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In This Issue of JAMA Cardiology
June 2018


JAMA Cardiol. 2018;3(6):449. doi:10.1001/jamacardio.2017.3366

Whether the neutrophil-to-lymphocyte ratio (NLR) is associated with mortality and cardiovascular disease (CVD) in prospective studies is unknown. Kim and coauthors investigated associations of NLR with mortality and CVD events in 5301 participants in the Jackson Heart Study and also evaluated whether the Duffy antigen variant, a common genetic variant of African origin associated with relative neutropenia, modifies these associations. In adjusted analyses, elevated NLR (>2.15) was prospectively associated with all-cause mortality, coronary heart disease, and heart failure. The Duffy antigen variant locus was associated with a lower baseline NLR and modified the mortality and CVD associations.

Long-term clinical implications of heart failure (HF) hospitalizations at hospitals based on 30-day risk-standardized mortality rates (RSMRs) are unclear. Pandey and coauthors examined the association of hospital-specific 30-day RSMRs with long-term survival in 106 304 patients hospitalized with HF in 317 centers participating in the American Heart Association Get With The Guidelines–HF registry, among which 30-day RSMR ranged from 8.6% (quartile 1) to 10.7% (quartile 4). In adjusted analysis, lower hospital-level 30-day RSMR was associated with greater 1-, 3-, and 5-year survival. These findings suggest that 30-day RSMR may be a performance metric to incentivize quality care and improve long-term HF outcomes.

Sacubitril/valsartan (S/V) improves overall health-related quality of life compared with enalapril, as determined by the Kansas City Cardiomyopathy Questionnaire. To examine the effects of S/V on physical and social activities, Chandra and coauthors assessed components of the physical and social limitation sections of the Kansas City Cardiomyopathy Questionnaire at 8 months and longitudinally in 7618 patients enrolled in the Prospective Comparison of ARNI With an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial. Patients receiving S/V compared with enalapril had significantly better adjusted change scores in most physical and social activities at 8 months and through 36 months, most notably in household chores and sexual relationships.

Timing of surgical aortic valve replacement (SAVR) in patients with aortic stenosis and previous stroke remains uncertain regarding risk of recurrent stroke. Andreasen and coauthors used Danish administrative registries to study all 14 030 adult patients with aortic stenosis who underwent SAVR between 1996 and 2014, of whom 616 had prior stroke. Compared with patients without prior stroke, patients with stroke less than 3 months before SAVR had significantly increased risk of ischemic stroke (18.4% vs 1.2%) and major adverse cardiovascular events (23.3% vs 5.7%) after SAVR. In an Invited Commentary, Mullen and Messé recommend avoiding SAVR within the first 3 months after a stroke unless surgery is urgent and waiting would be harmful.

Invited Commentary