Echocardiographic E/e for the prediction of recurrent atrial fibrillation after ablation or electrical cardioversion: a systematic review and meta-analysis

Background

Atrial Fibrillation (AF) is the most common arrhythmia, with important sequelae if left untreated. Markers help to predict the recurrence of AF after an intervention like ablation or electrical cardioversion (ECV). E/e' ratio is an echocardiographic marker which is potentially useful in predicting AF recurrence, however, present data is conflicting. Adding a simple tool like E/e' ratio to evaluation of patients for AF intervention may help in advising patients better about their risk for recurrent AF after intervention without adding much cost to the diagnostic work-up.

Purpose

To determine if there is a significant difference in pooled mean E/e' ratio among AF patients with recurrence after ablation or ECV compared to those who maintained sinus rhythm, and to determine the odds ratio of recurrent AF given an abnormal E/e' ratio.

Methods

The investigators systematically searched Pubmed, Medline, Cochrane Database, and Google Scholar for articles on patients undergoing catheter ablation or ECV for AF and who were adjudicated on recurrence of the arrhythmia. We calculated the weighted mean difference of E/e' ratio between those with recurring AF and those who maintained sinus rhythm, and the odds ratio of AF recurrence given an abnormal E/e' ratio. Statistical analysis was done using RevMan 5.4.1 software.

Results

A total of 38 studies involving 7048 patients were included in the initial analysis (26 studies on ablation with continuous data and 2 with dichotomous data based on a set cutoff, and 10 studies on ECV). One study was excluded due to absence of a blanking period and and another due to outlaying data in funnel plot analysis. The remaining 36 studies with 6910 patients were analyzed. There was a significant difference in the weighted mean E/e' ratio between the two groups in AF patients undergoing ablation (Mean Difference (MD)=0.60 (95% CI [0.20,1.00] p=0.003, I2=63%]), and ECV (MD=2.07 (95% CI [1.66, 2.49] p<0.ehab724.0361, I2=12%), with an odds ratio of 1.88 (95% CI [1.04, 3.37] p=0.04, I2=52%) among those with dichotomous data. Subgroup analyses were done to reduce heterogeneity. E/e' ratio was not significantly different in the population of paroxysmal AF undergoing ablation (MD=0.64, 95% CI [−0.55, 1.83], p=0.29, I2=76%) but significantly different in patients with non-paroxysmal AF undergoing ECV (MD=2.19, 95% CI [1.82, 2.56], I2=0%).

Conclusion

This analysis suggests that a higher E/e' ratio may be used to predict recurrence of AF after ablation or ECV, especially in patients undergoing ECV. The heterogeneity of the data for E/e' ratio in AF ablation and the variety of co-morbid conditions to atrial fibrillation limits its clinical applicability. Further studies are recommended to determine the optimal cutoff of this ratio that would predict AF recurrence.

Funding Acknowledgement

Type of funding sources: None. Forest plot for studies on AblationForest plot for studies on ECV

Access to assistive technology (AT) information in Spanish on state and territory program websites: United States, 2018

BACKGROUND

Compared to non-Hispanic white individuals, assistive technology (AT) utilization is lower among Hispanic individuals.^1-7 In the US, Spanish is the 2nd most frequently spoken language. Greater than one-fifth of Spanish-speaking households are limited English proficiencty (LEP) households (i.e., all individuals over age 14 in the household speak English less than "very well").⁸ Availability of AT materials in Spanish is one factor influencing knowledge about and utilization of AT among Spanish-speakers.

OBJECTIVE

To examine the availability of Spanish-language AT information on state AT program websites and to assess the relationship between availability and state demographic and linguistic characteristics.

METHODS

In 2018, we evaluated 56 state and territory AT program websites for the availability of AT information in Spanish. We calculated 4 measures (US Hispanic population in the state/territory; Hispanic individuals as a proportion of state population; overall Spanish-speaking households, and Spanish-speaking, limited English proficient households) from the 2016 American Community Survey and created ranked lists for each measure. Point biserial (r_pb) correlations were calculated to test associations between each measure and availability of AT information in Spanish on each program's website.

RESULTS

Sixteen program websites (15 states, 1 territory) provided access to Spanish-language AT information. None of the 4 measures were strongly associated with this outcome (r_pb ranged from 0.30 to 0.42). For any of the 4 measures, no more than half of states in the top 10 ranks offered online access to AT information in Spanish.

CONCLUSIONS

Improving the online availability of AT information in Spanish is necessary to increase equity in AT utilization among Spanish-speaking people with disabilities.

Micellar electrokinetic chromatography method for the determination of several natural red dyestuff and lake pigments used in art work

The identification of organic colorants used in artistic paintings is an important information source for reconstructing the working techniques found in a particular work and for defining a programme for the restoration and conservation of the painting. In this work, sodium dodecyl sulfate (SDS) was used as a surfactant in micellar electrokinetic chromatography (MEKC) for separating a broad range of red organic pigments, based on their colouring matters: madder (colouring matters: alizarin, quinizarin and purpurin), cochineal (colouring matter: carminic acid), red sandalwood (colouring matter: santalin), brazilwood (colouring matter: brazilin), lac dye (colouring matter: laccaic acid) and dragon's blood (colouring matter: dracorhodin). The running electrolyte used was 20 mM borax (pH 9), containing 20 mM SDS and 10% acetonitrile as organic modifier. Separation was carried out by applying a +20 kV voltage at the injection end, 25 degrees C and 214 nm/254 nm as detection wavelengths. All colorants were separated within less than 13 min with a good baseline resolution. The method was applied to the analysis of paint samples obtained from the Diocesan Museum of Holy Art of Bilbao.

Human and rat lung biotransformation of cyclosporin A and its derivatives using slices and bronchial epithelial cells

Lung biotransformation of the immunosuppressants, cyclosporin A (CSA), the hydroxyethyl derivative SDZ IMM 125 (IMM), and the methylcarbonate derivative SDZ SCP 764 (SCP), was demonstrated in slices from human and rat. The major biotransformation pathway for CSA and IMM (0.1-10 microM) was hydroxylation at amino acid 1 to form AM1 or IMM1, while for SCP it was an esterase cleavage of the methylcarbonate group to form AM1 in both species. The initial rate (0-1 hr) of human total metabolite formation increased proportionally with substrate concentration. AM1 formation was five times greater from SCP, an esterase pathway, than CSA, an oxidative pathway which was inhibited (50%) by ketoconazole. At 24 hr human lung CSA metabolite formation was greater than IMM (3-fold) or SCP (2-fold), whereas rat lung and liver and human bronchial epithelial cell SCP metabolite formation generally exceeded CSA or IMM metabolism. CSA biotransformation is expected to occur throughout the human lung as demonstrated by the similar metabolite profile and extent of metabolism by slices derived from five different regions. The scaling of slice total metabolism to organ metabolism revealed that initially lung CSA metabolite formation would be equal to liver but with time liver metabolism would exceed lung for human and rat. This study has demonstrated that human and rat lung are metabolically active, exhibiting oxidative and esterase pathways toward cyclosporin derivatives. The lung will play an important role in this metabolism, particularly when administered via inhalation; however, the liver will also be a major organ involved in the total clearance of these compounds.