bluuebunny/crossref_metadata_2025_split huggingface dataset:
Genetic profiles of oligometastatic non-small-cell lung cancer and corresponding brain metastases
Authors: Werner Raphael S , Rechsteiner Markus , Moch Holger , Curioni-Fontecedro Alessandra , Weller Michael , Weiss Tobias , Regli Luca , Le Rhun Emilie , Mairinger Fabian , Opitz Isabelle , Soltermann Alex 
Published: May 2024

Abstract

OBJECTIVES
In patients with oligometastatic non-small-cell lung cancer (NSCLC), systemic therapy in combination with local ablative treatment of the primary tumour and all metastatic sites is associated with improved prognosis. For patient selection and treatment allocation, further knowledge about the molecular characteristics of the oligometastatic state is necessary. Here, we performed a genetic characterization of primary NSCLC and corresponding brain metastases (BM).

METHODS
We retrospectively identified patients with oligometastatic NSCLC and synchronous (&lt;3 months) or metachronous (&gt;3 months) BM who underwent surgical resection of both primary tumour and BM. Mutation profiling of formalin-fixed paraffin-embedded tumour cell blocks was performed by targeted next-generation sequencing using the Oncomine Focus Assay panel.

RESULTS
Sequencing was successful in 46 paired samples. An oncogenic alteration was present in 31 primary tumours (67.4%) and 40 BM (86.9%). The alteration of the primary tumours was preserved in the corresponding BM in 29 out of 31 cases (93.5%). The most prevalent oncogenic driver in both primary tumours and BM was a KRAS (Kirsten rat sarcoma viral oncogene) mutation (s = 21). In 16 patients (34.8%), the BM harboured additional oncogenic alterations. The presence of a private genetic alteration in the BM was an independent predictor of shorter overall survival.

CONCLUSIONS
In oligometastatic NSCLC, BM retain the main genetic alterations of the primary tumours. Patients may profit from targeted inhibition of mutated KRAS. Additional private genetic alterations in the BM are dismal.
Renal artery stenosis increases the risk of incident atrial fibrillation and cardiovascular events incorporating death
Authors: Chan Y , Lau N , Yiu K H , Tse H F 
Published: May 2024

Abstract

Background
Renal artery stenosis (RAS) remains an under-recognized clinical risk factor for cardiovascular complications. Its long-term impact on AF arrhythmogenesis is unclear.

Objective
To investigate the role of RAS on incident AF and related adverse cardiovascular events

Methods
We performed a retrospective cohort study that comprised 100 patients with ultrasonographically-confirmed atherosclerotic RAS, and 50 age- and sex-matched controls who were healthy renal transplant donors (age 52.6 ±5.6 vs 50.1 ±10.7years, women 59% vs 70%). Incident AF was ascertained from clinical records. Primary endpoint was defined as the composite of incident AF, myocardial infarction, unstable angina, heart failure, ischemic stroke, peripheral arterial disease, end-stage renal failure, and cardiovascular death.

Results
Over a follow-up duration of 4818 ± 2751 days, RAS was significantly associated with incident AF (9.4% versus 0%, P=0.025). Kaplan-Meier analyses showed that RAS was associated with reduced incident AF event-free survival (Log-rank Mantel-Cox=4.6 P=0.032, Figure). Multivariable logistic regression showed that after adjustment for potential confounders (including age, sex, smoking, alcohol use, history of hypertension, diabetes mellitus, myocardial infarction, heart failure, ischemic stroke, renal function and serum low-density lipoprotein level), RAS was independently associated with substantially increased risk of the primary endpoint (OR=27.8, 95%CI [2.3 – 333.9], P=0.009),

Conclusions
RAS is an important and under-recognized independent risk factor for AF and cardiovascular events incorporating death. Its pathophysiological implications with a view to potential interventions need to be further explored.
Clinical characteristics and genetic substrate of lone atrial fibrillation: a single center experience
Authors: Berruquier P , Dusi V , Saglietto A , Vallarino C , Bertello E , Tallone L , Solano A , Brach Del Prever G M , Giustetto C , Matta M , Castagno D , Ferraris F , Deaglio S , De Ferrari G M , Anselmino M 
Published: May 2024

Abstract

Background
Juvenile-onset lone atrial fibrillation (LAF) may be the initial manifestation of a concealed channelopathy or cardiomyopathy (CMP) or it may be due to an atrial specific genetic susceptibility. Clinical characteristics, genetic background and proper management are still largely unknown.

Purpose
Aim of the present study is to describe the clinical and genetic characteristics of patients with juvenile-onset LAF.

Methods
We enrolled patients referred to our center for ablation between 1/2018 and 11/2023 with a first diagnosis of LAF before the age of 60, a structurally normal heart (absence of known CMP, ischemic, valvular, congenital heart disease) and no overt channelopathy. A concealed Brugada syndrome was systematically excluded. Genetic testing was performed using Next Genome Sequencing and a dedicated gene panel.

Results
89 patients were included (84% male, LAF onset 43 ± 8 years, BMI 25 ± 7 kg/m2): 32% had a first-degree family history of AF (including 15% below 60 years), 18% of sudden death, 8% of cardiac conduction disorders and 2% of CMP. Cardiovascular risk factors included arterial hypertension in 24%, smoking in 47% and obstructive sleep apnea syndrome in 4%; 20% were competitive athletes. Most patients (89%) presented with paroxysmal AF and 92% were symptomatic (mainly palpitations). At presentation LVEF was 61±5% and LAVI 35±14 ml/m2. Median follow-up time after the first AF episode was 6 years (IQR 4-10). Most patients (81, 91%) underwent at least one transcatheter ablation procedure after failed anti-arrhythmic drug (AAD) therapy (mostly IC). The first procedure (73% radiofrequency, 27% cryoablation) included pulmonary veins isolation (PVI) in all and additional lesions in 5%; the second procedure (n=18, 22% of the ablation group) included PV re-isolation in all (mostly due to multiple vein reconnections) and additional lesions in 17%; the third procedure (n=8, 10% of the ablation group) included PV re-isolation in 25% and additional lesions in 75%. The remaining 8 patients were treated with AAD only (mostly IC). By the last follow-up, 7% of patients in the ablation group and 25% in the AAD group had documented recurrences (even though 50% of those who received ablation were still on AAD). Among the 35 patients subjected to genetic investigation, 10 have available results: 30% tested positive for C4-C5 variants (2 for KCNQ1, 1 for TTN), 50% for C3 variants (RYR2, ABCC9, LMNA, KCNH2 and RMB20) and 20% were negative.

Conclusions
In the present single center cohort of patients with juvenile-onset LAF, a positive family history was found in almost one third of patients. Despite prompt diagnosis and treatment (including &gt;1 ablation in 20% of patients), recurrences rate is not trivial. The yield of genetic test so far is high, supporting its use in this population.
Atrial functional mitral regurgitation as a marker of atrial remodeling and ablation outcomes in atrial fibrillation patients
Authors: Mohsen Y , Horlitz M , Stoeckigt F , Rottlaender D 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) triggers a cascade of atrial remodeling processes, significantly impacting atrial function and the efficacy of ablation therapies. This remodeling fosters the development of atrial cardiomyopathy and atrial dilation, which is linked to the emergence of mitral regurgitation, paving the way for the concept of atrial functional mitral regurgitation (aFMR).
Our study delves into the intricate relationship between aFMR and the electrical architecture of the atrium, specifically focusing on left atrial bipolar voltage and the prevalence and extent of low-voltage areas (LVAs) in AF patients. By exploring these associations, this research aims to deepen our understanding of the interplay between the atrial substrate alterations and the development of aFMR.

Methods
A total of 282 patients were enrolled, who had presented for a redo PVI procedure after experiencing AF recurrence following a previous PVI. All patients received echocardiography prior to the electrophysiological procedure. All procedures were performed using 3D mapping and radiofrequency ablation. Reconnected pulmonary veins were detected in all patients and were re-isolated. The voltage of the electroanatomical points was documented on each of the atrial walls. LVAs were calculated in selected HD maps. Patients were followed-up for one year after the blanking period.

Results
Our cohort comprised 282 patients, predominantly male (69.4%), with a mean age of 64 years. 56% of the patients presented with persistent AF. LA area was larger in patients with aFMR ≥ 1+ as compared to aFMR &lt; 1+ (17.0 [14.6-19.7] vs 20.6 [16.6-24.7] cm2, p&lt;0.001). We observed significant differences in left atrial voltage and LVA extent between patients with varying degrees of aFMR (Table 1). Upon further investigation Patients with aFMR = 1+ showed significantly lower atrial voltage compared with aFMR &lt; 1+ yet no significant increase in LVAs area. Patients with aFMR = 2 exhibited lower average voltage amplitudes in all atrial regions and larger LVA in the posterior wall, atrial roof, and septum compared to their aFMR &lt; 1+ counterparts. Notably, the recurrence of AF was significantly higher in the AFMR ≥ 1+ (59% vs 46% p=0.027) group within one year of follow-up. aFMR was associated with AF recurrence even after adjusting for sex, age and AF types (HR:1.517, 95% CI: 1.057-2.184, p=0.025).

Conclusion
The presence of aFMR in AF patients may serve as a marker of progressive atrial remodeling and the onset of left atrial cardiomyopathy, characterized by reduced atrial voltage and increased LVAs. Additionally, aFMR is linked to the outcomes of PVI, suggesting that aFMR should be considered in the decision-making process for AF therapy. Further research is needed to explore the potential reversibility of these changes.Left atrial voltage and low voltage area
Plasmatic NT-proBNP is strongly associated with atrial fibrillation in patients without severely reduced left ventricular ejection fraction in an ICD collective
Authors: Allgaier R , Strack C , Wallner S , Hubauer U , Lehn P , Luchner A , Maier L , Jungbauer C 
Published: May 2024

Abstract

Background and objectives
Atrial fibrillation is common in patients with chronic heart failure and associated with poor outcome in these patients. Plasmatic NT-proBNP represents the gold standard biomarker for chronic heart failure. Further, a recent analysis showed a strong association of plasmatic NT-proBNP and atrial fibrillation (AFib). Aim of the study was to assess the association of plasmatic NT-proBNP depending on left ventricular ejection fraction (LVEF) in a cohort of patients with implantable cardioverter defibrillator (ICD).

Methods
412 patients were included in the study. Blood samples were used to assess plasmatic NT-proBNP. Follow-up was performed after 45 months. LVEF was estimated by echocardiography according to Simpsons’ method. At enrollment, a 12-lead electrocardiogram was performed (sinus rhythm (SR, n = 306), atrial fibrillation (AFib, n = 79)). Patients were divided into two subgroups by LVEF of 40%.

Results
Patients suffering from severely reduced LVEF ≤ 40% showed significant higher age, higher rates of chronic kidney disease, diabetes, coronary artery disease, primary prevention ICD indication, coronary artery disease, dilatative cardiomyopathy and plasmatic NT-proBNP compared to patients with LVEF &gt; 40% (each p &lt; 0.05). There were no differences regarding hypertension and occurrence of AFib between patients with LVEF ≤ 40% compared to patients with LVEF &lt; 40% (each p = n.s.).
In ROC analysis there was a significantly higher AUC in patients with LVEF &gt; 40% (AUC: 0.87, IQR 0.82-0.92) compared to patients with severely reduced LVEF ≤ 40% (AUC: 0.72, IQR 0.64-0.80) regarding plasmatic NT-proBNP and prediction of AFib (p &lt; 0.002).
In patients with LVEF &gt; 40% plasmatic NT-proBNP was shown as significant predictor regarding existence of atrial fibrillation in binary logistic regression analysis, beside age (p &lt; 0.05). Diabetes, hypertension, serum creatinine, coronary artery disease and primary prevention ICD indication were no significant predictors (p = n.s.). In patients with LVEF ≤ 40% plasmatic NT-proBNP was not shown as significant predictor regarding existence of atrial fibrillation in binary logistic regression analysis.

Conclusion
Elevated levels of plasmatic NT-proBNP are strongly associated with the prevalence of atrial fibrillation in patients without severely reduced LVEF in a cohort of ICD patients.
Stroke after implantable cardioverter-defibrillator shocks in patients with heart failure
Authors: Dyrbus M , Pyka Ł T , Kurek A K , Niedziela J T , Adamowicz-Czoch E , Ostrega M A , Sokola K , Pres D W , Tajstra M P , Gasior M 
Published: May 2024

Abstract

Introduction
In patients with atrial fibrillation (AF), an elevated risk of stroke has been demonstrated in the first days after successful electrical cardioversion of AF. Shock therapies delivered by implantable cardioverter-defibrillators (ICD) often result in termination of AF, potentially increasing the risk of stroke in those patients. However, the association between ICD shocks and the risk of stroke in patients with AF is unknown.

Purpose
To define whether there is any temporal association between ICD shocks and strokes in remotely monitored patients with heart failure (HF) and AF.

Methods
The clinical data of patients enrolled in the remote monitoring (RM) programme after implantation of an ICD were obtained from the single-centre COMMIT-HF registry. The data regarding the occurrence of the first stroke after inclusion to the registry were obtained (based on the International Classification of Diseases codes I63-I64) from the healthcare provider. The RM data of all patients were obtained from the investigator-initiated and -maintained registry of RM, which summarizes all major findings in remotely monitored patients in our department. Each patient with a stroke had the RM history evaluated for the period of the prior 30 days, with emphasis on the last 10 days preceding stroke.

Results
During the period between 2011 and 2020, 1,299 patients with detailed clinical characteristics were enrolled in the RM programme, and their clinical data are summarized in Table 1.There were 33.4% patients with AF at baseline, and AF de novo was identified during follow-up in further 14.0% of patients. Among patients without and with AF at baseline, respectively 30.9% and 34.1% received any ICD shocks during follow-up (p=NS). In 38.2% of patients without AF at baseline, who developed de novo AF, at least one shock occurred.
The median follow-up was 4.4 years, and the incidence of stroke was 45 (3.5%) in the studied population, with a rate of stroke of 2.8% (25/865) in patients without AF at baseline and 4.6% (20/434) in patients with AF (p=NS), as presented in Figure 1. The median (Q1-Q3) time from ICD implantation to stroke was 1.5 (0.8-2.5) years. Strokes occurring less than 10 days from ICD shock were noted in only two patients (0.5% of patients with any ICD shock) and both occurred within 24 hours from the shock. In the first case, the device appropriately terminated ventricular tachycardia which degenerated to ventricular fibrillation after antitachycardia pacing, and in the second case, a shock therapy was delivered due to VF in a 59-year-old male with HF and concomitant paroxysmal AF, who was on chronic treatment with warfarin.

Conclusions
Our findings indicate an overall low risk of stroke associated with ICD shocks, both in patients with and without AF.Baseline population characteristicsAnalysed population flowchart
Incidence and predictors of heart failure events following cardiac surgery in patients with atrial fibrillation - insights from the LAAOS-III trial
Authors: Xing L Y , Whitlock R , Belley-Cote E , Mcintyre W F , Paparella D , Svendsen J H , Diederichsen S Z , Brady K , Connolly S , Wong J , Conen D , Johnson L , Healey J S 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) is a common comorbidity in patients undergoing cardiac surgery and further increases the risk of incident heart failure (HF). However, only limited data exist on HF events following surgery in patients with AF.

Methods
The Left Atrial Appendage Occlusion Study (LAAOS) III was a randomized trial evaluating concomitant left atrial appendage occlusion in patients with AF undergoing cardiac surgery. In this secondary analysis, we aimed to identify independent predictors of the composite outcome of HF hospitalization or HF-related death following discharge, using a multivariable Cox model – incorporating sex, age (≥65 vs &lt;65 years), systolic blood pressure (≤140 vs &gt;140 mmHg), body mass index (BMI; &lt;25 vs 25-29.9 vs ≥30 kg/m2), diabetes mellitus (DM), prior HF diagnosis, prior stroke, ischemic heart disease (IHD), heart valve surgery, AF history duration, rhythm on discharge electrocardiogram, and trial allocation. Supplementary analyses were undertaken to further assess the continuous variables using cubic spline regression.

Results
Of 4770 patients enrolled, in-hospital death occurred in 201 (4.2%) and complete discharge data were available for 4564 (95.7%). During a median follow up of 3.9 years, 533 (11.7%) of 4564 patients were hospitalized for HF. In total, 873 (19.1%) died after discharge, including 95 HF-related deaths. The composite outcome of HF hospitalization or HF-related death occurred at an annualized event rate of 3.31%/year [95% confidence interval: 3.04-3.60]. The independent risk factors included age (event rate of 3.64%/year vs 2.03%/year for ≥65 vs &lt;65 years; hazard ratio (HR) 1.71 [1.32-2.21]), DM (4.71%/year vs 2.71%/year for with vs without DM; HR 1.59 [1.34-1.90]), prior HF diagnosis (4.27%/year vs 2.17%/year for with vs without HF; HR 2.00 [1.66-2.41]), IHD (3.63%/year vs 2.85%/year for with vs without IHD; HR 1.26 [1.03-1.54]), AF history duration (3.81%/year vs 2.89%/year for &gt;2 vs &lt;0.5 years; HR 1.23 [1.01-1.50]), and AF rhythm at discharge (3.87%/year vs 2.68%/year for AF vs non-AF rhythm; HR 1.31 [1.09-1.58]). The supplementary spline analyses further revealed a positive correlation between BMI and the risk of the composite outcome (p-value 0.042).

Conclusions
In patients with AF undergoing cardiac surgery, post-discharge HF hospitalization and HF-related death occurred at a rate of 3.31% per year. Our study identified several significant risk factors including advanced age, higher BMI, DM, prior HF diagnosis, IHD, AF history &gt;2 years, and AF rhythm at discharge.The associations of HF with age and BMI
A novel score predictor for atrial fibrillation in cardiac implantable electronic device patients
Authors: Jaroonpipatkul S , Sathapanasiri T , Pokawattana A , Navaravong L 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) in individuals with cardiac implantable electronic devices is associated with heightened risks of adverse outcomes. Despite this, risk stratification for AF development in this patient cohort remains unexplored. Consequently, we present the development and validation of a simplified multi-parameter risk-based scoring system for predicting AF in patients with cardiac implantable electronic devices.

Methods and Results
A cohort of 226 consecutive patients with cardiac implantable electronic devices at Rajavithi Hospital underwent comprehensive follow-up to observe AF development, defined by 12-lead EKG evidence of AF. Analysis encompassed risk factors and AF incidence. The resulting V-DASH score integrated a History of vascular disease, including coronary artery disease (CAD) and peripheral arterial disease (PAD) (1.5 points), Diabetes (1 point), Apical lead position (1 point), Sex (female gender (1.5 points)), and Hypertension (1 point). Predictive value assessment revealed that Diabetes, Female gender, and a history of vascular disease were significantly associated with AF incidence. Apical lead position and Hypertension emerged as robust risk factors for AF development.
Over a median follow-up duration of 13 months, 8 (3.53%) patients developed AF. The incidence of AF exhibited a noteworthy escalation in correlation with the V-DASH score (4.68 times higher risk per point increase). Among patients with a V-DASH score ≥4, the probability of AF occurrence was 97.34%. The V-DASH score demonstrated exceptional predictive capability (area under the curve, 0.90; 95% CI, 0.79–1.00), calibration ability (Hosmer-Lemeshow goodness-of-fit P=0.552), and accuracy (sensitivity 87.50% and specificity 83.94%), surpassing other clinical scores such as the C2HEST score.

Conclusions
The V-DASH score emerged as a robust predictor of AF incidence in patients with cardiac implantable electronic devices, with the highest risk observed in those with a V-DASH score ≥4. The potential clinical utility of the V-DASH score in this patient population warrants further investigation.ROC curve for predicting AFPerformance calibration plot