Publications

This meta-analysis supports WMHs and CMBs as independent predictors of stroke recurrence and death in AIS. Burden and distribution further refine prognostic accuracy and inform poststroke risk assessment.

Regular MVPA at any time was associated with lower AF risk, with exploratory evidence suggesting greater benefit in the morning, particularly among younger adults and those with comorbidities.

Figure This depicts R860 Q variant mutation where residue R860 is located near residue N755 forming a hydrogen-bonding interaction, stabilizing the structure of the domain. Background: Long QT syndrome (LQTS) is an ion-channel disorder characterized by QT prolongation and Twave abnormalities on the ECG along with syncope or sudden death from torsade de pointes (TdP). We describe a new genetic variant in CACNA1C associated with LQTS in a survivor of cardiac arrest. Methods and Results: The proband presented with VF arrest. ECG revealed long QT interval (720 msec) and notched T wave in pericordial leads V4-V6. Also, family history of sudden infant death syndrome (SIDS) was reported and hence genetic analysis of 12 genes associated with LQTS was performed. We identified a variant in the CACNA1C gene causing a substitution of CGA to CAA; specifically, c.2579 G . A in exon 19 on chromosome 12 of the CACNA1C (polypeptide isoform); referred to as R860Q. This variant is classified as "likelydisease causing". (Figure Conclusion: To the best of our knowledge, this is the first report of the CACNA1C R860Q variant and is associated with LQTS and SCD in this family. This suggests that this CACNA1C variant is associated with LQTS and carries risk for SCD.

Among AF patients with 1 NGR stroke risk factor (ie, CHA2DS2-VASc 1 in males or 2 in females), OAC use as indicated according to the guidelines was associated with a positive net clinical benefit for the prevention of stroke and thromboembolic events.

In patients anticoagulated for atrial fibrillation after ischemic stroke or transient ischemic attack, magnetic resonance imaging markers of SVD are associated with an increased risk of ischemic stroke during follow-up; improved stroke prevention treatments are required in this population. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02513316.

AF patients with SAD are associated with a high risk of all-cause death, thrombotic, and hemorrhagic events. These patients merit careful follow-up and integrated care management to improve their prognosis.

There was an increasing trend of OAC prescription, temporally associated with a decreased risk of ischaemic stroke and mortality. Among DOACs users, the risk of ischaemic stroke declined gradually, partly explained by the increasing prescriptions of higher dose DOACs. Both patient and non-patient factors were associated with non-anticoagulation. Further efforts are required to increase OAC prescription.

Over 12 months after initiation, apixaban and dabigatran conferred progressive increases in event free time for stroke/SE and MB vs warfarin, whereas rivaroxaban conferred an increase in stroke/SE-free time but a loss in MB-free time vs warfarin.

aAF is reported in about one third of patients with newly diagnosed AF and is associated with a 2.3-fold risk for stroke compared to sAF. Therefore, screening for aAF in high-risk patients might be appropriate to prevent further embolic cerebrovascular events.

Abstract Background Intracerebral haemorrhage (ICH) is a devastating vascular event, and secondary prevention is central to avoid cerebral complications. The PRESTIGE-AF trial is a multinational randomized controlled trial designed to investigate the optimal stroke prevention strategy in atrial fibrillation (AF) patients who have suffered an ICH. Purpose To examine one-year risk of cerebrovascular events in a study population similar to the expected PRESTIGE-AF trial. Methods We used the Danish nationwide registries to identify all patients presenting with incident ICH and prevalent AF between 2003–2018. The study population was restricted using key inclusion criteria for trial participation: indication for antithrombotic treatment due to AF, and at least two CHA2DS2-VASc score stroke risk factors (three for females). Exclusion criteria were: ICH event occurring as a result of trauma or vascular malformation; other indication for long-term anticoagulant treatment; or use of left atrial appendage occlusion device. Patients were followed up in the Danish Stroke Registry, and outcomes were reported stratified by levels of the CHA2DS2-VASc score (score 2–3; 4–6; and >6 points). Results A total of 16,269 ICH patients were identified and after exclusions, 1797 patients were eligible for analysis. The main reason for exclusion was lack of AF diagnosis (81.2%). The study population mean age was 79.5 (SD: 8.7) and 48.1% were females. Among included patients 573 (%) had a CHA2DS2-VASc score of 2–3, 829 (%) had a score of 4–6, and 395 (%) had a score >6. The most prevalent stroke risk factors were hypertension (76.6%) and prior stroke (33.2%). During one-year follow-up, 56 ischemic stroke events and 43 recurrent ICH were observed at a rate of 4.33 (per 100 person-years) and 3.30, respectively. The Figure depicts risk development over time by means of cumulative incidence function based on the Aalen-Johansen estimator (factoring competing risk of death into the analytic approach). The risk of ischemic stroke was generally similar across strata of the stroke risk categories, while the risk of recurrent ICH was highest among patients with a CHA2DS2-VASc score >6 points. Conclusion Using the Danish Stroke Registry, we identified a population mirroring the PRESTIGE-AF trial population. The patients were generally elderly and more than 68% had a CHA2DS2-VASc score of 4 or higher. The observed risk of ischemic stroke was similar across strata, while recurrent ICH was highest among those with a score >6 points. The outputs from the PRESTIGE-AF trial are warranted to determine optimal stroke prevention treatment patients with AF presenting with an ICH. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement no. 754517

Abstract Background Patients with hypertrophic cardiomyopathy (HCM) have high risk of death related to cardiovascular (CV) death. Improvements in risk stratification are needed to help identify those HCM patients at higher risk of all-cause death and cardiovascular death. Methods This French longitudinal cohort study from the database covering hospital care from 2010 to 2019 analyzed adultshospitalized with isolated HCM. The overall sample of 52,091 patients was randomly partitioned into derivation (n=26,067) and validation (n=26,024) populations. A logistic regression model was used to construct HCM death and CV-death scores in the derivation sample, which were compared to the Charlson index, Frailty index and CHA2DS2VASc scores using c-indexes and calibration analysis. Results In 52,091 patients with isolated HCM, 12,676 (24.0%) died during follow-up of 3.0±2.8 years (median 2.3, interquartile range 0.4–5.0). Rate of all-cause death was 8.10%/year (7.96–8.24) and was 2.76%/year (2.68–2.84) for CV death.Independent predictors of CV death in HCM were older age, diabetes mellitus, heart failure, history of pulmonary edema, atrial fibrillation, ventricular tachycardia or fibrillation, ischemic stroke, while smoking and poor nutrition were associated with better survival (all p<0.05). In addition to these, male sex, vascular disease, alcohol related diagnoses, kidney disease, lung disease, liver disease anemia and cancer were independent predictors of all-cause death. In the derivation cohort, c-indexes for the HCM death score were 0.720 (0.713–0.727) for all-cause death and 0.695 (0.685–0.705) for CV death. For the HCM CV-death score, c-indexes were 0.679 (0.671–0.686) for all-cause death and 0.723 (0.712–0.733) for CV death. Performances were very similar in the validation cohort. Both scores had good calibrations. Charlson and Frailty indexes however had a better clinical usefulness than the HCM death score and HCM CV-death scores for predicting all-cause death. Decision curve analysis for CV death demonstrated that the HCM CV-death score had the best clinical usefulness of all the tested risk scores. Conclusion HCM patients have a high risk of all-cause and CV mortality. Independent predictors of CV-mortality in HCM were used to derive and validate a simple risk prediction model (French HCM CV-mortality score) which performed better than clinical scores, Charlson Index and Frailty Index; showing the best clinical usefulness, with good calibration. Funding Acknowledgement Type of funding sources: None.

Given the high prevalence, AF-related thromboembolism and bleeding impose considerable economic burden on the Chinese society. Efforts to improve the management of AF may confer substantial economic benefits.