Relationship between low Ankle-Brachial Index and rapid renal function decline in patients with atrial fibrillation: A prospective multicentre cohort study

OBJECTIVE: To investigate the relationship between Ankle-Brachial Index (ABI) and renal function progression in patients with atrial fibrillation (AF). DESIGN: Observational prospective multicentre cohort study. SETTING:Atherothrombosis Center of I Clinica Medica of 'Sapienza' University of Rome; Department of Medical and Surgical Sciences of University Magna Græcia of Catanzaro; Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study. PARTICIPANTS: 897 AF patients on treatment with vitamin K antagonists. MAIN OUTCOME MEASURES: The relationship between basal ABI and renal function progression, assessed by the estimated Glomerular Filtration Rate (eGFR) calculated with the CKD-EPI formula at baseline and after 2 years of follow-up. The rapid decline in eGFR, defined as a decline in eGFR >5 mL/min/1.73 m(2)/year, and incident eGFR<60 mL/min/1.73 m(2) were primary and secondary end points, respectively. RESULTS: Mean age was 71.8±9.0 years and 41.8% were women. Low ABI (ie, ≤0.90) was present in 194 (21.6%) patients. Baseline median eGFR was 72.7 mL/min/1.73 m(2), and 28.7% patients had an eGFR60 mL/min/1.73 m(2), 153 (23.9%) had a reduction of the eGFR <60 mL/min/1.73 m(2). ABI ≤0.90 was also an independent predictor for incident eGFR<60 mL/min/1.73 m(2) (HR 1.851, 95% CI 1.205 to 2.845, p=0.005). CONCLUSIONS: In patients with AF, an ABI ≤0.90 is independently associated with a rapid decline in renal function and incident eGFR<60 mL/min/1.73 m(2). ABI measurement may help identify patients with AF at risk of renal function deterioration

Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p &lt;0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p &lt;0.0001), age (OR 1.03 per year, p &lt;0.001), hypertension (OR 2.30, p &lt;0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention

Mission Analysis, GNC and ATD for Reusable Launch Vehicles within ASCenSIon: Multi-Orbit Multi-Payload Injection, Re-Entry and Safe Disposal

Reusable Launch Vehicles (RLVs) are not only key for an economically and ecologically sustainable space access but also represent a paramount innovation towards the increasing demand for smaller satellites and mega- constellations. In order to ensure Europe's independent space access capabilities, ASCenSIon (Advancing Space Access Capabilities - Reusability and Multiple Satellite Injection) is born as an innovative training network with fifteen Early Stage Researchers, ten beneficiaries, and fourteen partner organisations across Europe. This paper provides an overview of the mission, ranging from the ascent to the re-entry of the reusable stages and including the multi-orbit injection and the safe disposal. A special focus is put on the activities developed within ASCenSIon regarding Mission Analysis (MA), Guidance Navigation and Control (GNC) and Aerothermodynamics (ATD). The foreseen methods, approaches and goals of the project are presented. These topics require innovation within and a high level of collaboration due to their interconnection. The pre-flight design capability drives the necessity of a MA and GNC missionisation tool coupled with ATD software to test/explore re-entry solutions. Such a reliable and efficient tool will require the development of GNC algorithms for the re-entry of the launcher. Additionally, specific challenges of trajectory optimization for RLVs are addressed, such as integrated multi-disciplinary vehicle design and trajectory analysis, fast and reliable on-board methods. The results of this study are subsequently used to develop the controlled strategy. Moreover, to perform the novel multi-orbit multi-payload injection. This activity is followed by the development of, a GNC architecture capable of optimally steering the vehicle towards a targeted landing site under precision and soft-landing constraints. In addition, ATD affects the mission profile at multiple phases and needs to be considered at each design step. Due to complexity and limited computational resources during the preliminary design phase, surrogate models with low response times are required to predict wall heat fluxes along the considered trajectories based on the pressure topology. The complete profile is wrapped up with the Post Mission Disposal strategies to be used by the launchers in order to ensure the compliance with the space debris mitigation guidelines, as well as preliminary reliability aspects of these strategies. The paper provides a preliminary analysis of the discussed topics and their interconnections within the work-frame of ASCenSIon paving the way towards the development of novel cutting-edge technologies for RLVs

Prevalence of sarcopenia and associated factors in the healthy older adults of the Peruvian Andes

Aim To assess the prevalence of sarcopenia and associated factors in a population of older people living in a rural area of the Peruvian Andes. Materials and methods The study concerned 222 people aged ≥65 years. Sarcopenia was diagnosed on the basis of skeletal muscle mass, measured using bioimpedance analysis, and gait speed, measured with the 4-m walking test, as recommended by the International Working Group on sarcopenia. Self-reported physical activity, the Short Physical Performance Battery, and the Six-Minute Walking Test also contributed information on participants’ physical performance status. Disabilities were investigated by assessing participants’ self-reported difficulties in performing one or more basic or instrumental activities of daily living. Results The prevalence of sarcopenia was 17.6%. Compared with participants without sarcopenia, individuals who were found sarcopenic were significantly older, female and were less frequently farmers, had fewer children, had a worse nutritional status, a significantly lower physical performance, and higher levels of disability in the instrumental activities of daily living. After adjusting for potential confounders, age, female sex, a low body mass index, a self-reported low physical activity level, a worse Six-Minute Walking Test scores, and a low number of children were significantly associated with sarcopenia. Conclusion The prevalence of sarcopenia seems to be quite high among community-dwelling older subjects in the Peruvian Andes. Age, female sex, a low body mass index, little physical activity, a poor Six-Minute Walking Test scores, and a low number of children could be associated with this condition. © 2016 Elsevier Ireland Lt

Lights and shadows in the management of old and new oral anticoagulants in the real world of atrial fibrillation by Italian internists. A survey from the Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study

The lights and shadows in the management of old and new oral anticoagulants are described in the real world of atrial fibrillation by Italian internists

Aspirin and renal insufficiency progression in patients with atrial fibrillation and chronic kidney disease

BACKGROUND: In experimental models, thromboxane (Tx)A2 reduced renal perfusion and accelerated renal failure. The aim of the study was to investigate the association between the use of aspirin, which inhibits TxA2 production, and the incidence of an estimated Glomerular Filtration Rate (eGFR) &lt;60 and &lt;45ml/min/1.73m2 in patients with atrial fibrillation (AF) and chronic kidney disease (CKD). METHODS: Prospective multicentre observational cohort study including 800 anticoagulated AF patients; CKD was defined as an eGFR &lt;90ml/min/1.73m2 by CKD-EPI formula; eGFR was measured at baseline and after a median of 28.0months. Urinary 11-dehydro-TxB2, was measured in 401 patients. The incidence of cardiovascular events (CVEs) was also registered. RESULTS: Baseline eGFR was 65.1ml/min/1.73m2; 147 and 91 patients had incident eGFR&lt;60 and &lt;45ml/min/1.73m2, respectively; 16.5% patients received a concomitant treatment with aspirin 100mg/day. Multivariate logistic regression analysis showed a direct association with incident eGFR&lt;45ml/min/1.73m2 for female sex (odds ratio [OR]:1.910, p=0.005) and hypertension (OR: 7.589, p=0.047), while aspirin use was inversely associated (OR: 0.347, p=0.016). Propensity score adjustment confirmed this association (p=0.017). Patients with incident eGFR&lt;45ml/min/1.73m2 had higher TxB2, compared to those without (123.0 vs. 90.0ng/mg creatinine, p=0.031); TxB2 was inversely associated with incident eGFR&lt;45ml/min/1.73m2 (log TxB2 OR 2.239, p=0.036). Incident eGFR&lt;45ml/min was associated with an increased rate of CVEs (HR: 2.211, p=0.01). CONCLUSION: Aspirin use was associated with a less decline in eGFR in our cohort of AF patients with CKD. Our findings suggest that TxA2 may be implicated in renal function deterioration in AF

Carotid plaque detection improves the predictve value of CHA2DS2-VASc score in patients with non-valvular atrial fibrilation: The ARAPACIS Study

Background and aims: Vascular disease (VD), as assessed by history of myocardial infarction or peripheral artery disease or aortic plaque, increases stroke risk in atrial fibrillation (AF), and is a component of risk assessment using the CHA(2)DS(2)-VASc score. We investigated if systemic atherosclerosis as detected by ultrasound carotid plaque (CP) could improve the predictive value of the CHA(2)DS(2)-VASc score.Methods: We analysed data from the ARAPACIS study, an observational study including 2027 Italian patients with non-valvular AF, in whom CP was detected using Doppler Ultrasonography.Results: VD was reported in 351 (17.3%) patients while CP was detected in 16.6% patients. Adding CP to the VD definition leaded to higher VD prevalence (30.9%). During a median [IQR] follow-up time of 36 months, 56 (2.8%) stroke/TIA eventswere recorded. Survival analysis showed that conventional VD alone did not increase the risk of stroke (Log-Rank: 0.009, p = 0.924), while addition of CP to conventional VD was significantly associated to an increased risk of stroke (LR: 5.730, p = 0.017). Cox regression analysis showed that VD + CP was independently associated with stroke (HR: 1.78, 95% CI: 1.05-3.01, p = 0.0318). Reclassification analysis showed that VD + CP allowed a significant risk reclassification when compared to VD alone in predicting stroke at 36 months (NRI: 0.192, 95% CI: 0.028-0.323, p = 0.032).Conclusions: In non-valvular AF patients the addition of ultrasound detection of carotid plaque to conventional VD significantly increases the predictive value of CHA(2)DS(2)-VASc score for stroke. (C) 2017 Published by Elsevier Ireland Ltd