bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transposition of great arteries with left outflow tract obstruction and non-committed VSD: surgical management and late results
Authors: Kari Fabian A , Uzdenov Murat , Kroll Johannes , Bohnens Holger , Stiller Brigitte , Bauer Ulrike , Kubicki Rouven 
Published: October 2021

Abstract

OBJECTIVES
Transposition of the great arteries with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) is a rare malformation. Our objective was to report on management and results of the cohort with non-committed VSD from a national registry for congenital heart disease.

METHODS
Multicentre data were screened in the German National Registry for Congenital Heart Defects (Berlin, Germany) for repairs of transposition of the great arteries–VSD–LVOTO. A subgroup of patients with a remote/non-committed VSD was identified. End points included survival, reoperation and a composite of reoperations for LVOTO-/VSD- or baffle-related problem.

RESULTS
N = 47 patients were identified treated in 14 different national centres between 1984 and 2020. The mean age was 14 (standard deviation 9) months, ranging from 7 days to 9.5 years. Nine patients (19%) were treated as neonates, 21 (45%) as infants and 17 children (36%) beyond the age of 1 year. Survival was &gt;90% (80–100%) at 20 years. Freedom from any reoperation was 30% (10–50%) at 20 years. Freedom from the composite end point was 72% (50–90%) at 20 years. Patients after Rastelli underwent more reoperations compared to those without intraventricular baffle (freedom from reoperation 14% vs 50%, P = 0.1). The rates of the composite end point were similar when comparing Rastelli to other techniques (63% vs 83%, P = 0.32).

CONCLUSIONS
The Rastelli operation yields robust results in the setting of non-committed VSD. Late results after neonatal arterial switch operation are outstanding. If LVOTO is not resectable and neonatal arterial switch operation suboptimal, interim palliation does not negatively impact outcome, patients can be safely delayed to beyond 1 year of age.
Twinning during the pandemic
Authors: Catalano Ralph , Bruckner Tim , Casey Joan A , Gemmill Alison , Margerison Claire , Hartig Terry 
Published: October 2021

AbstractBackground and objectivesThe suspicion that a population stressor as profound as the COVID-19 pandemic would increase preterm birth among cohorts in gestation at its outset has not been supported by data collected in 2020. An evolutionary perspective on this circumstance suggests that natural selection in utero, induced by the onset of the pandemic, caused pregnancies that would otherwise have produced a preterm birth to end early in gestation as spontaneous abortions. We test this possibility using the odds of a live-born twin among male births in Norway as an indicator of the depth of selection in birth cohorts.MethodologyWe apply Box–Jenkins methods to 50 pre-pandemic months to estimate counterfactuals for the nine birth cohorts in gestation in March 2020 when the first deaths attributable to SARS-CoV-2 infection occurred in Norway. We use Alwan and Roberts outlier detection methods to discover any sequence of outlying values in the odds of a live-born twin among male births in exposed birth cohorts.ResultsWe find a downward level shift of 27% in the monthly odds of a twin among male births beginning in May and persisting through the remainder of 2020.Conclusions and implicationsConsistent with evolutionary theory and selection in utero, birth cohorts exposed in utero to the onset of the COVID-19 pandemic yielded fewer male twins than expected.Lay SummaryOur finding of fewer than expected male twin births during the onset of the COVID-19 pandemic provides more evidence that evolution continues to affect the characteristics and health of contemporary populations.
Monte Carlo Simulation Approaches for Quantitative Bias Analysis: A Tutorial
Authors: Banack Hailey R , Hayes-Larson Eleanor , Mayeda Elizabeth Rose 
Published: October 2021

Abstract
Quantitative bias analysis can be used to empirically assess how far study estimates are from the truth (i.e., an estimate that is free of bias). These methods can be used to explore the potential impact of confounding bias, selection bias (collider stratification bias), and information bias. Quantitative bias analysis includes methods that can be used to check the robustness of study findings to multiple types of bias and methods that use simulation studies to generate data and understand the hypothetical impact of specific types of bias in a simulated data set. In this article, we review 2 strategies for quantitative bias analysis: 1) traditional probabilistic quantitative bias analysis and 2) quantitative bias analysis with generated data. An important difference between the 2 strategies relates to the type of data (real vs. generated data) used in the analysis. Monte Carlo simulations are used in both approaches, but the simulation process is used for different purposes in each. For both approaches, we outline and describe the steps required to carry out the quantitative bias analysis and also present a bias-analysis tutorial demonstrating how both approaches can be applied in the context of an analysis for selection bias. Our goal is to highlight the utility of quantitative bias analysis for practicing epidemiologists and increase the use of these methods in the epidemiologic literature.
(Mis)Matched College Aspirations and Expectations: The Role of Social Background and Admission Barriers
Authors: Finger Claudia 
Published: October 2021

AbstractNot all high school students who wish to study think that they will be able to realize this wish. This article examines whether admission barriers to higher education (HE) are a potential reason for this mismatch between educational aspirations and expectations and whether they are more constraining for students from socially less advantaged backgrounds. It does so for the German context in which the role of admission barriers for social inequality in HE has long been neglected. Empirically, the paper uses a unique combination of individual data on high school students’ educational aspirations and expectations and institutional data on admission barriers that vary by field of study. Findings indicate that the socially most privileged students stick to their college aspiration regardless of admission barriers to their aspired field of study. However, they seem to be willing to compromise their preferred field of study if this comes along with high admission barriers. Contrastingly, socially less privileged students seem willing to compromise both their general college aspiration and their aspired field of study if admission appears difficult. The concluding section discusses the implications of these findings for social inequality in education.
Predicting silent atrial fibrillation in the elderly – NOMED-AF study
Authors: Mitrega K , Lip G Y H , Sredniawa B , Sokal A , Streb W , Przyludzki K , Zdrojewski T , Wierucki L , Rutkowski M , Bandosz P , Kazmierczak J , Grodzicki T , Opolski G , Kalarus Z 
Published: October 2021

Abstract

Background
Asymptomatic (“silent”) atrial fibrillation is common and associated with poor outcomes. It is important to determine the risk factors that predispose elderly individuals from the general population to atrial fibrillation (AF). However, population-based data for silent AF (SAF) are limited.

Design
First, to study the risk factors for symptomatic AF and SAF in an elderly (≥65 years) general population. Second, to develop a risk stratification model for predicting SAF.

Methods
Continuous ECG monitoring was performed for up to 30 days using a vest-based system in a cohort from NOMED-AF, a cross-sectional study based on a nationwide population sample. The independent risk factors for AF and SAF were determined using multiple logistic regression. ROC analysis was applied to validate developed risk stratification score.

Results
From the total cohort of 3014 subjects, AF was diagnosed in 680 individuals (mean age, 77.5±7.9; 50.1% men) with AF, and of these, 279 (41%) had SAF. Independent associations with an increased risk of AF were age, male gender, coronary heart disease, thyroid diseases, prior ischemic stroke or transient ischemic attack (ICS/TIA), diabetes, heart failure, chronic kidney disease (CKD), obesity (BMI&gt;30) and NT-proBNP &gt;125 ng/ml. Prior revascularization was negatively associated with risk of AF.
The main risk factors for SAF were age, male gender, prior ICS/TIA, diabetes, heart failure, CKD and NT-proBNP &gt;125 ng/ml.
We developed a simple clinical risk scale (MR-DASH score) which had good prediction in the derivation cohort (AUC 0.726) and the validation cohort (AUC 0.730).

Conclusions
SAF is associated with various clinical risk factors in a population sample of individuals ≥65 years. Stratifying individuals from the general population according to their risk for SAF may be possible using the MR-DASH score, facilitating targeted screening programs of individuals with high risk of SAF

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Centre for Research and Development
Are the results of the RATE-AF trial reproducible in daily practice? Clinical outcomes with digoxin vs beta-blocker for heart rate control in permanent atrial fibrillation
Authors: Fauchier L , Bisson A , Bodin A , Spiesser P.H , Clementy N , Pierre B , Babuty D , Lip G.Y.H 
Published: October 2021

Abstract

Background
There is little evidence to support selection of heart rate control therapy in patients with permanent atrial fibrillation (AF), in particular those with coexisting heart failure. In the recent RATE-AF trial that included patients with permanent AF and symptoms of heart failure, treatment with low-dose digoxin or bisoprolol did not result in statistically significant difference in quality of life at 6 months. The purpose of the study was to analyse whether the clinical outcomes may differ among unselected patients with permanent AF treated with digoxin or beta-blocker seen in daily practice.

Methods
All patients with atrial fibrillation (AF) seen in an academic institution were identified in a database. We examined the clinical course of 8962 consecutive patients with AF seen over a 10-year period. The adverse outcomes were investigated during follow-up and we identified the causes of death. Among them 1,787 patients had the RATE-AF criteria of inclusion (permanent AF, age ≥60 and NYHA ≥2), of whom 512 patients (29%) were treated with beta-blocker alone, 425 (24%) were treated with digoxin alone and 237 (13%) were treated with both a beta-blocker and digoxin. Outcomes in patients treated with beta-blocker alone or digoxin alone were compared after 1:1 propensity-score matching.

Results
After propensity score matching, 270 patients treated with beta-blocker were matched 1:1 with 270 patients treated with digoxin. In these patients (age 79±8 years, CHA2DS2VASc score 4.0±1.3), 125 deaths were recorded during a follow-up of 2.2±2.7 years (median 1.1, interquartile 0.1–3.5 years, yearly rate of death 10.4%) including 72 cardiovascular deaths (yearly rate 6.0%). Major clinical events (all-cause death, myocardial infarction, ischemic stroke or major bleeding) were recorded in 192 patients (yearly rate 19.1%). In this matched analysis, risk was not statistically significant in the 2 groups for all-cause death (HR 0.95, 95% CI 0.67–1.35 for beta-blocker use vs digoxin use), cardiovascular death (HR 1.23, 95% CI 0.77–1.96 for beta-blocker use vs digoxin use) or major clinical events (HR 0.98, 95% CI 0.74–1.31 for beta-blocker use vs digoxin use).

Conclusion
Our analysis included more patients and had a longer follow-up than in the RATE-AF trial, resulting in a 10-fold higher number of clinical events. We found that among patients with permanent AF and symptoms of HF, there was no statistically significant difference in the risk of all-cause death, cardiovascular mortality and major clinical events between those treated with digoxin or beta-blocker. Concerns regarding the use of digoxin, such as the narrow therapeutic window and drug interactions, were not issues resulting in worse clinically relevant cardiovascular outcomes with the approach used in the current study.

Funding Acknowledgement
Type of funding sources: None.
Age and impaired left atrial performance are associated with increased atrial fibrosis in patients with paroxysmal and persistent atrial fibrillation
Authors: Traykov V , Radoslavova R , Boychev D , Konstantinova V , Marchov D , Marinov M , Gelev V 
Published: October 2021

Abstract

Background
Atrial performance assessed by strain imaging is used as a surrogate for left atrial (LA) structural remodelling. Presence of low voltage zones (LVZs) detected by three-dimensional electroanatomical mapping in patients with atrial fibrillation (AF) denotes more expressed extrapulmonary substrate potentially leading to worse outcomes following pulmonary vein isolation (PVI) for the treatment of AF.

Purpose
The current study aims to investigate the association between strain imaging parameters from echocardiography and the presence and extent of LVZs derived from LA electroanatomical mapping in patients undergoing AF ablation.

Methods
Seventy-eight patients (58 males, 74%) aged 59±9.48 years undergoing PVI for paroxysmal (35 patients, 49%) or persistent AF were prospectively studied. Preprocedural echocardiography included LA strain imaging assessing global LA strain (LAS) and regional strain of the basolateral region (RSLB). During the procedure, LA electroanatomical mapping during paced atrial rhythm was performed in all patients obtaining a LA voltage map. All LA maps were analysed offline using a custom-made software calculating the zone of low bipolar voltage &lt;0.5 mV (LVZ&lt;0.5mV) and the total LA endocardial area excluding pulmonary veins antra. LVZ&lt;0.5mv was expressed as an absolute value and as percentage of the whole LA area.

Results
Patients aged more than 65 years (N=21, 27%) demonstrated a larger area of LVZ&lt;0.5mV: 25.5±17.8 cm2 vs. 9.4±10.6 cm2 in those younger than 65 years, P=0.001. This corresponded to a higher proportion of the LA area demonstrating LVZ&lt;0.5mV in patients older than 65 years: 22.6±14.6% vs. 8.9±11.8% in those younger than 65 years, P&lt;0.0001. Twenty-nine of 78 patients (37.1%) had preprocedural LAS&lt;20% and 23 (29.5%) demonstrated RSLB of &lt;21%. Patients with LAS &lt;20% had a higher total LVZ&lt;0.5mV: 20.3±16.6 cm2 vs. 9.8±12.1 cm2 in patients with LAS≥20% at baseline, P=0.004. This equaled to 17.7±15.6% vs. 9.5±11.9% of total LA area, respectively (P=0.011). Patients with RSLB&lt;21% also demonstrated larger areas of LVZ&lt;0.5mV in the LA: 21.6±17.9 cm2 vs. 10.39±11.83 cm2 in the patients with RSLB ≥21%, P=0.012. Expressed as a proportion of the whole LA area the difference remained significant: 18.8±17.1% vs. 9.9±11.6%, respectively P=0.01.

Conclusion
Older age and impaired LA performance assessed by LA strain imaging are associated with larger areas of LVZ&lt;0.5mV possibly reflecting more expressed LA fibrotic changes in patients with paroxysmal and persistent AF. These findings might serve in the preprocedural selection of the patients undergoing catheter ablation of AF.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Bulgarian Society of Cardiology
DOAC versus warfarin in patients with atrial fibrillation and stage IV-V chronic kideny disease including patients on dialysis
Authors: Wartanian A , Lewinter C , Edfors R 
Published: October 2021

Abstract

Introduction
Patients with atrial fibrillation (AF) and severe chronic kidney disease (CKD) were excluded from most phase III randomized controlled trials (RCTs) of direct oral anticoagulants (DOACs). Evidence of warfarin versus DOAC in the AF population with stage IV-V CKD is therefore limited.

Aim
To evaluate the effectiveness and safety of DOAC compared with warfarin on this population including dialysis patients.

Methods
A systematic review and meta-analysis of RCTs and observational studies involving AF patients with stage IV-V CKD treated with warfarin versus DOACs were conducted to evaluate the following outcomes: stroke (ischemic and hemorrhagic) or systemic embolism (SE), all-cause mortality, major bleeding, gastrointestinal (GI) bleeding, and intracranial bleeding. If the heterogeneity between studies was moderate to high calculated as the I2 ≥50%, a meta regression was undertaken between baseline characteristics and the study outcomes. We conducted a literature search using key words related to AF, severe CKD, DOAC and warfarin in PubMed, Embase and Cochrane Library.

Results
Nine studies were included in the meta-analysis. Compared to warfarin, DOAC was significantly associated with a reduced risk of stroke or systemic embolism (SE) (risk ratio [RR] = 0.69; 95% confidence interval [CI] 0.50–0.95) (Figure 1), intracranial bleeding (RR=0.54; 95% CI 0.35–0.84) and hemorrhagic stroke (RR=0.39; 95% CI 0.16–0.95). There was no significant difference between DOACs and warfarin in the risk of all-cause mortality (RR=0.80; 95% CI 0.57–1.13), major bleeding (RR = 0.70; 95% CI 0.44–1.11) (Figure 2) and GI bleeding (RR=0.76; 95% CI 0.56–1.02). For the outcome stroke or SE, dabigatran (compared with apixaban) significantly eliminated the net effect of DOAC as compared with warfarin (coefficient, 0.8; P=0.003). Regarding major bleeding, rivaroxaban and dabigatran both eliminated the DOAC effect from the meta-analysis as compared to apixaban (P=0.01 & P&lt;0.0001). Dabigatran significantly increased the risk of GI bleeding in comparison to apixaban (coefficient, 0.48; P=0.002) in comparison with the overall similar effect of warfarin in the meta-analysis.

Conclusion
Among patients with AF and stage IV or V CKD including dialysis patients, DOAC appears to have similar or better effectiveness and safety compared to warfarin.

Funding Acknowledgement
Type of funding sources: None. Stroke or systemic embolism
The individual approach to management of patients with atrial fibrillation and its influence on patient adherence to anticoagulant therapy
Authors: Novikova T , Ashurov A , Babova T , Bitakova F , Hagush A , Liksyutina N , Podoprigora E , Sayganov S 
Published: October 2021

Abstract

Background
The key points in the treatment of patients with atrial fibrillation (AF) with the ABC (Atrial Fibrillation Better Care) pathway are the prevention of stroke and increasing patient adherence to therapy. The basis for increasing adherence to therapy is regular communication between medical staff and the patients.

Purpose
To assess the effect of telephone contact (TC) frequency on patient adherence to anticoagulant therapy (ACT).

Methods
A prospective, non-interventional observational study was carried out, during which 84 patients with non-valvular AF were observed remotely after being discharged from the hospital. Patient education was provided in the hospital, which included an explanation of the importance of ACT. The observation period was 12 months. All enrolled patients were 18 years of age or older; AF was documented before enrolment on the basis of objective electrocardiographic evaluation; all patients had indications for taking anticoagulants (AC) for stroke prevention. Adherence to therapy was assessed using the Morisky-Green test.

Results
The patients were randomized into 2 groups: group 1 – TC monthly, group 2 – TC every 6 months. In the first group, 85.7% of patients received the non–vitamin K antagonist oral anticoagulants (NOAC), and 14.3% received warfarin; in the 2nd group, 92.9% of patients received NOAC, and 7.1% received warfarin. The mean score of the adherence to therapy according to the Morisky-Green test was initially 3.3±0.8 in group 1, and 3.3±0.7 in group 2, p=0.78. After 12 months: in group 1, 14.6% of patients refused to take AC; and in group 2, 25.0% did the same. The mean value score of the adherence to therapy in group 1 underwent a statistically insignificant change over time (from 3.3±0.8 to 3.1±1.5, p=0.48). In group 2, after 12 months, the mean score of adherence to therapy saw a significant decrease from 3.3±0.7 to 2.7±1.6, p=0.03. Both in group 1 and in group 2, the decrease in the mean score of adherence to therapy occurred mainly due to patients with an initially insufficient level of adherence.

Conclusions
The results of our study confirm the need for individual strategy for managing patients through the ABC pathway. In most cases, face-to-face or telephone contact with medical staff once every six months is sufficient for patients who are initially adherent to therapy, after receiving an introductory briefing. Patients with insufficient level of adherence require more frequent contact.

Funding Acknowledgement
Type of funding sources: None.
Cancer and atrial fibrillation/flutter: an analysis of patients referred to electrical cardioversion
Authors: Menezes Fernandes R , Mota T.F , Costa H.A , Espirito Santo M , Bento D , Candeias R , Mimoso J , Jesus I 
Published: October 2021

Abstract

Introduction
Cancer is associated with an increased risk of atrial fibrillation (AF) development. Both an active tumour and AF are related to increased thromboembolic risk.

Purpose
To determine the clinical characteristics, management and prognosis of cancer patients with AF or atrial flutter (AFL) referred to electrical cardioversion (EC).

Methods
We conducted a retrospective study encompassing patients referred to EC due to AF/ AFL in our Cardiology Department, from September 2011 to September 2020. Clinical characteristics, echocardiographic studies and follow-up data were analysed. We considered patients with a recent (up to 5 years) diagnosis of cancer. Primary endpoints were the occurrence of stroke, bleeding complications and all-cause mortality.

Results
A total of 691 patients were included, with a median age of 67 years-old and 70,8% male predominance. AFL was identified in 21,1% of patients and 57,4% had arterial hypertension. Persistent AF/AFL was diagnosed in 60,7%, 20,4% presented with first diagnosed AF/AFL and 17,9% had paroxysmal episodes. 89,5% of patients had indication for anticoagulation therapy and, of these, 75,4% were medicated with non-vitamin K antagonist oral anticoagulants (NOAC). 58 patients (8,4%) had a recent diagnosis of cancer, who were older (69,7 vs 67,9 years-old; p&lt;0,001) and more frequently cardioverted in an outpatient setting (63,8%). They had a lower rate of heart failure (1,9% vs 16,7%; p=0,004), but a higher prevalence of sleep apnea (13% vs 5,4%; p=0,025) and chronic kidney disease (10,9% vs 4,2%; p=0,027). HAS-BLED score was applied, and higher values were obtained in cancer patients (1,0 vs 0,7; p=0,002). CHA2DS2-VASc score was not significantly different between both groups. NOAC were preferred in cancer patients (86,8% vs 74,2%; p=0,043), instead of vitamin K antagonists. These patients were less referred to AF/AFL ablation procedures (1,9% vs 11,6%; p=0,027). During a median follow-up of 1342 days, no significant differences were found regarding the occurrence of ischemic stroke and bleeding complications. All-cause mortality was significantly higher in cancer patients (31,5% vs 15,5%; p=0,003), but none died from cardiovascular causes.

Conclusion
Cancer is frequent in patients with AF/AFL referred to EC, who are older and had a higher bleeding risk. Stroke rate was not significantly different than other patients, and NOAC seem to be a safe medication in this population. All-cause mortality is high in cancer patients, but we did not find any association with cardiovascular causes.

Funding Acknowledgement
Type of funding sources: None.