Likelihood of Spontaneous Conversion of Atrial Fibrillation to Sinus Rhythm

AbstractObjectives. We sought to determine the likelihood and predictors of spontaneous conversion to sinus rhythm of recent-onset atrial fibrillation (symptoms <72 h).Background. Although spontaneous conversion of recent-onset atrial fibrillation is common, the likelihood and clinical and echocardiographic predictors have not been fully defined. Such data would be important for management of patients in whom early cardioversion is desired: Cardioversion could be delayed in patients with a high likelihood of spontaneous conversion, and it could be expeditiously pursued if spontaneous conversion is unlikely.Methods. We screened 1,822 consecutive adults admitted to the hospital with atrial fibrillation and prospectively identified 356 patients (45% male, mean age ± SD 68 ± 16 years) with atrial fibrillation of <72-h duration. The occurrence of spontaneous conversion to sinus rhythm and clinical and echocardiographic data were identified through retrospective chart review.Results. Spontaneous conversion to sinus rhythm occurred in 68% of the study group (n = 242; 95% confidence interval [CI] 63% to 73%). Among patients with spontaneous conversion, the total duration of atrial fibrillation was <24 h in 159 (66%), 24 to 48 h in 42 (17%) and >48 h in 41 (17%) (p < 0.001). Logistic regression analysis of clinical data identified presentation <24 h from onset of symptoms as the only predictor of spontaneous conversion (odds ratio 1.8, 95% CI 1.4 to 2.4, p < 0.0001). Normal left ventricular systolic function was more common among patients with spontaneous conversion (p = 0.03), but it was not an independent predictor of conversion. Left atrial dimension was similar between groups.Conclusions. Spontaneous conversion to sinus rhythm occurs in almost 70% of patients presenting with atrial fibrillation of <72-h duration. Presentation with symptoms of <24-h duration is the best predictor of spontaneous conversion

Controlled trial of fish oil for regression of human coronary atherosclerosis

AbstractObjectives. This randomized clinical trial tested whether fish oil supplements can improve human coronary atherosclerosis.Background. Epidemiologic studies of populations whose intake of oily fish is high, as well as laboratory studies of the effects of the polyunsaturated fatty acids in fish oil, support the hypothesis that fish oil is antiatherogenic.Methods. Patients with angiographically documented coronary heart disease and normal plasma lipid levels were randomized to receive either fish oil capsules (n = 31), containing 6 g of n-3 fatty acids, or olive oil capsules (n = 28) for an average duration of 28 months. Coronary atherosclerosis on angiography was quantified by computer-assisted image analysis.Results. Mean (±SD) baseline characteristics were age 62 ± 7 years, plasma total cholesterol concentration 187 ± 31 mg/dl (4.83 ± 0.80 mmol/liter) and triglyceride levels 132 ± 70 mg/dl (1.51 ± 0.80 mmol/liter). Fish oil lowered triglyceride levels by 30% (p = 0.007) but had no significant effects on other plasma lipoprotein levels. At the end of the trial, eicosapentaenoic acid in adipose tissue samples was 0.91% in the fish oil group compared with 0.20% in the control group (p < 0.0001). At baseline, the minimal lumen diameter of coronary artery lesions (n = 305) was 1.64 ± 0.76 mm, and percent narrowing was 48 ± 14%. Mean minimal diameter of atherosclerotic coronary arteries decreased by 0.104 and 0.138 mm in the fish oil and control groups, respectively (p = 0.6 between groups), and percent stenosis increased by 2.4% and 2.6%, respectively (p = 0.8). Confidence intervals exclude improvement by fish oil treatment of >0.17 mm, or >2.6%.Conclusions. Fish oil treatment for 2 years does not promote major favorable changes in the diameter of atherosclerotic coronary arteries

Family history of severe cardiovascular disease in Marfan syndrome is associated with increased aortic diameter and decreased survival

Objectives.We attempted to determine whether a family history of severe cardiovascular disease in patients with the Marfan syndrome is associated with increased aortic dilation or decreased survival, or both.Background.The prognostic importance of a family history of severe cardiovascular disease in patients with the Marfan syndrome has been incompletely examined. We hypothesized that such a family history would correlate with increased aortic dilation and would be associated with decreased survival.Methods.One hundred eight affected patients and 48 unaffected family members from 33 multigenerational families with the Marfan syndrome underwent echocardiographic measurement of the aortic root, arch and mid-abdominal aorta. Date of birth and age at death ascertained from family pedigrees were used to perform life table analysis and estimate survival.Results.Aortic root and arch diameters were significantly greater in patients with a family history of severe cardiovascular disease than in patients without such a family history. Of subjects in the highest quartile for aortic size, >80% had such a family history in contrast to <10% of those in the lowest quartile (chisquare 57.37, p < 0.00001). Mean age at death and cumulative probability of survival were significantly lower in patients with such a family history.Conclusions.Among patients with the Marfan syndrome, aortic dilation is greater and life expectancy shorter in those with a family history of severe cardiovascular manifestations. These data suggest that such a family history is an important risk factor for cardiovascular events in patients with the Marfan syndrome

Core Collapse via Coarse Dynamic Renormalization

In the context of the recently developed "equation-free" approach to computer-assisted analysis of complex systems, we extract the self-similar solution describing core collapse of a stellar system from numerical experiments. The technique allows us to side-step the core "bounce" that occurs in direct N-body simulations due to the small-N correlations that develop in the late stages of collapse, and hence to follow the evolution well into the self-similar regime.Comment: 5 pages, 3 figure

Optical and ultraviolet spectroscopic analysis of SN 2011fe at late times

We present optical spectra of the nearby Type Ia supernova SN 2011fe at 100, 205, 311, 349, and 578 days post-maximum light, as well as an ultraviolet spectrum obtained with Hubble Space Telescope at 360 days post-maximum light. We compare these observations with synthetic spectra produced with the radiative transfer code PHOENIX. The day +100 spectrum can be well fit with models which neglect collisional and radiative data for forbidden lines. Curiously, including this data and recomputing the fit yields a quite similar spectrum, but with different combinations of lines forming some of the stronger features. At day +205 and later epochs, forbidden lines dominate much of the optical spectrum formation; however, our results indicate that recombination, not collisional excitation, is the most influential physical process driving spectrum formation at these late times. Consequently, our synthetic optical and UV spectra at all epochs presented here are formed almost exclusively through recombination-driven fluorescence. Furthermore, our models suggest that the ultraviolet spectrum even as late as day +360 is optically thick and consists of permitted lines from several iron-peak species. These results indicate that the transition to the "nebular" phase in Type Ia supernovae is complex and highly wavelength-dependent.Comment: 22 pages, 21 figuress, 1 table, submitted to MNRA

Impaired left atrial mechanical function after cardioversion: Relation to the duration of atrial fibrillation

AbstractObjectives. We hypothesized that the time course of the recovery of atrial systolic function may be related to the duration of atrial fibrillation before cardioversion and sought to study noninvesively the recovery of left atrial mechanical function utilizing serial transthoracic Doppler studies.Background. Recovery of atrial mechanical function may be delayed for several weeks after successful cardioversion of atrial fibrillation to sinus rhythm.Methods. After successful cardioversion, 60 patients with atrial fibrillation of brief (≤2 week, 17 patients), moderate (>2 to 6 weeks, 22 patients) or prolonged (>6 weeks, 21 patients) duration were followed up with serial transmitral pulsed Doppler echocardiography immediately (60 patients) and at 24 h (45 patients), 1 week (41 patients), 1 month (31 patients) and >3 months (30 patients) after cardioversion.Results. Atrial mechanical function is greater immediately and at 24 h and 1 week after cardioversion in patients with “brief” compared with “prolonged” atrial fibrillation. In all groups, atrial mechanical function increases over time, ultimately achieving similar levels. Full recovery of atrial mechanical function, however, is achieved within 24 h in patients with brief atrial fibrillation, within 1 week in patients with moderate-duration atrial fibrillation and within 1 month in patients with prolonged atrial fibrillation.Conclusions. Recovery of left atrial mechanical function is related to the duration of atrial fibrillation before cardioversion. These findings have important implications for assessing the early hemodynamic benefit of successful cardioversion

Heme metabolism genes Downregulated in COPD Cachexia.

IntroductionCachexia contributes to increased mortality and reduced quality of life in Chronic Obstructive Pulmonary Disease (COPD) and may be associated with underlying gene expression changes. Our goal was to identify differential gene expression signatures associated with COPD cachexia in current and former smokers.MethodsWe analyzed whole-blood gene expression data from participants with COPD in a discovery cohort (COPDGene, N = 400) and assessed replication (ECLIPSE, N = 114). To approximate the consensus definition using available criteria, cachexia was defined as weight-loss &gt; 5% in the past 12 months or low body mass index (BMI) (&lt; 20 kg/m2) and 1/3 criteria: decreased muscle strength (six-minute walk distance &lt; 350 m), anemia (hemoglobin &lt; 12 g/dl), and low fat-free mass index (FFMI) (&lt; 15 kg/m2 among women and &lt; 17 kg/m2 among men) in COPDGene. In ECLIPSE, cachexia was defined as weight-loss &gt; 5% in the past 12 months or low BMI and 3/5 criteria: decreased muscle strength, anorexia, abnormal biochemistry (anemia or high c-reactive protein (&gt; 5 mg/l)), fatigue, and low FFMI. Differential gene expression was assessed between cachectic and non-cachectic subjects, adjusting for age, sex, white blood cell counts, and technical covariates. Gene set enrichment analysis was performed using MSigDB.ResultsThe prevalence of COPD cachexia was 13.7% in COPDGene and 7.9% in ECLIPSE. Fourteen genes were differentially downregulated in cachectic versus non-cachectic COPD patients in COPDGene (FDR &lt; 0.05) and ECLIPSE (FDR &lt; 0.05).DiscussionSeveral replicated genes regulating heme metabolism were downregulated among participants with COPD cachexia. Impaired heme biosynthesis may contribute to cachexia development through free-iron buildup and oxidative tissue damage

Scope for Credit Risk Diversification

This paper considers a simple model of credit risk and derives the limit distribution of losses under different assumptions regarding the structure of systematic risk and the nature of exposure or firm heterogeneity. We derive fat-tailed correlated loss distributions arising from Gaussian risk factors and explore the potential for risk diversification. Where possible the results are generalised to non-Gaussian distributions. The theoretical results indicate that if the firm parameters are heterogeneous but come from a common distribution, for sufficiently large portfolios there is no scope for further risk reduction through active portfolio management. However, if the firm parameters come from different distributions, then further risk reduction is possible by changing the portfolio weights. In either case, neglecting parameter heterogeneity can lead to underestimation of expected losses. But, once expected losses are controlled for, neglecting parameter heterogeneity can lead to overestimation of risk, whether measured by unexpected loss or value-at-risk

The Lick AGN Monitoring Project 2011: Dynamical Modeling of the Broad-Line Region

We present models of the H$\beta$-emitting broad-line region (BLR) in seven Seyfert 1 galaxies from the Lick AGN (Active Galactic Nucleus) Monitoring Project 2011 sample, drawing inferences on the BLR structure and dynamics as well as the mass of the central supermassive black hole. We find that the BLR is generally a thick disk, viewed close to face-on, with preferential emission back toward the ionizing source. The dynamics in our sample range from near-circular elliptical orbits to inflowing or outflowing trajectories. We measure black hole masses of $\log_{10}(M_{\rm BH}/M_\odot) = 6.48^{+0.21}_{-0.18}$ for PG 1310$-$108, $7.50^{+0.25}_{-0.18}$ for Mrk 50, $7.46^{+0.15}_{-0.21}$ for Mrk 141, $7.58^{+0.08}_{-0.08}$ for Mrk 279, $7.11^{+0.20}_{-0.17}$ for Mrk 1511, $6.65^{+0.27}_{-0.15}$ for NGC 4593, and $6.94^{+0.14}_{-0.14}$ for Zw 229$-$015. We use these black hole mass measurements along with cross-correlation time lags and line widths to recover the scale factor $f$ used in traditional reverberation mapping measurements. Combining our results with other studies that use this modeling technique, bringing our sample size to 16, we calculate a scale factor that can be used for measuring black hole masses in other reverberation mapping campaigns. When using the root-mean-square (rms) spectrum and using the line dispersion to measure the line width, we find $\log_{10}(f_{{\rm rms},\sigma})_{\rm pred} = 0.57 \pm 0.19$. Finally, we search for correlations between $f$ and other AGN and BLR parameters and find marginal evidence that $f$ is correlated with $M_{\rm BH}$ and the BLR inclination angle, but no significant evidence of a correlation with the AGN luminosity or Eddington ratio.Comment: 26 pages, 14 figures. Accepted for publication in Ap