Bobby Lazzara, MD

	In this Medical News Minute prepared for Practical Cardiology, Dr Bobby Lazzara highlights a new study published in the journal 

 that investigated the effect of catheter ablation used to restore sinus rhythm (SR) on left ventricular function (LVF) in patients with paroxysmal or persistent atrial fibrillation (AF).

	Research has shown that after restoration of SR, LV structural remodeling and dysfunction can be modestly reversed. The current study found that in patients with lone AF, impaired myocardial energetics and subtle LV dysfunction were not fully resolved after ablation leading the authors to suggest that AF may not be the cause of an occult cardiomyopathy but rather the consequence of underlying dysfunction.

Wijesurendra RS, Liu A, Eichhorn C, et al. 

Lone atrial fibrillation is associated with impaired left ventricular energetics that persist despite successful catheter ablation.

 Circulation. 2016;134. 2016 Sep 14. pii: CIRCULATIONAHA.116.022931. [Epub ahead of print]

Videos

Study questions whether reduction in AF burden after catheter ablation leads to sustained beneficial cardiac remodeling.

LV Dysfunction Persists Post-Ablation for Lone AF (VIDEO)

	
	Dr Bobby Lazzara in this Medical News Minute produced for Practical Cardiology highlights a study published online in 

 that sought to learn more about sexual function and activity among young adults who experience an acute myocardial infarction (AMI). Specifically they were interested in the impact of the event on intimate behavior in the year after AMI and in identifying indicators that might predict decrements in sexual activity. Data were evaluated from the prospective longitudinal Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study. Subjects’ median age was 49 (44-52) years (range, 18-55 years).

	Women were more likely than men to experience post-AMI sexual problems and were less likely than men to report no sexual function problems in the year after the event. Subjects who had not had communication with a physician about sex during the first month post-AMI were more likely to delay resuming sex. Dr Lazzara details the most prevalent sexual problems identified in this short video.  

 Lindau ST, Abramsohn E, Bueno H, et al. 

Sexual activity and function in the year after an acute myocardial infarction among younger men and women in the United States and Spain. 

 JAMA Cardiol. 2016;  doi: 10.1001/jamacardio.2016.2362. [Epub ahead of print]

What outcomes do you expect from this study? One modifiable risk factor is actually in your hands.

Predictors of Sexual Function Post-AMI in Young Adults

	Heart failure (HF) is the leading diagnosis at hospital discharge among patients age ≥65 years. On average HF patients take 6.8 prescriptions a day and the majority also take over the counter and complimentary/alternative medications (CAM). Combined with the often complex dosing schedules for prescription medications, these regimens put older patients at high risk for drug-drug interactions, direct myocardial toxicity-or both.

	In this Medical News Minute, Dr Bobby Lazzara reviews a recent scientific statement from the American Heart Association on pharmaceutical agents that may directly cause or exacerbate heart failure. The statement includes a compendium of agents from analgesics and anticancer meds to urologic and QT-interval prolonging medications that may cause or exacerbate heart failure. It also includes several tables of CAM that may be harmful in HF or have significant interactions with HF drugs.

 Page RL, O'Bryant CL, Cheng D, et al and on behalf of the American Heart Association Clinical Pharmacology and Heart Failure and Transplantation Committees of the Council on Clinical Cardiology; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association. Circulation.2016;134. 

http://dx.doi.org/10.1161/CIR.0000000000000426  

VIDEO: In a Medical News Minute, a topline review of the AHA's comprehensive guide to risk reduction in HF patients.

AHA Statement on Heart Failure and Polypharmacy

	In this Medical News Minute produced exclusively for Practical Cardiology, Dr Bobby Lazzara highlights a first-of-its-kind study from the University of Gothenburg in Sweden that evaluated the power of aerobic capacity (VO

) to predict mortality in middle-aged men during 45 years of follow-up.

	Published in the 

European Journal of Preventive Cardiology

, the study found that reduced aerobic capacity was associated with increased mortality among men born in 1913 and followed from age 54 years to age 99 years. The association was independent of traditional cardiovascular risk factors including smoking, blood pressure, and serum cholesterol. In fact, the predictive power of aerobic capacity in this population was second only to smoking.
	 

Dr Bobby Lazzara reviews a first-of-its-kind study that found aerobic capacity second only to smoking as a predictor of death.

Aerobic Capacity at Middle Age Predicts Mortality in Swedish Men

	In the 2015 SPRINT (Systolic Blood Pressure Intervention Trial), reaching a target systolic blood pressure (SBP) of <120 mm Hg was associated with lower cardiovascular disease (CVD) risk compared with reaching an SBP goal of <140 mm Hg. The latter value had long been held as an appropriate goal for patients with hypertension.

	In this Medical News Minute, produced exclusively for Practical Cardiology, Dr Bobby Lazzara reviews a study published in the February issue of the Journal of the American College of Cardiology that sought to estimate the prevalence and number of US adults meeting SPRINT eligibility criteria and to establish beyond that the broader population to whom the SRPINT study results could be generalized.

	Approximately 7.6% of US adults and 16.8% of adults with treated hypertension met the criteria. Note that adults excluded from the original SRPINT trial included those with diabetes, history of stroke, proteinuria, heart failure, eGFR <20 ml/min/1.73 m

	Source: Bress AP, Tanner RM, Hess R, et al. 

Generalizability of SPRINT results to the US adult population.

 J Am Coll Cardiol. 2016 Feb 9;67:463-72. doi: 10.1016/j.jacc.2015.10.037. Epub 2015 Nov 9

How many US adults are considered eligible for SPB equal to/less than 120 mm Hg? What about those who aren't?

SPRINT: What Now?

	In this Medical News Minute video, developed exclusively for Practical Cardiology, Dr Bobby Lazzara top-lines results of the recent study published in

 that found silent myocardial infarction (MI) was equally as common as clinically recognized MI (CMI); that 45% of MIs are silent; and that there are race and sex differences in both the incidence and prognostic value of SMI.

	Analysis was based on approximately 9500 subjects in the Atherosclerosis Risk in Communities (ARIC) study who were free of cardiovascular disease at baseline (visit 1, 1987–1989).

	The authors say their findings underscore the importance of detecting SMI in clinical practice since these patients are largely asymptomatic; they have not received appropriate preventive care and are thus at greater risk for future events. The results also support an individualized CHD prevention plan that accounts for race and sex.

	Zhang ZM, Rautaharju PM, Prineas RJ, et al. 

Race and sex differneces in the incidence and prognostic significance of silent myocardial infarction in the Atherosclerosis Risk in Communities (ARIC) study.

 Circulation. 2016;133:2141-8. doi: 10.1161/CIRCULATIONAHA.115.021177. Epub 2016 May 16.

The unsettling finding makes a case for a targeted screening strategy in higher-risk populations.