bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic and invasive evaluation of left atrial pressure in patients undergoing catheter ablation for atrial fibrillation
Authors: Cersosimo A , Arabia G , Inciardi R M , Cerini M , Bonelli A , Dell'era G , Degiovanni A , Spinoni E , Bosco M , Salghetti F , Lombardi C M , Patti R , Metra M , Curnis A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

AIMS
Estimation of left ventricle (LV) filling pressure is one of the most important parameters to provide information in clinical practice. However, the challenging in investigating this parameter through invasive methods makes it difficult to be used.
The study aims to investigate the association between cardiac structure and function derived by transthoracic echocardiography (TTE) and left atrial (LA) invasive pressure (LAP).

Methods
The study was a multi-center prospective study enrolling 73 patients (mean age 65 ± 8, 27% female) undergoing primary catheter ablation for AF. Patients were evaluated and enrolled from June 2021 to April 2022. Complete TTE assessing measures of LV, LA and right ventricle (RV) structure and function including speckle tracking echocardiography, was performed at baseline.
Echocardiographic data have been assessed the same day of the invasive measurement of the LAP during AF ablative procedure. Linear regression analysis has been performed to assess the relationship between measures of cardiac structure and function and LAP. Logistic regression analysis assessed the parameters associated with elevated LAP (≥ 15mmHg).

Results
Baseline clinical characteristics of the study population did not differ according to elevated LAP vs. non-elevated LAP. Patients with elevated LAP showed instead abnormal measures of LV global longitudinal strain, measures of LA structure and function, except for LA maximal volume, and RV structure and function. After multivariable adjustment, including demographic factors and comorbidities, E/e`(p = 0,024), LA minimal volume (p = 0,009), LA emptying fraction (LAEF) (p = 0,012), LA Reservoir (p = 0,039), TAPSE (p= 0,010) and RV free wall strain (p= 0,028), but not LA maximal volume (p=0,11), were significantly associated with LAP. Similarly, these measures, but nor LA maximal volume, were significant determinants of elevated LAP. Overall, LA minimal volume and LAEF showed the best diagnostic accuracy to predict elevated LAP (AUC 0.72 and 0.73, respectively).

Conclusions
Novel measures of LA structure and function, but not standard assessment by LA maximal volume, were significantly associated with LAP in patients affected by AF. These measures, along with measures of LV and RV function may be used in the diagnostic assessment of filling pressure in ambulatory settings.
Association between atrial fibrillation and healthcare costs among patients with cardiac implantable electronic devices
Authors: Peigh G , Zhou J , Roberts A I , Rosemas S C , Longacre C , Schwab G , Soderlund D , Passman R S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Previous research on atrial fibrillation (AF)-related healthcare cost is limited by claims-derived categorization of AF diagnosis and does not assess for incremental differences in cost based on degree of AF burden.

Objective
To directly assess the incremental cost of device detected AF (ddAF), and compare relative costs among cohorts with no AF, paroxysmal AF (pAF), persistent AF (PeAF), and permanent AF (PermAF) in patients with cardiac implantable electronic devices (CIED) capable of sensitive and continuous atrial arrhythmia detection.

Methods
Using the de-identified Optum® Clinformatics® U.S. claims database (2015 to 2020) linked with the Medtronic CareLink® database, we identified CIED patients that transmitted data ≥6 months post-implant (baseline period). Annualized per-patient costs in follow up were analyzed from insurance claims and adjusted to 2020 US Dollars. Total costs were compared between patients with no AF and those with device detected pAF, PeAF and PermAF. Analyses were adjusted for geographical region, insurance type, CHA2DS2-VASc Score, and implant year.

Results
Of the 21,391 patients (72.9±10.9 yrs; 56.3% male) analyzed, 7,798 (36.5%) had ddAF. Among these, 5,966 (76.5%) were pAF (avg burden 2.9±8.6%), 1,145 (14.7%) were PeAF (avg burden 47.2±29.9%), and 687 (8.8%) were PermAF (avg burden 99.3±0.7%). Patients with ddAF had higher overall annualized total healthcare costs than those without ddAF (fig). The incremental annualized increased cost in those with ddAF was $12,789 ± $161,749 per patient. Patients with pAF, PeAF and PermAF all had higher adjusted healthcare costs than those without AF (p for all &lt;0.001). Patients with PeAF and PermAF both had higher total adjusted costs than patients with pAF. In addition, patients with PeAF had higher healthcare costs than those with PermAF (fig).

Conclusions
In the present analysis of CIED patients, ddAF was associated with increased healthcare costs after adjustment for clinical and demographic covariates. Among those with ddAF, patients with PeAF had the highest healthcare costs. Preventing development of AF, and progression to PeAF, may reduce healthcare costs.
Impact of pulmonary vein anatomy and ostial dimensions on long term outcome after single-shot device guided cryoablation for paroxysmal atrial fibrillation
Authors: Isgandarova K , Bergau L , El Hamriti M , Braun M , Piran M , Imnadze G , Khalaph M , Molatta S , Sciacca V , Fink T , Sommer P , Guckel D , Sohns C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cryoballoon (CB)-guided pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF).

Purpose
Assessment of the role of individual anatomical characteristics to predict long-term freedom from arrhythmia recurrence after CB-guided PVI for paroxysmal AF (PAF).

Methods
353 consecutive patients (58±11 years, 56% males), undergoing PVI between 2012 and 2018 were analysed. Individual pulmonary vein (PV) anatomy was assessed using preprocedural cardiac magnetic resonance imaging (MRI). The impact of PV characteristics and CSA on long-term AF-free survival was evaluated.

Results
Acute PVI was achieved in all patients. 223 patients (63%) had a normal PV anatomy. Variant PV anatomy was present in 130 patients (37%). During the observation period of 48 months AF-recurrence was documented in 167 patients (47 %). Patients with AF-recurrence presented with significantly enlarged right-sided PVs and left superior PVs (LSPVs) (p&lt;0.001). The presence of left common PVs (LCPVs) (n=75, Log-rank p&lt;0.001) as well as right variant PVs (n=35, Log rank p&lt;0.001) was associated with a significantly worse long-term AF-free survival rate compared to patients with normal PV characteristics.

Conclusion
Variant PV anatomy predicted long-term AF-recurrence. Preprocedural imaging may help to improve patients’ selection for single-shot device guided PVI.
Reduction of major gastrointestinal bleeding risk with proton pump inhibitor therapy in patients with atrial fibrillation receiving direct oral anticoagulant
Authors: Lee S R , Choi E K , Lee S W , Ahn H J , Kwon S , Han K D , Oh S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This research was supported by a grant from the Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC21C0028).

Background
In patients with atrial fibrillation (AF) receiving direct oral anticoagulant (DOAC), gastrointestinal bleeding (GIB) is itself a serious event for the patient, and it causes an increase in the thromboembolic risk caused by discontinuation of anticoagulation therapy. There are limited data on the benefit of preventive PPI use to reduce the risk of GIB in DOAC users.

Methods
We included patients with AF receiving DOAC from 2013 to 2020 based on the Korean Health Insurance Review and Assessment database. For comparison between patients with and without PPI, propensity score (PS) weighting method was used. Primary outcome was major GIB and secondary outcomes were major upper GIB and upper GIB requiring transfusion.

Results
A total of 171,494 patients were included (mean 72±10 years, mean CHA2DS2-VASc 4.3±1.8; 50,577 of rivaroxaban, 23,010 of dabigatran, 54,461 of apixaban, and 43,446 of edoxaban). Among the total population, 40% of patients were prescribed PPI and 55% of PPI users were prescribed low dose PPI. After PS weighting, patients with PPI were associated with lower risks of major GIB, major upper GIB, and upper GIB requiring transfusion than those without PPI (hazard ratio [95% confidence interval]; 0.816 [0.758-0.878], 0.834 [0.770-0.901], and 0.814 [0.734-0.902], respectively, Figure A). Patients with low dose PPI showed significant risk reduction for major GIB, major upper GIB, and upper GIB requiring transfusion than those without PPI (0.570 [0.515-0.632], 0.563 [0.505-0.628], and 0.505 [0.435-0.587], respectively). The protective effect of PPI was slightly different among DOAC types (Figure B). In the subgroup analyses, major GIB risk reduction of PPI co-therapy was more accentuated in patients older than 75 years and those with underlying GI disease or symptoms.

Conclusion
In this largest Asian cohort of patients with AF receiving DOAC, PPI co-therapy might be beneficial to reduce the risk of major GIB and upper GIB. This was consistently observed with low-dose PPI. The protective effect of PPI was more pronounced in the high bleeding risk patients.
Clinical profile and arrhythmic burden in MINOCA
Authors: Lypovetska S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is considered to be a puzzling clinical phenomenon with unclear prognosis. This study aims to compare the clinical characteristics, impact of arrythmias and prognosis of MINOCA with MI with obstructive coronary artery disease (MICAD).

Methods
Data was obtained from our university hospital database. Patients with MI between 28 August 2018 and 31 December 2020 were included in the study. Subjects were divided in 2 groups: 1 - MINOCA; 2 -MICAD. Follow-up analysis included death from any cause, major adverse cardiac events (MACE: cardiac death, MI, stroke), readmissions due to cardiovascular causes, and in-hospital mortality. Median follow up was 18 months.

Results
MINOCA occurred in 49 (11 %) out of 443 pts with MI. There were no differences in age (p=0.732). In MINOCA group there were more females (34.7% vs 22.8%, p&lt;0.001), never smokers (30.6% vs 21.8%, p&lt;0.001), lower rates of hypertension (67.3% vs 73.8%, p=0.036), diabetes (18.3% vs 29.9%, p&lt;0.001), hyperlipidaemia (28,5 % vs 35.7%, p=0.475), stroke in anamnesis (2.0% vs 6.8%, p&lt;0.001), preavious MI (2.0% vs 22.8%, p&lt;0.001). Symptoms at admission didn't differ between the two groups, however MINOCA group had lower mean heart rate (72±15 vs 87±19, p&lt;0.001), lower systolic arterial pressure (139±22 vs 145±28, p&lt;0.001).
There were no significant differences between STEMI or NSTEMI: 55.1 % and 44.9 % in the MINOCA group vs 53.8 % and 46.2 % in MICAD (p=0.534). MINOCA patients had lower C-RP levels (19 vs 56 mg/L, p&lt;0.001), high-sensitivity cardiac troponin T levels: (112 vs 376 ng/L, p&lt;0.001) and lower BNP levels (99±26.9 vs 142±64.2, p&lt;0.001). Left ventricular dysfunction (EF &lt; 50 %) was more prevalent in the MICAD group (16.3% vs 27.9%, p&lt;0.001). There was no need in inotropic support in MINOCA patients (0% vs 4.8%, p=0.04).
Atrial fibrillation (AF) was more often found in MICAD group (4.1% vs 6.8%, p &lt;0.001). There were no diffrenecs in ventricular arrhythmias during admmision in both groups. Death rates were lower in hospital (0% vs 2.8%, p=0.131) and during the follow up period (8.1% vs 10.9 %, p=0.369). There was no significant difference in MACE outcomes (p=0.612) and readmission of cardiovascular causes (p=0.310) in both groups. Independent predictors for MACE in MINOCA patients were older age (≥60 years), females, reduced LVEF and atrial fibrillation.

Conclusion
MINOCA patients had lower prevalence of classic cardiovascular risk factors, no clinical differences at admission, lower levels of C-RP and high-sensitivity cardiac troponin T, preserved left ventricle EF, lower in- hospital and during follow up death rate, but no significant difference in MACE outcomes. Older age, females, reduced LVEF and atrial fibrillation are considered to be predictors of MACE in MINOCA. Further research is needed to provide more evidence on the optimal management.
Effect of history of atrial arrhythmias on the rate of recurrent stroke in patients after PFO closure
Authors: Jiravsky O , Gajdusek L , Hudec M , Balusik J , Chovancik J , Kufova P , Miklik R , Sknouril L , Januska J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Although the importance of persistent foramen ovale (PFO) closure is well established, it is far from complete its role in patients with atrial arrhythmias. Patients with a history of atrial arrhythmias, especially younger and healthy persons with PFO after a stroke, are indicated for PFO closure. This is despite the uncertainty of whether atrial arrhythmia (it means silent atrial fibrillation) is the actual cause of the stroke.

Objectives
To describe prospective observations comparing cohort PFO closure patients with and without atrial arrhythmias.

Method
A retrospective analysis of the real world of a prospective registry of patients after PFO closure. This is a set of patients from one cardiac center over 19 years; each patient was followed up once a year for seven years. The recurrence of ischemic stroke was monitored.

Results
A total of 712, 378 females (53.1%) and 334 males, aged 50 (+/-12) years, were indicated for PFO closure mostly due to stroke (436 i.e. 61.4%) and systemic embolization (56 i.e. 7.9%). DM was present in 55 patients ( i.e. 7.7%), and arterial hypertension was also in 306 patients (i.e. 43%). See other demographic data in Table 1. A history of atrial arrhythmias ( salvage SVES or intrinsic atrial fibrillation) before PFO closure was described in 50 patients ( 7.1%). During the 7-year follow-up, recurrent stroke was detected in a total of 14 cases, 13 in the group without previous arrhythmic history (4.3%) and 1 with previous arrhythmic history (3.8%, p=0.912). A surprising finding was the statistically higher representation of women in the cohort with previous arrhythmic history (p=0.001), in the cohort of shorter (p=0.012) and thinner (p=0.022) women, and thus in the cohort with lower BSA (p=0.006). On the other hand, unsurprisingly, there was a statistically higher proportion of diabetics (p0.024) and patients with coronary artery disease (p=0.013) in the cohort with atrial arrhythmias in the pre-hospital period. Detailed results are in table 1.

Conclusion
There was no difference in the incidence of recurrent stroke between the cohorts of patients with and without a prior history of atrial arrhythmias in the seven-year follow-up after PFO closure. The cohort of patients with a previous history of atrial arrhythmias was, unsurprisingly, statistically larger in patients with diabetes and coronary artery disease.
Systolic, diastolic blood pressure and pulse pressure and risk of stroke in young aged patients with atrial fibrillation
Authors: Lee S R , Choi E K , Ahn H J , Lee S W , Han K D , Oh S , Lip G Y H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
It is well-known that higher blood pressure (BP) is associated with a higher risk of stroke with atrial fibrillation (AF). However, there is limited data about the effect of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) on the risk of ischemic stroke in young and low-risk AF patients

Methods
Using the Korean Health Insurance Service database, patients who were newly diagnosed with AF between January 2009 and December 2016 and had health screening examination data within 2-year after AF diagnosis were included. Patients aged between 20 and 39 years were finally included in this analysis. During follow-up, incident ischemic stroke was evaluated as a primary outcome. Hazard ratio (HR) and the corresponding 95% confidence intervals (CI) were calculated using multivariable Cox proportional hazard models.

Results
A total of 15,980 patients were included in this analysis (mean age 32.4±4.8 years, 66.9% of men). Mean CHA2DS2-VASc score was 0.7±0.8 and oral anticoagulation rate was 5.6%. During a median 5.2-year of follow-up, 73 patients had an incident ischemic stroke (incidence rate, 0.9 per 1,000 person-years). After multivariable adjustment, SBP ranging from 140 to 159 mmHg and 160 mmHg or higher were associated with a significantly higher risk of ischemic stroke by 8.4-fold and 11.6-fold compared to SBP under 100 mmHg (Figure). DBP 95mmHg or higher was associated with a higher risk of ischemic stroke by 4.2-fold than DBP under 65 mmHg (Figure). Patients with PP ranging from 50 to 59 mmHg and 60 mmHg or higher showed a significantly higher risk of ischemic stroke than those with PP ranging from 40 to 49 mmHg (HR [95% CI]; 1.81 [1.04-3.18] and 3.15 [1.49-6.64], respectively). Also, lower PP than 30 mmHg was associated with a higher risk of stroke (3.96 [1.36-11.53]).

Conclusion
Optimal BP control might be crucial to preventing ischemic stroke in these young and low-risk AF patients.
Electrophysiological findings in HFpEF patients presenting for AF ablation
Authors: Lee J , Sponder M , Stojkovic S , Riesenhuber M , Hammer A , Hofbauer T , Sulzgruber P , Burger S , Kastl S , Schoenbauer R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
The prevalence of atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFpEF) patients is high. Impaired left atrial (LA) function is a major determinant in HFpEF. The extent of arrhythmogenic left atrial tissue degeneration in HFpEF patients is unknown.

Methods and results
We prospectively enrolled consecutive patients presenting for first time AF ablation. Each patient underwent baseline laboratory and transthoracic echocardiography assessment. The HFA-PEFF score was utilized to identify HFpEF patients. Bipolar high density voltage mapping [1213 (825 to 1606) mapping points] was created in sinus rhythm prior to PVI to evaluate the general LA bipolar voltage and quantify areas of low voltage, a well known surrogate for fibrosis and arrhythmogenesis.
160 patients were enrolled (55 % male). 42 patients (26 %) suffered from HFpEF. Low voltage areas (LVAs) were present in 84 patients (53 %).
HFpEF was associated with generally decreased LA bipolar voltage (0.95 ± 0.45 mV vs. 1.59 ± 0.91 mV respectively; p &lt; 0.001) (Fig. 1) and predictive for the existence of low voltage areas (81 % vs. 45 % low voltage area positive, respectively; p = 0.006). The HFA-PEFF score inversely correlated with LA bipolar voltage (r = - 0.380; p &lt; 0.001) (Fig. 1). Furthermore, the HFA-PEFF score closely correlated to the extent of LVAs (r = 0.275; p = 0.001) and to the low voltage amplitude of atrial myocardium excluding areas of low voltage (r = - 0.403; p &lt; 0.001).

Conclusion
HFpEF is highly predictive for generally decreased LA bipolar voltage and for the existence of fibrotic and arrhythmogenic left atrial tissue degeneration.
Association of cardiac rhythm with cognitive performance in atrial fibrillation patients
Authors: Mosher L , Coslovsky M , Hennings E , Aeschbacher S , Paladini R E , Bonati L H , Conen D , Kuehne M , Osswald S , Meyer-Zurn C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation,

Background
Atrial fibrillation (AF) is strongly associated with an increased risk of cognitive decline and dementia. AF-induced cerebral hypoperfusion, caused by loss of atrial contraction and RR interval variation, is discussed as one possible underlying mechanism. However, the short-term association between heart rhythm and cognitive performance is not clear. Here, we aimed to investigate the association of rhythm (AF vs. sinus rhythm, SR) with cognitive performance in AF patients.

Methods
We enrolled patients from a prospective, multicenter cohort study. At study visits, patients underwent 5-minute resting ECG recordings and extensive cognitive testing including the Montreal Cognitive Assessment (MoCA) and cognitive construct score (CoCo). Multivariable adjusted mixed effect linear regression models were used to investigate the association between acute heart rhythm on ECG (AF vs. SR) and cognitive performance. Further, we investigated the association between heart rhythm and the Geriatric Depression Score (GDS) as well as the European Quality of Life Visual Analogue Scale (EQ-VAS 100).

Results
5206 ECGs from 1648 AF patients were available for analysis. 46% of ECGs were in AF. Mean age of the patients was 72 years and 27% were females. After adjustment for pre-defined covariables, we did not identify an independent association between heart rhythm (AF vs. SR) and cognitive performance in any test. However, patients with present AF on ECG had reported worse GDS and EQ-VAS 100 scores.

Conclusion
In our large cohort of AF patients, there was no acute association between heart rhythm (AF or SR) and cognitive performance.