Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Olivine inclusions in Siberian diamonds and mantle xenoliths: Contrasting water and trace-element contents

A subject of continuing debate is how the Earth's lithospheric portion of the upper mantle has remained the thickest (> 200 km) and oldest (> 3 Gy) beneath cratons and is yet surrounded by a vigorously convecting asthenosphere. It is generally admitted that water is a key parameter in the strength and longevity of cratonic roots, because olivine, the main phase of the lithospheric mantle, becomes stronger if its water content decreases. Expanding upon the work presented in Novella et al. (2015) and Taylor et al. (2016), we report new water contents for additional olivine inclusions in diamonds together with the trace-element composition for all olivine inclusions, as well as for mantle xenoliths from various kimberlite pipes located on the Siberian craton. The olivine diamond inclusions from this study have systematically low-water contents (< 50 ppmw H2O), moderate to high forsterite (e.g., Fo91–94) contents and low Ni, Co, and Zn ppm contents (e.g., < 2848, < 108, and < 47 ppm, respectively). In contrast, olivines from Siberian craton mantle xenoliths have a wide range of water contents (6–323 ppmw H2O) and extend to lower-Fo (91–92), Ni, Co, and Zn-rich compositions, compared to the diamond inclusions. Depleted incompatible trace-element concentrations in olivine (0.1–0.001 × Primitive Mantle) advance our hypothesis for the protogenetic origins for the majority of Siberian diamond inclusions. These observations are consistent with the peridotite xenoliths as representing a part of the cratonic lithosphere that has experienced melt re-fertilization, which has also transported water. The olivine diamond inclusions, on the other hand, preserve “micro-samples” of an initial, dry cratonic lithosphere, mostly resulting from melting events. These inclusions are likely sourced from the initial cratonic mantle lithosphere, which thereby, resisted delamination over time, due to its buoyancy and strength, imparted from melt and water depletion, respectively. And thus, our data provides a major argument that the kimberlite-hosted mantle xenoliths may be more metasomatized than common rocks at the base of the Siberian and other cratonic roots away from kimberlite fields