bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3743A routine nursing questionnaire adds predictive value to conventional risk scores for TAVI (Transcatheter Aortic Valve Implantation) outcome
Authors: Gharibeh S X , Zweiker D , Binder J , Toth-Gayor G , Schmidt A , Zirlik A , Zweiker R 
Published: October 2019

Abstract

Background
Previous studies indicate that frailty is associated with poor outcome following TAVI.

Purpose
This study aimed to investigate whether a questionnaire routinely administered by nurses might serve as a surrogate for frailty and predict outcome in TAVI patients in addition to conventional risk scores.

Methods
This is a retrospective single-centre study performed at a university clinic with a high volume of TAVI. We included 461 consecutive patients (age 82±6 years, 60.5% female) scheduled for TAVI between 2012 and 2016. Based on seven questions addressing levels of patients' self-dependence assessed by nurses on admission, TAVI patients were divided into a “frail” group (at least one answer indicating limited self-dependence) and a self-dependent group (all other patients). We sought to assess (1) prevalence of frail TAVI patients, and (2) impact of frailty on two-year mortality assessed by Cox regression in addition to established risk scores.

Results
The prevalence of frail TAVI patients was 40.3%. Frail patients had significantly higher two-year mortality than self-dependent (non-frail) patients (25.3% vs 14.9%, p=0.014, Figure). In multivariate analysis stratified for age and left-ventricular function, body mass index (BMI), atrial fibrillation (AF) and frailty were significant predictors of increased two-year mortality (BMI, per kg/m2: HR 0.95 [95% CI 0.90–0.99], p=0.028; AF: HR 2.07 [1.35–3.18], p=0.001; frailty: HR 1.81 [1.18–2.76], p=0.006).
In addition to the Society of Thoracic Surgeons (STS) risk of mortality score, both AF and frailty significantly predicted increased two-year mortality (AF: HR 2.02 [1.32–3.09], p=0.001; frailty: HR 1.55 [1.01–2.38], p=0.045).

Conclusion
This study shows that a routine nurses' questionnaire covering levels of self-dependence serves as risk indicator for long-term mortality after TAVI. This unconventional geriatric assessment adds predictive power for two-year-mortality to a conventional risk score (such as STS) and might be used to stratify patients for greatest benefit from TAVI.
P3746Temporal patterns of premature atrial contractions predict atrial fibrillation occurrence in bradycardia patients continuously monitored through pacemaker diagnostics
Authors: Boriani G , Botto G L , Pieragnoli P , Ricci R P , Biffi M , Marini M , Sagone A , Avella A , Pignalberi C , Ziacchi M , Ricciardi G , Tartaglione E , Grammatico A , Gasparini M 
Published: October 2019

Abstract

Background
The frequency of premature atrial complexes (PACs) has been indirectly related with atrial fibrillation (AF) occurrence and adverse outcomes.

Objective
To evaluate whether temporal patterns of PACs are directly associated with AF onset in pacemaker patients with continuous monitoring of the atrial rhythm.

Methods
Overall, 193 pacemaker patients (49% female, 72±9 years old), enrolled in a national registry, were analyzed. Frequency of daily PACs was measured in a 14-day initial observation period, during which patients were in sinus rhythm. In the following period, temporal occurrence and frequency of daily PACs and eventual onset of AF were derived by pacemaker diagnostics.

Results
In the run-in period, median PACs frequency was 614 PACs/day (interquartile range=70–3056). Subsequently, in a median follow-up of 6 months, AF occurred in 109 patients, in particular in 37/96 (38.5%) patients with a PAC rate<614 PACs/day and in 72/97 (74.2%) patients with PAC rate≥614 PACs/day (p<0.001). In patients with AF occurrence, the number of daily PACs, normalized by dividing for the average of PACs in 10 preceding days, progressively increased in the 5–6 days preceding AF (Figure). Cox Model predictive analysis showed that the risk of AF was significantly higher in patients with a relative increase of the daily PACs higher than 30% compared with PACs average number in 10 preceding days (hazard ratio (95% confidence interval) = 3.67 (2.40–5.59), p<0.001).
PACs changes daily trend before AF

Conclusion
PACs frequency increases in the 5–6 days preceding AF onset. A relative increase of the daily PACs is significantly associated with the risk of AF occurrence.
P3751The reinnrevation with pulmonary vein isolation associated cardiac autonomic dysfunction
Authors: Kodama T , Kikuchi T K , Yoneyama A 
Published: October 2019

Abstract

Background
It is well-known that cardiac autonomic nerve is impaired after Pulmonary vein isolation (PVI) for atrial fibrillation (Af), but the the long-term change in cardiac autonomic function is unclear.

Objective
We followed the long-term cardiac autonomic nervous function after PVI and clarified its recoverability.

Subjects
Of 136 patients who received 1st session PVI from 2013 to 2017, 49 patients [Male: 86%, 62±11y, Diabetes meritus: 16%, radiofrequency (RF) ablation: 59%, cryoballoontechnique (Cryo): 41%, left atrial diameter: 37.2±4.5mm, LVEF: 67.4±9.7%, BNP: 103±108pg/dl]who satisfied the Inclusion criteria (No history of cardiac surgery, no recurrence of Afafter PVI for more than 1 year, with Holter ECG record of sinus rhythm before PVI and every 3 months after PVI for 1 year or more.

Method
Heart rate variability (HRV) parameters for each period (before PVI and after PVI 0–3 months, 3–6 months, 6–9 months, 9–12 months) were obtained from each Holter ECG records using MemCalcsystem. We defined the HRV before PVI as 100% and examined the rate of change for each HRV (see Figure) after PVI retrospectively.

Result
All of HRV indicators after PVI had been decreased significantly at 0–3 months after PVI (from 21.7% to maximum of 77.9% down). Figure is a series of indexes from front to back in order of decreasing HRV at 0–3 months after PVI, and the frequency domain index concentrates on the front. These decreased HRVs gradually recovered through 12 months after PVI (shown in figure left), but this change is more responsive in the frequency domain index than in the time-domain index, and after 3–6 months, all indices has already showed a significant rise compared with 0–3 months after PVI. In any of the indices, this increase over time did not receive interaction due to the difference in the procedure (RF, Cryo).

Conclusion
HRV decreased by PVI showed a significant rise over time, mainly in the frequency domain, at 3–6th month after PVI, suggesting the existence of reinnervation of cardiac autonomic nerve at this period.
P3753Does empagliflozin modulate the autonomic system among patients with type 2 diabetes and coronary artery disease? Insights from the Holter sub-study of the EMPA-Heart CardioLink-6 Randomised Trial
Authors: Garg V , Verma S , Connelly K A , Yan A T , Sikand A , Garg A , Dorian P , Zuo F , Leiter L A , Zinman B , Juni P , Verma A , Quan A , Mazer C D , Ha A C T 
Published: October 2019

Abstract

Introduction
The mechanism behind how empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, reduces all-cause and cardiovascular mortality among patients with type 2 diabetes (T2DM) and coronary artery disease (CAD) is unknown. Autonomic tone, as reflected by changes in heart rate variability (HRV), is an established prognosticator in patients with CAD and/or heart failure.

Purpose
To assess if empagliflozin treatment changes HRV in subjects with T2DM and CAD.

Methods
In the double-blind EMPA-Heart trial, 97 subjects with T2DM and CAD were randomised to empagliflozin 10 mg/day or placebo for 6 months and underwent 24-hour Holter monitoring at baseline and 6 months. Using automated algorithms, time and frequency HRV domain measures were obtained (standard deviation of NN intervals (SDNN); SD of the average NN intervals for each 5-minute segment (SDANN); root mean square of successive RR interval differences (rMSSD); % interval differences of successive NN intervals >50 ms (pNN50); ratio of low to high frequency (LF/HF)). Changes of these HRV parameters were calculated over 6 months. Between-group differences in HRV parameters were compared using ANCOVA.

Results
Complete Holter data (baseline and 6-month) were available for 68% (n=66) of the cohort. The average heart rate (HR) at baseline/6 months was 69.5±9.8 bpm/72.8±8.1 bpm and 76±10.4 bpm/76.5±10.6 in the placebo group and empagliflozin group, respectively. Both groups had similar changes in average HR over 6 months. Key Holter data are summarised in the table. SDNN and SDANN were higher in the placebo vs. empagliflozin group at 6 months; no significant difference was noted for all other measures.
Empagliflozin 10 mg/day (n=33) Placebo (n=33) Adjusted difference between Empagliflozin and Placebo (ANCOVA) Baseline, Mean (SD) 6-month, Mean (SD) Baseline, Mean (SD) 6-month, Mean (SD) Mean, (95% CI) P-value SDNN (ms) 100.49 (43.74) 98.05 (38.86) 109.35 (30.02) 125.08 (43.83) −18.55 (−34.28, −2.82) 0.022 SDANN (ms) 86.84 (39.34) 83.76 (35.53) 94.70 (28.52) 118.28 (77.41) −20.24 (−37.27, −3.21) 0.021 rMSSD (ms) 27.00 (11.84) 27.22 (13.48) 28.00 (11.58) 27.17 (9.38) −1.23 (−6.02, 3.55) 0.608 pNN50 (%) 7.81 (7.59) 8.32 (9.51) 8.26 (7.8) 6.93 (5.35) 0.51 (−2.61, 3.62) 0.746 LF/HF ratio 1.63 (0.52) 1.65 (0.51) 1.53 (0.43) 1.83 (0.82) −0.08 (−0.38, 0.22) 0.602

Conclusions
Among subjects with T2DM and CAD, changes in HRV over 6 months were similar in the empagliflozin and placebo arms suggesting that the mortality benefit conferred by empagliflozin is not associated with positive modulation of autonomic tone.

Acknowledgement/Funding
This trial was supported by an unrestricted investigator-initiated study grant from Boehringer Ingelheim.
P3756Diverse activation patterns during persistent atrial fibrillation characterised by dipole density non-contact mapping
Authors: Shi R , Chen Z , Butcher C , Zaman Z , Boyalla V , Wang Y K , Riad O , Sathishkumar A , Norman M , Haldar S , Jones D G , Hussain W , Markides V , Wong T 
Published: October 2019

Abstract

Background
Global simultaneous recording of activation during atrial fibrillation (AF) can elucidate underlying mechanisms contributing to AF maintenance. A better understanding of these mechanisms may allow for a personalised ablation strategy to treat persistent AF.

Purpose
To characterise left atrial endocardial activation patterns during AF using a novel non-contact dipole density mapping.

Methods
Activation patterns were characterised into three sub-types: (i) focal with centrifugal activation (FCA); (ii) localised rotational activation (LRA); (iii) localised irregular activation (LIA). Continuous activation patterns were quantified and distributed in the left atrium.

Results
A total of 144 persistent AF segments with 1068 activation patterns from 25 patients were analysed. The most common pattern was LIA (63%), which consist of four disparate features: slow conduction (45%), pivoting (30%), collision (16%) and acceleration (7%). LRA was the second commonest pattern (20%). FCA (17%) arose frequently from the PVs/ostia. Continuous AF activations comprise multiple combinations of FCA, LRA and LIA, transitioning from one to the next without a discernible order. Preferential conduction areas were typically seen in mid-anterior (48%) and lower-posterior (40%) walls where dominant activations were made up of LRA and LIA.

Conclusion
AF is characterised by heterogenous activation patterns that vary between individuals. Clinical implications of individualised ablation strategies guided by dipole density mapping will have to be determined.

Acknowledgement/Funding
None
P3770Interatrial block: a prognostic factor for atrial fibrillation in cryptogenic stroke patients
Authors: Mendieta Badimon L G , Guasch E , Weir D , Aristizabal D , Llull L , Mont L , Bayes De Luna A , Sitges M 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is a well-known risk factor for ischemic stroke. Interatrial block (IAB), resulting from a conduction delay in Bachmann's bundle, is an electrical abnormality that, especially in its advanced (A-IAB) form, has been associated with atrial fibrotic cardiopathy and remodeling, sharing a common pathologic substrate with AF. Therefore, IAB has been proposed as a marker of atrial electromechanical dysfunction that may predispose to the development of AF. We hypothesized that IAB could be a marker of AF in patients with cryptogenic stroke (CS).

Methods
We retrospectively screened a cohort of CS patients with no prior history of AF, and collected their demographic, cardiovascular risk factors and other co-morbidities, stroke severity and resultant functional disability (NIHSS and mRS scales), CHA2DS2-VASc score, baseline 12-lead ECG, transthoracic echocardiogram, and neuroimaging studies on admission. All patients underwent continuous ECG monitoring for at least 48h. Forty-eight (64%) patients underwent additional out-patient 24h Holter monitoring following hospital discharge. P-wave (PW) analysis of baseline ECG classified patients into three groups: normal p-wave duration (N, PW <120 ms), partial IAB (P-IAB, PW ≥120 ms) and advanced IAB (A-IAB, PW ≥120 ms and biphasic morphology in leads DII, DIII and aVF). AF episodes (defined as irregular supraventricular arrhythmias without detectable PWs lasting >30 s), frequent premature atrial contractions (PACs) (>1%) and atrial tachyarrhythmia episodes (runs of >3 consecutive PACs) were detected on 24h Holter readings. Ischemic brain lesions were classified as cortical, subcortical or lacunar in relation to their localization and maximal diameter.

Results
Out of the 80 consecutive CS patients identified, 5 were excluded due to poor quality ECG readings. A high prevalence of both P-IAB (n=30, 40%) and A-IAB (n=23, 30.7%) was found in the final analysis with 75 CS patients. No differences were found between demographics, cardiovascular risk factors and co-morbidities, NIHSS, mRS and CHA2DS2-VASc scores, left atrial size and left ventricular ejection fraction among the 3 ECG categories. Cortical ischemic brain lesions were more frequent in patients in the IAB groups than in the N ECG group. After a mean follow-up of 522 days, AF was clinically diagnosed in 13 patients (17%), with an increasing risk in accordance to the severity of the IAB (p<0.05) (Figure 1A). 24h Holter readings showed greater frequency of PACs and atrial tachyarrhythmia episodes in patients with IAB (p<0.05) (Figure 1B).
Figure 1

Conclusions
In CS, IAB is associated with a greater risk to develop AF and its presence identifies a subgroup of patients with probable atrial fibrotic cardiopathy that could potentially benefit from early oral anticoagulation in secondary prevention.
P3772Risk factors for future development of atrial fibrillation are not evident among apparently healthy individuals with paroxysmal atrial fibrillation
Authors: Koshiyama M , Tamaki K , Ohsawa M 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is one of the important factors of cardiovascular morbidity and mortality and to find not only patients with persistent AF but also individuals with paroxysmal AF among apparently healthy people is a crucial strategy for decreasing number of patients with serious cardio-embolic stroke. However, screening ability using previously known risk factors for future development of AF has not been examined in individuals with paroxysmal AF.

Methods
A total of 59730 male individuals, aged 40 years or older who underwent multiple comprehensive physical check-ups including 12 lead electrocardiogram (ECG) from 2012 to 2015 were enrolled. Persistent AF was defined a case that consecutively manifested AF till the last checkup. Paroxysmal AF was defined as a case who transiently manifested AF in each of the checkup and subsequently manifested sinus rhythm at the last checkup. Non-AF was defined as a case that never manifested AF in any of checkup. Age-adjusted prevalence rates and their 95% confidence intervals of known-risk factors in the first survey were estimated by logistic regression analysis separately by the three groups (non-AF (n=58602), paroxysmal AF (n=392) and persistent AF (736)).

Results
Age-adjusted prevalence rates (95% confidence interval) of risks factors for AF are shown in the table. Already known risk factors were evidently manifested in persistent AF group, however, prevalence rates of these factors in paroxysmal AF group were not different from the rates in non-AF group.

Conclusion
The repeated measurements of ECG study indicated that individuals who would develop paroxysmal AF in the near future did not have typical risk factors for AF and a screening test using risk factors for AF have no chance to find a high-risk individual for paroxysmal AF.
P3787Incidence, risk predictors, and mortality risk of new heart failure in an incident hospitalised atrial fibrillation cohort: a Western Australia population-based study, 2000–2010
Authors: Weber C , Hung J , Hickling S , Nedkoff L , Murray K , Li I , Briffa T 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is a risk factor for heart failure (HF) and new HF onset is associated with increased mortality.

Purpose
To determine the incidence, risk predictors and mortality risk of a new HF hospitalisation event in patients after incident AF hospital admission.

Methods
This was a contemporary, population-based retrospective cohort study which included all Western Australian residents, aged 25 to 94 years, who survived an incident hospitalisation for AF, between 2000 and 2010. Patients hospitalised with AF that had no previous AF or HF hospitalisations up to 15 years beforehand were identified. Time to first-ever HF hospitalisation in the three years following incident AF was assessed using Kaplan-Meier methods, accounting for all-cause death as a competing risk. Cox proportional hazards models were used to determine independent predictors of HF. The association of first HF with subsequent survival was estimated using a time-dependent HF variable with other risk covariates in a proportional hazards model.

Results
The cohort comprised of 34 999 patients, 56.8% male, with a mean age of 71.0 (SD 13.1) years. Females were on average 6 years older than males (P<0.001). Among the cohort, 20.4% had died from any cause at 3-year follow-up. The cumulative incidence of a first HF hospitalisation event at 3 years (n=4298), after accounting for death as a competing risk, was 12.3% (95% CI 11.9%-12.6%). Most HF hospitalisations (56.2%) occurred within the first year after incident AF admission (median of 279 days; IQR 64–649 days). Of the incident HF hospitalisations, 88.9% were an emergency admission. Independent predictors of an increased risk of HF hospitalisation included older age and a history of hypertension, diabetes, excessive alcohol consumption, myocardial infarction, chronic obstructive pulmonary disease, valvular heart disease, and chronic kidney disease (all P<0.0001). Incident AF patients who were hospitalised for first HF had an adjusted hazard ratio of 2.89 (95% CI; 2.71–3.08) for all-cause mortality (P<0.0001).

Conclusion
Hospitalisation for HF is a frequent and troublesome problem in patients after incident AF admission, and is independently associated with increased risk of mortality. The clinical predictors of new HF occurrence highlight the importance of assessment and comprehensive management of associated risk factors and comorbid diseases in order to prevent HF morbidity and mortality in AF patients.

Acknowledgement/Funding
NHMRC CRECOI Scholarship
P3794MOODS: a novel risk score to identify patients with atrial fibrillation and sleep apnoea
Authors: Kadhim K , Elliott A , Middeldorp M , Hendriks J , Gallagher C , Mahajan R , McEvoy R D , Lau D , Sanders P , Linz D 
Published: October 2019

Abstract

Background
Sleep-disordered breathing (SDB) is an important risk factor for developing atrial fibrillation (AF), and treatment of concomitant SDB can improve AF rhythm outcomes. Diagnosis of SDB requires sleep studies which can pose a significant time and resource burden. We sought to develop a prediction score based on clinical characteristics that can help identify AF patients who require further assessment for SDB.

Methods
Prospectively-collected data for 442 consecutive patients treated for AF from 2009 to 2017 were analysed. All patients were considered candidates for rhythm-control and therefore referred for sleep studies. The diagnosis of SDB was confirmed using in-lab polysomnography and classified using the apnoea-hypopnoea-index (AHI), with cut-offs of ≥15/hr and ≥30/hr indicating moderate-to-severe and severe SDB respectively. Patients treated up to 2015 formed the derivation cohort (n=311) and the remainder (n=113) formed the validation cohort. Multivariate logistic regression analysis was used to identify clinical variables predictive of moderate-to-severe SDB. A risk score model was developed based on regression coefficients and tested using receiver-operating-characteristics analyses on the validation cohort.

Results
Overall, mean age was 60±11 years, mean body mass index (BMI) was 30±5 kg/m2 and 69% were men. The prevalence of moderate-to-severe SDB was 33.7%. There were no significant differences in baseline characteristics between the derivation and validation cohorts. Male gender (score=1), overweight (BMI: 25–29 kg/m2, score=2), obesity (BMI≥30 kg/m2, score=3), diabetes (score=1), and stroke (score=2) were significantly independently predictive of moderate-to-severe SDB and formulated the score. The score performed well to predict moderate-to-severe SDB with a C-statistic of 0.73 (95% CI: 0.67–0.79, P<0.001) in the derivation cohort, and 0.67 (95% CI: 0.57–0.77, P<0.001) in the validation cohort. As a rule-out test, a score of ≤3 had a negative predictive value of 77% for moderate-to-severe SDB (91% for severe SDB). A score of ≥4 had an intermediate positive likelihood ratio (PLR) of 2 for moderate-to-severe SDB (2.2 for severe SDB), while a score of ≥5 had a high PLR of 6.5 and 6.8 for moderate-to-severe SDB and severe SDB respectively.
Sensitivity and specificity table

Conclusion
A novel risk score comprising clinical characteristics can identify patients with AF likely to benefit from further assessment for SDB. Application of this model may aid optimise resource utilisation and facilitate timely patient care.