Left atrial enlargement and non-paroxysmal atrial fibrillation as risk factors for left atrial thrombus/spontaneous Echo contrast in patients with atrial fibrillation and low CHA2DS2-VASc score

Objective To determine the risk factors for thromboembolism in lower risk patients with non-valvular atrial fibrillation(AF)and low CHA2DS2-VASc scores,which remain undefined.Methods We retrospectively analyzed the baseline clinical characteristics,routine laboratory parameters,and echocardiographic measurements of 705 patients(71.1%male;mean age:52.10±9.64 years)with low CHA2DS2-VASc score(0 or 1;1 point for female sex)out of 1346 consecutive patients with non-valvular AF who underwent transesophageal echocardiography(TEE)at Guangdong Cardiovascular Institute between January 2013 and December 2015.Results Patients with left atrial thrombus(LAT)or spontaneous echo contrast(SEC)on TEE(24/705,4%)showed a higher incidence rate of vascular disease(54.2%vs.32.9%,P=0.045)and non-paroxysmal AF(79.2%vs.29.4%,P<0.001),larger left atrial diameter(43.08±4.59 vs.36.02±5.53 mm,P<0.001),and lower left ventricular ejection fraction(58.23±8.82%vs.64.15±7.14%,P<0.001)than those without.Multivariate logistic regression analysis identified left atrial diameter[odds ratio(OR)=1.171,95%confidence interval(CI):1.084–1.265,P<0.001]and non-paroxysmal AF(OR=3.766,95%CI:1.282–11.061,P=0.016)as independent risk factors for LAT/SEC.In ROC curve analysis,a left atrial dimeter cutoff of 37.5 mm yielded 95.0%sensitivity and 62.7%specificity(AUC:0.847,P<0.0001,95%CI:0.793–0.914).Conclusion In patients with non-valvular AF with low CHA2DS2-VASc score,the presence of LAT or SEC was associated with left atrial enlargement,which had moderate predictive value,and non-paroxysmal AF.

Predictive value of red cell distribution width on left atrial thrombus or left atrial spontaneous echo contrast in patients with non-valvular atrial fibrillation

Objective To evaluate the predictive value of red cell distribution width （RDW） on left atrial thrombus （LAT） or left atrial spontane- ous echo contrast （LASEC） in patients with non-valvular atrial fibrillation （AF）. Methods We reviewed 692 patients who were diagnosed as non-valvular AF and underwent transesophageal echocardiography （TEE） in Guangdong Cardiovascular Institute from April 2014 to December 2015. The baseline clinical characteristics, laboratory test of blood routine, electrocardiograph measurements were analyzed. Results Eighty-four patients were examined with LAT/LASEC under TEE. The mean RDW level was significantly higher in LAT/LASEC patients compared with the non-LAT/LASEC patients （13.59% ± 1.07% ws. 14.34% ± 1.34%; P 〈 0.001）. Receiver-operating characteristic curve analysis was performed and indicated the best RDW cut point was 13.16%. Furthermore, multivariate logistic regression analysis indicated that RDW level 〉 13.16% could be an independent risk factor for LAT/LASEC in patients with AF. Conclusion Elevated RDW level is associated with the presence of LAT/LASEC and could be with moderate predictive value for LAT/LASEC in patients with non-valvular AF.

Predictive value of serum uric acid on left atrial spontaneous echo contrast in non-valvular atrial fibrillation patients

Objectives To investigate the relationship between serum uric acid （SUA） and left atrial spontaneous echo contrast （LA-SEC） in non-valvular atrial fibrillation （AF） patients. Methods We retrospectively screened 1,476 consecutive hospitalized patients with AF who underwent transesophageal echocardiography prior to radiofrequency catheter ablation, left atrial appendage closure and electric cardiover- sion at Guangdong General Hospital. Data on the clinical baseline characteristics of all patients were collected from electronic medical re- cords and analyzed. Results After exclusion of patients with left atrial thrombus, 1,354 patients entered into present study and 57 were LA-SEC. The mean female SUA level （380.88 ± 94.35 μmol/L vs. 323.37 ± 72.19μmol/L, P 〈 0.001） and male SUA level （416.97 ± 98.87 μmol/L vs. 367.88 ＋ 68.50 μmol/L, P = 0.008） were both significantly higher in patients with LA-SEC than in the controls. The mean left atrial dimension （41.32 ± 5.12 mm vs. 36.12 ± 5.66 mm, P 〈 0.001） was markedly larger in patients with LA-SEC. In multivariate regression analysis, SUA level was an independent risk factor for LA-SEC （OR： 1.008, P 〈 0.001）. In receiver operating characteristic curve analysis, the corresponding area under the curve for SUA predicting LA-SEC in female and male were 0.670 and 0.657, respectively. SUA level is significantly higher in non-valvular AF patients with LA-SEC. Conclusion SUA level is an independent risk factor and has a moderate predictive value for LA-SEC among non-valvular AF patients in Southern China.

Prevalence and modifiable risk factors of degenerative valvular heart disease among elderly population in southern China

Objective To investigate the prevalence and modifiable risk factors of degenerative valvular heart disease(DVHD)among elderly population in southern China.Methods A stratified multistage sampling method was used to recruit subjects.The contents of the survey included the questionnaire,laboratory examination,echocardiography,and other auxiliary examinations.The possible risk factors of DVHD were analyzed by logistic regression analysis.Results A total of 3538 subjects≥65 years of age were enrolled.One thousand three hundred and seven subjects(36.9%)were diagnosed with DVHD.Degenerative was the most common etiology of VHD.Prevalence of DVHD increased with advancing age.The prevalence of DVHD differed by living region(χ^(2)=45.594,P<0.001),educational level(χ^(2)=50.557,P<0.001),and occupation(χ^(2)=36.961,P<0.001).Risk factors associated with DVHD included age(two-fold increased risk for each 10-year increase in age),elevated level C-reactive protein(OR=1.346,95%CI:1.100-1.646),elevated level low density lipoprotein(OR=1.243,95%CI:1.064-1.451),coronary artery disease(OR=1.651,95%CI:1.085-2.513),smoking(OR=1.341,95%CI:1.132-1.589),and hypertension(OR=1.414,95%CI:1.221-1.638).Other significant risk factors included reduced or elevated level red blood cell(OR=1.347,95%CI:1.031-1.761;OR=1.599,95%CI:1.097-2.331;respectively),elevated level platelets(OR=1.891,95%CI:1.118-3.198),elevated level uric acid(OR=1.282,95%CI:1.112-1.479),and stroke(OR:1.738,95%CI=1.085-2.513).Conclusions The survey characterized the baseline conditions of DVHD cohort of elderly population in Guangzhou city.The established and emerging risk factors for DVHD may represent challenges and opportunities for therapy.

Prevalence and incidence of heart failure among community in China during a three-year follow-up

BACKGROUND Epidemiological surveys on heart failure(HF)in Chinese community are relatively lacking.This study aimed to estimate the prevalence and incidence of HF among community residents in southern China.METHODS Baseline data of this prospective study was collected from 2015 to 2017 among 12,013 permanent residents aged≥35years in Guangzhou,China.The same survey process was carried out for individuals aged≥65 years after a three-year follow-up.RESULTS The overall prevalence of HF in community residents aged≥35 years was 1.06%.Male had significantly higher risk of HF prevalence[odds ratio(OR)=1.50,P=0.027].The gender-adjusted risk of HF was 1.48 times higher per 10 years aging.HF prevalence was statistically associated with atrial fibrillation,valvular heart disease,hypertension and chronic obstructive pulmonary disease after adjusting for age and gender(OR=8.30,5.17,1.11,2.28,respectively;all P<0.05).HF incidence in individuals aged≥65 years were 847 per 100,000 person-years.Baseline atrial fibrillation,valvular heart disease,and diabetes mellitus were risk factors for HF incidence for individuals aged≥65 years adjusting for age and gender(OR=5.05,3.99,2.11,respectively;all P<0.05).Besides,residents with new-onset atrial fibrillation and myocardial infarction were at significantly higher risk of progression to HF(OR=14.41,8.54,respectively;all P<0.05).CONCLUSIONS Both pre-existing and new-onset cardiovascular diseases were associated with HF incidence in southern China.Management of related cardiovascular diseases may be helpful to reduce the incidence of HF.

Automated Ultra-High Density Mapping in atrial fibrillation hybrid procedure

A 70-year-old female visited our hospital due to a 5-year history of long-standing persistent atrial fibrillation （LSPsAF） refractory to medical treatment. Chest x-ray and echocardiography were free of abnormalities and did not detect manifest structural heart disease. A hybrid AF pro- cedure （Epicardial thoracoscopic ablation ＋ appendage re- section, and endocardial catheter ablation） was referred to patient.

Biatrial Macroreentry Atrial Tachycardia after Atria Fibrillation Ablation

Catheter ablation is an important therapy for atrial fibrillation （AF） in the last decade. In parallel, atrial tachycardia （AT） has become the most common type of arrhythmia after AF ablation, especially after extensive left atrial （LA） substrate modification,t^j The occurrence of AT after AF is due to the conduction gaps of ablation lines and the conduction obstacle caused by the ablation lesions？-~1 Most of these ATs locate in LA, and here, we described a biatrial macroreentry AT （MAT） after AF ablation.

Digit Sets for Self-similar Tiles

A new class of digit sets, which we called very weak product-form digit sets, is introduced and it is shown that they are tile digit set for self-similar tiles. This extends previous results about product-form and weak product-form digit sets.