Search

Background: Observational data suggest that catheter ablation may be safe and effective to treat younger and older patients with atrial fibrillation. No large, randomized trial has examined this issue. This report describes outcomes according to age at entry in the CABANA trial (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation).Methods: Patients with atrial fibrillation ≥65 years of age, or <65 with ≥1 risk factor for stroke, were randomly assigned to catheter ablation versus drug therapy. The primary outcome was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. Secondary outcomes included all-cause mortality, the composite of mortality or cardiovascular hospitalization, and recurrence of atrial fibrillation. Treatment effect estimates were adjusted for baseline covariables using proportional hazards regression models.Results: Of 2204 patients randomly assigned in CABANA, 766 (34.8%) were <65 years of age, 1130 (51.3%) were 65 to 74 years of age, and 308 (14.0%) were ≥75 years of age. Catheter ablation was associated with a 43% reduction in the primary outcome for patients <65 years of age (adjusted hazard ratio [aHR], 0.57 [95% CI, 0.30-1.09]), a 21% reduction for 65 to 74 years of age (aHR, 0.79 [95% CI, 0.54-1.16]), and an indeterminate effect for age ≥75 years of age (aHR, 1.39 [95% CI, 0.75-2.58]). Four-year event rates for ablation versus drug therapy across age groups, respectively, were 3.2% versus 7.8%, 7.8% versus 9.6%, and 14.8% versus 9.0%. For every 10-year increase in age, the primary outcome aHR increased (ie, less favorable to ablation) an average of 27% (interaction P value=0.215). A similar pattern was seen with all-cause mortality: for every 10-year increase in age, the aHR increased an average of 46% (interaction P value=0.111). Atrial fibrillation recurrence rates were lower with ablation than with drug therapy across age subgroups (aHR 0.47, 0.58, and 0.49, respectively). Treatment-related complications were infrequent for both arms (<3%) regardless of age.Conclusions: We found age-based variations in clinical outcomes for catheter ablation compared with drug therapy, with the largest relative and absolute benefits of catheter ablation in younger patients. No prognostic benefits for ablation were seen in the oldest patients. No differences were found by age in treatment-related complications or in the relative effectiveness of catheter ablation in preventing recurrent atrial arrhythmias.Registration: URL: https://www.Clinicaltrials: gov; Unique identifier: NCT00911508. [ABSTRACT FROM AUTHOR]

We report on the impact of flour production from small- and large-seed varieties of broad bean on the quantitative and qualitative distribution of dietary fibre and starch. The experimental material consisted of the seeds of small-seed varieties of broad bean: Gobik and Goral, large-seed varieties of broad bean: Windsor Bialy and Bartom, and pea seeds of Albatros, Karat and Miko varieties (for comparison). The seeds were at full physiological maturity. Soaking and hydrothermal processing were shown to cause multidirectional, statistically significant changes in dietary fibre and starch, depending on both parameters of the process and type of the seeds. The flours of both small-seed broad bean varieties contained 20.15%-28.31%, flours of the large-seed broad bean 23.10%-27.50%, and those from pea seeds 20.13%-22.81% total dietary fibre. Attention should be paid to the considerable, approximately 2-fold increase in the soluble dietary fibre (SDF) content, compared to the raw material. The processing of seeds caused significant changes also with reference to starch. The most considerable changes were observed when the variant with the longest times of soaking (18 h) and heating (45 min) was applied. In the broad bean flours, the content of analytically available starch decreased by 22.94-30.60% and its digestibility was observed to decrease up to 30.25%. The pea flours, however, were characterised by an increased concentration of both forms of starch, especially significant for the digestible starch. The calculated content of resistant starch (RS) differentiated, to a high extent, the flours obtained. Under the same processing conditions, the flours of small-seed Gobik and Goral varieties of broad bean were characterised by a significantly higher RS content than those obtained from the large-seed varieties. A decrease in the starch digestibility rate index (SDRI) values, especially high for the small-seed varieties, should also be emphasised. The results obtained indicate that the nutritional value of flours can be determined by controlled processing parameters.

Selected biologically active non-nutrient components (BANS) were determined in broad bean seeds of fine-size and large-size seed varieties and in pea seeds for comparison. Among the analysed biologically active substances the broad bean seeds of fine-size and large-size seed varieties were differentiated mainly by phenolic compounds (including flavanols and proantocyanidines) which appear in twice as large quantities in large-size seed varieties. It was shown that in comparison to pea, broad bean seeds are characterised by a higher content of phenolic compounds, phytates as well as a higher activity of inhibitors of trypsin and amylases. Moreover, it was found that phenolic compounds accumulate mainly in the dark-colored seed coats of large-size broad bean and this fact is related to higher activity inhibiting-amylases of methanol extracts from this fraction of seeds.

This paper characterizes starch and dietary fibre in the seeds of fine-size and large-size seed varieties of broad bean and in edible varieties of pea for comparison. The experimental material included seeds at full physiological maturity. The fine-size seed varieties of broad bean, Gobik and Goral, contained slightly less total starch (62.32% and 62.19% of dry matter) than the large-size seed varieties, Windsor Bialy and Bartom (65.32% and 65.26% of dry matter). It was shown that fine-size seed varieties of broad bean are a good source of resistant starch, which is comparable to large-size seed varieties. As far as the content of total starch is concerned, the share of this form of starch in broad bean seeds amounted to 1/3. Digestible starch in broad beans was in the range of 39-42% of dry matter, pea contained approximately one half less starch of this type. Moreover, it was found that the relation of rapidly digestible starch to slowly digestible starch amounted to 1:1 irrespective of broad bean variety. Dietary fibre in broad beans was in the range of 20.36%-26.79% of dry matter while half of it was found to be concentrated in the seed coat. The soluble fraction of the total content of fibre amounted to 11.81% in the Bartom variety and up to 15.89% in the Gobik variety.