bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implantable defibrillator-computed respiratory disturbance index predicts new-onset atrial fibrillation: the DASAP-HF study
Authors: Boriani G , Pisano' E.C.L , Pieragnoli P , Locatelli A , Capucci A , Talarico A , Zecchin M , Rapacciuolo A , Piacenti M , Indolfi C , Arias M.A , Diemberger I , Checchinato C , D'Onofrio A ,   DASAP-HF
Published: October 2021

Abstract

Introduction
Sleep apnea (SA), as measured by polysomnography, is a risk factor for atrial fibrillation (AF). The DASAP-HF study previously demonstrated that the Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe SA, is associated with cardiovascular events, and independently predicts death.

Purpose
In the present analysis we tested the hypothesis that device-detected RDI could also predict AF burden.

Methods
Patients with left ventricular ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. One month after implantation, patients underwent a polysomnographic study. The weekly average RDI value was considered, as calculated by the algorithm during the entire follow-up period and over a 1 week period preceding the sleep study, and patients were stratified according to an RDI value ≥ or &lt;30 episodes/hour. The endpoints were: daily AF burden of ≥5 minutes, ≥6 hours, ≥23 hours.

Results
164 enrolled patients had usable RDI values during the entire follow-up period. Severe SA (RDI≥30 episodes/h) was diagnosed in 92 (56%) patients at the time of the polysomnographic study. During a median follow-up of 25 months, AF burden ≥5 minutes/day was documented in 70 (43%), ≥6 hours/day in 48 (29%), and ≥23 hours/day in 33 (20%) patients. Device-detected RDI≥30 episodes/h at the time of the polysomnographic study, as well as the polysomnography-measured apnea hypopnea index ≥30 episodes/h, were not associated with the occurrence of the endpoints, using a Cox regression model. However, using time-dependent Cox model continuously measured weekly average RDI≥30episodes/h was independently associated with AF burden ≥5 minutes/day (HR: 2.13, 95% CI: 1.24–3.65, p=0.006), ≥6 hours/day (HR: 2.75, 95% CI: 1.37–5.49, p=0.004), and ≥23 hours/day (HR: 2.26, 95% CI: 1.05–4.86, p=0.037), after correction for history of AF, left atrial diameter, and gender.

Conclusions
In heart failure patients implanted with an ICD, device-diagnosed severe SA is associated with a higher risk of AF. In particular, severe SA on follow-up data review identifies patients who are from two- to three-fold more likely to experience an AF episode, according to various thresholds of daily AF burden.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Promoted by the Italian Heart Rhythm Society (AIAC).Supported by a research grant from Boston Scientific.
Exploring the temporal relationship between atrial fibrillation and heart failure development. Analysis from nationwide database
Authors: Cottin Y , Ben Messaoud B.M , Yao H , Laurent G , Bisson A , Eicher J.C , Bodin A , Herbert J , Juilliere Y , Zeller M , Fauchier L 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) and heart failure (HF) often coexist and are closely intertwined, each condition worsening the other. The temporal relationships between these two disorders have not yet been fully explored. We assessed, on a nationwide scale, the prognosis of patients hospitalized with HF and AF, based on the timing of AF and HF development.

Methods
From the administrative database covering hospital care for the whole French population, we identified 1,349,638 patients diagnosed with both AF and HF between 2010 and 2018: 956,086 of these AF patients developed HF first (prevalent HF) and 393,552 developed HF after AF (incident HF). The outcome analysis (all-cause death, cardiovascular [CV] death, ischemic stroke or hospitalization for HF) was performed with follow-up starting at the time of last event between AF or HF in the whole cohort and in 427,848 propensity-score-matched patients (213,924 with incident HF and 213,924 with prevalent HF).

Results
During follow-up (mean follow-up 1.6±1.9 year), matched patients with prevalent HF had a higher risk of all-cause death (21.6 vs 19.2%/year), CV death (7.6 vs 6.5%/year) as well as non-cardiovascular death (13.9 vs 12.7%/year) than those with incident HF. The risk for ischemic stroke was lower in the prevalent HF group (1.2 vs 2.4%/year).

Conclusion
In patients hospitalized with both AF and HF, we identified two distinct clinical entities based on the chronological sequence of the two disorders. Patients in whom HF preceded AF (prevalent HF) had higher mortality and higher risk of rehospitalization for HF.

Funding Acknowledgement
Type of funding sources: None.
Burden of atrial fibrillation in influenza hospitalizations: analysis from 2018 national inpatient sample
Authors: Thyagaturu H , Shah K , Li S , Kumar A 
Published: October 2021

Abstract

Introduction
Influenza infection could cause systemic inflammatory response and lead to increase sympathetic tone. The association and impact of atrial fibrillation (AF) on Influenza has not been well studied.

Purpose
To evaluate the association of atrial fibrillation with mortality and resource utilization in influenza hospitalizations.

Methods
We queried 2018 National Inpatient Sample (NIS) database to identify influenza and AF hospitalizations using appropriate ICD-10 codes. Influenza with AF group was compared to influenza without AF. Chi-square test and linear regression were used for categorical and continuous variables, respectively. Multivariate logistic regression was used to adjust for potential hospital and patient confounders (age, sex, race, diabetes, systolic heart failure, chronic kidney disease, obesity, charlson co-morbidity index, hospital location, teaching status, bed size and income status). Discharge weights provided in the database was used to calculate the national estimates. STATA 16.1 was used to perform all statistical analysis.

Results
345,419 weighted influenza hospitalizations were identified. Of which, 78,824 (22.8%) of them had atrial fibrillation. Influenza patients with AF were older (mean age: 77 vs. 65 yrs; p&lt;0.01) but had similar number of female (52% vs 48%; p&lt;0.01) compared to influenza patients without AF. After adjusting for potential hospital and patient level confounders, we observed statistically significant increase in mortality [Adjusted Odds Ratio (aOR): 1.5 (1.4–1.7); p&lt;0.01], length of stay [6.5 vs 5.4 days; p&lt;0.01], total hospitalization charges [USD: $65,302 vs $54,149; p&lt;0.01], right heart failure [aOR: 2.4 (1.6–3.6); p&lt;0.01], cardiogenic shock [aOR: 1.9 (1.5–2.5); p&lt;0.01] in influenza patients with AF when compared to those without AF.

Conclusion
Presence of AF is an independent predictor of mortality, length of stay, hospitalization charges, right heart failure and cardiogenic shock in hospitalized patients with influenza. This study helps to assume prognosis and raise awareness on the intensity of care needed toward these patients.

Funding Acknowledgement
Type of funding sources: None.
Population screening for atrial fibrillation in subjects with sleep apnea
Authors: Guo Y , Zhang H , Chen Y ,   mAFA investigators
Published: October 2021

Abstract

Background
Sleep apnea is highly associated with atrial fibrillation (AF), resulting in increased risk of mortality. However, early identification and intervention of AF is limit among subjects with sleep apnea as often asymptomatic.

Objective
The present study aimed to investigate the occurrence of AF in subjects at high risk for sleep apnea with smart technology.

Methods
The photoplethysmographic (PPG)-based smart devices (wristband: Huawei Band B6, Honor Band 6); wristwatch: Huawei Watch GT2, Huawei Watch FIT, Honor Watch GS Pro, Honor Watch ES, Honor MagicWatch2, Huawei Technologies Co., Ltd., Shenzhen, China) were used for screening AF across China, which has been validated in Pre-mAFA (Huawei Heart Study). The PPG-based detecting sleep apnea has been developed. High-risk sleep apnea was defined as more than 80% monitoring measures with Apnoea–Hypopnoea Index (AHI) ≥30 during the sleep, monitored by PPG-based smart devices. The identified AF and high-risk sleep apnea were further confirmed by health providers with clinical evaluation, electrocardiogram, 24-hour Holter, or polysomnograph, respectively.

Results
There were 187,933 subjects (38.18±10.77 years, 90.88% male) who recruited for screening sleep apnea between December 2019, and December 2020. Among these, 9088 (4.84%,42.62±9.27 years, 98.13% male) were identified as high-risk sleep apnea, with average AHI of 27.99 (interquartile range [IQR]: 19.27–36.40).
Among those, 184,970 (of 187,933, 98.42%)subjects monitored sleep apnea and pulse rhythm with PPG-smart devices, with 8837 subjects of high-risk sleep apnea. Ninety-three (93/8837, 1.05%) AF were identified among those at high-risk sleep apnea, which was higher compared to those without sleep apnea (203/54916, 0.37%, p&lt;0.001). With the increased risk for sleep apnea, identified AF raised (normal-, low-, moderate-, high-risk: 0.37%, 0.72%, 0.95%, and 1.05%, p&lt;0.001, Figure 1).
Compared with non-AF subjects, subjects with identified AF were at much high -risk sleep apnea (8744/183736, 4.76% vs. 93/1234, 7.54%, p&lt;0.001).
In multivariate analysis, high-risk sleep apnea increased 5.36 (95% CI: 3.43–8.37)fold risk of AF, after adjustment of age, sex, body mass index, hypertension, diabetes mellitus, coronary artery disease, heart failure, and hyperthyroidism.
The sensitivity analysis of the high-risk sleep apnea subjects (n=460,42.41±8.04 years, 98.70% male), which further confirmed with the diagnosis of sleep apnea by doctors and polysomnography, demonstrated the similar proportion identified AF (5/460, 1.09%).

Conclusions
In this population-based screening study, high-risk sleep apnea increased more than five-fold risk for AF, highlighting the compelling need for effective intervention of AF.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health Care of China (20BJZ26)
The association between novel ST2, BNP, atrial fibrillation and heart failure
Authors: Al-Wahaibi K , Khan I , McAdam B , Leong T 
Published: October 2021

Abstract

Background/Introduction
ST2, a novel marker of fibrosis has been proposed as a novel biomarker for heart failure. There is paucity of data suggesting its association with Atrial Fibrillation (AF), in particular, with regards to the its independent effect after adjustment for clinical factors and traditional biomarkers such as BNP. There is increasing evidence that inflammation and fibrosis are important players in the pathogenesis of AF, the most common arrhythmia that is associated with considerable morbidity.

Purpose
We sought to examine the association of ST2 with AF and its possible incremental value in combination with traditional biomarkers already used in routine clinical practice such as BNP.

Methods
Unselected patients presenting to a Cardiology service who had BNP for clinical reasons, concomitantly had ST2 sent. These patients included those with heart failure, acute coronary syndromes and AF, as well as patients attending cardioversion and cardiac catheterisation. The association between ST2, BNP and clinical factors was examined. ST2 was examined in tertiles as its distribution was highly skewed. Raised BNP was defined as usual (≥100 pg/ml).

Results
Of the 619 patients, the mean age was 69 years and 66% were male. The prevalence of co-morbidities were: Coronary heart disease - CHD (41%), Atrial Fibrillation – AF (30%), Heart Failure - HF (20%), Chronic Kidney Disease – CKD (23%). The mean eGFR was 68 ml/h and the mean LV ejection fraction was 55%. Both ST2 and BNP levels were significantly higher in patients with heart failure, CKD and AF. Mean levels of ST2 were (in ng/ml): HF vs no HF (65 vs. 38, p=0.0001) and in CKD vs. no CKD (49 vs. 41, p=0.001), CAD vs no CAD (43 vs. 42, p=0.3). Mean levels of BNP were (in pg/ml): HF vs no HF (579 vs. 131, p=0.0001), CKD vs. no CKD (379 vs. 173, p=0.0001), CAD vs. no CAD (239 vs. 206, p=0.5).
In patients with AF, levels of both ST2 and BNP were higher, as were their mean ages and prevalence of co-morbidities (see Table 1). Both ST2 and BNP correlated with AF (Pearson r=0.2, p&lt;0.0001 for ST2 and r=0.5, p&lt;0.0001 for BNP). There was also a graded association of ST2 with AF (15%, 33% and 40% across tertiles of ST2, p=0.0001).
Both ST2 and raised BNP were significant associated with AF in both univariable and multi-variable regression models, and remained independent predictors when adjusted for HF, CHD, LV EF and eGFR (Table 2, Model 2 – Relative risk ratio of AF with ST2 across tertiles 1.5, p0.005, and Odds ratio of AF with raised BNP 7.4, p&lt;0.001). However, ST2 loses significance when BNP is added to the model in combination (Table 2 – Model 3).

Conclusions
Both ST2 and BNP are independent predictors of AF even after adjustment for heart failure and other clinical factors. When ST2 is used in combination with BNP, raised BNP appears to be a stronger predictor of AF than ST2.

Funding Acknowledgement
Type of funding sources: None.
Risk of atrial fibrillation development of sodium-glucose co-transporter 2 inhibitor and thiazolidinedione treatment among patients with type 2 diabetes
Authors: Kim Y.R , Lee S.E , Kim K.A 
Published: October 2021

Abstract

Background
Type 2 diabetes is an independent risk factor for the development of atrial fibrillation (AF). Recently, SGLT-2i has been shown to decrease the incidence of AF through several mechanisms including reduction of atrial dilatation via diuresis and lowering body weight. On the other hand, the use of TZD was found to protect diabetic patients from new-onset AF in observational studies. Thus, we aimed to compare the effect of SGLT-2i and TZD on the risk of AF development.

Methods
Using the Korean National Health Insurance Service database, we included patients with type 2 diabetes who were prescribed SGLT-2i or TZD at least once from January 2014 to December 2018. Patients were followed until the outcome event, death, or 31 December 2018. Sensitivity analysis was performed only including patients who prescribed study drugs ≥90 days.

Results
A total of 206,986 patients were included (88,227 patients in SGLT-2i group and 118,759 in TZD group). Baseline characteristics were mean age was 57 years and 57.4% were male; mean body mass index was 26.3kg/m2 and 68.3% had hypertension. During follow-up, the incidence rates of AF were 1.36% in SGLT-2i-treated patients and 0.87% TZD-treated patients, respectively (p=0.0002). The hazard ratio (HR) of AF was 0.846 (95% confidence interval [CI]: 0.0.775–0.923) in SGLT-2i-treated patients compared with TZD-treated patients.

Conclusions
In this study, the risk of AF development was significantly lower in patients treated with SGLT-2i versus TZD. SGLT2 would be a good choice for the patients with high risk of AF development among diabetes mellitus.

Funding Acknowledgement
Type of funding sources: None.
Long term outcomes of patients with chronic inflammatory diseases after percutaneous coronary intervention
Authors: Marcusohn E , Zukermann R , Roguin A , Kobo O 
Published: October 2021

Abstract

Introduction
Patients with chronic inflammatory diseases are at increased risk for coronary artery disease.

Aim
We aimed to assess the long-term outcomes of patients with chronic inflammatory diseases who underwent percutaneous coronary intervention.

Methods
A Retrospective cohort study of all adult (&gt;18 years) patients who underwent PCI in a large [1000 bed] tertiary care centerfrom January 2002 to August 2020.

Results
A total of 12,951 patients underwent PCI during the study period and were included in the cohort. The population of chronic inflammatory diseases includes 247/12,951 [1.9%]; 70 with IBD and 173 with AIRD. The composite endpoint of mortality, ACS or CHF admission was more frequent in the inflammatory disease group (77.5% in AIRD group, 72.9% in the IBD group and 59.6% in the non-inflammatory group, p&lt;0.001). The adjusted cox regression model found a statistically significant increased risk of the composite primary endpoints of around 40% for patients both with AIRD and IBD. The increased risk for ACS was 61% for AIRD patients and 37% for IBD patients. Patients with inflammatory diseases were found to have a significant increased risk CHF admission, while both IBD and AIED patients had a non-significant increased risk for mortality.

Conclusion
Patients with AIRD and IBD are at higher risk for cardiovascular events also in long term follow up once diagnosed with CAD and treated with PCI.

Funding Acknowledgement
Type of funding sources: None.
Clinical significance of microRNA-126 in Coronary artery disease patients
Authors: Ali Sheikh M S 
Published: October 2021

Abstract

Background
Coronary artery disease (CAD) is major public health problem and the leading cause of premature death all over the world. Early diagnosis with adequate management of CAD patients can significantly reduce morbidity and mortality rate.

Purpose
The purpose of this study was to explore the clinical significance of plasma miR-126 as a biomarker of stable angina pectoris patients and investigated the protective effects of hypoxic exposed HUVEC cell injury.

Methods
Angiographically confirmed 127 stable coronary artery (CAD) patients, 55 healthy subjects and 18hours hypoxic (1% O2) HUVEC cells were included in this study.

Results
The expression of miR-126 levels were remarkably down-regulated in stable CAD patients and hypoxic exposed HUVEC cells as compared with controls (p&lt;0.001). Circulating plasma miR-126 was able to accurately differentiated stable CAD patients from healthy subjects with high sensitivity and specificity (AUC 0.928). The caspase-3 activity, apoptosis rate, LDH levels and intracellular ROS generation were significantly increased in 24hours hypoxic exposed HUVEC cells than normal control cells (p&lt;0.001). On the contrary, over expressions of miR-126 were evidently reduced caspase-3 activity, apoptosis rate, LDH levels, intracellular ROS production and significantly improved HUVEC cellular viability (p&lt;0.001). Moreover, TNF receptor-associated factor 6 (TRAF6) expressions were markedly increased in Hypoxic induced HUVEC cells, whereas mimic expression of miR-126 significantly decreased TRAF6 expression.

Conclusion
Down-regulated miR-126 may consider as a potential risk factor for stable CAD patients and it may used as a possible biomarker for early evaluation of CAD patients. Mimic expression of miR-126 remarkably decreased caspase-3 activity, LDH secretions, ROS levels and markedly improved HUVEC cellular viability by down-regulating TRAF6 expression, suggesting a newer therapeutic target for CAD patients.

Funding Acknowledgement
Type of funding sources: None.
Feasibility of virtual fractional flow reserve derived from coronary angiography and its correlation with invasive functional assessment
Authors: Mano T , Ferreira V , Ramos R , Oliveira E , Santana A , Melo J , Reis J , Bras P , Teixeira B , Cardoso I , Castelo A , Cacela D , Cruz Ferreira R 
Published: October 2021

Abstract

Introduction
Invasive functional assessment (iFA) of coronary artery disease (CAD) needs expensive devices, has potential procedure-related complications and is still underutilized. Virtual Fractional Flow Reserve (vFFR) derived from invasive coronary angiography (ICA) has the potential to overcome these limitations.

Purpose
To investigate the feasibility of vFFR analysis and its correlation with iFA (iFR, RFR or FFR).

Methods
Retrospective analysis of consecutive patients (pts) who underwent iFA in a tertiary center between 2019 and 2020. vFFR was calculated using a dedicated software (CAAS Workstation 8.4) based on standard non-hyperaemic coronary angiograms acquired in ≥2 different projections, by operators blinded to iFA results. Diagnostic performance and accuracy of vFFR were evaluated. vFFR was considered positive when &lt;0.80. FFR &lt;0.8 and iFR/RFR &lt;0.90 were classified as positive according to current clinical standards.

Results
Out of 113 coronary arteries of 102 pts, vFFR was successfully analysed in 106 (94%). Reasons for vFFR analysis failure were: vessel projection overlap (48%), &lt;2 angiographic projections (28%) and table movement while acquisition (24%). From 106 coronary arteries of 95 pts with analysable vFFR (78% male, mean age 67.8±9.7 years), 90 (85%) showed agreement with the respective iFA result. The vFFR predicted which lesions were physiologically significant and which were not with accuracy, sensitivity, specificity, positive and negative predictive values of 73%, 73%, 83%, 53%, and 92% respectively. The mean difference between vFFR and iFA were −0.0484±0.096 and Pearson's correlation coefficient was 0.533 (p&lt;0.001). The ROC area under the curve was 0.839 (0.751–0.928, p&lt;0.001).

Conclusion
FFR were feasible in 94% of cases analysed retrospectively. As compared to gold-standard iFA, vFFR had an overall moderate accuracy in detecting ischemia-producing lesions and a negative predictive value &gt;90%. vFFR has the potential to substantially simplify physiological coronary lesion assessment and thus improve its current uptake.

Funding Acknowledgement
Type of funding sources: None. Bland-Altman plot between vFFR and IFA
Virtual fractional flow reserve derived from coronary angiography – artery and lesion specific correlations
Authors: Mano T , Ferreira V , Ramos R , Bras P , Reis J , Grazina A , Jacinto S , Teixeira R , Oliveira E , Santana A , Melo J , Cacela D , Cruz Ferreira R 
Published: October 2021

Abstract

Introduction
Virtual Fractional flow reserve (vFFR) from standard non-hyperaemic invasive coronary angiography (ICA) has emerged as a promising non-invasive test to assess hemodynamic severity of coronary artery disease (CAD).

Purpose
To investigate the difference in vFFR analysis between vessels and specific lesions.

Methods
Retrospective analysis of consecutive patients (pts) who underwent invasive functional assessment (iFA) in a tertiary center between 2019 and 2020. vFFR was calculated using dedicated software (CAAS Workstation 8.4) based on coronary angiograms of the acquired in ≥2 different projections, by operators blinded to iFA results. Diagnostic performance of vFFR was evaluated and correlated with iFA, according to coronary vessel, vessel diameter at stenosis, diameter stenosis and area stenosis at lesion. vFFR was considered positive when &lt;0.80. FFR &lt;0.8 and iFR/RFR &lt;0.90 were classified as positive according to current clinical standards.

Results
106 coronary arteries of 95 pts (78% male, mean age 67.8±9.7 years) underwent vFFR evaluation. ICA indications were chronic coronary syndrome in 63% or acute coronary syndrome (non-culprit lesion) in the remaining pts. VFFR accuracy was good (AUC 0.839 (p&lt;0.001) and Pearson's correlation coefficient 0.533 (p&lt;0.001) when vFFR was measured in the distal vessel segment. The correlation improved when vFFR were assessed at lesion site (r=0.631, p&lt;0.001) or up to 1cm below the stenosis (0.610, p&lt;0.001). Binary concordance of 89% were observed in RCA and LAD (Sensibility -S 68%, Specificity-Sp 96%, False positive -FP 3.8%, False negative - FN 31%, predictive positive value-PPV 87%, predictive negative value- PNV 89%), while in the circumflex coronary artery binary concordance were of 77% (S 50%; Sp 82%; FP 18%; FN 50%; PPV 33% and PNV 90%). Correlation between vFFR and iFA was higher in vessels ≥2mm (r=0.730, p&lt;0.001). and in lesions in the extremes of the severity spectrum (Table 1).

Conclusion
vFFR has a moderate to high linear correlation to iFA, depending on the artery and type of lesion studied. The higher correlation was found when vFFR were measured at lesion site, in non-circumflex artery stenosis, in vessels ≥2mm and in vessels with mild or severe stenosis.

Funding Acknowledgement
Type of funding sources: None.