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

Reduced Rainfall Variability Reduces Growth of <i>Nothofagus alessandrii</i> Espinosa (Nothofagaceae) in the Maule Region, Chile

Nothofagus alessandrii Espinosa is an endemic species of the coastal Maulino forest of central Chile that has historically been severely threatened by the reduction of its habitat and the isolation of its fragments. In addition, a gradual reduction in precipitation has been observed in recent years across its entire natural distribution area. Although the genus Nothofagus has been extensively analyzed in dendrochronological studies in the Southern Hemisphere, the dendrochronological potential of this species is unknown. In this study, we developed a novel tree-ring chronology of N. alessandrii in order to examine the climate sensitivity of the radial growth and to thus understand its response to climate change in central Chile. Our ring-width chronology showed a series intercorrelation value of 0.48 for the period of 1942–2016 (EPS N. alessandrii growth was strongly influenced by precipitation from May to November (the austral winter and spring seasons), while the temperature signal was weak. We observed that the radial growth patterns of N. alessandrii chronology showed upward growth trends, with a marked positive slope until the mid-1980s. However, a negative trend was observed for the period of 1985–2016, which was related to the increased drought conditions (rainfall and soil moisture reductions) in past decades and affected the entire natural distribution of the species. We suggest that drier winters and springs would slow the growth of this species. This information is of vital importance to understanding the growth dynamics of N. alessandrii, a critically endangered species, and to take on urgent adaptation and mitigation measures in the face of climate change

Reduced Rainfall Variability Reduces Growth of Nothofagus alessandrii Espinosa (Nothofagaceae) in the Maule Region, Chile

Nothofagus&nbsp;alessandrii Espinosa is an endemic species of the coastal Maulino forest of central Chile that has historically been severely threatened by the reduction of its habitat and the isolation of its fragments. In addition, a gradual reduction in precipitation has been observed in recent years across its entire natural distribution area. Although the genus Nothofagus has been extensively analyzed in dendrochronological studies in the Southern Hemisphere, the dendrochronological potential of this species is unknown. In this study, we developed a novel tree-ring chronology of N. alessandrii in order to examine the climate sensitivity of the radial growth and to thus understand its response to climate change in central Chile. Our ring-width chronology showed a series intercorrelation value of 0.48 for the period of 1942&ndash;2016 (EPS &lt; 0.85, with 10 trees), showing a strong common growth signal among the trees. N. alessandrii growth was strongly influenced by precipitation from May to November (the austral winter and spring seasons), while the temperature signal was weak. We observed that the radial growth patterns of N. alessandrii chronology showed upward growth trends, with a marked positive slope until the mid-1980s. However, a negative trend was observed for the period of 1985&ndash;2016, which was related to the increased drought conditions (rainfall and soil moisture reductions) in past decades and affected the entire natural distribution of the species. We suggest that drier winters and springs would slow the growth of this species. This information is of vital importance to understanding the growth dynamics of N. alessandrii, a critically endangered species, and to take on urgent adaptation and mitigation measures in the face of climate change

Extreme drought triggers parallel shifts in wood anatomical and physiological traits in upper treeline of the Mediterranean Andes

Abstract Background Treeline ecotones of Mediterranean ecoregions have been affected by the increasing intensity and severity of droughts. Even though the effect of droughts on forest dynamics has been widely documented, knowledge is relatively scarce of how extreme climate episodes affect the hydraulic structure and, therefore, the physiology of woody plants. The Mediterranean Andes have experienced an uninterrupted period of drought since 2010, including an extremely dry year in 2019 with approximately 80% rainfall deficit. Here, we investigated shifts in wood anatomical and physiological traits of Kageneckia angustifolia, an endemic treeline species, in response to this drought period. Methods We evaluated the xylem plasticity of three K. angustifolia populations across their natural distribution (31–35° SL) based on anatomical (vessel structure and distribution) and physiological (intrinsic water-use efficiency) variables in the tree rings. We focused on the period 2000–2020 that corresponds to before the megadrought (2000–2007), (ii) megadrought (2008–2018) and (iii) hyperdrought (2019–2020). The variables were annualized and analyzed by linear mixed-effects models. Results Our results provide insights to the anatomical and physiological mechanisms underlying the resilience of treeline forests to persistent droughts in central Chile. We found that the extreme drought in 2019–2020 triggered shifts in vessel size and frequency that increased hydraulic safety. These significant shifts in vessel traits occurred in parallel with a decrease in pit aperture area and an increase in water-use efficiency, further increasing the resilience of K. angustifolia to extreme drought stress. Conclusions Our results revealed coordinated shifts in vessel size and frequency and water-use efficiency in response to the megadrought, thereby reducing vulnerability to hydraulic failure. The apparent resilience of K. angustifolia to extreme droughts suggests that this adaptation to drought stress may increase its ability to tolerate novel climatic conditions of treeline environments of the Mediterranean Andes, although it is not clear whether these adaptations will be sufficient to persist in scenarios that predict intensification of climate stress. Finally, our results provide empirical evidence that integrating wood anatomical and physiological traits facilitates the understanding of resilience mechanisms that treeline forests develop in the face of increasing drought stress

Recent multispecies tree-growth decline reveals a severe aridity change in Mediterranean Chile

Soil moisture (SM) is a crucial factor in the water cycle, sustaining ecosystems and influencing local climate patterns by regulating the energy balance between the soil and atmosphere. Due to the absence of long-term, in-situ measurements of SM, studies utilizing satellite-based data and tree-ring analysis have become valuable in assessing variations of SM at regional and multi-century scales, as well as determining its effects on tree growth. This information is particularly pertinent in biodiversity hotspots made up of semi-arid ecosystems currently threatened by climate change. In the Mediterranean Chile region (MC; 30°–37° S), an ongoing megadrought since 2010 has resulted in a significant decline in the forest throughout the area. However, the impact of SM on tree growth at a multi-species and regional level remains unexplored. We analyzed a new network of 22 tree-ring width chronologies across the MC to evaluate the main spatiotemporal tree-growth patterns of nine woody species and their correlation with SM, using PCA. We also reconstructed the SM variations over the past four centuries and assessed its connection with large-scale climate forcings. Our results indicate that the primary growth patterns (PC1) explained 27% of the total variance and displayed a significant relationship with SM between 1982–2015 ( r = 0.91), accurately reflecting the current megadrought. The tree-ring SM reconstruction covers the period 1616–2018 and shows a strong decrease around the year 2007, revealing an unprecedented recent change in aridity with respect to the last four centuries. The intensity of the South Pacific subtropical anticyclone, which primarily owe their existence to the subsiding branch of the Hadley Cell, appears as the primary climatic mechanism correlated with the reconstruction and the present aridity conditions in MC. The current SM conditions align with anticipated aridity changes in MC, providing a bleak perspective of future regional climate

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

Background: Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. Objectives: We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. Methods: A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. Results: Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55–0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. Conclusions: In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones