Achlorhydria, determined by the augmented histamine test, is the functional expression of the most severe atrophic gastritis and is followed by a 4- to 6-fold increased risk of gastric cancer, as we found 5 cancers in 114 patients after a mean observation period of 8.4 years. The cancers developed from 1 to 17 years after achlorhydria diagnosis--three cases after more than 9 years. The study showed no difference in gastric cancer risk between patients with and without pernicious anaemia. Spontaneous achlorhydria is the late result of atrophic gastritis, which should be regarded the premalignant condition. The development of gastric cancer from pharmacologically reduced acid secretion must be regarded as highly hypothetical, since this is not followed by atrophic gastritis.

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The leucocyte count was 12-9 x 109/1 with 71% neutrophils. After blood had been taken for culture he was put on intravenous penicillin (2 million units four times a day) and netilmicin (150mg three times a day) without effect. Because a weak positive Legionella titre was detected the antibiotic treatment was changed to intravenous erythromycin (1 g four times a day). Four days later oral rifampicin (300 mg three times a day) was added because a low grade fever persisted. The patient improved and his temperature became normal. Nineteen days after admission the chest x ray was normal and echocardiography showed only a minor pericardial effusion.Blood cultures showed no bacterial growth. Legionella longbeachae titres were 32 on day 2, 2,000 on day 14, 512 on day 45, and 256 on day 73.

Background Ischemic stroke is one of the leading causes of death and disability-adjusted life-years worldwide. It has several subtypes and cardioembolic stroke (CES) accounts for 15–30% of ischemic strokes. Atrial fibrillation (AF) is the most important risk factor for CES. AF increases the risk of stroke up to 5-fold and there is a substantial overlap in the aetiology of AF and CES. Large genome-wide association studies (GWAS) on AF have identified more than 150 common and rare genetic variants. However, the difficulty in acquiring large sample sizes of CES cohorts has hindered the genetic description of the disease. Purpose In this study, we mapped the genetics of CES to increase our understanding of the molecular biology driving the disease. By leveraging the large genetic cohorts of AF through a multi-trait analysis of AF and CES, we aimed to bypass the lack of statistical power for studying the genetics of CES. Methods First, we obtained the largest possible sample size of AF GWAS by conducting a meta-analysis on publicly available summary statistics from the FinnGen study (v5) and the largest multi-ethnic meta-analysis on AF to date. Summary statistics for stroke were obtained from the largest multi-ancestry GWAS on stroke to date, MEGASTROKE, which examined different ancestries and stroke subtypes. Multi-trait analysis requires a high genetic correlation. Genetic correlations between the different stroke summary statistics and the AF meta-analysis were assessed with LD Score Regression. Second, we performed a joint meta-analysis of CES with MTAG using the CES summary statistics from MEGASTROKE and the AF GWAS meta-analysis. MTAG recalculates p-values and effect sizes for each trait separately by leveraging the covariation for correlated traits. The MTAG-computed summary statistics for CES and AF were subjected to genomic loci characterisation, with functional and annotation analysis carried out by FUMA. Results We show a high genetic correlation between CES and AF (rg = 0.88). Using MTAG, the GWAS meta-analysis of CES increased the effective sample size by almost 3 folds (n=24,639, Table 1). We discovered 50 CES loci whereof 47 are novel (Fig. 1). We mapped 101 genes to CES MTAG computed summary statistics, obtaining enrichment in gene sets involved in cardiac conduction and contraction, cardiac tissue development and cranial skeleton morphogenesis. Conclusion In conclusion, we identified 47 novel CES loci and demonstrated a substantial shared genetic variation with AF. We furthermore mapped 98 genes not previously linked to CES by AF. These results represent findings that potentially could be used for antithrombotic drug discovery and are a major advance in our understanding of the genetic underpinnings of CES Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): John and Birthe Meyer Foundation, the Research Foundation of the Heart Centre, Rigshospitalet, the Research Council at Rigshospitalet.The Hallas-Møller Emerging Investigator Novo Nordisk (NNF17OC0031204), Arvid Nilsson Foundation

The stroke volume (SV) was determined by first passage radionuclide cardiography and the left ventricular ejection fraction (LVEF) by multigated radionuclide cardiography in 20 patients with ischemic heart disease. The results were evaluated against those obtained by the invasive dye dilution or thermodilution and left ventricular cardioangiographic techniques. In a paired comparison the mean difference between the invasive and radionuclide SV was −1 ml (SED 3.1) with a correlation coefficient of 0.83 (p<0.01). Radionuclide LVEF values also correlated well with cardioangiographic measurements, r=0.93 (p<0.001). LVEF determined by multigated radionuclide cardiography was, however, significantly lower than when measured by cardioangiography, the mean difference being 6 per cent (p<0.001). These findings suggest that radionuclide determinations of SV and LVEF are reliable. The discrepancy between the non-invasive and invasive LVEF values raises the question, whether LVEF is overestimated by cardioangiography or underestimated by radionuclide cardiography.

Sources of variation in cardiac output determined by the first-passage radionuclide technique were evaluated in 30 patients with coronary artery disease. In 12 fasting patients the standard deviations of differences in cardiac output measured three times with 1-hour intervals were 0.77 and 0.93 liters/min. No systematic variation was evident. An 8 % reduction was demonstrated in cardiac output measured in 18 patients at 2-day intervals (p < 0.01), possibly due to anxiety or discomfort at the first examination. The standard deviation of the day-to-day differences was 0.61 liters/min and thus not higher than that of the hour-to-hour differences. The standard deviation of differences between two-observer analysis was 0.34 liters/min, and a small difference of 3.7% was statistically significant (p < 0.05). No significant intraobserver variation was found. Intraobserver differences had standard deviations of 0.34 and 0.48 liters/min. In patients with coronary artery disease, the first-passage radionuclide cardiac output accordingly varies considerably over time, but the precision of this technique is high.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): he Innovation Fund Denmark (grant no.: 12-135225), The Research Foundation for the Capital Region of Denmark, The Danish Heart Foundation (grant no.: 11-04-R83-A3363-22625 and 18-R125-A8534-22083), Aalborg University Talent Management Programme, Arvid Nilssons Fond, Skibsreder Per Henriksen, R. og Hustrus Fond, and Medtronic Background Left atrial (LA) speckle tracking is a novel technique that provides detailed information on atrial function. Its utility for predicting subclinical atrial fibrillation (SCAF) is, however, not well-established. Purpose To investigate whether LA speckle tracking measures are associated with SCAF as detected by long-term continuous rhythm monitoring. Methods This was an echocardiographic substudy of a randomized controlled clinical trial that enrolled elderly individuals (≥70 years) with a CHADS2-score≥2 to either no intervention or implantation of a loop recorder (Reveal LINQ) to detect SCAF (≥6 minutes). A subset of the participants receiving a loop recorder was included in this analysis. An echocardiographic examination was performed, which included conventional measurements and LA speckle tracking. LA speckle tracking allowed for assessment of reservoir, conduit, and contraction strain. Multivariable proportional hazards Cox regression was applied to adjust for the clinical risk score (CHARGE-AF) and net reclassification index (NRI) was used to assess prognostic improvement of this score. Incidence rate curves were constructed using Poisson models. Results Overall, 976 participants were eligible for analysis. Median follow-up time was 3 years (interquartile range: 1.7-4.0 years), during which 284 (29%) were diagnosed with SCAF. The mean age was 74 years, 56% were male, median CHA2DS2-VASc-score was 4. A dilated LA (LA volume≥34ml/m2) was observed in 152 (16%). LA speckle tracking revealed that both LA reservoir strain and contraction strain were univariable predictors of SCAF (HR = 1.05 (1.03-1.06) and HR = 1.07 (1.05-1.10), p &lt; 0.001, per 1% decrease), such that decreasing reservoir and contraction strain were linearly associated with an increased risk of SCAF (figure). LA conduit strain was not a predictor of SCAF. These findings were unchanged after adjusting for the CHARGE-AF score, and both LA strain measures significantly improved the NRI when added to the CHARGE-AF score by 23% and 33%, respectively. Even in participants with normal LA size, both reservoir and contraction strain were independent predictors of SCAF after multivariable adjustment (HR = 1.03 (1.01-1.05), p = 0.001 and HR = 1.06 (1.04-1.09), p &lt; 0.001, per 1% decrease). Conclusion Decreasing left atrial reservoir and contraction strain are independently associated with an increased risk of SCAF as detected by long-term continuous monitoring and provide incremental prognostic value in addition to clinical risk score. Abstract Figure.

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon2020 Introduction Wearable devices are gaining interest in the clinical assessment of physical behavior as a marker of disease severity. With the increased use, patient willingness and adherence will be increasingly important. As part of the SafeHeart study, examining the potential of physical behavior as an identifier of clinical deterioration in patients with an implantable cardioverter defibrillator (ICD), we present preliminary results on adherence to a wrist-worn wearable used for physical behavior assessment. Purpose Define the willingness to participate and long-term adherence to wearables in an ICD population. Methods This is a preliminary analysis of the ongoing multicenter, prospective, observational SafeHeart study. SafeHeart is aimed to construct a personalized prediction engine for ICD therapy using wearable-assessed physical behavior, remote ICD monitoring, electronic health records, and patient-reported data. The study will enroll 400 participants with an ICD with or without cardiac resynchronization therapy (CRT-D). In this preliminary analysis, wearable data was analyzed for the first 50 participants, where inclusion required a minimum of 1 month of follow up data. No data from the wearables were provided to the participants. The wrist-worn wearables were used continuously (day and night) for up to 12 months of follow-up. Adherence to the wearable was measured through patient-reported (subjective) adherence and wearable-measured (objective) adherence. Data were extracted from the wearables and non-wear time was detected via open source algorithms. A valid day was set to 22 hours of available wear time with 24-hour periods assessed from 3pm to 3pm for sleep metric capture. The willingness to participate and dropout rates were calculated for the same first 50 patients of the study. Results A total of 50 ICD participants were included in this study. The mean age was 65.1 years, 82 % male, with a mean follow up of 7 weeks, generating 326 patient weeks of data. Regarding patient-reported adherence, participants reported 81.4% full adherence and 18.6 % of participants reported very brief non-wear due to e.g. sauna or surgery. Of those reporting non-wear, 62.5% described one episode only of non-wear lasting 15-75 minutes. Regarding objectively measured adherence from wearable data, full adherence was shown in 91.7% of days. The mean number of valid days per participant was 41.3. Recruitment rates showed a willingness to participate of 50% (50/100) out of eligible subjects invited. No participants were lost to follow Conclusion Results show high adherence and reasonable willingness to participate without wearable adherence dropping over time. Comparison of objectively measured and patient-reported adherence showed similar values.