bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is there a role for conicity index in 10-year risk cardiovascular disease prediction?
Authors: Candjondjo A , Quintal J , Rato Q , Melo E , Sousa J , Jose M , Casas J , Coelho R , Farinha J , Fatima A , Feereira J , Lopes A , Goncalves S , Seixo F , Caria R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular disease (CVD) is the leading cause of death globally and one of the most frequent causes of disability. Therefore, the complete and correct evaluation of cardiovascular risk factors is essential to timely prevent CVD. Once central obesity is related with the amount of visceral adipose tissue - an independent predictor of CVD risk - its assessment may play an important role in 10-year CVD prediction. The conicity index (C-Index) assesses central adiposity but there is limited data regarding its role in 10-year CVD risk prediction.

Purpose
To evaluate the role of C-Index in predicting 10-year risk of fatal and non-fatal CVD according to SCORE2 and SCORE2-OP models in a moderate-risk country population.

Methods
We conducted a cross-sectional study in a Portuguese population sample. Individuals aged 40-90 years without known established Atherosclerotic Cardiovascular Disease, Diabetes mellitus, Chronic Kidney Disease or Familial Hypercholesterolemia were included in the study through a local cardiovascular (CV) screening event in Portugal, during May 2022. The C-Index was calculated for each individual according to the Valdez’s formula. For CVD risk assessment, we used the cut-offs values proposed by Pitanga et al. 1.18 for women and 1.25 for men. The population was divided into two groups according to the C-Index (risk high versus low). The 10-year risk of fatal and non-fatal CVD was calculated using SCORE2 and SCORE2-OP models.

Results
A total of 431 individuals were enrolled in this study. Median age was 71 years (Q1-Q3: 65-75) and 66.8% of were women. A total of 48.1% had hypertension, 38.3% dyslipidemia, 25.5% obesity and 6.6% were active smokers. Overall, 387 (90.2%) individuals were found to have elevated C-Index (SCORE2/2-OP mean± DP: 14.99± 7.56 versus 09.81± 3.37), of which 259 were female. In the univariate analysis, there was a correlation between C-Index and estimation of the Risk Cardiovascular Disease according to SCORE2/2-OP but was not statistically significant (Exp (beta) 95 % (CI):2.52 (-2.06-7.10, p=0.28)). However, in the multivariable linear regression analyzes the variable waist circumference (Exp (beta) 95 % (CI)18.47 (4.69 – 32.24, p&lt;0.001)) was independent predictive factor related to the Risk of Cardiovascular Disease according to SCORE2 and SCORE2-OP.

Conclusions
In the present study most of the patients were categorized into high-risk category. Conicity index was not significantly correlated with estimation of the Risk of Cardiovascular Disease according to SCORE2 and SCORE2-OP models, but the variable waist circumference (Exp (beta) 95 % (CI)18.47 (4.69 – 32.24, p&lt;0.001)) was an independent predictive factor related. More studies are needed to assess the role of C-Index in CVD risk prediction.
Double rhythm mapping for coherent electrophysiological substrate characterization in atrial fibrillation patients
Authors: Grossi B , Pagani S , Taormina A , Ceriotti C , Poggio L , Galimberti P , Battaglia V , Del Monaco G , Gregusova N , Latini A C , Valcher S , Stankowski K , Mincione G , Condorelli G , Frontera A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) progresses with a cascade of combined structural, functional, and systemic dysfunctions. Electro-anatomical maps are employed to investigate pro-arrhythmic areas, characterized by abnormal electrical properties. However, single rhythm maps provide only a partial reconstruction: rhythm and wavefront directionality might mask some of these areas.

Purpose
To demonstrate that the combined quantitative analysis of different rhythm maps (i.e., parallel sinus rhythm and paced maps) could allow consistent identification of structural and functional defects sustaining AF.

Methods
Thirty AF clinical procedures have been performed with mapping system support. In particular, a sinus rhythm activation map and a paced map have been created with a multipolar catheter exploiting the parallel mapping feature by setting an extra beat (pacing interval = ERP + 40 ms) every three sinus beats. Areas of abnormal conduction have been identified and a comparison of electrophysiological biomarkers (EGMs voltage and fractionation) among the two rhythms has been performed.

Results
This comparative analysis allowed us to identify both structural and functional electrophysiological phenomena. Specifically, we distinguished: (i) abnormal conduction zones confirmed in both maps, both characterized by signal fractionation and a lower voltage (0,56 ± 0,18 mV) with respect to healthy atrial tissue (2,40 ± 0,41 mV), and (ii) abnormal conduction zones visible in only one of the two maps. In the latter, we distinguished whether the absence of the phenomena was due to wavefront orthogonality to the diseased area (revealed in paced rhythm thanks to a change in wavefront direction) or due to the presence of a functional phenomenon induced by the pacing. In the first group signal fractionation has been detected in both rhythms and a lower voltage has been found (1,79 ± 1,1 mV) with respect to normal conduction zones (3,26 ± 0,98 mV), while in functional cases EGMs fractionation has been identified only in paced maps and no significant difference has been observed in terms of voltage.

Conclusion
Double rhythm mapping provides a more robust characterization of atrial abnormal conduction phenomena. In fact, it allowed the distinction of true structural dysfunctions from dynamic (functional) ones thanks to the different wavefront directionality and rhythm. Moreover, the structural defects have been confirmed by EGMs analysis, which revealed both low voltage amplitude and high fractionation, characteristics that have not been reported in functional cases.
Volumetric quantification of peri-atrial fat inflammation in atrial fibrillation patients
Authors: Vickneson K , Tonko J , Williams M C , Gharaviri A , Dweck M , Baptiste T , Alonso Solis Lemus J , Corrado C , Niederer S , O' Neill M , Whitaker J , Williams S E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Centre for Research Excellence Award III (RE/18/5/34216).
SEW is supported by the British Heart Foundation (FS/20/26/34952). MCW is supported by the British Heart Foundation (FS/ICRF/20/26002)

Introduction
Peri-atrial fat may have pro-inflammatory and pro-fibrotic effects on atrial myocardium and increase the risk of developing atrial fibrillation. Both peri-atrial fat volume and density have been proposed as markers for atrial fibrillation risk, but prior studies considered only single-plane analysis or peri-atrial fat attenuation limited to the posterior left atrium.

Purpose
We aimed to assess total peri-atrial fat volume and attenuation and to explore the relationship between both parameters and the occurrence of atrial fibrillation.

Methods
Contrast-enhanced cardiac computed tomography (CT) imaging was performed pre-ablation in atrial fibrillation patients (n=32) and in control patients (n=37) without atrial fibrillation undergoing investigation for chest pain. We developed a volumetric method for peri-atrial fat segmentation and quantification using seg3D2 and CEMRGapp. Peri-atrial fat volume and attenuation (Hounsfield units, HU) were compared between patients with and without atrial fibrillation in univariable and multivariable analyses. A sensitivity analysis was performed to assess the impact of fat proximity to the left atrial wall.

Results
Atrial fibrillation participants were older (64±11 years vs 58±7 years, P=0.004) and more likely to have a history of coronary artery disease (50% vs 25%, P=0.03). Participants with atrial fibrillation had greater left atrial volume (88±28 ml vs 69±19 ml, P=0.002) and mass (29±6 g vs 14±0.9 g, P=0.018) compared to controls. Peri-atrial fat volume was greater in those with than without atrial fibrillation (18.5±6.6 ml vs 14.2±7.0 ml, adjusted odds ratio (AOR) per ml 1.21; 95% confidence interval [CI] 1.03-1.48), after adjusting for age, body mass index, comorbidities, left atrial dimensions and mass. However, total peri-atrial fat attenuation was not significantly different between groups (-74.8 vs -73.0 HU; AOR per HU 1.01; 95% CI 0.82-1.22). Sensitivity analysis did not identify an interaction between interrogation distance from the left atrial wall and peri-atrial fat attenuation on prevalent atrial fibrillation (p=0.872).

Conclusion
Peri-atrial fat volume, but not attenuation, is associated with prevalent atrial fibrillation. Further mechanistic studies are needed to study the role of peri-atrial fat in atrial fibrillation pathogenesis.
Impact of sleep apnea on left atrial remodeling and stroke risk factors
Authors: Kim D , Lee K N , Roh S Y , Kim D H , Shim J M , Choi J I , Lee D I , Kim Y H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Obstructive sleep apnea (OSA) is associated with left atrial (LA) remodeling, which increases the thromboembolic risk of atrial fibrillation (AF) and recurrence of atrial fibrillation after catheter ablation of AF. This study aimed to assess the association between severity of OSA and LA remodeling.

Method
In 126 patients with AF who underwent catheter ablation for AF (male 78.4% male, 58.0 ± 10 years old, persistent AF 27%), LA voltage distribution were analyzed during atrial pacing. All the subjects underwent polysomnography for screening of OSA. We categorized the subjects into 4 groups based on the severity of OSA which was determined by the respiratory disturbance index (RDI; RDI &lt;5: normal, 5≤RDI&lt;15: Mild, 15≤RDI&lt;30: moderate, 30≤RDI: severe). The presence of stroke risk factors (left atrial appendage [LAA] pulse wave velocity &lt; 20cm/sec, NT pro BNP &gt;1,250 ng/l, presence of spontaneous echo contrast [SEC] and LA volume index &gt;32 ml/m3) were evaluated.

Result
The LA low voltage area was significantly greater (p=0.007) and LA volume measured by cardiac magnetic resonance imaging (MRI) was significantly larger with the severity of OSA (p=0.004). The presence of SEC (3.2% vs. 13.6%; p=0.201) and LAA pulse wave velocity &lt; 20cm/sec (3.2% vs. 9.6%; p=0.454) were higher in patients with moderate to severe OSA but it did not reach statistical significance. In the multivariate regression analysis, the total number of the stoke risk factors other than CHA2DS2-VASc was significantly associated with RDI (β=0.191; p=0.037).

Conclusion
The severity of OSA has significant relationship with stroke risk factors.
Voltage characterization of abnormal conduction zones in patients affected by atrial fibrillation
Authors: Gregusova N , Grossi B , Pagani S , Taormina A , Cariotti C , Poggio L , Galimberti P , Battaglia V , Del Monaco G , Latini A C , Valcher S , Stankowski K , Mincione G , Condorelli G , Frontera A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In case of persistent atrial fibrillation (AF), atrial substrate assumes a dominant role in sustaining the arrhythmia. Recent studies prove that low voltage areas (LVA, Voltage Amplitude &lt; 0,5 mV) represent an additional target for ablation of AF patients.

Purpose
The purpose of this study is to analyse whether structural atrial conduction abnormalities (i.e., pivot sites and slow conduction corridors) may occur outside low voltage areas.

Methods
The study is based on the retrospective analysis of 31 consecutive maps of patients undergoing AF ablation (16 paroxysmal and 15 persistent cases). The clinical procedures have been performed with the support of a mapping system. Sinus rhythm activation maps and bipolar maps used for this analysis have been created with a multipolar mapping catheter. Map points were only acquired when the electrode was in contact with the endocardial tissue to avoid misleading voltage amplitude information. Slow conduction corridors and pivot sites have been analysed. At these sites, EGMs characterization included voltage amplitude (mV), signal duration (ms) and fractionation.

Results
The average value of EGMs amplitude reported at pivot sites and slow conduction zones, respectively, amounted to 2,08 ± 0,63 mV and 2,1 ± 0,66 mV in paroxysmal cases. In persistent cases, there were slight decreased values to 1,95 ± 0,93 mV and 1,89 ± 0,89 mV. Characterization at pivot sites documented a mean duration value of 45,4 ± 4,64 ms and 49,93 ± 5,51 ms in paroxysmal and persistent patients, respectively, while in slow conduction zones 41,53 ± 7,94 ms and 49,04 ± 6,41 ms have been reported. As for fractionation, more than five deflections per signal have been identified in all abnormal conduction areas.

Conclusion
Our study proves that functional electrophysiological phenomena can occur outside low voltage areas, even in persistent cases. According to this analysis, not all LVA represent the correct target for catheter ablation, encouraging the development of further methods for investigation of atrial substrate.
The role of education level in the mortality of hospitalized patients with atrial fibrillation
Authors: Sztaniszlav A , Bjorkenheim A , Magnuson A , Bryngelsson I L , Edvardsson N , Poci D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The association between social status and cardiovascular morbidity and mortality is well­–known. Education level is an important socioeconomic factor which influences the incidence, symptoms, and treatments of atrial fibrillation (AF). However, data about the effects of education level on all-cause mortality in patients with AF are scarce.

Aim
To explore any association between education level and all-cause mortality in patients hospitalized with AF.

Methods
This retrospective cohort study is based on a database created by linking Swedish nationwide registries including all patients hospitalized with an AF diagnose between 1995 and 2003. In all, 158 577 patients were included in the study (56% male and 44% female; mean age 72 ± 11 years). The follow up was 5 years with an observation time of 636 597 person–years. Education level was described by 3 categories representing primary, secondary, and academic education. Kaplan-Meier curves and Cox proportional hazard models adjusted with age, sex, time of index hospitalization, categorized Charlson´s Comorbidity Index (CCI) score, and CHA2DS2-VASc score were used for statistical analysis. Hazard ratio (HR) with 95% confidence interval (CI) was used as estimate of association and P &lt; 0.05 was regarded as statistically significant. The risk of all-cause mortality was estimated in subpopulations defined by mortality risk factors as CCI, CHA2DS2-VASc score, heart failure, coronary artery disease, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, and cancer.

Results
Patients with academic education had the lowest all–cause mortality, which was seen early during follow–up. Compared to patients with primary education, those with secondary or academic education showed lower relative mortality risk in the adjusted Cox regression model (secondary education HR: 0.875, 95% CI: 0.86 – 0.89, p&lt;0.001; academic education HR: 0.695, 95% CI: 0.67 – 0.72; p&lt;0.001).
Among the subpopulations, the HR varied between 0.72 and 0.95 for secondary and between 0.43 and 0.79 for academic education respectively. All risk differences were statistically significant.

Conclusion
Academic education was associated with the lowest and primary education with the highest risk of all-cause mortality. This pattern was consistent through all analyzed subpopulations.
Atrial fibrillation diagnosis in patients with single- and dual chamber ICD devices in England: a real-world cohort study
Authors: Davidson J A , Farrer A , Wan S , Schmetz A , Thompson Hilpert S , Schrader J , Bonhomme C , Pettit S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): BIOTRONIK SE & Co. KG

Background and Purpose
Atrial fibrillation (AF) detection and subsequent treatment is known to be sub-optimal in the general population. It is unclear how implanted devices with atrial sensing contribute to AF diagnosis. This study compares real-world AF diagnosis rates in patients with ICDs without (single chamber ICD, VR ICD) and with atrial sensing (dual chamber ICD, DR ICD) and contrasts them with detection rates in trials which are estimated to be 200 per 1000 person years (Reinhold, 2018).

Methods
Linked primary care data from the Clinical Practice Research Datalink (CPRD), secondary care data from Hospital Episode Statistics (HES) and mortality statistics from the Office of National Statistics (ONS) were used. All patients who received a VR- or DR ICD between 1 April 2016 and 31 October 2020, with at least 12 months primary care registration and no AF diagnosis prior to ICD implant were included in the analysis. Time to AF detection was calculated; in Cox proportional hazards regression analysis comorbidities, age, gender, and disease aetiology were adjusted for. Stroke rates were estimated for the total cohort.

Results
835 patients with a VR ICD and 1034 patients with a DR ICD were identified. Both patient groups had similar comorbidity profiles, with VR ICD patients being on average younger (mean 57.5±13.9 vs 61.5±15.4 years). During 2700 and 3600 person-years follow-up the incidence of new AF diagnoses was 45.6 (CI: 37.6-53.7) per 1000 person years in VR ICD and 54.7 (CI: 47.1-62.4) per 1000 person-years in DR ICD patients. Median time to AF diagnosis was also similar at 36.3 (IQR: 26-49.6) and 36.9 (IQR: 25.2-51.5) months, respectively. In the adjusted analysis, ICD-10 or SNOMED coded diagnosis of AF was not significantly different between groups (HR: 0.88 [95% CI 0.70-1.10]; p-value=0.3). Stroke rates in the total cohort (with or without AF) were 5.7% in the VR ICD and 3.4% in the DR ICD cohort at 36 months.

Conclusion
The analysis highlights a difference between the rate of clinically relevant AF observed in patients with cardiac implanted electronic devices (CIED) in clinical trials and in real-world practice. The occurrence of stroke appears to also be higher in real world practice than in clinical trial populations and this is particularly marked in patients with VR ICD. These findings could indicate low use of remote monitoring or clinician uncertainty about the clinical relevance of CIED-detected AF in the real world. The latter may be because of a still accumulating body of predictive evidence towards the surveillance of AF. We propose that consistent use of remote monitoring with daily transmission in combination with CIEDs with atrial sensing will enable improvement of care.
Surviving critical COVID-19 requiring mechanical ventilation is associated with a high long-term risk of de novo arrhythmic events
Authors: Liliequist A , Svensson P , Hoffmann R , Habel H , Nordberg P , Stahlberg M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Research Council
Swedish Heart- and Lung Foundation

Background
The long-term risk of de novo arrhythmic events after severe COVID-19 requiring intensive care is largely unknown, especially after adjusting for multiple risk factors such as co-morbidities and socio-economic factors.

Objective
The primary objective of this study was to investigate the long-term, co-variate adjusted risk of arrhythmic event after discharge from intensive care unit for critical COVID-19.

Methods
We performed a nationwide case-control study on patients with severe COVID-19 (cases) treated with mechanical ventilation and discharged alive from an intensive care unit. Each case was matched (age, sex, district of residence) with up to 10 population-based control. The study database from the Swedish ICU register was merged with multiple compulsory national registries. The primary outcome was hospitalizations with the following arrhythmias identified: ventricular tachycardia, atrial fibrillation, any other tachy-arrhythmia, or bradycardia/pacemaker implantation. Hazard ratios were adjusted for co-morbidities, socioeconomic status, level of education, region of birth and disposable income. Average follow-up was 12 months.

Results
We included 3 023 patients with severe COVID-19 that were treated with mechanical ventilation at a Swedish ICU (March 1, 2020 to June 8, 2021) and were discharged alive. Control subjects (n= 28,463 ) were selected based on matching by age, sex and district of residence.
The Hazard ratios for the risk of de novo arrhythmic event post ICU discharge for COVID-19 adjusted for age, gender, all comorbidities, level of education, marital status and income were increased between 13.1 – 21.0 in all four types of arrhythmias (Table 1).

Conclusions
We report increased risks for major arrhythmic events following severe COVID-19 even after adjusting for cardiovascular risk factors and for socio-economic factors. These data suggest that at least patients with inherit risk factors for developing arrhythmias in need of ICU treatment for COVID-19 should be closely followed-up after discharge.
Incidence of atrial fibrillation in patients with central retinal artery occlusion: A Systematic Review and Meta-Analysis
Authors: Nedios S , Prakash G , Anjos R , Miguel A , Salangsang J , Hindricks G , Bollmann A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Central retinal artery occlusion (CRAO) is a devastating event and atrial fibrillation (AF) is a recognized cause that may not be present at the time of the event.

Purpose
We performed a meta-analysis for the association of CRAO with the risk of new-onset AF and stroke during follow-up.

Methods
We searched the databases MEDLINE, Embase and SCOPUS from inception to May 2022 for the terms ‘atrial fibrillation’ and ‘retinal artery occlusion’ and identified 205 studies. We excluded duplicates, non-relevant studies and those not reporting new-onset AF after CRAO. We used random effects models to calculate the pooled odds ratio (OR) and 95% confidence intervals (CI) of AF risk in patients with CRAO or stroke in comparison to control groups. Analysis was performed with RevMan 5.4.1 (Cochrane 2020).

Results
We included 7 studies with 1.476 patients with CRAO compared to a control group without CRAO (n=9.843) and a group with stroke (n=7.058). There were 196 new AF cases (13.4%) in 18 months after CRAO. CRAO was associated with a higher risk for new-onset AF (OR:1.59, CI:1.20-2.11, p=0.001) and stroke (OR:2.46, CI:1.74-3.47, p&lt;0.001) when compared to controls. However, the risk for AF after CRAO was similar to that after a stroke (OR:0.83, CI:0.41-1.71, p=0.62).

Conclusions
CRAO is associated with a higher risk for new-onset AF and stroke. AF risk after CRAO though is similar to that after stroke. Thus, CRAO should be regarded as cryptogenic stroke and mandate a closer follow-up with screening for AF and evaluation of early anticoagulation.