The American Journal of Cardiology (AM J CARDIOL)

Publisher: American College of Cardiology, Elsevier

Journal description

Full Text Online Access, and More, to Paid Subscribers at Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has the shortest lag time of all scientific journals (less than 5 months) from receipt of manuscript to publication. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are case reports, brief reports, editorials, readers' comments, and symposia.

Current impact factor: 3.43

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 3.425
2012 Impact Factor 3.209
2011 Impact Factor 3.368
2010 Impact Factor 3.68
2009 Impact Factor 3.575
2008 Impact Factor 3.905
2006 Impact Factor 3.015
2005 Impact Factor 3.059
2004 Impact Factor 3.14
2003 Impact Factor 3.059
2002 Impact Factor 2.327
2001 Impact Factor 2.637
2000 Impact Factor 2.762
1999 Impact Factor 2.361
1998 Impact Factor 2.137
1997 Impact Factor 2.402
1996 Impact Factor 2.373
1995 Impact Factor 2.238
1994 Impact Factor 2.253
1993 Impact Factor 2.164
1992 Impact Factor 2.503

Impact factor over time

Impact factor

Additional details

5-year impact 3.41
Cited half-life 8.80
Immediacy index 0.72
Eigenfactor 0.07
Article influence 1.23
Website American Journal of Cardiology, The website
Other titles The American journal of cardiology
ISSN 0002-9149
OCLC 850121
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Pre-print allowed on any website or open access repository
    • Voluntary deposit by author of authors post-print allowed on authors' personal website, or institutions open scholarly website including Institutional Repository, without embargo, where there is not a policy or mandate
    • Deposit due to Funding Body, Institutional and Governmental policy or mandate only allowed where separate agreement between repository and the publisher exists.
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months .
    • Set statement to accompany deposit
    • Published source must be acknowledged
    • Must link to journal home page or articles' DOI
    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Atrial fibrillation (AF) is a common arrhythmia encountered after coronary artery bypass surgery (CABG) and is associated with poor outcomes. Whether initiation of statins prior to CABG reduces the risk of post-operative AF remains controversial. Objective: To systematically determine if initiation of statin therapy prior to CABG would reduce the risk of post-operative AF. Methods: We searched the Medline and Web of Science databases, the Cochrane Register of Controlled Trials, and major conference proceedings for clinical trials that randomized patients undergoing CABG to pre-operative statin therapy versus placebo. We required that the trial reported the incidence of post-operative AF. Two authors independently extracted the data on study characteristics and outcomes. Random effects summary odds ratio (OR) were constructed using a DerSimonian-Laird model. Sensitivity analysis for the trials that reported AF as a primary outcome along with subgroup analyses according to the different statins used were also conducted. Results: Twelve trials with 2,980 patients met our inclusion criteria. Atorvastatin was tested in 8 trials while rosuvastatin was studied in 2 studies. Statins were associated with a lower risk of post-operative AF (OR 0.42, 95% confidence interval [CI] 0.27-0.66, p<0.0001). There was benefit with atorvastatin (OR 0.35, 95% CI 0.25-0.50, p<0.0001), but not rosuvastatin (OR 0.69, 95% CI 0.28-1.71, p=0.42). On sensitivity analysis limited to trials that reported AF as a primary outcome, the risk of post-operative AF was still reduced with statins (OR 0.40, 95% CI 0.25-0.90, p=0.02). The mean duration of the hospital stay was significantly lower in the statin group: 8.5 +/- 1.8 days versus 9.1 +/- 2.2 days, p<0.0001. Conclusion: Statin therapy, particularly atorvastatin, prior to CABG was associated with a reduction in the risk of post-operative AF.
    The American Journal of Cardiology 06/2015;
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    ABSTRACT: It has not been adequately addressed yet how long the excess cardiovascular event risk persists after acute myocardial infarction (AMI) as compared with stable coronary artery disease. Among 10,470 consecutive patients undergoing PCI either with sirolimus-eluting stent (SES) only or with bare-metal stent (BMS) only in the Coronary REvascularization Demonstrating Outcome study-Kyoto registry Cohort-2, 3,710 patients (SES: N=820, and BMS: N=2,890) and 6,760 patients (SES: N=4,258, and BMS: N=2,502) presented with AMI (AMI group) and non-AMI (non-AMI group), respectively. During median 5-year follow-up, the excess adjusted risk of the AMI group relative to the non-AMI group for the primary outcome measure (cardiac death/myocardial infarction) was significant (HR 1.53 [95%CI 1.30-1.80], P<0.001). However, the excess event risk was limited to the early period within 3-month. Late adjusted risk beyond 3-month was similar between the AMI and non-AMI groups (HR 1.16 [95%CI 0.95-1.41], P=0.15). The higher risk of the AMI group relative to the non-AMI group for stent thrombosis (ST) was significant within 3-month (HR 3.38 [95%CI 2.04-5.60], P<0.001), while the risk for ST was not different between the 2 groups beyond 3-month (HR 1.11 [95%CI 0.65-1.90], P=0.70). There were no interactions between the types of stents implanted and the risk of the AMI group relative to the non-AMI groups for all the outcome measures including ST. In conclusion, AMI patients as compared with non-AMI patients were associated with similar late cardiovascular event risk beyond 3-month after PCI despite their higher early risk within 3-month.
    The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.03.036
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    ABSTRACT: Earlobe crease (ELC) has been linked to coronary artery disease; however, systematic evaluations of the earlobe and its relation to ischemic stroke are lacking. The objectives were to define the ELC using a single-blind approach and to determine through multivariate analysis its association with cardiovascular events (CVEs) comprising coronary, ischemic cerebrovascular, and peripheral vascular diseases. A single-blind cross-sectional study was performed in 2 phases: (1) an initial study (n = 300) to define ELC classification criteria and (2) a confirmation stage (n = 1,000) to analyze ELC association with CVEs. Each of the participants' pinnae were photographed and classified blindly by joint decision according to ELC's inclination, length, depth, and bilateralism. Patients' medical histories were reviewed for age, cardiovascular risk factors, and CVEs. The concordance rate after the classification of all photographs was 89.6%. The first phase did not find any correlation between the different depth degrees or vertical creases and CVEs. The second stage concluded that diagonal bilateral ELC prevalence in patients with CVEs was 43% compared with 29% in the control patients (p <0.001). The multivariate analysis showed an association between ELC and CVEs (odds ratio 1.45, 95% confidence interval [CI] 1.08 to 1.93, p = 0.012), with a sensitivity and specificity of 43% and 70%, respectively. Ischemic stroke alone was also associated with diagonal bilateral ELC (odds ratio 1.67, 95% confidence interval 1.1 to 2.51, p = 0.015). In conclusion, diagonal bilateral ELC is independently associated with CVEs in the hospitalized population. An independent association with ischemic stroke has also been demonstrated for the first time. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.04.023
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    ABSTRACT: Cardiac resynchronization therapy (CRT) is underused. Recent guidelines have expanded indications for CRT to include less severe symptoms but now favor left bundle branch block morphology in patients with moderate QRS prolongation. The prevalence of CRT eligibility according to historical and current guidelines is uncertain. The aim of this review was to identify and synthesize all existing published research reporting the prevalence of CRT eligibility. A systematic review of electronic databases including MEDLINE, Embase, and the Cochrane Library was performed. The primary outcome was the proportion of patients eligible for CRT according to historical and current criteria. Secondary outcomes included the individual components of eligibility (the ejection fraction, symptoms, and QRS duration and morphology). Eligibility estimates were pooled using random-effects models because of marked heterogeneity in between-study variance. Thirty studies were identified. No study used current guideline criteria. On the basis of historical criteria, 11 ± 3% of ambulatory and 9 ± 3% of hospitalized patients are eligible for CRT. However, New York Heart Association class II in current guidelines is at least as frequent as New York Heart Association III or IV. Approximately 1/3 of patients have QRS prolongation, 2/3 of whom have left bundle branch block. Only a few patients have non-left bundle branch block with QRS duration <150 ms. Medical contraindication or ineligibility was rarely assessed. In conclusion, current estimates of need are outdated. Inclusion of milder symptoms potentially doubles the eligible population. Studies in unselected cohorts are needed to accurately define the individual components of eligibility, together with the prevalence and reasons for ineligibility. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.04.026
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    ABSTRACT: Although treadmill exercise testing can provide an assessment of cardiorespiratory fitness, which serves as an independent prognostic indicator, numerous studies now suggest that usual gait speed, time, or distance covered during walk performance tests and weekly walking distance/time are powerful predictors of mortality and future cardiovascular events in selected patients. This review summarizes the relation between these variables and their association with cardiovascular and all-cause mortality, with specific reference to potential underlying mechanisms and implications for the clinician. Contemporary health care providers have escalating opportunities to promote lifestyle physical activity using pedometers, accelerometers, and smartphone-based health and wellness applications. In conclusion, fitness and/or ambulatory indexes should be considered a "vital sign" in middle-aged and older adults. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.04.024
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    ABSTRACT: Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular diseases (CVDs). Fetuin-A, a novel hepatokine, has been associated with the metabolic syndrome (MetS), insulin resistance, and type 2 diabetes mellitus, all of which are highly prevalent in patients with OSA and associated with increased CVD risk. The goal of this study was to determine whether fetuin-A could be involved in the pathogenesis of CVD risk in patients with OSA, through relations of fetuin-A with MetS components and/or insulin resistance. Overweight or obese, nondiabetic volunteers (n = 120) were diagnosed with OSA by in-laboratory nocturnal polysomnography. Steady-state plasma glucose concentrations derived during the insulin suppression test were used to quantify insulin-mediated glucose uptake; higher steady-state plasma glucose concentrations indicated greater insulin resistance. Fasting plasma fetuin-A and lipoprotein concentrations were measured. Whereas neither the prevalence of MetS nor the number of MetS components was associated with tertiles of fetuin-A concentrations, the lipoprotein components of MetS, triglycerides and high-density lipoprotein cholesterol, increased (p <0.01) and decreased (p <0.05), respectively, across fetuin-A tertiles. Additionally, comprehensive lipoprotein analysis revealed that very low density lipoprotein (VLDL) particles and VLDL subfractions (VLDL1+2 and VLDL3) were increased across fetuin-A tertiles. In contrast, neither insulin resistance nor sleep measurements related to OSA were found to be modified by fetuin-A concentrations. In conclusion, abnormalities of lipoprotein metabolism, but not MetS or insulin resistance per se, may represent a mechanism by which fetuin-A contributes to increased CVD risk in patients with OSA. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.04.014
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    ABSTRACT: Device uptake and development have progressed over the last decade, but few quantitative data exist examining the overall operating characteristics and temporal trends of these clinical trials. We performed a systematic analysis of all cardiovascular device clinical trials from 2001 to 2012 published in medical and cardiovascular journals with the 8 highest impact factors. Of the 1,224 identified cardiovascular clinical trials, 299 (24.4%) focused specifically on devices. Each trial included a median of 335 patients (162 to 745) recruited from a median of 14 sites (3 to 38) over a median enrollment duration of 1.9 years (1.2 to 3.3). Median enrollment rate was 1.1 patients/site/month (0.5 to 4.2). Most device trials targeted coronary artery disease (55.2%), followed by arrhythmias (17.4%). Most were industry sponsored (53.6%) and included mortality as a primary end point (69.6%). The median number of patients (225 to 499, p <0.001 for trend) and enrolling sites (11 to 19, p = 0.07 for trend) increased from 2001 to 2012. During the study period, multinational enrollment grew and approached 50% (p = 0.03), whereas trials enrolling in North America exclusively decreased from 30% to 17% (p = 0.10 for trend). Approximately 70% of device trials met their primary end points; this rate did not significantly change over time. In conclusion, this descriptive study of the contemporary cardiovascular device clinical trials highlights recent trends toward larger, more international trial programs. These aggregate data may help inform future cardiovascular device development. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.03.062
  • The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.04.008
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    ABSTRACT: Total and differential leukocyte counts are useful inflammatory biomarkers. The ability of the neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with Kawasaki disease (KD) was assessed in this study. All patients with KD who underwent consecutive complete blood count analyses during the acute febrile phase before intravenous immunoglobulin (IVIG), 2 days after IVIG regardless of defervescence, and 3 to 4 weeks after defervescence were enrolled. NLR was calculated by dividing the neutrophil count by the lymphocyte count. NLR values that best predicted IVIG resistance and the development of coronary artery abnormalities were determined by receiver-operating characteristic curve and multivariate analyses. Of the 587 patients with KD, 222 were IVIG resistant. IVIG-resistant patients had higher NLRs than IVIG-responsive patients. The best NLR cut-off values during the acute febrile phase and 2 days after IVIG for predicting IVIG resistance were 5.49 (p <0.001) and 1.26 (p <0.001), respectively. Sixty-two patients developed coronary artery abnormalities; 47 had coronary dilatation, and 15 had aneurysms. Patients with aneurysms, but not patients with dilatation, had higher NLRs than patients without coronary artery abnormalities. The best NLR cut-off value 2 days after IVIG for predicting aneurysm development was 1.01 (p <0.001). Multivariate analysis revealed that the NLR 2 days after IVIG independently predicted coronary aneurysm development (p = 0.03) and IVIG resistance (p <0.001). In conclusion, the NLR can be used for risk stratification in patients with KD. An NLR 2 days after IVIG that exceeded 1 was predictive of coronary aneurysm development and IVIG resistance. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.04.021
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    ABSTRACT: Hypertrophic cardiomyopathy (HC) is a relatively common genetic heart disease responsible for mortality and morbidity at all ages. Using contemporary treatment advances, such as implantable defibrillators, surgical myectomy, heart transplant, and modern defibrillation for out-of-hospital cardiac arrest, it is now possible to reduce HC-related mortality considerably to 0.5% per year, less than expected in the general US adult population. However, in much of the developing world, HC has not yet become a priority given the many other cardiac conditions, such as coronary artery disease and systemic hypertension, so prevalent in the most populous countries such as China and India. Management of HC is best achieved in dedicated centers within institutions, such as previously demonstrated in the United States, Canada, some European countries, and Australia. This model has recently been introduced for the first time in India at the Amrita Institute of Medical Sciences and Research in Kochi, Kerala, in which a robust program focused on HC has emerged. This novel initiative, created despite the many obstacles in the Indian health care system, is an important step forward and is reported here detail. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.04.027
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    ABSTRACT: Renal dysfunction is a major adverse event after cardiovascular surgery. Therefore, the preoperative prediction of which patients will require renal replacement therapy (RRT) after cardiac surgery is an important issue. In the present study, 1,822 consecutive patients who underwent cardiovascular surgery from 2008 and 2013 at a single institution were reviewed. Patients who were already receiving long-term hemodialysis before surgery (n = 134) were excluded. The remaining 1,688 patients were separated into 2 groups: those requiring postoperative RRT and those without RRT requirement. A total of 128 patients (7.6%) required RRT. Patients requiring RRT had greater perioperative blood loss, longer intubation time, and longer hospital stays (p <0.0001 for all). Multivariate analysis revealed that cardiopulmonary bypass use, preoperative body surface area, the left ventricular ejection fraction, serum albumin, and creatinine were independent risk factors for postoperative RRT (odds ratios 2.435, 0.204, 0.976, 0.556, and 5.394, 95% confidence intervals 1.471 to 4.140, 0.054 to 0.841, 0.962 to 1.025, 0.363 to 0.860, and 3.671 to 8.223, respectively, p <0.05 for all). A subgroup of patients with relatively preserved renal function before surgery (creatinine <1.12 mg/dl, a cut-off value for RRT requirement obtained from receiver-operating characteristic curve analysis [area under the curve 0.74748, sensitivity 60.2%, specificity 85.0%]) showed that preoperative serum albumin concentration was most significantly associated with postoperative RRT requirement (odds ratio 0.048, 95% confidence interval 0.023 to 0.095, p <0.0001). In conclusion, cardiopulmonary bypass use, preoperative renal impairment as reflected by elevated creatinine level, small body size, a low left ventricular ejection fraction, and hypoalbuminemia were associated with a requirement for postoperative RRT. In patients with preserved renal function, hypoalbuminemia was most significantly related to requirement for RRT. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.04.022
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    ABSTRACT: In patients with persistent atrial fibrillation (AF), the sinus rhythm (SR) can be restored by direct current cardioversion (DCC), although the recurrence of AF after successful DCC is common. We examined whether transesophageal echocardiography (TEE)-guided early DCC, compared with the conventional approach of DCC after 3 weeks of anticoagulation with dabigatran-etexilat, reduces the recurrence of AF. A total of 126 consecutive patients with persistent AF were randomly assigned to a TEE followed by early DCC (n = 65) or to a conventional treatment with dabigatran-etexilat for 3 weeks followed by DCC (n = 61). None of the patients received any antiarrhythmic treatment other than β blockers, and all the DCCs were successful. Forty-eight-hour Holter monitoring was performed at 28 days and at 3, 6, and 12 months after the DCC. The primary outcome was AF recurrence lasting ≥30 seconds. The analysis was stratified by AF duration <60 (n = 62) or >60 days (n = 64) before DCC. We observed a significant reduction in the AF recurrence risk (p = 0.003) in patients with persistent AF <60 days who received early DCC, but there was no significant benefit of early DCC (p = 0.456) in patients with persistent AF lasting >60 days. The recurrence-free survival probability at 28 days in patients with persistent AF <60 days was 0.27 (95% confidence interval 0.14 to 0.51) in the conventional treatment group compared with 0.69 (95% confidence interval 0.54 to 0.87; p = 0.006) in the early DCC group. A benefit of early DCC persisted throughout 12 months of follow-up. In conclusion, TEE-guided early DCC in patients with persistent AF <60 days results in a significant reduction of AF recurrence. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.04.013
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    ABSTRACT: Mortality after transcatheter aortic valve implantation (TAVI) has been reported to range up to 3 years. However, long-term mortality remains underexplored. The aims of this study were to determine long-term mortality in patients who undergo TAVI and to identify correlates of long-term death. From a single institution's prospectively collected TAVI database, all patients who underwent TAVI with a maximum follow-up duration of 5 years were analyzed. The population was analyzed on the basis of access route (transapical TAVI or transfemoral TAVI). Cox regression and Kaplan-Meier survival analysis were conducted. A total of 511 patients who underwent TAVI were included in the analysis (transapical TAVI n = 115, transfemoral TAVI n = 396). The mean Society of Thoracic Surgeons score was 9.6 ± 4. Mortality at 30 days (18% vs 6%, p <0.001) and 1 year (32% vs 21%, p <0.01) was significantly increased in the transapical TAVI group. Long-term survival probability was <50% for the 2 approaches (log-rank p = 0.33). Vascular complications (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.38 to 3.33, p = 0.001), more than mild aortic insufficiency (HR 1.81, 95% CI 1.15 to 2.83, p = 0.01), atrial fibrillation (HR 1.87, 95% CI 1.36 to 2.57, p <0.001), and in-hospital stroke (HR 2.35, 95% CI 1.39 to 4.00, p = 0.002) were independently associated with long-term death. The survival probability of patients at high surgical risk versus those who were inoperable was similar in the long term (log-rank p = 0.53). In conclusion, the overall long-term survival of patients with aortic stenosis who were approved to undergo TAVI was <50% irrespective of access method. Strategies geared toward reducing in-hospital stroke, vascular complications, and aortic regurgitation are still needed, as these variables are correlates of long-term mortality. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 04/2015; DOI:10.1016/j.amjcard.2015.04.016