Lucian Petrescu

Prognosis and treatment of atrial fibrillation patients by European cardiologists: One Year Follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry)

BACKGROUND The EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot) provides systematic collection of contemporary data regarding the management and treatment of 3119 subjects with AF from 9 member European Society of Cardiology (ESC) countries. In this analysis, we report the development of symptoms, use of antithrombotic therapy and rate vs. rhythm strategies, as well as determinants of mortality and/or stroke/transient ischaemic attack (TIA)/peripheral embolism during 1-year follow-up in this contemporary European registry of AF patients. METHODS The registry population comprised consecutive in- and out-patients with AF presenting to cardiologists in participating ESC countries. Consecutive patients with AF documented by ECG were enrolled. Follow-up was performed by the local investigator, initially at 1 year, as part of a long-term cohort study. RESULTS At the follow-up, patients were frequently asymptomatic (76.8%), but symptoms are nevertheless common among paroxysmal and persistent AF patients, especially palpitations, fatigue, and shortness of breath. Oral anticoagulant (OAC) use remains high, ∼78% overall at follow-up, and of those on vitamin K antagonist (VKA), 84% remained on VKA during the follow-up, while of those on non-VKA oral anticoagulant (NOAC) at baseline, 86% remained on NOAC, and 11.8% had changed to a VKA and 1.1% to antiplatelet therapy. Digitalis was commonly used in paroxysmal AF patients. Of rhythm control interventions, electrical cardioversion was performed in 9.7%, pharmacological cardioversion in 5.1%, and catheter ablation in 4.4%. Despite good adherence to anticoagulation, 1-year mortality was high (5.7%), with most deaths were cardiovascular (70%). Hospital readmissions were common, especially for atrial tachyarrhythmias and heart failure. On multivariate analysis, independent baseline predictors for mortality and/or stroke/TIA/peripheral embolism were age, AF as primary presentation, previous TIA, chronic kidney disease, chronic heart failure, malignancy, and minor bleeding. Independent predictors of mortality were age, chronic kidney disease, AF as primary presentation, prior TIA, chronic obstructive pulmonary disease, malignancy, minor bleeding, and diuretic use. Statin use was predictive of lower mortality. CONCLUSION In this 1-year follow-up analysis of the EORP-AF pilot general registry, we provide data on the first contemporary registry focused on management practices among European cardiologists, conducted since the publication of the new ESC guidelines. Overall OAC use remains high, although persistence with therapy may be problematic. Nonetheless, continued OAC use was more common than in prior reports. Despite the high prescription of OAC, 1-year mortality and morbidity remain high in AF patients, particularly from heart failure and hospitalizations.

Asymptomatic Atrial Fibrillation: Clinical Correlates, Management, and Outcomes in the EORP-AF Pilot General Registry

OBJECTIVE Atrial fibrillation is often asymptomatic, but outcomes require further characterization. The study objective was to investigate the clinical presentation, management, and outcomes in asymptomatic and symptomatic patients with atrial fibrillation who were prospectively enrolled in the EurObservational Research Programme - Atrial Fibrillation (EORP-AF) Pilot General Registry. METHODS A total of 3119 patients were enrolled, and 1237 (39.7%) were asymptomatic (European Heart Rhythm Association [EHRA] score I). Among symptomatic patients, 963 (51.2%) had mild symptoms (EHRA score II) and 919 (48.8%) had severe or disabling symptoms (EHRA III-IV). Permanent atrial fibrillation was 3-fold more common in asymptomatic patients than in symptomatic patients. RESULTS On multivariate analysis, male gender (odds ratio [OR], 1.630; 95% confidence interval [CI], 1.384-1.921), older age (OR, 1.019; 95% CI, 1.012-1.026), previous myocardial infarction (OR, 1.681; 95% CI, 1.350-2.093), and limited physical activity (OR, 1.757; 95% CI, 1.495-2.064) were associated significantly with asymptomatic (EHRA I) atrial fibrillation. Fully asymptomatic atrial fibrillation (absence of current and previous symptoms) was present in 520 patients (16.7%) and was associated independently with male gender, age, and previous myocardial infarction. Appropriate guideline-based prescription of oral anticoagulants was lower in these patients, and aspirin was prescribed more frequently. Mortality at 1 year was more than 2-fold higher in asymptomatic patients compared with symptomatic patients (9.4% vs 4.2%, P < .0001) and was associated independently with older age and comorbidities, including chronic kidney disease and chronic heart failure. CONCLUSIONS Asymptomatic atrial fibrillation is common in daily cardiology practice and is associated with elderly age, more comorbidities, and high thromboembolic risks. A higher 1-year mortality was found in asymptomatic patients compared with symptomatic patients.

Quantifying crustal thickness over time in magmatic arcs

We present global and regional correlations between whole-rock values of Sr/Y and La/Yb and crustal thickness for intermediate rocks from modern subduction-related magmatic arcs formed around the Pacific. These correlations bolster earlier ideas that various geochemical parameters can be used to track changes of crustal thickness through time in ancient subduction systems. Inferred crustal thicknesses using our proposed empirical fits are consistent with independent geologic constraints for the Cenozoic evolution of the central Andes, as well as various Mesozoic magmatic arc segments currently exposed in the Coast Mountains, British Columbia, and the Sierra Nevada and Mojave-Transverse Range regions of California. We propose that these geochemical parameters can be used, when averaged over the typical lifetimes and spatial footprints of composite volcanoes and their intrusive equivalents to infer crustal thickness changes over time in ancient orogens.

Constraints on plateau architecture and assembly from deep crustal xenoliths, northern Altiplano (SE Peru)

Newly discovered xenoliths within Pliocene and Quaternary intermediate volcanic rocks from southern Peru permit examination of lithospheric processes by which thick crust (60–70 km) and high average elevations (3–4 km) resulted within the Altiplano, the second most extensive orogenic plateau on Earth. The most common petrographic groups of xenoliths studied here are igneous or meta-igneous rocks with radiogenic isotopic ratios consistent with recent derivation from asthenospheric mantle ( 87 Sr/ 86 Sr = 0.704–0.709, 143 Nd/ 144 Nd = 0.5126–0.5129). A second group, consisting of felsic granulite xenoliths exhibiting more radiogenic compositions ( 87 Sr/ 86 Sr = 0.711–0.782, 143 Nd/ 144 Nd = 0.5121–0.5126), is interpreted as supracrustal rocks that underwent metamorphism at ~9 kbar (~30–35 km paleodepth, assuming a mean crustal density of 2.8 g/cm 3 ) and ~750 °C. These rocks are correlated with nonmetamorphosed rocks of the Mitu Group and assigned a Mesozoic (Upper Triassic or younger) age based on detrital zircon U-Pb ages. A felsic granulite Sm-Nd garnet whole-rock isochron of 42 ± 2 Ma demonstrates that garnet growth took place in Eocene time. Monazite grains associated with quenched anatectic melt networks in the same rocks yield ion microprobe U-Pb ages ranging from 3.2 ± 0.2 to 4.4 ± 0.3 Ma (2σ). These disparate geochronologic data sets are reconciled by a model wherein Mesozoic cover rocks were transferred to >30 km depth beneath the plateau in the Eocene and progressively heated until at least Pliocene time. Isothermal decompression and partial melting ensued as these rocks were entrained as xenoliths in volcanic host magmas and transported toward the surface. Mafic granulites and peridotites from the same xenolith suite comprise the basement of the metasedimentary sequence, exhibiting isotopic characteristics of Central Andean crust. Calculated equilibrium pressures for these basement rocks are >11 kbar, suggesting that the basement-cover interface lies beneath the northernmost Altiplano at ~30–40 km below the surface. Together, these results indicate that crustal thickening under the northernmost Altiplano started earlier than major latest Oligocene and Miocene uplift episodes affecting the region and was coeval with a flat slab–related regional episode of deformation. Total shortening must have been at least 20% more than previous estimates in order to satisfy the basement to cover depth constraints provided by the xenolith data. Sedimentary rocks at >30 km paleodepth require that Andean basement thrusts decapitated earlier Triassic normal faults, trapping Paleozoic and Mesozoic rocks below the main decollement. Magma loading from intense Cenozoic plutonism within the plateau probably played an additional role in transporting Mesozoic cover rocks to >30 km and thickening the crust beneath the northern Altiplano.

Ferruginous microstromatolites related to Middle Jurassic condensed sequences and hardgrounds (Bucegi Mountains, Southern Carpathians, Romania)

Integrated analyses of ferruginous laminated crusts and macro-oncoids associated with Middle Jurassic (Bathonian-Callovian) hardgrounds and condensed horizons cropping out in the Bucegi Mountains (Southern Carpathians) allowed an assessment of their microbial origin and the paleoenvironmental context of their genesis. The ferruginous microstromatolites reveal different morphological types (or macrofabrics): ferruginous microstromatolites representing the hardgrounds crusts, ferruginous endostromatolites and oncoidal ferruginous microstromatolites. The last are associated with ooidal bioclastic grainstone, ooidal bioclastic grainstone-packstone, bioclastic ooidal packstone-grainstone, oncoidal floatstone and rudstone, stromatolitic bindstone, bioclastic wackestone-packstone and bioclastic wackestone microfacies. The host mineral of the ferruginous microbialites is calcite, but microbially induced iron oxyhydroxides (goethite and magnetite) prevail in the ferruginous laminae. Petrographical and scanning electron microscope (SEM) investigations revealed that these ferruginous microstromatolites were formed by the activity of microbial mats dominated by putative bacterial and fungal filaments. Locations with reduced or no sedimentation, in relatively deep-water, open-marine shelf environments, below fair-weather wave base or near to storm wave base, within the deep euphotic zone, were favorable for the hardening of the seafloor and the development of the microbial mats. The scarcity of an autochthonous benthic fauna and of burrowing, as well as the presence of framboidal pyrite suggest dysaerobic conditions. In such an environment, iron would have been in its soluble state (Fe2+) and the activity of micro-aerophylic iron-oxidizing bacteria appears to have been particularly intensive at the dysoxic-anoxic interface, inducing the precipitation of iron oxyhydroxides and the formation of diverse ferruginous microstromatolites.

Glomerular filtration rate in patients with atrial fibrillation and 1-year outcomes.

We assessed 1-year outcomes in patients with atrial fibrillation enrolled in the EurObservational Research Programme AF General Pilot Registry (EORP-AF), in relation to kidney function, as assessed by glomerular filtration rate (eGFR). In a cohort of 2398 patients (median age 69 years; 61% male), eGFR (ml/min/1.73 m2) calculated using the CKD-EPI formula was ≥80 in 35.1%, 50–79 in 47.2%, 30–49 in 13.9% and <30 in 3.7% of patients. In a logistic regression analysis, eGFR category was an independent predictor of stroke/TIA or death, with elevated odds ratios associated with severe to mild renal impairment, ie. eGFR < 30 ml/min/1.73 m2 [OR 3.641, 95% CI 1.572–8.433, p < 0.0001], 30–49 ml/min/1.73 m2 [OR 3.303, 95% CI 1.740–6.270, p = 0.0026] or 50–79 ml/min/1.73 m2 [OR 2.094, 95% CI 1.194–3.672, p = 0.0003]. The discriminant capability for the risk of death was tested among various eGFR calculation algorithms: the best was the Cockcroft-Gault equation adjusted for BSA, followed by Cockcroft-Gault equation, and CKD-EPI equation, while the worst was the MDRD equation. In conclusion in this prospective observational registry, renal function was a major determinant of adverse outcomes at 1 year, and even mild or moderate renal impairments were associated with an increased risk of stroke/TIA/death.

Evolution of the Sibişel Shear Zone (South Carpathians): A Study of Its Type Locality Near Răşinari (Romania) and Tectonic Implications

Romanian Executive Agency for Higher Education, Research, Development and Innovation [PN-II-ID-PCE-2011-3-0217, PN-II-ID-PCE-2011-3-0030]

U‐PB Detrital Zircon Geochronology of the Lower Danube and Its Tributaries: Implications for the Geology of the Carpathians

We performed a detrital zircon (DZ) U-Pb geochronologic survey of the lower parts of the Danube River approaching its Danube Delta- Black Sea sink, and a few large tributaries (Tisza, Jiu, Olt and Siret) originating in the nearby Carpathian Mountains. Samples are modern sediments. DZ age spectra reflect the geology and specifically the crustal age formation of the source area, which in this case is primarily the Romanian Carpathians and their foreland with contributions from the Balkan Mountains to the south of Danube and the East European Craton. The zircon cargo of these rivers suggests a source area that formed during the latest Proterozoic and mostly into the Cambrian and Ordovician as island arcs and backarc basins in a Peri-Gondwanan subduction setting (~600 -440 Ma). The Inner Carpathian units are dominated by a U-Pb DZ peak in the Ordovician (460-470 Ma) and little inheritance from the nearby continental masses, whereas the Outer Carpathian units and the foreland has two main peaks, one Ediacaran (570-610 Ma) and one in the earliest Permian (290-300 Ma), corresponding to granitic rocks known regionally. A prominent igneous Variscan peak (320-350 Ma) in the Danube’s and tributaries DZ zircon record is difficult to explain and points out to either an extra Carpathian source or major unknown gaps in our understanding of Carpathian geology. Younger peaks corresponding to arc magmatism during the Alpine period make up as much as about 10% of the DZ archive, consistent with the magnitude and surface exposure of Mesozoic and Cenozoic arcs.

Erratum: Corrigendum: Glomerular filtration rate in patients with atrial fibrillation and 1-year outcomes

Corrigendum: Glomerular filtration rate in patients with atrial fibrillation and 1-year outcomes