bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3707CHA2DS2 VASC score as predictor of the incidence of stroke in patients with stable coronary artery disease and sinus rhythm in the long-term follow-up
Authors: Sanchez J J , Ruiz-Ortiz M , Ogayar C , Mesa D 
Published: October 2019

Abstract

Background
Cerebral vascular disease and coronary artery disease (CAD) share risk factors. Our aim was to study CHA2DS2VASC score as predictor of stroke incidence in a sample of patients with sinus ryhtm and stable CAD (sCAD) during long term follow-up.

Methods
The CICCOR registry (“Chronic ischaemic heart disease in Cordoba”) is a prospective monocentric cohort study. Between February 2000 and January 2004 all patients with sCAD who attended two outpatient cardiology clinics in a city of the South of Spain were recruited. We analyzed the relationship between baseline CHA2DS2VASC score and the incidence of stroke in a sample of patients with sCAD without atrial fibrillation during long term follow-up. Patients without sinus rythm were excluded.

Results
1268 patients with sCAD were recruited (median age 68±10 years, 73% male). 69 patients showed atrial fibrillation and were excluded. The median follow-up was 11.2 years (maximum follow-up of 17 years). During this period, only 2 patients were lost, and 136 patients (11.5% of the sample) suffered stroke. Baseline mean CHA2DS2 VASC score was 3.21. Most patients showed CHA2DS2 VASC score lower than 4 (81.4% of the sample). Higher CHA2DS2 VASC score at baseline was associated with higher risk of suffering stroke during follow-up (Hazard Ratio = 1.31 (1.16–1.48); p<0.001). Mean results are shown in the table.
Table 1 No stroke (n=1063) Stroke (n=136) Hazard ratio (CI 95%) p Sex male (%) 777 (88.8) 98 (11.2) High blood pressure (%) 561 (86.6) 86 (13.3) Diabetes mellitus (%) 317 (86.4) 50 (13.6) 75 years and older (%) 205 (83.7) 40 (16.3) Mean CHADS VASC score 3.17 3.55 1.31 (1.16–1.48) <0.001 CHADS VASC score higher than 4 (%) 185 (84.1) 35 (15.9) 2.00 (1.33–3.01) 0.001
Stroke incidence according to CHADSVASC

Conclusion
Higher CHA2DS2 VASC score was significantly associated with higher stroke incidence during long term follow-up in this real-world sample of patients with sCAD in sinus rythm.
P3710Long term follow-up in a real-world study cohort after patent foramen ovale closure
Authors: Hamm C , Doerr O , Haas M , Schulz L , Koerschgen T , Nef H M , Keller T , Fischer-Rasokat U , Hamm C W , Liebetrau C 
Published: October 2019

Abstract

Background
Patent foramen ovale (PFO) closure is the treatment of choice after cryptogenic stroke according recent evidence. The indication is based on results of several randomized controlled trials; however, the results of these trials may not be extrapolated to a real-world clinical setting. Therefore, the aim of the present study was to evaluate long-term outcome regarding recurrent stroke, migraine, and/or peripheral embolism in patients after PFO closure.

Methods
We retrospectively analyzed outcomes of consecutive patients undergoing PFO closure from 2011 to 2018 at two interventional sites with respect to periprocedural events occurring during hospitalization and long-term follow-up. Follow-up data were collected from outpatient visits or telephone interviews.

Results
The analysis included 214 consecutive patients (mean age 52 years; 58% male). The follow-up rate was 96% and the mean follow-up time was 38 (SD 22) months. The index vascular event leading to PFO closure was stroke (n=190; 89%), including patients with repetitive stroke (n=36), embolic myocardial infarction (n=21), and migraine (n=3). One quarter (24.6%) of the population studied had an atrial septal aneurysm (>15 mm). Procedural success was achieved in 98%. There were no procedure-related strokes or deaths. Periprocedural complications occurred in 16 patients (7%): two cases of pericardial tamponade, seven complications at the access site mainly caused by bleeding, two cases of transient atrial fibrillation, and five other complications. The Amplatz Septal Occluder™ was used in two thirds (64.5%) of the cases and the Gore Cardioform™ device in one third (28.6%). Four (2%) patients died during follow-up. None of these patients experienced a recurrent stroke. Ten (5%) other patients experienced a recurrent stroke. Patients with recurrent stroke events were older than patients without recurrent stroke (mean 62.6 [SD 8.8] years vs. mean 52.2 [SD 13.8] years; p=0.015) and had a higher rate of preexisting cerebrovascular occlusive disease (5 [50%] vs. 10 [6%]; p<0.0001). There was no difference in risk for recurrent stroke between patients with one prior stroke and more than one stroke before PFO closure (p=0.71). Atrial fibrillation occurred in 6.6% of the patients during follow-up, but only one of these patients had recurrent stroke. No other anatomic and vascular risk factors or antithrombotic treatments were identified as being predictive of embolic events after closure.

Conclusion
In this real-world PFO closure cohort the recurrent stroke rate is low, although it is higher than reported in the recent randomized controlled trials. Recurrent strokes after PFO closure may reflect additional comorbid risk factors such as age or cerebrovascular occlusive disease that are unrelated to the potential for paradoxical embolism.
P3712The omega-3 fatty acid eicosapentaenoic acid (EPA) is inversely associated with ischemic brain infarcts in elderly patients with atrial fibrillation
Authors: Reiner M F , Baumgartner P , Wiencierz A , Aeschbacher S , Rodondi N , Baretella O , Kuehne M , Moschovitis G , Bonati L H , Von Schacky C , Luescher T F , Camici G G , Osswald S , Conen D , Beer J H 
Published: October 2019

Abstract

Background
The association of individual omega-3 fatty acids (n-3 FAs) with ischemic stroke remains unclear. Experimental data strongly suggest that n-3 FAs reduce ischemic stroke due to their anti-thrombotic and anti-inflammatory properties. Yet, recent clinical trials yielded mixed results. While marine n-3 FA supplementation (1g/day) did not reduce stroke, icosapent ethyl, a purified eicosapentaenoic acid (EPA) ethyl ester (4g/day), significantly reduced stroke incidence in patients at high cardiovascular risk. In the current study, we examined the association of fish-derived EPA, docosapentaenoic acid (DPA), docosahexaenoic acid (DHA) and the plant-derived alpha-linolenic acid (ALA) with the prevalence of ischemic brain infarcts in elderly patients with atrial fibrillation.

Methods
In this cross-sectional analysis of the Swiss atrial fibrillation (swissAF) cohort study, we determined baseline whole blood n-3 FAs by gas chromatography according to the HS-Omega-3 Index methodology in 1665 patients aged ≥65 years with atrial fibrillation. Large non-cortical and cortical infarcts (LNCCI) were assessed by brain MRI. Total and individual n-3 FAs were correlated with the prevalence of LNCCI in a logit model with continuous factors. Analyses were adjusted for sex, age, body mass index, smoking, alcohol intake, family history of cardiovascular disease and atrial fibrillation, physical activity, hypertension, diabetes, chronic kidney disease, prior stroke, prior transient ischemic attack, aspirin, anticoagulation and type of atrial fibrillation.

Results
A total of 373 patients with LNCCI (22.4%) were identified. After adjustment, lower risk of LNCCI was associated with higher EPA (odds ratio [OR] 0.50 per increase of one percentage point EPA, 95% confidence interval [CI] 0.28–0.88) and a higher risk was detected with DPA (OR 2.39, 95% CI 1.43–4.01). No statistically significant association was detected with DHA (OR 1.13, 95% CI 0.94–1.35), ALA (OR 0.83, 95% CI 0.23–2.95) or total n-3 FAs (OR 1.03, 95% CI 0.92–1.16).

Conclusions
Higher levels of EPA are associated with a lower prevalence of ischemic infarcts in aged patients with atrial fibrillation. Unexpectedly, DPA shows a direct correlation with ischemic infarcts. This study demonstrates that individual n-3 FAs may differentially affect stroke risk and that supplementation of EPA may be an interesting strategy to prevent ischemic stroke in atrial fibrillation patients.

Acknowledgement/Funding
Swiss National Science Foundation
P3731The improvement in left atrial strain among patients undergoing percutaneous left atrial appendage closure
Authors: Ijuin S , Hamadanchi A , Haertel F , Baez L , Schulze C , Franz M , Moebius-Winkler S 
Published: October 2019

Abstract

Background
Percutaneous left atrial appendage closure (LAAC) is being established as an alternative option for atrial fibrillation (AF) patients with high bleeding risk. Few studies reported the influence of percutaneous LAAC on left atrial (LA) performance, but most of the studies demonstrated no remarkable changes in their parameters after the procedure.

Method
The study included 95 patients (age: 75±6.7 years, 67% male) whom underwent percutaneous LAAC in a single center between September 2012 and November 2018. LA strain was evaluated at three different time intervals by transesophageal echocardiography (baseline, 45 days and 180 days after procedure). All data were analyzed using a dedicated. 70 patients had atrial fibrillation whereas 25 were in sinus rhythm. Analysis was performed for peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) from segment of lateral wall in mid-esophageal 4 chamber view. The validity of lateral wall left atrial analysis was recently shown by our group. PACS was obtained in patients with sinus rhythm during exams.

Results
Compared to baseline, PALS was significantly increased after 45 days (12.4±8.4% vs 16.0±10.7%, p=0.001) and remained stable after 180 days (13.8±9.0% vs 17.0±12.4%, p=0.098). Even in only patients with atrial fibrillation during exams, it was increased (10.8±7.7% vs 13.4±7.1%, p=0.012 and 8.5±5.1% vs 13.9±8.1%, p=0.014). Similarly, compared with the baseline, PACS was significantly increased after 45 days and 180 days (5.8±3.9% vs 10.6±7.6%, p=0.001 and 4.5±2.6% vs 7.9±3.1%, p=0.036).
The Changes in PALS and PACS

Conclusion
Our study has demonstrated for the first time the improvement in LA strain following LAAC within 45 days of implantation by transesophageal echocardiography and these values were maintained at least for 6 months. Further appraisal is warranted for confirmation of these preliminary findings.
P3742Transcatheter aortic valve implantation in large annuli: incidence and predictors of specific adverse events with the largest self-expanding device
Authors: Veulemans V , Hellhammer K , Maier O , Klein K , Afzal S , Piayda K , Jung C , Westenfeld R , Kelm M , Zeus T 
Published: October 2019

Abstract

Background
The recently released largest self-expanding transcatheter aortic valve device (STHV-34) is characterized by good results but nevertheless demands an experienced team for the implantation in large annuli.

Purpose
Looking at multi slice computed tomography (MSCT) and procedural data, we tried to identify characteristics that could explain intraprocedural VARC-2 and valve specific non-VARC-2 events.

Methods
We performed a single center retrospective analysis in 80 patients treated with STHV-34. STHV-34 patients were separated into subjects without events (NE, n=43, 54%) and the following adverse events: resheathing/-capture processes (RS/C, n=19, 24%), valve dislodgments (VD, n=21; 26%), infolding (IF, n=6, 8%) and complete dislocation with bail-out valve-in-valve implantation (ViV, n=3, 4%). Events were further categorized in non-VARC-2 and VARC-2. The analysis sought for underlying anatomical conditions and defined risk factors by multivariate analysis.

Results
Primary device success was reached in 96% and immediate postprocedural absence of moderate-to-severe aortic regurgitation was 100%. We identified specific anatomical conditions predisposing for non-VARC-2 and VARC-2 events: RS/C: annular calcium load<1600 AU (OR 47 [CI 1.4–216], p=0.0004). IF: peripheral kinking (RR 5.0 [CI 1.0–24], p=0.0478) and previous RS/C maneuvers (83%). ViV: annular ellipticity index (NS 1.2±0.1 vs. ViV 1.4±0.1, p=0.0049), aortic angulation (AA) angle (NS 54.0±7.0° vs. ViV 61.7±1.5°, p=0.0240) and LVOT-AO angle (NS 149.1±18.9° vs. ViV 130.3±3.5°, p=0.0470).

Conclusion
We confirm high procedural success for the largest currently available STHV-34. The incidence of intraprocedural non-VARC-2 and VARC-2 events are associated with anatomical characteristics that may influence valve selection and implantation strategy.
P3759Comparison of equations for renal function assessment and major adverse outcomes in atrial fibrillation: an analysis from the EORP-AF long-term general registry
Authors: Boriani G , Proietti M , Laroche C , Fantecchi E , Popescu M , Marin F , Maggioni A P , Lip G Y H 
Published: October 2019

Abstract

Background
Several equations exist to estimate creatinine clearance according to serum creatinine values and baseline characteristics. The CKD-EPI equation is usually recommended in general population, while the Cockroft-Gault (CG) equation has been used in atrial fibrillation (AF) clinical trials.

Purpose
To perform a comparison between 6 different equations for evaluation of renal function in AF patients.

Methods
We calculated CKD-EPI, CG, body surface area adjusted CG (CG BSA), MDRD, BIS1 and FAS equations in AF patients enrolled in the EORP-AF Long-Term General Registry. Outcomes at 1-year follow-up were considered.

Results
Renal equations were calculated in 7725 patients. According to CKD-EPI mean (SD) creatinine clearance was 69.14 (21.06) mL/min/1.73 m2. Taking CKD-EPI as reference, the MDRD equation showed the highest agreement (weighted kappa [95% CI]: 0.843 [0.833–0.852]), while CK showed the lowest agreement (weighted kappa [95% CI]: 0.593 [0.580–0.606]. The remaining equations showed moderate agreement. Cox regression analysis showed that all equations were inversely associated with all major adverse outcomes [Figure]. The CKD-EPI equation showed modest predictive ability for the three outcomes (c-statistics: any TE/ACS/CV Death: 0.63379; CV Death: 0.68512; All-Cause Death: 0.67183), with all other equations reporting higher c-statistics (delta-c statistic ranging from +0.01497 for FAS equation for any TE/ACS/CV Death to +0.04547 for CG BSA for all-cause death) for all outcomes (all p<0.0001, for any equation for any outcome). Compared to CKD-EPI, all the other equations showed an improvement in prediction of outcomes, according to IDI and NRI, with the exception of FAS equation for any TE/ACS/CV Death. CG BSA equation showed the greatest improvement in prediction of outcomes compared to CKD-EPI (relative IDI: 21.9% for any TE/ACS/CV Death, 28.8% for CV Death, 34.4% for All-Cause Death).
Cox Regression Analysis

Conclusions
Compared to CKD-EPI equation, all the other equations for creatine clearance has stronger associations with adverse outcomes, with the CG BSA reporting the higher yield for all the outcomes considered.
P3762The impact of type and burden of atrial fibrillation on stroke occurrence in patients with atrial fibrillation: from a prospective cohort of atrial fibrillation patients (CODE-AF Registry)
Authors: Cho S , Kim T , Uhm J , Cha M , Lee J , Park J , Park J , Kang K , Shim J , Kim J , Park H , Choi E , Kim J , Lee Y , Joung B 
Published: October 2019

Abstract

Background and purpose
Although several studies reported that stroke risk in patients with paroxysmal atrial fibrillation (AF) is similar to those with persistent or permanent AF, there is still controversy on the relationship of AF type and stroke occurrence. We investigated the effect of AF type on AF burden and stroke risk in patients with non-valvular AF.

Methods
Within the CODE-AF prospective, outpatient registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation), we identified 8,883 patients ≥18 years of age with non-valvular AF and eligible follow-up visits. We compared AF burden and stroke risk among patients with 3 types of AF: paroxysmal (n=5,808) or persistent (n=2,806) or permanent (n=269).

Results
The median age of the overall population was 68.0 (interquartile range, 60.0–75.0); 36.0% were female. Patients with persistent and permanent AF were older and had higher CHA2DS2-VASc scores and anticoagulation rate than those with paroxysmal AF. Compared with permanent AF (5.2±16.4%), the arrhythmic burden of AF on 24hrs Holter monitoring was significantly lower in paroxysmal AF (2.1±7.2%, p<0.001) and persistent AF (2.0±7.5%, p<0.001). During median follow-up period of 1.38 years (interquartile range: 0.96–1.67), total 82 (0.92%) patients experienced ischemic stroke with incidence rates of 0.51, 1.04 and 1.69 events per 100 person-years for paroxysmal, persistent and permanent AF, respectively. Compared with paroxysmal AF, the risk of ischemic stroke was increased in persistent AF with clinical variable adjusted hazard ratio (aHR) of 1.94 (95% confidence intervals [CI], 1.23–3.07; P=0.005) and permanent AF with aHR of 2.64 (95% CI, 1.09–6.41; P=0.03).
AF type and HR of stroke occurrence Paroxysmal (n=5,808) Persistent (n=2,806) Permanent (n=269) Stoke events 39 37 6 Person years (PYs) 7673 3544 356 /100 PYs 0.51 1.04 1.69 HR (95% CI), p-value HR (95% CI), p-value HR (95% CI), p-value Unadjusted HR 1 (Reference) 2.05 (1.27–3.31), 0.003 3.32 (1.15–7.90), 0.02 Clinical variables adjusted HR 1 (Reference) 1.94 (1.23–3.07), 0.005 2.64 (1.09–6.41), 0.03 PYs: Person years; HR: Hazard ratio.

Conclusion
Persistent and permanent AF was associated with the increased risk of stroke than paroxysmal AF, after adjustment of clinical variables including age, sex, comorbidities and anticoagulation rate. These results suggest that AF type and burden might be related with the risk of ischemic stroke and should be considered in the stroke prevention of AF.
P3766New-onset peri-operative atrial fibrillation is associated with increased mortality in patients undergoing total knee and hip replacements
Authors: Varon B , Kandel L , Rivkin G , Leibowitz D 
Published: October 2019

Abstract

Background
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common surgeries performed in elderly patients with osteoarthritis. Limited data address the clinical significance of peri-operative atrial fibrillation (AF) in these patients.

Purpose
This study aimed to determine whether pre-existing or new onset AF is associated with increased 1-year mortality rates.

Methods
280 patients over the age of 60 undergoing THA or TKA with peri-operative AF and 280 control matched patients were retrospectively identified, and their files reviewed. The primary endpoint was 1-year mortality from the date of the surgery.

Results
Of the 280 patients with peri-operative AF, 37 had new onset AF with a 1-year mortality rate of 10.8%. This mortality was significantly higher in patients with new-onset AF compared to patients without AF or patients with previous AF (10.8%, vs. 1.1% and 2.5%, respectively; p=0.005). On multivariate analysis, this difference remained significant after adjustment for risk factors associated with mortality.
Variables associated with mortality Characteristic P value Adjusted Odds Ratio 95% confidence interval When AF type is included:   Chronic renal failure 0.004 7.64 1.91–30.64   Timing of AF (New onset) 0.005 9.95 1.99–49.77 When AF timing is included:   Chronic renal failure 0.005 7.47 1.83–30.40   Timing of AF (post-op) 0.0.1 7.59 1.62–35.62 AF, atrial fibrillation.

Conclusion
One-year mortality in elderly patients undergoing TKA or THA is significantly increased in patients with new postoperative AF. These patients warrant increased clinical surveillance following surgery.
P3775Income level is associated with risk of adverse events in patients with atrial fibrillation
Authors: Liao J.-N , Chao T F , Chen S A 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) increases the risk of cardiovascular events, major bleeding, and all-cause mortality. Risk factors for adverse events in AF patients have been identified, but data regarding the effect of income level were limited.

Methods
From the year 2010 to 2015, a total of 185,052 patients with AF aged ≥20 years were identified from the “National Health Insurance Research Database” in Taiwan and 169,450 of them had a CHA2DS2-VASc score ≥1 (for males) or ≥2 (for female). Among them, income data were available in149,489 patients and these subjects constituted our study population. Patients were classified into low-, intermediate- and high-income group. The baseline characteristics were analyzed. Subgroup analysis (low income versus high income; intermediate versus high income) was done using matched populations. The end-points include all-cause mortality, ischemic stroke, intracerebral hemorrhage (ICH), major bleeding and composite outcomes (any of mortality, ischemic stroke or ICH)

Results
Compared to the low-income group, patients in intermediate- and high-income groups were younger and had less underlying diseases. Besides, the percentage of anticoagulant use increased with income levels. The annual incidences of mortality, stroke, ICH, major bleeding and composite outcome increase with the decrease of income. Multi-variate Cox regression analysis showed that higher income was significantly associated with a lower risk of adverse events. The observations that high income conveys a lower risk remained consistent after matched subgroup analysis. (Figure) Compared to low-income group, the high-income group had a decreased risk of ischemic stroke by 18%, ICH by 22.5%, major bleeding by 16.4%, mortality by 44.4%, and composite outcome by 33.7%.
Incidence and hazard ratio

Conclusions
Income levels were associated with the risk of adverse events in AF patients and should be taken into account when taking care of AF patients.