This cohort study assesses whether long-term variability and rate of change of blood pressure from young adulthood to midlife are associated with cardiovascular disease and all-cause mortality by middle age.

Increased attention has focused on shared decision-making (SDM) and use of decision aids for treatment decisions in cardiology. In this issue of JAMA Cardiology, Coylewright et al report the results of a rigorously performed pilot study on the use of a decision aid to facilitate SDM for patients with symptomatic severe aortic stenosis (AS) at high or prohibitive risk for surgery considered for transcatheter aortic valve replacement vs medical therapy. Comparisons were made between encounters before clinicians were trained to use a decision aid and the first and fifth encounters after a decision aid was used. The patient-clinician interactions were audio recorded and later coded by independent reviewers using a validated measure to assess SDM. This mixed-methods study found that SDM significantly improved in a stepwise manner from the initial usual care encounter (before use of a decision aid) to the first and then fifth encounters after implementation of the decision aid. Along with this improvement in SDM, patients (n = 35) demonstrated increased knowledge about their treatment choices and reported increased satisfaction in their care with no increase in decisional conflict. In contrast, clinicians (n = 6) reported that they believed they already engaged in SDM prior to use of the decision aid and, after multiple uses of the decision aid, believed patients did not understand or benefit from this tool. The disconnect between clinician and patient perspectives was sobering and has implications for the adoption of decision aids or other tools to facilitate SDM in the clinical setting. Notable limitations of the study, which are acknowledged by the authors, include (1) small sample size (of clinicians and patients); (2) the decision aid is most useful for the relatively smaller number of patients at high or prohibitive risk for surgery for whom transcatheter aortic valve replacement and medical therapy may both be reasonable options; and (3) the lack of diversity in the clinicians (all male), which reflects the current demographics of interventional cardiology and cardiac surgery.

This case report describes bilateral calcified coronary aneurysms with a significant proximal left anterior descending and right coronary artery stenoses immediately distal to the aneurysms.

This mixed-methods pilot study examines whether the repeated use of a decision aid by heart teams was associated with greater shared decision-making, along with improved patient-centered outcomes and clinicians’ attitudes about decision aids.

In this issue of JAMA Cardiology, Lim and colleagues report on cardiovascular functional reserve in people with end-stage renal disease before and after kidney transplant. They performed a 3-arm, prospective, concurrent cohort study to assess change in cardiovascular functional reserve after kidney transplant using state-of-the-art cardiopulmonary exercise testing (CPET). They also assessed left ventricular morphologic findings 1 year after transplant. They enrolled 81 participants with stage 5 chronic kidney disease (CKD) who underwent kidney transplant, 85 wait-listed participants with stage 5 CKD who had not undergone transplant, and 87 controls treated for hypertension only. The authors quantified cardiovascular functional reserve using CPET in parallel with transthoracic echocardiography. One year after transplant, a significant improvement in maximum oxygen consumption was found in the transplant group compared with the nontransplant group. Moreover, left ventricular function improved but not the body mass index.

To the Editor We read the recent article by Klauser et al with great interest. While the potential implications of the findings are exciting, we have several concerns. First, the authors do not explicitly state whether electrocardiogram gating was used in their study. This is an important detail because cardiac motion artifact is a source of artifactual coloration with dual-energy computed tomography (DECT), particularly with dual-source scanners given the approximately 80-millisecond temporal difference between the 2 radiography beams. Furthermore, beam hardening artifact from calcified atheromas and partial volume effect, known sources of artifacts in the 2-material decomposition algorithm of DECT, may largely explain the findings. While patients with gout had higher prevalence of coronary calcification (55 of 59 patients [93%]) and cardiovascular monosodium urate (MSU) deposition (51 of 59 patients [86%]) than controls, the authors do not report whether the 4 patients with gout without coronary calcifications exhibited MSU deposition nor the number of controls or cadaveric hearts with coronary calcification. The images from the article show areas of green pixelization occurring adjacent to calcified plaques on grayscale computed tomography images (eg, Figure 2A and D, left anterior descending artery [yellow arrowhead]), which would favor this artifact hypothesis without additional data.

In Reply We appreciate the valuable comments of Becce et al on our article. We applied prospective electrocardiography gating using a thin-slice cardiac protocol to ensure highest spatial resolution with minimal motion artifact. A noncontrast electrocardiography-gated computed tomography (CT) examination with standardized scan parameters was performed using a 128-slice dual-source CT (SOMATOM Definition Flash; Siemens) with a detector collimation of 2 × 64 × 0.6 mm, rotation time of 0.28 seconds, and prospective electrocardiography triggering for heart rates less than 65 beats per minute (diastolic padding, 70% of RR interval) and more than 65 beats per minute (systolic padding, 40% of RR interval). Axial images were reconstructed with 0.75-mm slice width, increment of 0.5, and a medium-smooth convolution kernel (B26f). When motion artifact was present, it was distinguished by visual analysis of an experienced observer and colorized pixels related to motion were excluded.

This cohort study assesses cardiovascular functional reserve before and after kidney transplant in patients with end-stage renal disease.

Lowering low-density lipoprotein cholesterol (LDL-C) levels remains a mainstay of cardiovascular disease prevention, but gaps in treatment remain, even in persons with hypercholesterolemia and greatly elevated LDL-C levels. Although well-described gene variants in the apolipoprotein B (APOB), low-density lipoprotein receptor (LDLR), and proprotein convertase subtilisin/kexin type 9 (PCSK9) genes explain small but important fractions of monogenic hypercholesterolemia, recent attention has turned to prognostication of cardiovascular disease using polygenic risk scores (PRS) that incorporate common genetic variants derived from large-scale genome-wide association studies of lipid subfractions. Earlier PRS considered only variants with genome-wide significance, and newer studies have focused on methods that better capture the variance conferred by millions of variants, suggesting an ability to identify risk equivalent to monogenic mutations. There remains a gap in evidence from prospective observational studies or treatment trials regarding the appropriate placement of PRS in risk assessment and lipid treatment decisions relative to information on rare monogenic gene variants, particularly in multiethnic populations.

This cohort study uses the UK Biobank cohort data to compare the association of monogenic vs polygenic hypercholesterolemia with the risk of atherosclerotic cardiovascular disease among individuals with comparable levels of low-density lipoprotein cholesterol.

This randomized clinical trial assesses the effectiveness of an implantable loop recorder plus 24-hour Holter electrocardiographic monitoring vs standard 24-hour Holter electrocardiographic monitoring alone for detecting arrhythmias in pregnant women with structural heart disease and/or symptoms suggestive of arrhythmias.

Secondary mitral regurgitation (MR) has long been recognized as prognostically important. Even mild MR is associated with adverse outcomes. Yet, surgical trials have not shown improved survival with invasive therapy whereas medical therapy and cardiac resynchronization therapy are associated with improved outcomes. The 2018 publication of the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) and Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation (MITRA-FR) trials and their apparently discordant results have focused attention on the differences in trial design as well as patient populations.

This Special Communication proposes a classification of patients with left-ventricular disease according to the severity of mitral regurgitation that is proportionate vs disproportionate to left-ventricular end-diastolic volume.

This Special Communication analyzes the conclusions drawn from effective regurgitant orifice area analysis and end-diastolic volume analysis from 2 randomized clinical trials to assess disparities in the different clinical outcomes.

Mission Statement: JAMA Cardiology publishes exceptional original research, state-of-the-art reviews, and informative opinions that advance the science and practice of cardiology, enhance cardiovascular health, and inform health care policy. JAMA Cardiology is the definitive journal for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. JAMA Cardiology focuses on all aspects of cardiovascular medicine, including epidemiology and prevention, diagnostic testing, interventional and pharmacologic therapeutics, translational research, health care policy and outcomes, and global health.

With a date span of 1779 through 1955, the McManus-Young Collection provides a rich survey of the literature of "illusion practices," which includes works on conjuring, ventriloquism, fortune-telling, spiritualism, witchcraft, gambling, hypnotism, automata, and mind reading comprised of a gathering of thousands of pamphlets and offprints. This ephemeral literature is the backbone of modern...

Robert Evett (1922-1975) was a composer, arts editor, and critic who made his home primarily in the Washington, D.C., area. This collection contains several scores, sketches, and instrument parts for works composed by Evett; biographical information collected by Evett's family after his death; and his published book and music reviews for the "Atlantic Monthly," "New Republic," and "Washington...

Radio actor, writer, and producer from the 1930s-1950s. Scripts, financial records, correspondence, and visual materials primarily pertain to radio and television programming. Chiefly documented is the show Gang Busters from its conception to its iterations on television and film.

The Wallace Earl Dryer World War II map collection consists of Army Map Service maps of Italy and Northwest Europe, a Dutch map of the Western Front, and a German map of Holland. Dryer served in the American army and was a painter and photographer after the war.

Collection of papers, photographs, interviews, field recordings and other audiovisual materials comprising the professional archive of folklorist Nancy Sweezy created in the course of her career as a folk arts advocate, author, and administrator of non-profit folk craft and performance organizations. Includes research materials for her books Raised in Clay: The Southern Pottery Tradition,...

Dewey Library - PQ6653.E62 M6613 2020

Hayden Library - PQ7082.P7 C23 2018

Dewey Library - PQ7390.G773 D6613 2018

Dewey Library - PQ7082.P7 W45 2018

Hayden Library - PQ7123.W6 E88 2018

Movie stars in 2014's polls are a welcome addition to the fray. For those carping about how stars represent glamour and gloss, why not?

The disappearance of inflammatory communal slogans from political speeches suggests development is the agenda for 2014.

By fielding one of its vice-presidents – former television soap star Smriti Irani – against Congress’s Rahul Gandhi in Amethi Lok Sabha constituency, BJP has shown it is inclined to take the electoral battle to one of two Gandhi pocket boroughs in Uttar Pradesh.

On the face of it the Fifa World Cup is all about quality football, generally recognised as the greatest sporting showpiece on earth.