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2,408 results for “Atrial fibrillation”

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zenodo12/100

Dataset related to the article "First-line therapy: insights from a real-world analysis of cryoablation in patients with atrial fibrillation"

<p>This record contains raw data related to the article &quot;First-line therapy: insights from a real-world analysis of cryoablation in patients with atrial fibrillation&quot;&nbsp;</p> <p>&nbsp;</p> <p><em><strong>Abstract</strong></em></p> <p><strong>Aims:&nbsp;</strong>Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) is mainly reserved for patients with drug-refractory or drug-intolerant symptomatic atrial fibrillation. We evaluated a large cohort of patients treated in a real-world setting and examined the safety and efficacy profile of CBA when applied as a first-line treatment for atrial fibrillation.</p> <p><strong>Methods:&nbsp;</strong>In total, 249 patients (23% women; 56 &plusmn; 13 years; mean left atrial diameter 41 &plusmn; 7 mm; 73.5% paroxysmal atrial fibrillation; and 26.5% persistent atrial fibrillation) underwent an index PVI by CBA. Data were collected prospectively in the framework of the 1STOP ClinicalService project, involving 26 Italian cardiology centers.</p> <p><strong>Results:&nbsp;</strong>Median procedure and fluoroscopy times were 90.0 and 21.0 min, respectively. Acute procedural success was 99.8%. Acute/periprocedural complications were observed in seven patients (2.8%), including: four transient diaphragmatic paralyses, one pericardial effusion (not requiring any intervention), one transient ischemic attack, and one minor vascular complication. The Kaplan--Meier freedom from atrial fibrillation recurrence was 86.3% at 12 months and 76% at 24 months. Seventeen patients (6.8%) had a repeat catheter ablation procedure during the follow-up period. At last follow-up, 10% of patients were on an anticoagulation therapy, whereas 6.8% were on an antiarrhythmic drug.</p> <p><strong>Conclusion:&nbsp;</strong>In our multicenter real-world experience, PVI by CBA in a first-line atrial fibrillation patient population was well tolerated, effective, and promising. CBA with a PVI strategy can be used to treat patients with paroxysmal and persistent atrial fibrillation with good acute procedural success, short procedure times, and acceptable safety.</p> <p><strong>Clinical trial registration:&nbsp;</strong>clinicaltrials.gov (<a href="http://clinicaltrials.gov/show/NCT01007474">NCT01007474</a>).</p> <p>&nbsp;</p>

restrictedMar 2022View details →
zenodo12/100

Dataset related to the article "Cryoballoon atrial fibrillation ablation: Single-center safety and efficacy data using a novel cryoballoon technology compared to a historical balloon platform".

<p>This record contains raw data related to the article &quot;Cryoballoon atrial fibrillation ablation: Single-center safety and efficacy data using a novel cryoballoon technology compared to a historical balloon platform&quot;.</p> <p>&nbsp;</p> <p><em><strong>Abstract</strong></em></p> <p><strong>Introduction:&nbsp;</strong>Catheter ablation is superior to drugs regarding atrial fibrillation (AF) recurrence, symptoms improvement, and mortality reduction in heart failure. POLARx&trade; is a novel cryoballoon, with technical improvements seeking to improve outcomes. So far, its clinical evidence is restricted to a case report.</p> <p><strong>Methods:&nbsp;</strong>To compare the POLARx&trade; cryoballoon procedural safety and efficacy to the already established Arctic Front Advance PRO&trade; (AFAP) in a single-center cohort study, consecutive patients undergoing AF cryoablation with the POLARx&trade; were enrolled. Data were prospectively gathered. POLARx&trade; patients were compared with a historical cohort of patients submitted to AF cryoablation with the AFAP.</p> <p><strong>Results:&nbsp;</strong>Seventy patients were analyzed, 20 in POLARx&trade;, and 50 in the AFAP group. They all underwent first-time pulmonary vein isolation, 77% were male, 94% had paroxysmal AF, median age was 62.5 years, median CHA<sub>2</sub>&nbsp;DS<sub>2</sub>&nbsp;-VASc 1, left-atrium size 34 ml/m&sup2;, and 65% were receiving anticoagulation. The primary end-point, all pulmonary veins isolation, was 100% in both groups. The complication rate was similar (0% POLARx&trade; vs. 5.7% AFAP, p = .39). The median total procedural time was longer in the POLARx&trade; group (90 min vs. 60 min, p &lt; .001), but the overall time-to-isolation (TTI; 44.8 s vs. 39 s, p = .253) and ablation time (15 min vs. 13.7 min, p = .122) was similar between POLARx&trade; and AFAP groups, respectively. Despite equal TTI, the POLARx&trade; had a lower minimal temperature reached (-57&deg;C vs -47&deg;C, p &lt; .001).</p> <p><strong>Conclusion:&nbsp;</strong>The novel POLARx&trade; cryoballoon had similar efficacy and safety compared with the AFAP. It was also associated with longer procedural times, similar TTI, and lower minimum temperature reached.</p>

restrictedMar 2022View details →
zenodo12/100

Diagnosis of left atrial appendage thrombus in patients with atrial fibrillation: delayed contrast-enhanced cardiac CT

<p>Dataset from the article&nbsp;Spagnolo P, Giglio M, Di Marco D, Canna&ograve; PM, Agricola E, Della Bella PE, Monti CB, Sardanelli F. Diagnosis of left atrial appendage thrombus in patients with atrial fibrillation: delayed contrast-enhanced cardiac CT. Eur Radiol. 2021 Mar;31(3):1236-1244. doi: 10.1007/s00330-020-07172-2. Epub 2020 Sep 4. PMID: 32886202; PMCID: PMC7880950.</p> <p><strong>Abstract</strong></p> <p><strong>Objectives:&nbsp;</strong>The current reference standard for diagnosing LAA thrombi is transesophageal echocardiography (TEE), a semi-invasive technique. We aimed to devise an optimal protocol for cardiac computed tomography (CCT) in diagnosing left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF), using TEE as reference standard.</p> <p><strong>Methods:&nbsp;</strong>Two hundred sixty consecutive patients referred for radiofrequency ablation for AF were prospectively enrolled. All patients underwent CCT and TEE within 2 hours. The CCT protocol included one standard angiographic phase and three delayed acquisitions at 1-, 3-, and 6-min after contrast injection. Thrombi were defined as persisting defects at 6-min delayed acquisition.</p> <p><strong>Results:&nbsp;</strong>TEE demonstrated spontaneous contrast in 52 (20%) patients and thrombus in 10 (4%). In 63 patients (24%), CCT demonstrated LAA early filling defects at angiographic phase. Among them, 15 (6%) had a persistent defect at 1-min, 12 (5%) at 3-min, and 10 (4%) at 6-min. All 10 thrombi diagnosed on TEE were correctly identified by delayed CCT, without any false positives. For all phases, sensitivity and negative predictive were 100%. Specificity increased from 79% for the angiographic phase to 100% at 6-min. Positive predictive value increased from 16% to 100%. Estimated radiation exposure was 2.08 &plusmn; 0.76 mSv (mean &plusmn; standard deviation) for the angiographic phase and 0.45 &plusmn; 0.23 mSv for each delayed phase.</p> <p><strong>Conclusion:&nbsp;</strong>A CCT protocol adding a 6-min delayed phase to the angiographic phase can be considered optimized for the diagnosis of LAA thrombi, with a low radiation dose.</p>

restrictedJul 2021View details →
geo12/100

Cholesterol Homeostasis Disruption and Monocyte Recruitment Drive Atrial Fibrillation in Hypertension

GEO Series GSE285199. Homo sapiens. 6 samples. Type: Expression profiling by high throughput sequencing.

openGEO-OpenDec 2025View details →
zenodo8/100

Proposal for a clinical and an echocardiographic score for prediction of left atrial thrombosis in atrial fibrillation patients undergoing early electrical cardioversion

<p>Aims: Left&nbsp;&nbsp; &nbsp;atrial&nbsp;&nbsp; &nbsp;thrombosis&nbsp;&nbsp; &nbsp;(LAT)&nbsp;&nbsp; &nbsp;is&nbsp;&nbsp; &nbsp;usually&nbsp;&nbsp; &nbsp;detected&nbsp;&nbsp; &nbsp;by&nbsp;&nbsp; &nbsp;transesophageal&nbsp;&nbsp; &nbsp;echocardi-<br> ography&nbsp;&nbsp; &nbsp;(TEE).&nbsp;&nbsp; &nbsp;The&nbsp;&nbsp; &nbsp;aim&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;present&nbsp;&nbsp; &nbsp;study&nbsp;&nbsp; &nbsp;was&nbsp;&nbsp; &nbsp;to&nbsp;&nbsp; &nbsp;identify&nbsp;&nbsp; &nbsp;clinical&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;echocardio-<br> graphic&nbsp;&nbsp; &nbsp;factors&nbsp;&nbsp; &nbsp;associated&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;left&nbsp;&nbsp; &nbsp;atrial&nbsp;&nbsp; &nbsp;thrombosis&nbsp;&nbsp; &nbsp;in&nbsp;&nbsp; &nbsp;atrial&nbsp;&nbsp; &nbsp;fibrillation&nbsp;&nbsp; &nbsp;(AF)&nbsp;&nbsp; &nbsp;patients&nbsp;&nbsp; &nbsp;<br> undergoing&nbsp;&nbsp; &nbsp;early&nbsp;&nbsp; &nbsp;electrical&nbsp;&nbsp; &nbsp;cardioversion&nbsp;&nbsp; &nbsp;(ECV)&nbsp;&nbsp; &nbsp;in&nbsp;&nbsp; &nbsp;order&nbsp;&nbsp; &nbsp;to&nbsp;&nbsp; &nbsp;create&nbsp;&nbsp; &nbsp;scores&nbsp;&nbsp; &nbsp;that&nbsp;&nbsp; &nbsp;can&nbsp;&nbsp; &nbsp;<br> predict&nbsp;&nbsp; &nbsp;LAT,&nbsp;&nbsp; &nbsp;in&nbsp;&nbsp; &nbsp;a&nbsp;&nbsp; &nbsp;non-invasive&nbsp;&nbsp; &nbsp;way.<br> Methods: A&nbsp;&nbsp; &nbsp;consecutive&nbsp;&nbsp; &nbsp;cohort&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;patients&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;persistent&nbsp;&nbsp; &nbsp;AF&nbsp;&nbsp; &nbsp;scheduled&nbsp;&nbsp; &nbsp;for&nbsp;&nbsp; &nbsp;ECV&nbsp;&nbsp; &nbsp;<br> was&nbsp;&nbsp; &nbsp;evaluated&nbsp;&nbsp; &nbsp;by&nbsp;&nbsp; &nbsp;transthoracic&nbsp;&nbsp; &nbsp;echocardiography&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;TEE.&nbsp;&nbsp; &nbsp;By&nbsp;&nbsp; &nbsp;a&nbsp;&nbsp; &nbsp;logistic&nbsp;&nbsp; &nbsp;regression&nbsp;&nbsp; &nbsp;<br> model,&nbsp;&nbsp; &nbsp;variables&nbsp;&nbsp; &nbsp;significantly&nbsp;&nbsp; &nbsp;associated&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;LAT&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;assessed&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;introduced&nbsp;&nbsp; &nbsp;in&nbsp;&nbsp; &nbsp;<br> predictive models to develop both a clinical and an echocardiographic prediction&nbsp;<br> score&nbsp;&nbsp; &nbsp;for&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;presence&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;LAT.<br> Results: In&nbsp;&nbsp; &nbsp;total,&nbsp;&nbsp; &nbsp;125&nbsp;&nbsp; &nbsp;patients&nbsp;&nbsp; &nbsp;[median&nbsp;&nbsp; &nbsp;71&nbsp;&nbsp; &nbsp;(range&nbsp;&nbsp; &nbsp;49-88)&nbsp;&nbsp; &nbsp;years,&nbsp;&nbsp; &nbsp;60.0%&nbsp;&nbsp; &nbsp;males]&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;<br> enrolled.&nbsp;&nbsp; &nbsp;Transesophageal&nbsp;&nbsp; &nbsp;echocardiography&nbsp;&nbsp; &nbsp;showed&nbsp;&nbsp; &nbsp;LAT&nbsp;&nbsp; &nbsp;in&nbsp;&nbsp; &nbsp;35&nbsp;&nbsp; &nbsp;patients&nbsp;&nbsp; &nbsp;(28%).&nbsp;&nbsp; &nbsp;The&nbsp;&nbsp; &nbsp;<br> clinical&nbsp;&nbsp; &nbsp;variables&nbsp;&nbsp; &nbsp;significantly&nbsp;&nbsp; &nbsp;associated&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;LAT&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;previous&nbsp;&nbsp; &nbsp;stroke&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;4.17),&nbsp;&nbsp; &nbsp;<br> higher&nbsp;&nbsp; &nbsp;CHA2DS2-VASc&nbsp;&nbsp; &nbsp;score&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;1.93),&nbsp;&nbsp; &nbsp;lower&nbsp;&nbsp; &nbsp;estimated&nbsp;&nbsp; &nbsp;glomerular&nbsp;&nbsp; &nbsp;filtration&nbsp;&nbsp; &nbsp;rate&nbsp;&nbsp; &nbsp;<br> (OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;0.80),&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;higher&nbsp;&nbsp; &nbsp;brain&nbsp;&nbsp; &nbsp;natriuretic&nbsp;&nbsp; &nbsp;peptide&nbsp;&nbsp; &nbsp;levels&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;1.44).&nbsp;&nbsp; &nbsp;Among&nbsp;&nbsp; &nbsp;echocar-<br> diographic&nbsp;&nbsp; &nbsp;parameters,&nbsp;&nbsp; &nbsp;E/e&prime;&nbsp;&nbsp; &nbsp;ratio&nbsp;&nbsp; &nbsp;was&nbsp;&nbsp; &nbsp;directly&nbsp;&nbsp; &nbsp;associated&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;LAT&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;2.25),&nbsp;&nbsp; &nbsp;while&nbsp;&nbsp; &nbsp;<br> an&nbsp;&nbsp; &nbsp;inverse&nbsp;&nbsp; &nbsp;correlation&nbsp;&nbsp; &nbsp;was&nbsp;&nbsp; &nbsp;detected&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;left&nbsp;&nbsp; &nbsp;ventricular&nbsp;&nbsp; &nbsp;ejection&nbsp;&nbsp; &nbsp;fraction&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;0.43)&nbsp;&nbsp; &nbsp;<br> and&nbsp;&nbsp; &nbsp;total&nbsp;&nbsp; &nbsp;global&nbsp;&nbsp; &nbsp;left&nbsp;&nbsp; &nbsp;atrial&nbsp;&nbsp; &nbsp;strain&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;0.59).&nbsp;&nbsp; &nbsp;Two&nbsp;&nbsp; &nbsp;prediction&nbsp;&nbsp; &nbsp;scores&nbsp;&nbsp; &nbsp;(clinical&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;echo-<br> cardiographic)&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;developed.&nbsp;&nbsp; &nbsp;The&nbsp;&nbsp; &nbsp;positive&nbsp;&nbsp; &nbsp;predictive&nbsp;&nbsp; &nbsp;values&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;clinical&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;<br> echocardiographic&nbsp;&nbsp; &nbsp;score&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;80%&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;100%,&nbsp;&nbsp; &nbsp;respectively,&nbsp;&nbsp; &nbsp;while&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;negative&nbsp;&nbsp; &nbsp;pre-<br> dictive&nbsp;&nbsp; &nbsp;values&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;98%&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;94%,&nbsp;&nbsp; &nbsp;respectively.&nbsp;&nbsp; &nbsp;Combined&nbsp;&nbsp; &nbsp;use&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;scores&nbsp;&nbsp; &nbsp;reached&nbsp;&nbsp; &nbsp;<br> a&nbsp;&nbsp; &nbsp;positive&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;negative&nbsp;&nbsp; &nbsp;predictive&nbsp;&nbsp; &nbsp;value&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;100%.<br> Conclusions: When providing concordant information the two scores are able to cor-<br> rectly&nbsp;&nbsp; &nbsp;identify&nbsp;&nbsp; &nbsp;patients&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;or&nbsp;&nbsp; &nbsp;without&nbsp;&nbsp; &nbsp;LAT.&nbsp;&nbsp; &nbsp;An&nbsp;&nbsp; &nbsp;external&nbsp;&nbsp; &nbsp;validation&nbsp;&nbsp; &nbsp;is&nbsp;&nbsp; &nbsp;necessary&nbsp;&nbsp; &nbsp;to&nbsp;&nbsp; &nbsp;<br> demonstrate their usefulness in the clinical practice.</p>

restrictedAug 2021View details →
zenodo8/100

Proposal for a clinical and an echocardiographic score for prediction of left atrial thrombosis in atrial fibrillation patients undergoing early electrical cardioversion

<p>Aims: Left&nbsp;&nbsp; &nbsp;atrial&nbsp;&nbsp; &nbsp;thrombosis&nbsp;&nbsp; &nbsp;(LAT)&nbsp;&nbsp; &nbsp;is&nbsp;&nbsp; &nbsp;usually&nbsp;&nbsp; &nbsp;detected&nbsp;&nbsp; &nbsp;by&nbsp;&nbsp; &nbsp;transesophageal&nbsp;&nbsp; &nbsp;echocardi-<br> ography&nbsp;&nbsp; &nbsp;(TEE).&nbsp;&nbsp; &nbsp;The&nbsp;&nbsp; &nbsp;aim&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;present&nbsp;&nbsp; &nbsp;study&nbsp;&nbsp; &nbsp;was&nbsp;&nbsp; &nbsp;to&nbsp;&nbsp; &nbsp;identify&nbsp;&nbsp; &nbsp;clinical&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;echocardio-<br> graphic&nbsp;&nbsp; &nbsp;factors&nbsp;&nbsp; &nbsp;associated&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;left&nbsp;&nbsp; &nbsp;atrial&nbsp;&nbsp; &nbsp;thrombosis&nbsp;&nbsp; &nbsp;in&nbsp;&nbsp; &nbsp;atrial&nbsp;&nbsp; &nbsp;fibrillation&nbsp;&nbsp; &nbsp;(AF)&nbsp;&nbsp; &nbsp;patients&nbsp;&nbsp; &nbsp;<br> undergoing&nbsp;&nbsp; &nbsp;early&nbsp;&nbsp; &nbsp;electrical&nbsp;&nbsp; &nbsp;cardioversion&nbsp;&nbsp; &nbsp;(ECV)&nbsp;&nbsp; &nbsp;in&nbsp;&nbsp; &nbsp;order&nbsp;&nbsp; &nbsp;to&nbsp;&nbsp; &nbsp;create&nbsp;&nbsp; &nbsp;scores&nbsp;&nbsp; &nbsp;that&nbsp;&nbsp; &nbsp;can&nbsp;&nbsp; &nbsp;<br> predict&nbsp;&nbsp; &nbsp;LAT,&nbsp;&nbsp; &nbsp;in&nbsp;&nbsp; &nbsp;a&nbsp;&nbsp; &nbsp;non-invasive&nbsp;&nbsp; &nbsp;way.<br> Methods: A&nbsp;&nbsp; &nbsp;consecutive&nbsp;&nbsp; &nbsp;cohort&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;patients&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;persistent&nbsp;&nbsp; &nbsp;AF&nbsp;&nbsp; &nbsp;scheduled&nbsp;&nbsp; &nbsp;for&nbsp;&nbsp; &nbsp;ECV&nbsp;&nbsp; &nbsp;<br> was&nbsp;&nbsp; &nbsp;evaluated&nbsp;&nbsp; &nbsp;by&nbsp;&nbsp; &nbsp;transthoracic&nbsp;&nbsp; &nbsp;echocardiography&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;TEE.&nbsp;&nbsp; &nbsp;By&nbsp;&nbsp; &nbsp;a&nbsp;&nbsp; &nbsp;logistic&nbsp;&nbsp; &nbsp;regression&nbsp;&nbsp; &nbsp;<br> model,&nbsp;&nbsp; &nbsp;variables&nbsp;&nbsp; &nbsp;significantly&nbsp;&nbsp; &nbsp;associated&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;LAT&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;assessed&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;introduced&nbsp;&nbsp; &nbsp;in&nbsp;&nbsp; &nbsp;<br> predictive models to develop both a clinical and an echocardiographic prediction&nbsp;<br> score&nbsp;&nbsp; &nbsp;for&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;presence&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;LAT.<br> Results: In&nbsp;&nbsp; &nbsp;total,&nbsp;&nbsp; &nbsp;125&nbsp;&nbsp; &nbsp;patients&nbsp;&nbsp; &nbsp;[median&nbsp;&nbsp; &nbsp;71&nbsp;&nbsp; &nbsp;(range&nbsp;&nbsp; &nbsp;49-88)&nbsp;&nbsp; &nbsp;years,&nbsp;&nbsp; &nbsp;60.0%&nbsp;&nbsp; &nbsp;males]&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;<br> enrolled.&nbsp;&nbsp; &nbsp;Transesophageal&nbsp;&nbsp; &nbsp;echocardiography&nbsp;&nbsp; &nbsp;showed&nbsp;&nbsp; &nbsp;LAT&nbsp;&nbsp; &nbsp;in&nbsp;&nbsp; &nbsp;35&nbsp;&nbsp; &nbsp;patients&nbsp;&nbsp; &nbsp;(28%).&nbsp;&nbsp; &nbsp;The&nbsp;&nbsp; &nbsp;<br> clinical&nbsp;&nbsp; &nbsp;variables&nbsp;&nbsp; &nbsp;significantly&nbsp;&nbsp; &nbsp;associated&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;LAT&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;previous&nbsp;&nbsp; &nbsp;stroke&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;4.17),&nbsp;&nbsp; &nbsp;<br> higher&nbsp;&nbsp; &nbsp;CHA2DS2-VASc&nbsp;&nbsp; &nbsp;score&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;1.93),&nbsp;&nbsp; &nbsp;lower&nbsp;&nbsp; &nbsp;estimated&nbsp;&nbsp; &nbsp;glomerular&nbsp;&nbsp; &nbsp;filtration&nbsp;&nbsp; &nbsp;rate&nbsp;&nbsp; &nbsp;<br> (OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;0.80),&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;higher&nbsp;&nbsp; &nbsp;brain&nbsp;&nbsp; &nbsp;natriuretic&nbsp;&nbsp; &nbsp;peptide&nbsp;&nbsp; &nbsp;levels&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;1.44).&nbsp;&nbsp; &nbsp;Among&nbsp;&nbsp; &nbsp;echocar-<br> diographic&nbsp;&nbsp; &nbsp;parameters,&nbsp;&nbsp; &nbsp;E/e&prime;&nbsp;&nbsp; &nbsp;ratio&nbsp;&nbsp; &nbsp;was&nbsp;&nbsp; &nbsp;directly&nbsp;&nbsp; &nbsp;associated&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;LAT&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;2.25),&nbsp;&nbsp; &nbsp;while&nbsp;&nbsp; &nbsp;<br> an&nbsp;&nbsp; &nbsp;inverse&nbsp;&nbsp; &nbsp;correlation&nbsp;&nbsp; &nbsp;was&nbsp;&nbsp; &nbsp;detected&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;left&nbsp;&nbsp; &nbsp;ventricular&nbsp;&nbsp; &nbsp;ejection&nbsp;&nbsp; &nbsp;fraction&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;0.43)&nbsp;&nbsp; &nbsp;<br> and&nbsp;&nbsp; &nbsp;total&nbsp;&nbsp; &nbsp;global&nbsp;&nbsp; &nbsp;left&nbsp;&nbsp; &nbsp;atrial&nbsp;&nbsp; &nbsp;strain&nbsp;&nbsp; &nbsp;(OR&nbsp;&nbsp; &nbsp;=&nbsp;&nbsp; &nbsp;0.59).&nbsp;&nbsp; &nbsp;Two&nbsp;&nbsp; &nbsp;prediction&nbsp;&nbsp; &nbsp;scores&nbsp;&nbsp; &nbsp;(clinical&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;echo-<br> cardiographic)&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;developed.&nbsp;&nbsp; &nbsp;The&nbsp;&nbsp; &nbsp;positive&nbsp;&nbsp; &nbsp;predictive&nbsp;&nbsp; &nbsp;values&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;clinical&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;<br> echocardiographic&nbsp;&nbsp; &nbsp;score&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;80%&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;100%,&nbsp;&nbsp; &nbsp;respectively,&nbsp;&nbsp; &nbsp;while&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;negative&nbsp;&nbsp; &nbsp;pre-<br> dictive&nbsp;&nbsp; &nbsp;values&nbsp;&nbsp; &nbsp;were&nbsp;&nbsp; &nbsp;98%&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;94%,&nbsp;&nbsp; &nbsp;respectively.&nbsp;&nbsp; &nbsp;Combined&nbsp;&nbsp; &nbsp;use&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;the&nbsp;&nbsp; &nbsp;scores&nbsp;&nbsp; &nbsp;reached&nbsp;&nbsp; &nbsp;<br> a&nbsp;&nbsp; &nbsp;positive&nbsp;&nbsp; &nbsp;and&nbsp;&nbsp; &nbsp;negative&nbsp;&nbsp; &nbsp;predictive&nbsp;&nbsp; &nbsp;value&nbsp;&nbsp; &nbsp;of&nbsp;&nbsp; &nbsp;100%.<br> Conclusions: When providing concordant information the two scores are able to cor-<br> rectly&nbsp;&nbsp; &nbsp;identify&nbsp;&nbsp; &nbsp;patients&nbsp;&nbsp; &nbsp;with&nbsp;&nbsp; &nbsp;or&nbsp;&nbsp; &nbsp;without&nbsp;&nbsp; &nbsp;LAT.&nbsp;&nbsp; &nbsp;An&nbsp;&nbsp; &nbsp;external&nbsp;&nbsp; &nbsp;validation&nbsp;&nbsp; &nbsp;is&nbsp;&nbsp; &nbsp;necessary&nbsp;&nbsp; &nbsp;to&nbsp;&nbsp; &nbsp;<br> demonstrate their usefulness in the clinical practice.</p>

restrictedAug 2021View details →
zenodo8/100

Mechanical concordance between left atrium and left atrial appendage in nonvalvular atrial fibrillation: can it be exploited to avoid transesophageal echocardiography prior to electrical cardioversion during Covid‑19 pandemic?

<p>Transesophageal echocardiography (TEE) is the gold standard for assessing left atrial appendage (LAA) mechanic and throm-<br> bosis (LAAT); however, TEE is a high-risk procedure for viral transmission during coronavirus disease 2019 (COVID-19)&nbsp;<br> pandemic. We investigated whether deformation indices of left atrium (LA) at transthoracic echocardiography (TTE) correlate&nbsp;<br> with those of LAA assessed by TEE in nonvalvular atrial fibrillation (NVAF) patients undergoing electrical cardioversion&nbsp;<br> (ECV). Consecutive patients with NVAF of &ge; 48&nbsp;h or unknown duration, who underwent TEE and TTE at our Institution&nbsp;<br> before ECV were retrospectively investigated. Standard echo-Doppler and LA and LAA myocardial strain and strain rate&nbsp;<br> parameters were analyzed. A total of 115 NVAF patients (71.3 &plusmn; 8.1&nbsp;yr/o, 59.1% men) were included: LAAT was diagnosed&nbsp;<br> in 25 (21.7%) patients. Compared to patients without LAAT, those with LAAT had significantly higher &nbsp;CHA2DS2-VASc&nbsp;<br> Risk score (4.5 &plusmn; 1.4 vs. 3.5 &plusmn; 1.1, p &lt; 0.001), and lower ejection fraction (46.0 &plusmn; 14.8 vs. 57.6 &plusmn; 8.6%, p &lt; 0.001). In LAAT&nbsp;<br> patients, global strain of LA (8.7 &plusmn; 2.6 vs. 16.3 &plusmn; 4.5%, p &lt; 0.001) and LAA (7.0 &plusmn; 1.7 vs. 11.7 &plusmn; 2.0%, p &lt; 0.001) was sig-<br> nificantly reduced compared to non-LAAT patients. A close relationship between left atrial strain reservoir (LASr) and&nbsp;<br> LAA-global strain was demonstrated (r = 0.81). By univariable analysis, CHA2DS2-VASc Risk Score (OR 2.01, 95%CI&nbsp;<br> 1.34&ndash;3.00), NT-proBNP (OR 1.36, 95%CI 1.19&ndash;1.54), ejection fraction (OR 0.92, 95%CI 0.88&ndash;0.96), E/e&rsquo; ratio (OR 2.07,&nbsp;<br> 95%CI 1.51&ndash;2.85), and LASr (OR 0.39, 95%CI 0.25&ndash;0.62) were strongly associated with LAAT presence at TEE. By mul-<br> tivariable analysis, only LASr (OR 0.40, 95%CI 0.24&ndash;0.70) retained statistical significance. ROC curve analysis revealed&nbsp;<br> that an LASr cut-off value &le; 9.3% had 98.9% sensibility and 100% specificity to identify LAAT by TEE (AUC = 0.98). In&nbsp;<br> patients with NVAF of &ge; 48&nbsp;h or unknown duration, scheduled to undergo ECV, LA deformation assessment by TTE might&nbsp;<br> substitute invasive measurement of LAA function by TEE, simplifying diagnostic approach and possibly contributing to&nbsp;<br> reduce COVID-19 infection diffusion.</p>

restrictedSep 2021View details →
zenodo8/100

Incremental diagnostic role of left atrial strain analysis in thrombotic risk assessment of nonvalvular atrial fibrillation patients planned for electrical cardioversion

<p>Raw data related to the article</p> <p>Abstract<br> During the COVID-19 pandemic, transesophageal echocardiography (TEE) for left atrial appendage thrombosis (LAAT)<br> detection should be limited to situations of absolute necessity. We sought to identify the main conventional and functional<br> echocardiographic parameters associated with LAAT on TEE in non-valvular atrial fibrillation (NVAF) patients planned<br> for electrical cardioversion (ECV). This retrospective study included 125 consecutive NVAF patients (71.5&plusmn;7.8 yrs, 75<br> males), who underwent TEE at our Institution between April 2016 and January 2020, to exclude LAAT before scheduled<br> ECV. All patients underwent a transthoracic echocardiography (TTE) implemented with speckle tracking echocardiography<br> (STE) analysis of left atrial (LA) strain and strain rate (SR) parameters. 28% of patients were diagnosed with LAAT, while<br> 72% without LAAT. Compared to controls, patients with LAAT had significantly higher CHA2DS2-<br> Vasc Score and average<br> E/e&rsquo; ratio, and significantly lower left ventricular ejection fraction (LVEF). Moreover, LA-peak positive global atrial strain<br> (GSA+) and LA-SR parameters were significantly reduced in patients with LAAT. Multivariate logistic regression revealed<br> that, differently from CHA2DS2-<br> Vasc Score, LVEF (OR 0.88, 95%CI 0.81&ndash;0.97, p = 0.01), average E/e&rsquo; ratio (OR 2.36,<br> 95%CI 1.41&ndash;3.98, p = 0.001), and LA-GSA+ (OR 0.57, 95%CI 0.36-0-90, p = 0.01) were independently associated with<br> LAAT. LA-GSA+ (optimal cut-off &le; 9.1%, AUC 0.95) showed the highest diagnostic performance. Finally, a strong linear<br> correlation of LA peak-to-peak SR with both LA appendage filling (r = 0.86) and emptying (r = 0.83) velocities was demonstrated.<br> TTE implemented with STE analysis of LA mechanics improves thrombotic risk assessment of NVAF patients.</p>

restrictedAug 2021View details →

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