respectively, were 78.8% vs 64.3% at 3 years and 62.4% vs 44.4% at 6 years.
  • Surgery for Mitral Regurgitation: Sooner or Later?

    Abstract Full Text
    JAMA. 2013; 310(6):587-588. doi: 10.1001/jama.2013.8644
  • JAMA October 21, 2009

    Figure 1: Pedigree Showing Offspring of the Sperm Donor

    In the 2 genetically affected offspring without left ventricular (LV) hypertrophy, other clinical evidence of the hypertrophic cardiomyopathy (HCM) phenotype was present, including abnormal electrocardiogram with T-wave inversion in leads II and III, aVF, and Q waves in leads V4 to V6 (IV-3), or mild systolic anterior motion of the mitral valve (IV-6). One offspring (IV-11) died of progressive heart failure due to obstructive HCM and was tested retrospectively on a stored DNA sample extracted from peripheral blood obtained prior to death. Although cardiac evaluation was not available in any of the donor's parents, grandparents, or siblings, the donor reported that he was unaware of any evidence of HCM in these family members. The cause of death in the paternal grandmother (I-2) was reported to be a “heart attack” at age 56 years. Both of the donor's parents underwent prosthetic valve replacement. All offspring with unshaded pedigree symbols had reportedly normal cardiac evaluations. Diamond represents 4 additional offspring who did not participate directly in the study but have not pursued genetic testing and have had ongoing cardiac evaluations that were reportedly normal.
  • Survival and Outcomes Following Bioprosthetic vs Mechanical Mitral Valve Replacement in Patients Aged 50 to 69 Years

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    JAMA. 2015; 313(14):1435-1442. doi: 10.1001/jama.2015.3164

    In this cohort study, there was no survival difference at 15 years among older patients who underwent mechanical prosthetic vs bioprosthetic mitral replacement.

  • Doppler Echocardiography in the Evaluation of a Heart Murmur

    Abstract Full Text
    JAMA. 2015; 313(10):1050-1051. doi: 10.1001/jama.2015.1278
  • Comparison of Balloon-Expandable vs Self-expandable Valves in Patients Undergoing Transcatheter Aortic Valve Replacement: The CHOICE Randomized Clinical Trial

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    JAMA. 2014; 311(15):1503-1514. doi: 10.1001/jama.2014.3316

    In a randomized clinical trial involving 241 patients undergoing transcatheter aortic valve replacement, Abdal-Wahab and co-authors found that use of balloon-expandable valves resulted in a greater rate of device success than use of self-expandable valves.

  • JAMA March 6, 2013

    Figure 1: Derivation of the Study Cohort

    aSignificant coronary artery disease was defined as >50% luminal stenosis in any epicardial coronary artery on angiography. Athletic heart was defined as left ventricular dilatation with preserved/mildly reduced ejection fraction and high stroke volume, on a background of regular organized endurance training, with raised maximal oxygen uptake on cardiopulmonary exercise testing. Significant primary valvular disease was defined as moderate or higher valvular stenosis/regurgitation, with the exception of functional mitral regurgitation. Functional mitral regurgitation was defined as mitral regurgitation secondary to left ventricular remodeling resulting in failure of leaflet coadaptation, in the setting of normal mitral valve anatomy, on echocardiography and cardiovascular magnetic resonance imaging.
  • JAMA June 16, 1999

    Figure 1: Typical Location of Abnormal Diastolic Murmurs

    There are 3 important areas to auscultate for diastolic murmurs. Area 1 is the second and third intercostal spaces at the right-sternal border. Area 2 is the second and fourth intercostal spaces at the left-sternal border. Aortic regurgitation murmurs may be heard in both areas 1 and 2. If the murmur is loudest in area 1, then the underlying cause of aortic regurgitation may be an ascending aortic aneurysm or aortic dissection. Pulmonic regurgitation murmurs are loudest in the superior part of area 2, and may radiate downward. The murmur of mitral stenosis and the Flint murmur of aortic regurgitation are best heard at the apex (area 3).
  • Outcomes in Adults With Bicuspid Aortic Valves

    Abstract Full Text
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    JAMA. 2008; 300(11):1317-1325. doi: 10.1001/jama.300.11.1317
  • JAMA August 1, 2012

    Figure 2: Nonlinear Association Between Self-Reported Weekly Minutes of Exercise (From Months 9-12) and BDI-II Scores at 12 Months

    Adjusted for sex, age, race, smoking status, blood urea nitrogen, left ventricular ejection fraction, New York Heart Association class, hypertension, diabetes, 6-minute walk distance, Weber score, Kansas City Cardiomyopathy Questionnaire score, site, β-blocker dose, mitral valve regurgitation, ventricular conduction status, use of any antidepressant medication, and baseline and 3-month Beck Depression Inventory II (BDI-II) scores. The weekly minutes term in the model was fitted using a 3-knot restricted cubic spline. The analysis is limited to participants in the aerobic exercise group who had complete BDI-II data at 12 months (n = 629). The fitted line is for a typical participant (median of continuous covariates, most prevalent class for categorical variables). Shaded area represents 95% confidence intervals. Data markers display data density with respect to minutes of exercise, are drawn at actual minutes of exercise values for each patient along the fitted regression line, and are scattered vertically along fitted line to display case density; some data markers may extend beyond the x-axis range in order to display case density more clearly. Comparing a participant who reported 90 minutes of exercise per week to a participant who reported 0 minutes per week revealed a regression coefficient of −1.67 (95% CI, −2.62 to −0.73).
  • Outcomes Following Transcatheter Aortic Valve Replacement in the United States

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    JAMA. 2013; 310(19):2069-2077. doi: 10.1001/jama.2013.282043

    To report the initial US experience with newly approved transcatheter aortic valve replacement, Mack and coauthors gathered outcome data, including all-cause in-hospital mortality and stroke, from 7710 cases in 224 participating US registry hospitals. Bonow comments in an editorial.

  • Association of Warfarin Therapy Duration After Bioprosthetic Aortic Valve Replacement With Risk of Mortality, Thromboembolic Complications, and Bleeding

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    JAMA. 2012; 308(20):2118-2125. doi: 10.1001/jama.2012.54506
    Mérie and coauthors performed a nationwide study of thrombosis and bleeding associated with the duration of warfarin therapy after bioprosthetic aortic valve replacement surgery in 4075 patients. See the related Editorial by Mehta.
  • Association Between Early Surgical Intervention vs Watchful Waiting and Outcomes for Mitral Regurgitation Due to Flail Mitral Valve Leaflets

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    JAMA. 2013; 310(6):609-616. doi: 10.1001/jama.2013.8643

    Suri and coauthors ascertain the comparative effectiveness of initial medical management (nonsurgical observation) vs early mitral surgery following the diagnosis of mitral regurgitation due to ruptured chordae tendineae (flail leaflets) in 1021 patients from France, Italy, Belgium, and the United States. In an Editorial, Otto discusses the risks of early surgical intervention and how the new findings influence patient care.

  • Effect of Cerebral Embolic Protection Devices on CNS Infarction in Surgical Aortic Valve Replacement: A Randomized Clinical Trial

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    JAMA. 2017; 318(6):536-547. doi: 10.1001/jama.2017.9479

    This randomized clinical trial compares the efficacy and adverse effects of 2 cerebral embolic protection devices vs a shared control group in reducing ischemic central nervous system injury during surgical aortic valve replacement.

  • Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI and Atrial Fibrillation Catheter Ablation: The DECAAF Study

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    JAMA. 2014; 311(5):498-506. doi: 10.1001/jama.2014.3

    Marrouche and coauthors report the results of the DECAAF study, which was a multicenter assessment of the association of atrial tissue fibrosis identified by delayed enhancement magnetic resonance imaging (MRI) and catheter ablation outcomes in patients with atrial fibrillation.

  • Cardiac Surgery in the Adult

    Abstract Full Text
    JAMA. 2008; 299(23):2798-2800. doi: 10.1001/jama.299.23.2798-b
  • Clinical Outcomes at 1 Year Following Transcatheter Aortic Valve Replacement

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    JAMA. 2015; 313(10):1019-1028. doi: 10.1001/jama.2015.1474

    In this follow-up study of a US registry of patients undergoing transcatheter aortic valve replacement, 1-year outcomes included overall mortality of 23.7%, stroke rate of 4.1%, and a composite of death and stroke of 26.0%.

  • Clinical Characteristics and Outcome of Infective Endocarditis Involving Implantable Cardiac Devices

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    JAMA. 2012; 307(16):1727-1735. doi: 10.1001/jama.2012.497
    To describe the clinical characteristics and outcome of cardiac device infective endocarditis and to evaluate the association between device removal and outcome, Athan and coauthors, writing for the International Collaboration on Endocarditis–Prospective Cohort Study Investigators, assessed data from 177 patients with cardiac device infective endocarditis.