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Background: Non-vitamin K oral anticoagulants have become the standard therapy for preventing stroke and ischemic thromboembolism in most patients with atrial fibrillation (AF). The effectiveness and safety of non-vitamin K oral anticoagulants in patients on hemodialysis is not well known., Methods: From June 2017 through May 2022, AXADIA-AFNET 8 (Compare Apixaban and Vitamin K Antagonists in Patients With Atrial Fibrillation and End-Stage Kidney Disease), an investigator-initiated PROBE (prospective randomized open blinded end point) outcome assessment trial, randomized patients with AF on chronic hemodialysis to either apixaban (2.5 mg BID) or the vitamin K antagonist (VKA) phenprocoumon (international normalized ratio, 2.0 to 3.0). The composite primary safety outcome was defined by a first event of major bleeding, clinically relevant nonmajor bleeding, or all-cause death. The primary efficacy outcome was a composite of ischemic stroke, all-cause death, myocardial infarction, and deep vein thrombosis or pulmonary embolism. Our hypothesis was that apixaban is noninferior to VKA., Results: Thirty-nine sites randomized 97 patients (30% women; mean age 75 years; mean CHA 2 DS 2 -VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female sex] score, 4.5; baseline characteristics balanced between groups): 48 to apixaban and 49 to VKA. The median follow-up time was 429 days (range, 37 to 1370) versus 506 days (range, 101 to 1379), respectively. Adherence to apixaban was >80% in 44 of 48 patients; the median time in therapeutic range on VKA was 50.7%. Composite primary safety outcome events occurred in 22 patients (45.8%) on apixaban and in 25 patients (51.0%) on VKA (hazard ratio, 0.93 [95% CI, 0.53-1.65]; P noninferiority =0.157). Composite primary efficacy outcome events occurred in 10 patients (20.8%) on apixaban and in 15 patients (30.6%) on VKA ( P =0.51; log rank). There were no significant differences regarding individual outcomes (all-cause mortality, 18.8% versus 24.5%; major bleeding, 10.4% versus 12.2%; and myocardial infarction, 4.2% versus 6.1%, respectively)., Conclusions: In this randomized trial comparing apixaban and VKA in patients with AF on hemodialysis with long follow-up, no differences were observed in safety or efficacy outcomes. Even on oral anticoagulation, patients with AF on hemodialysis remain at high risk of cardiovascular events. Larger randomized trials are needed to determine the optimal anticoagulation regimen for patients with AF on hemodialysis., Registration: URL: https://www., Clinicaltrials: gov; Unique identifier: NCT02933697.

Background: Atrial fibrillation (AF) is a common arrhythmia with relevant impact on mortality and morbidity. Pulmonary vein isolation (PVI) is an established therapy in patients who remain symptomatic under optimal medical therapy. However, up to 70% of patients present with recurrence of AF after PVI. Therefore, identifying ideal candidates is an unmet clinical need. Left atrial (LA) fibrosis is associated with reduced LA function. Analysis of LA mechanics using 2D speckle tracking echocardiography (STE) might give more insight into LA substrates and be therefore of predictive value., Methods: This prospective single-center pilot study included 31 patients (mean age, 62.3 ± 9.1 years; 19 males) with AF who underwent PVI and 20 matched healthy controls (mean age, 60.6 ± 6.6 years; 10 males). 2D STE strain indices of LA reservoir (RLA), conduit, and, if feasible, contractile function, were analyzed before and 6 months after PVI. Assessment of the LV diastolic function was based on standard indices. Responders to PVI were defined as being asymptomatic and free of AF in a 7-day Holter-ECG after 6 months., Results: At baseline, all patients with AF had significantly lower reservoir and contractile function compared with controls. After 6 months, 17 patients (54.8%) were identified as responders. At baseline, the reservoir function was significantly higher in responders compared with nonresponders (32.7 ± 11.1 vs. 22.9 ± 10.9%; P = 0.019). Only in responders, RLA and contractile LA function improved and reached normal values whereas LA function remained unchanged in nonresponders. In a ROC analysis, a RLA value of ≥19.5% discriminated responders and nonresponders in patients with persistent AF with a sensitivity of 86% and a specificity of 100% (P = 0.012; area under the curve 0.943; CI, 0.81-1.0)., Conclusions: LA reservoir function helps to predict efficacy of PVI after 6 months. Only in responders, reservoir, and contractile function normalized within 6 months after PVI indicating a lower level of atrial remodeling at baseline. No deleterious effects of ablation were detected in nonresponders.

Background We aimed to evaluate the predictive value of left atrial ( LA) reservoir, conduit, and contractile function parameters as assessed by speckle tracking echocardiography ( STE) for invasively measured hemodynamic parameters in a patient cohort with myocardial and valvular diseases. Methods Sixty-nine patients undergoing invasive hemodynamic assessment were enrolled into the study. Invasive hemodynamic parameters were obtained by left and right heart catheterization. Transthoracic echocardiography assessment of LA reservoir, conduit, and contractile function was performed by STE. Results Forty-nine patients had sinus rhythm ( SR) and 20 patients had permanent atrial fibrillation ( AF). AF patients had significantly reduced LA reservoir function compared to SR patients. In patients with SR, LA reservoir, conduit, and contractile function inversely correlated with pulmonary capillary wedge pressure ( PCWP), left ventricular end-diastolic pressure, and mean pulmonary artery pressure ( PAP), and showed a moderate association with cardiac index. In AF patients, there were no significant correlations between LA reservoir function and invasively obtained hemodynamic parameters. In SR patients, LA contractile function with a cutoff value of 16.0% had the highest diagnostic accuracy (area under the curve, AUC: 0.895) to predict PCWP ≥18 mm Hg compared to the weaker diagnostic accuracy of average E/Eʹ ratio with an AUC of 0.786 at a cutoff value of 14.3. In multivariate analysis, LA contractile function remained significantly associated with PCWP ≥18 mm Hg. Conclusion In a cohort of patients with a broad spectrum of cardiovascular diseases LA strain shows a valuable prediction of hemodynamic parameters, specifically LV filling pressures, in the presence of SR. [ABSTRACT FROM AUTHOR]