Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The asymptomatic nature and paroxysmal frequency of AF lead to suboptimal early detection. A novel technology, photoplethysmography (PPG), has been developed for AF screening. However, there has been limited validation of smartphone and smart band applications with PPG compared to 12-lead electrocardiograms (ECG). Objective: We investigated the feasibility and accuracy of a smartphone- and smart band-based algorithm (PRO AF PPG) for AF detection using pulse data measured by PPG. Methods: One hundred twelve consecutive inpatients were recruited from the Chinese PLA General Hospital from 15 March to 1 April 2018. Participants were simultaneously tested with smartphones (HUAWEI Mate 9, HUAWEI Honor 7X), smart bands (HUAWEI Band 2), and 12-lead ECG for 3 minutes. Results: One hundred eight patients (56 with normal sinus rhythm, 52 with persistent AF) were enrolled in the final analysis after excluding 4 patients with unclear cardiac rhythms. The corresponding sensitivity and specificity of the smart band PPG were 95.36% (95% confidential interval, CI 92.00-97.40%) and 99.70% (95% CI 98.08-99.98%), respectively. The positive predictive value of the smart band PPG was 99.63% (95% CI 97.61-99.98%), the negative predictive value was 96.24% (95% CI 93.50-97.90%), and the accuracy was 97.72% (95% CI 96.11-98.70%). Moreover, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of smartphones with PPG for AF detection were over 94%. There was no significant difference after further statistical analysis of the results from the different smart devices compared with the gold-standard ECG (P=.999). Conclusions: The algorithm based on smartphones and smart bands with PPG demonstrated good performance in detecting AF and may represent a convenient tool for AF detection in at-risk individuals, allowing widespread screening of AF in the population. Clinical Trial: The present study was registered in the Chinese Clinical Trial Registry, International Clinical Trials Registry Platform of the World Health Organization (ChiCTR-OOC-17014138).

Korean Circulation Journal 대한심장학회지 순환기 Li YG, et al. Korean Circ J. 2018 Aug;48(8):665-684. https://doi.org/10.4070/kcj.2018.0190

Background: Early assessment of carotid atherosclerotic plaque characteristics is essential for atherosclerotic cardiovascular disease (ASCVD) risk stratification and prediction. We aimed to identify different trajectories of lipid profiles and investigate the association of lipid trajectories with carotid atherosclerosis (CAS) progression in a large, longitudinal cohort of the Chinese population. Methods: 10,412 participants aged ≥18 years with ≥2 times general health checkups were included in this longitudinally prospective cohort study at Peking University Third Hospital. We used latent class trajectory models to identify trajectories of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) over follow-up time (757 days, IQR: 388–844 days). Results: Participants with carotid plaque were more likely to be older, male, have higher body mass index, have a higher prevalence of hypertension and diabetes, and have a higher level of blood pressure, TG, TC, and LDL-C, compared with carotid intima-media thickness (cIMT) and normal group. Subjects were trichotomized according to different trajectory patterns into stable, moderate-stable, and elevated-increasing classes. TC ≥ 5.18 mmol/L and moderate-stable class (hazard ratio (HR): 1.416, 95% confidence interval (CI): 1.285–1.559, p: 0.000), TG ≥ 1.70 mmol/L and moderate-stable class (HR: 1.492, 95% CI: 1.163–1.913, p: 0.002), TG ≥ 1.70 mmol/L and elevated-increasing class (HR: 1.218, 95% CI: 1.094–1.357, p: 0.000), LDL-C ≥ 3.36 mmol/L and stable class (HR: 1.500, 95% CI: 1.361–1.653, p: 0.000) were statistically significant associated with CAS progression compared with the reference group. Conclusions: Borderline elevated baseline lipid (TC, TG, and LDL-C) with stable and elevated-increasing trajectories were associated with CAS progression. Long-term strategies for low-level lipid are beneficial for ASCVD management.

Atrial fibrillation (AF) is associated with substantially increased risk of cardiovascular events and overall mortality. The Atrial fibrillation Better Care (A—Avoid stroke, B—Better symptom management, C—Cardiovascular and comorbidity risk management) pathway provides a simple and comprehensive approach for integrated AF therapy. This study’s goals were to evaluate the ABC pathway compliance and determine the main gaps in AF management in the Middle East population, and to assess the impact of ABC pathway adherence on the all-cause mortality and composite outcome in AF patients. 2021 patients (mean age 57; 52% male) from the Gulf SAFE registry were studied. We evaluated: A—appropriate implementation of OACs according to CHA₂DS₂-VASc score; B—symptom control according to European Heart Rhythm Association (EHRA) symptom scale; C—proper cardiovascular comorbidities management. The primary endpoints were the composite cardiovascular outcome (ischemic stroke or systemic embolism, all-cause death and cardiovascular hospitalization) and all-cause mortality. One-hundred and sixty-eight (8.3%) patients were optimally managed according to adherence with the ABC pathway. Over the one-year follow up (FU), there were 578 composite outcome events and 224 deaths. Patients managed with integrated care had significantly lower rates for the composite outcome and mortality comparing to non-ABC group (20.8% vs. 29.3%, p = 0.02 and 7.3% vs. 13.1%, p = 0.033, respectively). On multivariable analysis, ABC compliance was independently associated with reduced risk of composite outcome (HR 0.53; 95% CI 0.36–0.8, p = 0.002) and death (HR 0.46; 95% CI 0.25–0.86, p = 0.015). Integrated ABC pathway adherent care resulted in the reduced composite outcome and all-cause mortality in AF patients from Middle East, highlighting the necessity of promoting comprehensive holistic and integrated care management of AF.

Background: Sustained atrial high‐rate episodes (SAHREs) among individuals with a cardiac implantable electronic device are associated with an increased risk of adverse outcomes. Risk stratification for the development of SAHREs has never been investigated. We aimed to assess the performance of the C ₂ HEST (coronary artery disease or chronic obstructive pulmonary disease [1 point each], hypertension [1 point], elderly [age ≥75 years, 2 points], systolic heart failure [2 points], thyroid disease [1 point]) score in predicting SAHREs in patients with cardiac implantable electronic devices without atrial fibrillation. Methods and Results: Five Hundred consecutive patients with cardiac implantable electronic devices in the West Birmingham Atrial Fibrillation Project in the United Kingdom were followed since the procedure to observe the development of SAHREs, defined by atrial high‐rate episodes lasting >24 hours. Risk factors and incidence of SAHREs were analyzed. The predictive value of the C ₂ HEST score for SAHRE prediction was evaluated. Over a mean follow‐up of 53.1 months, 44 (8.8%) patients developed SAHREs. SAHREs were associated with higher all‐cause mortality ( P <0.001) and ischemic stroke ( P =0.001). Age and heart failure were associated with SAHRE occurrence. The incidence of SAHREs increased by the C ₂ HEST score (39% higher risk per point increase). Among patients with a C ₂ HEST score ≥4, the incidence of SAHREs was 3.62% per year (95% CI, 2.14–5.16). The C ₂ HEST score had moderate predictive capability (area under the curve, 0.73; 95% CI, 0.64–0.81) and discriminative ability (log‐rank P =0.003), which was better than other clinical scores (CHA ₂ DS ₂ ‐VASc, CHADS ₂ , HATCH). Conclusions: The C ₂ HEST score predicted SAHRE incidence in patients without atrial fibrillation who had an cardiac implantable electronic device, with the highest risk seen in patients with a C ₂ HEST score ≥4 The benefit of using the C ₂ HEST score in clinical practice in this patient population needs further investigation.