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

The potential of ultrasonic non-destructive measurement of residual stresses by modal frequency spacing using leaky lamb waves

This paper investigates the potential of ultrasonic non-destructive measurements of residual stresses using the modal frequency spacing method based on the interference spectrum of leaky Lamb waves as an alternative to the commonly used flight-time approach in ultrasonic methods. Extensive experiments were carried out to verify the viability and robustness of the technique using an instrumented leaky Lamb wave setup with uniaxial stressed samples and welded steel samples. To improve the signal-to-noise ratio, multiple sets of raw signals of specularly reflected and leaky Lamb waves were acquired and then averaged in the time domain. The acquired data in the time domain were then transformed into the frequency domain to form the interference spectrum of leaky Lamb waves with a good repeatability. The acoustoelastic coefficient of carbon steel is then derived from the measured relationship of wave velocity and applied stress. Finally, a welded steel plate was examined and residual stress was evaluated. The current work demonstrates the feasibility and the potential of the proposed method in measuring residual stresses in welded plates and thin-walled structures