bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of atrial fibrillation in patients with stroke: a systematic review with meta-analysis
Authors: Helbitz A , Haris M , Younsi T , Romer E , Raveendra K , Hayward C , Shuweihdi F , Larvin H , Wu J , Gale C P , Nadarajah R 
Published: May 2024

Abstract

Background
Atrial fibrillation-related strokes have a high rate of recurrence,1 and are associated with substantial morbidity, long-term disability, and mortality.2,3 Detection of AF at the time of stroke may require extended cardiac rhythm monitoring,4-6 which is costly.7 Identifying patients with stroke at high risk for AF can be challenging but important for preventing recurrent strokes.

Purpose
To provide an overview of prediction tools for AF in patients with an acute stroke, and to determine suitability for clinical use by synthesising discriminatory abilities.

Methods
We performed a systematic review of prediction tools (including multivariable scores and individual parameters) derived, validated and/or augmented for AF prediction in patients with strokes using Medline and Embase through 25 October 2023. Discrimination measures for tools with c-statistic data from ≥3 cohorts were pooled by Bayesian meta-analysis, with heterogeneity assessed through a 95% prediction interval (PI). Summary discrimination values of &lt;0.60, 0.60-0.70, 0.70-0.80, and &gt;0.80 were defined a priori as inadequate, adequate, good and excellent.1

Results
From 8125 unique records we included 71 studies from 135 cohorts with a mean age and percentage of women ranging from 43.0 years to 77.5 years, and 25.2% to 55.3%, respectively. We identified 99 prediction tools for incident AF after a stroke. 33 predictive tools used clinical variables, 13 only used Echocardiographic data, 14 only used electrocardiogram (ECG) data, and 39 used combinations of the above modalities.
87 tools were developed with Cox or logistic regression and 12 tools through machine learning approaches. 36 had undergone external validation, with 27 demonstrating a c-statistic &gt;0.75 on external validation.
Nine multivariable prediction models and two predictive factors (B-type natriuretic peptide and age) were eligible for meta-analysis. Of multivariable prediction models, 4 showed good summary discrimination with wide heterogeneity (Figure 1): LADS (n = 1286, summary c-statistic 0.713, 95% CI 0.534-0.882 95% PI 0.379 -0.979), CHASE-LESS (n = 22747 summary c-statistic 0.726, 95% CI 0.667-0.785 95% PI 0.608-0.836), AS5F (n = 31517, summary c-statistic 0.726, 95% CI 0.693-0.754 95% PI 0.645-0.808), STAF (n = 3759, summary c-statistic 0.771, 95% CI 0.679-0.859 95% PI 0.456-0.973). BNP showed excellent summary discrimination with acceptable heterogeneity (Figure 2), (n = 1343 summary c-statistic 0.832, 95% CI 0.776-0.886 95% PI 0.718-0.927).

Conclusions
Five prediction tools externally validated for prediction of risk of AF in those who have had an acute stroke demonstrate good predictive ability. In meta-analysis, BNP performed the best out of all the models and variables tested.
NT-proBNP in severe aortic valve stenosis: necessity for higher cut-off values regarding congestive heart failure detection in atrial fibrillation
Authors: Schober A , Heidel C , Roth N , Xu C , Schober A , Schober M , Hubauer U , Lehn P , Burkhardt R , Luchner A , Maier L , Debl C , Jungbauer C 
Published: May 2024

Abstract

Background
NT-proBNP is an established biomarker for the determination of fluid overload. Patients suffering from atrial fibrillation seem to have higher serum levels of NT-proBNP than patients in sinus rhythm, independent from fluid overload. However, there is no established alternative cut-off for patients with atrial fibrillation, especially in patients with severe aortic valve stenosis.

Aim
The aim of the current study was to evaluate the levels of serum NT-proBNP for patients with atrial fibrillation (AF) and sinus rhythm (SR) for the determination of fluid overload in patients with severe aortic valve stenosis.

Methods
167 Patient suffering from severe aortic valve stenosis undergoing evaluation for TAVR at our hospital were included in this study. Upon recruitment blood samples from every patient were collected and an ECG was documented for each patient. Serum NT-proBNP was measured and volume overload was objectivated by calculation of plasma volume status (PVS), an already published method to estimate fluid overload or depletion by using a formula including weight and haematocrit.

Results
37 patients (22.2%) suffered from AF upon recruitment. 47 patients (28.1%) showed fluid overload, indicated by increased PVS (PVS &gt; 0, SR n=37, AF n=10). 94 patients (56.3%) were male and mean age was 80 years. Patients with and without AF showed no significant difference in age, sex or prevalence of cardiovascular diseases, except for gradients across the aortic valve (SR 47mmHg vs. AF 38mmHg; p&lt;0.05) and left ventricular ejection fractions (SR 57% vs. AF 55%; p&lt;0.05).
Patients suffering from atrial fibrillation showed significantly higher serum levels of NT-proBNP (4843 ng/L vs. 1226 ng/L, p&lt;0.001). ROC-analyses in patients with SR and severe aortic valve stenosis, showed satisfying results for NT-proBNP (AUC 0.72; sensitivity 0.81; specificity 0.58) to detect fluid overload. Comparable results were evident in patients with AF (AUC 0.77; sensitivity 0.70; specificity 0.78), but cut-off-values in patients suffering from atrial fibrillation were more than six times as much as in patients with sinus rhythm (6575 ng/L vs. 1053 ng/L).

Conclusion
NT-proBNP proved itself as a sufficient marker to determine volume overload in patients with severe aortic valve stenosis. Cut-offs for accurate determination of fluid overload deviate greatly in patients with sinus rhythm and atrial fibrillation, therefore different cut-offs might be required.
Screening for atrial fibrillation in patients with symptoms of cognitive impairment
Authors: Hygrell T , Henckel J , Rosenqvist M 
Published: May 2024

Abstract

Introduction
A diagnosis of atrial fibrillation increases the risk for dementia (1). Large register studies including approximately 400,000 patients with atrial fibrillation, have suggested that oral anti-coagulation treatment is associated with a 30-50% reduction of dementia development (2). Still, there are no studies investigating the true prevalence of atrial fibrillation in patients with cognitive problems.

Purpose
We studied the incidence of silent atrial fibrillation in patients with symptoms of cognitive impairment, participation rate in atrial fibrillation screening and the tolerance of the screening method in this specific population.

Method
Patients ≥70 years of age, referred from primary care for cognitive investigation at a specialised memory clinic, were invited to undergo a long-term ECG recording using an ECG-patch for two weeks. Patients with a known diagnosis of atrial fibrillation or who already were prescribed oral anti-coagulation treatment were excluded. Participants with detected atrial fibrillation (&gt;30 seconds) were referred to a cardiologist for follow-up and oral anti-coagulation treatment was initiated according to clinical guidelines.

Results
During the inclusion period n=734 patients were examined for symptoms of cognitive impairment at a memory clinic. Of those, n=191 (26%) had already known atrial fibrillation and n=2 (0.3%) had oral anti-coagulation treatment for other reasons. Of the patients eligible for inclusion n=255/541 (47%) agreed to participate in screening for atrial fibrillation. Participants had a median age of 77 (IQR 74-82) years and median CHA2DS2-VASc score 3 (IQR 3-5). Long-term ECG was recorded for a median of 13.7 (IQR 12.6-14.0) days. Among the 255 participants n=14 (6%) had new atrial fibrillation detected. Total prevalence of atrial fibrillation in the population undergoing cognitive investigation increased with two percent units after screening to 28%.

Conclusion
The incidence of atrial fibrillation is remarkably high in patients with symptoms of cognitive impairment. Participation rate in screening is high in the selected population and the screening method is well-tolerated.
Comparison between Novel and Conventional Electrocardiographic Markers of Atrial Cardiomyopathy for identification of Persons at Risk for Ischemic Stroke
Authors: Huang T , Aldaoud S A , Mueller-Edendorn B M E , Pilia N P , Eichenlaub M E , Allgeier J A , Keyl C K , Neumann F J N , Trenk D T , Westermann D W , Arentz T A , Jadidi A J 
Published: May 2024

Abstract

Background
Atrial cardiomyopathy is associated with increased risk for future atrial fibrillation (AF) and ischemic stroke. Several ECG-derived parameters have been reported to assess the risk for future ischemic stroke.

Purpose
To predict risk of future ischemic stroke by comparison of the novel parameter duration of the amplified digital sinus-p-wave (APWD; 80mm/mV; 175mm/sec) vs previously described p-wave indices and clinical risk factors (cerebrovascular disease (CVD), CHADS-VASc-score).

Methods
P-wave-derived parameters were measured on digital 12-lead-sinus-ECGs (recorded +/- 6 months from the clinical stroke event) using the software "ECG-Precision-Analysis V-1-2023".
and clinical CHA2DS2-VASc Score was assessed in 80 patients with ischemic stroke (no history of AF, no oral anticoagulation (OAC)) and compared to 80 control patients (without OAC, AF or ischemic stroke within the next five years).

Results
Patients with ischemic stroke vs control patients presented a higher CHA2DS2-VASc Score (3.7 vs 3.2, p=0.04), had more frequently heart failure (25% vs 13%, p=0.04) and cerebrovascular atherosclerotic disease with stenosis &gt;40% ((22.5% vs 10%, p=0.032).
P-wave indices were as follows in patients who developed ischemic stroke within the next 12 months versus patients without stroke within a follow-up period of five years, respectively: APWD (144 vs 128ms, p&lt;0.0001), non-amplified SPWD (118 vs 116ms, p=0.081), A-PTF-V1 (-4660 vs -3860µV*ms, p=0.005), durations and amplitudes of terminal-p-wave in V1 (A-Duration-V1 (83 vs 79ms, p=0.119), A-Amplitude-V1 (-50µV vs -50µV, p=0.028), and advanced interatrial block (aIAB in 25% vs 3.8% of patients; p&lt;0.0001.
The novel ECG-derived parameter (duration of the amplified sinus-P-wave &gt;140ms) was the best predictor for future ischemic stroke (accuracy: 74%, sensitivity and specificity: 61% and 86%, respectively; PPV: 82%; area under ROC: 0.776). Sensitivity and specificity of the SPWD, aPTFV1 and aIAB were significantly lower (SPWD&gt;120ms: sensitivity 35% and specificity 78%, PPV: 61%; aPTFV1 ≤-5000µV*ms, accuracy: 61%, sensitivity 46%% and specificity 75%, PPV: 65%; aIAB: accuracy: 61%, sensitivity 25% and specificity 96%, PPV: 87%).

Conclusions
Among the currently identified ECG markers of atrial cardiomyopathy, the novel APWD and advanced interatrial block have the best predictive performances for diagnosis of persons at risk for ischemic stroke.Comparison between ECG ParametersPredictive Accuracy of Parameters
Left atrial strain measurement in patients with heart failure and atrial fibrillation compared to a control group
Authors: Herzer L , Duckwitz N , Kirsch K , Mettke F , Hamadanchi A , Schulze P C , Surber R , Grosse A 
Published: May 2024

Abstract

Background
Left atrial (LA)-strain measurement is a non-invasive and widely available echocardiographic method to detect atrial cardiomyopathy as a process of structural and functional remodeling. The aim of this study is to measure LA-strain in patients with heart failure (HF) and atrial fibrillation (AF), compared to patients without structural heart disease and to evaluate whether or not LA-Strain could be part of a multi-modality assessment that influences therapy strategies and prognosis in patients suffering AF.

Methods
This study includes 18 patients with HF in sinus rhythm who underwent CRT implantation (HF group), 25 patients with persistent AF and preserved ejection fraction (EF) who underwent left atrial catheter ablation (AF group) and 22 patients without structural heart disease or AF who underwent electrophysiological study (control group). All subjects received measurement of reservoir (LASr), conduit (LAScd) and contraction (LASct) LA strain imaging using two-dimensional speckle tracking echocardiography (2D-STE).

Results
Patient characteristics in the HF-group showed mean age 68y (SD 10,6), mean EF 29% (SD 6,8), 66% male compared to the AF-group with mean age 66y (SD 8.0), mean EF 60% (SD 5.1), 68% male. The control-group showed mean age 55y (SD 13.8), mean EF 60% (SD 5.4), 55% male.
For LASr we found normal values in the control groups and reduced values in the HF und AF group (HF: mean 20% [9 – 45%], AF: mean 24% [7 – 52%], control: mean 42% [30 – 67%]). In LASr, LAScd and LASct there was a statistically significant difference between the HF and the control group (p &lt; 0.001) as well as the AF and control group (p &lt; 0.001), whereas there was no difference between AF and HF group (p = 0.444).

Discussion
Patients with persistent AF show similar LA-strain compared to patients with HF and patients without structural heart disease present significant better LA strains. The findings of this study suggest, that LA strain analysis might contribute to comprehensive assessment of patients with AF especially as a simple imaging method. A limitation of our results could be the significant younger age of our control group (p = 0.004) as fibrotic remodeling increases in advanced age. It remains to be analyzed whether early AF treatment could prevent further fibrotic remodeling and whether measuring LA strain could provide further information for risk stratification and the definition of therapeutic intervention strategies.
Validation of CT in comparison to TEE in routine workflow for detection of LAA thrombus in patients under oral anticoagulation presenting for left atrial ablation
Authors: Stolterfoht H , Graeger S T , Hamadanchi A , Schulze P C , Grosse A 
Published: May 2024

Abstract

Background
Left atrial (LA) thrombus in patients (pts) presenting for LA ablation is an absolute contraindication to ablation. Although thrombi can still form despite the use of oral anticoagulation (OAC) in advance of the procedure. Transesophageal echocardiography (TEE) has been considered the gold standard for LAA thrombus detection. Additional cardiac computer tomography (CT) is often performed in pts with persistent atrial fibrillation (AF) or atrial tachycardia (AT). The aim of the study was in routine workflow 1) to identify the incidence of LAA thrombi in TEE and CT, 2) to search for an association in detecting LAA thrombi in the 2 methods and 3) to find out if the LAA flow velocity/ LA volume influences the thrombus detection.

Methods
Between 05/2018 and 10/2023 patients with AF/AT under OAC which were scheduled for a LA ablation were included. TEE and CT searching for LAA thrombus were carried out at intervals of up to 7 days. LAA flow velocity measured in the TEE. The LA volume which included LAA and excluded the pulmonary veins were obtained from the CT at the end-systole.

Results
Patients characteristics: 283 pts were included, mean age of 66y (+9y), 182 male, mean CHA2DS2-VASc score 3 [0-7]. All patients, mostly on NOACs (n=265), were orally anticoagulated. Mean LA volume (LA + LAA) was 158 ml (+45ml), LAA flow velocity was reduced (&lt; 40 cm/s) in 119 pts (42%). In the majority of cases (73%), TEE and CT were performed at the same day or with an interval of 1 day. In 16 pts a LAA thrombus was detected using TEE,42 pts had SEC/Sludge but no solid thrombus. An LAA thrombus in the CT was described in 26 pts (10%), 6% couldn't definitively diagnose thrombi due to contrast recesses/flow phenomena in 16 pts. In 8 out of 34 events (23%) TEE and CT agreed on the diagnosis of a thrombus, in 6 cases during same-day examinations. 18 pts: LAA thrombus on CT, not on TEE (mean interval: 2d). 8 pts: LAA thrombus on TEE, not on CT (mean interval: 1.5d). In 71% (200 out of 283) of cases, CT and TEE agreed in ruling out a thrombus (p=0.358). LAA flow velocity and thrombus verification by TEE showed a significant correlation (p &lt; 0.001). No correlation was found between the presence of a thrombus on CT and LA volume (p= 0.964).

Discussion
In 12% of the patients, all treated with OAC, a thrombus was described in at least one of the examinations or in both. Only in one out of four pts TEE and CT agreed on the diagnosis of a thrombus. It was notable that both examinations excluded thrombi in 70%. LAA flow velocity and thrombus verification in the TEE are significant correlated. LA volume and thrombus notification in CT are not related.

Conclusion
Routine diagnosis of LAA thrombus remains challenging, with frequent discrepancies between TEE, the gold standard, and CT. TEE results depend on the examining physician, while CT is limited by flow phenomena and scan timing.
The potentially underestimated influence of atrial fibrillation on NT-proBNP in chest pain
Authors: Lang F , Schlossbauer M , Staudner S , Leininger S , Vogel M , Lehn P , Burckhard R , Zimmermann C , Hupf J , Hubauer U , Maier L , Jungbauer C 
Published: May 2024

Abstract

Introduction/Purpose
NT-proBNP is a widely used diagnostic marker in the emergency department (ED). The main objective of the current study was to determine the association of NT-proBNP in patients with chest pain presenting with sinus rhythm (SR) compared to atrial fibrillation (AFib). Hereby, a focus was the evaluation of serum NT-proBNP head-to-head to urinary NT-proBNP.

Methods
In this study, urinary as well as blood concentrations of NT-proBNP were measured in a total of 601 patients, who presented with acute chest pain in the ED (mean age = 61.1 y, SD = 16.9 y). In the initial ECG 68 patients suffered from AFib and 533 showed SR.
The participants were categorized according to their diagnosis into acute coronary syndrome (ACS, AFib n = 28, SR n = 261), acute decompensated heart failure (ADHF, AFib n= 16, SR n = 21), non-ischemic chest pain without congestion (NICP, AFib n = 24, SR n = 96) or chest-wall syndrome (CWS, SR n = 155).

Results
In the overall study cohort, patients with AFib showed significantly higher concentrations of urinary as well as blood NT-proBNP compared to those in sinus rhythm (each p &lt; 0.001). Additionally, among patients with acute coronary syndrome (ACS), there were significantly increased biomarker concentrations in patients presenting with AFib compared to sinus rhythm (each p &lt; 0.001, AUCblood = 0.801, AUCurine = 0.701), similarly for patients categorized into NICP (each p &lt; 0.001, AUCblood = 0.833, AUCurine = 0.756). The same pattern was observed among the ACS subcategories (each p &lt; 0.001). Regarding ROC analysis, promising predictive values were shown for detection of AFib: STEMI (AUCblood = 0.902, AUCurine = 0.867), NSTEMI (AUCblood = 0.757, AUCurine = 0.696) and UA (AUCblood = 0.821, AUCurine = 0.681). Comparing ROC curves, significant differences were noted in UA (p &lt; 0.001), opposite to STEMI as well as NSTEMI (each p = n. s.). Regarding ADHF, paradoxically higher NT-proBNP concentrations were noted among patients showing sinus rhythms compared to AFib. Furthermore, a multivariate binary regression analysis showed blood NT-proBNP and age as independent predictors of atrial fibrillation (p &lt; 0.05), opposite to urinary NT-proBNP, high-sensitivity troponin T and diabetes (each p = n. s.).

Conclusion
Urinary and to a larger extent blood NT-proBNP showed significantly higher concentrations in AFib. In conclusion, in ED patients elevated NT-proBNP may potentially be frequently caused by a coexisting AFib. Regarding ADHF patients, the effect of AFib might be consumed by other conditions that have a greater impact on NT-proBNP.
Single center experience of efficacy and safety of atrioventricular node ablation after left bundle branch area pacing for the management of atrial fibrillation
Authors: Jacobs M , Bodin A , Spiesser P , Babuty D , Clementy N , Bisson A 
Published: May 2024

Abstract

Introduction
Atrioventricular node ablation (AVNA) with permanent pacing is an effective treatment of symptomatic atrial fibrillation (AF). Permanent right ventricular pacing is associated with cardiac dyssynchrony, which can worsen heart failure (HF) symptoms. Left bundle branch area pacing (LBBAP) is a recent pacing technique, more physiologic and less associated with cardiac dyssynchrony.

Purpose
To evaluate feasibility, safety and outcomes at 6 months of AVNA associated with LBBAP in patients with symptomatic AF.

Methods
In this retrospective monocentric study, we included all consecutive patients treated with AVNA procedure and LBBAP. Procedures characteristics, clinical follow-up, electrical and echographic data at baseline and 6 months were studied and compared to the data of a matched cohort (1:1) of patients who received an AVNA procedure with conventional pacing between March 2010 and February 2023.

Results
75 AVNA procedures and LBBAP were studied. The success rate of AVNA was 98.7% at first ablation without any complications, especially no lead dislodgement or threshold rise. Pacing electrical parameters at implant were good, and stable at 6 months follow-up, with no threshold rise. At 6 months, 4 (5%) patients were hospitalized for heart failure and 1 (1.3%) was deceased. Patients had a significative improvement in NYHA class, palpitations symptoms, and left ventricular ejection fraction (LVEF) (p ≤ 0.0001 for all). After matching with a cohort of patients with AVNA and conventional pacing (n=68), patients with LBBAP had a significantly better improvement of LVEF (+5.27±9.62% versus -0.48±14%; p = 0.01), and a lower rate of a composite endpoint (all cause death and hospitalization for HF) (HR 0.34, 95%CI: 0.1-1.06; p = 0.064).

Conclusions
AVNA with LBBAP in patients with symptomatic AF was feasible and safe. Complication rate and adverse outcomes at 6 months were similar to AVNA with conventional pacing, and LVEF improvement was significantly greater.Matched populationsOutcomes at 6 months
Long-term anti-arrhythmic is effective than no anti-arrhythmic in patients with first developed paroxysmal atrial fibrillation
Authors: Park Y M , Cha M S , Kang W C , Shim J , Choi I S 
Published: May 2024

Abstract

Background
There is no detailed guideline recommendation of AAD treatment for the firstly developed paroxysmal atrial fibrillation (AF). Anti-arrhythmic drugs (AAD) prevent recurrence of AF and short-term AAD treatment would increase drug safety by reducing treatment duration.

Introduction
We designed the prospective, randomized trial to evaluate the efficacy of short- and long-term AAD (flecainide) compared with no treatment in maintaining sinus rhythm in patients with firstly developed paroxysmal atrial fibrillation (PAF).

Methods
Definition of the firstly developed PAF was the patients with firstly developed symptomatic PAF without history of palpitation. Sixty patients were randomly assigned into no AAD treatment (Group I; N=21), short-term AAD treatment (flecainide 100mg bid for 4 weeks, Group II; N=20) or long-term AAD treatment (flecainide 100mg bid for 6 months, Group III; N=19). All patients were in sinus rhythm at randomization. Patients received clinical follow up with serial evaluation of rhythm status.

Results
There were no significant differences in age, gender, cardiovascular comorbidities and echocardiographic parameters. Among the total population, AF recurred in 16 patients (26.7%) during the follow up period. AF free survival was significantly different among groups (p=0.038) (Fig 1).

Conclusions
Long-term AAD at least 6 months is beneficial in maintaining sinus rhythm than no or shot-term AAD in patients with firstly developed PAF.