bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antithrombotic Therapy in Atrial Fibrillation Associated with Valvular Heart Disease: Executive Summary of a Joint Consensus Document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, Endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE)
Authors: Lip Gregory , Collet Jean , de Caterina Raffaele , Fauchier Laurent , Lane Deirdre , Larsen Torben , Marin Francisco , Morais Joao , Narasimhan Calambur , Olshansky Brian , Pierard Luc , Potpara Tatjana , Sarrafzadegan Nizal , Sliwa Karen , Varela Gonzalo , Vilahur Gemma , Weiss Thomas , Boriani Giuseppe , Rocca Bianca 
Published: December 2017

AbstractManagement strategies for patients with atrial fibrillation (AF) in association with valvular heart disease (VHD) have been less informed by randomized trials, which have largely focused on ‘non-valvular AF’ patients. Thromboembolic risk also varies according to valve lesion and may also be associated with CHA2DS2-VASc score risk factor components, rather than only the valve disease being causal.Given the need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD, a task force was convened by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group (WG) on Thrombosis, with representation from the ESC WG on Valvular Heart Disease, Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE) with the remit to comprehensively review the published evidence, and to produce a consensus document on the management of patients with AF and associated VHD, with up-to-date consensus statements for clinical practice for different forms of VHD, based on the principles of evidence-based medicine.This is an executive summary of a consensus document which proposes that the term ‘valvular AF’ is outdated and given that any definition ultimately relates to the evaluated practical use of oral anticoagulation (OAC) type, we propose a functional EHRA (Evaluated Heartvalves, Rheumatic or Artificial) categorization in relation to the type of OAC use in patients with AF, as follows: (1) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 1 VHD, which refers to AF patients with ‘VHD needing therapy with a vitamin K antagonist (VKA)’ and (2) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 2 VHD, which refers to AF patients with ‘VHD needing therapy with a VKA or a non-VKA oral anticoagulant also taking into consideration CHA2DS2-VASc score risk factor components.
Risk Factors for the Progression from Low to High Titres in 260 Children with Severe Haemophilia A and Newly Developed Inhibitors
Authors: Mancuso Maria Elisa , Fischer Kathelijn , Santagostino Elena , Oldenburg Johannes , Platokouki Helen , Königs Cristoph , Escuriola-Ettingshausen Carmen , Rivard George , Cid Ana , Carcao Manuel , Ljung Rolf , Petrini Pia , Altisent Carmen , Kenet Gili , Liesner Raina , Kurnik Karin , Auerswald Günther , Chambost Hérvè , Mäkipernaa Anne , Molinari Angelo , Williams Mike , van den Berg H. ,   on behalf of the European Pediatric Network for Haemophilia Management (PedNet) the REMAIN (REal life MAnagement of children with INhibitors) Study Group
Published: December 2017

AbstractIn children with severe haemophilia A, inhibitors to factor VIII (FVIII) usually develop during the first 50 treatment exposure days and are classified as low or high titre depending on the peak inhibitor titre being greater or less than 5 Bethesda units/mL (BU/mL). Classification of the inhibitor may change with time, as some low-titre inhibitors progress to high titre following re-exposure to FVIII concentrate. The aim of this study was to investigate potential risk factors for such a progression in children with severe haemophilia A and newly diagnosed inhibitors. This study was a follow-up study of the PedNet Registry and included 260 children with severe haemophilia A and inhibitors born between 1990 and 2009 and recruited consecutively from 31 haemophilia centres. Clinical and laboratory data were collected from the date of each child's first positive inhibitor test for at least 3 years. At the time of first positive inhibitor test, 49% (n = 127) had low-titre inhibitors, with 50% of them progressing to high titre and only 25% maintaining low titres. The FVIII gene (F8) mutation type was known in 247 patients (95%), and included 202 (82%) null mutations. The progression to high-titre inhibitors was associated with null F8 mutations (odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.0–6.5), family history of inhibitors (OR: 7.2; 95% CI: 1.8–28.4) and the use of high-dose immune tolerance induction, defined as ≥100 IU FVIII concentrate/kg/d (OR: 3.9; 95% CI: 1.5–10.0). These results suggest that high-dose immune tolerance induction should be avoided as the initial strategy in patients who develop low-titre FVIII inhibitors.
Incidence of Venous Thromboembolism in Asian Populations: A Systematic Review
Authors: Lee Lai , Gallus Alexander , Jindal Ravul , Wang Chen , Wu Chau-Chung 
Published: December 2017

Introduction Despite a marked recent increase in the number of publications describing the incidence of venous thromboembolism (VTE) in Asia, and especially in mainland China, Hong Kong, Taiwan, Korea, Japan and Singapore, there remains a lack of consensus on the true risks, and trends over time, to inform appropriate clinical practice. The purpose of this systematic review was therefore to examine evidence about the incidence of symptomatic VTE in Asia.
Methods Databases were searched for studies from Asia, published between January 1995 and February 2016, on the incidence of symptomatic VTE, deep vein thrombosis (DVT) or pulmonary embolism. Review of eligible studies was conducted independently by two reviewers. Data were extracted on incidence, predispositions and recurrence of VTE.
Results One thousand nighty-five studies were identified, of which 73 were eligible for full text review and data extraction. Three population-wide estimates of VTE rates identified from Korea, Taiwan and Hong Kong reported annual incidences of 13.8, 15.9 and 19.9 per 100,000, respectively. Nine studies of Asian hospital registries or databases reported VTE rates ranging from 11 to 88 cases per 10,000 admissions. Population-based estimates of post-surgical DVT rates ranged from 0.15 to 1.35%. Age was a significant risk factor for VTE in all population groups.
Conclusion Population-wide incidence estimates in Asia were approximately 15 to 20% of the levels recorded in western countries but have increased over time. It is anticipated this synthesis of evidence on the incidence of VTE and its predisposing factors will increase awareness about VTE in Asian populations.
Levels of Circulating Intermediate Monocytes Decrease after Aortic Valve Replacement in Patients with Severe Aortic Stenosis
Authors: Hewing Bernd , Ellerbroek Rena , Au Sebastian , Stangl Verena , Dreger Henryk , Laule Michael , Grubitzsch Herko , Knebel Fabian , Baumann Gert , Ludwig Antje , Stangl Karl 
Published: December 2017

AbstractAortic valve stenosis (AS) is a chronic inflammatory disease. We have previously shown that severe AS is associated with increased levels of circulating intermediate monocytes. Haemodynamics are considered to influence levels of circulating monocyte subsets; we therefore hypothesized that aortic valve replacement may result in changes in the distribution of circulating monocyte subsets. In the present study, we evaluated levels of circulating monocyte subsets in patients with severe AS undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Levels of classical (CD14++CD16–), intermediate (CD14++CD16+), and non-classical (CD14+CD16++) CD86-positive monocytes were determined by flow cytometry in peripheral blood of patients with severe AS before (baseline) and at 3- and 6-month follow-ups (FUP) after SAVR (n = 25 patients) or TAVR (n = 44 patients). Absolute and relative levels of circulating intermediate monocytes decreased from median 39.9/µL (interquartile range [IQR]: 31.7–53.6/µL) and 6.7% (5.6–8.1%) at baseline to 31.6/µL (24.3–42.4/µL; p < 0.001) and 5.4% (4.4–6.7%; p < 0.001) at 6-month FUP after aortic valve replacement, respectively. The decrease in levels of circulating intermediate monocytes appeared earlier (between baseline and 3-month FUP) in the TAVR group compared with the SAVR group (between 3- and 6-month FUP). In conclusion, levels of circulating intermediate monocytes decrease after SAVR or TAVR in patients with severe AS.
Dabigatran after Short Heparin Anticoagulation for Acute Intermediate-Risk Pulmonary Embolism: Rationale and Design of the Single-Arm PEITHO-2 Study
Authors: Klok Frederikus , Ageno Walter , Barco Stefano , Binder Harald , Brenner Benjamin , Duerschmied Daniel , Empen Klaus , Faggiano Pompilio , Ficker Joachim , Galiè Nazzareno , Ghuysen Alexandre , Held Matthias , Heydenreich Nadine , Huisman Menno , Jiménez David , Kozak Matija , Lang Irene , Lankeit Mareike , Münzel Thomas , Petris Antoniu , Pruszczyk Piotr , Quitzau Kurt , Schellong Sebastian , Schmidt Kai-Helge , Stefanovic Branislav , Verschuren Franck , Wolf-Puetz Anamaria , Meyer Guy , Konstantinides Stavros ,   for the PEITHO-2 Investigators
Published: December 2017

AbstractPatients with intermediate-risk pulmonary embolism (PE) may, depending on the method and cut-off values used for definition, account for up to 60% of all patients with PE and have an 8% or higher risk of short-term adverse outcome. Although four non-vitamin K-dependent direct oral anticoagulants (NOACs) have been approved for the treatment of venous thromboembolism, their safety and efficacy as well as the optimal anticoagulation regimen using these drugs have not been systematically investigated in intermediate-risk PE. Moreover, it remains unknown how many patients with intermediate-high-risk and intermediate-low-risk PE were included in most of the phase III NOAC trials. The ongoing Pulmonary Embolism International Thrombolysis 2 (PEITHO-2) study is a prospective, multicentre, multinational, single-arm trial investigating whether treatment of acute intermediate-risk PE with parenteral heparin anticoagulation over the first 72 hours, followed by the direct oral thrombin inhibitor dabigatran over 6 months, is effective and safe. The primary efficacy outcome is recurrent symptomatic venous thromboembolism or death related to PE within the first 6 months. The primary safety outcome is major bleeding as defined by the International Society on Thrombosis and Haemostasis. Secondary outcomes include all-cause mortality, the overall duration of hospital stay (index event and repeated hospitalizations) and the temporal pattern of recovery of right ventricular function over the 6-month follow-up period. By applying and evaluating a contemporary risk-tailored treatment strategy for acute PE, PEITHO-2 will implement the recommendations of current guidelines and contribute to their further evolution.
Assessing Bleeding Risk in Atrial Fibrillation Patients: Comparing a Bleeding Risk Score Based Only on Modifiable Bleeding Risk Factors against the HAS-BLED Score. The AMADEUS Trial
Authors: Esteve-Pastor María , Rivera-Caravaca José , Shantsila Alena , Roldán Vanessa , Lip Gregory , Marín Francisco 
Published: December 2017

Background The HAS-BLED (hypertension, abnormal renal/liver function, previous stroke, bleeding history or predisposition, labile international normalized ratio [INR], elderly and drugs/alcohol consumption) score has been validated in several scenarios but the recent European guidelines does not recommend any clinical score to assess bleeding risk in atrial fibrillation (AF) patients and only focus on modifiable clinical factors.
Purpose The aim of this study was to test the hypothesis that the HAS-BLED score would perform at least similarly to an approach only based on modifiable bleeding risk factors (i.e. a ‘modifiable bleeding risk factors score’) for predicting bleeding events.
Methods We performed a comparison between the HAS-BLED score and the new ‘modifiable bleeding risk factors score’ in a post hoc analysis in 4,576 patients included in the AMADEUS trial.
Results After 347 (interquartile range, 186–457) days of follow-up, 597 patients (13.0%) experienced any clinically relevant bleeding event and 113 (2.5%) had a major bleeding. Only the HAS-BLED score was significantly associated with the risk of any clinically relevant bleeding (Cox's analysis for HAS-BLED ≥ 3: hazard ratio 1.38; 95% confidence interval [CI], 1.10–1.72; p = 0.005). The ‘modifiable bleeding risk factors score’ ≥ 2 were non-significantly associated with any clinical relevant bleeding. The two scores had modest ability in predicting bleeding events. The HAS-BLED score performed best in predicting any clinically relevant bleeding (c-indexes for HAS-BLED, 0.545 [95% CI, 0.530–0.559] vs. the ‘modifiable bleeding risk factors score’, 0.530 [95% CI, 0.515–0.544]; c-index difference 0.015, z-score = 2.063, p = 0.04). The HAS-BLED score with one, two and three modifiable factors performed significantly better than the ‘modifiable bleeding risk factors scores’ with one, two and three modifiable risk factors.
Conclusion When compared with an approach only based on modifiable bleeding risk factors proposed by European Society of Cardiology (ESC) AF guidelines, the HAS-BLED score performed significantly better in predicting any clinically relevant bleeding in this clinical trial cohort. While modifiable bleeding risk factors should be addressed in all AF patients, the use of a formal bleeding risk score (HAS-BLED) has better predictive value for bleeding risks, and would help decision-making in identifying ‘high risk’ patients for scheduling reviews and follow-up.
Ventricular Tachycardia Ablation in the Elderly
Authors: Vakil Kairav , Garcia Santiago , Tung Roderick , Vaseghi Marmar , Tedrow Usha , Della Bella Paolo , Frankel David S. , Vergara Pasquale , Di Biase Luigi , Nagashima Koichi , Nakahara Shiro , Tzou Wendy S. , Burkhardt J. David , Dickfeld Timm , Weiss J. Peter , Bunch Jared , Callans David , Lakkireddy Dhanunjaya , Natale Andrea , Sauer William H. , Stevenson William G. , Marchlinski Francis , Shivkumar Kalyanam , Tholakanahalli Venkatakrishna N. 
Published: December 2017

Background
Successful ventricular tachycardia (VT) ablation is associated with improved survival in patients with heart failure. However, the safety and efficacy of VT ablation in the elderly, a population with higher competing nonsudden death risk and comorbidities, have not been well defined.

Methods and Results

The International Ventricular Tachycardia Center Collaborative Study Group registry of 2061 patients who underwent VT ablation at 12 international centers was analyzed. Kaplan–Meier analysis was used to estimate survival of patients ≥70 years with and without VT recurrence. Of the 2049 patients who met inclusion criteria, 681 (33%) patients were ≥70 years of age (mean age, 75±4 years). Among these, 92% were men, 71% had ischemic VT, and 42% had VT storm at presentation. Mean (±SD) left ventricular ejection fraction was 30±11%. Compared with patients <70 years, patients ≥70 years had higher in-hospital (4.4% versus 2.3%;
P
=0.01) and 1-year mortality (15% versus 11%;
P
=0.002) but a similar incidence of VT recurrence at 1 year (26% versus 25%;
P
=0.74) and time to VT recurrence (280 versus 289 days;
P
=0.20). Absence of VT recurrence during follow-up was strongly associated with improved survival in patients ≥70 years.

Conclusion
VT ablation in the elderly is feasible and reasonably safe with a modestly higher in-hospital and 1-year mortality, with similar rates of VT recurrence at 1 year compared with younger patients. Successful VT ablation, that is, lack of VT recurrence, is strongly associated with improved survival even in this elderly subgroup.
Ablation of Rotor Domains Effectively Modulates Dynamics of Human
Authors: Calvo David , Rubín José , Pérez Diego , Morís César 
Published: December 2017

Background:
In human long-standing persistent atrial fibrillation, rotors potentially explain atrial fibrillation maintenance, but their ablation remains controversial. We aimed to explore original phase/frequency mapping methods to locate rotors and track changes induced by their ablation.

Methods and Results:

Thirteen patients with long-standing persistent atrial fibrillation (duration, 12–72 months) underwent phase/frequency mapping (Hilbert/Fourier transforms; CARTO-Finder) of the left and right atria (PentaRay catheter). A rotor domain was defined as an area displaying at least 3 consecutive rotations. Ablation was performed by circumferential pulmonary vein isolation plus linear ablation of extrapulmonary rotor domains. We identified 19 rotor domains in 10 patients (1.8±1.1 per patient; 7 in the right atrium versus 12 in the left atrium; 15 extrapulmonary). Overall, rotor domains (9.2±2.2 rotations) displayed higher frequency of activation (6.41 Hz; 95% confidence interval, 6.24–6.57) than nonrotor domains (6.17 Hz; 95% confidence interval, 6.1–6.23;
P
=0.021), with interatrial frequency gradients established by the spatial location of the rotor domain (
P
=0.016). Fibrillatory conduction was suggested as a decrease in the frequency of the slower atria after ablation close to main interatrial conduction fascicles (
P
=0.035). Ablation of rotor domains (ablation line, 3.5±0.9 cm) effectively decreased the frequency of activation in both ipsilateral and contralateral atria (
P
<0.05 for both), whereas ablation of nonrotor domains did not. Acute conversion to sinus rhythm was observed in 2 patients after ablation of rotor domains. At 1-year follow-up, 70% remained in sinus rhythm (85% out-of-antiarrhythmic drugs).

Conclusions:
Rotor domains appropriately explain long-standing persistent atrial fibrillation physiology at its frequency content. Their ablation effectively modifies dynamics on restricted ablation.
Position of the South Atlantic Anticyclone and Its Impact on Surface Conditions across Brazil
Authors: Gilliland Joshua M. , Keim Barry D. 
Published: December 2017

AbstractThis study examines the surface wind characteristics of Brazil on the basis of the location of the maximum high pressure center in the South Atlantic basin (SAB), known as the South Atlantic anticyclone (SAA), from three reanalysis datasets for the period of 1980–2014. Linear wind speed trends determined for Brazil are geographically related to surface and macroscale atmospheric conditions found in the SAB. The daily mean position of the SAA exhibited a latitudinal poleward shift for all seasons, and a longitudinal trend was dependent upon extratropical activity found in the SAB. Results also show that wind speed and sea level pressure for northern Brazil are dependent upon the latitudinal position of the SAA. Consequently, surface wind correlations for southern Brazil tend to be related to changes in the longitudinal position of the SAA, which result from transient anticyclones migrating over the SAB. An examination of positive and negative wind anomalies shows that shifts in the position of the SAA are coupled with changes in sea level pressure for northern Brazil and air temperature for southern Brazil. From these findings, a surface wind analysis was performed to demonstrate how the geographical location of the SAA affects wind speed anomalies across Brazil and the SAB. Results from this study can assist in understanding how atmospheric systems change within the SAB so that forthcoming socioeconomic and climate-related causes of wind for the country of Brazil can be known.
Bimodality of Directional Distributions in Ocean Wave Spectra: A Comparison of Data-Adaptive Estimation Techniques
Authors: Simanesew Abushet W. , Krogstad Harald E. , Trulsen Karsten , Nieto Borge José Carlos 
Published: December 2017

AbstractThe properties of directional distributions in ocean wave spectra are studied, with an emphasis on sea states with bimodal directional distributions in the high-frequency tails of single-peaked wave systems. A peak-splitting tendency has been a challenge in the interpretation of results from some data-adaptive estimation methods. After a survey of the theory, mathematical and numerical explanations are presented regarding domains of uni- and bimodality for symmetric Burg and Shannon maximum entropy methods. The study finds that both the Burg and Shannon maximum entropy methods have a tendency to split peaks, and that the domains of uni- and bimodality for these two methods depend on the Fourier coefficients input into the algorithms. Comparisons of data-adaptive methods based on data collected near the Ekofisk oil field in the North Sea and from nonlinear wave simulations are presented. The maximum likelihood (ML) method, the iterative maximum likelihood (IML) method, and the Burg and Shannon maximum entropy methods are applied. A large fraction of the directional wave spectra from Ekofisk shows bimodal features for distributions above the spectral peak for all of the abovementioned methods. In particular, strong similarity in bimodal features between the iterative maximum likelihood and the Burg maximum entropy methods are found. In general, the bimodality is consistent with previous observations, and it seems to be associated with wave and spectral development owing to nonlinear wave–wave interactions rather than being associated with the peak-splitting tendency in the estimates from any of the algorithms. The bimodal directional distributions were sometimes persistent and sometimes formed or decayed within the order of hours.
Pathways to functional outcomes following a first episode of psychosis: The roles of premorbid adjustment, verbal memory and symptom remission
Authors: Jordan Gerald , Veru Franz , Lepage Martin , Joober Ridha , Malla Ashok , Iyer Srividya N 
Published: December 2017

Objective: Most studies have investigated either the singular or relative contributions of premorbid adjustment, verbal memory and symptom remission to functional outcomes in first-episode psychosis. Fewer studies have examined the pathways of these factors in impacting functioning. Our study addresses this gap. The objective was to determine whether the relationship between premorbid adjustment and functional outcomes was mediated by verbal memory and symptom remission. Method: A total of 334 first-episode psychosis participants (aged 14–35 years) were assessed on premorbid adjustment, verbal memory upon entry, and positive and negative symptom remission and functioning at multiple time points over a 2-year follow-up. Results: Mediation analyses showed that over the first year, the relationship between premorbid adjustment and functioning was mediated by verbal memory and positive symptom remission (β = –0.18; 95% confidence interval = [–0.51, –0.04]), as well as by verbal memory and negative symptom remission (β = –0.41; 95% confidence interval = [–1.11, –1.03]). Over 2 years, the relationship between premorbid adjustment and functioning was mediated by verbal memory and only negative symptom remission (β = –0.38; 95% confidence interval = [–1.46, –0.02]). Conclusion: Comparatively less malleable factors (premorbid adjustment and verbal memory) may contribute to functional outcomes through more malleable factors (symptoms). Promoting remission may be an important parsimonious means to achieving better functional outcomes.