bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of fibrosis in heart failure and atrial fibrillation using TIMP- 1 serum levels
Authors: Grosse A , Mettke F , Kirsch K , Gruen K , Franz M , Schulze P C , Surber R 
Published: November 2023

Abstract

Background
Tissue inhibitor of metalloproteinase- 1 (TIMP-1) levels are strongly associated with cardiac extracellular matrix accumulation and atrial fibrosis. The aim of this study was 1) to compare the TIMP-1 plasma levels in heart failure (HF) and atrial fibrillation (AF) patients and 2) to search for a local production in the heart.

Methods
This study included 13 patients with HF who underwent CRT implantation (CRT- group), 13 patients with persistent AF who underwent left atrial catheter ablation (AF- group) and 13 patients without structural heart disease or AF, who underwent electrophysiological study (control group). Blood was collected at the begin of the procedures from the coronary sinus (CS), superior vena cava (SVC) and aorta (Ao). Level of TIMP-1 in the CS (TIMP-1-CS), RA (TIMP-1-SVC) and aorta (TIMP-Ao) was measured.

Results
Patients characteristics: CRT- group: mean age 74y, 8 male, LV- EF 32%, 3 with a history of atrial fibrillation. AF- group: mean age 68y, 9 male, LV- EF 55%. Control- group: mean age 54y, 9 male, LV- EF 65%.
The levels of TIMP-1 in the SVC was in the CRT group significantly higher 213 ± 70 ng/ml vs 160 ± 23 ng/ml in controls (p= 0,03). The level of TIMP-1 in the AF- group (191 ± 73 ng/ml) was not significantly different from the control group (p= 0,195) (figure 1). At the various collection sites (CS, SVC and aorta), no significant differences between the 3 groups were noted.
Discussion: TIMP-1 serum levels in HF patients are significantly elevated compared to a control group without structural heart disease. No significant differences in levels of TIMP-1 were seen between AF patients and the control group. This is an expression of the advanced disease in the HF patients. The source of serum TIMP-1 are unclear as differences in the level of TIMP-1 between CS, SVC and aorta were not detectable.
Atrial fibrillation organisation correlates with ventricular response regularity in patients with persistent atrial fibrillation
Authors: Ahsan N , Sau A , Neerahoo R , Qureshi N , Koa-Wing M , Keene D , Malcolme-Lawes L , Lefroy D C , Linton N W F , Lim P B , Varnava A , Whinnett Z I , Kanagaratnam P , Peters N S , Ng F S 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is characterised by an irregularly irregular ventricular rhythm. However, the mechanisms by which the regularity of ventricular response is influenced by AF dynamics is yet to be understood. In AF, there is a spectrum of organisation of atrial electrical activity; from organised AF sustained by focal drivers through to disorganised AF sustained by multiple wavelet re-entry. We aimed to investigate whether the ventricular response in AF was associated with the organisation of atrial electrical activity, with the hypothesis that AF organisation correlates with ventricular response regularity.

Methods
We retrospectively reviewed data from 239 patients with persistent AF undergoing pulmonary vein isolation (PVI). In each patient both before and after ablation, AF organisation and measures of ventricular variability and irregularity were evaluated in 50s segments. Shannon entropy (ShEn) and Sample entropy (SampEn) derived from coronary sinus (CS) atrial electrograms were used to assess AF organisation. RR interval (RRI) metrics derived from the surface ECG were used to determine ventricular variability and irregularity. RRI variability was evaluated using the time-domain measures: normalised mean RRI difference, standard deviation of RRIs (SD RRI), normalised SD RRI, root mean square of successive RRI differences (rMSSD) and percentage of successive RR intervals that differ from each other by more than 50ms (pNN50). RRI irregularity was measured using SampEn and normalised SampEn.

Results
A significant decrease in atrial ShEn and SampEn was observed following PVI across all CS channels (e.g. SampEn CS 3-4: pre-ablation=0.907±0.512 vs post-ablation=0.790±0.447, p&lt;0.0001). Both ShEn and SampEn from CS atrial electrograms were significantly correlated with the RRI variability and irregularity measures from surface ECG (pNN50, normalised mean RRI difference, normalised SD RRI and normalised SampEn) both pre- and post-ablation (pNN50: r=0.0771, p=0.00838, Figure 1; normalised mean RRI difference: r=0.144, p&lt;0.0001; normalised SD RRI: r=0.175, p&lt;0.0001; normalised SampEn: r=0.168, p&lt;0.0001; correlations with SampEn CS 3-4 pre-ablation shown).

Conclusion
The reduction in atrial ShEn and SampEn following PVI suggests that an increase in AF organisation occurs with PVI. The significant correlations between atrial entropy and measures of RRI variability and irregularity suggest that AF organisation impacts ventricular response regularity. Therefore, interpretation of the RRI variability and irregularity from the surface ECG may give some insight, non-invasively, into the level of AF organisation.Figure 1
Risk of incident atrial fibrillation and subsequent use of oral anticoagulants in patients with dementia
Authors: Chao T , Kuo L , Lip G Y H , Chen S A 
Published: November 2023

Abstract

Background
Dementia and atrial fibrillation (AF) have many shared risk factors, and the presence of AF is associated with a higher risk of incident dementia. Although patients with dementia have higher risk of adverse cardiovascular events, there are limited data on the risks of incident AF, and the associated AF-related clinical outcomes. Patients with dementia are under-represented in randomised trials, and even if AF is present, oral anticoagulants (OAC) are not prescribed frequently. We aimed to report the incidence of newly-diagnosed AF in dementia patients, and the impact on stroke and bleeding outcomes with vitamin K antagonist (VKA, eg warfarin) and non-VKA OAC (NOACs).

Methods
Nationwide cohort study of 544,074 patients with dementia, compared to 554,074 age- and sex-matched patients without dementia.

Results
Rates of newly-diagnosed AF were higher in patients with dementia compared to those without history of dementia (1.89 per 100 person-years vs 1.78 per 100 person-years, respectively); adjusted risk of incident AF was greater in all types of dementia, pre-senile/senile dementia and vascular dementia (Figure 1). When compared to non-OAC users, warfarin use was associated with higher risk of ischaemic stroke (aHR, 1.290; 95% CI, 1.156 - 1.440), intracranial hemorrhage (ICH) risk (aHR, 1.678; 95% CI, 1.346 - 2.09) and major bleeding (aHR, 1.192; 95% CI, 1.073 - 1.323). NOAC use was associated with lower risk of ischaemic stroke (aHR, 0.42; 95% CI, 0.352 - 0.501) and major bleeding (aHR; 0.504, 95% CI, 0.433 - 0.587), when compared to non-OAC use (Figure 2).

Conclusions
In this large nationwide cohort of dementia patients, the incidence rate of newly-diagnosed or incident AF was higher in patients with dementia compared to patients without dementia. Compared to non-OAC users, NOAC use was associated with a lower risk of ischaemic stroke and major bleeding. Patients with dementia require a holistic approach to their care and management, including the use of NOACs to reduce their risks of clinical events.
Prevalence of atrial fibrillation in patients with atrial septal defect and its impact on in-hospital outcomes
Authors: Htwe K , Baral N , Aung T , Moza A , Munir A 
Published: November 2023

Abstract

Background
Atrial septal defect (ASD) is one of the most common congenital heart diseases in adulthood. ASDs have left-to-right shunt and primarily right-sided volume overload. This leads to electrical remodeling that may predispose patients to atrial fibrillation (AF). There is limited data on the impact of AF on clinical outcomes in patients with ASD.

Purpose
To study the prevalence of AF and its impact on in-hospital outcomes in adult patients with ASD.

Methods
This is a retrospective cohort analysis of all ASD related hospitalizations between January 1, 2016, and December 31, 2020, from the National Inpatient Sample, the largest publicly available all-payer inpatient care database in the United States. Our study population included adult patients (≥ 18 years) with ASD using ICD-10 diagnostic codes. Patients with a diagnosis of acquired ASD were excluded. ASD patients were divided into two groups: with and without AF. We used Chi square test for categorical variables and t-test for continuous variables to compare group differences between ASD with AF and ASD without AF. Univariate and multivariate logistic regression were used to analyze the clinical outcomes between the two groups.

Results
From 2016 to 2020, we identified 82,574 hospitalizations with primary diagnosis of ASD, of which 23,907 (29%) had coexisting AF. The mean age was 71 years. Among them, 48% were female. Racial distributions were: 81% Whites, 8.8% Blacks, 5.9% Hispanics and 2.1% Asians. Compared to ASD without AF, ASD with AF hospitalizations were older in age (mean age: 71 vs 59, p&lt;0.001), had higher prevalence of chronic heart failure (56% vs 25%, p&lt;0.001), hypertension (71% vs 61%, p&lt;0.001), obstructive sleep apnea (16% vs 9%, p&lt;0.001), and higher Charlson comorbidity index (CCI) of ≥3 (52% vs 46%, p&lt;0.001). ASD patients with AF had higher in-hospital mortality (aOR: 1.25, 95% CI: 1.14, 1.37, p&lt;0.001), longer length of stay (beta coefficient: 0.15, 95% CI 0.13, 0.17, p&lt;0.001), higher odds of acute heart failure (aOR:3, 95% CI: 2.86, 3.15, p&lt;0.001), cardiogenic shock (aOR: 2.68, 95% CI: 2.42, 2.97, p&lt;0.001), acute kidney injury (aOR:1.4, 95% CI: 1.35, 1.46, p&lt;0.001) and requirement of permanent pacemaker (PPM) (aOR: 2.51, 95% CI: 2.16, 2.92, p&lt;0.001) compared to ASD without AF after controlling for age, race, CCI, obesity, COPD and pulmonary hypertension.

Conclusions
Our study showed that a significant percentage of hospitalized patients with ASD had concomitant AF. AF can contribute to higher in-hospital mortality and worse clinical outcomes in patients with ASD. This highlights the importance of optimal management of AF in patients with ASD.
The relationship between changes of antithrombotic drug regimen after ischemic stroke and risks of clinical outcomes in patients with atrial fibrillation
Authors: Chao T , Lip G Y H , Chen S A 
Published: November 2023

Abstract

Background
Stroke prevention is central to the management of patients with atrial fibrillation (AF), but the impact of changes in antithrombotic regime following presentation with an ischaemic stroke on subsequent clinical events is unceratin.

Methods
From 2012 to 2018, 23,165 AF patients who experienced ischemic stroke and survived longer than 90 days after stroke were identified from Taiwan National Health Insurance Research Database. The relationships between post-stroke antithrombotic drug regimen and subsequent clinical outcomes were analyzed.

Results
Compared to NOACs (reference), there was a significant increase in ischaemic stroke in non-anticoagulated and antiplatelet users (both aHR approx 1.8), with no significant differences to warfarin. The same was evident for a higher mortality in non-anticoagulated and antiplatelet users (aHRs 3.441 and 1.483, respectively). Addition of antiplatelets to NOAC or warfarin resulted in non-significant differences in ischaemic stroke or mortality (Figure 1).
Among 769 pateints who received NOACs before and continuously stayed on NOACs after stroke, the shifting to a different NOAC post-stroke was associated with a higher risk of ischaemic stroke (aHR 2.07) as well as the composite outcomes (aHRs between 1.359-1.849), with no difference in major bleeding, mortality or ICH (Figure 2).

Conclusions
Adding antiplatelet agents to NOACs for AF patients after ischemic stroke did not provide additional clinical benefits. For patients under NOACs who experienced ischemic stroke, the change to a different NOAC post-stroke was not associated with a better clinical outcome.
The association between HbA1c variability and strokes in patients receiving anticoagulants
Authors: Huang J , Chandramouli C , Wu M Z , Ren Q W , Tse H F , Lip G Y H , Yiu K H 
Published: November 2023

Abstract

Background
Diabetes, higher glycaemic level, is associated with an increased risk of stroke in patients with atrial fibrillation (AF) and is integrated into the CHA2DS2-VASc score for stroke risk prediction. However, the association between glycaemic variability and stroke risk in AF patients remains unclear.

Objective
To evaluate the association between glycaemic variability and stroke among diabetic and non-diabetic patients with nonvalvular AF receiving anticoagulants.

Methods
Newly diagnosed AF from 2013-2018 (n=8,790) were divided by their diabetes status. Variability in glycaemic, represented by coefficient of variation (CV) on HbA1c (haemoglobin A1c), was assessed by at least three HbA1c measurements following enrollment to the end of the follow-up period. Participants with ischaemic stroke (IS)/systemic embolism (SE), haemorrhagic stroke (HS) or all-cause mortality at baseline or within 1 year of enrollment were excluded. Multivariate Cox regression was performed to evaluate the association between variability in HbA1c and subsequent incident IS/SE, HS and all-cause mortality. Sensitivity analyses included defining HbA1c variability using average successive variability (ASV) and variability independent of the mean (VIM).

Results
Diabetes status significantly modified the relationship between HbA1c variability and risk of IS/SE (Pinteraction = 0.36)and all-mortality (Pinteraction &lt;0.01). Greater incidence rates were observed among individuals with diabetes, compared to those without diabetes (3.74 vs. 2.41 for IS/SE, 0.54 vs. 0.33 for HS and 4.89 vs. 2.42 for all-cause mortality per 100 person years). Among those with diabetes, greater HbA1c variability was significantly associated with increased risk of IS/SE (hazard ratio [HR] = 1.21, 95% confidence interval [CI]: 1.11-1.31), all-cause mortality (HR = 1.13, 95%CI: 1.05-1.20) and HS (HR = 1.10, 95%CI: 1.02-1.23). Similar patterns were found in individuals without diabetes (IS/SE: HR = 1.28, 95%CI: 1.08-1.52; all-cause mortality: HR = 1.50, 95%CI: 1.29-1.75). However, no significant association was observed between glycemia variability and HS among those without diabetes. Results were consistent with alternative measures of HbA1c variability.

Conclusion
Variability in HbA1c was independently associated with the risk of IS/SE and all-cause mortality among patients with AF, regardless of diabetes status.
Neurofilament light chain (NFL) - a neuron-specific plasma biomarker for evaluating risk of ischemic cerebral events in atrial fibrillation
Authors: Aulin J , Sjolin K , Lindback J , Benz A P , Connolly S J , Eikelboom J W , Hijazi Z , Oldgren J , Wallentin L , Burman J 
Published: November 2023

Abstract

Background
A history of ischemic stroke is one of the strongest risk factors for future stroke in patients with atrial fibrillation (AF). Circulating biomarkers specific for the brain may be used to detect overt and covert cerebral ischemia. Neurofilament light chain (NFL) is a neuron-specific cytoskeleton protein that is released into blood at increased levels when the brain is injured and may be a complement to already established risk factors of AF.

Purpose
We hypothesized that NFL measured in plasma (pNFL) is an independent and incremental risk indicator of ischemic stroke in patients with AF.

Methods
pNFL was measured in venous blood samples from 1,056 patients with AF randomised to aspirin in the ACTIVE A trial. Samples were collected at randomisation and the median follow-up duration was 3.6 years. pNFL was analysed with a single molecule array. Associations between pNFL and subsequent clinical outcomes were evaluated by Cox-regression models adjusted for fifteen clinical characteristics and NT-proBNP levels.

Results
The median concentration of pNFL was 17.3 (interquartile range 10.9-28.3) ng/L. The variables most strongly associated with higher pNFL levels were advanced age, renal dysfunction, lower body mass index, prior stroke/transient ischemic attack and female sex. In multivariable analyses, pNFL was a stronger risk indicator for ischemic stroke than any clinical factor, including previous stroke (Figure 2), and of similar prognostic importance as NT-proBNP. pNFL was independently associated with ischemic stroke (per doubling of pNFL, hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.01-1.50, p=0.038), all-cause death (HR 1.30, 95% CI 1.12-1.51, p&lt;0.001) and heart failure (HR 1.30, 95% CI 1.09-1.54, p=0.003) when adjusting for both clinical characteristics and other biomarkers including NT-proBNP. pNFL improved the discriminatory value (c-index) for ischemic stroke from 0.676 to 0.686 (p=0.038) when added to a fully adjusted model including NT-proBNP.

Conclusions
In patients with AF, pNFL was associated with an increased risk of ischemic stroke, independent of clinical characteristics and NT-proBNP. pNFL was a stronger risk factor for ischemic stroke than previous stroke and of similar prognostic importance as NT-proBNP. pNFL may be a novel plasma biomarker improving the evaluation of the risk of ischemic cerebral events in patients with AF.Stroke risk by pNFL quartile groupVariable importance for ischemic stroke
Left atrial appendage morphology and mitral annular plane systolic excursion predict stroke in patients with atrial fibrillation and high thromboembolic risk
Authors: Sarb A , Lazar R D , Zehan I G , Schiop-Tentea C P , Coseriu G , Apetrei C A , Moldovan M , Mocanu L , Jelnean M , Sarb O F , Gusetu G , Serban A , Chiorescu R , Pop S , Blendea D 
Published: November 2023

Abstract

Background
Previous research has revealed a relationship between the morphology and function of the left atrial appendage (LAA) and the rate of thromboembolic events in patients with atrial fibrillation (AF). There is limited data on the impact of the left ventricular (LV) function on LAA thrombus formation. Emptying of the LAA depends on the active contraction of this structure as well as on the passive motion due to external compression from the LV base during ventricular diastole.

Purpose
Given these considerations the goal of this study was to investigate by transesophageal and transthoracic echocardiography the morphology and function of the LAA in relationship with the LV function and to assess the impact on incidence of stroke in a group of patients with AF with high thromboembolic risk who underwent TEE-guided direct current cardioversion.

Methods
We included 148 patients (age 65 ±11 yrs, 79men, median CHA2DS2-VASc score 4 (IQR 2-6), left ventricular ejection fraction 48±11%), who underwent transesophageal echocardiography before cardioversion. During a median follow-up period of 23 months (range 1-107) 34 patients developed stroke or TIA.

Results
The distribution of the four LAA morphologies (Figure 1) was: Cactus [47 (32%)], Cauliflower [30 (20%)], Windsock [38(26%)], and Chicken Wing [33 (22%)].
During the follow-up period stroke/TIA occurred significantly more frequently in patients with cactus or cauliflower LAA morphology vs. patients with windsock or chicken wing morphology (25 (35%) vs 9 (11%); p value=0.001). Patients who developed stroke or TIA had significantly lower MAPSE vs patients with event free survival (8±3 vs 12±3mm; p value=0.001).
Kaplan-Meier survival curves for different categories of MAPSE and LAA morphology are shown in Figure 2. The significant relationship between MAPSE and stroke-free survival was retained in Cox multivariable analysis that included LAA morphology, CHA2DS2-VASc score and AF types. This association was present whether MAPSE was entered into the multivariable model as a continuous or dichotomized variable.

Conclusions
In patients with high thromboembolic risk, MAPSE predicts the occurrence of stroke independent of LAA morphology and CHA2DS2-VASc score. This phenomenon could be related to the impact LV diastole on LAA emptying.
The prognostic value of atrial fibrillation in patients with cardiac sarcoidosis
Authors: Fujimoto Y , Matsue Y , Maeda D , Dotare T , Sunayama T , Akama Y , Yoshioka K , Kitai T , Naruse Y , Taniguchi T , Tanaka H , Okumura T , Baba Y , Nabeta T , Minamino T 
Published: November 2023

Abstract

Background/Introduction
The prognostic value of the presence of atrial fibrillation (AF) at the time of diagnosis in patients with cardiac sarcoidosis (CS) is unknown.

Purpose
The aim of this study is to investigate the association between the presence of AF at the time of diagnosis of CS and prognosis.

Methods
This study is a post-hoc analysis of ILLUMINATE-CS (Illustration of the Management and Prognosis of Japanese Patients With Cardiac Sarcoidosis), a multicenter, retrospective, and observational study that evaluated the clinical characteristics and prognosis of cardiac sarcoidosis. The primary endpoint was the combined endpoint of all-cause death and heart failure hospitalization.

Results
After excluding 32 patients with missing data about the presence of AF, 480 patients with CS (61.6±11.4 years, 36% men) diagnosed according to current guidelines were analyzed, and 86 primary endpoints were observed during a median follow-up period of 3.3 (interquartile range, 1.8-6.0) years. Patients with AF were associated with older age, higher levels of brain natriuretic peptide (BNP), and the prevalence of heart failure admission compared to those without AF. Kaplan-Meier curve analysis indicated that AF was significantly associated with a high incidence of primary endpoints (log-rank P=0.002), and this association was retained even after adjusting for known risk factors including log-transformed BNP and left ventiricular ejection fraction (LVEF) (hazard ratio, 2.10 [95% CI, 1.16-3.82]; P=0.015).

Conclusion
The presence of atrial fibrillation at the time of diagnosis in patients with cardiac sarcoidosis is independently associated with adverse events.