bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical characteristics and risk profile of patients with atrial fibrillation with mid-range ejection fraction, insights from the Polish part of EORP-AF Long-Term General Registry
Authors: Marchel M , Tyminska A , Ozieranski K , Budnik M , Wancerz A , Massler E , Tscheinig O , Peller M , Lodzinski P , Kalarus Z , Lenarczyk R , Grabowski M , Balsam P 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) comprises a wide range of patients (pts), from those with preserved to those with reduced left ventricular ejection fraction (LVEF). According to 2016 ESC guidelines, pts with LVEF in the range of 40–49% represent a “grey area”, which is defined as heart failure with mid-range ejection fraction (HFmrEF). Not much is known about the clinical characteristics of AF pts with mid-range ejection fraction.

Purpose
To determine the potential differences in the clinical characteristics, risk profile, and the outcomes of AF with moderate systolic dysfunction, measured by LVEF.

Methods
The EURObservational Research Programme on AF (EORP-AF) Long-Term General Registry analyzed consecutive AF patients who have presented to cardiologists in 250 centers from 27 European countries, including 25 centers from Poland. We analyzed data collected at baseline and at a 1-year follow-up visit from 568 Polish patients included in 25 Polish centers in the years 2013–2016. Pts were divided into three groups based on LVEF: the preserved LVEF (pEF) group (LVEF ≥50%), the mid-range LVEF (mrEF) group (40–49%), and the reduced LVEF (rEF) group (&lt;40%).

Results
117/568 pts with rEF represented 20,6%, 105/568 mrEF 18,5% and 346/568 pEF 60,9% of the whole analyzed group. With regard to the most typical risk factors, the mrEF population appeared between rEF and pEF, presenting a moderate risk profile with the exception of hypertension, which was the most common in the mrEF group. While permanent AF was the most common in the rEF group and paroxysmal in the pEF pts, pts with mrEF had a higher rate of long-lasting persistent AF. Taking into account the risk factors profile, surprisingly, pts with AF and mrEF more often presented with dyspnea/shortnes of breath (mrEF 38,1% vs. rEF 18,8% vs. pEF 22,5%; p=0,001) and fatigue (mrEF 38,1% vs. rEF 23,9% vs. pEF 25,4%; p=0,025). AF pts with mrEF also had the highest thrombo-embolic risk estimated with the CHA2DS2-VASc score (mrEF 4 [2–5], n=105; rEF 3 [2–5], n=117, pEF 3 [2–4], n=346, p=0.005). However, this did not translate into the highest number of thromboembolic events after one year which did not significantly differ (mrEF 10.5%, rEF 15.4%, pEF 11.3%, p=0.30) between the three groups.

Conclusions
The risk factor profile of AF pts with mrEF was milder than for those with rEF and more severe than for pEF pts. AF pts with mrEF more often presented HF symptoms. Their estimated thrombo-embolic risk was higher but the number of events in the one year follow-up did not significantly differ between groups.

Funding Acknowledgement
Type of funding source: None
Implications of new-onset atrial fibrillation for in-hospital and long-term prognosis in patients with acute myocardial infarction: the CBD Bank study
Authors: Yang W , Lip G , Li H 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) often coexists with coronary artery disease. Data on the incidence and prognostic impact of new-onset AF following acute myocardial infarction (AMI) with current optimal therapy are insufficient, especially in Asian populations.

Purpose
To investigate the incidence of new-onset AF following AMI and to assess its impact on in-hospital and long-term prognosis.

Methods
We included consecutive AMI patients between December 2012 and July 2019, and excluded those with prior known AF on presentation. New-onset AF was defined as newly detected AF during the index hospitalization following AMI. The primary outcomes comprised of all-cause death and cardiovascular death occurred during hospitalization; and all-cause death and cardiovascular death during long-term follow-up among those AMI survivors. Follow-up visits were routinely scheduled after discharge, at 1 month, 3 months, 6 months, 12 months and every 12 months thereafter.

Results
Of 3686 patients enrolled, new-onset AF was documented in 138 (3.7%) patients during a mean duration of hospitalization of 8.8±5.8 days. Independent risk factors of new-onset AF were age ≥75 years, left atrial diameter ≥40mm, high levels of cardiac troponin-I or high sensitive C reactive protein. During hospitalization, all-cause death occurred in 22 (15.9%) new-onset AF patients and 67 (1.9%) non-AF patients (p&lt;0.001); cardiovascular death occurred in 19 (13.8%) new-onset AF patients and 58 (1.6%) non-AF patients (p&lt;0.001). On multivariable logistic analysis, new-onset AF was an independent predictor of in-hospital all-cause death (OR 5.85, 95% CI: 3.24–10.55) and cardiovascular death (OR 5.44, 95% CI: 2.90–10.20). Apart from the in-hospital deaths, another 265 (7.7%) were lost to follow-up; thus, 3332 patients were included in the long-term follow-up analysis: 106 new-onset AF and 3226 non-AF patients. After a mean follow-up period of 1096.7±682.0 days, all-cause death occurred in 19 new-onset AF patients and 249 non-AF patients; corresponding rates were 8.08 (95% CI: 5.15–12.67) vs. 2.55 (95% CI: 2.25, 2.88) per 100 person-years, respectively (p&lt;0.001). Cardiovascular death occurred in 11 new-onset AF patients and 150 non-AF patients; corresponding rates were 4.68 (95% CI: 2.59–8.45) vs. 1.53 (95% CI: 1.31–1.80) per 100 person-years, respectively (p=0.002). After multivariable Cox adjustment, there was no significant association between new-onset AF and long-term all-cause death (HR 1.45, 95% CI: 0.90–2.35) or cardiovascular death (HR 1.21, 95% CI: 0.65–2.26).

Conclusion
New-onset AF following AMI was an independent predictor of increased risk of in-hospital mortality, but had no independent association with long-term death.

Funding Acknowledgement
Type of funding source: None
Heart rate recovery after exercise as a prognostic predictor in patients with atrial fibrillation
Authors: Kato Y , Itahashi N , Uejima T , Semba H , Arita T , Yagi N , Suzuki S , Otsuka T , Kishi M , Kanou H , Matsuno S , Oikawa Y , Yajima J , Yamashita T 
Published: November 2020

Abstract

Background
A delayed heart rate recovery (HRR) after exercise is related to mortality in sinus rhythm. This study aimed to investigate this concept can be applied to patients with atrial fibrillation (AF).

Methods
We analyzed 483 patients with AF (mean 65 years, male 74%). HRR integral was calculated by integrating the difference in HR in every 3 second between the end of exercise and the specified time after the exercise (30, 60, 120 and 180 seconds). After evaluating the prognostic power of each HRR integral, we selected HRR integral of 180 seconds (180HRR-integral).

Results
We divided the patients into two groups using median value of 180HRR-integral. All-cause mortality, the incidence of cardiovascular events and heart failure events were higher in the poor 180HRR-integral. After adjustment for covariates, the impact of the high 180HRR-integral for all-cause mortality was 3.15 (p=0.057), 1.77 for cardiovascular events (p=0.067) and 1.28 for heart failure events (p=0.519).

Conclusion
Poor HRR was associated with worse prognosis in patients with AF.

Funding Acknowledgement
Type of funding source: None
Effect of alirocumab on incidence of atrial fibrillation after acute coronary syndromes: insights from ODYSSEY OUTCOMES
Authors: Lopes R , Steg P.G , Bhatt D.L , Bittner V.A , Dauchy A , Diaz R , Goodman S.G , Harrington R.A , Jukema J.W , Pordy R , Sourdille T , Szarek M , White H.D , Zeiher A.M , Schwartz G.G 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) is a marker of risk in patients presenting with acute coronary syndromes (ACS). The potential effect of inhibiting proprotein convertase subtilisin/kexin type 9 (PCSK9) on the incidence of AF is unknown.

Methods
The ODYSSEY OUTCOMES trial compared randomized treatment with the PCSK9 inhibitor alirocumab or placebo in patients with recent ACS and residual dyslipidaemia despite optimal statin therapy. The current analysis determined: 1) whether alirocumab treatment influenced incident AF; 2) whether a history of AF influenced the risk of major adverse cardiovascular events (MACE); and 3) whether there was interaction between AF at baseline and randomized treatment on MACE. AF was determined from the medical history and investigator reports of adverse events.

Results
Of 18,924 participants, 662 (3.5%) had a history of AF at randomization and 18,262 (96.5%) had no history of AF. Of the latter category, 499 (2.7%) had incident AF. Older age, randomization in South America or Eastern Europe, history of heart failure or myocardial infarction, and higher body mass index were factors associated with incident AF. Treatment with alirocumab or placebo did not influence incident AF (2.2% vs 2.6%, respectively; hazard ratio 0.90, 95% confidence interval 0.75–1.08; Figure). Patients with a history of AF had a greater burden of comorbidities, including cerebrovascular disease, peripheral artery disease, hypertension and heart failure; they also had higher rates of MACE (Table). There was no significant interaction between AF and randomized treatment on risk of MACE (P interaction=0.78)

Conclusions
Although treatment with alirocumab did not significantly modify the risk of incident AF after ACS in this analysis, future studies with more sensitive and systematic methods of ascertainment may be warranted. History of AF is a strong predictor of risk of recurrent MACE after ACS.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Sanofi, Regeneron Pharmaceuticals, Inc
Are all CHA2DS2-VASc risk factors created equal? An assessment of stroke risk among 34,470 patients with CHA2DS2-VASc scores of 1 or 2
Authors: Zweibel S , Passman R , Sarkar S , Koehler J , Ziegler P 
Published: November 2020

Abstract

Introduction
The CHA2DS2-VASc score is commonly used to assess ischemic stroke risk in patients with documented atrial fibrillation (AF). Whether each combination of CHA2DS2-VASc score 1 or 2 confers a similar stroke risk is poorly understood.

Methods
A de-identified database of aggregated electronic health record (EHR) data from 2007–2017 was used to identify patients not on oral anticoagulation (OAC) who had documented AF and CHA2DS2-VASc scores of 1 or 2. CHA2DS2-VASc=1 groups included patients with only heart failure, hypertension, age 65–74, diabetes, vascular disease or female gender. The 17 possible permutations of CHA2DS2-VASc =2 scores were consolidated into 6 groups: prior stroke/TIA, age &gt;75, 2 co-morbidities, 1 co-morbidity + age 65–74, 1 co-morbidity + female gender, or age 65–74 + female gender. Stroke risk hazard ratios were computed for each of these groups.

Results
A total of 34,470 patients (61.0±12.0 years, 67.3% male) not on OAC with a documented history of AF and CHA2DS2-VASc scores of 1 (n=16,572) or 2 (n=17,898) were identified. The annual risks of ischemic stroke among CHA2DS2-VASc 1 and 2 patients were 0.22% [0.18–0.26] and 0.38% [0.33–0.43], respectively. For CHA2DS2-VASc =1 patients, age 65–74 conferred a greater risk of stroke while female gender conferred a lower risk. For CHA2DS2-VASc =2 patients, prior stroke/TIA conferred a greater risk of stroke while 1 co-morbidity + female gender conferred a lower risk [Figure].

Conclusion
Ischemic stroke risk varies significantly across specific risk factors in patients with CHA2DS2-VASc scores =1 or 2. Therefore, OAC decisions in these patients should consider individual risk factors rather than the aggregate score alone.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Medtronic
Usefulness of H2FPEF score as an independent predictor of heart failure development in patients with atrial fibrillation
Authors: Miyasaka Y , Taniguchi N , Suwa Y , Nakai E , Harada S , Shiojima I 
Published: November 2020

Abstract

Background
The H2 FPEF score, which based on simple clinical characteristics and echocardiography, enables discrimination of HFpEF from noncardiac causes of dyspnea.

Purpose
We sought to evaluate whether H2 FPEF score predicts congestive heart failure (CHF) development in patients with atrial fibrillation (AF).

Methods
Among adult AF patients who underwent transthoracic echocardiography between July 2007 and December 2008, those with preserved left ventricular ejection fraction (LVEF) (≥50%) were included and followed up to new-onset CHF events. Patients with a history of CHF, cardiac surgery, or significant left-sided valvular heart disease were excluded. The H2 FPEF score was calculated from 6 variables (obesity = 2 points, treatment with ≥2 antihypertensive drugs = 1 point, AF = 3 points, echocardiographic pulmonary artery systolic pressure &gt;35 mmHg = 1 point, age &gt;60 years = 1 point, and echocardiographic E/e'ratio &gt;9 = 1 point). CHF was ascertained using Framingham criteria. Cox-proportional hazards modeling was used to assess risk of CHF development.

Results
Of 562 AF patients, 367 (69±10 year old, 66% men) met all study criteria. Of whom, 37 (10%) developed CHF events during a mean follow–up of 56±43 months. The mean H2 FPEF score was 5.50±1.14, and the number of patients with H2 FPEF score ≥7 was 64 (17%). After adjusting for comorbidities in a multivariate model, H2 FPEF score was significant predictor of new-onset CHF events both as continuous (HR=1.43, 95% CI: 1.05–1.96, P&lt;0.05) or categorical (H2 FPEF score ≥7) (HR=2.32, 95% CI: 1.17–4.63, P&lt;0.05) variables. The Kaplan-Meier estimates of CHF-free survival stratified by H2 FPEF status (≥7 or &lt;7) were shown in Figure.

Conclusion
H2 FPEF score provides prognostic information for new-onset CHF development in patients with AF.
Figure 1

Funding Acknowledgement
Type of funding source: None
Histomolecular fibrotic profile and an extent of the atrial and ventricular electroanatomical substrate in patients with atrial fibrillation and heart failure
Authors: Orshanskaya V , Orshanskaya V.S , Kamenev A.V , Mitrofanova L.B , Belyakova L.A , Titov V.A , Naimushin M.A , Mikhaylov E.N , Tatarskiy R.B , Moiseeva O.M , Lebedev D.S 
Published: November 2020

Abstract

Background and purpose
The aim of this pilot study was to investigate the association between an extent of the atrial and ventricular electroanatomical substrate, serum fibrotic biomarkers and histological and immune-histochemical myocardial characteristics in ipatients with atrial fibrillation and heart failure.

Methods
We prospectively analyzed electroanatomical ultra-high density bipolar maps (HDBM) in 72 patients with AF and CHF, who underwent circular pulmonary veins (PVs) isolation. LA areas outside PVs ostia with bipolar signals ≤0.75mV, associated with local conduction velocity delay were considered as EAS and measured. Relative area of low voltage zones in right (RV) and left ventricles (RV) with bipolar signals in range of 0,5–1,5 mV were also consistently measured. Endomyocardial biopsy samples were taken from low, mediate and high septal areas of RV; histological and immune-histochemical staining was performed and an extent of myocardial interstitial fibrosis (MIF) was calculated. Before the operation we measured plasma MMP2, MMP9, TIMP, MMPs/TIMPs, galectin 3 (Gal3), TGF, soluble ST2 and the cross-linked collagen I/III synthesis and degradation product levels. The patients were divided into groups according to their ejection fraction Simpson (EF) (groups 1: EF≥50%, groups 2: EF 40–49%, and groups 3: EF&lt;40%).

Results
The data of electroanatomical mapping, serum biomarkers and myocardial expression are presented in the table. According to results of correlation analysis, an extent of LA EAS were correlated with Gal3 and PIIICP plasma level and Gal3 myocardial expression and MIF extent (Rs=0,40, 0,45 and 0,42 respectively). The relative extent of LV EAS was correlated with MMP9 serum level (Rs=0,38); LV volume (LVV) was correlated with sST2 serum level and RVV was correlated with CD 133 myocardial expression (Rs=0,42) (picture 1). The patients with lower EF had larger extent of the LA EAS, (group 3: 28±12.4% vs. 1: 17.7±11.6%, p=0.03), an extent of LV EAS and LVV (group 3: 8,4±4,5% vs. 1: 5,1±3,8% p=0.02; group 3 vs group 1 p=0,05 relatively),higher Gal3 plasma level (group 1: 7,1±2 vs. group 2: 8,9±1,5, p=0.05) and higher MIF extent (group 2: 134±56 vs. 3: 151±30 p=0.04) (picture 2).

Conclusion
Our data suggest that relative extent of LA EAS in patients with atrial fibrillation is associated with Gal3 plasma level and Gal3 myocardial expression; severity of myocardial remodeling is connected to CD 3/133 myocardial expression and myocardial interstitial fibrosis extent, especially in patients with HF with restricted LV ejection fraction.

Funding Acknowledgement
Type of funding source: None
Slow conduction zone as an early electrical remodeling change in patients with atrial fibrillation
Authors: Kishima H , Mine T , Fukuhara E , Ishihara M 
Published: November 2020

Abstract

Background
The slow conduction zone (SCZ) in the left atrium (LA) detected using 3-D mapping and high-resolution imaging system has attracted attention as an arrhythmia substrate of atrial fibrillation (AF). However, the occurrence mechanism of SCZ remains unclear.

Purpose
This aim of this study is to clarify whether SCZ is related to the low voltage zone (LVZ) or the LA anatomical contact areas with other organs such as aorta or thoracic spine in patients with AF.

Methods
We studied 36 patients (21 males, 68±10 years, 14 paroxysmal AF; PAF, 17 persistent AF; PeAF, 5 long-standing persistent AF; LS-PeAF) who received catheter ablation for AF. High-density LA mapping during sinus rhythm or right atrial pacing after pulmonary vein isolation were constructed by acquiring more than 2000 endocardial points in each patient. Isochronal activation maps were created at 5-ms interval setting, and the SCZ was identified on the activation map by finding a site with isochronal crowding of ≥3 isochrones, which are calculated as ≤27 cm/s (figure). The LVZ was defined as the following; mild (&lt;1.5 mV), moderate (&lt;1.0 mV), and severe LA-LVZ (&lt;0.5 mV). The LA contact areas (CoAs; ascending aorta-anterior LA, descending aorta-posterior LA, and vertebrae-posterior LA) were assessed using computed tomography.

Results
The SCZ was distributed linearly (figure), and observed in 35 of 36 patients (97.2%). The SCZ was often found in the anterior (89%), roof (64%), and septal wall (47%) of LA, and longest in patients with LS-PeAF (PAF: 56±34 mm, PeAF; 79±41 mm, LS-PeAF; 107±34mm, P=0.0351). The prevalence rate of SCZ (97.2%) was higher than LVZ (figure, mild LA-LVZ; 91.7%, moderate LA-LVZ: 66.7%, severe LA-LVZ; 25%). The 55.8% of SCZ overlapped with mild LA-LVZ, 37.6% of SCZ with moderate LA-LVZ, and 19.1% of SCZ with severe LA-LVZ. The LA CoAs were found in all patients. A total of 72 CoAs (average surface area, 7.0±4.0 cm2) were identified. A CoA was found in each of the three representative regions, ascending aorta-anterior LA (4.1±2.0 cm2, 36 of 36 patients, 100%), descending aorta-posterior LA (2.3±1.2 cm2, 12 of 36 patients, 33%), and vertebrae-posterior LA (3.4±2.1 cm2, 24 of 36 patients, 67%). However, only 22% of SCZ matched with the LA anatomical contact areas.

Conclusion
The slow conduction zone reflects LA electrical remodeling and may be a precursor finding of the low voltage zone, not LA contact areas in patients with atrial fibrillation.

Funding Acknowledgement
Type of funding source: None
Antiarrhythmic effect of ranolazine in combination with selective NCX-inhibition in an experimental model of atrial fibrillation
Authors: Wolfes J , Ellermann C , Broer N , Willy K , Rath B , Leitz P , Wasmer K , Eckardt L , Frommeyer G 
Published: November 2020

Abstract

Background
Previous studies showed an antiarrhythmic effect of ranolazine in different clinical and experimental studies. The aim of this study was to investigate the effects of a combination of ranolazine with different selective NCX-inhibitors in an established experimental model of atrial fibrillation.

Methods and results
18 hearts of New Zealand white rabbits were retrogradely perfused. Left and right atrial catheters were used to record monophasic action potentials. Hearts were paced at three different cycle lengths (350ms, 250ms, 150ms). Thereby, cycle-length dependent atrial action potential durations (aAPD90), atrial effective refractory periods (aERP) and atrial post-repolarization refractoriness (aPRR=aERP-aAPD90) were obtained. Vulnerability to AF was tested by a standardized protocol employing several trains of burst pacing. After generating baseline data, the hearts were perfused with a combination of acetylcholine (ACh, 1μM) and isoproterenol (Iso, 1μM) to increase occurrence of AF. Afterwards, the hearts were assigned to two groups and additionally perfused with a combination of 10 μM ranolazine and 1 μM of the selective NCX-inhibitor ORM-10103 (group 1: Rano-ORM) or 10 μM ranolazine and 1 μM of another NCX-inhibitor, SEA0400 (group 2: Rano-SEA). Infusion of ACh/Iso led to a shortening of aAPD90 (group 1/2: −27.2ms/−24.5ms p&lt;0.05), aERP (−29.2ms/−35.6ms p&lt;0.05), aPRR (−12.2ms/−13.7ms p=ns) and the occurrence of AF-Episodes was significantly increased (group 1: baseline 6 episodes to 34 episodes under ACh/Iso p&lt;0.05, group 2: baseline 7 episodes to 26 episodes under ACh/Iso p&lt;0.05). Additional perfusion with ranolazine and ORM-10103 did not alter aAPD90 (−0,47ms) while effective refractory periods (+21.4ms, p&lt;0.05) and aPRR (+43ms, p&lt;0.05) were significantly prolonged and AF episodes were effectively reduced to 15 episodes (p&lt;0.05). In group 2, Rano-SEA led to a slight decrease in aAPD90 (−9.5ms) while aERP (+13.3ms, p&lt;0.05) and aPRR (+19.8ms, p&lt;0.05) were prolonged. The occurrence of AF episodes was reduced to 15 episodes (p=0.1).

Conclusion
To our knowledge this is the first study investigating the effect of ranolazine combined with different selective NCX-inhibitors in an isolated whole-heart model of AF. Atrial repolarization was not significantly changed with either of the combinations. However, both combinations prolonged aERP and aPRR and thereby suppressed induction of AF. Combining novel cellular targets may therefore lead to new potentially interesting options for antiarrhythmic AF therapy that have to be tested in clinical studies.

Funding Acknowledgement
Type of funding source: None