Publications

In routine clinical care, DOACs (whether reduced or full dose) were associated with a lower risk of ischaemic stroke, mortality, and the composite endpoint, when compared with non-OAC use in high-risk elderly AF patients at increased bleeding risk. Our findings provide complementary 'real-world' data to support the generalizability of the results of the ELDERCARE-AF trial to other DOACs in daily clinical practice.

In anticoagulated patients with AF followed-up over a long-term period, the novel ABC-stroke score does not offer significantly better predictive performance compared with the CHA₂DS₂-VASc score.

Abstract Objectives Malignant hypertension (MHT) is a rare, yet severe condition characterized by high morbidity and mortality rates. This study aimed to assess the potential of machine learning (ML) algorithms in forecasting prognostic outcomes in MHT patients. Methods The dataset from the West Birmingham MHT Registry was used. We evaluated the efficacy of 9 ML algorithms, CatBoost, Decision Tree (DT), Light-Gradient Boosting Machine (LightGBM), K-Nearest Neighbors (KNN), Logistic Regression (LR), Multi-Layer Perceptron (MLP), Random Forest (RF), Support Vector Machine (SVM) and XGBoost, in predicting a composite outcome of all-cause mortality or dialysis. Evaluation metrics included the area under the receiver operating characteristic curve (AUC) and the F1 score. The SHapley Additive exPlanations values were employed to quantify the importance of each feature in the models. Results The study cohort comprised 385 individuals diagnosed with MHT (mean age of 48±13 years, 66% male). During a median follow-up period of 11 years (interquartile range: 3-18 years), 282 patients (73%) experienced the composite outcome. From 24 demographic and clinical variables, 16 were selected into the ML models. Among 9 models, the SVM and LR models exhibited robust predictive performance, achieving AUCs of 0.86 (95% CI: 0.76-0.93) and 0.81 (95% CI: 0.72-0.93), respectively. Furthermore, these models demonstrated high F1 scores (SVM: 0.89, LR: 0.85) and sensitivity (SVM: 0.89, LR: 0.83) (Table). Age, smoking history, systolic blood pressure at follow-up and baseline creatinine levels were commonly identified as primary prognostic features in both SVM and LR models (Figure). Conclusions The application of ML algorithms facilitates effective prediction of prognostic outcomes in patients with MHT, illustrating their potential utility in clinical decision-making through more targeted risk stratification and individualized patient care in these high-risk patients.

Abstract Background Heart Rate Score (HRSc), the percent of atrial beats in the largest paced/sensed 10-bpm histogram bin recorded in cardiac devices, is a metric of chronotropic incompetence. It remains uncertain if HRSc independently predicts atrial high-rate episodes (AHREs) in patients with sinus node dysfunction (SND) undergoing pacemaker (PM) implantation. Objective To determine the relationship between initial HRSc post-PM implant and new-onset AHREs in patients with SND. Methods The cohort included patients with Boston Scientific PMs implanted for SND from 2012-2021 at Cleveland Clinic, University of Occupational and Environmental Health, Japan, Kyushu Rosai Hospital, and JCHO Kyushu Hospital. Patients were excluded if they had atrial fibrillation before PM implant or AHREs in the initial 3-months post-implant. Subsequent AHREs post-implant (>1% of atrial beats>170 bpm) were evaluated. Results Over 48.9 (IQR 25.8-50.4) months, 136 consecutive PM patients (age 75±10 years, 42% male) were followed. The median initial HRSc was 73(55-86)%. AHREs developed in 28/136 (21%). Although %RA pacing and HRSc correlated, rate-responsive pacing was associated with a HRSc only in the patients with high %RA pacing. Patients with HRSc≥80% had higher occurrence of AHREs than those with HRSc<80% (p=0.01, log-rank test). After adjusting for age, race, comorbidities, left ventricular ejection fraction, left atrial diameter, %RA/RV pacing, and rate-response programming, HRSc (HR:2.84, 95% CI:1.17-6.92; P=0.02) and male sex (HR:2.55, 95% CI:1.15-6.19; P=0.04) were independent predictors of AHREs. Conclusion HRSc≥80% independently predicted new-onset, device-determined AHREs for patients undergoing PM implant for SND. HRSc may have prognostic and therapeutic implications.

Spironolactone temporarily reduced proinflammatory monocyte markers (Mon3 count and CD14 expression on Mon1). Mon1 may have a positive effect on diastolic dysfunction in AF.

Non-vitamin K antagonist OACs are the preferred first-line OAC in older adults with AF, including high-risk subpopulations, after individual assessment of stroke and bleeding risk, except those with mechanical heart valves and moderate-to-severe mitral stenosis. Head-to-head comparisons of NOACs are not available, therefore the choice of drug (and dose) should be based on an individual's risk (stroke and bleeding) and incorporate their treatment preferences. Treatment decisions must be person-centered and principles of shared decision-making applied.

SGLT2i therapy was not associated with an overall lower risk of SCD or VAs in patients with T2DM and/or HF and/or CKD. However, further research is needed since the number of SCD and VA events were relatively few leading to wide confidence intervals, and the point estimates suggested potential benefits.

Introduction: It has been found in short series in the 1990s that significant mitral regurgitation (MR) might be protective against left atrial spontaneous echo contrast formation and against stroke in patients with non-rheumatic atrial fibrillation (AF). The effect of MR on the risk of stroke in patients with AF is still debated. We studied whether or not MR was associated with a decreased risk of stroke in a large series of patients with non-valvular AF. Methods: Among 8053 patients with nonvalvular AF (ie. no prosthetic valve or mitral stenosis), 740 patients (9%) had MR, among whom 107 (14%) had severe MR. Patients with MR were significantly older and had a higher CHA 2 DS 2 -VASc score. Results: After follow up of 868±1043 days, 627 stroke/ thromboembolic (TE) events were recorded. Patients with MR had a similar risk of thromboembolic events when compared to patients with no MR (unadjusted hazard ratio [HR] 1.19; 95%CI 0.93-1.52, p=0.18, adjusted HR 0.99, 95%CI 0.77-1.28, p=0.95 after adjustment for age, gender, VKA and antiplatelet use and CHA 2 DS 2 -VASc score). Severe MR was associated with a nonsignificant higher risk for stroke/TE events (HR 1.59; 95%CI 0.85-2.98, p=0.14, adjusted HR 1.85, 95%CI 0.95-3.57, p=0.07). In the 2 groups, stroke/TE risk increased with a higher CHA 2 DS 2 -VASc score. Factors independently associated with increased risk of stroke/TE events were older age (HR 1.27, 95%CI 1.17-1.36 per 10-year increase, p 2 DS 2 -VASc score (HR 1.31, 95%CI 1.23-1.39, p Conclusions: In patients with nonvalvular AF, neither MR nor severe MR was independently associated with a different risk of stroke/TE events. The perceived protective effect of MR against the risk of thrombo-embolic events is not relevant in AF patients in relation to risk strata using a contemporary risk stratification scheme, the CHA 2 DS 2 -VASc score.