bluuebunny/crossref_metadata_2025_split huggingface dataset:
ConsAlifold: considering RNA structural alignments improves prediction accuracy of RNA consensus secondary structures
Authors: Tagashira Masaki , Asai Kiyoshi 
Published: October 2021

AbstractMotivationBy detecting homology among RNAs, the probabilistic consideration of RNA structural alignments has improved the prediction accuracy of significant RNA prediction problems. Predicting an RNA consensus secondary structure from an RNA sequence alignment is a fundamental research objective because in the detection of conserved base-pairings among RNA homologs, predicting an RNA consensus secondary structure is more convenient than predicting an RNA structural alignment.ResultsWe developed and implemented ConsAlifold, a dynamic programming-based method that predicts the consensus secondary structure of an RNA sequence alignment. ConsAlifold considers RNA structural alignments. ConsAlifold achieves moderate running time and the best prediction accuracy of RNA consensus secondary structures among available prediction methods.Availability and implementationConsAlifold, data and Python scripts for generating both figures and tables are freely available at https://github.com/heartsh/consalifold.Supplementary informationSupplementary data are available at Bioinformatics online.
Pathophysiological pathways in patients with heart failure and atrial fibrillation
Authors: Santema Bernadet T , Arita Vicente Artola , Sama Iziah E , Kloosterman Mariëlle , van den Berg Maarten P , Nienhuis Hans L A , Van Gelder Isabelle C , van der Meer Peter , Zannad Faiez , Metra Marco , Ter Maaten Jozine M , Cleland John G , Ng Leong L , Anker Stefan D , Lang Chim C , Samani Nilesh J , Dickstein Kenneth , Filippatos Gerasimos , van Veldhuisen Dirk J , Lam Carolyn S P , Rienstra Michiel , Voors Adriaan A 
Published: October 2021

Abstract

Aims
Atrial fibrillation (AF) and heart failure (HF) are two growing epidemics that frequently co-exist. We aimed to gain insights into the underlying pathophysiological pathways in HF patients with AF by comparing circulating biomarkers using pathway overrepresentation analyses.

Methods and results
From a panel of 92 biomarkers from different pathophysiological domains available in 1620 patients with HF, we first tested which biomarkers were dysregulated in patients with HF and AF (n = 648) compared with patients in sinus rhythm (n = 972). Secondly, pathway overrepresentation analyses were performed to identify biological pathways linked to higher plasma concentrations of biomarkers in patients who had HF and AF. Findings were validated in an independent HF cohort (n = 1219, 38% with AF). Patient with AF and HF were older, less often women, and less often had a history of coronary artery disease compared with those in sinus rhythm. In the index cohort, 24 biomarkers were up-regulated in patients with AF and HF. In the validation cohort, eight biomarkers were up-regulated, which all overlapped with the 24 biomarkers found in the index cohort. The strongest up-regulated biomarkers in patients with AF were spondin-1 (fold change 1.18, P = 1.33 × 10−12), insulin-like growth factor-binding protein-1 (fold change 1.32, P = 1.08 × 10−8), and insulin-like growth factor-binding protein-7 (fold change 1.33, P = 1.35 × 10−18). Pathway overrepresentation analyses revealed that the presence of AF was associated with activation amyloid-beta metabolic processes, amyloid-beta formation, and amyloid precursor protein catabolic processes with a remarkable consistency observed in the validation cohort.

Conclusion
In two independent cohorts of patients with HF, the presence of AF was associated with activation of three pathways related to amyloid-beta. These hypothesis-generating results warrant confirmation in future studies.
Clinical risk factors and P wave indices in prediction of atrial fibrillation development during long-term follow-up after acute ST-segment elevation myocardial infarction
Authors: Baturova M , Demidova M.M , Carlson J , Erlinge D , Platonov P.G 
Published: October 2021

Abstract

Introduction
In patients with high thromboembolic risk detection of atrial fibrillation (AF) is crucial for implementation of proper anticoagulation therapy, which highlights the need for identification of patients at risk for AF. P wave indices reflect atrial structural abnormalities linked to AF development.

Purpose
We aimed to assess the value of clinical risk factors and P wave indices in prediction of incident AF after acute ST-segment elevation myocardial infarction (STEMI) in patients undergoing primary percutaneous intervention (PCI).

Methods
Study sample comprised of 2277 consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2010. SWEDEHEART registry was used as the source of information regarding clinical characteristics and events during index admission. Patients without known AF at discharge were included in the current study (n=1837, mean age 65±12 years, 30% females). AF in follow-up (median 9, interquartile range 25–75% (IQR) 7–10 years) was documented by linkage with the Swedish National Patient Register and Swedish Cause-of-Death Register. The closest available ECGs prior to STEMI (median 448, interquartile rate 25–75% 112–1390 days before STEMI) were extracted from the regional electronic ECG databases and automatically processed using Glasgow algorithm. P-wave duration, PR interval, P-wave frontal axis and P terminal force in lead V1 (PTF-V1) were assessed. PTF-V1 &gt;40 mm*ms was considered abnormal.

Results
In follow-up incident AF was documented in 285 patients (15.4%). In univariate Cox regression analysis age, hypertension, history of myocardial infarction, heart failure, history of stroke, smoking status, P wave duration &gt;120 ms, PR interval and abnormal PTF-V1 predicted the AF development during follow-up (Table). In multivariate Cox regression analysis in which significantly associated variables were included only age (hazard ratio (HR) 1.07, 95% CI 1.05–1.08, p&lt;0.001) and abnormal PTF-V1 (HR 1.49, 95% CI 1.08–2.05, p=0.015, Figure) remained independent predictors of incident AF.

Conclusion
In patients with acute STEMI incident AF developed during long-term follow-up after discharge from hospital was strongly associated with age and atrial structural abnormalities reflected as abnormal PTF-V1 on pre-STEMI ECG which might serve as a tool in risk stratification of STEMI patients in regard to AF development.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Scholarship grant from Swedish Institute. Table 1Figure 1
Impact of polypharmacy on clinical outcomes in elderly patients with nonvalvular atrial fibrillation: sub-analysis of the ANAFIE Registry
Authors: Yamashita T ,   ANAFIE Registry Group
Published: October 2021

Abstract

Background
Elderly patients with AF often have multimorbidities leading to treated by polypharmacy, which has been reported to be associated with worse prognosis. Although stroke prevention is a cornerstone of optimal anticoagulation management, data on elderly NVAF patients aged ≥75 years with polypharmacy are lacking.

Purpose
The All Nippon Atrial Fibrillation In the Elderly (ANAFIE) Registry is a prospective, multicenter, observational study that seeks to elucidate real-world data on the clinical status and prognosis of more than 30,000 Japanese patients (aged ≥75 y) with NVAF. This sub-analysis of the ANAFIE Registry assessed 2-year outcomes and the status of anticoagulant management in elderly NVAF patients in view of polypharmacy.

Methods
A total of 32,275 patients from the ANAFIE Registry were divided into 3 groups by the number of concomitant medicines other than oral anticoagulants (OAC) (0 to 4, 5 to 8, ≥9 medicines). The annualized incidence rates of clinical outcomes were determined by Kaplan-Meier analysis. Hazard ratios (HR) for clinical outcomes were determined using the Cox proportional-hazards model.

Results
In the overall population, the mean age was 81.5 y; men accounted for 57.3%; the mean CHA2DS2-VASc score was 4.5; the mean HAS-BLED score was 1.9; the prevalence of paroxysmal AF was 42.1%; the mean follow-up period was 1.88 y; oral anticoagulants (OAC) were used by 92.4% of patients (WF, 25.5%; DOAC, 66.9%); the major concomitant medicines were antihypertensive drugs (70.9%), antiarrhythmic drugs (56.2%), dyslipidemia drugs (37.1%), and proton pump inhibitors (36.6%). The numbers of patients using 0 to 4, 5 to 8, and ≥9 concomitant medicines were 12,186 (37.8%), 13,597 (42.1%), and 5,636 (17.5%), respectively. As the number of concomitant medicines increased, the prevalence of comorbidities and renal dysfunction of creatinine clearance &lt;50 mL/min increased. With an increase in concomitant medications, use of WF increased and that of DOAC decreased. Overall annualized incidence rates (% per patient-year) of clinical outcomes were 1.62 for stroke or systemic embolic events (SEE), 1.08 for major bleeding, 5.91 for cardiovascular (CV) events, 1.08 for CV death, and 3.71 for all-cause mortality. The annualized incidence rates and HR for each clinical outcome are shown in the table. As the number of concomitant medicines increased, the incidence for major bleeding, gastrointestinal bleeding, CV events, and all-cause death were significantly increased.

Conclusions
In elderly NVAF patients from the ANAFIE registry, polypharmacy was associated with increased risks of major bleeding, CV events, CV death, and all-cause mortality.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Co., Ltd.
Outcomes of radiofrequency catheter ablation for persistent and long-standing persistent atrial fibrillation
Authors: Azul Freitas A , Sousa P , Goncalves V , Ferreira C , Martinho S , Almeida J , Rosa J , Campos G , Jorge E , Antonio N , Elvas L , Goncalves L 
Published: October 2021

Abstract

Introduction
Catheter ablation has become the first-line treatment for symptomatic patients with atrial fibrillation (AF). Several approaches of substrate ablation have been used for persistent and long-standing persistent AF and the best protocol procedure is yet to be established. The purpose of this study was to evaluate the outcomes of patients submitted to catheter ablation of persistent and long-standing persistent AF adding extra-pulmonary substrate approaches to pulmonary vein isolation.

Methods
We retrospectively studied 67 consecutive patients referred for the first procedure of catheter ablation of persistent or long-standing persistent AF from May 2016 to October 2018. The first 27 patients were subjected to pulmonary vein isolation and complex fractionated atrial electrograms (CFAE) ablation (group 1) and the last 40 patients were subjected to a tailored approach guided by voltage map areas and CFAE (group 2). Patient characteristics, procedure details and follow-up were assessed, and predictors of recurrence were determined.

Results
Mean age was 59±11 years with 58% being male. During a mean follow-up of 16±6 months 27% of the patients showed AF recurrence. There were no differences in baseline characteristics of group 1 and 2. A higher recurrence rate was found in group 1 by comparison with group 2 (40.7% vs 17.5%, Log Rank X2 = 5.076, P=0.024) (Figure 1). Also, recurrence was associated with a longer AF duration, an increased baseline Brain Natriuretic Peptide (BNP), an increased left atrium (LA) volume, the presence of hyperthyroidism, the absence of sinus rhythm after procedure, the inducibility of AF post-ablation and the absence of an antiarrhythmic drug at hospital discharge. After adjustment for other confounders, the patient group (HR 5.16 [1.23–21.71] P=0.025), a long-standing AF (HR 9.09 [1.41–58.82] P=0.020), the BNP value at admission (HR 1.03 [1.01–1.05] P=0.033) and the LA volume index (HR 1.13 [1.02–1.25] P=0.017) were the only independent predictors of recurrence.

Conclusion
Ablation of persistent and long-standing persistent AF is feasible with good results when a substrate approach is added to pulmonary vein isolation. A tailored approach seems to be more efficient, showing best outcomes in mid-term follow-up. A long-standing AF, higher BNP value and the LA enlargement are important predictors of recurrence and should be used to better select patients and to manage follow-up.

Funding Acknowledgement
Type of funding sources: None.
Local impedance characteristics and advanced mapping capabilities to better understand pulmonary veins reconnections during repeat AF ablation procedures: insight from the CHARISMA registry
Authors: Segreti L , Maggio R , Bencardino G , Izzo G , De Lucia R , Notaristefano F , Ricciardi G , Rossi P , Giannotti Santoro M , Ferraro A , Perna F , Solimene F , Stocco C , Malacrida M , Bongiorni M.G 
Published: October 2021

Abstract

Background
Detailed characterization of pulmonary veins (PV) reconnection during repeat AF ablation through high-density mapping (HDM) and local impedance (LI) algorithm is still lacking.

Purpose
We aimed to characterize PV gaps and underlying electrical activity during and after ablation of PVs in AF patients (pts).

Methods
Consecutive patients (pts) undergoing redo AF ablation from the CHARISMA registry with complete characterization of PV gaps (PVG) at 8 Italian centers were included. Rhythmia mapping system was used to map the left atrium and PVs before and after ablation. LI characteristics were collected through a RF ablation catheter equipped with a dedicated LI algorithm (DirectSense). A novel map analysis tool (Lumipoint) that automatically identifies split potentials and continuous activation was used sequentially on each PV component, in order to better assess PVG. Each PVG was characterized in terms of LI and its variations during the procedure. Ablation endpoint was PVI as assessed by entrance and exit block.

Results
Fifty PVGs were automatically identified through the Lumipoint tool in 23 cases, mostly at anterior sites (21, 42%), followed by posterior (15, 30%) and carina (10, 20%) sites. One PVG was identified in 7 (28%) pts, 2 gaps in 10 (43.5%) pts and &gt;2 gaps in 6 (26.1%) pts. The mean LI at PVG sites was 111.3±12Ω prior to ablation: it was significantly higher than LI at scar tissue closer to PVG (99.3±8Ω, p&lt;0.0001) but was significantly lower than LI at healthy tissue (120.8±11Ω, p=0.0015). The mean linear extension of PVGs detected through Lumipoint was significantly lower than the one recognized through voltage map (11.5±8 mm vs 13.3±9 mm, p=0.01) whereas was comparable to the one identified through conventional activation map (11.8±7 mm, p=0.1161 vs Lumipoint). Complete identification of the whole area of PVG was achieved in 31 (62%) and 42 (84%) cases through voltage and activation map, respectively whereas the identification was only partial in 18 (36%) and 7 (14%) cases, respectively. In 1 case both voltage and activation map failed to identify a PVG. No complications during the procedures were reported. All PVs were successfully isolated in all study pts.

Conclusion
Advanced mapping capabilities were useful to pinpoint the search for PVGs, enabling a more targeted ablation approach vs relying on voltage mapping. LI values correlated well with PVGs characteristics and they significantly differ from both scar and healthy tissue.

Funding Acknowledgement
Type of funding sources: None.
Cryoablation: safety of same day discharge
Authors: Carrington M , Silverio Antonio P , Nunes-Ferreira A , Rodrigues T , Cunha N , Couto Pereira S , Brito J , Alves Da Silva P , Valente Silva B , Lima Da Silva G , Carpinteiro L , Cortez-Dias N , J Pinto F , De Sousa J 
Published: October 2021

Abstract

Introduction
Discharge after overnight hospital stay is standard procedure in patients submitted to elective atrial fibrillation (AF) ablation. Taking into consideration the low rate of cryoablation procedure complications could the same day discharge be an option?

Purpose
To assess the safety of same day discharge of patients submitted to AF cryoablation.

Methods
Single-center retrospective study of consecutive patients admitted to elective AF cryoablation in a tertiary center between February 2017 and November 2020. Patients were divided into two groups: same day discharge and next day discharge. Only patients submitted to ablation until 4 p.m. were included. Complication rates were obtained up to six months after the procedure. Complications were defined as death, pericardial tamponade, hematoma requiring evaluation and/or intervention, major bleeding requiring transfusion, hospital admission related to the procedure.

Results
One hundred fifty-four patients were included, with a mean age of 61±10.9 years, 66.2% were males, 18.2% with diabetes, 65.6% with dyslipidemia, 77.9% with hypertension, 10.4% with chronic kidney disease KDIGO stage 3 or more. Median follow-up of 436 [178 – 729] days. Most of the patients had paroxysmal (73.4%) and persistent short duration AF (23.4%). Sixty-two patients (40.3%) were early discharged and there were no differences between the two groups regarding epidemiological and clinical characteristics (p=NS).
A very low rate of complications in both groups was observed, occurring in 6.5% of patients with early discharge and in 8.7% of patients in overnight stay, without statistical significance between the two groups (p=0.61). The most frequent complications were local hematoma (5 patients, 2 in early discharged group), pericardial effusion (3 patients, all in overnight stay), femoral pseudo-aneurism (2 patients, 1 in each group) and arteriovenous fistula (1 patient in overnight stay group). The type of complications did not differ between the two groups (p=0.51). Two patients died during follow up, and this was unrelated to the procedure. In addition, no difference in success rate and arrhythmic recurrence was observed between the two groups (p=NS).

Conclusion
Our study suggests that it is safe to early discharge patients submitted to AF ablation, reducing the hospital stay length in selected patients. Larger studies are needed to confirm this data before routine implementation of this strategy.

Funding Acknowledgement
Type of funding sources: None.
The effect of shared decision-making for stroke prevention on treatment adherence and safety outcomes in patients with atrial fibrillation: a randomized clinical trial
Authors: Noseworthy P , Branda M.E , Kunneman M , Hargraves I.G , Sivly A.L , Brito J.P , Burnett B , Gorr H , Suzuki T , Lee A.T , Jackson E.A , Hess E , Brand-McCarthy S.R , Shah N.D , Montori V.M ,   Shared Decision Making for Atrial Fibrillation (SDM4AFib) Trial Investigators
Published: October 2021

Abstract

Background
Guidelines promote shared decision-making (SDM) for anticoagulation in patients with atrial fibrillation (AF). We recently showed that adding a within-encounter SDM tool to usual care (UC) increases patient involvement in decision making and clinician satisfaction, without affecting encounter length.

Purpose
We aimed to estimate the extent to which use of an SDM tool affected patient adherence to the decided care plan and clinical safety endpoints.

Methods
We conducted a multi-center, encounter-level randomized trial assessing the efficacy of UC with vs. without an SDM conversation tool for use during the clinical encounter (Anticoagulation Choice, AC) in patients with non-valvular AF considering starting or reviewing anticoagulation treatment. We conducted a chart and pharmacy review, blinded to randomization status, at 10 months post-enrollment to assess primary adherence (proportion of patients who were prescribed an anticoagulant who filled their first prescription) and secondary adherence (estimated using the proportion of days for which treatment was supplied and filled [PDC] for DOAC, and as time in therapeutic range (TTR) for warfarin). We also followed for any safety outcomes (stroke [stroke or transient ischemic attack], major bleeding, or death).

Results
We enrolled 922 evaluable patient encounters (AC=463, UC=459), of which 814 (88%) had pharmacy and clinical follow-up. We found no differences between arms in either primary (78% of patients in AC filled their first prescription vs. 81% in UC) or secondary adherence to anticoagulation (see Figure, PDCDOAC was 74.1% in AC vs. 71.6% in UC; TTRwarfarin was 66.6% in AC vs. 64.4% in UC). PDCDOAC was better (65%) in AC than in UC (55%) (OR 1.49, CIs 1.00, 2.22). Safety outcomes, mostly bleeds, occurred in 13% (AC) of and 14% (UC) of participants.

Conclusions
This is the largest reported randomized trial in AF comparing usual care with and without an SDM tool to promote SDM. Although patients were more actively involved in SDM, we found no significant differences between arms in primary or secondary adherence to anticoagulation or clinical safety outcomes.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The trial was funded by and conducted independently of the National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health (RO1 HL131535-01). The funding body had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Figure 1
Early rhythm-control therapy in patients with atrial fibrillation: a nationwide cohort study
Authors: Chao T , Chan Y.H , Lip G.Y.H , Chen S.A 
Published: October 2021

Abstract

Background
In the Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST-AFNET 4), early rhythm control was associated with better clinical outcomes for patients with atrial fibrillation (AF). However, the intervention arm had more structured and regular followup, and whether the better outcomes of patients assigned to rhythm control were solely due to “early” intervention or because of more regular and structured follow up was unclear.

Purpose
We aimed to investigate whether the findings of the EAST trial are applicable to the “real world” clinical setting, where a less structured management protocol is operated.

Methods
From 2001 to 2016, 301,064 newly-diagnosed AF patients were identified from Taiwan National Health Insurance Research Database. Among these patients, 62,649 AF patients receiving antiarrhythmic drugs or catheter ablation within 1 year after AF being diagnosed (similar to the timing definition of the EAST-AFNET 4 trial) were categorized as the early rhythm control group, and the remaining 238,415 patients were defined as usual care group. Risk of clinical events were compared between 2 groups.

Results
Compared to usual care, early rhythm control was associated with a lower adjusted risk of ischemic stroke (aHR 0.771, 95CI 0.751–0.792; p&lt;0.001), heart failure (aHR 0.851, 95% CI 0.806–0.891; p&lt;0.001), acute myocardial infarction (aHR 0.915, 95% CI 0.877–0.955; p&lt;0.001), mortality (aHR 0.794, 95% CI 0.782–0.806; p&lt;0.001) and composite adverse events (aHR 0.823, 95% CI 0.813–0.834; p&lt;0.001) (Figure). Compared to usual care, the lower risks of ischemic stroke (aHR 0.746, 95% CI 0.717–0.775), heart failure (aHR 0.819, 95% CI 0.798–0.841), mortality (aHR 0.777, 95% CI 0.759–0.795) and composite adverse events (aHR 0.802, 95% CI 0.787–0.818) associated with early rhythm control were even more evident when performed early (&lt;3 months) than later periods (3–6 months, 7–9 months and 10–12 months; pint &lt;0.001). Principal results were generally consistent for majority of subgroups studied and among the cohort after the propensity matching.

Conclusions
In this nationwide cohort study, early rhythm control therapy was associated with a lower risk of adverse events than usual care among patients with early AF. Outcomes were even better with earlier (&lt;3 months) intervention.

Funding Acknowledgement
Type of funding sources: None.