Modified Hatch Score Predicts 6-Month Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation: Data from the University Of Massachusetts Atrial Fibrillation Registry

AIMS: Pre-procedural identification of patients with atrial fibrillation (AF) who will benefit most from pulmonary vein isolation remains challenging. The HATCH score [Hypertension x1 + Age≥75 x1 + Thrombo-embolic event x2, COPD x1, Heart failure x2] has been associated with progression of AF and recently with adverse outcomes after catheter ablation. However, data regarding the HATCH score are limited. This study aimed to evaluate the performance of a modified HATCH scoring system, including pre-procedural obstructive sleep apnea as an additional risk element, compared to the CHADS risk score as a predictor of AF recurrence after an index pulmonary vein isolation procedure for AF. METHODS AND RESULTS: Seventy eight patients (48 men, mean age 60 ± 1.1 years) with paroxysmal or persistent AF underwent an index pulmonary vein isolation procedure between 2010 and 2014 using either radiofrequency (n=64) or cryoballoon (n = 14). Over a 6-month follow-up period, 35 patients had recurrence (44.9%) when monitored using Holter monitoring and in-office ECGs. The modified HATCH score was associated on univariate testing with AF recurrence. In multivariate logistic regression analyses including factors known to be associated with AF recurrence, the modified HATCH score (p: 0.03) was independently associated with AF recurrence and showed superior test characteristics using ROC curve analysis (C statistic = 0.64 for modified HATCH vs. 0.55 for CHADS2). The difference between the modified HATCH and the CHADS2 scores in predicting recurrence was not statistically significant (p = 0.8). CONCLUSIONS: AF recurred in 44% of patients over a 6-month follow-up. A modified HATCH including OSA successfully identified individuals at risk for 6-month recurrence. Further research is needed including larger cohorts of patients undergoing ablation and followed for more extended periods to further validate the performance of the modified HATCH score

Two-Dimensional Intravascular Near-Infrared Fluorescence Molecular Imaging of Inflammation in Atherosclerosis and Stent-Induced Vascular Injury

ObjectivesThis study sought to develop a 2-dimensional (2D) intravascular near-infrared fluorescence (NIRF) imaging strategy for investigation of arterial inflammation in coronary-sized vessels.BackgroundMolecular imaging of arterial inflammation could provide new insights into the pathogenesis of acute myocardial infarction stemming from coronary atheromata and implanted stents. Presently, few high-resolution approaches can image inflammation in coronary-sized arteries in vivo.MethodsA new 2.9-F rotational, automated pullback 2D imaging catheter was engineered and optimized for 360° viewing intravascular NIRF imaging. In conjunction with the cysteine protease-activatable imaging reporter Prosense VM110 (VisEn Medical, Woburn, Massachusetts), intra-arterial 2D NIRF imaging was performed in rabbit aortas with atherosclerosis (n =10) or implanted coronary bare-metal stents (n = 10, 3.5-mm diameter, day 7 post-implantation). Intravascular ultrasound provided coregistered anatomical images of arteries. After sacrifice, specimens underwent ex vivo NIRF imaging, fluorescence microscopy, and histological and immunohistochemical analyses.ResultsImaging of coronary artery–scaled phantoms demonstrated 8-sector angular resolution and submillimeter axial resolution, nanomolar sensitivity to NIR fluorochromes, and modest NIRF light attenuation through blood. High-resolution NIRF images of vessel wall inflammation with signal-to-noise ratios >10 were obtained in real-time through blood, without flushing or occlusion. In atherosclerosis, 2D NIRF, intravascular ultrasound–NIRF fusion, microscopy, and immunoblotting studies provided insight into the spatial distribution of plaque protease activity. In stent-implanted vessels, real-time imaging illuminated an edge-based pattern of stent-induced arterial inflammation.ConclusionsA new 2D intravascular NIRF imaging strategy provides high-resolution in vivo spatial mapping of arterial inflammation in coronary-sized arteries and reveals increased inflammation-regulated cysteine protease activity in atheromata and stent-induced arterial injury