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 < 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 < 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.
Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The LOOP Study was supported by Innovation Fund Denmark [grant number 12-1352259], The Research Foundation for the Capital Region of Denmark, The Danish Heart Foundation [grant number 11-04-R83-A3363-22625], Aalborg University Talent Management Program, Arvid Nilssons Fond, Skibsreder Per Henriksen, R og Hustrus Fond, the European Union’s Horizon 2020 program [grant number 847770 to the AFFECT-EU consortium], Læge Sophus Carl Emil Friis og hustru Olga Doris Friis’ Legat, and an unrestricted grant from Medtronic. Background The recently published LOOP Study was a randomized controlled clinical trial to evaluate systematic atrial fibrillation (AF) screening with long-term continuous monitoring in an elderly population at risk and found no significant reduction in stroke. However, the screening effects seemed to differ across levels of systolic blood pressure (SBP). It is well-known that hypertension constitutes a prominent risk factor for clinical AF and stroke alike, but data on the impacts of SBP on subclinical AF and hereby AF screening efficacy are lacking. Purpose With this post hoc analysis of the LOOP Study, we aimed to provide insights into the interaction between SBP and benefits of systematic AF screening. Methods The LOOP Study randomized individuals aged 70-90 years with ≥1 stroke risk factor (hypertension, diabetes, heart failure, or previous stroke) and without prior AF to either monitoring with implantable loop recorder (ILR) and initiation of oral anticoagulation upon detection of new-onset AF episodes lasting ≥6 minutes, or usual care (control group). In total, 5997 participants with available SBP measurements at enrolment were included in the present analysis. The interaction between SBP and ILR screening efficacy on stroke or systemic arterial embolism (SAE), as indicated by hazard ratio (HR) for ILR versus control, was assessed with polynomial moving-average regression. The lowest SBP threshold with significant screening benefits was further determined and used to examine clinical outcomes and the occurrence of AF with respect to dichotomized SBP. Additionally, penalized spline models were employed to assess AF occurrence by SBP as a continuous variable. Results HR of stroke/SAE for ILR versus control decreased with increasing SBP and the lowest threshold for significant screening benefits was at SBP ≥150 mmHg. ILR screening of participants with SBP ≥150 mmHg yielded a 45% risk reduction of stroke/SAE (HR 0.55 [0.37-0.82]). Within the ILR group, SBP ≥150 mmHg was associated with an increased risk of AF episodes ≥24 hours as compared to lower SBP (HR 1.57 [1.01-2.45]), but not with the overall occurrence of AF (HR 1.14 [0.95-1.36]). No significant association between SBP and AF occurrence in the ILR group was reported in penalized spline models either (p-value: 0.73). Conclusions The benefits of ILR screening for AF on stroke/SAE increased with increasing blood pressure. SBP ≥150 mmHg was associated with a 1.5-fold increased risk of AF episodes ≥24 hours, along with an almost 50% risk reduction of stroke/SAE by ILR screening.
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