bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomarkers to predict improvement of left ventricular ejection fraction after atrial fibrillation ablation
Authors: Serban T , Hennings E , Strebel I , Knecht S , Du Fay De Lavallaz J , Krisai P , Arnet R , Voellmin G , Osswald S , Sticherling C , Kuehne M , Badertscher P 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) and heart failure (HF) frequently coexist. Catheter ablation (CA) of AF is increasingly used in patients with AF and HF. However, prediction of improvement of HF after CA is challenging.

Aim
We aimed to evaluate the value of biomarkers, alone and in conjunction with a clinical tool (Antwerp score) to predict left ventricular ejection fraction (LVEF) recovery after CA in patients with AF and HF.

Methods
Patients undergoing CA for AF with depressed LVEF (&lt;50%) were included. Plasma levels of 13 biomarkers were measured immediately prior to CA. Patients were categorized into "responders" (LVEF normalisation after CA in case of HFmrEF and at least 10% LVEF improvement and LVEF &gt; 40% at follow-up in case of HFrEF) and "non-responders" (no LVEF recovery after CA). Models were constructed by comparing the plasma levels of the various biomarkers in responders and non-responders and by adjusting for age, sex, and Antwerp score and subsequent biomarkers were then combined according based on likelihood-ratios. The predictive power of the biomarkers alone and combined in outcome prediction, as well as improvement of the Antwerp score was then evaluated.

Results
Out of 1665 patients undergoing CA of AF, we included 208 patients with depressed LVEF (median age 63 years, 19% female, median LAVI 42 ml/m2, median LVEF 43%). The median follow-up time was 30 months [IQR 20-34] and the median time to LVEF recovery was 8 months [IQR 3-22]. Of these, 161 (77%) were responders and 47 (23%) were non-responders. Out of 13 biomarkers, four biomarkers (ANG2, GDF15, FGF23 and MyBPC3) were significantly different between responders and non-responders (p ≤0.001). A biomarker panel using these four biomarkers could predict LVEF recovery after CA for AF with an AUC of 0.72 (95%CI 0.64-0.81) overall, 0.69 (95%CI 0.59-0.78) in HFmrEF and 0.88 (95%CI 0.77-0.98) in HFrEF (Figure, A). Only ANG2 and GDF15 remained significantly associated with LVEF recovery after adjustment for age, sex, and the Antwerp score. The AUC of the Antwerp score for prediction of LVEF recovery improved from 0.75 (95% CI 0.67-0.83, Figure, B) to 0.78 (95% CI 0.70-0.86, Figure, C) in the overall population, from 0.71 (95% CI 0.61-0.81) to 0.74 (95% CI 0.64-0.84) in case of HFmrEF and from 0.87 (95% CI 0.78-0.97) to 0.92 (95% CI 0.85-0.99) in case of HFrEF when ANG2 and GDF15 were included in the model.

Conclusion
A biomarker panel using ANG2, GDF15, FGF23 and MyBPC3 performs similarly for prediction of LVEF recovery after CA in AF compared to the Antwerp score. The biomarkers ANG2 and GDF15 slightly improve the predictive value of the Antwerp score.Figure
Timing of detection of atrial fibrillation recurrence in patients with transient new-onset atrial fibrillation detected during hospitalization for noncardiac surgery or medical illness
Authors: Mcintyre W F , Johnson L S , Vadakken M E , Latendresse N R , Kribo F , Ramasundarahettige C , Wong J A , Healey J S 
Published: May 2024

Abstract

Background
Approximately one third of patients who experience transient new-onset atrial fibrillation (AF) during a hospitalization for noncardiac surgery or medical illness will have recurrent AF within 1 year.

Purpose
To estimate the expected rate of detection of AF recurrence using different durations of continuous ECG monitoring during follow-up of patients who have had AF occurring transiently during physiologic stress.

Methods
We used continuous ECG data from participants enrolled in the AFOTS Follow-up Study. Participants had transient new-onset AF while hospitalized for noncardiac surgery or medical illness and were discharged from hospital in sinus rhythm. We calculated the median time to detection of the first recurrent AF episode and the proportion of recurrent AF events that would be captured with an ECG monitor worn for 24 h, 48 h, 7 days and 14 days, and with a repeated 14-day monitor worn approximately 6 months after the first monitor.

Results
A total of 139 participants (41.0% female, median CHA2DS2-VaSC Score 3.0 (Interquartile Range [IQR] 2.0- 4.0)) wore at least one ECG monitor for a median of 13.5 days (IQR 11.7-13.8). A second ECG monitor was worn by 83 (59.7%) participants for a median of 12.9 days (IQR 10.0-13.9); the second monitor was worn a median of 175.0 days (IQR 153.0-216.0) after the first monitor.
Among the study participants in whom recurrent AF was detected (n = 40, 28.8%), the median time to AF lasting at least 30 seconds was 128.0 hours (IQR 32.5-232.5). The proportion of AF recurrences detected after more than 24 hours of monitoring was 75.0% (n = 30).
The yield of AF detection increased with longer monitoring times (Figure 1). AF was detected in 5.0% of participants at 24 hours, 5.8% at 48 hours, 6.5% at 72 hours, 12.2% at 7 days, 21.6% at 14 days and in 28.8% of participants by the end of the second 14-day monitor.

Conclusions
In patients who have experienced transient new-onset AF during a hospitalization for noncardiac surgery or medical illness, the rate of capture of AF recurrence in follow-up increases with longer monitoring durations. 14-day monitors capture nearly 4 times as many AF events as 48 h monitors.
Sex differences at diagnosis and in one-year outcomes in patients with early atrial fibrillation
Authors: Trinks-Roerdink E M , Seelig J , Chu G , Van Der Horst S F B , Voorhout L , De Vries T A C , Van Gelder I C , Huisman M V , Rutten F H , Hemels M , Geersing G J 
Published: May 2024

Abstract

Background
Little is known about differences in clinical phenotype between men and women with atrial fibrillation (AF). Our aim was to explore phenotypical sex differences at diagnosis and at one-year follow-up, in patients with early AF.

Methods
We used data from 5,469 participants of the DUTCH-AF registry; a nationwide prospective registry of patients with early AF or atrial flutter (diagnosis ≤ 6 months before inclusion) in the Netherlands, aged ≥ 18 years. We describe sex differences in clinical phenotype at diagnosis and at one-year follow-up, including the following outcomes: i) ischemic and bleeding events, ii) all-cause mortality, iii) AF-related hospital admissions, including ablation and cardioversion, and iv) AF progression patterns.

Results
At inclusion, women were older than men (median 73 vs. 69 years, p&lt;0.001), had more often paroxysmal AF (66% vs. 55%, p&lt;0.001), and less often persistent AF (27% vs. 37%, p&lt;0.001). They also had hypertension more often (59% vs. 53%, p&lt;0.001), and less often vascular disease (12% vs. 21%, p&lt;0.001, and reported more often symptoms at inclusion and in the month before follow-up; 56% vs. 46%, p&lt;0.001, and 31% vs. 23%, p&lt;0.001, respectively. Women underwent cardioversion and ablation procedures less often than men (14% vs. 21% p&lt;0.001 and 3% vs. 5%, p&lt;0.001, respectively). Moreover, for the combined rhythm control intervention cardioversion and ablation, women also underwent this rhythm control outcome less often than men (unadjusted odds ratio was 0.63 95% CI (0.55-0.73)), regardless of age, and the type of AF (i.e., paroxysmal or persistent AF) at inclusion (adjusted odds ratio 0.77 95% CI (0.62-0.92)). No differences were observed for ischemic and bleeding events, all-cause mortality, or AF progression patterns, but the number of these events was small.

Conclusion
Men and women with early AF differ in age, comorbidities, symptoms, and management. These findings are building blocks for individualized sex-specific AF care and research.
Time-trends of sex differences in stroke risk in atrial fibrillation: Are female patients still at higher risk today? A nationwide cohort study
Authors: Nielsen P B , Broendum R F , Noehr A K , Overvad T F , Lip G Y H 
Published: May 2024

Abstract

Background
Female sex is associated with higher risk of stroke in patients with atrial fibrillation (AF), particularly in the presence of other stroke risk factors. This has implications for oral anticoagulant treatment (OAC) decision-making, based on points of the CHA2DS2-VASc score. However, stroke rates have declined over recent years, and management has evolved over time towards a holistic approach that may have diminished the sex differences in AF-related stroke.

Purpose
To examine the changes in stroke risk over time in relation to risk differences between males and females not treated with oral anticoagulants in a nationwide cohort study.

Methods
This was an observational cohort study including patients with a hospital diagnosis of AF between 2007 and 2021. Data were obtained from the Danish nationwide registries. We identified a cohort of adult patients who were not receiving OAC treatment for up to 30 days after their AF diagnosis. Patients were followed up for thromboembolic events within one year after the AF diagnosis. Survival analysis was applied to describe the yearly rate of events and to estimate the risk ratio for females vs males of thromboembolism according to baseline risk levels, i.e., the CHA2DS2-VA score level (leaving out the ‘Sc’ sex criterion).

Results
A total of 188,704 AF patients (median age 75 years (IQR: 64 to 84); 49.7% female) who did not receive OAC treatment were included. The risk of thromboembolism during the entire study period was overall higher in females (3.5% in males vs. 4.7% among females). The overall one-year thromboembolic risk declined over time from 4.9% between 1997-2000 to 3.3% between 2017-2020, with male-female risk differences less evident in recent years (Figure 1a). The relative risk of stroke diminished from 1.22 (95%CI 1.10-1.34) in years 1997-2000 to 1.02 (95%CI 0.85-1.19) in years 2017-2020 for patients with a CHA2DS2-VA score of ≥2 (Figure 1b). For patients with a score of &lt;2, the relative risk was lowest between 2005-2008 (1.02 (95%CI 0.63-1.42)) and was 1.18 (95%CI 0.54-1.83) in the latest time period. Formal statistical test for time trends according to score level revealed non-significant results (p-value=0.10 for score 0-1; p-value=0.17 for score levels of ≥2).

Conclusion
The risk of stroke among patients with AF has been declining over the last two decades. The excess stroke risk observed among females relative to males has also diminished, most evident among AF patients with ≥2 prevalent stroke risk factors.
New-onset atrial fibrillation in patients with ST-elevation myocardial infarction
Authors: Minder J , Mannhart D , Katic J , Knecht S , Krisai P , Nestelberger T , Leibundgut G , Sticherling C , Kuehne M , Badertscher P 
Published: May 2024

Abstract

Background
New-onset atrial fibrillation (NOAF) complicating ST-elevation myocardial infarction (STEMI) remains clinically challenging. Little is known regarding the long-term clinical impact of NOAF in the acute STEMI phase compared to a prior diagnosis of AF before the onset of STEMI.

Methods
We retrospectively reviewed consecutive patients undergoing percutaneous coronary intervention (PCI) for STEMI between May 2015 and September 2023. Patients were stratified based on NOAF diagnosis during the index-hospitalization vs. preexisting AF prior to the onset of STEMI. Long-term follow-up was obtained for stroke, major bleeding, or death.

Results
We analyzed 1327 consecutive patients undergoing PCI for STEMI. NOAF was detected in 117 patients (9%) and 69 patients (5%) had prior AF. Patients with NOAF and prior AF had similar baseline characteristics. NOAF patients were 65% males, with a mean age of 69 ± 13 years. All patients were treated with enoxaparin, but only 30% of patients with NOAF and 65% with prior AF were discharged with triple therapy, p&lt;0.05. During a median follow-up of 696 days, the rates of stroke were 11% in patients with NOAF compared to 6% (p= 0.03) in patients with prior AF. Major bleeding occurred in 7% vs. 9%, p= 0.59, and death in 19% vs. 22%, p= 0.25 of patients with NOAF vs. prior AF.

Conclusion
NOAF was detected in almost 1 out of 10 STEMI patients and was associated with a similar rate of major bleeding and death as in patients with prior AF. The risk of NOAF for stroke might be higher than that of prior AF. These finding warrant confirmation in larger data sets.Central illustration
Post-operative atrial fibrillation after noncardiac surgery: diagnostic role of ambulatory rhythm monitoring for recurrent arrhythmia after hospital discharge
Authors: De Melo Junior J , Naser J , Chamberlain A , Gersh B , Noseworthy P , Siontis K 
Published: May 2024

Abstract

Introduction
Postoperative atrial fibrillation (POAF) after noncardiac surgery constitutes 10-15% of all cases of incident atrial fibrillation (AF) in the community and has been associated with an increased risk of stroke. The risk of subsequent AF among patients with POAF is not well defined.

Purpose
To evaluate the role of systematic 30-day electrocardiographic (ECG) monitoring in the detection of AF recurrence after POAF.

Methods
In a prospective interventional study, patients who underwent major noncardiac surgeries and had new AF documented by ECG in the post-operative period between May 2022 and April 2023 were identified. For these patients, a 30-day ambulatory ECG monitor was recommended upon discharge, with final ordering deferred to the primary inpatient teams. Rates of recurrent AF of any duration detected by 30-day monitoring plus routine care versus routine care alone after the surgery were compared.

Results
Eighty-five patients with new-onset POAF were included (mean age 72 years, male 67%). Of these, 35 (41%) patients underwent up to 30 days [median 23 (IQR 6-27) days] of continuous ECG monitoring after hospital discharge. There were no significant differences in baseline characteristics between patients who did or did not undergo monitoring (Table 1). During median 281 (IQR 197-385) days of follow-up, recurrent AF was documented in 14/35 (40%) patients in the monitoring group as opposed to 7/50 (14%) patients in the usual care group (log-rank p=0.003, Figure 1). The median time from day of surgery until documented AF recurrence was 25 (IQR 6-53) days in the monitoring group and 66 (IQR 25-145) in the usual care group. Overall, 81% of recurrent AF events in both groups were detected in the first 3 months after surgery. The median burden of AF in the cardiac monitoring group was 7% (IQR 1-15), with the longest AF event lasting a median of 6 (IQR 2-18) hours. Anticoagulation for AF was prescribed in 24/64 (37%) patients with POAF without recurrence and in 16/21 (76%) patients with recurrent AF.

Conclusion
Recurrent AF following POAF is common and detected most frequently in the first 3 months after noncardiac surgery. Systematic ambulatory rhythm monitoring is associated with a higher rate of AF detection following hospital discharge and may identify a patient subgroup who might benefit from anticoagulation therapy.Table 1Figure 1
Effectiveness of a stepwise approach for screening of atrial fibrillation after stroke: insights from the SAFAS study
Authors: Guenancia C , Benali K , Garnier L , Duloquin G , Didier R , Pommier T , Laurent G , Vergely C , Bejot Y 
Published: May 2024

Abstract

Background
Detection of atrial fibrillation (AF) is critical after ischemic stroke, providing information regarding the mechanism of the event and leading to modification in the antithrombotic strategy. While most guidelines recommend screening patients for AF with 12-lead ECG, telemetry, long-duration Holter monitoring and implantable cardiac monitor (ICM), the optimal timing and combination of such screening tools remain unclear.

Objective
This study aimed at investigating the suitability of a sequential combination of screening techniques (12-lead ECG, telemetry, in hospital long-lasting Holter monitoring, and ICM in the detection of AF after stroke.

Methods
Patients without previously known AF admitted to the Dijon University Hospital stroke unit for acute ischemic stroke were prospectively enrolled. After a stepwise screening approach for AF based on admission ECG, telemetry monitoring during the stroke unit stay and long-duration Holter monitoring during hospital stay, cryptogenic stroke patients were implanted of an ICM. Primary endpoint was the presence of AF detected during the 3-year period after stroke based on this sequential screening approach.

Results
A total of 240 patients were included. Among them, 104 (43.3%) patients had a documented cause of stroke non-related to AF. Among the remaining 136 patients (53.7% male, 70.8±13.7 yo), AF was detected in 82 (60%) patients over the acute screening phase or the 3-year follow-up with ICM. AF was diagnosed using 12-lead ECG, in-hospital telemetry, and in hospital long-lasting Holter monitoring in 17 (13%), 25 (18%), and 18 (13%) patients, respectively. AF was detected after the first 24 hours on the long-lasting Holter monitoring in 66% of patients. Among the 76 (56%) patients classified as cryptogenic after the complete stroke work-up and implanted from an ICM, AF was detected in 22 (29%) patients. AF occurred during the first, second, and third years of implantable monitoring in 14 (18.4%), 5 (6.6%), and 3 (3.9%) patients, respectively (Figure 1). Mean time from ICM implantation to AF diagnosis was 308+/-279 days. Finally, among all AF detected, 72% (60/83) were found during the initial intensive in-hospital screening.

Conclusion
A stepwise approach for AF screening after ischemic stroke allows the early detection of AF in a substantial number of patients during hospital stay. Even with such proactive initial monitoring strategy, invasive monitoring remains complementary to non-invasive screening tools not to overlook more distant AF episodes. Studies focusing on the relative risk of ischemic stroke recurrence according to AF timing and burden are needed.Figure 1
Genetic and clinical risk factors for stroke recurrence with different impact by assessment age: data from the UK Biobank
Authors: Chung S , Yang P S , Jang E , Kim D , Yu H T , Kim T H , Uhm J S , Sung J H , Pak H N , Lee M H , Joung B 
Published: May 2024

Abstract

Background
The predictive utility of genetic risk factors added to clinical risk factors for stroke recurrence is unclear. Furthermore, whether those predictive utility change in different age groups is uncertain. This study aimed to compare the association of genetic and clinical risk factors with recurrent stroke.

Methods
Data were collected from 5,378 patients with a history of stroke from the UK Biobank. Cox proportional hazards regression models were used to assess the associations of genetic, demographic, lifestyle, and comorbidity risk factors with stroke recurrence, both in overall and three age-based groups.

Results
Over a median follow-up of 11.5 (interquartile range [IQR] 10.6–12.3) years, 417 patients had recurrent stroke. The hazard ratio (HR) for recurrent stroke was most pronounced for diabetes mellitus (HR 2.28, 95% confidence interval [CI] 1.83-2.86). Additionally, current smoking, hypertension, age, and polygenic risk score for ischemic stroke (stroke PRS) were also significantly associated with recurrent stroke. Based on concordance index (C-index, 95% CI), the strongest predictors were diabetes mellitus (0.578, 0.556-0.599) followed by age, hypertension and stroke PRS. However, the stroke PRS (0.577, 0.527-0.627) was the strongest predictor in the younger 1/3 patient group (median age 54, IQR 50-57). In addition to demographic, lifestyle, and comorbidity risk factors, genetic risk factor improved C-index of the prediction model from 0.640 (0.592-0.688) to 0.652 (0.602-0.703) in the younger group.

Conclusions
Recurrent stroke is significantly associated with genetic and clinical risk factors. Genetic risk factor enhances the predictive model`s accuracy, particularly in younger patients.Prediction of stroke recurrence
Temporal trends of ischemic stroke rates in atrial fibrillation without anticoagulation: a nationwide cohort study from 2007 to 2018
Authors: Teppo K , Airaksinen K E J , Halminen O , Jaakkola J , Salmela B , Kouki E , Haukka J , Luojus A , Putaala J , Linna M , Aro A , Mustonen M , Hartikainen J , Lehto M 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) is a major risk factor for ischemic stroke (IS), but whether the magnitude of this risk has changed over time is unknown.

Purpose
To evaluate temporal trends in IS rates in patients with AF who have not initiated oral anticoagulant (OAC) therapy.

Methods
The registry-linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study covers all patients with incident AF in Finland from 2007 to 2018. A four-week quarantine period from AF diagnosis was applied and only follow-up time without OAC therapy was included. IS incidence rates were computed in four-year intervals.

Results
In total, 129 789 patients with new-onset AF (49.2% women; mean age 71.4 years) were identified. The IS incidence rate trends according to sex and the CHA2DS2-VA score are depicted in the Figure, along with the previously estimated treatment thresholds for direct oral anticoagulants (red broken line) and warfarin therapy (blue broken line). Between the calendar year intervals of 2007-2010 and 2015-2018, their mean CHA2DS2-VA score increased from 2.5 to 3.0, while concurrently the overall IS rate decreased by 25% from 36.7 (95% CI 34.5-39.0) to 27.6 (95% CI 26.1-29.0) events per 1000 patient years. This trend was driven by a 32% decrease in women, particularly among those with high CHA2DS2-VA scores. The overall IS rate in patients with a CHA2DS2-VA score of 1 was 8.2 (95% CI 7.2-9.4) events per 1000 patient years and it remained stable across the study period.

Conclusions
The IS rates in AF patients without OAC therapy have decreased by 25% between 2007 and 2018, despite their rising stroke risk scores. In patients with a CHA2DS2-VA score of 1 the IS rate appears to be lower than previously assumed and approximately at the threshold at which the potential benefits and harms of OAC therapy have been estimated to overlap.