Predictors Of New Atrial Fibrillation Research Articles

ECHOCARDIOGRAPHIC AND ELECTROCARDIOGRAPHIC PREDICTORS OF NEW ATRIAL FIBRILLATION IN END-STAGE RENAL DISEASE PATIENTS WITH PRESERVED LEFT VENTRICULAR SYSTOLIC FUNCTION

Objective: We investigated the echocardiographic and electrocardiographic predictors for future development of AF in patients with ESRD and preserved LV EF who had never diagnosed AF. Design and method: Atrial fibrillation (AF) is a common cause which leads to adverse cardiovascular outcome in patients with end-stage renal disease (ESRD). AF is common arrhythmia in patients with reduced left ventricular (LV) ejection fraction (EF). It is unclear the predictor of new AF in patients with preserved LV EF. We enrolled 226 patients with ESRD who has performed transthoracic echocardiography. We excluded the 1) 16 patients who has been received a diagnosis of AF, and 2) 19 patients with LV EF < 50%, and 191 patients (121 males, mean 62 ± 14 years) Results: During a mean follow-up period of 885 ± 720 days, AF occurred in 20 (10.5%) patients. The patients with AF development was older (69 ± 12 vs. 61 ± 14 years, p=0.023). There were no differences in history of hypertension, diabetes, stroke and coronary artery disease between two groups. In univariate Cox regression analysis, left atrial volume index (LAVI), right ventricular systolic pressure, age and QRS duration were associated with future AF events. After multivariate Cox regression analysis, age (HR: 1.015, 95% CI: 1.008-1.105, p value: 0.022) and QRS duration (HR: 1.025, 95% CI: 1.001-1.049, p value: 0.043) significantly predicted the future development of AF. Conclusions: QRS duration is well known predictor of cardiovascular outcome in patients with reduced LV EF. In this study, we demonstrated QRS duration predicted new AF events in ESRD patients with preserved LV EF.

Atrial fibrillation detected with outpatient cardiac rhythm monitoring in patients with ischemic stroke or TIA of undetermined cause

ObjectivesGuidelines advise cardiac rhythm monitoring for 3 up to 30 days for detecting atrial fibrillation (AF) in patients with ischemic stroke of undetermined cause. However, the optimal monitoring duration is unknown. We aimed to determine the AF detection rate during 7-day outpatient cardiac rhythm monitoring in this patient group. MethodsParticipants from a large tertiary hospital in a prospective observational study (ATTEST) underwent outpatient cardiac rhythm monitoring after a negative standard diagnostic evaluation (i.e., 12-lead electrocardiogram and in-hospital telemetry). Primary outcome was the rate of newly detected AF. ResultsWe examined 373 patients [age: 67.8±11.6 years; women: 166(44.5%); stroke: 278(74.5%)]. Median monitoring duration was 7 days (Inter Quartile Range (IQR) 7-7), performed after median of 36 days (IQR 27-47). AF was newly detected in 17(4.6%) patients, 5.4% of patients with ischemic stroke and 2.1% of patients with TIA. 53% of AF was detected on day-1, after day-3 73% of new AF was found. First AF episodes were detected up to day-7. Diabetes and increasing age were independent predictors of new AF. ConclusionAfter ischemic stroke or TIA of undetermined cause, 7-day outpatient cardiac rhythm monitoring detected new AF in 4.6%. Patients with AF had significantly more cardiovascular risk factors. Although about 50% of first AF episodes occurred during the first day of monitoring, new AF was detected up to day-7, implying that the recommended minimum of 3 days cardiac rhythm monitoring after ischemic stroke of undetermined cause is insufficient. Subsequent long-term rhythm monitoring should be considered in selected patients.

PS-C02-4: QRS DURATION AS A PREDICTOR OF FUTURE ATRIAL FIBRILLATION IN END-STAGE RENAL DISEASE PATIENTS WITH PRESERVED LEFT VENTRICULAR SYSTOLIC FUNCTION

Objective: We investigated the echocardiographic and electrocardiographic predictors for future development of AF in patients with ESRD and preserved LV EF who had never diagnosed AF. Design and method: Atrial fibrillation (AF) is a common cause which leads to adverse cardiovascular outcome in patients with end-stage renal disease (ESRD). AF is common arrhythmia in patients with reduced left ventricular (LV) ejection fraction (EF). It is unclear the predictor of new AF in patients with preserved LV EF. We enrolled 226 patients with ESRD who has performed transthoracic echocardiography. We excluded the 1) 16 patients who has been received a diagnosis of AF, and 2) 19 patients with LV EF < 50%, and 191 patients (121 males, mean 62 ± 14 years years). Results: During a mean follow-up period of 885 ± 720 days, AF occurred in 20 (10.5%) patients. The patients with AF development was older (69 ± 12 vs. 61 ± 14 years, p = 0.023). There were no differences in history of hypertension, diabetes, stroke and coronary artery disease between two groups. In univariate Cox regression analysis, left atrial volume index (LAVI), right ventricular systolic pressure, age and QRS duration were associated with future AF events. After multivariate Cox regression analysis, age (HR: 1.015, 95% CI: 1.008–1.105, p value: 0.022) and QRS duration (HR: 1.025, 95% CI: 1.001–1.049, p value: 0.043) significantly predicted the future development of AF. Conclusions: QRS duration is well known predictor of cardiovascular outcome in patients with reduced LV EF. In this study, we demonstrated QRS duration predicted new AF events in ESRD patients with preserved LV EF.

184 The presence of atrial fibrillation in acute myocardial infarction patients and hyperglycaemia

Abstract Aims In patients with acute myocardial infarction (AMI), hyperglycaemia is a common feature determining a worse prognosis. Few studies have examined the relationship between hyperglycemic status and atrial fibrillation in-hospital stay. To evaluate the relationship between admission hyperglycaemia (aHGL) and occurrence of atrial fibrillation (AF) in-hospital stay in patients with AMI, categorized as myocardial infarction with obstructive coronary artery disease (MIOCA) and myocardial infarction with nonobstructive coronary artery disease (MINOCA). Methods and results Hyperglycaemia was defined as a serum glucose level ≥140 mg/dl at the time of hospital admission. AF was defined as a beat-to-beat variability in cycle length and morphology with irregular fibrillatory waves on surface ECG. Among 2702 patients (32.1% were female, mean age was 70.1 ± 13.4 years), 24.2% were diabetic. Out of 2702 patients, 2457 were MIOCA and 245 (9.1%) were MINOCA patients. At admission, the mean value of serum glucose levels was 146 ± 66 mg/dl. At hospital admission, hyperglycemic status was present in 37.7% of patients and 8.3% presented atrial fibrillation. At hospital admission, atrial fibrillation (aAF) was significantly frequent in hyperglycemic than normoglycaemic patients (11.5% vs. 6.3%, respectively; P < 0.001). In aHGL MIOCA patients had a higher rate of aAF (10.7%) than normoglycaemic MIOCA (6.4%; P < 0.001). In aHGL MINOCA patients had 31% aAF than normoglycaemic MINOCA patients (7.5%; P < 0.001). During the hospital stay, the new onset of atrial fibrillation was higher in aHGL than normoglycaemic status in total population (6.3% vs. 2.9%, P < 0.001), in MIOCA subgroup (6.3% vs. 3.1%, P < 0.001) and MINOCA subgroup (7.3% vs. 1.5%, P = 0.003). Multivariate analysis adjusted for age, sex, and diabetes revealed that the presence of hyperglycaemia was an independent predictor for the onset of atrial fibrillation (OR: 1.7; 95% CI: 1.1–2.6; P = 0.02). Conclusions Hyperglycaemia was an independent predictor of new atrial fibrillation during hospitalization in patients with AMI. Moreover, at hospital admission, patients with hyperglycemic status presented a higher incidence of atrial fibrillation, both in MIOCA and MINOCA subgroups. Further studies are needed to understand the biological mechanisms involved in these associations.

On-treatment HDL cholesterol predicts incident atrial fibrillation in hypertensive patients with left ventricular hypertrophy

Purpose: Hypertensive patients are at increased risk of atrial fibrillation (AF). Although low baseline high density lipoprotein (HDL) cholesterol has been associated with a higher risk of AF, this has not been verified in recent population-based studies. Whether changing levels of HDL over time are more strongly related to the risk of new AF in hypertensive patients has not been examined.Material and methods: Incident AF was examined in relation to baseline and on-treatment HDL levels in 8267 hypertensive patients with no history of AF, in sinus rhythm on their baseline electrocardiogram, randomly assigned to losartan- or atenolol-based treatment. HDL levels at baseline and each year of testing were categorised into quartiles according to baseline HDL levels.Results: During 4.7 ± 1.10 years of follow-up, 645 patients (7.8%) developed new AF. In univariate Cox analyses, compared with the highest quartile of HDL levels (>1.78 mmol/l), patients with on-treatment HDL in the lowest quartile (≤ 1.21 mmol/l) had a 53% greater risk of new AF. Patients with on-treatment HDL in the second and third quartiles had intermediate increased risks of AF. Baseline HDL in the lowest quartile was not a significant predictor of new AF (hazard ratio (HR): 1.14, 95% confidence interval (CI): 0.90–1.43). In multivariable Cox analyses adjusting for multiple baseline and time-varying covariates, the lowest quartile of on-treatment HDL remained associated with a nearly 54% increased risk of new AF (HR: 1.54, 95% CI: 1.16–2.05) whereas a baseline HDL≤ ⩽1.21 mmol/l was not predictive of new AF (HR: 1.01, 95% CI: 0.78–1.31).Conclusion: Lower on-treatment HDL is strongly associated with risk of new AF. These findings suggest that serial assessment of HDL can estimate AF risk better than baseline HDL in hypertensive patients with left ventricular hypertrophy. Future studies may investigate whether therapies that increase HDL can lower risk of developing AF.Clinical Trials Registration: http://clinicaltrials.gov/ct/show/NCT00338260?order=1

Computed tomography predictors of mortality, stroke and conduction disturbances in women undergoing TAVR: A sub-analysis of the WIN-TAVI registry

BackgroundAortic valve calcification patterns were associated with short- and long-term outcomes in previous small observational datasets of patients undergoing transcatheter aortic valve implantation (TAVI). The specific impact of multi detector-row computed tomography (MDCT) findings on outcomes in women has not been reported. We sought to describe the associations between MDCT characteristics and clinical outcomes in a registry of 547 women undergoing TAVI. MethodsWIN-TAVI is the first all-female registry to study the safety and effectiveness of TAVI in women (n = 1019). Thirteen sites participated in the MDCT sub-study and contributed pre-TAVI MDCT studies in 547 consecutive subjects. All MDCT data were analyzed in an independent core lab blinded to clinical outcomes. Key measurements included number of valve leaflets, aortic annulus area and perimeter, left and right coronary artery height, aortic cusp calcium volume, commissural calcification and left ventricular outflow tract (LVOT) calcification. Calcium volume of the aortic valvular complex was quantified using a threshold relative to patient-specific contrast attenuation in the arterial blood pool. We examined univariate and multivariate associations between ECG-gated contrast MDCT characteristics and 1-year mortality or stroke, new pacemaker implantation and new onset atrial fibrillation (AF). ResultsThe CT sub-study sample had a mean age of 82.8 ± 6.3 years, mean logistic EuroSCORE of 17.8 ± 11.3%, and mean STS score of 8.2 ± 7.4%. Transfemoral access was used in 89.6% of patients. After multivariate adjustment, moderate or severe LVOT calcification was an independent predictor of 1-year mortality or stroke (HR = 1.91; 95% CI: 1.11–3.30; p = 0.02). Calcium volume in the right coronary cusp was an independent predictor of new pacemaker (HR = 1.18 per 100 m3 increment; p = 0.04), whereas calcium volume of the non-coronary cusp had a protective effect (HR = 0.78 per 100 mm3 increment; p = 0.004). Severe calcification of the non-coronary/right-coronary commissure was an independent predictor of new AF (HR = 5.1; p = 0.008). ConclusionComputed tomography provides important prognostic information in women undergoing TAVI. Moderate or severe LVOT calcification is associated to an almost two-fold increased risk of mortality or stroke at one year. Different calcification patterns of the aortic valve may predict diverse rhythm abnormalities.

OP.7B.06] RELATIONSHIP OF INCIDENT ATRIAL FIBRILLATION TO THE ELECTROCARDIOGRAPHIC STRAIN PATTERN IN HYPERTENSIVE PATIENTS WITH ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY

Objective: Atrial fibrillation (AF) is strongly related to hypertension and to left ventricular hypertrophy (LVH), and both regression of ECG-LVH and achievement of lower systolic blood pressure (SBP) are associated with lower incidence of AF. The ECG strain pattern of lateral ST depression and T-wave inversion has been associated with more severe LVH, decreased LV systolic function and an increased risk of cardiovascular morbidity and mortality, including new heart failure (HF). However, whether ECG strain is associated with an increased risk of new AF is unclear. Design and method: Risk of new-onset AF was examined in relation to the presence of the strain pattern on baseline ECG in 7921 hypertensive patients with ECG-LVH with no history of AF, who were in sinus rhythm on their baseline ECG, had baseline strain determination and were randomized to losartan- vs. atenolol-based treatment. Results: During 4.7 ± 1.1 yrs. of follow-up, new-onset AF was diagnosed in 621 patients (7.8%). Baseline ECG strain was present in 882 patients (11.1%) and was associated with a significantly higher 5-yr. incidence of AF in Kaplan-Meier estimates (12.2 vs 7.4%, p < 0.001) and with a 66% greater risk of new AF in a univariate Cox model (HR 1.66, 95% CI 1.34–2.06, p < 0.001), compared with the absence of ECG strain. After adjusting for other univariate predictors of new AF in this population, including age, sex, race, prior anti-hypertensive treatment, randomized treatment allocation, prevalent diabetes, history of ischemic heart disease, prior myocardial infarction, stroke or HF, baseline serum cholesterol and urine albumin/creatinine ratio entered as standard covariates and incident HF and on-treatment diastolic BP, SBP, heart rate and Cornell product LVH entered as time-varying covariates, ECG strain remained associated with a 39% greater risk of new-onset AF (HR 1.39, 95% CI 1.09–1.76, p = 0.008). Conclusions: The presence of baseline ECG strain is strongly associated with an increased risk of developing new-onset AF in hypertensive patients with ECG-LVH, independent of other AF risk factors and the effects of incident HF, LVH regression and SBP reduction. These findings suggest that hypertensive patients with ECG strain should be followed for development of new AF.

Predictors and Risk Scores for New Atrial Fibrillation After Coronary Artery Bypass Grafting

Background: New atrial fibrillation (AF) is a common complication after cardiac surgery, and is associated with increased length of hospital stay, morbidity and mortality. Identifying high risk patients may allow a targeted approach to preventing new AF. We evaluated the risk factors of and performance of risk models at predicting new AF after coronary artery bypass grafting (CABG). Methods: All patients without preoperative AF undergoing isolated CABG at Auckland City Hospital from July 2010-June 2012 were included. The prognostic utility of the AF risk index by El-Chami et al., 2012, CHADS2, CHA2DS2-VASc, EuroSCOREs and STS Score for new AF after CABG was assessed. Results: There were 757 (of 818) CABG patients without preoperative AF, mean age 64.0+/-10.0 years and 157 (20.7%) females. Postoperative AF occurred in 179 (23.7%), and was associated with prolonged intensive care (p = 0.012) and hospital stay postoperatively (p < 0.001). Independent predictors of new AF included increased age, weight, congestive heart failure and three-vessel coronary disease. Areas under the curve (95% confidence intervals) for predicting new AF were El-Chami index 0.600 (0.553-0.647), CHADS2 0.559 (0.512-0.606), CHA2DS2-VASc 0.594 (0.547-0.642), logistic EuroSCORE 0.594 (0.545-0.643), EuroSCORE II 0.546 (0.498-0.595) and STS Score 0.584 (0.535-0.634). Conclusion: New AF after CABG was common, and associated with prolonged hospital stay, but was modestly and suboptimally predicted by AF and cardiac surgery risk models. More accurate scores need to be developed to guide clinical practice.

Stroke as the First Manifestation of Atrial Fibrillation.

Atrial fibrillation may remain undiagnosed until an ischemic stroke occurs. In this retrospective cohort study we assessed the prevalence of ischemic stroke or transient ischemic attack as the first manifestation of atrial fibrillation in 3,623 patients treated for their first ever stroke or transient ischemic attack during 2003–2012. Two groups were formed: patients with a history of atrial fibrillation and patients with new atrial fibrillation diagnosed during hospitalization for stroke or transient ischemic attack. A control group of 781 patients with intracranial hemorrhage was compiled similarly to explore causality between new atrial fibrillation and stroke. The median age of the patients was 78.3 [13.0] years and 2,009 (55.5%) were women. New atrial fibrillation was diagnosed in 753 (20.8%) patients with stroke or transient ischemic attack, compared to 15 (1.9%) with intracranial hemorrhage. Younger age and no history of coronary artery disease or other vascular diseases, heart failure, or hypertension were the independent predictors of new atrial fibrillation detected concomitantly with an ischemic event. Thus, ischemic stroke was the first clinical manifestation of atrial fibrillation in 37% of younger (<75 years) patients with no history of cardiovascular diseases. In conclusion, atrial fibrillation is too often diagnosed only after an ischemic stroke has occurred, especially in middle-aged healthy individuals. New atrial fibrillation seems to be predominantly the cause of the ischemic stroke and not triggered by the acute cerebrovascular event.

Abstract 12077: Stroke as the First Manifestation of Atrial Fibrillation

Introduction: Atrial fibrillation (AF) may remain undiagnosed until an ischemic stroke occurs. In this retrospective cohort study we assessed the prevalence of ischemic stroke or transient ischemic attack (TIA) as the first manifestation of AF in a cohort of patients with AF-associated stroke or TIA. Methods: Altogether 3,623 patients treated for their first ever ischemic stroke or TIA during 2003-2012 were identified from the electronic patient records of four clinical centers. Two groups were formed: patients with a history of AF and patients with new AF diagnosed during hospitalization for stroke or TIA. A control group of 781 patients with intracranial hemorrhage was compiled similarly to explore the direction of causality between new AF and stroke. Results: The median age of the patients was 78.3 [13.0] years and 2,009 (55.5%) were women. New AF was diagnosed in 753 (20.8%) patients with stroke or TIA, compared to 15 (1.9%) with intracranial hemorrhage. Younger age (odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00-1.02; p=0.014) and no history of coronary artery disease (OR: 1.45; 95% CI: 1.16-1.82; p=0.001) or other vascular diseases (OR: 1.75, 95% CI: 1.09-2.79. p=0.020), heart failure (OR: 2.62; 95% CI: 1.94-3.54, p&lt;0.001), or hypertension (OR: 1.22; 95% CI:1.01-1.47; p=0.041) were the independent predictors of new AF detected concomitantly with an ischemic event. Thus, ischemic stroke was the first clinical manifestation of AF in 37% of younger (&lt;75 years) patients with no history of cardiovascular diseases (Figure). Conclusions: In conclusion, AF is too often diagnosed only after an ischemic stroke has occurred, especially in middle-aged healthy individuals. New AF seems to be predominantly the cause of the ischemic stroke and not triggered by the acute cerebrovascular event.

Abstract 11359: Relationship of Incident Atrial Fibrillation to the Electrocardiographic Strain Pattern in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy

Background: Atrial fibrillation (AF) is strongly related to hypertension and to left ventricular hypertrophy (LVH) and both regression of ECG LVH and achievement of lower systolic blood pressure (SBP) are associated with lower incidence of AF. The ECG strain pattern of lateral ST depression and T-wave inversion has been associated with more severe LVH, decreased LV systolic function and an increased risk of cardiovascular mortality and morbidity, including new heart failure (HF). However, whether ECG strain is associated with an increased risk of new AF is unclear. Methods: Risk of new-onset AF was examined in relation to the presence of the strain pattern on baseline ECG in 7921 hypertensive patients with ECG LVH with no history of AF, who were in sinus rhythm on their baseline ECG, had baseline strain determination and were randomized to losartan- vs atenolol-based treatment. Results: During 4.7±1.1 years follow-up, new-onset AF was diagnosed in 621 patients (7.8%). Baseline ECG strain was present in 882 patients (11.1%) and was associated with a significantly higher 5-year incidence of AF in Kaplan-Meier estimates (12.2 vs 7.4%, p&lt;0.001) and with a 66% greater risk of new AF in a univariate Cox model (HR 1.66, 95% CI 1.34-2.06, p&lt;0.001), compared with the absence of ECG strain. After adjusting for other univariate predictors of new AF in this population, including age, sex, race, prior anti-hypertensive treatment, randomized treatment allocation, prevalent diabetes, history of ischemic heart disease, prior myocardial infarction, stroke or HF, baseline serum cholesterol and urine albumin/creatinine ratio entered as standard covariates and incident HF and on-treatment diastolic BP, SBP, heart rate and Cornell product LVH entered as time-varying covariates, ECG strain remained associated with a 39% greater risk of new-onset AF (HR 1.39, 95% CI 1.09-1.76, p=0.008). Conclusions: The presence of strain on a baseline ECG is strongly associated with an increased risk of developing new-onset AF in hypertensive patients with ECG LVH, independent of other AF risk factors and the effects of incident HF, LVH regression and SBP reduction. These findings suggest that hypertensive patients with ECG strain should be followed closely for development of new AF.

Abstract 9371: Low In-Treatment HDL Cholesterol Strongly Predicts Incident Atrial Fibrillation: The LIFE Study

Background: Hypertensive patients are at increased risk of atrial fibrillation (AF). Although low baseline HDL levels have been associated with a higher risk of AF in some analyses, this has not been born out in recent population-based studies; whether changing levels of HDL over time are more strongly related to the risk of new AF has not been examined. Methods: Incident AF was examined in relation to baseline and in-treatment HDL levels prior to development of AF in 8267 hypertensive patients with no history of AF, in sinus rhythm on their baseline ECG, randomly assigned to losartan- or atenolol-based treatment. HDL levels at baseline and each year of testing were categorized into quartiles according to baseline HDL levels. Results: During 4.7±1.1 years follow-up, new AF developed in 645 patients (7.8%). In univariate analyses, compared with HDL &gt;1.78 mMol/L, patients with in-treatment HDL &lt;1.21 entered as a time-varying covariate had a 53% greater risk of new AF; patients with in-treatment HDL in the 2 nd or 3 rd quartiles had intermediate increased risks of AF. Baseline HDL was only a weak predictor of new AF. In multivariate Cox analyses adjusting for multiple AF risk factors, including the previously demonstrated predictive value of in-treatment heart rate and Cornell product LVH, there was no attenuation of the risk of new AF associated with low in-treatment HDL. In-treatment non-HDL cholesterol (p=0.171) and statin use (p=0.626) were not significant predictors of new AF in the multivariate model including in-treatment HDL. Baseline HDL was not a significant predictor of AF in multivariate analysis. Conclusions: Lower in-treatment HDL is strongly associated with risk of new AF, even after adjusting for other potential AF risk factors and treatment effects. These findings suggest that serial assessment of HDL can better estimate AF risk in hypertensive patients. Further study is indicated to determine whether therapies that increase HDL can lower risk of developing AF.

Prediction and prevention of atrial fibrillation in patients with high blood pressure or history of hypertension

Prediction and prevention of atrial fibrillation in patients with high blood pressure or history of hypertension

ELEVATED BNP PREDICTS NEW ONSET ATRIAL FIBRILLATION COMPLICATING ACUTE MYOCARDIAL INFARCTION: ANALYSIS OF THE TRIUMPH REGISTRY

Abstract Category: Clinical Electrophysiology--Supraventricular ArrhythmiasPresentation Number: 1081-149Authors: Susmita Parashar, Jonathan J. Langberg, Viola Vaccarino, Kimberly J. Reid, John Spertus, Michael S. Lloyd, Emory University, Atlanta, GA, Mid America Heart Institute, Kansas City, MO Introduction: Atrial fibrillation (AF) is an independent predictor of mortality after acute myocardial infarction (MI). We determined whether biomarkers linked to inflammation [high sensitivity C-reactive protein (hsCRP)] and atrial stretch [NT-pro-brain natriuretic peptide (NT-proBNP)] are associated with new-onset AF at MI hospitalization.Methods: In a prospective registry of MI (TRIUMPH) from >25 US centers, we measured NT-proBNP and hsCRP in AMI patients without prior AF (N=4123) during hospitalization. New-onset AF was defined as AF during the index hospitalization without a history of AF. Multivariable -adjusted results were analyzed using hierarchical logistic regression models. Due to their skewed distribution, hs-CRP and NT-pro-BNP data were analyzed in quartiles.Results: New-onset AF was documented in 254 (6.2%) MI patients (mean age 58 years; 33% women). Multivariate analysis with demographics, comorbidities and clinical factors including LVEF and Killip class, high NT-pro-BNP significantly predicted new AF (comparing NT-pro-BNP quartile 4 vs 1, the OR and 95% CI were 2.45; 1.17, 5.24). Hs-CRP was not a predictor of AF (Figure).Conclusion: Patients with the highest values of NT-proBNP, but not hsCRP have significantly greater risk of new-onset AF post-MI. Elevated BNP was a more potent predictor of new AF than any clinical parameters suggesting that markers for atrial stretch and not markers for inflammation may be important in the pathogenesis of AF in MI.

Predictors of outcome in a multicenter port-access valve registry

Background. The aim of this study was to examine the predictors of outcome in patients undergoing isolated valve operation using port-access techniques. Methods. Logistic regression analysis was performed in a prospective, multi-institutional registry of patients undergoing isolated aortic valve replacement (AVR, n = 252), mitral repair (MVP, n = 491), or mitral replacement (MVR, n = 568) using port-access techniques from 1997 to 1999. Results. Endoaortic balloon occlusion was used in 2% (AVR), 93% (MVP), and 90% (MVR) of cases. Conversion to full sternotomy occurred in 3.8% of all cases. For all patients, early mortality was 50 of 1,311 (3.8%) and onset of new atrial fibrillation occurred in 140 of 1,311 (11%) patients. The determinants of 30-day mortality were redo, age, and MVR or AVR. The determinants of reoperation for bleeding were age, reoperation, and MVR. Age was a predictor for stroke, and age and low or medium volume center were predictors of new atrial fibrillation. Conclusions. Excellent short-term results can be obtained using port-access techniques in isolated mitral or aortic valve operations. Patient outcome is not related to institutional case volume, and the primary determinants of outcome after port-access valve procedures are generally patient-related factors.