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Katapadi A, Chelikam N, Garg J, Gopinathannair R, Park P, Darden D, Venkata K Pothineni N, Atkins D, Kabra R, Bommana S, Chung M, DiBiase L, Natale A, Lakkireddy D. Dynamic Data-Driven Management of Atrial Fibrillation With Implantable Cardiac Monitors: The MONITOR AF Study. Heart Rhythm 2025:S1547-5271(25)00025-6. [PMID: 39826639 DOI: 10.1016/j.hrthm.2025.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 01/07/2025] [Accepted: 01/11/2025] [Indexed: 01/22/2025]
Abstract
BACKGROUND Implantable cardiac monitors (ICMs) provide valuable insights into managing atrial fibrillation (AF). Data suggest that ICMs increase AF detection, but their impact on management is still uncertain. OBJECTIVES To evaluate and compare the impact of ICMs on the clinical management of AF. METHODS MONITOR-AF (NCT06352060) was a retrospective, multi-center study of patients with AF between 2018 to 2021 who received an ICM or routine monitoring with electrocardiograms or long-term monitoring. Patients were followed for 12 months, making note of AF-related clinical outcomes. RESULTS There were 2293 patients who received an ICM (n=1115) or routine monitoring (n=1178). Although comorbidities between ICM and non-ICM were significantly different, none of the AF-related characteristics were significantly different. Patients in the ICM group had more attempts at rhythm control with AAD (100% vs. 59.9%, p<0.001) and CA (91.7% vs. 59.7%, p<0.001). This led to higher freedom from AF at 12 months (86.0% vs. 61.8%, p<0.001) and freedom from anti-arrhythmic drugs (75.9% vs. 39.4%, p<0.001) and oral anticoagulation (69.6.8% vs. 39.4%, p<0.001) usage, and was associated with reduced rates of stroke (0.3% vs. 1.6%, p<0.001) and major bleeding (1.6% vs. 2.9%, p<0.001). CONCLUSIONS Dynamic monitoring with ICM is associated with beneficial AF outcomes with improved freedom from AF at 12 months and fewer complications. Thus, ICM use should be considered for the management of chronic AF.
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Affiliation(s)
| | | | - Jalaj Garg
- Loma Linda University Health, Loma Linda, CA
| | | | - Peter Park
- Kansas City Hearth Rhythm Institute, Overland Park, KS
| | | | | | - Donita Atkins
- Kansas City Hearth Rhythm Institute, Overland Park, KS
| | - Rajesh Kabra
- Kansas City Hearth Rhythm Institute, Overland Park, KS
| | - Sudha Bommana
- Kansas City Hearth Rhythm Institute, Overland Park, KS
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Kang DS, Yang PS, Kim D, Jang E, Yu HT, Kim TH, Sung JH, Pak HN, Lee MH, Lip GY, Joung B. Racial Differences in Bleeding Risk: An Ecological Epidemiological Study Comparing Korea and United Kingdom Subjects. Thromb Haemost 2024; 124:842-851. [PMID: 38359877 PMCID: PMC11349425 DOI: 10.1055/a-2269-1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/13/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND This study aimed to evaluate racial differences in bleeding incidence by conducting an ecological epidemiological study using data from Korea and the United Kingdom. METHODS We included healthy participants from the Korean National Health Insurance Service-Health Screening and the UK Biobank who underwent health examinations between 2006 and 2010 and had no comorbidities or history of medication use. Finally, 112,750 East Asians (50.7% men, mean age 52.6 years) and 210,995 Caucasians (44.7% men, mean age 55.0 years) were analyzed. The primary outcome was composed of intracranial hemorrhage (ICH) and bleeding from the gastrointestinal, respiratory, and genitourinary systems. RESULTS During the follow-up, primary outcome events occurred in 2,110 East Asians and in 6,515 Caucasians. East Asians had a 38% lower 5-year incidence rate compared with Caucasians (3.88 vs. 6.29 per 1,000 person-years; incidence rate ratio [IRR]: 0.62, 95% confidence interval [CI]: 0.59-0.65). East Asians showed a lower incidence of major bleeding (IRR: 0.86, 95% CI: 0.81-0.91), bleeding from the gastrointestinal (IRR: 0.53, 95% CI: 0.49-0.56), and genitourinary systems (IRR: 0.49, 95% CI: 0.44-0.53) compared with Caucasians. The incidence rates of ICH (IRR: 3.20, 95% CI: 2.67-3.84) and bleeding from the respiratory system (IRR: 1.28, 95% CI: 1.11-1.47) were higher in East Asians. Notably, East Asians consuming alcohol ≥3 times/week showed a higher incidence of the primary outcome than Caucasians (IRR: 1.12, 95% CI: 1.01-1.25). CONCLUSION This ecological study revealed significant racial differences in bleeding incidence, influenced by anatomical sites and lifestyle habits, underscoring the need for tailored approaches in bleeding management based on race.
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Affiliation(s)
- Dong-Seon Kang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Sung Yang
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hoon Sung
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Wyatt B, McIntosh G, Campbell A, Little M, Rogers L, Wyatt B. Simulating left atrial arrhythmias with an interactive N-body model. J Electrocardiol 2024; 86:153762. [PMID: 39059214 DOI: 10.1016/j.jelectrocard.2024.153762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/31/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Heart disease and strokes are leading global killers. While atrial arrhythmias are not deadly by themselves, they can disrupt blood flow in the heart, causing blood clots. These clots can travel to the brain, causing strokes, or to the coronary arteries, causing heart attacks. Additionally, prolonged periods of elevated heart rates can lead to structural and functional changes in the heart, ultimately leading to heart failure if untreated. The left atrium, with its more complex topology, is the primary site for complex arrhythmias. Much remains unknown about the causes of these arrhythmias, and computer modeling is employed to study them. METHODS We use N-body modeling techniques and parallel computing to build an interactive model of the left atrium. Through user input, individual muscle attributes can be adjusted, and ectopic events can be placed to induce arrhythmias in the model. Users can test ablation scenarios to determine the most effective way to eliminate these arrhythmias. RESULTS We set up muscle conditions that either spontaneously generate common arrhythmias or, with a properly timed and located ectopic event, induce an arrhythmia. These arrhythmias were successfully eliminated with simulated ablation. CONCLUSIONS We believe the model could be useful to doctors, researchers, and medical students studying left atrial arrhythmias.
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Affiliation(s)
- Bryant Wyatt
- Tarleton State University, Department of Mathematics,1333 W Washington St, Stephenville, TX 76401, United States of America.
| | - Gavin McIntosh
- Tarleton State University, Department of Mathematics,1333 W Washington St, Stephenville, TX 76401, United States of America
| | - Avery Campbell
- Oncor Electric Delivery, 1616 Woodall Rodgers Fwy, Dallas, TX 75202, United States of America
| | - Melanie Little
- MD Anderson School of Health Professions, 1515 Holocombe Blvd, Houston, TX 77030, United States of America
| | - Leah Rogers
- Tarleton State University, Department of Mathematics,1333 W Washington St, Stephenville, TX 76401, United States of America
| | - Brandon Wyatt
- Biosense Webster, 31 Technology Dr. Suite 200, Irvine, CA 92618, United States of America
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Drapkina OM, Kontsevaya AV, Kalinina AM, Avdeev SN, Agaltsov MV, Alekseeva LI, Almazova II, Andreenko EY, Antipushina DN, Balanova YA, Berns SA, Budnevsky AV, Gainitdinova VV, Garanin AA, Gorbunov VM, Gorshkov AY, Grigorenko EA, Jonova BY, Drozdova LY, Druk IV, Eliashevich SO, Eliseev MS, Zharylkasynova GZ, Zabrovskaya SA, Imaeva AE, Kamilova UK, Kaprin AD, Kobalava ZD, Korsunsky DV, Kulikova OV, Kurekhyan AS, Kutishenko NP, Lavrenova EA, Lopatina MV, Lukina YV, Lukyanov MM, Lyusina EO, Mamedov MN, Mardanov BU, Mareev YV, Martsevich SY, Mitkovskaya NP, Myasnikov RP, Nebieridze DV, Orlov SA, Pereverzeva KG, Popovkina OE, Potievskaya VI, Skripnikova IA, Smirnova MI, Sooronbaev TM, Toroptsova NV, Khailova ZV, Khoronenko VE, Chashchin MG, Chernik TA, Shalnova SA, Shapovalova MM, Shepel RN, Sheptulina AF, Shishkova VN, Yuldashova RU, Yavelov IS, Yakushin SS. Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2024; 23:3696. [DOI: 10.15829/1728-8800-2024-3996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024] Open
Abstract
Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.
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Göçer K, Öztürk B. Role of Malnutrition in Atrial Fibrillation: A Prospective Study including Individuals ≥ 75 Years of Age. Nutrients 2023; 15:4195. [PMID: 37836479 PMCID: PMC10574320 DOI: 10.3390/nu15194195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common rhythm disorder in the elderly. The AF can cause life-threatening thromboembolic complications. Therefore, there is a need to determine the risk factors of AF. In this study, we aimed to examine the association of markers of malnutrition with AF in individuals aged 75 years and older and to find the factors that may affect mortality. METHODS In this prospective study, 358 consecutive individuals aged 75 years and older presenting to the cardiology outpatient clinic were included. All participants were divided into AF and sinus rhythm (SR) groups. In addition, a questionnaire and scoring system were used to assess malnutrition status. Information was obtained from all patients through outpatient clinic visits or telephone interviews for one year. Death from any cause was considered as the endpoint. RESULTS AF was observed in 71 (19.8%) patients. Death was higher in patients with AF (p < 0.001), high CONUT score (p = 0.018), and GLIM malnutrition (p = 0.018). GLIM malnutrition caused a 2.8-fold increase in the development of AF. CONCLUSIONS Screening for malnutrition in the elderly is essential. According to GLIM criteria, malnutrition may play a role in the development of AF and increase one-year mortality in the elderly.
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Affiliation(s)
- Kemal Göçer
- Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras 46050, Türkiye
| | - Bayram Öztürk
- Department of Cardiology, Medical Park Goztepe Hospital, Istanbul 34730, Türkiye
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Meza C, Juega J, Francisco J, Santos A, Duran L, Rodriguez M, Alvarez-Sabin J, Sero L, Ustrell X, Bashir S, Serena J, Silva Y, Molina C, Pagola J. Accuracy of a Smartwatch to Assess Heart Rate Monitoring and Atrial Fibrillation in Stroke Patients. SENSORS (BASEL, SWITZERLAND) 2023; 23:4632. [PMID: 37430546 DOI: 10.3390/s23104632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 07/12/2023]
Abstract
(1) Background: Consumer smartwatches may be a helpful tool to screen for atrial fibrillation (AF). However, validation studies on older stroke patients remain scarce. The aim of this pilot study from RCT NCT05565781 was to validate the resting heart rate (HR) measurement and the irregular rhythm notification (IRN) feature in stroke patients in sinus rhythm (SR) and AF. (2) Methods: Resting clinical HR measurements (every 5 min) were assessed using continuous bedside ECG monitoring (CEM) and the Fitbit Charge 5 (FC5). IRNs were gathered after at least 4 h of CEM. Lin's concordance correlation coefficient (CCC), Bland-Altman analysis, and mean absolute percentage error (MAPE) were used for agreement and accuracy assessment. (3) Results: In all, 526 individual pairs of measurements were obtained from 70 stroke patients-age 79.4 years (SD ± 10.2), 63% females, BMI 26.3 (IQ 22.2-30.5), and NIHSS score 8 (IQR 1.5-20). The agreement between the FC5 and CEM was good (CCC 0.791) when evaluating paired HR measurements in SR. Meanwhile, the FC5 provided weak agreement (CCC 0.211) and low accuracy (MAPE 16.48%) when compared to CEM recordings in AF. Regarding the accuracy of the IRN feature, analysis found a low sensitivity (34%) and high specificity (100%) for detecting AF. (4) Conclusion: The FC5 was accurate at assessing the HR during SR, but the accuracy during AF was poor. In contrast, the IRN feature was acceptable for guiding decisions regarding AF screening in stroke patients.
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Affiliation(s)
- Claudia Meza
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Jesus Juega
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Jaume Francisco
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Alba Santos
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Laura Duran
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Maite Rodriguez
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| | - Jose Alvarez-Sabin
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Laia Sero
- Department of Neurology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
| | - Xavier Ustrell
- Department of Neurology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
| | - Saima Bashir
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), 17790 Girona, Spain
- Department of Neurology, Hospital Universitari de Girona Dr. JosepTrueta, 17007 Girona, Spain
| | - Joaquín Serena
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), 17790 Girona, Spain
- Department of Neurology, Hospital Universitari de Girona Dr. JosepTrueta, 17007 Girona, Spain
| | - Yolanda Silva
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), 17790 Girona, Spain
- Department of Neurology, Hospital Universitari de Girona Dr. JosepTrueta, 17007 Girona, Spain
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
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Kim M, Yu HT, Kim TH, Lee DI, Uhm JS, Kim YD, Nam HS, Joung B, Lee MH, Heo JH, Pak HN. Ischemic Stroke in Non-Gender-Related CHA2DS2-VA Score 0~1 Is Associated With H2FPEF Score Among the Patients With Atrial Fibrillation. Front Cardiovasc Med 2022; 8:791112. [PMID: 35211517 PMCID: PMC8862762 DOI: 10.3389/fcvm.2021.791112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Ischemic strokes (ISs) can appear even in non-gender-related CHA2DS2-VA scores 0~1 patients with atrial fibrillation (AF). We explored the determinants associated with IS development among the patients with non-gender-related CHA2DS2-VA score 0~1 AF. Methods and Results In this single-center retrospective registry data for AF catheter ablation (AFCA), we included 1,353 patients with AF (24.7% female, median age 56 years, and paroxysmal AF 72.6%) who had non-gender-related CHA2DS2-VA score 0~1, normal left ventricular (LV) systolic function, and available H2FPEF score. Among those patients, 113 experienced IS despite a non-gender-related CHA2DS2-VA score of 0~1. All included patients underwent AFCA, and we evaluated the associated factors with IS in non-gender-related CHA2DS2-VA score 0~1 AF. Patients with ISs in this study had a lower estimated glomerular filtration rate (eGFR) (p < 0.001) and LV ejection fraction (LVEF; p = 0.017), larger LA diameter (p < 0.001), reduced LA appendage peak velocity (p < 0.001), and a higher baseline H2FPEF score (p = 0.018) relative to those without ISs. Age [odds ratio (OR) 1.11 (1.07–1.17), p < 0.001, Model 1] and H2FPEF score as continuous [OR 1.31 (1.03–1.67), p = 0.028, Model 2] variable were independently associated with ISs by multivariate analysis. Moreover, the eGFR was independently associated with IS at low CHA2DS2-VA scores in both Models 1 and 2. AF recurrence was significantly higher in patients with IS (log-rank p < 0.001) but not in those with high H2FPEF scores (log-rank p = 0.079), respectively. Conclusions Among the patients with normal LVEF and non-gender-related CHA2DS2-VA score 0~1 AF, the high H2FPEF score, and increasing age were independently associated with IS development (ClinicalTrials.gov Identifier: NCT02138695).
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Affiliation(s)
- Min Kim
- Division of Cardiology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Dae-In Lee
- Division of Cardiology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University Health System, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University Health System, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
- *Correspondence: Hui-Nam Pak
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8
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The Determinants of the 13-Year Risk of Incident Atrial Fibrillation in a Russian Population Cohort of Middle and Elderly Age. J Pers Med 2022; 12:jpm12010122. [PMID: 35055437 PMCID: PMC8779704 DOI: 10.3390/jpm12010122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and a predictor of the complications of atherosclerotic cardiovascular diseases (ASCVDs), particularly thromboembolic events and the progression of heart failure. We analyzed the determinants of the 13-year risk of incident AF in a Russian population cohort of middle and elderly age. A random population sample (n = 9360, age 45–69 years) was examined at baseline in 2003–2005 and reexamined in 2006–2008 and 2015–2017 in Novosibirsk (the HAPIEE study). Incident AF was being registered during the average follow-up of 13 years. The final analysis included 3871 participants free from baseline AF and cardiovascular disease (CVD) who participated in all three data collections. In a multivariable-adjusted Cox regression model, the 13-year risk of AF was positively associated with the male sex (hazard ratio (HR) = 2.20; 95% confidence interval (CI) 1.26–3.87); age (HR = 1.10 per year; 95% CI 1.07–1.14); body mass index (BMI), (HR = 1.11 per unit; 95% CI 1.07–1.15); systolic blood pressure (SBP), (HR = 1.02 per 1 mmHg; 95% CI 1.01–1.02), and it was negatively associated with total cholesterol (TC), (HR = 0.79 per 1 mmol/L; 95% CI 0.66–0.94). In women, the risk of AF was more strongly associated with hypertension (HT) and was also negatively related to total cholesterol (TC) level (HR = 0.74 per 1 mmol/L; 95% CI 0.56–0.96). No independent association was found with mean alcohol intake per drinking occasion. These results in a Russian cohort have an implication for the prediction of AF and ASCVD complications in the general population.
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Sridharan A, Maron MS, Carrick RT, Madias CA, Huang D, Cooper C, Drummond J, Maron BJ, Rowin EJ. Impact of comorbidities on atrial fibrillation and sudden cardiac death in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2022; 33:20-29. [PMID: 34845799 PMCID: PMC10092906 DOI: 10.1111/jce.15304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/25/2021] [Accepted: 10/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The impact of comorbid disease states on the development of atrial and ventricular arrhythmias in patients with hypertrophic cardiomyopathy (HCM) remains unresolved. OBJECTIVE Evaluate the association of comorbidities linked to arrhythmias in other cardiovascular diseases (e.g., obesity, systemic hypertension, diabetes, obstructive sleep apnea, renal disorders, tobacco, and alcohol use) to atrial fibrillation (AF) and sudden cardiac death (SCD) events in a large cohort of HCM patients. METHODS A total of 2269 patients, 54 ± 15 years of age, 1392 males, were evaluated at the Tufts HCM Institute between 2004 and 2018 and followed for an average of 4 ± 3 years for new-onset clinical AF and SCD events (appropriate defibrillation for ventricular tachyarrhythmias, resuscitated cardiac arrest, or SCD). RESULTS One or more comorbidity was present in 75% of HCM patients, including 50% with ≥2 comorbidities, most commonly obesity (body mass index [BMI] ≥ 30 kg/m2 ) in 43%. New-onset atrial fibrillation developed in 11% of our cohort (2.6%/year). On univariate analysis, obesity was associated with a 1.7-fold increased risk for AF (p = .03) with 12% of obese patients developing AF (3.3%/year) as compared to 7% of patients with BMI < 25 kg/m2 (1.6%/year; p = .006). On multivariate analysis, age and LA transverse dimension emerged as the only variables predictive of AF. Comorbidities, including obesity, were not independently associated with AF development (p > .10 for each). SCD events occurred in 3.3% of patients (0.8%/year) and neither obesity nor other comorbidities were associated with increased risk for SCD (p > .10 for each). CONCLUSIONS In adult HCM patients comorbidities do not appear to impact AF or SCD risk. Therefore, for most patients with HCM, adverse disease related events of AF and SCD appear to be primarily driven by underlying left ventricular and atrial myopathy as opposed to comorbidities.
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Affiliation(s)
- Aadhavi Sridharan
- Division of Cardiology, HCM Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Martin S Maron
- Division of Cardiology, HCM Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Richard T Carrick
- Division of Cardiology, HCM Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Christopher A Madias
- Division of Cardiology, HCM Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Dou Huang
- Division of Cardiology, HCM Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Craig Cooper
- Division of Cardiology, HCM Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jennifer Drummond
- Division of Cardiology, HCM Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Barry J Maron
- Division of Cardiology, HCM Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ethan J Rowin
- Division of Cardiology, HCM Institute, Tufts Medical Center, Boston, Massachusetts, USA
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10
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A Reiffel J. The Importance of Atrial Fibrillation's Associated Comorbidities as Clinical Presentation and Outcome Contributors. J Atr Fibrillation 2021; 14:20200517. [PMID: 34950378 DOI: 10.4022/jafib.20200517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) has a heterogeneous clinical presentation. It can occur: (a) in the presence or absence of detectable heart disease, and, (b) with or without relatedsymptoms. Its prognosis in terms of thromboembolismand mortality is most benign when applied to young individuals (aged less than 60 years) without clinical orechocardiographic evidence of cardiopulmonary disease [termed "lone AF"]. However, by virtue of aging or because of the development of concomitant cardiovascular disorders, patientsmove out of the lone AF category over time, accompanied by increased risks for thromboembolism and mortality. Thus, underlying and/or associated comorbidities must play an important role in the presentation and consequences of patients with AF. While, no doubt, most clinicians likely appreciate that the majority of the AF patients they see have associated cardiovascular, pulmonary, metabolic, endocrinologic, genetic, and/or other disorders, it is not clear how much they appreciate that these disorders directly relate to the presenting symptoms and to the risks from AF in addition to their role as risk factors (or markers) for AF. This issue is the subject of this review manuscript.
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Affiliation(s)
- James A Reiffel
- Columbia Memorial Hospital and New York Presbyterian Westchester Division
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Rydén L, Sacuiu S, Wetterberg H, Najar J, Guo X, Kern S, Zettergren A, Shams S, Pereira JB, Wahlund LO, Westman E, Skoog I. Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-based MRI Study. Neurology 2021; 97:e1608-e1619. [PMID: 34521692 PMCID: PMC8548961 DOI: 10.1212/wnl.0000000000012675] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives Atrial fibrillation (AF) has been associated with cognitive decline and dementia. However, the mechanisms behind these associations are not clear. Examination of cerebrovascular pathology on MRI may shed light on how AF affects the brain. This study aimed to determine whether AF is associated with a broad range of cerebrovascular diseases beyond the well-known association with symptomatic stroke, including silent infarcts and markers of small vessel disease, i.e., cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and lacunes, in a population-based sample of 70-year-olds. Methods Data were obtained from the Gothenburg H70 Birth Cohort Studies, in which individuals are invited based on birthdate. This study has a cross-sectional design and includes individuals born in 1944 who underwent structural brain MRI in 2014 to 2017. AF diagnoses were based on self-report, ECG, and register data. Symptomatic stroke was based on self-report, proxy interviews, and register data. Brain infarcts and CMBs were assessed by a radiologist. WMH volumes were measured on fluid-attenuated inversion recovery images with the Lesion Segmentation Tool. Multivariable logistic regression was used to study the association between AF and infarcts/CMBs, and multivariable linear regression was used to study the association between AF and WMHs. Results A total of 776 individuals were included, and 65 (8.4%) had AF. AF was associated with symptomatic stroke (odds ratio [OR] 4.5, 95% confidence interval [CI] 2.1–9.5) and MRI findings of large infarcts (OR 5.0, 95% CI 1.5–15.9), lacunes (OR 2.7, 95% CI 1.2–5.6), and silent brain infarcts (OR 3.5; 95% CI 1.6–7.4). Among those with symptomatic stroke, individuals with AF had larger WMH volumes (0.0137 mL/total intracranial volume [TIV], 95% CI 0.0074–0.0252) compared to those without AF (0.0043 mL/TIV, 95% CI 0.0029–0.0064). There was no association between AF and WMH volumes among those without symptomatic stroke. In addition, AF was associated to CMBs in the frontal lobe. Discussion AF was associated with a broad range of cerebrovascular pathologies. Further research is needed to establish whether cerebrovascular MRI markers can be added to current treatment guidelines to further personalize anticoagulant treatment in patients with AF and to further characterize the pathogenetic processes underlying the associations between AF and cerebrovascular diseases, as well as dementia.
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Affiliation(s)
- Lina Rydén
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden.
| | - Simona Sacuiu
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Hanna Wetterberg
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Jenna Najar
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Xinxin Guo
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Silke Kern
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Anna Zettergren
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Sara Shams
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Joana B Pereira
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Lars-Olof Wahlund
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Eric Westman
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Ingmar Skoog
- From the Institute of Neuroscience and Physiology (L.R., S.Sacuiu, H.W., J.N., X.G., S.K., A.Z., I.S.), Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg; Department of Psychiatry Cognition and Old Age Psychiatry (L.R., S.S., J.N., S.K., I.S.), Sahlgrenska University Hospital, Region Västra Götaland, Mölndal; Department of Mood Disorders (X.G.), Sahlgrenska University Hospital, Region Västra Götaland, Göteborg; Division of Clinical Geriatrics (S.Shams, J.B.P., L.-O.W., E.W.), Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (S.S.), Stanford, CA; and Clinical Memory Research Unit (J.B.P.), Department of Clinical Sciences, Malmö, Lund University, Sweden
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Singleton MJ, Imtiaz-Ahmad M, Kamel H, O'Neal WT, Judd SE, Howard VJ, Howard G, Soliman EZ, Bhave PD. Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study. J Am Heart Assoc 2020; 9:e016380. [PMID: 32495723 PMCID: PMC7429041 DOI: 10.1161/jaha.120.016380] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Atrial fibrillation (AF) is associated with a 5-fold increased stroke risk. While most patients with AF warrant anticoagulation, optimal treatment remains uncertain for patients with AF without cardiovascular comorbidities because the risk of stroke in this population has not been well-characterized. Methods and Results Participants (N=28 253; 55% women, mean age 64.6±9.4 years), from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study (2003-present) were classified into 1 of 4 groups based on the presence or absence of AF and the presence or absence of cardiovascular comorbidities. Cox proportional hazards analysis was used to compare the risk of stroke between groups. During 244 560 person-years of follow-up (median 8.7 years), 1206 strokes occurred. Compared with patients with neither AF nor cardiovascular comorbidities, we did not find an increased stroke risk (hazard ratio [HR], 1.23; 95% CI, 0.62-2.18 [P=0.511]) among participants with AF alone. Participants without AF but with cardiovascular comorbidities had both an elevated stroke risk (HR, 1.77; 95% CI, 1.48-2.18 [P<0.0001]) and an increased risk of cardioembolic stroke (HR, 2.34; 95% CI, 1.48-3.90 [P=0.0002]). Conclusions In this large cohort of participants with AF without cardiovascular comorbidities, we found that AF itself, without cardiovascular comorbidities, did not confer increased risk of stroke. Cardiovascular comorbidities, however, were associated with an increased risk of both stroke of any type and cardioembolic stroke, even in the absence of AF.
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Affiliation(s)
| | | | - Hooman Kamel
- Department of Neurology Weill Cornell Medical College New York NY
| | - Wesley T O'Neal
- Division of Cardiology Department of Internal Medicine Emory University School of Medicine Atlanta GA
| | - Suzanne E Judd
- Department of Biostatistics University of Alabama at Birmingham AL
| | | | - George Howard
- Department of Biostatistics University of Alabama at Birmingham AL
| | - Elsayed Z Soliman
- Department of Internal Medicine and Epidemiological Cardiology Research Center Wake Forest School of Medicine Winston-Salem NC
| | - Prashant D Bhave
- Section of Cardiology Wake Forest School of Medicine Winston-Salem NC
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