bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of the new risk score to predict occurrence of atrial fibrillation early after acute myocardial infarction
Authors: Iwakura K , Onishi T , Okamura A , Koyama Y , Hirao Y , Tanaka K , Iwamoto M , Tanaka N , Okada M , Watanabe H , Nakatani D , Hikoso S , Sakata Y , Sakata Y 
Published: October 2022

Abstract

Background/Introduction
New onset of atrial fibrillation (AF) is associated with adverse short- and long-term outcomes after acute myocardial infarction (AMI), and its prediction is relevant for the risk stratification in patients with AMI. Although several risk scores were developed for AF in the general population, there is no established risk score for AF occurrence after AMI.

Purpose
To develop a risk score to predict occurrence of AF early after AMI.

Methods
We enrolled consecutive 751 patients with AMI who admitted to our hospital between April 2006 and September 2012 for the present study. New occurrence of AF was defined as AF detected during hospital stay in a patient showing normal regular sinus rhythm at admission. Parameters relevant to the occurrence of AF was selected from the clinical characteristics, physical status and blood test data at admission, and peak CK/CK-MB, by stepwise logistic regression analysis. We constructed a risk score model to predict the new occurrence of AF, using selected parameters and their logistic regression coefficients. C-statistics was determined by constructing a receiver operating characteristic curve to evaluate the accuracy of the risk score for prediction of AF occurrence.

Results
We excluded 48 patients (6.4%) who had AF at admission, and 208 patients without sufficient data at admission, and thus, the study group consisted of 459 patients (age; 65±13 years, male gender; 79.6%). New AF occurrence was observed in 72 patients (14.5%). The following 7 parameters was selected as parameters related with AF (as p&lt;0.1); Inferior/posterior AMI, use of β blockers, use of diuretics, single vessel disease, absence of reperfusion therapy, systolic blood pressure (sBP) at admission, and smoking. One point was given to sBP&gt;128mmHg, 2 points to absence of reperfusion, and one point to other parameters. Sum of these points was calculated as the AF risk score (Table 1). AF occurred in 27.1% of patients with ≥5 points whereas it was observed 5.2% of those with &lt;5 points. C-statistics of the risk score was 0.75 (95% CI 0.68–0.83).

Conclusion
We developed a novel risk score to estimate the risk of AF occurrence early after AMI, which can be a useful tool for the risk stratification after AMI.

Funding Acknowledgement
Type of funding sources: None.
Prognosis of low-flow low-gradient aortic valve stenosis with atrial fibrillation
Authors: Nishinarita R , Arao K , Sugisaki K , Yamashita T , Yozawa A , Kasahara T , Mase T 
Published: October 2022

Abstract

Background
Patients with Low-flow low-gradient (LFLG) aortic valve stenosis (AS) have possibly poor prognosis. Recently, it was reported that the LFLG AS patients have similar outcomes compared to high-gradient (HG) patients but worse outcomes compared to the normal-flow low-gradient [NFLG: SVi≥35 ml/m2, mPG &lt;40mmHg] subgroup. The main determinant of LF state in severe AS patients with preserved LVEF are male gender, heart rate, LV volume and atrial fibrillation (AF). However, the relationship between the comorbidity with AF in LFLG AS and the risk of heart failure (HF) remains unclear.

Purpose
We elucidated about the prognosis of LFLG AS with AF.

Methods
We included 225 consecutive patients with severe AS (SAS, iAVA&lt;0.6 cm2/m2) from 2013 to 2020. Among these patients, high-gradient SAS [HG-SAS; mean pressure gradient (mPG) ≥40 mmHg, n=88] and LFLG AS [stroke volume index (SVi) ≤35 ml/m2, mPG &lt;40 mmHg, n=82] patients was extracted and the baseline characteristics including the presence or absence of AF were evaluated. The primary endpoint was worsening HF that required unplanned hospitalization or readjustment of HF drug therapy.

Results
Among patients with HG SAS and LFLG AS, worsening HF was observed in 65 patients. LFLG AS patients exhibited a higher oral rate of renin-angiotensin-system inhibitors (p=0.02). In addition, SVi and E/e' was lower in LFLG AS patients compared with HG SAS [SVi; 29.4 (24.4–34.0) versus 37.7 (28.2–45.3), p&lt;0.0001, E/E'; 16.0 (13.1–21.5) vs 20.9 (16.0–27.4), p=0.002]. There is no differences between 2 groups in AF prevalence. Furthermore, 2 groups were subdivided as follow; HG SAS with AF (n=25), HG SAS without AF (n=63), LFLG AS with AF (n=24), LFLG AS without AF (n=58). The Kaplan Meier curves demonstrated LFLG SAS with AF experienced higher rate of worsening HF compared with HG SAS without AF and equivalent rate of worsening HF compared with HG SAS with AF (log rank, p&lt;0.001). In the Cox hazard analysis among the LFLG AS patients, LFLG AS with paroxysmal AF (pAF, n=12) instead of chronic AF (cAF, n=12) showed a higher risk for worsening HF compared with those without AF (HR 5.0; 95% CI, 1.8–14; p=0.0028, HR 1.9; 95% CI, 0.62–5.8; p=0.26, respectively).

Conclusion
LFLG AS with AF exhibited a poor prognosis for HF compared with HG SAS without AF and equivalent rate of worsening HF compared with HG SAS with AF. Furthermore, the presence of pAf was associated with an increased risk of HF in patients with LFLF AS. Thus, intervention including drugs and catheter ablation for pAF in LFLG AS patients could lead to prevent worsening clinical outcomes.

Funding Acknowledgement
Type of funding sources: None.
Untreated sleep apnea and left atrial dilatation in patients with atrial fibrillation prior to catheter ablation
Authors: Tanaka N , Okada M , Tanaka K , Harada S , Kawahira M , Hirao Y , Onishi T , Koyama Y , Fujii K , Watanabe H , Okamura A , Iwakura K 
Published: October 2022

Abstract

Background
Sleep apnea and left atrial dilatation are both risk factors for an arrhythmia recurrence after catheter ablation (CA) of atrial fibrillation (AF). Negative intrathoracic pressure fluctuations during an obstructive apnea episode may cause the left atrium to distend and stretch its wall. Whether sleep apnea is associated with left atrial dilatation in patients receiving CA of AF remains unknown.

Purpose
We sought to elucidate whether moderate or severe untreated sleep apnea was associated with left atrial dilatation in patients with AF before CA.

Methods
This study was conducted under a retrospective, single-center, observational design. The data were derived from screening tests for sleep apnea, which were routinely performed in patients scheduled to receive CA of AF in our institution. After excluding patients who were already diagnosed with sleep apnea, we enrolled 1265 consecutive patients (age 65±11 years, 27.8% females, and 46.2% of non-paroxysmal AF) who underwent both home sleep apnea testing and multidetector computed tomography (MDCT) before the CA of AF. The severity of the sleep apnea was evaluated by the apnea-hypopnea index (AHI) using a watch-type peripheral arterial tonometry. Left atrial dilatation was evaluated by the left atrial maximum volume (LA max V) using 256-slice MDCT.

Results
The age was 65±11 years, 27.8% were females, and 46.2% had non-paroxysmal AF. The mean AHI was 20.3±15.3 and LA max V 105±34 ml (R2=0.075, p&lt;0.0001). LA dilatation was defined by larger than mean LA max V (LA max V≥105 ml). We examined an LA max V≥105 ml as a predictor. After an adjustment by an advanced age (≥65 years), non-paroxysmal AF, male sex, obesity, hypertension, and congestive heart failure, all of which were significant predictors of an LA max V≥105ml in the univariate analysis, moderate or severe sleep apnea (AHI≥15) was a significant predictor of an LA max V≥105 ml (odds ratio 1.63, 95% confidence interval 1.24–2.14, p=0.0005).

Conclusion
Among the patients scheduled to receive catheter ablation of AF, moderate or severe sleep apnea was independently associated with left atrial dilatation.

Funding Acknowledgement
Type of funding sources: None.
Incidence and risk factors for residual adverse events despite anticoagulation in atrial fibrillation: results from phase II/III of the GLORIA-AF registry
Authors: Ding W Y , Lane D A , Gupta D , Huisman M V , Lip G Y H 
Published: October 2022

Abstract

Background
Residual risk of ischaemic stroke despite anticoagulation in patients with atrial fibrillation (AF) remains poorly investigated. We aimed to evaluate the incidence and risk factors for residual adverse events in AF.

Methods
Using data from phase II/III of the prospective GLORIA-AF registry, we studied anticoagulated patients from 935 centres across 38 participating who were consecutively enrolled with newly diagnosed AF and an increased risk of stroke (CHA2DS2-VASc ≥1). The primary outcome of interest was ischaemic stroke. Secondary outcomes were all-cause death, cardiovascular (CV) death and myocardial infarction. Risk factors for residual ischaemic stroke were identified using Cox proportional hazards analyses.

Results
22410 patients were included; median age 65 (IQR 71–78) and 10044 (44.8%) females. Over 3.0 (IQR 2.2–3.1) years, the incidence per 100-PYs of ischaemic stroke was 0.60 (95% CI, 0.54–0.67), all-cause death 3.22 (95% CI, 3.08–3.37), CV death 1.08 (95% CI, 1.00–1.16) and myocardial infarction 0.59 (95% CI, 0.53–0.66). Using multivariable Cox proportional hazards analysis, independent predictors of residual ischaemic stroke were age (HR 1.05 [95% CI, 1.03–1.06]), diabetes mellitus (HR 1.42 [95% CI, 1.09–1.85]), prior thromboembolism (HR 2.32 [95% CI, 1.79–3.00]), chronic obstructive pulmonary disease (HR 1.53 [95% CI, 1.04–2.26]) and use of anti-arrhythmic drugs (HR 0.70 [95% CI, 0.51–0.96]). The incidence of ischaemic stroke was comparable among patients treated with non-vitamin K antagonist oral anticoagulants vs. vitamin K antagonist; however, there were differences in the independent predictors between both groups.

Conclusion
Patients with AF remain at significant risk of ischaemic stroke despite anticoagulation therapy. Risk factors for residual ischaemic stroke were prior thromboembolism, age, persistent AF, diabetes mellitus, chronic obstructive pulmonary disease and non-use of anti-arrhythmic drug therapy. This emphasises the need to treat these risk factors, if modifiable, beyond antithrombotic therapy.

Funding Acknowledgement
Type of funding sources: None.
Impact of the atrial fibrillation better care pathway in clinically complex patients with atrial fibrillation: a report from the ESC-EHRA EORP-AF General Long-Term Registry
Authors: Romiti G F , Proietti M , Vitolo M , Bonini N , Fawzy A M , Ding W Y , Fauchier L , Marin F , Nabauer M , Dan G A , Potpara T , Boriani G , Lip G Y H 
Published: October 2022

Abstract

Background
Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The “Atrial fibrillation Better Care” (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We analyzed the impact of the ABC pathway in a contemporary cohort of clinically complex AF patients.

Methods
From the ESC-EHRA EORP-AF General Long-Term Registry, we analyzed clinically complex AF patients, defined as the presence of frailty (according to a 40-items Frailty Index), multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on the risk of all-cause death, major adverse cardiovascular events (MACEs) and the composite outcome of all-cause death and MACE was analyzed through Cox-regression analyses, and delay of event (DoE) analyses; number needed to treat (NNT) was also estimated at 1 year of follow-up.

Results
Among 9,966 AF patients, 8,289 (92.3%) were clinically complex. Risk of all outcomes was higher among clinically complex patient. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.71, 95% CI 0.57–0.89), major adverse cardiovascular events (MACEs, aHR: 0.68, 95% CI 0.53–0.87) and composite outcome (aHR: 0.69, 95% CI: 0.57–0.84). Using cluster analysis, we identified a high clinical complexity group of AF patients. Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.73, 95% CI 0.55–0.96) and composite outcome (aHR: 0.69, 95% CI 0.57–0.84) in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all-cause death (Figure 1), MACEs, and composite outcome in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the NNTs for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome.

Conclusions
An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes amongst clinically complex AF patients.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Since the start of EORP, several companies have supported the programme with unrestricted grants.
The first Brazilian cardiovascular registry of atrial fibrillation: the primary results of the RECALL study
Authors: Lopes R D , Barros E Silva P G , Hoffmann Filho C R , Cavalvante M A , Miranda C M , Esper R B , De Lima G G , Ritt L E F , Silva R M F L , Nakazone M , Zimerman L I , De Souza O F , Fagundes A A , Saad E B , Teixeira R A 
Published: October 2022

Abstract

Background
There is limited prospective real-world evidence of patients with atrial fibrillation (AF) in Latin America.

Methods
The rationale and design of the study were previously published (1). Briefly, RECALL was the first nationwide prospective study of patients in Brazil with known atrial fibrillation. A total of 4,585 patients were included among 89 sites from April 2012 to August 2019. All patients were followed for one year by the protocol. Patient characteristics, medications under use and clinical outcomes during the follow-up were collected.

Results
From the total of patients enrolled, 41 were excluded from the analysis since they did not have a confirmed diagnosis of atrial fibrillation. The median age was 70 (61–78) years, 46% were women and the majority of the cases were permanent AF (53,8%). The mean CHA2DS2VASc was 3.2±1.6 and the median HASBLED was 2 [2–3]. The most common risk factor was arterial hypertension (77.9%). The median heart rate was 74 [65–85] and the mean ejection fraction was 52.2±2.6 (%). Only 4.4% of patients had history of previous ablation and 30.4% were using anti-arrhythmic. At baseline, 22.0% did not use anticoagulants (Figure 1) and 9.1% did not use any antithrombotic therapy. The most common anticoagulant was vitamin K antagonist – VKA (62.6%) while the remaining 37.4% were direct oral anticoagulants. The main reasons for not using an oral anticoagulant were physician judgment's (low risk of stroke – 24.6%) and difficult to control (14.7%) or perform INR (9.9%) while patient preference and adverse event represented respectively 5.3% and 4.1%, respectively. Only 42.5% of the INRs at baseline were between 2 and 3. During follow-up, the use of anticoagulants and INR in the therapeutic range increased to 87.1% and 59.1%, respectively. In one year, 17.8% of patients were hospitalized due to atrial fibrillation. At 1 year, the rates of death, stroke, systemic embolism and major bleeding were 5.76 [5.12–6.47], 2.77 [2.32–3.32] 1.01 [0.75–1.36], 2.21 [1.81–2.70], respectively. Among VKA users, the rate of mortality and bleeding was higher in the group with time in therapeutic range below 60% (Figure 2).

Conclusion
RECALL represents the largest prospective registry of patients with atrial fibrillation in Latin America. Our findings highlight important gaps in the treatment of patients which can inform clinical practice and help to guide future interventions to improve the care of these patients.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Brazilian Society of Cardiology
Left atrial cardiomyopathy and 10-year risk of Atrial Fibrillation
Authors: Uhe T , Stegmann T , Langhammer R , Laufs U , Dagres N , Wachter R 
Published: October 2022

Abstract

Background
Left atrial cardiomyopathy (LACMP) is considered a precursor or prerequisite of incident atrial fibrillation (AF). Various definitions including humoral, ECG- and echocardiographic parameters have been proposed, but not been rigorously and comparatively investigated and the role of excessive supraventricular ectopic activity (ESVEA) is poorly studied. We aimed to analyse the ten-year risk to develop AF in patients with cardiovascular risk factors and to define the impact of LACMP, its components and ESVEA on AF risk.

Methods
148 patients free of AF at baseline were followed for 10 years. Baseline examination included medical history, physical examination, echocardiography, 12-lead-ECG and 7-day-Holter ECG. LACMP was defined as either left atrial enlargement (left atrial volume index (LAVI) &gt;35 ml/m2), P-terminal force in lead V1 (PTFV1) ≤ −4000 ms$cdot$μV or elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) &gt;250 pg/ml. Firstly, we analyzed the association of these parameters on AF-free survival in Kaplan-Meier plots. Secondly, we repeated this analysis for ESVEA (defined as either &gt;720 premature atrial contractions (PAC) per day or at least one atrial run &gt;20 beats per day). Finally, parameters significantly associated with AF-free survival were included in a multivariable analysis to identify those independently predictive for AF.

Results
At baseline, eighty-nine patients fulfilled at least one criterion of LACMP while eight patients fulfilled all criteria. After ten years of follow-up, AF was newly detected in twelve patients (13.4%) with LACMP and two patients (3.4%) without LACMP (p=0.04). LAVI (p=0.005), ESVEA (p=0.016) and NT-proBNP (p=0.010) showed significant association with AF-free survival in univariate analysis while PTFV1 did not. In a combined Cox model of LACMP parameters, significant associations were found for log-transformed NT-proBNP (HR 3.56; 95% CI 1.33–5.31; p=0.04) and log-transformed PAC (HR 2.66; 95% CI 1.25–10.15; p=0.01) but not for LAVI and not for PTFV1.

Conclusion
The risk for AF is higher in patients with evidence of left atrial cardiomyopathy. NT-proBNP and premature atrial contractions independently predict AF-free survival. The role of supraventricular ectopic activity is underestimated and requires further study.

Funding Acknowledgement
Type of funding sources: None.
Linac-based stereotactic arrhythmia radioablation of paroxysmal atrial fibrillation in elderly patients
Authors: Di Monaco A , Gregucci F , Bonaparte I , Troisi F , Surgo A , Di Molfetta D , Vitulano N , Romanazzi I , Quadrini F , Carbonara R , Ludovico E , Guida P , Ciliberti M P , Fiorentino A , Grimaldi M 
Published: October 2022

Abstract

Background
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in 1–2% of the general population. Patients affected by AF have an increased risk of stroke and heart failure and European guidelines recommend catheter ablation of AF in symptomatic patients refractory to antiarrhythmic therapy. In elderly patients, the AF ablation procedure is associated with a higher rate of overall complications. Recently, stereotactic arrhythmia radioablation (STAR) with precise high-dose of radiation was used to treat ventricular arrhythmias.

Purpose
No data were reported in literature about the use of Linac-based STAR, so a prospective phase-II trial was designed to evaluate safety of Linac-based STAR in elderly patients with paroxysmal AF.

Methods
Fourteen patients (mean age 78±6 years; 57% male) were enrolled in the study. All patients had symptomatic paroxysmal AF refractory to antiarrhythmic drugs. All patients performed 1-week ECG-Holter monitoring (ECG-HM) and transthoracic echocardiogram before and after STAR. Primary end-point was defined as all the adverse events of special interest related to STAR treatment; secondary end-point was defined as AF recurrence after the treatment. The study was approved by the local Ethics Committee and all patients signed informed consent.

Results
All patients performed STAR with a mean overall treatment time of 3 minutes. No serious adverse events were documented acutely and after 6 months of follow up. Transthoracic echocardiogram did not show cardiac damage after STAR. The 1-week ECG-HM performed before STAR documented symptomatic AF episodes in all patients. The 1-week ECG-HM performed 1-month after procedure documented frequent symptomatic atrial ectopy and atrial tachycardias without AF recurrences. The 1-week ECG-HM performed 3 and 6 months after procedure did not revealed AF recurrences. Two patients had a single episode of sustained atrial tachycardia 6 months after STAR. Both patients performed a left atrial mapping using CARTO system and Pentaray mapping catheter documenting PV isolation without vein stenosis (figure); no phrenic nerve damage was documented in both patients. All patients had an improvement in quality of life.

Conclusion
Our preliminary data reported for the first time that the LINAC-based STAR approach could represent a valid alternative to perform PVI in elderly patients with paroxysmal AF.

Funding Acknowledgement
Type of funding sources: None.
Mobile health-technology integrated care in elderly atrial fibrillation patients: a report from the mAFA-II randomized clinical trial
Authors: Guo Y , Romiti G F , Proietti M , Bonini N , Zhang H , Lip G Y H 
Published: October 2022

Abstract

Background
The prospective Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) randomized trial demonstrated the efficacy of a mobile health (mHealth) technology implemented “Atrial fibrillation Better Care” (ABC) pathway approach (mAFA intervention) for holistic or integrated care management in reducing the risk of adverse events in in patients with atrial fibrillation (AF). Whether these benefits also apply to elderly patients (who may be less adoptive of mHealth approaches) is unclear.

Purpose
In this ancillary analysis of the mAFA-II trial, we evaluated the effect of the mAFA intervention among elderly AF patients (age ≥75 years).

Methods
The mAFA-II trial enrolled adults AF patients across 40 centres in China between June 1, 2018 and August 16, 2019. The main outcome was the composite outcome of stroke or thromboembolism, all-cause death, and rehospitalization. Effect of the mAFA intervention was assessed through Cox proportional hazard models after the adjustment for baseline risk factors and cluster effect. We also assessed the interaction between age and the mAFA intervention effect on the main trial population.

Results
In this analysis, 1,163 elderly AF patients (mean age: 82.6±5.3 years, 43.1% females) were included, of which 520 were allocated to mAFA intervention and 643 to usual care. The mAFA intervention was associated with a significant reduction of the composite outcome (adjusted hazard ratio [aHR]: 0.58, 95% CI: 0.35–0.97) and rehospitalizations alone (aHR: 0.47, 95% CI: 0.24–0.91). A significant interaction between age and mAFA allocation group was observed for both the composite outcome (p=0.002; Figure 1, Panel A) and rehospitalization alone (p=0.015; Figure 1, Panel B), with the beneficial effect of the mAFA intervention decreasing with increasingly higher age, particularly at age ≥80 years old.

Conclusions
A mHealth-technology implemented ABC pathway is effective in reducing adverse clinical events in older AF patients aged ≥75 years old. The benefits obtained with mAFA intervention were attenuated at extreme ages, especially in those aged ≥80 years old.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This research was funded by the National Natural Science Foundation of China 82170309). This study was an investigator-initiated project, with limited funding by independent research and educational grants.