Nuova ricerca


Assegnista di ricerca
Dipartimento Educazione e Scienze Umane

Home |


2024 - Asymptomatic vs. symptomatic atrial fibrillation: Clinical outcomes in heart failure patients [Articolo su rivista]
Boriani, G.; Bonini, N.; Vitolo, M.; Mei, D. A.; Imberti, J. F.; Gerra, L.; Romiti, G. F.; Corica, B.; Proietti, M.; Diemberger, I.; Dan, G. -A.; Potpara, T.; Lip, G. Y.

Background: The outcome implications of asymptomatic vs. symptomatic atrial fibrillation (AF) in specific groups of patients according to clinical heart failure (HF) and left ventricular ejection fraction (LVEF) need to be clarified. Methods: In a prospective observational study, patients were categorized according to overt HF with LVEF≤40 %, or with LVEF>40 %, or without overt HF with LVEF40 %≤ or > 40 %, as well as according to the presence of asymptomatic or symptomatic AF. Results: A total of 8096 patients, divided into 8 groups according to HF and LVEF, were included with similar proportions of asymptomatic AF (ranging from 43 to 48 %). After a median follow-up of 730 [699 -748] days, the composite outcome (all-cause death and MACE) was significantly worse for patients with asymptomatic AF associated with HF and reduced LVEF vs. symptomatic AF patients of the same group (p = 0.004). On adjusted Cox regression analysis, asymptomatic AF patients with HF and reduced LVEF were independently associated with a higher risk for the composite outcome (aHR 1.32, 95 % CI 1.04-1.69) and all-cause death (aHR 1.33, 95 % CI 1.02-1.73) compared to symptomatic AF patients with HF and reduced LVEF. Kaplan-Meier curves showed that HF-LVEF≤40 % asymptomatic patients had the highest cumulative incidence of all-cause death and MACE (p < 0.001 for both). Conclusions: In a large European cohort of AF patients, the risk of the composite outcome at 2 years was not different between asymptomatic and symptomatic AF in the whole cohort but adverse implications for poor outcomes were found for asymptomatic AF in HF with LVEF≤40 %.

2024 - Validating the predictive ability of the 2MACE score for major adverse cardiovascular events in patients with atrial fibrillation: results from phase II/III of the GLORIA-AF registry [Articolo su rivista]
Ding, W. Y.; Fawzy, A. M.; Romiti, G. F.; Proietti, M.; Pastori, D.; Huisman, M. V.; Lip, G. Y. H.; Abban, D. W.; Abdul, N.; Abud, A. M.; Adams, F.; Addala, S.; Adragão, P.; Ageno, W.; Aggarwal, R.; Agosti, S.; Agostoni, P.; Aguilar, F.; Linares, J. A.; Aguinaga, L.; Ahmed, J.; Aiello, A.; Ainsworth, P.; Aiub, J. R.; Al-Dallow, R.; Alderson, L.; Velasco, J. A. A.; Alexopoulos, D.; Manterola, F. A.; Aliyar, P.; Alonso, D.; da Costa, F. A. A.; Amado, J.; Amara, W.; Amelot, M.; Amjadi, N.; Ammirati, F.; Andrade, M.; Andrawis, N.; Annoni, G.; Ansalone, G.; Ariani, M. K.; Arias, J. C.; Armero, S.; Arora, C.; Aslam, M. S.; Asselman, M.; Audouin, P.; Augenbraun, C.; Aydin, S.; Ayryanova, I.; Aziz, E.; Backes, L. M.; Badings, E.; Bagni, E.; Baker, S. H.; Bala, R.; Baldi, A.; Bando, S.; Banerjee, S.; Bank, A.; Esquivias, G. B.; Barr, C.; Bartlett, M.; Kes, V. B.; Baula, G.; Behrens, S.; Bell, A.; Benedetti, R.; Mazuecos, J. B.; Benhalima, B.; Bergler-Klein, J.; Berneau, J. B.; Berrospi, P.; Berti, S.; Berz, A.; Best, E.; Bettencourt, P.; Betzu, R.; Bhagwat, R.; Bhatta, L.; Biscione, F.; Bisignani, G.; Black, T.; Bloch, M. J.; Bloom, S.; Blumberg, E.; Bo, M.; Bøhmer, E.; Bollmann, A.; Bongiorni, M. G.; Boriani, G.; Boswijk, D. J.; Bott, J.; Bottacchi, E.; Kalan, M. B.; Bradman, D.; Brautigam, D.; Breton, N.; Brouwers, P. J. A. M.

The 2MACE score was specifically developed as a risk-stratification tool in atrial fibrillation (AF) to predict cardiovascular outcomes. We evaluated the predictive ability of the 2MACE score in the GLORIA-AF registry. All eligible patients from phase II/III of the prospective global GLORIA-AF registry were included. Major adverse cardiac events (MACEs) were defined as the composite outcome of stroke, myocardial infarction and cardiovascular death. Cox proportional hazards were used to examine the relationship between the 2MACE score and study outcomes. Predictive capability of the 2MACE score was investigated using receiver-operating characteristic curves. A total of 25,696 patients were included (mean age 71 years, female 44.9%). Over 3 years, 1583 MACEs were recorded. Patients who had MACE were older, with more cardiovascular risk factors and were less likely to be managed using a rhythm-control strategy. The median 2MACE score in the MACE and non-MACE groups were 2 (IQR 1-3) and 1 (IQR 0-2), respectively (p < 0.001). The 2MACE score was positively associated with an increase in the risk of MACE, with a score of & GE; 2 providing the best combination of sensitivity (69.6%) and specificity (51.6%), HR 2.47 (95% CI, 2.21-2.77). The 2MACE score had modest predictive performance for MACE in patients with AF (AUC 0.655 (95% CI, 0.641-0.669)). Our analysis in this prospective global registry demonstrates that the 2MACE score can adequately predict the risk of MACE (defined as myocardial infarction, CV death and stroke) in patients with AF. Clinical trial registration:. Unique identifiers: NCT01468701, NCT01671007 and NCT01937377

2023 - Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal [Articolo su rivista]
Lip, G. Y. H.; Proietti, M.; Potpara, T.; Mansour, M.; Savelieva, I.; Tse, H. F.; Goette, A.; Camm, A. J.; Blomstrom-Lundqvist, C.; Gupta, D.; Boriani, G.

Stroke prevention in patients with atrial fibrillation (AF) is one pillar of the management of this common arrhythmia. Substantial advances in the epidemiology and associated pathophysiology underlying AF-related stroke and thrombo-embolism are evident. Furthermore, the introduction of the non-vitamin K antagonist oral anticoagulants (also called direct oral anticoagulants) has clearly changed our approach to stroke prevention in AF, such that the default should be to offer oral anticoagulation for stroke prevention, unless the patient is at low risk. A strategy of early rhythm control is also beneficial in reducing strokes in selected patients with recent onset AF, when compared to rate control. Cardiovascular risk factor management, with optimization of comorbidities and attention to lifestyle factors, and the patient's psychological morbidity are also essential. Finally, in selected patients with absolute contraindications to long-term oral anticoagulation, left atrial appendage occlusion or exclusion may be considered. The aim of this state-of-the-art review article is to provide an overview of the current status of AF-related stroke and prevention strategies. A holistic or integrated care approach to AF management is recommended to minimize the risk of stroke in patients with AF, based on the evidence-based Atrial fibrillation Better Care (ABC) pathway, as follows: A: Avoid stroke with Anticoagulation; B: Better patient-centred, symptom-directed decisions on rate or rhythm control; C: Cardiovascular risk factor and comorbidity optimization, including lifestyle changes.

2021 - Screening for Atrial Fibrillation in Relation to Stroke and Mortality Risk [Articolo su rivista]
Proietti, M.; Boriani, G.