2020
Implications of Abnormal Exercise Electrocardiography With Normal Stress Echocardiography
Daubert MA, Sivak J, Dunning A, Douglas PS, Coyne B, Wang TY, Mark DB, Velazquez EJ. Implications of Abnormal Exercise Electrocardiography With Normal Stress Echocardiography. JAMA Internal Medicine 2020, 180: 494-502. PMID: 31985749, PMCID: PMC6990669, DOI: 10.1001/jamainternmed.2019.6958.Peer-Reviewed Original ResearchConceptsNormal stress echocardiographyComposite end pointStress echoExercise electrocardiographyStress echocardiographyMyocardial infarctionDownstream testingEnd pointDuke University Medical CenterExercise stress echoNegative exercise ECGStress ECG findingsAdverse cardiac eventsIncremental prognostic valueObservational cohort studyAdverse clinical eventsCoronary artery diseaseIndividual adverse eventsPopulation of patientsUniversity Medical CenterImaging resultsCoronary revascularizationAdverse eventsCardiac eventsCohort studyPrevention of cardiovascular disease for historically marginalized racial and ethnic groups living with HIV: A narrative review of the literature
Muiruri C, Longenecker CT, Meissner EG, Okeke NL, Pettit AC, Thomas K, Velazquez E, Bloomfield GS. Prevention of cardiovascular disease for historically marginalized racial and ethnic groups living with HIV: A narrative review of the literature. Progress In Cardiovascular Diseases 2020, 63: 142-148. PMID: 32057785, PMCID: PMC7237291, DOI: 10.1016/j.pcad.2020.02.006.Peer-Reviewed Original ResearchMeSH KeywordsAnti-HIV AgentsCardiovascular DiseasesComorbidityHealth Status DisparitiesHealthcare DisparitiesHIV InfectionsHIV Long-Term SurvivorsHumansPreventive Health ServicesPrognosisProtective FactorsRace FactorsRisk AssessmentRisk FactorsSocial Determinants of HealthSocial MarginalizationSocioeconomic FactorsViral LoadVulnerable PopulationsConceptsHuman immunodeficiency virusCardiovascular diseaseComorbid human immunodeficiency virusNarrative reviewSocial determinantsRacial disparitiesCommon social determinantsEthnic disparities persistEthnic groupsCVD morbidityImmunodeficiency virusClinical practiceTranslation of researchClinical researchDisparities persistDiseaseHealthDisparitiesGroupMorbidityReviewPersonsPrevention
2019
Association between systolic ejection time and outcomes in heart failure by ejection fraction
Patel PA, Ambrosy AP, Phelan M, Alenezi F, Chiswell K, Van Dyke MK, Tomfohr J, Honarpour N, Velazquez EJ. Association between systolic ejection time and outcomes in heart failure by ejection fraction. European Journal Of Heart Failure 2019, 22: 1174-1182. PMID: 31863532, PMCID: PMC7493053, DOI: 10.1002/ejhf.1659.Peer-Reviewed Original ResearchConceptsSystolic ejection timeEjection fractionHeart failureClinical outcomesVentricular systolic ejection timeOutpatient transthoracic echocardiogramReduced ejection fractionTertiary referral centerMultivariable logistic regressionHFrEF patientsHF patientsReferral centerTransthoracic echocardiogramAmbulatory patientsHF populationEjection timeEligibility criteriaLogistic regressionPatientsOutcomesAssociationHFpEFEchocardiogramEchocardiographic Assessment of Right Ventricular Function and Response to Therapy in Pulmonary Arterial Hypertension
Shelburne NJ, Parikh KS, Chiswell K, Shaw LK, Sivak J, Arges K, Tomfohr J, Velazquez EJ, Kisslo J, Samad Z, Rajagopal S. Echocardiographic Assessment of Right Ventricular Function and Response to Therapy in Pulmonary Arterial Hypertension. The American Journal Of Cardiology 2019, 124: 1298-1304. PMID: 31481176, DOI: 10.1016/j.amjcard.2019.07.026.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAntihypertensive AgentsEchocardiographyExercise TestFemaleFollow-Up StudiesHeart VentriclesHumansMaleMiddle AgedNorth CarolinaPrognosisPulmonary Arterial HypertensionRetrospective StudiesSeverity of Illness IndexStroke VolumeSurvival RateVentricular Function, RightYoung AdultConceptsTricuspid annular plane systolic excursionPulmonary arterial hypertensionRV global longitudinal strainRV systolic pressureRight ventricular functionGlobal longitudinal strainArterial hypertensionSystolic pressureVentricular functionSevere pulmonary arterial hypertensionAnnular plane systolic excursionLongitudinal strainPAH-specific therapyManagement of patientsRight atrial areaMid-RVPAH therapyCause mortalityEchocardiographic parametersClinical responseEchocardiographic variablesSystolic excursionWalk distanceEchocardiographic assessmentAtrial area
2018
Clinical Utility and Prognostic Value of Right Atrial Function in Pulmonary Hypertension
Alenezi F, Mandawat A, Il'Giovine ZJ, Shaw LK, Siddiqui I, Tapson VF, Arges K, Rivera D, Romano MMD, Velazquez EJ, Douglas PS, Samad Z, Rajagopal S. Clinical Utility and Prognostic Value of Right Atrial Function in Pulmonary Hypertension. Circulation Cardiovascular Imaging 2018, 11: e006984. PMID: 30571314, PMCID: PMC6309911, DOI: 10.1161/circimaging.117.006984.Peer-Reviewed Original ResearchConceptsPulmonary arterial hypertensionArterial hypertensionRA dysfunctionLongitudinal strainComplete echocardiographic dataResults Study subjectsRight atrial functionRight atrial enlargementComposite of timeEarly diastolic SRPeak longitudinal strainRA conduitRA reservoirMultivariable adjustmentPulmonary hypertensionAtrial functionComposite outcomeDiastolic SRAtrial enlargementAtrial sizePrimary outcomePrognostic importancePrognostic valueAdverse outcomesMean ageClinical and Echocardiographic Predictors of Outcomes in Patients With Pulmonary Hypertension
Siddiqui I, Rajagopal S, Brucker A, Chiswell K, Christopher B, Alenezi F, Mandawat A, Rivera D, Arges K, Tapson V, Kisslo J, Velazquez E, Douglas PS, Samad Z. Clinical and Echocardiographic Predictors of Outcomes in Patients With Pulmonary Hypertension. The American Journal Of Cardiology 2018, 122: 872-878. PMID: 30093068, PMCID: PMC6280670, DOI: 10.1016/j.amjcard.2018.05.019.Peer-Reviewed Original ResearchConceptsPrecapillary pulmonary hypertensionRV global longitudinal strainPulmonary hypertensionEchocardiographic parametersHard outcomesPulmonary arterial hypertension medicationsClass III symptomsREVEAL risk scoreRight heart functionCohort of patientsCumulative incidence rateCurrent clinical guidelinesGlobal longitudinal strainEchocardiographic predictorsHypertension medicationsNT-proBNPTransthoracic echocardiographyWalk distanceUnivariable analysisMean ageClinical guidelinesIncidence rateMultivariable modelSurrogate outcomesRisk scoreLong-term outcomes of mitral regurgitation by type and severity
Samad Z, Shaw LK, Phelan M, Glower DD, Ersboll M, Toptine JH, Alexander JH, Kisslo JA, Wang A, Mark DB, Velazquez EJ. Long-term outcomes of mitral regurgitation by type and severity. American Heart Journal 2018, 203: 39-48. PMID: 30015067, DOI: 10.1016/j.ahj.2018.05.001.Peer-Reviewed Original ResearchConceptsMR severityCause deathIschemic MRSurvival rateCause death riskCoronary artery diseaseLong-term outcomesAbsolute mortality ratesQualifying patientsArtery diseaseEchocardiography studyMitral regurgitationVentricular sizeIndeterminate causeBaseline severityDeath riskSevere MREchocardiography laboratoryHigh riskMortality rateClinical settingPatientsValve morphologySeverityMyxomatousDiastolic Dysfunction in Individuals With Human Immunodeficiency Virus Infection: Literature Review, Rationale and Design of the Characterizing Heart Function on Antiretroviral Therapy (CHART) Study
Butler J, Kalogeropoulos AP, Anstrom KJ, Hsue PY, Kim RJ, Scherzer R, Shah SJ, Shah SH, Velazquez EJ, Hernandez AF, Desvigne-Nickens P, Braunwald E. Diastolic Dysfunction in Individuals With Human Immunodeficiency Virus Infection: Literature Review, Rationale and Design of the Characterizing Heart Function on Antiretroviral Therapy (CHART) Study. Journal Of Cardiac Failure 2018, 24: 255-265. PMID: 29482027, PMCID: PMC5880702, DOI: 10.1016/j.cardfail.2018.02.001.Peer-Reviewed Original ResearchConceptsDiastolic dysfunctionAntiretroviral Therapy studyAntiretroviral therapyMyocardial fibrosisHeart functionMyocardial stressHuman immunodeficiency virus (HIV) infectionAge-matched control subjectsTherapy studiesLV diastolic dysfunctionVentricular systolic dysfunctionImmunodeficiency virus infectionCardiac magnetic resonance examinationHuman immunodeficiency virusMarkers of fibrosisImmune system activationSubclinical myocardial necrosisMagnetic resonance examinationOngoing inflammationSystolic dysfunctionAtrial functionCardiac involvementSystemic inflammationHIV individualsMyocardial effectsRationale and design of the comParIson Of sacubitril/valsartaN versus Enalapril on Effect on nt-pRo-bnp in patients stabilized from an acute Heart Failure episode (PIONEER-HF) trial
Velazquez EJ, Morrow DA, DeVore AD, Ambrosy AP, Duffy CI, McCague K, Hernandez AF, Rocha RA, Braunwald E. Rationale and design of the comParIson Of sacubitril/valsartaN versus Enalapril on Effect on nt-pRo-bnp in patients stabilized from an acute Heart Failure episode (PIONEER-HF) trial. American Heart Journal 2018, 198: 145-151. PMID: 29653636, DOI: 10.1016/j.ahj.2018.01.004.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, OralAgedAminobutyratesBiphenyl CompoundsCardiac Output, LowCause of DeathDose-Response Relationship, DrugDouble-Blind MethodDrug Administration ScheduleDrug CombinationsDrug Delivery SystemsEnalaprilFemaleHeart FailureHumansMaleMiddle AgedNatriuretic Peptide, BrainPatient SafetyPeptide FragmentsPrognosisProspective StudiesRisk AssessmentSeverity of Illness IndexSurvival RateTetrazolesTreatment OutcomeValsartanConceptsAcute decompensated heart failureSacubitril/valsartanB-type natriuretic peptideDecompensated heart failureAmino-terminal pro-B-type natriuretic peptideTerminal pro-B-type natriuretic peptideEjection fractionHeart failureHospital initiationNatriuretic peptideEnd pointClass angiotensin receptor neprilysin inhibitorAngiotensin receptor neprilysin inhibitorPg/Primary efficacy end pointAmbulatory HF patientsExploratory end pointsPIONEER-HF trialEfficacy end pointReduced ejection fractionSafety end pointOpen-label treatmentIncidence of angioedemaYears of agePIONEER-HF
2017
Prevalence and Outcomes of Left‐Sided Valvular Heart Disease Associated With Chronic Kidney Disease
Samad Z, Sivak JA, Phelan M, Schulte PJ, Patel U, Velazquez EJ. Prevalence and Outcomes of Left‐Sided Valvular Heart Disease Associated With Chronic Kidney Disease. Journal Of The American Heart Association 2017, 6: e006044. PMID: 29021274, PMCID: PMC5721834, DOI: 10.1161/jaha.117.006044.Peer-Reviewed Original ResearchMeSH KeywordsAdultAge FactorsAgedAged, 80 and overAortic ValveAortic Valve StenosisComorbidityDatabases, FactualEchocardiographyFemaleGlomerular Filtration RateHumansKaplan-Meier EstimateKidneyMaleMiddle AgedMitral ValveMitral Valve InsufficiencyNorth CarolinaPrevalencePrognosisProportional Hazards ModelsRenal Insufficiency, ChronicRetrospective StudiesRisk FactorsSeverity of Illness IndexSex FactorsTime FactorsConceptsChronic kidney diseaseFive-year survival estimatesNon-CKD patientsCKD patientsMitral regurgitationMR severityKidney diseaseSurvival estimatesCoronary artery bypassGlomerular filtration ratePercutaneous coronary interventionSevere mitral regurgitationValvular heart diseaseSerum creatinine valuesAdverse prognostic markerRegurgitant valve lesionsIndex echocardiogramSevere ASArtery bypassIntervention patientsValve lesionsValve surgeryCoronary interventionHazard ratioHeart failureLeft ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: outcomes following an acute heart failure hospitalization
Buggey J, Alenezi F, Yoon HJ, Phelan M, DeVore AD, Khouri MG, Schulte PJ, Velazquez EJ. Left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: outcomes following an acute heart failure hospitalization. ESC Heart Failure 2017, 4: 432-439. PMID: 29154416, PMCID: PMC5695196, DOI: 10.1002/ehf2.12159.Peer-Reviewed Original ResearchConceptsAcute heart failure hospitalizationVentricular global longitudinal strainAbnormal LV-GLSLV-GLSHeart failure hospitalizationGlobal longitudinal strainAcute HFpEFFailure hospitalizationEjection fractionHeart failureLongitudinal strainCox proportional hazards modelDuke University Medical CenterComposite of mortalityMedian LV-GLSWorse LV-GLSChronic heart failureWorse clinical outcomesMyocardial systolic dysfunctionSpeckle-tracking analysisProportional hazards modelUniversity Medical CenterMultivariable adjustmentSystolic dysfunctionBaseline characteristicsAssessment of cardiac allograft systolic function by global longitudinal strain: From donor to recipient
DeVore AD, Alenezi F, Krishnamoorthy A, Ersboll M, Samsky MD, Schulte PJ, Patel CB, Rogers JG, Milano CA, Velazquez EJ, Khouri MG. Assessment of cardiac allograft systolic function by global longitudinal strain: From donor to recipient. Clinical Transplantation 2017, 31: e12961. PMID: 28294407, DOI: 10.1111/ctr.12961.Peer-Reviewed Original ResearchConceptsLV global longitudinal strainLeft ventricular ejection fractionGlobal longitudinal strainMedian left ventricular ejection fractionSystolic functionLongitudinal strainLV systolic dysfunctionMyocardial systolic performancePost-transplant outcomesLV systolic functionVentricular ejection fractionDonor-recipient pairsMyocardial deformation analysisAllograft dysfunctionCardiac allograftsCause hospitalizationSystolic dysfunctionPretransplant levelsEjection fractionSystolic performanceCorresponding recipientsClinical implicationsRecipientsEchocardiogramFurther studiesComparison of Clinical Characteristics and Outcomes of Patients With Versus Without Diabetes Mellitus and With Versus Without Angina Pectoris (from the Duke Databank for Cardiovascular Disease)
Banks A, Broderick S, Chiswell K, Shaw L, Devore A, Fiuzat M, O'Connor C, Felker GM, Velazquez E, Mentz R. Comparison of Clinical Characteristics and Outcomes of Patients With Versus Without Diabetes Mellitus and With Versus Without Angina Pectoris (from the Duke Databank for Cardiovascular Disease). The American Journal Of Cardiology 2017, 119: 1703-1709. PMID: 28395884, DOI: 10.1016/j.amjcard.2017.02.053.Peer-Reviewed Original ResearchConceptsCoronary artery diseaseAngina pectorisDiabetes mellitusDM statusCause mortalityMultivariable Cox regressionOutcomes of patientsDifferent prognostic implicationsSeverity of diseaseAP statusCV hospitalizationClinical characteristicsArtery diseaseCoronary angiographyDM patientsClinical outcomesCox regressionPrognostic implicationsPrognostic utilityRevascularizationSimilar riskPatientsRisk adjustmentMortalityPectoris
2016
Predicting Outcomes Over Time in Patients With Heart Failure, Left Ventricular Systolic Dysfunction, or Both Following Acute Myocardial Infarction
Lopes RD, Pieper KS, Stevens SR, Solomon SD, McMurray JJ, Pfeffer MA, Leimberger JD, Velazquez EJ. Predicting Outcomes Over Time in Patients With Heart Failure, Left Ventricular Systolic Dysfunction, or Both Following Acute Myocardial Infarction. Journal Of The American Heart Association 2016, 5: e003045. PMID: 27353607, PMCID: PMC4937254, DOI: 10.1161/jaha.115.003045.Peer-Reviewed Original ResearchConceptsVentricular systolic dysfunctionHeart failureMyocardial infarctionIntegrated discrimination improvementSystolic dysfunctionCardiovascular deathMultivariable Cox proportional hazardsAcute Myocardial Infarction trialNet reclassification improvement indexNonfatal heart failureMyocardial Infarction trialNonfatal myocardial infarctionPredictors of mortalityPatient informationBaseline heart rateAcute myocardial infarctionCox proportional hazardsCreatinine clearanceHospital arrivalHospital dischargeIndex hospitalizationPatient characteristicsOverall mortalityIndex eventClinical events
2015
Relation of Elevated Heart Rate in Patients With Heart Failure With Reduced Ejection Fraction to One-Year Outcomes and Costs
DeVore AD, Schulte PJ, Mentz RJ, Hardy NC, Kelly JP, Velazquez EJ, Maya JF, Kielhorn A, Patel HK, Reed SD, Hernandez AF. Relation of Elevated Heart Rate in Patients With Heart Failure With Reduced Ejection Fraction to One-Year Outcomes and Costs. The American Journal Of Cardiology 2015, 117: 946-951. PMID: 26805662, PMCID: PMC5429586, DOI: 10.1016/j.amjcard.2015.12.031.Peer-Reviewed Original ResearchConceptsBeats/minReduced ejection fractionElevated heart rateHeart rateHeart failureEjection fractionΒ-blockersMedical costsHospital cost accounting dataLarge tertiary care centerMortality/hospitalizationTertiary care centerOne-year outcomesDirect medical costsNational death recordsRoutine clinical practiceMedian heart rateProportional hazards modelDuke University HospitalHeart rate assessmentElectronic medical recordsCause mortalityEligible patientsMultivariate adjustmentAtrial fibrillationImportance of Angina in Patients With Coronary Disease, Heart Failure, and Left Ventricular Systolic Dysfunction Insights From STICH
Jolicœur EM, Dunning A, Castelvecchio S, Dabrowski R, Waclawiw MA, Petrie MC, Stewart R, Jhund PS, Desvigne-Nickens P, Panza JA, Bonow RO, Sun B, San TR, Al-Khalidi HR, Rouleau JL, Velazquez EJ, Cleland JGF. Importance of Angina in Patients With Coronary Disease, Heart Failure, and Left Ventricular Systolic Dysfunction Insights From STICH. Journal Of The American College Of Cardiology 2015, 66: 2092-2100. PMID: 26541919, PMCID: PMC4655599, DOI: 10.1016/j.jacc.2015.08.882.Peer-Reviewed Original ResearchConceptsCoronary artery diseaseLV systolic dysfunctionGreater survival benefitMedical therapySystolic dysfunctionCause mortalitySurvival benefitWorse prognosisCoronary artery bypass graft surgeryLeft ventricular systolic dysfunctionArtery bypass graft surgeryLong-term clinical outcomesGreater prognostic benefitBypass graft surgeryVentricular systolic dysfunctionEffect of CABGMultivariable CoxSTICH trialGraft surgeryPrognostic benefitArtery diseaseCoronary diseaseEjection fractionHeart failureClinical outcomesInfluence of QRS infarct score and QRS duration prior to transcatheter aortic valve replacement on follow-up left ventricular end systolic volume in patients with new persistent left bundle branch block
Hannink LG, Wagner GS, Kisslo J, Alenezi FA, Shaw LK, Hofmann P, Zusterzeel R, Phelan M, Velazquez EJ, Gorgels AP. Influence of QRS infarct score and QRS duration prior to transcatheter aortic valve replacement on follow-up left ventricular end systolic volume in patients with new persistent left bundle branch block. Journal Of Electrocardiology 2015, 48: 637-642. PMID: 25959263, DOI: 10.1016/j.jelectrocard.2015.04.010.Peer-Reviewed Original ResearchMeSH KeywordsAged, 80 and overAortic Valve StenosisBundle-Branch BlockDiagnosis, Computer-AssistedEchocardiographyElectrocardiographyFemaleFollow-Up StudiesHumansMalePrognosisReproducibility of ResultsRetrospective StudiesRisk AssessmentSensitivity and SpecificityStroke VolumeTranscatheter Aortic Valve ReplacementTreatment OutcomeConceptsLeft bundle branch blockTranscatheter aortic valve replacementPersistent left bundle branch blockVentricular end-systolic volumeAortic valve replacementBundle branch blockEnd-systolic volumeQRS durationInfarct scoreValve replacementVentricular functionBranch blockNew-onset left bundle branch blockLeft ventricular end-systolic volumeNew left bundle branch blockLeft ventricular functionLarger study populationStrict inclusion criteriaSuch predictive valueQRS scoreSystolic volumeInclusion criteriaStudy populationCardiac conditionsPredictive valueGenetic Variants Are Not Associated with Outcome in Patients with Coronary Artery Disease and Left Ventricular Dysfunction: Results of the Genetic Substudy of the Surgical Treatment for Ischemic Heart Failure (STICH) Trials
Feldman AM, She L, McNamara DM, Mann DL, Bristow MR, Maisel AS, Wagner DR, Andersson B, Chiariello L, Hayward CS, Hendry P, Parker JD, Racine N, Selzman CH, Senni M, Stepinska J, Zembala M, Rouleau J, Velazquez EJ, Lee KL. Genetic Variants Are Not Associated with Outcome in Patients with Coronary Artery Disease and Left Ventricular Dysfunction: Results of the Genetic Substudy of the Surgical Treatment for Ischemic Heart Failure (STICH) Trials. Cardiology 2015, 130: 69-81. PMID: 25592552, PMCID: PMC4367125, DOI: 10.1159/000368221.Peer-Reviewed Original ResearchConceptsIschemic Heart Failure (STICH) trialHeart Failure TrialSurgical treatmentFailure TrialGenetic substudyGenetic variantsCombination of deathCoronary artery bypassHeart failure populationCoronary artery diseaseLeft ventricular reconstructionPrognostic clinical variablesΒ2-adrenergic receptor geneReceptor geneArtery bypassVentricular dysfunctionCause mortalityMultivariable adjustmentArtery diseaseCardiovascular hospitalizationMedical therapyMultivariable analysisPrognostic significanceClinical variablesVentricular reconstruction
2014
Predictors and Progression of Aortic Stenosis in Patients With Preserved Left Ventricular Ejection Fraction
Ersboll M, Schulte PJ, Al Enezi F, Shaw L, Køber L, Kisslo J, Siddiqui I, Piccini J, Glower D, Harrison JK, Bashore T, Risum N, Jollis JG, Velazquez EJ, Samad Z. Predictors and Progression of Aortic Stenosis in Patients With Preserved Left Ventricular Ejection Fraction. The American Journal Of Cardiology 2014, 115: 86-92. PMID: 25456876, DOI: 10.1016/j.amjcard.2014.09.049.Peer-Reviewed Original ResearchConceptsModerate aortic stenosisAortic stenosisMild aortic stenosisVentricular ejection fractionMean gradientHemodynamic progressionEjection fractionClinical variablesLeft ventricular ejection fractionSevere aortic stenosisBaseline clinical variablesSubset of patientsRate of progressionEchocardiographic surveillanceRenal dysfunctionUnselected cohortAccelerated progressionLongitudinal linear regression modelsCurrent guidelinesDisease progressionRetrospective analysisPatientsSignificant interactionProgressionBaselineClinical outcome as a function of the PR-interval—there is virtue in moderation: data from the Duke Databank for cardiovascular disease
Holmqvist F, Thomas KL, Broderick S, Ersbøll M, Singh D, Chiswell K, Shaw LK, Hegland DD, Velazquez EJ, Daubert JP. Clinical outcome as a function of the PR-interval—there is virtue in moderation: data from the Duke Databank for cardiovascular disease. EP Europace 2014, 17: 978-985. PMID: 25164430, DOI: 10.1093/europace/euu211.Peer-Reviewed Original ResearchConceptsCoronary heart diseaseHeart diseaseDuke University Medical CenterMajor cardiovascular outcomesMajor cardiovascular eventsNative coronary arteriesUniversity Medical CenterPR interval durationCV eventsCardiovascular eventsCardiovascular outcomesCause mortalityCoronary angiographyDuke DatabankClinical outcomesAtrial fibrillationPoor outcomeCoronary arterySignificant stenosisSinus rhythmCardiovascular diseaseMedical CenterHigh riskPatientsRelevant covariates