bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is pre-diabetes a predictor of events in patients with atrial fibrillation?
Authors: Ledo Pineiro A , Raposeiras Roubin S , Noriega Caro V A , Gonzalez Garcia A , Iglesias Otero C , Cameselle Cortizo L , Gonzalez Fernandez D , Lizancos Catro A , Parada Barcia J A , Dominguez Erquicia P , Gonzalez Bermudez I , Abu-Assi E , Iniguez Romo A 
Published: November 2023

Abstract

Introduction
Diabetes mellitus (DM) not only increases the probability of presenting atrial fibrillation (AF), but it is also a predictor of ischemic stroke included in scales such as CHA2DS2VASc. However, there is limited information on the association between glycated hemoglobin (HbA1c) levels and ischemic, embolic or hemorrhagic events in patients with pre-diabetes and AF.

Objectives
This study aimed to investigate whether the presence of pre-diabetes in patients with AF increases the risk of ischemic events, hemorrhagic events, myocardial infarction or death.

Methods
We used data from the CardioCHUVI-AF registry, which included 18,285 patients with AF from a Galician health area between January 2014 and December 2019. Patients with valvular AF (n=376), with loss of follow-up (n=97), without information on baseline characteristics (n=48) and without data on HbA1c (12,473) were excluded. The final cohort consisted of 5,291 patients, 2,993 were non-diabetics (56.6%) and 2,298 with known diabetes (43.4%). This final cohort was classified according to HbA1c in diabetics if HbA1c is more than 6.5% (n= 1,546; 29.2%), pre-diabetics when HbA1c is between 5.7 and 6.4% (n =2,233; 42.2%) and non-diabetics if HbA1c was less than 5.7% (n = 1,512; 28.6%). Competing hazards regression analysis for non-fatal events (with death as the competing event) and conventional Cox regression for mortality were performed.

Results
2,993 non-diabetic patients with AF and HbA1c data were followed for 4.1 ± 1.6 years. The mean age was 73.0 ± 9.9 years, 47.4% were women, the mean CHA2DS2VASc score was 2.9 ± 1.4 points, the mean HASBLED score was 2.5 ± 1.2 points, and 2,407 (80.4%) patients were under treatment with oral anticoagulants. In the Kaplan Meier curves, no was observed a higher rate of events in pre-diabetes patients in comparison with patients with normal glycemia. In the multivariate analysis, after adjusting for the CHA2DS2VASc and HASBLED scales, as well as for anticoagulant therapy, it was observed that pre-diabetes was not associated with an increased risk of mortality ( HR= 0.80; 95% CI, 0.60-1.08), ischemic stroke (HR= 0.99; 95% CI, 0.71-1.38), major hemorrhage (HR= 0.78; 95% CI, 0.60-1.02) or myocardial infarction (HR= 1.08; 95% CI, 0.65-1.79), compared with patients with normal glycemia.

Conclusions
In our registry, non-diabetic patients with atrial fibrillation do not have a higher risk of events when their glycated hemoglobin is in the pre-diabetes range.
Plasma levels of direct oral anticoagulants in non-valvular atrial fibrillation patients at the time of acute cardioembolic or bleeding events
Authors: Godino C , Cozzani G , Nemola G , Russi A , Salerno A , Cera M , Vetrugno L , Leo G , Della Bella P , Montorfano M , Maisano F , Zangrillo A , Gaspardone C , D'angelo A , Margonato A 
Published: November 2023

Abstract

Background
Direct oral anticoagulants (DOACs) are approved for preventing cardioembolic events in patients with non-valvular atrial fibrillation (NVAF) (1). Unlike Heparin and vitamin K antagonists, DOACs are commonly used without the need for clotting time monitoring, which results in limited data on the correlation between plasma levels and adverse events (2).

Objective
This study aimed to evaluate, in a real-world cohort of NVAF patients, the relationship between the occurrence of acute cardioembolic or major bleeding events and the plasma levels of DOACs measured at the time of the events.

Methods and Results
This study included 400 NVAF patients on DOAC therapy from the INSIghT registry who underwent plasma drug level testing at the time of an adverse event (116 cases) or during an elective hospitalization or outpatient visit (284 controls). Out of 116 cases, 74 experienced a cardioembolic event while 42 had a major bleeding. Patients with cardioembolic events presented low (i.e., in the first and second quartiles) DOAC plasma levels (50 vs. 24, p&lt;0.01), while patients with major bleeding events had high (i.e., in the third and fourth quartiles) DOAC plasma levels (25 vs. 14, p&lt;0.01).

Conclusions
This study highlights the possible association between plasma levels of DOACs and the risk of adverse events, but further research is needed to fully understand the potential benefits DOAC monitoring and individualized dosing.Fig. 1Fig. 2
Silent cerebral embolism after left atrial appendage occlusion
Authors: Wang K , Wang Z I D U N , Ju W E I Z H U , Chen M I N G L O 
Published: November 2023

Abstract

Background
Left atrial appendage (LAA) intervention is an alternative to oral anticoagulation therapy for thromboprophylaxis in atrial fibrillation (AF). There is limited data on procedure-related silent cerebral embolisms (SCE) during LAA intervention. The aim of our study is to assess the incidence and risk factors of the new SCE after percutaneous LAA occlusion (LAAO)in AF patients and compare the rate of SCE after LAAO with LAA excision (LAAE).

Methods
Consecutive AF patients from 2 independent cohorts (LAAO cohort and LAAE cohort) between September 2018 and December 2020 were included. All patients underwent cerebral magnetic resonance imaging (MRI) before and within 7 days after the procedure. The incidence, size and location of SCE, as well as risk factors were analyzed.

Results
Forty-two patients from LAAO cohort and 32 patients from LAAE cohort were enrolled. In the LAAO cohort, patients developing SCE had significantly higher CHA2DS2-VASc scores (OR 2.172; 95% CI 1.149–4.104; p=0.017), longer LAAO placement time (OR 1.067; 95% CI 1.018–1.118; p=0.006), and lower peak activated clotting time (ACT) level (OR 0.976; 95% CI 0.954–0.998; p=0.035). Furthermore, a significantly higher incidence of new SCE was seen in LAAO cohort compared to LAAE (54.8% vs. 6.3%, p&lt;0.001). 71.4% of SCE located in the cortex.

Conclusions
The incidence of procedure-related SCE was strikingly high in patients with percutaneous LAAO. More cardiovascular co-morbidities, longer LAAO placement time and lower ACT level were significantly associated with the development of SCE during LAAO procedure.
Effect of left atrial appendage occlusion device type and position on potential determinants of device-related thrombus
Authors: Zhong Z , Gao G , Kovacs S , Vij V , Nelles D , Spano L , Nickenig G , Sonntag S , De Backer O , Soendergaard L , Sedaghat A , Mela P 
Published: November 2023

Abstract

Introduction
Device-related thrombus (DRT) after left atrial appendage occlusion (LAAO) is potentially linked to adverse events. Clinical reports suggest an association between the device type/position and the DRT risk, in-depth studies of its mechanistic basis are needed.

Purpose
To generate in silico model with precise geometry of LAAO devices and assess the impact of device type and position on local hemodynamics and surrogate markers of DRT risk.

Methods
Watchman (plug-type device) and Amulet (pacifier device) LAAO devices were modeled with precise geometry and virtually implanted in different positions into a patient-specific left atrium. Using computational fluid dynamics, the following surrogate markers of thrombogenicity were quantified: residual blood, wall shear stress (WSS) and endothelial cell activation potential (ECAP).

Results
In comparison to ostium-fitted device positions, deep implantations were associated with more residual blood surrounding the device (after six cardiac cycles: plug-type device 12% vs 8%; pacifier device 6% vs 5%). Furthermore, deep implantations resulted in lower average WSS that indicates increased risk in platelet adhesion (plug-type device 0.21 vs. 0.26 Pa; pacifier device 0.30 vs 0.35 Pa) and higher ECAP that represents higher potential in endothelial dysfunction (plug-type device 2.23 vs. 0.85 Pa-1; pacifier device 0.16 vs 0.10 Pa-1). For plug-type device, an off-axis orientation towards mitral valve resulted in even more residual blood (15% vs. 8%), higher ECAP (1.10 vs. 0.85 Pa-1) and a similar average WSS as compared to an ostium-fitted device position. In addition, the precise geometry of the LAAO device models allowed indication of residual blood accumulation on the device’s atrial surface surrounding the threaded insert as well as on the lateral device surface and on the left atrium tissue around the device landing zone. Similarly, low WSS and high ECAP were mostly found in these areas, suggesting an increased risk for potential thrombus in these areas, which corresponds to the clinical observational series.

Conclusions
This study demonstrated the effect of LAAO device type and position on potential DRT risk factors. In comparison to the plug-type device, the pacifier device showed lower blood stasis, platelet adhesion and endothelial dysfunction and, therefore, lower DRT risk. For both device types, deep implantations are associated to higher surrogate markers of DRT compared to ostium-fitted device positions. In addition, an off-axis device position of plug-type device were associated with higher DRT risk.
Association between brachial-ankle pulse wave velocity and new-onset atrial fibrillation: A report from Kailuan Study
Authors: Song W , Song Z , Zhang N , Tse G , Li G , Lip G Y H , Wu S , Liu T 
Published: November 2023

Abstract

Background
Several risk factors are common between atrial fibrillation (AF) and atherosclerosis. The brachial-ankle pulse wave velocity (baPWV) is a marker of arterial stiffness.

Objectives
To investigate the predictive value of baPWV for new-onset AF.

Methods
All participants without AF as of December 31, 2020 from the Kailuan cohort were included. Demographic characteristics and baPWV were recorded. The primary endpoint was new-onset AF. Participants were divided into three groups according to baPWV. We analyzed the predictive value when baPWV was as a continuous variable.

Results
A total of 49872 subjects (mean age: 47.57 years old, 74.2% male) were included with follow-up of 6.17(3.95-8.46) years. Compared with normal baPWV group, the risk of AF increased with increasing baseline baPWV, whereby the adjusted hazard ratio (aHR) of the high baPWV group and the atherosclerotic group were 1.82 (95% confidence interval [CI]: 1.18-2.80) and 2.08 (95% CI: 1.31-3.30), respectively. As a continuous variable, for every 361 cm/s increase in baseline baPWV, the risk of AF increased by 21.7% (aHR:1.22; 95% CI: 1.08-1.37). In subgroup analysis of non-hypertensive patients, the risks of AF in the high baPWV group (aHR: 3.16, 95% CI: 1.74-5.74) and atherosclerotic group (aHR: 2.26, 95% CI: 1.02-5.05) were significantly higher, compared with normal baPWV group. In overweight patients, the risk of AF in atherosclerotic group was significantly higher than that in normal baPWV group (aHR: 1.69, 95% CI: 1.00-2.83).

Conclusions
The risk of AF increases with the increase of baPWV, and baPWV is of predictive value in occurrence of AF.
The novel P-Wave Area index predicts low voltage areas in patients undergoing pulmonary vein isolation for treatment of atrial fibrillation
Authors: Seewoester T , Nedios S , Dagres N , Marinov K , Hindricks G , Bollmann A , Dilk P 
Published: November 2023

Abstract

Introduction
Presence of low voltage areas (LVA) mirrors progression of atrial fibrillation (AF) and is associated with an impaired rhythm outcome after AF ablation. P-wave indices can predict LVA, however accuracy is depending on myocardial mass, therefore the P Wave area was indexed for the left atrial area. The aim of current analysis was to investigate the association between the novel P-Wave Area Index (PWAi) and the presence of LVA.

Methods
Patients undergoing first AF ablation were included into analysis. LVA were determined using high-density maps and defined as &lt;0.5 mV. All patients underwent CMR imaging (Ingenia 1.5T Philips) and received 12 lead ecg in sinusrhythm before intervention. CMR data (LA area) and P-Wave Area in Leads I ( PWA(I)) and II (PWA(II)) were measured in all patients. Afterwards the P-Wave Area was indexed for LA area to create the PWAi.

Results
A total of 264 consecutive patients were included in the analysis (65 years, 41% females, 57% persistent AF, 30.6% LVAs). Of all analyzed P-Wave indices, P Wave Area in lead II could effectively identify LVA (AUC: 0.813, p&lt;0.001). In patients with LVA, PWAi below 0.4781 msec*mV*m²/cm² identified patients with LVA with an accuracy of 81% (81% sensitivity, 81% specificity, 65% pos. predictive value and 91% neg. predictive value) and was the strongest predictor among all analyzed parameters (OR: 20,578, AUC; 0.860)

Conclusion
The PWAi is a highly significant tool to identify potential LVA before AF Ablation. This findings help to further individualize AF treatment.Multivariate AnalysisROC analysis
Patterns of comorbidities and influence on the natural history of patients with atrial fibrillation: a latent class analysis from a prospective observational european AF registry
Authors: Romiti G F , Corica B , Mei D A , Vitolo M , Bisson A , Fauchier L , Boriani G , Proietti M , Lip G Y H 
Published: November 2023

Abstract

Background
Patients with Atrial Fibrillation (AF) usually present with multiple comorbidities at diagnosis, and their combinations heterogeneously influence management and outcomes. While the effect of multimorbidity on the natural history of AF is well-known, the influence of patterns of multimorbidity is far less understood.

Purpose
To identify and analyse subgroups of AF patients according to their comorbidities, through a latent class analysis of a contemporary cohort of AF patients.

Methods
We used data from a European-wide prospective observational AF registry, and performed a latent class analysis, according to the presence of chronic diseases (including cardiovascular, respiratory, metabolic and other conditions); class membership was assigned according to the modal posterior probability. Multivariable logistic regression models were used to analyse odds of receiving oral anticoagulant (OAC) prescription and type of OAC received; the risk of the primary outcome of all-cause death and MACE was assessed using multivariable Cox-regression model.

Results
9,613 AF patients were included in this analysis (mean age 68.9 ± 11.4 years, 40.2% females), and were grouped in 5 classes, which were different according to the burden of comorbidities: low morbidity pattern (46.1%), cardiovascular pattern (25.0%), metabolic pattern (11.3%), heart failure pattern (9.7%) and multisystemic pattern (8.0%) (Figure 1). Patients in the multisystemic pattern were older and more frequently frail and with polypharmacy compared to other classes. Compared to the low morbidity pattern, odds of receiving OAC was lower in those with cardiovascular pattern (OR [95%CI]: 0.73 [0.62-0.86]), heart failure pattern (OR [95%CI]: 0.60 [0.48-0.75] and multisystemic pattern (OR [95%CI]: 0.28 [0.22-0.36]), while those with metabolic pattern were more likely prescribed OAC (OR [95%CI]: 1.55 [1.20-2.00]). All patterns were less likely treated with NOAC compared to VKA (Figure 2). When analysing the risk of the primary composite outcome, all patterns except for the metabolic pattern were associated with higher hazard of events, with highest magnitude observed for the heart failure pattern (HR 2.68 [95%CI: 2.22-3.25]) and the multisystemic pattern (HR 2.67 [2.13-3.35]) (Figure 2).

Conclusions
Comorbidities are heterogeneously distributed in the AF population, and different phenotypes of AF patients may be identified according to the combination of other chronic diseases, with different OAC use for stroke prevention and an unequal impact on long-term prognosis. These findings reinforce the need for tailored preventive strategies to improve outcomes in AF patients, especially those with multimorbidity.Figure 1Figure 2
Mobile health technology integrated care in atrial fibrillation patients according to atrial fibrillation subtype: a subgroup analysis of the mAFA-II randomised trial
Authors: Corica B , Guo Y , Romiti G F , Mei D A , Proietti M , Zhang H , Lip G Y H 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is clinically categorised into different types (e.g. paroxysmal, persistent and permanent AF) according to the duration of the arrhythmia and whether it is accepted by physician and patient. These types of AF usually recognise different arrhythmic substrates, any may show different response to rate and rhythm control treatments. The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) prospective cluster randomised trial proved the efficacy of a mobile health (mHealth) implemented ‘Atrial fibrillation Better Care’ (ABC) pathway (mAFA intervention) for the integrated care management of patients with AF. Whether the effect of mAFA intervention could differ between different types of AF is still unknown.

Purpose
To assess the efficacy of mAFA intervention according to the type of AF.

Methods
mAFA-II was a cluster randomised trial which recruited 3,324 adults AF patients between June 2018 and August 2019 in 40 centres in China. Clusters were randomised in a 1:1 ratio to mAFA intervention or usual care. In this analysis, we included patients with either paroxysmal, persistent or long-standing/permanent AF; we then assessed the interaction between these three types of AF and the effect of mAFA intervention on the risk of major outcomes using multivariable Cox regression analysis. Results were expressed as adjusted Hazard Ratio (aHR) and 95% Confidence Intervals (95%CI). The primary outcome was the composite of ischemic stroke/thromboembolism, all-cause death, and rehospitalizations.

Results
2,489 AF patients were included in this analysis (mean age: 69.6±13.2, females 37.8%). Of these, 1,333 had paroxysmal AF (673 allocated to mAFA intervention), 828 had persistent AF (380 allocated to mAFA intervention), and 328 had long-standing/permanent AF (104 allocated to mAFA intervention). Patients with long-standing/permanent AF were older and more likely burdened by several comorbidities. On multivariable Cox regression analysis, the efficacy of the mAFA intervention on the risk of the primary composite outcome was similar in the three groups, without statistically significant interaction (p for interaction=0.337), with the highest effect seen among patients with persistent AF (aHR: 0.27, 95%CI: 0.11-0.66).

Conclusions
A mHealth-technology implemented ABC pathway showed a similar effect on the reduction of the primary composite outcome among patients with different subtype of AF. These findings support the implementation of integrated care approach also in patients with more advanced form of AF.Cox-regression models for interaction
Impact of chronic obstructive pulmonary disease on the natural history of atrial fibrillation: a report from the GLORIA-AF registry phase II & III
Authors: Romiti G F , Proietti M , Corica B , Mei D A , Frost F , Bisson A , Boriani G , Olshansky B , Chao T F , Huisman M V , Lip G Y H 
Published: November 2023

Abstract

Background
The relationship between chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) remains unclear. COPD may influence the management and prognosis of AF and may affect treatments, including beta-blockers prescription.

Purpose
To investigate the association between COPD and AF, and assess the impact of COPD on treatment patterns and major adverse outcomes in a large contemporary global cohort of AF patients.

Methods
The GLORIA-AF Registry enrolled newly diagnosed AF patients with at least 1 stroke risk factor. Diagnosis of COPD and treatments (including oral anticoagulant [OAC]) prescribed were recorded by investigators at baseline. We evaluated clinical characteristics associated with the diagnosis of COPD at baseline, OAC and other treatment prescription, and risk of OAC discontinuation. Adjusted Cox-regression models were utilized to analyse the relationship of COPD with major outcomes including a primary composite outcome of all-cause death and major adverse cardiovascular events (MACE).

Results
36,263 patients (mean age 70.1±10.5 years, 45.3% females) were included in this analysis. Patients with COPD (n=2,261, 6.2%) were older, and had higher thromboembolic risk. Increasing age, smoking status, BMI and cardiovascular comorbidities were associated with higher odds of COPD diagnosis at baseline. COPD was associated with higher odds of receiving OACs (Odds Ratio [OR] and 95% Confidence Interval [CI]: 1.31, 1.15-1.49), and with a higher risk of discontinuing OACs during follow-up (hazard ratio (HR): 1.14, 95%CI: 1.03-1.27). COPD patients were more likely prescribed with digoxin and verapamil or diltiazem, with lower prescription of beta-blockers (OR [95%CI]: 0.79, 0.72-0.87; Figure 1) and amiodarone (OR [95%CI]: 0.83, 0.73-0.96). Patients with COPD were at higher risk of the primary outcome of all-cause death and MACE (Hazard Ratio [95%CI]: 1.78, 1.58-2.01; Figure 2), and were also found at higher risk of all-cause mortality, cardiovascular death, MACE and major bleeding, while no statistically significant differences were observed for thromboembolism. There was no statistically significant interaction between beta-blocker use and risk of the primary composite outcome in COPD patients.

Conclusions
COPD is associated with different treatment patterns in AF patients, higher risk of OAC discontinuation, and ultimately a poorer clinical prognosis, with an increased risk of all-cause death, MACE and major bleeding. Beta-blocker use appeared safe in COPD patients.Figure 1Figure 2