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

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Synthesis and investigation of solvent effects on the ultraviolet absorption spectra of 1,3-bis-substituted-5,5-dimethylhydantoins

A series of 1,3-bis-substituted-5,5-dimethylhydantoins was synthesized using the reaction of 5,5-dimethylhydantoin with the corresponding alkyl halide in the presence of trimethylamine as catalyst and sodium hydroxide, according to a modified literature procedure. The experimental investigation included modification of the synthetic procedure in terms of starting materials, solvent, temperature, isolation techniques, as well as purification and identification of the products. The absorption spectra of the 1,3-bis-substituted-5,5-dimethylhydantoins were recorded in twelve solvents in the range 200400 nm. The effects of the solvent polarity and hydrogen bonding on the absorption spectra were interpreted by means of linear solvation energy relationships using a general equation of the form n = n0 + sp* + aa + bb and by two-parameter models presented by the equation n = n0 + sp* + aa, where p* is a measure of the solvent polarity/polarisability, a is the scale of the solvent hydrogen bond donor acidities and b is the scale of the solvent hydrogen bond acceptor basicities. The solvent and substituent effects on the electronic absorption spectra of the investigated hydantoins is discussed

The impact of network design on packet scheduling in slotted WDM packet rings

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Traffic grooming in WDM optical packet rings

International audienceThe present paper considers a WDM optical packet ring in which multiple wavelengths are operated in a synchronous manner. This architecture attempts to blend packet switching techniques with optical transparency in order to offer a flexible MAN architecture able to accomodate large amounts of traffic demands. This architecture also performs traffic ``grooming" (aggregation between different flows) but does not necessitate Optical-Electrical-Optical conversion in transit nodes. In each time slot, a station can send a single packet, selecting the wavelength on a per-slot basis. Once inserted on the ring, the packet is transmitted transparently to its destination. We consider 2 cases regarding receivers: in the non-WDM case, a station can only receive packets on a single wavelength whereas in the second case, a station can receive packets on all the wavelengths used in the network. In both cases, wavelengths can be shared between the stations. We address both network dimensioning and network capacity issues. The use of optical packet switching is first shown to greatly simplify the network configuration compared to any circuit-switched solution. We also show that with WDM receivers, a simple strategy of load balancing on all the wavelengths used in the network allows to increase the capacity of the network, with the same number of wavelengths, or even allows to dimension the ring with a smaller number of wavelengths. This shows that, in terms of traffic grooming, the system under study behaves similarly to non-transparent optical packet ring architectures that rely on Optical-Electrical-Optical conversion in transit nodes. On the other hand, it is expected to outperform those architectures in terms of node complexity and power consumption

Optimal dimensioning of the WDM unidirectional Ecoframe optical packet ring

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Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks