Funding Acknowledgements Type of funding sources: None. Background. Left atrial thrombus (LAT) is the main source of cardiac emboly in patients with non-valvular atrial fibrillation (NAF). Several risk scores – mostly modified CHADS2 and CHA2DS2-VASc – were offered to predict LAT in patients with NAF. However, their relative predictive value requires further evaluation. Purpose. Compare the ability of different risk scores to predict LAT before catheter ablation or cardioversion in patients with NAF. Methods. In a retrospective single-center study, medical records of 1994 patients with NAF who underwent transesophageal echocardiography before catheter ablation or cardioversion were analyzed. LAT was identified in 33 (1.6%) of them. For the control group 167 patients without LAT were randomly selected from this database. Logistic regression analysis and C-statistic were used for evaluation and comparison of predictive values of CHADS2, R2CHADS2, CHA2DS2-VASc, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc and CHA2DS2-VASc-AFR scores. Results. The mean age of studied patients was 60.3 ± 10.9 years, 110 (55%) of them were males. The mean CHA2DS2-VASc score was 2.54 ± 1.79. Results of univariate analysis and C-statistic for above mentioned risk scores are presented in the table. Each of them was associated with LAT. In comparison with a CHA2DS2-VASc score C-statistic was significantly higher for CHA2DS2-VASc-RAF and CHA2DS2-VASc-AFR scores (p values 0.03 and 0.001 respectively). In multivariate analysis only CHA2DS2-VASc-RAF score was associated with LAT (OR 1.37; 95% CI 1.21-1.55, p < 0.0001). OR for LАT in patients with CHA2DS2-VASc-RAF >3 was 12.8 (95% CI 3.75-43.9; p < 0.0001) with sensitivity, specificity, positive and negative predictive values 90.6%, 57.1%, 33.3% and 58.9% respectively. Conclusion. In a group of patients with NAF and relatively low incidence of LAT all studied scores were associated with LAT and CHA2DS2-VASc-RAF score has appeared the most informative. Predictors of LAT in patients with NAF Risk stratification models OR (95% CI) p-value C-statistic (95% CI) CHADS2 2.12 (1.55-2.91) <0.0001 0.77 (0.68-0.85) R2CHADS2 2.00 (1.53-2.62) <0.0001 0.78 (0.69-0.87) CHA2DS2-VASc 1.65 (1.36-2.05) <0.0001 0.74 (0.65-0.84) R-CHA2DS2-VASc 1.64 (1.34-2.03) <0.0001 0.76 (0.66-0.85) R2CHA2DS2-VASc 1.59 (1.32-1.92) <0.0001 0.76 (0.66-0.85) CHA2DS2-VASc- RAF 1.35 (1.27-1.52) <0.0001 0.84 (0.76-0.91) mCHA2DS2-VASc 1.83 (1.42-2.35) <0.0001 0.75 (0.65-0.85) CHA2DS2-VASc-AFR 1.75 (1.41-2.17) <0.0001 0.80 (0.71-0.88)
Background Though electronic cigarettes (EC) and heated tobacco products (HTP) are marketed as harm reduction products, the evidence is that like smoking, their use is dangerous for the lung health. Aim To explore the associations between EC and HTP use and major respiratory diseases (RD). Methods Cross-sectional data of adult representative sample from Russian Tobacco Control Policy Evaluation Survey are analysed, based on multistage sampling in 10 Russian regions in 2017-2018, stratified by smoking status: n = 11625: 6569 smokers, 2377 former smokers, 2679 never smokers. Self-reported formerly diagnosed RD as outcome indicators were analysed in relation with ever EC and HTP use, and current EC use, including HTP. Multiple logistic regression is employed; odds ratios (OR) with 95% CI adjusted by smoking status and socio-demographic factors. Results Chronic bronchitis (CB) was reported by 14% respondents, COPD-by 4.3%, asthma-by 3.1%, emphysema-1.5%, lung cancer-1.1%, tuberculosis (TB)-1.3%. Ever EC use was prevalent in 9.3%, HTP use-in 3.3%, and current EC use-in 2.5% of population. The prevalence of ever EC and HTP use and current EC use was higher among current smokers (13%,4.4%,3.5%), compared to former smokers (7.4%,3.4%,3.5%) and never smokers: 2.2%, 0.7% and 0.6% respectively, (p<.001). Ever HTP users had 2.5 times higher chances of CB: OR 2.52(95%CI 1.9-3.3), and 4 times higher chances of COPD: OR3.97(95%CI 2.8-5.7). The risk is even greater in case of dual EC and tobacco use in current smokers: OR 3.0(95%CI 2.2-4.1) and 4.2(95%CI 2.8-6.3) respectively. Current EC use was significantly associated with asthma: OR 2.9(95%CI 1.5-5.8) and OR 5.0(95%CI 2.6-11.3) in current smokers, lung cancer: OR 4.9(95%CI 1.6-14.8) and 7.2(95%CI 1.9-27.4); and TB:OR4.1(95%CI 1.7-11.6) and 5.4(95%CI 1.6-17.9) respectively. Conclusions EC and HTP use independent from smoking may increase the risk for major RD, combined with tobacco smoking the risk of RD is even greater. Key messages The use of Electronic cigarettes and heated tobacco products, independent from smoking, may increase the risk for major respiratory diseases. Prevalence of EC and HTP use is higher among smokers, compared to former and never smokers; combination of EC and HTP use with tobacco smoking makes the risk of respiratory diseases even greater.
Funding Acknowledgements Type of funding sources: None. Purpose to evaluate the frequency of perioperative atrial fibrillation in patients with postoperative signs of systemic congestion. Methods we examined 102 patients who underwent cardiac monitoring in the perioperative period to detect episodes of atrial fibrillation and focused echocardiography to detect signs of systemic congestion. All patients underwent abdominal surgery lasting more than 180 minutes.Clinical, laboratory, and echocardiographic criteria were used to verify systemic stagnation in the postoperative period in patients after non-cardiac surgery. Results we determined the number of patients with perioperative AF who had acute decompensation of HF in the early postoperative period, determined by signs of systemic stagnation. When assessing the number of patients with preoperative anamnestic AF, which was initially 16 people, in 100% of cases in the postoperative period, decompensation of HF was noted. When evaluating the number of patients with intraoperative AF, which was detected in 24 patients, decompensation of HF in the first 24 hours after abdominal surgery was observed in 23 patients (95.8%) (OR: 25.4; 95% CI: 3.27-198.14; p <0.001). When assessing the number of patients with postoperative AF, which was detected in 36 patients, decompensation of HF in the first 24 hours after abdominal surgery was observed in 35 patients (97.2%) (OR:57.4;95% CI:7.39-435.45; p <0.001). Conclusion in major non-cardiac operations, most patients with perioperative atrial fibrillation show signs of systemic stagnation in the postoperative period with FOCUS.
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