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

Overview of ASDEX Upgrade results\ue2\u20ac\u201ddevelopment of integrated operating scenarios for ITER

Significant progress has been made on ASDEX Upgrade during the last two years in the basic understanding of transport, in the extension of the improved H-mode in parameter space and towards an integrated operating scenario and in the development of control methods for major performance limiting instabilities. The important features were the understanding of particle transport and the control of impurity accumulation based on it, the satisfactory operation with predominantly tungsten-clad walls, the improved H-mode operation over density ranges and for temperature ratios covering (non-simultaneously) the ITER requirements on \u3bd*, n/nGW and Te/Ti, the ELM frequency control by pellet injection and the optimization of NTM suppression by DC-ECCD through variation of the launching angle. From these experiments an integrated scenario has emerged which extrapolates to a 50% improvement in n T \u3c4 or a 30% reduction of the required current when compared with the ITER base-line assumptions, with moderately peaked electron and controllable high-Z density profiles

Overview of ASDEX Upgrade results-development of integrated operating scenarios for ITER

This article based on the 2004 Fusion Energy Conference contribution (Vilamoura, Portugal, 1-6 November 2004