Publications

OAC rates were higher in Spain as compared to rWE. More women received OACs in Spain, while in rWE no difference by gender was observed. DOACs in rWE are the most prescribed OAC while in Spain, due to prescription barriers, its use remains low for both genders and VKAs are preferred. Spanish women received more DOACs compared to men. (NCT01468701).

Non-alcoholic fatty liver disease (NAFLD) is an increasingly common condition associated with type 2 diabetes (T2DM) and cardiovascular disease (CVD). Since systemic metabolic dysfunction underlies NAFLD, the current nomenclature has been revised, and the term metabolic-associated fatty liver disease (MAFLD) has been proposed. The new definition emphasizes the bidirectional relationships and increases awareness in looking for fatty liver disease among patients with T2DM and CVD or its risk factors, as well as looking for these diseases among patients with NAFLD. The most recommended treatment method of NAFLD is lifestyle changes, including dietary fructose limitation, although other treatment methods of NAFLD have recently emerged and are being studied. Given the focus on the liver-gut axis targeting, bacteria may also be a future aim of NAFLD treatment given the microbiome signatures discriminating healthy individuals from those with NAFLD. In this review article, we will provide an overview of the associations of fructose consumption, gut microbiota, diabetes, and CVD in patients with NAFLD.

A ML approach demonstrated high performance in identifying MASLD in patients with DM. This approach may facilitate better risk stratification and cardiovascular risk prevention strategies for high-risk patients with DM at risk of MASLD.

Introduction: Alcohol is an adjustable risk factor for atrial fibrillation (AF), but its impact on the young population is unclear. We examined the effect of alcohol intake on the risk of AF in young Korean adults. Hypothesis: The alcohol intake will show positive relationship with the risk of AF. Methods: From the National Health Insurance Service database, we identified 1 537 836 people aged 20-39 without AF who underwent 4 serial annual health checkups during 2009-2012. At the first checkup, we sorted subjects into “No” and “Yes” groups, according to whether their weekly drinking exceeded 105g. They were also scored according to their usual weekly alcohol intake: “0” (n=507 463), “1” (<105g/wk, n=639 651), “2” (105≤g<210/wk, n=242 842), and “3” (210g≤/wk, n=147 880). We defined the alcohol burden as the number of times the subject answered he/she drank more than 105g of alcohol weekly, in the four checkups. Score of cumulative amounts of alcohol was computed by adding up one’s alcohol intake scores over the 4 years. The AF risk was estimated using Cox proportional hazards model. Results: During a median of 5.6±1.2 years, new AF was diagnosed in 3 066 (0.2%). “Yes” group showed a higher risk of AF compared to “No” group (adjusted hazard ratios (aHR) 1.15, 95% confidence interval (CI) 1.06-1.25, p ≤0.001, Panel A). The risk was also in a positive association with the first drinking scores: aHRs with 95% CIs of the “1”, “2”, and “3” groups compared to “0” group were 1.00 (0.91-1.10), 1.11 (0.99-1.24), and 1.21 (1.07-1.37), p =0.039 (Panel B). As 57.3% in alcohol burden 0 group, 13.2% in 1, 9.6% in 2, 9.4% in 3, and 10.0% in 4, aHRs of burden 1, 2, 3, and 4 compared to burden 0 were 1.14 (1.02-1.27), 1.03 (0.90-1.17), 1.15 (1.02-1.30), and 1.24 (1.11-1.39); p =0.001 (Panel C). The score of cumulative amounts of alcohol was in a positive relationship with the risk of AF ( p =0.003, Panel D). Conclusions: Cumulative alcohol burdens and amounts showed positive correlations with the risk of AF in young adults.

URL: https://www.clinicaltrials.gov. Unique identifier: NCT02513316.

Alcohol is the most frequently consumed toxic substance in the world and remains a major global public health issue, with one in three adults consuming it worldwide. Alcohol use is a leading risk factor for disease, contributing to over 60 acute and chronic health conditions, with a particularly complex association with cardiovascular disease. Chronic excessive alcohol consumption is associated with a range of cardiac complications, including decreased myocardial contractility, hypertension, arrhythmias, MI and heart failure. However, low-level alcohol consumption is believed to have a protective effect against ischaemic heart disease and diabetes. In most cohort studies, small to moderate amounts of alcohol consumption have not been linked to heart failure, indicating a threshold effect of alcohol with individual (possibly genetic) predisposition rather than a continuous effect of exposure. This review article explores the potential benefits of alcohol on the heart, the association between alcohol use and alcoholic cardiomyopathy and the epidemiology, clinical correlates and management of alcoholic cardiomyopathy.

Abstract Background Atrial fibrillation (AF) is an age-related cardiac arrythmia that underlies one third of all strokes, with thromboemboli commonly originating from the left atrial appendage (LAA). Personalised in-silico modelling of Virchow’s triad (blood stasis, hypercoagulability and endothelial damage) can improve stroke risk assessment metrics, such as the CHA2DS2-VASc score, by providing quantitative mechanistic information [1]. The ability to quantify the impact of aging may play a critical role in patient stratification and therapy selection to reduce the risk of AF-related stroke. Aim We aim to perform in-silico modelling to quantify the effect of aging and AF on thrombus formation in the LAA by using advanced computational tools to capture blood flow, clotting mechanisms and endothelial damage [2]. Methods A virtual physiological LA model was derived from cardiac Cine MRI from an adult AF patient imaged during sinus rhythm (SR). Biomarkers for a geriatric patient were obtained from literature and applied as: i) elevated plasma fibrinogen concentration and ii) longer thrombin time-to-peak (ttP) [3]. Blood flow was simulated in SR and AF conditions for 5 cardiac cycles in the LA for both ages (totalling 4 test cases). The catalytic conversion of fibrinogen to a fibrin clot by thrombin was modelled to mimic hypercoagulability [2]. The site of endothelial injury was prescribed in the middle of the LAA. The area under curve for the fibrin concentration (Fn AUC) was measured to quantify thrombus formation. Results In the two SR cases, LA blood flow velocity increased to a maximum of 1.8 m/s after 0.6 s with a mean of 0.63 m/s during the cardiac cycle, while the two AF cases showed 1.3 m/s and 0.39 m/s, respectively, corresponding to a 38% decrease in AF. Peak velocity in the LAA was 0.35 m/s during SR and 0.18 m/s in AF. The fibrin concentration in the adult-SR case rose to 1.1 mmol/m³ over the first cardiac cycle, but both thrombin and fibrin were washed out of the LA after 1.5 s, with a Fn AUC of 0.045mmol s/m³ (Fig. 1a). The geriatric-SR case sustained fibrin generation throughout the 5 cardiac cycles reaching 3.1 mmol/m³, an Fn AUC of 2.4 mmol s/m³, and the formation of an LAA thrombus (Fig. 1b). Similarly, the adult-AF and geriatric-AF cases also saw continuous growth to 5.0 and 7.4 mmol/m³, with Fn AUCs of 6.4 and 12.6 mmol s/m³, respectively, with formation of a thrombus in the LAA in both (Fig. 1c and d). The thrombus formed in the adult-AF case was 25% larger than the geriatric-SR case, while thrombus in the geriatric-AF case was 80% larger. Conclusions This investigation quantifies the increased risk of LAA thrombus formation in older patients, with an Fn AUC increase of 55% between adult and geriatric in SR and a 100% increase when combining geriatric biomarkers with AF conditions. With further validation on larger patient cohorts, this novel in-silico tool may improve our understanding of the risks in AF-related stroke.

Polish Lipid Association, College of Family Physician in Poland, Valeant in Poland.

In the 2000s, cardiac resynchronization therapy (CRT) became a revolutionary treatment for heart failure with reduced left ventricular ejection fraction (HFrEF) and wide QRS. However, about one-third of CRT recipients do not show a favorable response. This review of the current literature aims to better define the concept of CRT response/nonresponse. The diagnosis of CRT nonresponder should be viewed as a continuum, and it cannot rely solely on a single parameter. Moreover, baseline features of some patients might predict an unfavorable response. A strong collaboration between heart failure specialists and electrophysiologists is key to overcoming this challenge with multiple strategies. In the contemporary era, new pacing modalities, such as His-bundle pacing and left bundle branch area pacing, represent a promising alternative to CRT. Observational studies have demonstrated their potential; however, several limitations should be addressed. Large randomized controlled trials are needed to prove their efficacy in HFrEF with electromechanical dyssynchrony.

The risks of cardiovascular events (CVEs) in people with epilepsy (PWE) are not well understood. To establish the short- and long-term burden of CVEs in PWE. Electronic health records from a global federated health research network (TriNetX) were used to establish a cohort of PWE. Primary outcomes were: (1) the proportion of people experiencing a composite outcome of cardiac arrest, acute heart failure (HF), acute coronary syndrome (ACS), atrial fibrillation (AF), severe ventricular arrhythmia or all-cause death within 30 days of a seizure; and (2) the 5-year risk for a composite outcome of ischemic heart diseases, stroke, hospitalization, or all-cause death in the PWE experiencing early CVEs. Cox-regression analyses with propensity score matching was used to produce hazard ratios (HRs) and 95% confidence intervals (CI). In 271,172 PWE (mean age 50 ± 20 years; 52% females), the 30-day risk of CVEs following seizure was: 8.7% for the composite outcome, 0.9% for cardiac arrest, 0.8% for HF, 1.2% for ACS, 4.1% for AF, 0.7% for severe ventricular arrhythmias, and 1.6% for all-cause death. For the 15,120 PWE experiencing CVEs within 30 days of seizure, the 5-year adjusted risks for all composite outcomes measured were significantly increased (overall HR: 2.44, 95% CI 2.37-2.51), ischemic heart diseases HR 3.23 (95% CI 3.10-3.36), stroke HR 1.56 (95% CI 1.48-1.64), hospitalization HR 2.03 (95% CI 1.97-2.10), and all-cause death HR 2.75 (95% CI 2.61-2.89). The large proportions of PWE with active disease that experience CVEs and the poor long-term outcome associated suggest the existence of an "epilepsy-heart syndrome."

A diagnosis of PE occurs in 2.6% of patients hospitalized with a principal diagnosis of pneumonia. Having concomitant PE was associated with greater risks of in-hospital mortality, increased use of mechanical ventilation and thrombolysis, extended hospital stay, and higher inpatient costs.

<b>Background</b> Global differences exist in the management of atrial fibrillation (AF), and cultural differences may influence patients' expectations and perceptions of healthcare. This survey investigated whether country-specific differences in patients' perceptions of AF and oral anticoagulation (OAC) exist and if recent stroke influences these perceptions. <b>Methods</b> Cross-sectional survey of 937 adults with nonvalvular AF receiving OAC for stroke prevention was conducted across United States, Canada, Germany, France, and Japan. Thirty-minute online interviews conducted between April and November 2015 included AF patients with recent stroke, and newly diagnosed AF and established AF, both without recent stroke. <b>Results</b> U.S. patients and those with recent stroke perceived AF as more serious (54.0 and 55.2%, respectively) and were more concerned about stroke (50.0 and 68.0%, respectively). Japanese patients were more likely to perceive AF as not serious (41.0%), but 50.4% were frequently concerned about stroke. Patients in the United States, Canada, and Germany and those without recent stroke preferred to be involved in OAC treatment decisions (either shared decision making or patient's choice), while French and Japanese patients and those with recent stroke preferred their doctor to choose. For all country groups, stroke prevention was the most important factor when choosing OAC. <b>Conclusion</b> In this international cohort of AF patients, country-specific differences exist in patients' perceptions of AF, concerns about stroke, and preference for involvement in OAC treatment decisions; recent experience of stroke significantly influenced patients' values and preferences regarding AF and treatment. Stroke prevention was rated as the most important factor when choosing OAC treatment.