184 research outputs found
Effect of sacubitril/valsartan on investigator-reported ventricular arrhythmias in PARADIGM-HF
Grain-size analysis of hurricane-induced event beds in a New England salt marsh, Massachusetts, USA
Author Posting. © Coastal Education and Research Foundation, 2021. This article is posted here by permission of Coastal Education and Research Foundation for personal use, not for redistribution. The definitive version was published in Journal of Coastal Research 37(2), (2021): 326-33, https://doi.org/10.2112/JCOASTRES-D-19-00159.1.Tropical cyclones pose a growing threat to coastal infrastructure and livelihood. Because instrumental and historic records are too short to help us understand interactions between tropical cyclones and climate on a longer scale, proxy records are the only means for reconstructing millennia of tropical cyclone impacts. This study determines grain-size trends in storm-induced overwash deposits along a transect of sediment cores from a salt marsh in Mattapoisett, Massachusetts, to characterize sorting trends and compare deposits associated with individual storms. The overwash deposits preserved within the high-marsh peat provide a record spanning the last two millennia. Building on a 2010 study, a different approach was used to accurately determine the grain-size distribution of overwash deposits from cores in a transect running perpendicular to the adjacent sandy/gravely barrier. Although maximum grain-size values are expected to decrease as distance from the barrier increases, not all event deposits that were studied follow this trend within uncertainty. Analysis of the storm event beds reveal a significant difference in settling trends between historic and prehistoric deposits, with historic deposits largely displaying landward-fining trends and prehistoric deposits largely displaying landward-coarsening trends. This suggests changes in the hydrodynamic or that geomorphic regime may have altered the way in which storm beds were deposited at this site. This new in-depth, transect-based approach has utility for improving the accuracy of future storm reconstructions, particularly for events for which no historic record exists
Potential sources of particulate iron in surface and deep waters of the terra nova bay (Ross sea, antarctica)
The distribution of particulate Fe (pFe), suspended particulate matter (SPM), and other particulate trace metals were investigated in Terra Nova Bay as part of CDW Effects on glaciaL mElting and on Bulk of Fe in the Western Ross sea (CELEBeR) and Plankton biodiversity and functioning of the Ross Sea ecosystems in a changing Southern Ocean (P-ROSE) projects. Variable concentrations of SPM (0.09–97 mg L−1 ), pFe (0.51–8.70 nM) and other trace metals were found in the Antarctic Surface waters (AASW) layer, where the addition of meltwater contributed to the pool with both lithogenic and biogenic forms. The deeper layer of the water column was occupied by High Salinity Shelf Water (HSSW) and Terra Nova Bay Ice Shelf Water (TISW) encompassing glacial water as confirmed by the lightest δ18 O measured values. The concentration of pFe in TISW (11.7 ± 9.2 nM) was higher than in HSSW samples (5.55 ± 4.43 nM), suggesting that the drainage of material released from glaciers surrounding the area is relevant in terms of pFe contribution. Particulate Fe/Al and Mn/Al ratios were substantially in excess compared with the mean crustal ratios. Microscopic analyses confirmed that more labile Fe oxyhydroxides and authigenic MnO2 phases were present together with biogenic sinking material. Future expected increasing melt rates of these glaciers enlarge Fe input, thus having a greater role in supplying iron and counteracting the reductions in sea ice cover around Terra Nova Bay
Etiological diagnosis, prognostic significance and role of electrophysiological study in patients with Brugada ECG and syncope.
BACKGROUND: Syncope is considered a risk factor for life-threatening arrhythmias in Brugada patients. Distinguishing a benign syncope from one due to ventricular arrhythmias is often difficult, unless an ECG is recorded during the episode. Aim of the study was to analyze the characteristics of syncopal episodes in a large population of Brugada patients and evaluate the role of electrophysiological study (EPS) and the prognosis in the different subgroups. METHODS AND RESULTS: One hundred ninety-five Brugada patients with history of syncope were considered. Syncope were classified as neurally mediated (group 1, 61%) or unexplained (group 2, 39%) on the basis of personal and family history, clinical features, triggers, situations, associated signs, concomitant therapy. Most patients underwent EPS; they received ICD or implantable loop-recorder on the basis of the result of investigations and physician's judgment. At 62±45months of mean follow-up, group 1 showed a significantly lower incidence of arrhythmic events (2%) as compared to group 2 (9%, p<0.001). Group 2 patients with positive EPS showed the highest risk of arrhythmic events (27%). No ventricular events occurred in subjects with negative EPS. CONCLUSION: Etiological definition of syncope in Brugada patients is important, as it allows identifying two groups with different outcome. Patients with unexplained syncope and ventricular fibrillation induced at EPS have the highest risk of arrhythmic events. Patients presenting with neurally mediated syncope showed a prognosis similar to that of the asymptomatic and the role of EPS in this group is unproven
PICKING THE BEST NOVEL ORAL ANTICOAGULANT FOR ATRIAL FIBRILLATION: EVIDENCE FROM A WARFARIN-CONTROLLED NETWORK META-ANALYSIS
Warfarin is a mainstay atrial ibrillation (AF) treatment, yet it has a narrow therapeutic window. Novel agents have been successfully
tested against warfarin, yet no direct comparison among them is available. We thus performed a pair-wise and warfarin-adjusted network metaanalyses
of novel oral anticoagulants for AF
Left atrial function after atrial fibrillation cryoablation concomitant to minimally invasive mitral valve repair: A pilot study on long-term results and clinical implications
Background and Objectives: Surgical atrial fibrillation (AF) ablation concomitant to minimally invasive mitral valve repair has been proven to offer improved short- and long-term sinus rhythm (SR) maintenance compared to mitral valve surgery only. The objective of the present study was to explore, by thorough echocardiographic assessment, long-term morphological and functional left atrial (LA) outcomes after this combined surgical procedure. Materials and Methods: From October 2006 to November 2015, 48 patients underwent minimally invasive mitral valve repair and concomitant surgical AF cryoablation. Results: After 3.8 ± 2.2 years, 30 (71.4%) of those completing the follow-up (n = 42, 87.5%) presented SR. During follow-up, four (9.5%) patients suffered from cerebrovascular accidents and two of these subjects had a long-standing persistent AF relapse and were in AF at the time of the event, while the other two were in SR. An echocardiographic study focused on LA characteristics was performed in 29 patients (69.0%). Atrial morphology and function (e.g., maximal LA volume indexed to body surface area and total LA emptying fraction derived from volumes) in patients with stable SR (60.6 ± 13.1 mL/mq and 25.1 ± 7.3%) were significantly better than in those with AF relapses (76.8 ± 16.2 mL/mq and 17.5 ± 7.4%; respectively, p = 0.008 and p = 0.015). At follow-up, patients who suffered from ischemic cerebral events had maximal LA volume indexed to body surface area 61 ± 17.8 mL/mq, with total LA emptying fraction derived from volumes 23.6 ± 13.7%; patients with strokes in SR showed very enlarged LA volume (>70 mL/mq). Conclusions: AF cryoablation concomitant with minimally invasive mitral valve repair provides a high rate of SR maintenance and this relates to improved long-term morphological and functional LA outcomes. Further prospective studies are needed to define the cut-off values determining an increase in the risk for thromboembolic complications in patients with restored stable SR
Use and misuse of multivariable approaches in interventional cardiology studies on drug-eluting stents: a systematic review.
Aims: Randomized clinical trials (RCTs) are the most reliable evidence, even if they require important resource and logistic efforts. Large, cost-free and real-world datasets may be easily accessed yielding to observational studies, but such analyses often lead to problematic results in the absence of careful methods, especially from a statistic point of view. We aimed to appraise the performance of current multivariable approaches in the estimation of causal treatment and effects in studies focusing on drug-eluting stents (DES). Methods and Results: Pertinent studies published in the literature were searched, selected, abstracted, and appraised for quality and validity features. Six studies with a logistic regression were included, all of them reporting more than 10 events for covariates and different length of follow-up, with an overall low risk of bias. Most of the 15 studies with a Cox proportional hazard analysis had a different follow-up, with less than 10 events for covariates, yielding an overall low or moderate risk of bias. Sixteen studies with propensity score were included: the most frequent method for variable selection was logistic regression, with underlying differences in follow-up and less than 10 events for covariate in most of them. Most frequently, calibration appraisal was not reported in the studies, on the contrary of discrimination appraisal, which was more frequently performed. In seventeen studies with propensity and matching, the latter was most commonly performed with a nearest neighbor-matching algorithm yet without appraisal in most of the studies of calibration or discrimination. Balance was evaluated in 46% of the studies, being obtained for all variables in 48% of them. Conclusions: Better exploitation and methodological appraisal of multivariable analysis is needed to improve the clinical and research impact and reliability of nonrandomized studies. (J Interven Cardiol 2012;**:1-1
Zero-fluoroscopy atrial fibrillation ablation in the presence of a patent foramen ovale: a multicentre experience
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