Dobbs, Ricky F

Moon, Krystyn R., 1974-

O'Meara, Lauren J

Hudley, Cynthia

Schwedt, Rachel E., 1944-

Kabir, Nahid Afrose

Crommelin, Claude August, 1840-1874

Grinyer, Anne, 1950-

Hanioğlu, M. Şükrü

Chelpi-den Hamer, Magali

Mandel, Debra

Boland, Mary L

Krzaklewska, Ewa , author

Springhall, John

Weale, R. A. (Robert Alexander)

Stephen, Lynn

Mentinis, Mihalis

González, Roberto J. (Roberto Jesús), 1969-

McKinney, Gordon B., 1943-

Mazur, Gail

Thompson, Katrina Daly, 1975-

Sachikonye, L. M

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.

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.

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.

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.

Chiefly correspondence dated 1954-1999 by writer Philip Roth to Robert Maurer and his wife, Charlotte Maurer, regarding Roth’s development as a writer, other professional work, and personal life. Also includes one letter between other Maurer family members dated 1945.

Hayden Library - PQ7082.P7 C23 2018

Hayden Library - PQ7296.J6 Z8928 2018

Dewey Library - PQ7070.C65 2018

Dewey Library - PQ7082.P7 W45 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 Congress manifesto is the polar opposite of policies pursued by UPA-II. It promises to undo measures that clogged the economy and make economic growth the "overriding priority".