bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of cardiac autonomic function in patients with permanent and paroxysmal atrial fibrillation
Authors: Khan A.A , Junejo R.T , Thomas G.N , Fisher J.P , Lip G.Y.H 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) is the commonest abnormal heart rhythm with significant related morbidity and mortality. There is increasing evidence that abnormalities of the cardiac autonomic nervous system (ANS) are involved in the pathogenesis of AF. Exploring the ANS is possible through heart rate variability (HRV) evaluation.

Purpose
To investigate whether HRV is more abnormal in patients with permanent AF compared to paroxysmal AF.

Design
In a cross-sectional comparison, we studied two patient groups: permanent AF (n=30) and paroxysmal AF (n=31). Time-domain, frequency-domain and non-linear measures of HRV were determined using eMotion Faros ECG sensor. Participant's breathing was controlled with a metronome set at 12 breaths per minute. Data was analysed using SPSS software.

Results
Time-domain and non-linear indices of HRV were significant higher in permanent AF group compared to paroxysmal AF (table 1). Permanent AF was the only independent predictor of HRV on multivariable analysis in this cohort of patients (p=0.006)

Conclusions
First study investigating autonomic function in patients with permanent AF and paroxysmal AF. HRV indices were significantly higher in permanent AF compared to paroxysmal AF which may suggest pronounced cardiac autonomic influence in the pathophysiology of permanent AF.

Funding Acknowledgement
Type of funding sources: None.
Circulatory microRNAs as potential biomarkers for major adverse cardiac events in patients with atrial fibrillation
Authors: Nopp S , Van Der Bent M.L , Koenigsbruegge O , Wojta J , Pabinger I , Ay C , Nossent A.Y 
Published: October 2021

Abstract

Background
Stratification for subsequent cardiovascular events among patients with atrial fibrillation is of great interest and could aid in guiding preventative strategies. However, current clinical and routine laboratory markers lack in accuracy to predict major adverse cardiac events (MACE). Thus, new prognostic approaches are needed. Small non-coding RNAs are present and stable in the circulation and reflect their tissue, or even their vascular bed, of origin, and may therefore be optimal candidate biomarkers to reflect disease status.

Purpose
We aimed to investigate small non-coding RNAs (e.g. microRNAs [miRNAs], transfer RNAs [tRNAs] -derived fragments) and their prognostic potential as biomarkers for cardiovascular events in patients with atrial fibrillation.

Methods
We conducted a nested case-control study within the framework of the BRAHMS (BioRepository of Atrial Fibrillation and HeMostasiS) registry, in which patients with atrial fibrillation were included and followed-up at a 6- to 12-month interval. Patients who experienced MACE (i.e. stroke, myocardial infarction, cardiovascular death) within a year after inclusion were defined as cases (n=13) and were matched by age, sex, and CHA2DS2-VASc score to controls who remained event-free (n=13). In all 26 patients, total small RNA-sequencing was performed on plasma samples collected and stored at study inclusion. The Benjamini-Hochberg procedure was used to control the false discovery rate (FDR).

Results
We detected 184 well-expressed miRNAs, 47 tRNAs, and 280 other non-coding RNAs, and did not find differences in expression between cases and controls, respecting a threshold of an FDR-adjusted p-value &lt;0.05. However, in the subgroup analysis of patients with subsequent cardiovascular death (5 cases vs. matched controls), three miRNAs (miR-150-5p, miR-127-3p, miR-1908-5p) were significantly associated with cardiovascular mortality (FDR-adjusted p&lt;0.05) (Figure 1).

Conclusion
This study proposes three well-expressed circulating miRNAs derived from peripheral blood as potential biomarkers for early cardiovascular death in patients with atrial fibrillation. Our findings are currently being verified in a larger study and in a different patient population.

Funding Acknowledgement
Type of funding sources: None.
Prevalence and impact of frailty in patients with atrial fibrillation: a systematic review and meta-analysis
Authors: Proietti M , Romiti G.F , Raparelli V , Diemberger I , Boriani G , Marzetti E , Lip G.Y.H , Cesari M 
Published: October 2021

Abstract

Background
Frailty is a clinical syndrome characterized by a reduced physiologic function, increased vulnerability to stressors, and an increased risk of adverse outcomes. Patients with Atrial Fibrillation (AF) are often burdened with a high number of comorbidities and prone to frailty. The prevalence of frailty, its management and association with major outcomes in patients with AF are still unclear.

Purpose
To estimate the pooled prevalence of frailty in patients with AF, as well as its association with AF-related risk factors and comorbidities, oral anticoagulants (OAC) prescription, and major outcomes.

Methods
We systematically searched PubMed and EMBASE, from inception to 31st January 2021, for studies reporting the prevalence of frailty (irrespective of the tool used for assessment). Pooled prevalence, odds ratio (OR), and 95% Confidence Intervals (CI) were computed using random-effect models; heterogeneity was assessed through the inconsistency index (I2). This study was registered in PROSPERO: CRD42021235854.

Results
A total of 1,116 studies were retrieved from the literature search, and 31 were finally included in the systematic review (n=842,521 patients). The frailty pooled prevalence was 39.6% (95% CI=29.2%-51.0%, I2=100%; Figure 1). Significant subgroup differences were observed according to geographical location (higher prevalence found in European-based cohorts; p=0.003) and type of tool used for the assessment (higher prevalence in studies using the Clinical Frailty Scale and Tilburg Frailty Index tools; p&lt;0.001). Meta-regressions showed that study-level mean age and prevalence of hypertension, diabetes, and history of stroke were directly associated with frailty prevalence. Frailty was significantly associated with a 29% reduced probability of OAC prescription in observational studies (OR=0.71, 95% CI=0.62–0.81). Frail patients with AF were at higher risk of all-cause death (OR=4.12, 95% CI=3.15–5.41), ischemic stroke (OR=1.55, 95% CI=1.01–2.38), and bleeding (OR=1.55, 95% CI=1.12–2.14), compared to non-frail patients with AF.

Conclusions
In this systematic review and meta-analysis analysis, the prevalence of frailty was high in patients with AF, and associated with study-level mean age and prevalence of several stroke risk factors. Frailty may influence the management of patients, and worsening the prognosis for all major AF-related outcomes.

Funding Acknowledgement
Type of funding sources: None. Prevalence of Frailty among AF patients
Quarterly versus annual ECG screening for atrial fibrillation in older Chinese (AF-CATCH): a prospective, randomised, controlled trial
Authors: Zhang W , Chen Y , Wang J.G ,   AF-CATCH
Published: October 2021

Abstract

Background
Screening for atrial fibrillation before symptoms manifested and subsequent initiation of oral anticoagulants (OACs), could prevent stroke and death. The most cost-effective strategy to screen atrial fibrillation in high-risk population aged 65 and over remains unknown.

Methods
We performed a randomised controlled trial that compares different screening frequencies of 30-second single-lead electrocardiography (ECG) in the detection of atrial fibrillation in Chinese residents (≥65 years old) in 5 community health centres in Shanghai. Participants without atrial fibrillation were randomised in a 1:1 ratio into annual (G1) and quarterly screening (G2) groups: the quarterly screening group was further randomised in a 3:1 ratio into subgroups of quarterly screening (G2–1) and quarterly screening PLUS (G2–2, ECG weekly for 1-month then quarterly). The primary outcome was the detection rate of atrial fibrillation. The intention-to-treat analysis was performed for all randomised patients who had at least one ECG recording during follow-up.

Results
Between April 17, 2017, and June 26, 2018, a total of 8240 participants were randomised into G1 (n=4120), G2–1 (n=3090) and G2–2 (n=1030), with a mean of 1.6, 3.5 and 5.2 ECG records respectively during a median of 2.1 years follow-up (13,284 person-years). 73 incident cases of atrial fibrillation occurred: 26 in G1 (4.1/1000 person-years) and 47 in G2 (6.7/1000 person-years; hazard ratio with G1, 1.71; 95% confidence interval [CI] 1.06–2.76; P=0.03). 40 incident cases were detected in G2–1 (7.2/1000 person-years; hazard ratio with G1, 1.83; 95% CI 1.12–3.00; P=0.02) and 7 in G2–2 (4.8/1000 person-years; hazard ratio with G1, 1.24; 95% CI 0.54–2.86; P=0.61). No significant difference was noted between G2–1 and G2–2 (hazard ratio with G2–1, 0.68; 95% CI 0.30–1.52; P=0.35).

Conclusion
Quarterly 30-second single-lead ECG screening significantly increased the detection rate of incident atrial fibrillation.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bayer Healthcare Company
Diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation: a systematic review and meta-analysis
Authors: Diaz-Arocutipa C , Gonzales-Luna A.C , Branez-Condorena A , Hernandez A.V 
Published: October 2021

Abstract

Background
There is limited evidence on the use of biomarkers to diagnose left atrial thrombus in atrial fibrillation.

Purpose
We evaluated the diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation.

Methods
We searched four electronic databases from inception to December 16, 2020 for observational studies evaluating diagnostic accuracy of D-dimer. Reference standard was left atrial thrombus detected by transesophageal echocardiography. Study quality was assessed with the QUADAS-2 tool. We performed a bivariate random-effects meta-analysis to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI). In addition, a summary receiver operating characteristic curve and optimal cut-off were estimated.

Results
Eleven cross-sectional studies involving 4380 patients were included. The mean age ranged from 49.8 to 74.1 years and 70% of patients were men. Left atrial thrombus was present in 7% of cases. In seven studies, the pooled sensitivity of D-dimer at 500 ng/mL was 53% (95% CI, 26–79%) and the pooled specificity was 92% (95% CI, 80–97%). The pooled sensitivity of age-adjusted D-dimer was 35% (95% CI, 18–57%) and the pooled specificity was 100% (95% CI, 100–100%) in two studies. The optimal cut-off was 390 ng/mL in 10 studies with a pooled sensitivity of 68% (95% CI, 44–85%) and a pooled specificity of 73% (95% CI, 54–86%). The risk of bias was low or unclear for all domains. Concerns regarding applicability were generally low for almost all studies

Conclusion
Our meta-analysis suggests that D-dimer has the potential to be useful to the detection of left atrial thrombus in patients with atrial fibrillation.

Funding Acknowledgement
Type of funding sources: None.
Left ventricular diastolic dysfunction in non-severe chronic obstructive pulmonary disease as a step forward in cardiovascular comorbidome
Authors: Cherneva Z.H , Cherneva R 
Published: October 2021

Abstract

Background
Chronic obstructive pulmonary disease (COPD) augments the likelihood of having left ventricular diastolic dysfunction (LVDD) – precursor of heart failure with preserved ejection fraction (HFpEF). LVDD shares overlapping symptomatology (cough and dyspnea) with COPD.

Purpose
Our aim was to evaluate the predictive value of inflammatory, oxidative stress, cardio-pulmonary and echocardiographic parameters at rest for the diagnosis of stress LVDD in non-severe COPD patients, who complain of exertional dyspnea and are free of overt cardiovascular diseases.

Methods
A total of 104 COPD patients underwent echocardiography before cardio-pulmonary exercise testing (CPET) and 1–2 minutes after peak exercise. Patients were divided into two groups based on peak E/e': patients with stress induced left ventricular diastolic dysfunction (LVDD) - E/e' &gt;15 (HFpEF) and patients LVDD (without HFpEF). CPET and echocardiographic parameters at rest were measured and their predictive value for stress E/e' was analysed. Markers for inflammation (resistin, prostaglandine E2) and oxidative stress (8-isoprostanes) were also determined.

Results
Stress induced LVDD occurred in 67/104 patients (64%). Those patients had lower work load, lower VO2 consumption, lower minute ventilation and higher VE/VCO2 slope in comparison to patients without. Except for prostglandine E2, none of the inflammatory, oxidative stress markers correlated to stress E/e'. The best independent predictors for HFpEF were RAVI, right ventricular parasternal diameter and RV E/A &gt;0.75. Their combination predicted HFpEF with the accuracy of 91.2%.

Conclusion
There is a high prevalence of HFpEF in non-severe COPD with exertional dyspnea, free of overt cardiovascular disease. RAVI, right ventricular parasternal diameter and RV E/A &gt;0.75 were the only independent clinical predictors of HFpEF.

Funding Acknowledgement
Type of funding sources: None.
Automated external defibrillators delivered by drones to patients with suspected out-of-hospital cardiac arrest
Authors: Schierbeck S , Hollenberg J , Nord A , Svensson L , Nordberg P , Ringh M , Forsberg S , Lundgren P , Axelsson C , Claesson A 
Published: October 2021

Abstract

Background
Early defibrillation is critical for the chance of survival in in out-of-hospital cardiac arrest (OHCA). Drones, used to deliver automated external defibrillators (AEDs), may shorten time to defibrillation, but this has never been evaluated in real-life emergencies.

Purpose
The aim of this study was to investigate the feasibility of AED-delivery by drones in real-life cases of OHCA.

Methods
In this prospective clinical trial, three AED-equipped drones were placed within controlled airspace in Sweden, covering approximately 80,000 inhabitants (125km2). Drones were integrated in the emergency medical services for automated deployment in beyond-visual-line-of-sight flights in; a) consecutive real-life suspected OHCAs b) test-flights from 06–01–20 to 09–30–20. Primary outcome was the proportion of successful AED-deliveries when drones were dispatched in cases of suspected OHCA. Among secondary outcomes were the proportion of cases where AED-drones arrived prior to ambulance and time benefit vs. ambulance.

Results
Totally 14 cases were eligible for dispatch during the study period in which AED-drones took off in 12 alerts to suspected OHCA; with a median distance to location 3,1 km (IQR:2,8–3,4). AED-delivery was feasible within 9 meters (IQR:7,5–10,5) from the location and successful in 11 alerts, 92%. AED-drones arrived prior to ambulances in 64%, with a median time benefit of 01:52 minutes (IQR:01:35–04:54). In an additional 61 test-flights the AED-delivery success rate was 90% (55/61).

Conclusion
In this pilot study, we have shown that AED-delivery by drones in real-life cases of OHCA is feasible with a substantial time benefit and a successful delivery rate of 92%. Further technological improvements are needed to increase dispatch rate and time gains.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swedish heart-lung foundation
The efficacy of vericiguat on improving quality of life among patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis
Authors: Marino B , Macatiag J.M 
Published: October 2021

Abstract

Background
Heart Failure with Preserved Ejection Fraction remains to be a global health concern since there is no proven effective therapy as of the moment. Data from 2017 have shown that half of the population with heart failure has preserved ejection fraction (HFpEF) and there is an observed increasing trend in numbers. HFpEF carries significant disease burden and greatly affects Quality of Life.

Objective
To determine the efficacy of Vericiguat in improving the quality of life among patients with Heart Failure with preserved Ejection Fraction.

Methodology
A comprehensive literature search was made by the authors for Randomized Controlled Trials comparing the efficacy of Vericiguat with placebo in improving the Quality of Life among patients with HFpEF. Authors were contacted if there were missing data. Two authors independently extracted data and appraised the different studies' characteristics, quality and outcomes. RevMan 5.4 was used for the statistical analysis.

Results
The authors found two RCTs with 1,218 participants. Pooled analysis of the moderate to high quality studies showed no statistically significant mean difference in the different domains of the Kansas City Cardiomyopathy Questionnaire including the Clinical Summary Score, Physical Limitation Score, Total Symptom Score, and Overall Summary Score (1.61 [−1.44, 4.66] p=0.30; 2.22 [−1.16, 5.60] p=0.20; 0.14 [−3.00, 3.29] p=0.93; and 1.35 [−1.65, 4.35] p=0.38, respectively) between Vericiguat and placebo. For the safety and adverse events, there was no statistically significant difference between Vericiguat and placebo with regards to syncope, hypotension and death, with RR of 1.10 [0.06, 18.61] p=0.95; 1.22 [0.70, 2.14] p=0.48 and 1.79 [0.67, 4.75] p=0.24, respectively.

Conclusion
Vericiguat compared to placebo did not significantly improve the Quality of Life among adult patients with Heart Failure with Preserved Ejection Fraction.

Funding Acknowledgement
Type of funding sources: None.
Relationship between venous congestion and systemic hypoperfusion in cardiorenal syndrome
Authors: Scagliola R , Bonino B , Viazzi F , Balbi M , Ameri P 
Published: October 2021

Abstract

Background
Renal impairment takes a relevant role in worsening clinical outcomes and increasing mortality risk in patients with heart failure (HF). In this context, the interplay between venous congestion and systemic perfusion in the pathogenesis of cardiorenal syndrome is currently a matter of extensive debate1.

Purpose
To investigate the relationship between renal function and hemodynamic variables, as the cardiac index and right atrial pressure, in a broad spectrum of HF patients undergoing right heart catheterization, as part of their pulmonary hypertension (PH) diagnostic work-up.

Patients and methods
From 1st September 2005 until 31st October 2019, hemodynamic data from 286 consecutive patients were collected, of whom 267 had available plasmatic creatinine values. The estimated glomerular filtration rate (eGFR) was calculated by using the Chronic Kidney Disease Epidemiology Collaboration formula. The overall study population was stratified in no PH group, pre-capillary PH group and post-capillary PH group, on the basis of the available hemodynamic values of mean pulmonary arterial pressure and pulmonary artery wedge pressure.

Results
Of the overall population, 46.1% of them were male, the mean age at the right heart catheterization was 65.5±13.7 years, and the mean eGFR value was 70.0±0.2 mL/min/1.73 m2. On the basis of hemodynamic parameters, 71 patients constituted the no PH group, 107 the pre-capillary PH group, and 63 the post-capillary PH group. Post-capillary PH patients were significantly older than both no PH and pre-capillary PH subjects (69.4±11.7 years; 61.2±16.7 years and 65.7±12.9 years respectively, p=0.003). eGFR was significantly lower in the post-capillary PH group, compared to both no PH group (63.1±22.8 mL/min/1.73 m2 vs. 73.0±23.9 mL/min/1.73 m2, p=0.029) and pre-capillary PH group (63.1±22.8 mL/min/1.73 m2 vs. 71.6±26.6 mL/min/1.73 m2, p=0.041). In post-capillary PH group, multivariate logistic regression analysis showed a significant correlation between eGFR &lt;60 mL/min/1.73 m2 and both reduced cardiac index (Odds ratio [OR] 0.05, 95% confidence interval [CI] 0.00 to 0.72, p=0.027) and right atrial pressure (OR 0.75, 95% CI 0.57 to 0.99, p=0.039), compared to no PH group and pre-capillary PH group.

Conclusions
A significant association between renal impairment and both low systemic perfusion and venous congestion, was found in patients with post-capillary PH, rather than in other hemodynamic subsets. Further investigations are needed to disentangle the impact of the both sides of circulation on renal function, in different hemodynamic phenotypes.

Funding Acknowledgement
Type of funding sources: None.
Kallistatin/ serpina3c inhibits fibrosis after myocardial infarction by regulating glycolytic pathway
Authors: Ji J.J , Yao Y.U.Y.U 
Published: October 2021

Abstract

Background
Fibrotic remodeling is the main pathological mechanism of heart failure after infarction. Studies have shown that the serine protease inhibitor Kallistatin/Serpina3c could inhibit the progression of myocardial hypertrophy and fibrosis after myocardial infarction, but the specific mechanism is unknown.

Methods and results
We used Serpina3c−/− and C57BL/6 mice to construct a MI model in vivo. TGF-β and hypoxia interfered with cardiac fibroblasts (CFs) to construct a fibrosis model in vitro. RNA-seq assessed the effect of Serpina3c knockout on the transcriptome. CCK-8 and BrdU were used to assess cell proliferation. Western blot and qPCR were used to verify the changes of glycolytic enzymes in the sequencing results. Co-IP was used to verify the interaction between Serpina3c and NR4A1. The results showed that Serpina3c expression decreased in the fibrotic tissue of MI heart and in the fibrosis model in vitro. After Serpina3c knockout, the degree of myocardial infarction fibrosis aggravated, and the proliferation and differentiation of CFs increased. Up-regulation of Serpina3c expression in CFs had the opposite effect, suggesting that Serpina3c had the ability to resist myocardial fibrosis. RNA-Seq results showed that glycolysis-related genes were significantly increased after Serpina3c knockout. Among them, the key enzyme of glycolysis, enolase (ENO1), had the largest change, and at the same time, the glycolysis reaction was enhanced. Inhibition of ENO1 can antagonize the promotion of Serpina3c knockout on the proliferation and differentiation of CFs. Activating the activity of NR4A1 could negatively regulate the expression of ENO1 and then inhibited the proliferation and differentiation of CFs.

Conclusions
Serpina3c inhibited the transcriptional activation of ENO1 by binding to NR4A1, and then reduced the fibrosis after myocardial infarction by inhibiting glycolysis. In short, Serpina3c provides a potential intervention target for the prevention and treatment of heart failure after infarction.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): National Nature Science Foundation of China (No. 81770452) Serpina3c is a key protein in MI.