Publications

Do Statins Improve Heart Failure Outcome in Post–Myocardial Infarction Patients With Moderate to Severe Left Ventricular Dysfunction?

The authors conducted this retrospective cohort study to assess the influence of statins on heart failure (HF) outcome by enrolling 500 consecutive acute myocardial infarction patients, majority (339 of 500) with moderate to severe left ventricular dysfunction (ejection fraction <40%) between March 2000 and March 2002 with 5.5-year mean follow-up. They were retrospectively analyzed according to whether they were discharged on a statin, and their HF outcome was evaluated independent of overt clinical ischemic events. Mortality in the statin group was 71 of 249 (28.5%; median survival 252 days) vs 48 of 90 (53%; median survival, 141.5 days; P<.001) in the no-statin group. Univariate analysis showed fewer HF readmissions (statin group, 7% vs no-statin group, 32%; P<.001) and HF deaths (statin group, 4% vs no-statin group, 13%; P=.002). Multivariate analysis by logistic regression showed that these effects due to statins are independent of cholesterol levels, age, sex, drugs, revascularization, and implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy. Statins have an important role in independently improving HF outcome in post-myocardial infarction patients with left ventricular ejection fraction < 40%.

Comparing atrial fibrillation guidelines: Focus on stroke prevention, bleeding risk assessment and oral anticoagulant recommendations

Ischaemic stroke in women with atrial fibrillation: temporal trends and clinical implications

The association between female sex and IS rate has decreased and become non-significant over the course of the study period from 2007 to 2018, suggesting that female sex could be omitted as a factor when estimating expected IS rates and the need for OAC therapy in patients with AF.

Modelling of longitudinal data to predict cardiovascular disease risk: a methodological review

Single stage models are still heavily utilized by many CVD risk prediction studies for modelling longitudinal data. Future studies should fully utilize available longitudinal data when analyzing CVD risk by employing two-stage and joint approaches which can often better utilize the available data.

Relationship between remnant cholesterol and risk of heart failure in participants with diabetes mellitus: Reply

Journal Article Relationship between remnant cholesterol and risk of heart failure in participants with diabetes mellitus: Reply Get access Ruoting Wang, Ruoting Wang Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China Search for other works by this author on: Oxford Academic Google Scholar Hertzel C Gerstein, Hertzel C Gerstein Department of Medicine, McMaster University, Hamilton, ON, CanadaPopulation Health Research Institute, McMaster University, Hamilton, ONCanada https://orcid.org/0000-0001-8072-2836 Search for other works by this author on: Oxford Academic Google Scholar Harriette G C Van Spall, Harriette G C Van Spall Department of Medicine, McMaster University, Hamilton, ON, CanadaPopulation Health Research Institute, McMaster University, Hamilton, ONCanada https://orcid.org/0000-0002-8370-4569 Search for other works by this author on: Oxford Academic Google Scholar Gregory Y H Lip, Gregory Y H Lip Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United KingdomDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark https://orcid.org/0000-0002-7566-1626 Search for other works by this author on: Oxford Academic Google Scholar Ivan Olier, Ivan Olier Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United KingdomSchool of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom https://orcid.org/0000-0002-5679-7501 Search for other works by this author on: Oxford Academic Google Scholar Sandra Ortega-Martorell, Sandra Ortega-Martorell Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United KingdomSchool of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom https://orcid.org/0000-0001-9927-3209 Search for other works by this author on: Oxford Academic Google Scholar Lehana Thabane, Lehana Thabane Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, CanadaDepartment of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada https://orcid.org/0000-0003-0355-9734 Search for other works by this author on: Oxford Academic Google Scholar Zebing Ye, Zebing Ye Department of Cardiology, Guangdong Second Provincial General Hospital, Guangzhou, China Search for other works by this author on: Oxford Academic Google Scholar Guowei Li Guowei Li Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, ChinaFather Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, CanadaDepartment of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada Corresponding author. Tel: 86-020-32640264; Fax: 86-020-89169025, Email: lig28@mcmaster.ca Search for other works by this author on: Oxford Academic Google Scholar European Heart Journal - Quality of Care and Clinical Outcomes, Volume 9, Issue 5, August 2023, Page 547, https://doi.org/10.1093/ehjqcco/qcad038 Published: 12 July 2023 Article history Received: 26 June 2023 Accepted: 29 June 2023 Corrected and typeset: 12 July 2023 Published: 12 July 2023

Blood Pressure Variability and Incidence of New-Onset Atrial Fibrillation

Blood pressure variability is a well-known risk factor for cardiovascular disease, but its association with atrial fibrillation (AF) is uncertain. We aimed to evaluate the association between visit-to-visit blood pressure variability and incident AF. This population-based cohort study used database from the Health Screening Cohort, which contained a complete set of medical claims and a biannual health checkup information of the Koran population. A total of 8 063 922 individuals who had at least 3 health checkups with blood pressure measurement between 2004 and 2010 were collected after excluding subjects with preexisting AF. Blood pressure variability was defined as variability independence of the mean and was divided into 4 quartiles. During a mean follow-up of 6.8 years, 140 086 subjects were newly diagnosed with AF. The highest blood pressure variability (fourth quartile) was associated with an increased risk of AF (hazard ratio, 95% CI; systolic blood pressure: 1.06, 1.05-1.08; diastolic blood pressure: 1.07, 1.05-1.08) compared with the lowest (first quartile). Among subjects in the fourth quartile in both systolic and diastolic blood pressure variability, the risk of AF was 7.6% higher than those in the first quartile. Moreover, this result was consistent in both patients with or without prevalent hypertension. In subgroup analysis, the impact of high blood pressure variability on AF development was stronger in high-risk subjects, who were older (≥65 years), with diabetes mellitus or chronic kidney disease. Our findings demonstrated that higher blood pressure variability was associated with a modestly increased risk of AF.

RELATION OF STROKE AND BLEEDING RISK PROFILES TO EFFICACY AND SAFETY OF DABIGATRAN IN ATRIAL FIBRILLATION AFTER PCI: AN ANCILLARY ANALYSIS FROM THE RE-DUAL PCI TRIAL

Use of statins and adverse outcomes in patients with atrial fibrillation: An analysis from the EURObservational Research Programme Atrial Fibrillation (EORP-AF) general registry pilot phase

Prevalence of atrial fibrillation in Northern Sri Lanka: a study protocol for a cross-sectional household survey

This study was approved by the Ethics Review Committee of Faculty of Medicine at University of Jaffna. Written informed consent will be obtained from all participants. Findings will be disseminated through publication in a peer-reviewed journal and presentations at conferences. The findings will enable early treatment for new AF diagnoses and inform interventions to improve community-based management of AF in LMICs.

Prediction of postoperative atrial fibrillation with postoperative epicardial electrograms

<i>Objectives.</i> New-onset postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. The arrhythmia often entails a longer hospital stay, greater risk of other complications, and higher mortality both short- and long-term. An investigation of the use of early atrial electrograms in predicting POAF in cardiac surgery was performed. <i>Design.</i> In this prospective observational study, a total of 99 consecutive adult patients undergoing coronary artery bypass grafting, valve surgery or both were included. On the first postoperative morning, standard 12-lead electrograms (ECG), unipolar atrial electrograms (aEG), and vital values were recorded. The outcome was new-onset POAF within one month postoperatively. <i>Results.</i> Three multivariable prediction models for POAF were formed using measurements derived from the ECG, aEG, and patient characteristics. Age, body mass index, and two unipolar electrogram measurements quantifying local activation time and fractionation were strongly associated with the outcome POAF. The performance of the POAF prediction models was assessed through receiver operating curve characteristics with cross-validation, and discrimination using the leave-one-out-method to internally validate the models. The cross-validated area under the receiver operating characteristic curve (AUC) was improved in a prediction model using atrial-derived electrogram variables (AUC 0.796, 95% CI 0.698-0.894), compared with previous ECG and clinical models (AUC 0.716, 95% CI 0.606-0.826 and AUC 0.718, 95% CI 0.613-0.822, respectively). <i>Conclusions.</i> This study found that easily obtainable measurements from atrial electrograms may be helpful in identifying patients at risk of POAF in cardiac surgery.

A Comparative Analysis of Cardiovascular Events Associated With Acalabrutinib Versus Ibrutinib in Chronic Lymphocytic Leukemia: Insights From a Global Federated Network

Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in adults, characterized by the accumulation of dysfunctional lymphocytes. Ibrutinib, a first-generation Bruton tyrosine kinase (BTK) inhibitor, has significantly improved CLL treatment but is associated with adverse cardiovascular events such as atrial fibrillation (AF) and hypertension (HTN). Second-generation BTK inhibitors (BTKi) such as acalabrutinib were developed to have greater selectivity for BTK to reduce off-target effects and improve safety. Comparative real-world data between ibrutinib and second-generation BTKi are limited. This study analyzed data from the TriNetX Global Collaborative Network to compare cardiovascular outcomes in CLL patients who received ibrutinib or acalabrutinib. The two groups were well-balanced using propensity score matching. The outcomes examined included new-onset AF, HTN, reported heart failure, ventricular arrhythmias, bleeding, and all-cause mortality. The incidence of AF/flutter was lower for acalabrutinib compared to ibrutinib [5.8% vs. 11.7%; HR 0.59 (95% CI 0.43-0.83); p = 0.002]. The incidence of HTN was also lower in the acalabrutinib cohort [15% vs. 26.3%; HR 0.65 (95% CI 0.53-0.81); p < 0.05]. The incidence of heart failure, ventricular arrhythmia, bleeding events, or all-cause mortality did not differ after 3 years of treatment with acalabrutinib or ibrutinib, respectively. Our findings indicate that acalabrutinib has a more favorable cardiovascular toxicity profile compared to ibrutinib; therefore, validating the ELEVATE-RR trial in a real-world setting.

A U-shaped relationship of body mass index on atrial fibrillation recurrence post ablation: A report from the Guangzhou atrial fibrillation ablation registry

BMI had good predictive value for AF ablation outcomes with a cut off value of ≥26.36 kg/m². Apart from being obese/overweight, being underweight might also be a risk factor for AF recurrence post ablation.

The optimal drug adherence to maximize the efficacy and safety of non-vitamin K antagonist oral anticoagulant in real-world atrial fibrillation patients

In an adherence level-dependent fashion, adherent use of NOAC showed better clinical outcomes without increasing bleeding risk. Maintaining ≥90% of adherence optimizes effectiveness of NOAC therapy without compromising its safety.

Metabolomics: Implication in cardiovascular research and diseases

Cellular metabolism influences all aspects of cellular function and is crucial for overall organismal health. Metabolic disorders related to cardiovascular health can lead to cardiovascular diseases (CVDs). Moreover, associated comorbidities may also damage cardiovascular metabolism, exacerbating CVD and perpetuating a vicious cycle. Given the prominent role of metabolic alterations in CVD, metabolomics has emerged as an imperative technique enabling a comprehensive assessment of metabolites and metabolic architecture within the body. Metabolite profile and metabolic pathways help to deepen and broaden our understanding of complex genomic landscape and pathophysiology of CVD. Here in this review, we aim to overview the experimental and clinical applications of metabolomics in pathogenesis, diagnosis, prognosis, and management of various CVD plus future perspectives and limitations.

Metabolically ‘extremely unhealthy’ obese and non-obese patients with diabetes and the risk of cardiovascular events: a French nationwide cohort study

Both non-obese and obese patients with DM with associated cardio-renal-metabolic co-morbidities are an 'extremely unhealthy' phenotype with the highest risk of CV death and CV events.

Thromboembolic events and major bleeding with warfarin, non-vitamin K antagonist oral anticoagulants or antiplatelets following mitral valve repair: A systematic review and meta-analysis

ABSTRACT Background International guidelines recommend the use of a vitamin K antagonist (VKA, e.g. warfarin) for the first three months after mitral repair as a Class IIa recommendation with Level of Evidence C. High rates of atrial fibrillation, thrombogenicity of the non-endothelialised repair components, and high rates of antiplatelet resistance are cited as rationale. However, surveys of practice indicate that surgeon compliance is low, suggesting uncertainty of the evidence. We sought to establish the best current evidence by conducting a systematic review as a precursor to a randomised trial. Methods We included prospective randomised and retrospective observational studies of adult patients undergoing mitral valve repair with no other indications for anticoagulation. Studies had to compare a VKA to a non-vitamin K antagonist oral anticoagulants (NOAC), anti-platelet or placebo/null treatment (“Other”). Outcomes had to include thromboembolic complications, major bleeding or mortality within three months. The Cochrane Register, Medline, Embase and Clinical Trials Registries were checked. Risk of Bias assessments were conducted using the ROBINS-I tool as part of the GRADE Pro methodology. Quantitative synthesis was agreed following review of the methodology and a random effects model using the Mantel-Haenszel method employed. Results There were no randomised controlled trials comparing VKA to other treatment strategies. Six observational studies comprising 5291 patients (2925 receiving VKA, 807 antiplatelet, 104 NOAC and 1455 null treatment) were included. Four studies reporting early thromboembolic risk found that the use of a VKA may not be associated with a reduction in risk (relative risk [RR] 0.54, 95% CI 0.13 – 2.35, p=0.41, I 2 = 68%, overall certainty of evidence = very low). Three studies reporting late thromboembolism also showed that use of VKA may not be associated with risk reduction (RR 0.84, 95% CI 0.57 – 1.24, p=0.37, I 2 = 23%). Two studies reported on early risks of major bleeding and found VKA treatment had very uncertain effects (RR 0.60, 95% CI 0.36 – 1.02, p=0.06, I 2 =0%, certainty of evidence = very low). Late bleeding reported by four studies was uncertain but seemed to show no risk reduction with VKA (RR 0.97, 95% CI 0.37 – 2.52, p=0.95, I 2 =73%). Three studies found an unclear effect of VKA use on early mortality (RR 0.39, 95% CI 0.10 – 1.51, p=0.17, I 2 =35%, certainty of evidence = low). Two studies comparing VKA with antiplatelets and no thromboprophylaxis respectively, showed there may be risk reduction in late mortality (RR 0.72, 95% CI 0.59 – 0.87, p=0.0006, I 2 =0%, certainty of evidence = very low), although this effect was weighted by a single study. Conclusion There is insufficient good quality evidence to inform anticoagulation, anti-platelet or null treatment practices following mitral valve repair. A high-quality trial is therefore required in this setting, with particular methodological focus on aspects found to increase risk of bias in current studies. Funding There was no funding for this systematic review. Registration The review protocol was published in PROSPERO (CRD42021271198).

Calibration plots for multistate risk prediction models

We recommend implementing either the pseudo-value or BLR-IPCW approaches to produce a calibration curve, combined with the MLR-IPCW approach to produce a calibration scatter plot. The methods have been incorporated into the "calibmsm" R package available on CRAN.

Ambulatory Atrial Fibrillation Detection and Quantification by a wrist-worn AI-device Compared to Standard Holter Monitoring