Publications

Higher BMI was independently associated with a lower risk of ischemic stroke, major bleeding, and better survival. Underweight patients had a higher risk of all-cause death and composite clinical outcome. The optimal BMI for patients with atrial fibrillation should be defined and managed according to an integrated care pathway.

ERC is associated with a lower risk of ischemic stroke among cancer survivors. An integrated approach that incorporates appropriate rhythm control strategies should be considered for cancer survivors with newly diagnosed AF.

Introduction of NOACs in routine practice for stroke prevention in AF was associated with improved rates of overall OAC use. However, significant practice-level variations in OAC and NOAC use remain producing social inequalities of OAC despite full reimbursement.

NOACs are increasingly used in AF patients in the Balkan Region, but NOAC use is predominantly guided by factors other than evidence-based decision-making (e.g., drug availability on the market or reimbursement policy). Efforts are needed to establish an evidence-based approach to OAC selection and to facilitate the optimal use of OAC, thus improving the outcomes in AF patients in this large region.

CA for AF has become an increasingly important treatment option. Although the proportion of high-risk patients increased, risks of complications decreased over time. Performing procedure without complications and prompt managements are essential to improve the outcome of the patients with AF underwent CA.

Background For patients with atrial fibrillation, a comprehensive care approach based on the Atrial fibrillation Better Care (ABC) pathway can reduce the occurrence of adverse outcomes. The aim of this paper was to investigate if an approach based on the ABC pathway is associated with a reduced risk of adverse events in "clinically complex" atrial fibrillation patients, including those with multiple comorbidities, polypharmacy, and prior hospitalizations. Methods and Results We performed a post hoc analysis of the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. The principal outcome was the composite of all-cause hospitalization and all-cause death. An integrated care approach (ABC group) was used in 3.8% of the multimorbidity group, 4.0% of the polypharmacy group, and 4.8%, of the hospitalized groups. In all "clinically complex" groups, the cumulative risk of the composite outcome was significantly lower in patients managed consistent with the ABC pathway versus non-ABC pathway-adherent (all <i>P</i><0.05). Cox regression analysis showed a reduction of composite outcomes in ABC pathway-adherent versus non-ABC pathway-adherent for multimorbidity (hazard ratio [HR], 0.61, 95% CI, 0.44-0.85), polypharmacy (HR, 0.68, 95% CI, 0.47-1.00), and hospitalization (HR, 0.59, 95% CI, 0.42-0.85) groups. Secondary analyses showed that the higher number of ABC criteria fulfilled the larger associated reduction in relative risk, even for secondary outcomes considered. Conclusions Use of an ABC consistent pathway is associated with fewer major adverse events in patients with atrial fibrillation who have multiple comorbidities, use of polypharmacy, and prior hospitalization.

Over the next decades, the prevalence of atrial fibrillation (AF) is estimated to double. Our aim was to investigate the causes of the long-term mortality in relation to the diagnosis of atrial fibrillation (AF) and chronic coronary syndrome (CCS). The analysed population consisted of 7367 consecutive patients referred for elective coronary angiography enrolled in a large single-centre retrospective registry, out of whom 1484 had AF and 2881 were diagnosed with obstructive CCS. During follow-up (median = 2029 days), 1201 patients died. The highest all-cause death was seen in AF(+)/CCS(+) [194/527; 36.8%], followed by AF(+)/CCS(-) [210/957; 21.9%], AF(-)/CCS(+) [(459/2354; 19.5%)] subgroups. AF ([HR]_AC = 1.48, 95%CI, 1.09-2.01; HR_CV = 1.34, 95%CI, 1.07-1.68) and obstructive CCS (HR_AC = 1.90, 95%CI, 1.56-2.31; HR_CV = 2.27, 95%CI, 1.94-2.65) together with age, male gender, heart failure, obstructive pulmonary disease, diabetes were predictors of both all-cause and CV mortality. The main findings are as follow among patients referred for elective coronary angiography, both AF and obstructive CCS are strong and independent predictors of the long-term mortality. Mortality of AF without CCS was at least as high as non-AF patients with CCS. CV deaths were more frequent than non-CV deaths in AF patients with CCS compared to those with either AF or CCS alone.

Our meta-analysis found that galectin-3 is significantly higher in patients with persistent AF than in those with paroxysmal AF, and can predict both AF development and recurrence after treatment.

The consensus of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation (AF) has been published in 2017 which provided useful clinical guidance for cardiologists, neurologists, geriatricians, and general practitioners in Asia-Pacific region. In these years, many important new data regarding stroke prevention in AF were reported. The Practice Guidelines subcommittee members comprehensively reviewed updated information on stroke prevention in AF, and summarized them in this 2021 focused update of the 2017 consensus guidelines of the APHRS on stroke prevention in AF. We highlighted and focused on several issues, including the importance of AF Better Care (ABC) pathway, the advantages of non-vitamin K antagonist oral anticoagulants (NOACs) for Asians, the considerations of use of NOACs for Asian patients with AF with single 1 stroke risk factor beyond gender, the role of lifestyle factors on stroke risk, the use of oral anticoagulants during the "coronavirus disease 2019" (COVID-19) pandemic, etc. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician's decision remains the most important factor in the management of AF.

Background:In experimental studies gut microbiota-dependent metabolites, in particular trimethylamine N-oxide (TMAO), have recently been reported to promote atherosclerosis and thrombosis.Here, we examined for the first time the relation of the gut microbe-dependent metabolite TMAO with the severity of aortic atherosclerosis.Moreover, the relation between choline and TMAO and the risk of cardiovascular events and recurrent stoke was determined in a derivation and a validation cohort of patients with first-ever ischemic stroke.Method: In a derivation study, the relationship of plasma TMAO levels with the severity of aortic atherosclerosis as assessed by transesophageal echocardiography was characterized in patients admitted with ischemic stroke (n=79).The relation between TMAO and choline with subsequent (1-year) cardiovascular events including myocardial infarction, recurrent stroke and death was examined in the derivation, and in a second independent validation cohort (n=593).Results: A close correlation was observed between TMAO levels and the severity of aortic atherosclerosis (r=0.39,P<0.01).In the initial study higher TMAO plasma levels were linked with an increased incident risk of cardiovascular events over a 1-year follow-up (HR: 2.31; 95% CI: 1.25-4.23;P<0.01).In the validation cohort, a markedly increased risk of cardiovascular events over a 1-year follow-up was observed in patients with high TMAO ((Quartile (Q) 4 vs Q1; HR: 5.0, 95% CI: 1.7 -14.8;P<0.01), but not choline levels.This was also observed after adjustment for sex, age, stroke severity, stroke etiology and cardiovascular risk factors including hypertension, diabetes and history of peripheral or coronary artery disease or myocardial infarction (Q4 vs Q1: HR 3.5; 95% CI: 1.1.-11.2;P=0.03).Moreover, patients with high TMAO levels were at greater risk of recurrent stroke (Q4 vs Q4: HR 2.7; 95% CI: 1.1.-6.1;P<0.01).Conclusion: These results suggest a close relation between the gut microbiotadependent metabolite TMAO and severity of aortic atherosclerosis in humans.The findings demonstrate for the first time a graded relation between TMAO levels and the risk of subsequent combined cardiovascular events and also recurrent stroke alone in patients with recent prior ischemic stroke.

Atrial fibrillation (AF) is the most common arrhythmia and is associated with worsened morbidity and mortality. The prevalence of AF is estimated to increase with an ageing population resulting in an ever-increasing burden on the healthcare system. Despite improvements in AF treatment, several questions remain unanswered in relation to the development and progression of AF. In this review, we discuss the evidence supporting the presence of vascular dysfunction in the development of AF, but also as a final common pathway explaining why AF constitutes a markedly increased risk of cardiovascular morbidity and mortality. Specifically, we summarise the work performed in humans related to the impact of AF on vascular structure and function, and whether measures of vascular function predict AF progression and the development of cardiovascular events. Subsequently, we discuss the potential mechanisms linking AF to the development of vascular dysfunction. Finally, we propose future perspectives of vascular health and AF, advocating a strong focus on regular exercise training as a safe and effective strategy to improve vascular function and, hence, reduce the risk for development and progression of AF and its associated risk for cardiovascular events.