bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between left atrial strain and peri-operative stroke in catheter ablation for atrial fibrillation
Authors: Tajima A , Yoshimoto I , Hamamoto Y , Ichiki H , Ninomiya Y , Kamada H , Uchiyama Y , Yasuda H , Iriki Y , Horizoe Y , Ikeda Y , Miyata M , Ohishi M 
Published: November 2023

Abstract

Background
It has been reported that left atrial (LA) phasic function, evaluated by LA strain, is associated with cardiogenic stroke in patients with atrial fibrillation (AF). There are no well-established echocardiographic findings to predict peri-operative stroke in AF ablation.

Purpose
The aim is to evaluate between LA strain and peri-operative stroke in AF ablation.

Methods
This study included 103 consecutive AF patients (90 paroxysmal and 13 non-paroxysmal AF cases) who underwent initial cryo-ablation without interruption of peri-operative anticoagulation from January 2019 to August 2022. Pre-operative echocardiography was used to measure the LA strain items: LA reservoir strain, contractile strain, and conduit strain in sinus rhythm. Twenty-three patients were excluded due to AF rhythm and atrial septal defect. Peri-operative stroke was detected by using magnetic resonance imaging on the day after ablation.

Results
Peri-operative stroke occurred in 9 patients (11.3%), and there was no symptomatic stroke. In univariate analysis, age (69.6 ± 4.8 years vs. 64.2 ± 10.9 years, p&lt;0.05) and log brain natriuretic peptide (1.61 ± 0.26 vs. 1.32 ± 0.42 p&lt;0.05) were significantly higher in the stroke group. On the other hand, LA reservoir strain (20.9 ± 5.6% vs. 29.8 ± 8.3%, p&lt;0.01) and LA conduit strain (10.9 ± 2.3% vs. 15.9 ± 7.0%, p&lt;0.01) in the stroke group was significantly lower compared with the non-stroke group. There were no significant differences in the rate of intra-operative electrical cardioversion and other clinical parameters between both groups. Receiver operating characteristic curve analysis revealed that LA reservoir strain cut-off value of 22.7% provided a c-statistic of 0.82 for predicting peri-operative stroke in AF ablation.

Conclusions
LA reservoir strain is closely associated with peri-operative stroke in AF ablation.ROC curve analysis
The association of vasoactive agents with postoperative atrial fibrillation after cardiac surgery
Authors: Hammer A , Hofer F , Kazem N , Schnaubelt S , Steinacher E , Baumer U , Koller L , Steinlechner B , Laufer G , Niessner A , Sulzgruber P 
Published: November 2023

Abstract

Background
Postoperative atrial fibrillation (POAF) constitutes a common complication after cardiac surgery, that is associated with major adverse cardiac events and prolonged hospital stay. Causes for developing POAF are multifactorial. While there are non-modifiable predisposing characteristics such as higher age or comorbidities, several factors of postoperative patient management could be modulated in order to lower the individual risk of POAF. In this regard, inotropic agents (i.e. norepinephrine, dobutamine) in postoperative care are known to possess arrhythmogenic potential. It is unknown, however, to what extent this postoperative catecholamine therapy influences the emergence of POAF.

Methods
Within this prospective observational study 514 patients were included who underwent elective coronary artery bypass graft (CABG), heart valve, or combined valve/CABG surgery. In total, 438 patients received vasoactive drugs during the postoperative course. These participants were subsequently followed for the occurrence of POAF.

Results
Overall, 43.4% (n=190) of all catecholamine-receiving patients developed POAF. Interestingly, participants who developed POAF had received significantly higher median doses of norepinephrine as compared to non-POAF individuals (POAF: 0.083μg/kg/min vs. non-POAF: 0.062μg/kg/min; p=0.001), while the median dobutamine dose did not significantly differ between groups (POAF: 3.332 μg/kg/min vs. non-POAF 3.289μg/kg/min; p=0.254). Moreover, regression analysis identified norepinephrine with an adjusted hazard ratio (HR) per standard deviation (1-SD) of 1.388 (95% CI:1.114-1.728; p=0.003) as an independent risk factor for the occurrence of POAF. In addition, a norepinephrine dose of 0.18μg/kg/min was determined as the cut-off value, from which the POAF risk increased significantly. Notably, no association between dobutamine and POAF was found (adjusted HR 1.140 [95% CI:0.773-1.683; p=0.508]).

Conclusion
Within this prospective observational study, we were able to demonstrate that the postoperative use of norepinephrine, in contrast to dobutamine, represents an independent risk factor for the development of POAF. Furthermore, a dose dependency was found for norepinephrine from which the risk for POAF substantially increased. To prevent POAF episodes and thus prolonged intensive care unit stay it may be suggested to further promote rapid norepinephrine weaning if feasible.
Epidemiology and clinical impact of chronic obstructive pulmonary disease in patients with atrial fibrillation: findings from an european prospective observational registry
Authors: Romiti G F , Proietti M , Corica B , Mei D A , Vitolo M , Frost F , Boriani G , Lip G Y H 
Published: November 2023

Abstract

Background
The interplay between atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) has been poorly investigated and understood, with previous studies reporting unsatisfactory management and poor prognosis of patients with AF and COPD.

Purpose
To describe the epidemiology, management and natural history of AF patients with COPD using a contemporary European prospective cohort.

Methods
From a European-wide prospective observational AF registry, we identified patients with COPD as reported by the investigators. We analysed the association between COPD and the odds of receiving oral anticoagulants (OAC) and other pharmacological treatments using multivariable logistic regression models. We also assessed the associations between COPD and risk of major outcomes using multivariable Cox-regression models. Our primary outcome was all-cause mortality; secondary outcome was the risk of major adverse cardiovascular events (MACE). We finally evaluated the interaction between disease-specific treatments for COPD and the risk of major outcomes in AF-COPD patients.

Results
A total of 10,219 AF patients were included in this analysis (mean age 69.2 ± 11.4 years; 40.3% females); COPD was found in 909 patients (8.9%). Patients with COPD were older, more likely males, and had a higher burden of thromboembolic and bleeding risk factors. No differences were observed in the likelihood of receiving OAC or non-vitamin K antagonist oral anticoagulants (NOAC) in COPD vs. no COPD patients (OR: 1.00, 95%CI: 0.81-1.24, and OR: 0.91, 95%CI: 0.77-1.06, respectively for OAC vs. non OAC and NOAC vs. VKA prescription). Patients with COPD were less likely treated with ACE inhibitors, beta-blockers, amiodarone and class IC antiarrhythmics, while they showed higher odds of receiving diuretic, digoxin, and non-dihydropyridinic calcium channel blockers (Figure 1). Over a median follow-up of 24.3 [IQR: 23.0-25.0] months, the risk of all-cause death was higher among COPD patients (HR: 1.52, 95%CI: 1.28-1.80), as well as the risk of MACE (HR: 1.49, 95%CI: 1.22-1.83) and the composite outcome of ‘all-cause death and MACE’ (HR: 1.50, 95%CI: 1.29-1.74) (Figure 2). No statistically significant interactions were observed between the use of beta-blockers, beta-2 agonists and anticholinergic drugs, and the risk of death in COPD patients.

Conclusions
COPD was common in AF patients and was associated with higher prescription of rate-control (except for beta-blockers) and lower prescription of rhythm control drugs, with no differences in OAC treatment. COPD was associated with worse prognosis, without significant interaction observed for beta-blockers or other COPD-specific treatment.Figure 1Figure 2
Role of liver disease in management and outcomes of european and asian patients with atrial fibrillation: a report from two regional prospective observational AF registries
Authors: Mei D A , Bucci T , Romiti G F , Shantsila A , Tse H F , Chao T F , Boriani G , Proietti M , Lip G Y H 
Published: November 2023

Abstract

Background
In patients with atrial fibrillation (AF), the impact of liver disease (LD) on prescription of oral anticoagulant (OAC) therapy and risk of outcomes remains unclear, as well as possible differences between ethnicities.

Objective
To examine the impact of LD in a large cohort of European and Asian AF patients on OAC prescriptions and the risks of adverse outcomes.

Methods
AF patients derived from from two large prospective observational AF registries, conducted in Europe and Asia, on the basis of the same electronic case report form. OAC prescription and risk of outcomes was analyzed according to LD at baseline. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). Logistic and Cox regression analyses were used to determine associations with LD, and interaction analyses were performed to examine possible differences between European and Asian patients.

Results
15,681 patients (mean age 69.0, SD 11.6 years; 38.7% female) were included, with 517 (3.3%) reporting LD. AF patients with LD were more likely permanent AF, symptomatic, higher thromboembolic and bleeding risks, and had higher multimorbidity, frailty and polypharmacy than those without LD. At baseline, AF patients with LD were less prescribed OAC, as well as with NOACs, than those without [Figure 1].
After adjustments, LD was associated with lower OAC prescription (OR 0.67, 95% CI 0.53-0.84) overall. OAC was less likely prescribed in European (OR 0.54, 95% CI 0.40-0.71) than in Asian (OR 0.95, 95% CI 0.66-1.39) patients (pint=0.015). No differences were found regarding prescription of NOACs vs. VKAs [Figure 1].
Adjusted Cox regression found that LD was associated with a higher risk of composite outcome (HR 1.42, 95% CI 1.11-1.81) and MACEs (HR 1.47, 95% CI 1.07-2.02), with no ethnic differences (Pint=0.631 and Pint= 0.495 for composite outcome and MACEs respectively). LD patients not receiving OAC were at higher risk for MACEs occurrence than those prescribed (pint=0.050). No differences were found regarding major bleeding.

Conclusions
Presence of LD in AF is associated with a lower prescription of OAC, especially amongst European patients. LD is associated with a higher risk for adverse outcomes, especially in those not prescribed with OAC.Figure 1
Pulmonary hypertension is an adverse risk factor for patients admitted with atrial fibrillation
Authors: Kodali M , Atluri R , Shoura S , Vardar U , Yalamanchili S 
Published: November 2023

Abstract

Background
Atrial Fibrillation (AF) poses a significant burden on the resources of the American Healthcare system. Heart failure and AF commonly coexist in patients. Elevated left ventricular and atrial pressures result in progressive left atrial dilation and remodeling which in turn predisposes to the generation of AF. Many of these patients develop pulmonary hypertension (PHT) due to the remodeling and elevated left-sided pressures. Since many who have AF could have PHT, we aimed to assess outcomes in this population.

Methods
We utilized the National Inpatient Sample from 2016-2019 to identify roughly 16,500,000 hospitalized adults who had AF. These hospitalizations were further stratified based on the presence of PHT. A multivariate regression model was used to adjust for confounders and analyze the variables.

Results
Of those with AF, 1,855,020 (11.2%) had PHT. In-hospital mortality was higher in those with PHT (5.6% vs 4.9%; p&lt;0.001). Figure 1 shows the Forrest plot for multivariate analysis of in-hospital outcomes when adjusted for patient demographics, comorbidities, and hospital characteristics. When adjusted similarly, patients with AF and PHT had longer length of stay (LOS) by 0.92 days (p&lt;0.001) and had additional hospital costs (HC) of $9,463 (p&lt;0.001).

Conclusion
In this study, patients admitted with AF with co-existing PHT had significantly worse outcomes in terms of in-hospital mortality, LOS, HC, cardiac arrest, pulmonary embolism, atrial flutter, AKI, blood transfusions, pneumonia, and endotracheal intubation. One major limitation of our study is the lack of outpatient follow up. Given that overall outcomes are worse in the setting of PHT, potential strategies for early rhythm control for AF should be pursued to avoid negative cardiac remodeling that would predispose to the development of PHT. AF patients with co-existing PHT should be aggressively monitored during hospitalizations as they have the potential to have worse outcomes.
Epicardial fat can predict the in-atrial thrombus in patients with atrial fibrillation
Authors: Shi T A O , Yan Y , Li M J , Guo J X , Wang H , Tang M Y 
Published: November 2023

Abstract

Background
Thromboprophylaxis is important in the management of patients with atrial fibrillation. Epicardial adipose tissue (EAT) is involved in the formation of the pre-thrombotic state. However, the potential of EAT in predicting the risk of thromboembolism in atrial fibrillation remains unknown.

Objective
To study the imaging features of EAT and its potential in predicting the risk of in-atrial thrombus in atrial fibrillation.

Methods
Patients were divided into the group with (thrombus group) and without (non-thrombus group) intra-atrial thrombosis according to the results of transesophageal echocardiography (TEE). The EAT volume, mean EAT density and EAT volume/whole heart volume ratio measured on coronary artery CT angiography (CA-CTA) were compared between the two groups.

Result
A total of 347 atrial fibrillation patients undergoing both TEE and CA-CTA were included and 38 cases were complicated with in-atrial thrombus. Using quartile values, EAT volume, mean EAT density, the ratio of EAT volume/whole heart volume are divided into four grades according to the values. By analyzing the ROC curve and comparing the area under the curve of AUC, EAT volume and EAT volume/whole heart volume ratio show potential diagnostic value in predicting the risk of in-atrial thrombus in atrial fibrillation. In addition, 38 cases without in-atrial thrombus were included in the non-thrombotic group after matching the propensity score by age and gender. On multivariate analysis, patients in the thrombus group had the larger EAT volume (P=0.000, P&lt;0.05) and higher ratio of EAT volume/whole heart volume ratio (P=0.004, P&lt;0.05) when compared with patients in the non-thrombotic group, but there was no difference of mean EAT density (P=0.224, P&gt;0.05) between the two groups. On logistic regression analysis, patients in the thrombus group had the larger EAT volume when compared with patients in the non-thrombotic group (P=0.003, P&lt;0.05).

Conclusions
EAT may be a potential marker in predicting the risk of in-atrial thrombus in atrial fibrillation. However, much more efforts and testing would be needed before our conclusion could be tried in other people and to elucidate pathogenic mechanisms of EAT.Figure 1Epicardial fat measuremeFigure 2ROC curve
High-sensitivity cardiac troponin-T concentrations and their prognostic implications in paroxysmal supraventricular tachycardia: A nationwide study
Authors: Laursen S B , Pareek M , Polcwiartek C B , Kragholm K H , Kristensen A M D , Tofig B J , Hansen M L , Riahi S , Biering-Sorensen T , Byrne C 
Published: November 2023

Abstract

Introduction
Paroxysmal supraventricular tachycardia (PSVT) may mimic symptoms and electrocardiographic findings compatible with acute coronary syndromes. As a result, cardiac troponin concentrations are frequently measured upon presentation. Although PSVT may increase troponin concentrations, the expected magnitude and prognostic clinical value of high-sensitivity troponin (hs-TnT) concentrations remain uncertain.

Purpose
The purpose of this study was to examine whether elevated hs-TnT concentrations in PSVT patients were associated with a higher risk of death from any cause.

Methods
We used Danish nationwide registry data from January 2013 through December 2019. PSVT was defined as all supraventricular tachycardias except atrial fibrillation and atrial flutter. The inclusion criteria were de novo PSVT and at least one measured hs-TnT level during hospitalization. Exclusion criteria were a history of cardiovascular disease (coronary artery disease, atrial fibrillation or flutter, or heart failure) or absence of hemoglobin or creatinine measurement within one day of the hs-TnT measurement. Elevated hs-TnT was defined as a value of ≥14 ng/l (the conventional 99th percentile upper reference limit). The primary outcome was death from any cause evaluated at 0-30 and 31-365 days, using multivariable Cox regression with average treatment effect, rendering standardized absolute and relative risks.

Results
A total of 1029 patients were included. Median age was 58 years (25th to 75th percentile: 45-71), and 45% were male. Elevated hs-TnT level was observed in 674 (65.5%) patients, who also had a higher prevalence of cardiovascular comorbidities. The median hs-TnT level was 16 ng/l (25th to 75th percentile: 10-35). The standardized mortality risk at 30 days was significantly higher in patients with elevated hs-TnT compared with patients with normal hs-TnT concentrations (2.38% [95% confidence interval (CI): 1.38 to 3.37] versus &lt;0.01% [95% CI: &lt;0.01 to &lt;0.01]) (Figure 1). The relative risk was 58722906 (95% CI: 23126570 to 94319242), p = 0.001. At 31-365 days, the standardized risk of death was 1.51% (95% CI: 0 to 3.28) in individuals with a normal hs-TnT and 4.23% (95% CI: 2.81 to 5.66) in those with an elevated hs-TnT (Figure 2), resulting in a relative risk of 2.81 (95% CI: 0 to 6.32), p = 0.31.

Conclusion
In patients without prior cardiovascular disease, an elevated hs-TnT concentration during the first episode of PSVT was only associated with an increased early mortality risk. Long-term mortality was not affected by elevated hs-TnT.Figure 1Figure 2
Low voltage mapping in atrio-ventricular nodal reentry tachycardia ablation: safety and efficacy in a single center experience
Authors: Martignani C , Spadotto A , Bartoli L , Angeletti A , Diemberger I , Massaro G , Ziacchi M , Bertelli M , Lazzeri M , Carecci A , Biffi M 
Published: November 2023

Abstract

Background
Atrio-ventricular nodal reentry tachycardia (AVNRT) is one of the most common supraventricular arrhythmias. Transcatheter ablation is the first-choice strategy for its treatment. Despite various ablation techniques, using different signal analyses and different energy sources, the reported incidence rate of AVNRT recurrences and high-grade or complete atrioventricular block are about 5% and 1% respectively. Voltage mapping for slow pathway localization is a novel technique for the treatment of AVNRT, that may increase procedural safety and effectiveness, particularly in pediatric patients.

Purpose
To evaluate the safety and efficacy of ablation of slow conduction pathway identified via three-dimensional voltage mapping of Koch’s triangle.

Methods
108 consecutive patients (45% male, mean age 58.6±15.4 years) scheduled for AVNRT ablation in our center underwent three-dimensional voltage mapping of the right atrial septum and Koch’s triangle. Voltage map was aimed at detecting an area of low voltage (voltage bridge) below the His bundle (adjusting the high-voltage slider to 1,5 mV), corresponding to the slow conduction pathway. Focusing on this target, we evaluated the number of radiofrequency (RF) pulses and RF time application for effective ablation of the slow conduction pathway defined by accelerated junctional rhythm (AJR) induction during RF delivery and absence of post-ablative AVNRT inducibility. After RF ablation, all patients underwent clinical evaluation every 3 months to identify AVNRT recurrences.

Results
Voltage mapping was performed in all patients. The mean duration of mapping was 5.7±3.8 minutes. In all patients, a low voltage bridge could be identified. Using this target, RF was delivered until AJR was elicited (mean number of RF pulses at 30W, 50°C = 1.5±1.1; mean time to AJR: 25±12 s). After successful ablation of the slow conduction pathway, AVNRT was no more inducible. No atrioventricular conduction defect (atrioventricular block of any grade) occurred after RF ablation in any patient (AH pre vs. AH post: 148.5±22.8 ms vs. 153.6±17.8 ms, p=n.s.; HV pre vs. HV post: 20.5±18.7 ms vs. 21.8±17.3 ms, p=n.s.; Wenkebach point pre vs. Wenkebach point post: 320.4±45.3 ms vs. 326.2±38.7 ms, p=n.s.). All patients were discharged without antiarrhythmic drug therapy. Overall, during a 2-year follow up, 4 patients had a recurrence of AVNRT (incidence rate of recurrences: 0.025/year).

Conclusions
Voltage mapping can easily identify the low voltage bridge area of Koch’s triangle as a target for slow pathway ablation. RF ablation of the slow pathway identified in this way is safe and effective. Success in slow pathway ablation can be achieved with a low number of very precise RF pulses. This approach can prevent the risk of ablation-related atrioventricular conduction defects and reduce the risk of AVNRT recurrences.
Increased levels of circulating endostatin are linked to orthostatic hypotension
Authors: Ricci F , Larsson A , Hamrefors V , Ruge T , Olshansky B , Sutton R , Fedorowski A , Johansson M 
Published: November 2023

Abstract

Background
Orthostatic hypotension (OH) occurs when blood pressure regulation fails. The underlying molecular mechanism of OH remain largely unexplored. Endostatin is a biologically active molecule cleaved by matrix metalloproteinases, elastases and cathepsins from collagen XVIII in the extracellular matrix and inhibits angiogenesis. Circulating levels of endostatin have been proposed to be involved in blood pressure (BP) regulation, by inducing nitric oxide release. To date, the relationship between endostatin and OH have not been examined.

Purpose
We aimed to investigate circulating levels of endostatin in patients with verified OH by tilt test at a tertiary syncope unit compared with healthy age- and sex-matched controls from the same geographical region.

Methods
We performed an age- and sex-matched case-control study in 150 patients with OH verified by positive head-up tilt-testing and other cardiovascular autonomic tests at a tertiary syncope unit, and 150 healthy controls with negative active standing tests and no history of syncope, orthostatic intolerance, and endocrine disease. High-sensitivity chemiluminescence sandwich immunoassay was used to measure circulating levels of endostatin in a blinded fashion. Receiver operating characteristic curves were constructed to analyze the discriminative ability of endostatin in OH compared with healthy controls. Multivariate logistic regression was used to assess the association between endostatin, OH and hemodynamic variables adjusting for age and sex.

Results
Study characteristics are displayed in the Table. Patients with OH had significantly higher absolute levels of circulating endostatin compared with healthy controls (59,024 ± 2513 vs. 44,090 ± 1978 pg/mL, p&lt;0.001). Multivariate-adjusted logistic regression analysis controlling for age, sex, minimum systolic and minimum diastolic BP during tilt, identified endostatin as an independent determinant for OH (beta-coefficient 0.80, p=0.025). The obtained area under the curve was 0.70, P&lt;0.001, Figure).

Conclusions
Our findings indicate that patients with orthostatic hypotension have increased circulating levels of endostatin, independent of age, sex, and hemodynamic variables. Our results highlight the relevance of investigating the molecular pathways related to orthostatic hypotension. Further studies are warranted to assess the prognostic and therapeutic role of endostatin assessment in individuals with orthostatic hypotension.Tablestudy characteristicsFigureROC Curve