Background
The oral anticoagulant dabigatran offers an effective alternative to vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), yet patient preference data are ...limited. The prospective observational RE-SONANCE study demonstrated that patients with AF, newly initiated on dabigatran, or switching to dabigatran from long-term VKA therapy, reported improved treatment convenience and satisfaction compared with VKA therapy. This pre-specified sub-study aimed to assess the impact of country and age on patients’ perceptions of dabigatran or VKA therapy in AF.
Methods
RE-SONANCE was an observational, prospective, multi-national study (NCT02684981) that assessed treatment satisfaction and convenience in patients switching from VKAs to dabigatran (Cohort A), or newly diagnosed with AF receiving dabigatran or VKAs (Cohort B), using the PACT-Q questionnaire. Pre-specified exploratory outcomes: variation in PACT-Q2 scores by country and age (< 65, 65 to < 75, ≥ 75 years) (both cohorts); variation in PACT-Q1 responses at baseline by country and age (Cohort B).
Results
Patients from 12 countries (Europe/Israel) were enrolled in Cohort A (
n
= 4103) or B (
n
= 5369). In Cohort A, mean (standard deviation) PACT-Q2 score increase was highest in Romania (convenience: 29.6 23.6) and Hungary (satisfaction: 26.0 21.4) (
p
< 0.001). In Cohort B, mean (standard error) increase in PACT-Q2 scores between dabigatran and VKAs was highest in Romania (visit 3: 29.0 1.3; 24.5 0.9,
p
< 0.001). Mean PACT-Q2 score increase by age (all
p
< 0.001) was similar across ages. PACT-Q1 responses revealed lowest expectations of treatment success in Romania and greatest concerns about payment in Estonia, Latvia, and Romania, but were similar across ages.
Conclusions
Treatment satisfaction and convenience tended to favor dabigatran over VKAs. Regional differences in treatment expectations exist across Europe.
Trial and clinical registry
Trial registration number: ClinicalTrials.gov NCT02684981.
Trial registration date: February 18, 2016.
Abstract Background Andersen-Tawil syndrome (ATS) is rare channelopathy caused by KCNJ2 mutation and probably KCNJ5 . It is characterized by arrhythmias, neurological symptoms, and dysmorphic ...features. The present study retrospectively examined the characteristics of 11 unrelated families with ATS. Methods This study consisted of 11 probands positive for KCNJ2 variants and 33 family members (mean age 30.0 ± 17.3 years, female n = 31). Additional genetic screening of 3 LQTS genes ( KCNQ1 , KCNH2 , SCN5A ) was performed in 9 families. Predictors of arrhythmias premature ventricular beats > 2000/24 h, biventricular and polymorphic ventricular tachycardia (VT), syncope, and/or cardiac arrest (CA) were evaluated. Results In KCNJ2 mutation carriers vs non-carriers ( n = 25 vs n = 19) significant differences were observed in U-wave manifestations in V2–V4, Tpeak − Tend duration, QTUc duration ( p < 0.0001), dysmorphic features, and neurological symptoms. Compared to asymptomatic carriers ( n = 9), in those with arrhythmias and/or syncope and/or CA ( n = 16) micrognathia ( p = 0.004), periodic paralysis ( p = 0.019), palpitation ( p = 0.005), U-wave n V2–V4 ( p = 0.049) were more frequent; QTU ( p = 0.045) and Tpeak − Tend ( p = 0.014) were also longer ( n = 9). In the subgroup of carriers with syncope and/or cardiac arrest ( n = 10, 90% women), K897T- KCNH2 polymorphism ( p = 0.02), periodic paralysis ( p = 0.004), muscle weakness ( p = 0.04), palpitations ( p = 0.04), arrhythmias (biventricular VT, p = 0.003; polymorphic VT, p = 0.009) were observed more frequently. Tpeak − Tend duration was longer ( p = 0.007) and the percentage of patients with premature ventricular contraction >2000/24 h was higher ( p = 0.005). Conclusion A higher risk of arrhythmia, syncope, and/or CA is associated with the presence of micrognathia, periodic paralysis, and prolonged Tpeak − Tend time. Our findings suggest that K897T may contribute to the occurrence of syncope.
Left ventricular remodeling (LVr) is still common after ST-segment elevation myocardial infarction (STEMI). Early predictors of remodeling are being investigated. The aims of this study were to ...evaluate the prognostic value of speckle-tracking echocardiography for the prediction of LVr 3 months after primary percutaneous coronary intervention in patients with STEMI and to analyze the relationship between values of peak longitudinal strain of particular LV segments and relative changes of their subvolumes.
Patients with first STEMI were enrolled. Baseline enzymes were collected, and electrocardiography and echocardiography (transthoracic echocardiography, speckle-tracking echocardiography, and three-dimensional studies) were preformed. Three months after myocardial infarction, two-dimensional and three-dimensional ultrasonographic studies were done.
Sixty-six patients were divided into two groups: 44 patients without LVr and 22 patients with LVr. Among 31 patients with anterior wall STEMI, the rate of LVr was 42%. On the basis of assessments of baseline and follow-up myocardial wall contractility, 1,041 segments were analyzed. All segments were divided into normal (n = 842), reversibly dysfunctional (n = 68), and irreversibly dysfunctional (n = 131). Receiver operating characteristic curve analysis showed that global longitudinal strain predicted LVr with an optimal cutoff value of -12.5% (area under the curve, 0.77). In multivariate analysis, diabetes mellitus (odds ratio, 4.61; 95% confidence interval, 1.19-18.02) and global longitudinal strain (odds ratio, 1.19; 95% confidence interval, 1.04-1.37) were determinants of LVr. Positive correlations were found between peak longitudinal strain and changes in subvolumes for all segments (R = 0.11, P = .005) and for those irreversibly dysfunctional (R = 0.22, P = .04).
In patients with STEMI treated by primary percutaneous coronary intervention, the frequency of LVr during 3-month follow-up was high and mainly affected the population with anterior wall myocardial infarction. The results of this study show the clinical value of global longitudinal strain measured by speckle-tracking echocardiography in the prediction of LVr. A moderate correlation was found between the value of peak longitudinal strain and changes in subvolumes attributed to irreversibly dysfunctional segments.
ObjectiveWe evaluated atrial fibrillation (AF) patients’ perceptions of anticoagulation treatment with dabigatran or a vitamin K antagonist (VKA) for stroke prevention, according to accepted ...indications.MethodsThe RE-SONANCE observational, prospective, multicentre, international study used the validated Perception on Anticoagulant Treatment Questionnaire (PACT-Q) to assess patients with AF already taking a VKA who were switched to dabigatran (cohort A), and newly diagnosed patients initiated on either dabigatran or a VKA (cohort B). Visit 1 (V1) was at baseline, and visit 2 (V2) and visit 3 (V3) were at 30–45 and 150–210 days after baseline, respectively. Primary outcomes were treatment satisfaction and convenience in cohort A at V2 and V3 versus baseline, and in cohort B for dabigatran and a VKA at V2 and V3.ResultsThe main analysis set comprised 4100 patients in cohort A and 5365 in cohort B (dabigatran: 3179; VKA: 2186). In cohort A, PACT-Q2 improved significantly (p<0.001 for all) for treatment convenience (mean change V1 vs V2=20.72; SD=21.50; V1 vs V3=24.54; SD=22.85) and treatment satisfaction (mean change V1 vs V2=17.60; SD=18.76; V1 vs V3=21.04; SD=20.24). In cohort B, mean PACT-Q2 scores at V2 and V3 were significantly higher (p<0.001 for all) for dabigatran versus a VKA for treatment convenience (V2=18.38; SE =0.51; V3=23.34; SE=0.51) and satisfaction (V2=15.88; SE=0.39; V3=19.01; SE=0.41).ConclusionsSwitching to dabigatran from long-term VKA therapy or newly initiated dabigatran is associated with improved patient treatment convenience and satisfaction compared with VKA therapy.
Observational studies have shown that migraine has been associated with patent foramen ovale (PFO). Whilst studies investigating PFO closure for the treatment of migraine have been neutral, there is ...some evidence that symptoms of migraine may improve if the PFO was closed after ischemic stroke.
To establish whether closure of PFO in patients with stroke or transient ischemic attack (TIA) is associated with reduction in the severity of co-existent migraine headaches.
Patients with ischemic stroke or TIA, PFO suitable for percutaneous closure and migraine, were given migraine severity questionnaires prior to PFO closure. These were followed up at 6 and 12 months after closure with the same questionnaire. The primary endpoint was change in migraine severity using the Migraine Severity Scale (MIGSEV). Migraine episode frequency, disability (using the MIDAS scale), and pain intensity were also assessed.
Sixty-two patients were included in the analysis. MIGSEV scores reduced from 7 (7-8) at baseline to 4 (3.25-6) at 6-month follow-up, and 3 (0-4) at 12-month follow-up (
< 0.001). Other measures of migraine headache were also improved at both 6- and 12-month follow-up. Twenty-four (38%) patients were rendered migraine free at 12 months.
PFO closure for stroke or TIA prevention in patients with migraine was associated with a reduction in markers of migraine headache severity.
Angiographically visible plaques in patent vein grafts are usually detected years after surgery. Our aim was to examine early plaque formation in vein grafts.
Bypass angiography and intravascular ...ultrasonography (IVUS) examination were performed on 77 aortocoronary saphenous vein grafts (SVGs) implanted in 36 patients during the first 2 years after CABG. In each graft, a good quality 25 mm ultrasound image was analyzed. We measured: plaque area, lumen area, external elastic membrane (EEM) area, graft area and wall area. For the comparative assessment of SVGs, the index plaque area/EEM area was calculated. Data were analyzed for the following 4 time periods: I - 0-4 months (22 grafts), II - 5-8 months (23 grafts), III - 9-12 months (19 grafts) and IV - 13-16 months (13 grafts) after CABG. Student's t and Fisher-Snedecor tests were used for the purpose of statistical analysis in this retrospective study.
In period I, plaque formation (neointimal) was observed in 10 grafts (45%), with a mean plaque area of 1.59 mm., in 6 grafts (26%) in period II, with a mean plaque area of 1.03 mm. and in 15 grafts (71%) in period III, with a mean plaque area of 1.41 mm., and in all (100%) grafts in period IV, with mean plaque area of 2,3 mm.. Average index plaque area/EEM area in periods I, II, III and IV were 0.12, 0.08, 0.13 and 0.22. We have showed a significant plaque increase between periods II and IV(P=0.038).
IVUS showed plaque in about 40% of venous grafts during the first year after CABG. Between 13-16 months plaque was visible in all studied grafts.
We sought to determine the frequency of left ventricular remodeling in the 6-month follow-up after anterior ST elevation myocardial infarction and the value of quantitative parameters of perfusion ...contrast echocardiography for prognosis of left ventricular remodeling against other established risk.
A total of 60 patients with anterior ST elevation myocardial infarction treated by primary percutaneous intervention were examined. In 28 patients, thromboaspiration was performed before stent implantation with Driver catheter. Before and after successful angioplasty, perfusion in myocardial blush grade (MBG) scale was assessed. Various electrocardiogram parameters were analyzed. Resting perfusion with myocardial contrast echocardiography was performed.
Logistic regression has permitted one to conclude that higher value of MBG, higher left ventricular ejection fraction at discharge, and higher value of parameter A at quantitative echocardiography in dysfunctional segments were prognostic for lack of remodeling over 6 months. The receiver operating characteristics curves for parameters of quantitative perfusion echocardiography (A, β, A×β) allowed us to conclude that value A>1.96 dB, value β>0.155 s, and value A×β>0.57 dB/s are optimal cut-off points prognostic for remodeling. Area under the curve was 0.8 for A and 0.85 for β.
The best predictors of remodeling in 6 months' observation have appeared to be lower left ventricular ejection fraction at discharge, poorer perfusion assessed angiographically (MBG scale), and the rate of signal intensity increase reflecting the mean bubble velocity of the myocardium by contrast as assessed by contrast echocardiography. Quantitative perfusion angiography independently has high predictive value for the development of remodeling in long-term follow-up.
Background: Repolarization dynamicity (QT/RR) is supposed to be a prognostic marker in post‐MI patients. However, data on the relationships between early and late phases of QT and RR intervals (QT ...peak/RR and T peak–T end/RR) are insufficient, and which ECG lead should be used for the analysis is unclear. We analyzed repolarization dynamicity in patients after anterior MI with and without VT/VF history using two leads of Holter recordings‐ modified V5 and V3. The daytime and nighttime periods were also analyzed.
Methods: Cohort of 88 patients after anterior MI (>6 months) consisted of 43 patients without VT/VF (33 males; 59 ± 12 years; LVEF: 41 ± 7%; NoVT/VF), and 45 patients with VT/VF history‐ ICD implanted as secondary prevention (40 males; 64 ± 10 years; LVEF: 32 ± 8%; VT/VF). QT/RR, QT peak/RR and T peak–T end/RR were calculated from 24‐hour ECG for the entire recording, daytime and nighttime periods, from V5 and V3 leads, respectively.
Results: VT/VF patients had lower LVEF (P = 0.001). There were no differences in age and gender. VT/VF group had steeper QT/RR, QT peak/RR, and T peak–T end/RR in V5: 0.233 ± 0.04 versus 0.150 ± 0.05, P = 0.0001, 0.181 ± 0.04 versus 0.120 ± 0.04, P = 0.0001, 0.052 ± 0.02 versus 0.030 ± 0.02, P = 0.0001, and in V3: 0.201 ± 0.04 versus 0.149 ± 0.05, P = 0.0001, 0.159 ± 0.03 versus 0.118 ± 0.04, P = 0.0001, and 0.042 ± 0.02 versus 0.031 ± 0.02, P = 0.004; respectively. VT/VF patients had higher indices in V5 than in V3 lead (P = 0.001). QT/RR and QT peak/RR were steeper at daytime period in both leads. It was not found for T peak–T end/RR.
Conclusions: Patients with VT/VF history are characterized by steeper relationships between repolarization duration and RR intervals. These findings are more evident in modified V5 lead.
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