Publications

Atrial High-Rate Episodes Detected by Cardiac Implantable Electronic Devices: Dynamic Changes in Episodes and Predictors of Incident Atrial Fibrillation

In patients with AHRE, the incidence of clinical AF or AHRE episodes lasting ≥24 h is high in a two-year follow-up. Baseline patients' characteristics (CHA₂DS₂-VASc score) and AHRE duration may help to intensify monitoring and decision-making, being independently associated with clinical AF at follow-up.

Prevalence, Clinical Characteristics and Prognosis of Vascular Disease in Valvular Heart Surgery: A Multi-Centre Study

Patients undergoing valvular heart surgery exhibit a high prevalence of vascular disease. The risk of adverse outcomes rises with both the presence and extent of vascular disease, and extracardiac vascular disease confers greater risk of MACE than CAD.

Validation of the Same-TT2R2 Score in a Multiethnic Cohort of Asian Patients with Atrial Fibrillation on Warfarin Therapy – A Multicenter Study

Visit-to-Visit Heart Rate Variability in the Prediction of Clinical Outcomes of Patients with Atrial Fibrillation

VVV-HR is an independent predictor for adverse clinical outcomes in patients with AF. A <i>J</i>-curve appearance was demonstrated for the effect of VVV-HR on all-cause death.

Atrial fibrillation after cardiac surgery: identifying candidate predictors through a Delphi process

NCT05255224.

1468Efficacy and safety of non-vitamin K oral anticoagulants in hypertrophic cardiomyopathy with non-valvular atrial fibrillation: a nationwide cohort study

Cardiorespiratory Multimorbidity in People Living With Chronic Lung Disease

Stroke complicating cardiac catheterization--a preventable and treatable complication.

Stroke is a rare but serious complication of cardiac catheterization. Due to the low incidence of stroke complicating catheterization of the left heart, there is no clearly defined optimal treatment. With increasing numbers of diagnostic and interventional cardiac procedures being performed, definitive management pathways for periprocedural neurological complications need to be defined. Many studies have shown excellent results with both thrombolytic and catheter-based neurovascular rescue, but equal attention should be paid to identify measures to prevent this iatrogenic complication. It is also imperative that management decisions be taken jointly by the cardiologist and stroke physician. We review the literature regarding the features of ischemic stroke complicating cardiac catheterization, the various management modalities and suggest a management protocol.

Cardiac fibrosis can be attenuated by blocking the activity of transglutaminase 2 using a selective small-molecule inhibitor

Cardiac fibrosis is implicit in all forms of heart disease but there are no effective treatments. In this report, we investigate the role of the multi-functional enzyme Transglutaminase 2 (TG2) in cardiac fibrosis and assess its potential as a therapeutic target. Here we describe the use a highly selective TG2 small-molecule inhibitor to test the efficacy of TG2 inhibition as an anti-fibrotic therapy for heart failure employing two different in vivo models of cardiac fibrosis: Progressively induced interstitial cardiac fibrosis by pressure overload using angiotensin II infusion: Acutely induced focal cardiac fibrosis through myocardial infarction by ligation of the left anterior descending coronary artery (AMI model). In the AMI model, in vivo MRI showed that the TG2 inhibitor 1-155 significantly reduced infarct size by over 50% and reduced post-infarct remodelling at 20 days post insult. In both models, Sirius red staining for collagen deposition and levels of the TG2-mediated protein crosslink ε(γ-glutamyl)lysine were significantly reduced. No cardiac rupture or obvious signs of toxicity were observed. To provide a molecular mechanism for TG2 involvement in cardiac fibrosis, we show that both TGFβ1-induced transition of cardiofibroblasts into myofibroblast-like cells and TGFβ1-induced EndMT, together with matrix deposition, can be attenuated by the TG2 selective inhibitor 1-155, suggesting a new role for TG2 in regulating TGFβ1 signalling in addition to its role in latent TGFβ1 activation. In conclusion, TG2 has a role in cardiac fibrosis through activation of myofibroblasts and matrix deposition. TG2 inhibition using a selective small-molecule inhibitor can attenuate cardiac fibrosis.

Lipid profile, lipid ratios, apolipoproteins, and risk of cardiometabolic multimorbidity in men: The Kuopio Ischaemic Heart Disease Risk Factor Study

The blood level of lipids, apolipoproteins, and lipid ratios are important predictors of some chronic diseases. However, their association with cardiometabolic multimorbidity (CMM) is less known. We evaluated a wide range of lipid profiles and lipid ratios, including low-density lipoprotein-cholesterol (LDL-C), very-low-density lipoprotein-cholesterol (VLDL-C), high-density lipoprotein-cholesterol (HDL-C), and apoA1 and B, as well triglyceride and total cholesterol with risk of incident CMM. In 1728 men aged 52.5 ± 5.2 years from the Kuopio Ischaemic Heart Disease were included in this study. We defined CMM as coexisting of two or more of stroke, type 2 diabetes mellitus (T2D), coronary heart disease (CHD). A Cox proportional hazard regression method was applied to evaluate the risk of CMM against the exposures. During the mean follow-up of 22.4 years, 335 men suffered from CMM conditions. Higher serum triglyceride and VLDL concentrations were associated with a higher risk of coexisting T2D-CHD (HRs 1.99 (95% CI, 1.12-3.53) and HRs 1.79 (95% CI, 1.04-3.11), respectively. Whereas higher HDL was associated with lower incident [HRs 0.49 (95% CI, 0.40-1.00)]. The HRs for coexisting T2D-CHD was 2.02 (95% CI, 1.01-3.07) for total cholesterol/HDL-C, 1.85 (95% CI, 1.04-3.29) for triglyceride/HDL-C, 1.69 (95% CI, 1.01-2.31) for Non-HDL-C/HDL-C, and 1.89 (95% CI, 1.03-2.46) for apoB/apoA1. In contrast, serum LDL-C/apoB ratios were inversely associated with the risk of coexisting T2D-CHD [HRs 0.50 (95% CI, 0.28-0.90)]. No associations were observed between our exposures and other CMM conditions. In conclusion, elevated triglyceride, VLDL-C, total cholesterol/HDL-C, TG/HDL-C, apoB/apoA1 as well as lower LDL-C/apoB were independently associated with the higher risk of T2D-CHD coexistence.

Importance of time in therapeutic range on bleeding risk prediction using clinical risk scores in patients with atrial fibrillation

Bleeding risk with vitamin K antagonists (VKAs) is closely related to the quality of anticoagulation in atrial fibrillation (AF) patients, reflected by time in therapeutic range (TTR). Here we compared the discrimination performance of different bleeding risk scores and investigated if adding TTR would improve their predictive value and clinical usefulness. We included 1361 AF patients stables on VKA for at least 6 months. Bleeding risk was assessed by the HAS-BLED, ATRIA, ORBIT and HEMORR₂HAGES scores. Major bleeding events were recorded after a median of 6.5 years follow-up. In this period 250 patients suffered major bleeds. Comparison of receiver operating characteristic (ROC) curves demonstrated that HAS-BLED had the best discrimination performance, but adding the 'labile INR' criteria (i.e. TTR <65%) to ATRIA, ORBIT and HEMORR₂HAGES increased their ability of discrimination and predictive value, with significant improvements in reclassification and discriminatory performance. Decision curve analyses (DCA) showed improvements of the clinical usefulness and a net benefit of the modified risk scores. In summary, in AF patients taking VKAs, the HAS-BLED score had the best predictive ability. Adding 'labile INR' to ATRIA, ORBIT and HEMORR₂HAGES improved their predictive value for major bleeding leading to improved clinical usefulness compared to the original scores.

Looking Back on 2020, Looking Forward to 2021

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Clinical Features and Prognosis in Patients with Atrial Fibrillation and Prior Stroke: Comparing the Fushimi and Darlington AF Registries

AF patients with previous stroke in the UK were at higher risk of recurrent stroke compared to Japanese patients, but OAC was utilised less frequently. There was a lower risk of recurrent stroke in the secondary prevention cohort from the Fushimi registry, but an increased risk of all-cause mortality.

#2929 Early versus delayed anticoagulation in acute ischaemic stroke in those with chronic kidney disease: a pre-specified subgroup analysis of the OPTIMAS randomised controlled trial

Abstract Background and Aims The OPTIMAS trial showed that early initiation of direct oral anticoagulant (DOAC) after acute ischaemic stroke (IS) related to atrial fibrillation is non-inferior to delayed initiation. Patients with chronic kidney disease (CKD) are at increased risk of IS and intracerebral haemorrhage, so the safety and efficacy of early DOAC in those with CKD is of interest. Method OPTIMAS was a randomised, parallel-group, open-label trial with blinded outcome assessment. Participants were randomised 1:1 to early (within 4 days of onset) or delayed (at day 7–14) DOAC initiation. The primary outcome was a composite outcome of recurrent IS, symptomatic intracranial haemorrhage (sICH) and systemic arterial embolism. Secondary outcomes included the individual components of the primary outcome and all-cause mortality. CKD was defined as a history of known CKD and collected systematically. We fitted mixed effects logistic regression models with interaction terms between CKD and treatment group. Results We included 3601 patients (mean age 78.0 ± 9.9 years, 45.3% female), 543 with CKD. For the primary outcome, there was no difference between early and delayed DOAC initiation in either the normal kidney function group (OR 1.01, 95% CI 0.67 to 1.51), or the CKD group (OR 0.90, 95% CI 0.36 to 2.25), interaction P = 0.822. Similarly, for the secondary outcomes we detected no modification of the treatment effect according to CKD (interaction p-values 0.637, 0.386 and 0.107 for IS, sICH and all-cause mortality respectively). Conclusion Compared to delayed initiation of DOAC, we found no evidence of increased efficacy nor risk of harm from early DOAC initiation after acute ischaemic stroke for those with AF and CKD. OPTIMAS is registered with ClinicalTrials.gov (NCT03759938) and funded by the British Heart Foundation.

Readmissions for Cardiac Disease Within 30 Days of Hospitalization for Cerebral Infarction: An Evaluation of the Stroke–Heart Syndrome Using the Nationwide Readmission Database

New cardiac-related hospital readmissions within 30 days after ischemic stroke occur in 2.4% of patients, with elective admission and cancer being a strong predictor of readmissions.

Malignant Hypertension: Current Perspectives and Challenges

Malignant hypertension is a hypertensive emergency, with rapid disease progression and poor prognosis. Although recognized as a separate entity more than a century ago, significant knowledge gaps remain about its pathogenesis and treatment. This narrative review summarizes current viewpoints, research gaps, and challenges with a view to pooling future efforts at improving treatment and prognosis.

Long-term follow-up after atrioventricular node ablation in patients with atrial fibrillation: A nationwide Danish cohort study

Introduction: Atrioventricular node (AVN) ablation after pacemaker implantation is a rate control option for patients with symptomatic atrial fibrillation (AF) when rhythm control with anti-arrhythmic drug therapy and/or ablation with pulmonary vein i

Guía ESC/ERS 2015 sobre diagnóstico y tratamiento de la hipertensión pulmonar

Cerebral Small Vessel Disease and Functional Outcome Prediction After Intracerebral Hemorrhage

ClinicalTrials.gov Identifier: NCT02513316.