Publications

Machine Learning Identifies Metabolic Dysfunction–Associated Steatotic Liver Disease in Patients With Diabetes Mellitus

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.

Abstract 13929: Do Tipsy Young People Develop More Atrial Fibrillation Than Sober Ones? - The Impact of Alcohol Burden on the Risk of Atrial Fibrillation: A Nationwide Population-Based Study

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.

Real-world clinical evidence on rivaroxaban, dabigatran, and apixaban compared with -vitamin K antagonists in patients with non-valvular atrial fibrillation: a systematic literature review

KEYWORDS: Anticoagulationdirect oral anticoagulantsnon-valvular atrial fibrillationreal-world evidencestroke prevention

Alcohol and Heart Failure

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.

Venous Thromboembolism in Patients With Atrial Fibrillation

The risk of VTE is highest in the first 3 to 6 months after AF diagnosis and decreases over time. The early initiation of anticoagulation in patients with AF may reduce the risk of VTE.

Incidence, predictors and outcomes associated with acute pulmonary embolism in patients hospitalized with pneumonia: Insights from the National Inpatient Sample

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.

Atrial fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia despite substantial efforts to understand the pathophysiology of the condition and develop improved treatments. Identifying the underlying causative mechanisms of AF in individual patients is difficult and the efficacy of current therapies is suboptimal. Consequently, the incidence of AF is steadily rising and there is a pressing need for novel therapies. Research has revealed that defects in specific molecular pathways underlie AF pathogenesis, resulting in electrical conduction disorders that drive AF. The severity of this so-called electropathology correlates with the stage of AF disease progression and determines the response to AF treatment. Therefore, unravelling the molecular mechanisms underlying electropathology is expected to fuel the development of innovative personalized diagnostic tools and mechanism-based therapies. Moreover, the co-creation of AF studies with patients to implement novel diagnostic tools and therapies is a prerequisite for successful personalized AF management. Currently, various treatment modalities targeting AF-related electropathology, including lifestyle changes, pharmaceutical and nutraceutical therapy, substrate-based ablative therapy, and neuromodulation, are available to maintain sinus rhythm and might offer a novel holistic strategy to treat AF.

Gender differences in antithrombotic treatment in patients with atrial fibrillation from Spain versus the rest of Western Europe. GLORIA-AF Program

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).

Patients' Perceptions of Atrial Fibrillation, Stroke Risk, and Oral Anticoagulation Treatment: An International Survey

<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.

Neuroticism and the Risk of Atrial Fibrillation

There was a significant longitudinal and causal relationship between neuroticism and AF. An integrated care including active mental health screening and management may benefit in high-risk populations.

Atrial Fibrillation and End-Stage COPD

An apparent paradox in visit-to-visit blood pressure variability and adverse outcomes in malignant hypertension patients: The West Birmingham malignant hypertension registry

Higher visit-to-visit BP variability was associated with lower prevalence of cardiovascular disease and mortality in a MHT population. Given the extremely high initial BP of MHT patients, the high BP variability reflects likely better BP control in the follow up visits, re-emphasizing the crucial role of early and rapid control of BP in this high-risk population.

Cognitive Impairment Before Intracerebral Hemorrhage Is Associated With Cerebral Amyloid Angiopathy

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

Outcome of atrial resynchronisation therapy in patients unsuitable for left atrial ablation for the management of drug resistant atrial fibrillation

The impact of aging and atrial fibrillation on thrombus formation in-silico

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.

Comparison of the 2MACE and TIMI-AF Scores for Composite Clinical Outcomes in Anticoagulated Atrial Fibrillation Patients

This study showed that the 2MACE and TIMI-AF scores had modest but significant predictive ability for composite outcomes in AF. The clinical usefulness of both scores was similar, but the 2MACE score may be simpler and easy to use.

Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage (LIPIDOGRAM2015)

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

Stricter blood pressure control reduces rate of left ventricular hypertrophy and diastolic dysfunction in ethnic minority groups in the UK:E-ECHOES study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation (PG/05/036) Primary Care Research Network-Central England. Background Blood pressure (BP, mmHg) targets have been mainly determined based on the white ethnic group. Optimal BP levels have been less established in people of South Asian and African Caribbean origin. There is less data on how different office BP values influence the presence of cardiac target organ damage, left ventricular hypertrophy (LVH) and diastolic dysfunction (DD). Methods This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, South Asian and African-Caribbean origin, age ≥45 years). Echocardiography was used to diagnose LVH and DD following British Echocardiographic Society criteria. Optimal receiver operator curves (ROC) cut-off values for predicting LVH and DD were determined using the Leu method. Multivariable logistic regression, adjusted for age and sex, was used to determine the effects of different BP values for LVH and DD, using SBP 130-&amp;lt;140 and DBP 80-&amp;lt;90 as comparators (STATA 13). Results The study included 3200 South Asians (age 59±10, 52% women), of whom 1568 (49%) had LVH, and 1497 (47%) had diastolic dysfunction. Of people with LVH, 869 (55%) had SBP &amp;gt;140, and 372 (24%) had DBP &amp;gt;90. The optimal BP cut-off for ROC analysis was 139/80.5 for LVH and 139/80.5 for diastolic dysfunction. SBP &amp;lt;130 and DBP &amp;lt;80 were both associated with a 31% reduction in diastolic dysfunction (Table). BP ≥140/90 was strongly predictive of LVH and DD. The study included 1922 African Caribbeans (62±12 age, 55% women), of whom 1186 (62%) had LVH and 1124 (58%) had DD. Of people with LVH, 778 (66%) had SBP &amp;gt;140, and 333 (28%) had DBP &amp;gt;90. The optimal BP cut-off for ROC analysis were 139/81.5 for LVH and 138/80.5 for DD. DBP &amp;lt;80 mmHg 27% reduction in LVH and 24% in DD (Table). BP ≥140/90 was strongly predictive of LVH and DD. Conclusions People of South Asian origin may benefit from stricter SBP (&amp;lt;130) control, and both ethnic groups may benefit from stricter DBP (&amp;lt;80) control.