Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Occurrence of onerow yellowcress Nasturtium microphyllum (Boenn.) Rchb. in the Ilanka River (Lubusz Land)

The paper presents three new localities of Nasturtium microphyllum reported on the Ilanka River near Rzepin. In one of the localities onerow yellowcress specimens were in the flowering and fruiting stages, while in the two other localities plants were flowering, but they were not bearing fruits. Fruiting specimens were identifi ed on the basis of seed sculpture traits, while flowering plants – by flow cytometry, based on the genome size

It is worth checking old data – validation of Asplenium onopteris L. presence in the most northeastern sites in Europe (Sudetes, SW Poland)

In Poland, isolated serpentine rocks are exclusive habitats of some Asplenium species, reaching here their north or northeastern border range. One of them was Asplenium onopteris, a diploid European species native to Mediterranean and Atlantic areas. Since the nineteenth century, Polish out-of-range sites of A. onopteris have been quoted in literature without critical verification. Thus, to verify occurrence of this species in Poland, we analyzed the nuclear DNA content and micromorphological features as well as critically reviewed the literature data. We proved that all individuals from Polish populations resembling A. onopteris were tetraploids and should be classified as A. adiantum-nigrum. In addition, we validated a taxon silesiacum reported as co-occurring with A. onopteris. The proposed diagnostic features are insufficient to indisputably delimit this taxon, and distinguishing it as a separate unit is not justified. Analyses of the DNA content revealed also the presence of a triploid A. ×centovallense, a new hybrid for Polish flora

Morphological, anatomical and cytological characteristics of spontaneous hybrid Pyrus x myloslavensis

Pyrus ×myloslavensis is a hybrid with intermediate characteristics of leaves and fruits inherited from its parental species P. salicifolia and P. communis. The aim of this study was to determine whether these intermediate nature of this taxon would be visible in the pollen and seed anatomy and morphology. In addition, the authors evaluated self-compatibility and crossability based on the observation of pollen tube growth. The investigations were carried out using light, fluorescence and electron microscopies and flow cytometer. Based on pollen and seed morphology the current study confirmed a hybrid origin of the investigated taxon. Especially, pollen grains had most features similar to both parental species. In respect to epidermal micromorphology, the seeds of P. ×myloslaviensis were like P. salicifolia, but anatomical structure of the seed coat of the hybrid was more consistent with P. communis. The data obtained from the current experiment showed that P. ×myloslavensis was self-incompatible and cross-compatible only with one of four tested P. communis cultivars (‘Conference’) and with P. salicifolia. In turn, the average genome size of the hybrid was smaller than putative parents

Genome size, leaf, fruit and seed traits-taxonomic tools for species identification in the Genus nasturtium R.Br.

Flow cytometry estimation of 2C nuclear DNA content of the examined Nasturtium species resulted in taxonomic identification of N. × sterile in eight new localities, N. microphyllum in four new localities and N. officinale in one new locality in western Poland. Scanning electron microscopy proved a few of the micromorphological traits of seeds and fruits (size and shape of cells on the fruit septum surface, their anticlinal walls; secondary sculpture on the outer periclinal walls of cells on the siliqua valve internal surface) to be of taxonomic importance

Molecular forms of acetylcholinesterase and pseudocholinesterase in chicken skeletal muscles : their distribution and change with muscular dystrophy

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