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Dimensional reduction of highly multidimensional datasets such as those acquired by Fourier transform infrared spectroscopy (FTIR) is a critical step in the data analysis workflow. To achieve this goal, numerous feature selection methods have been developed and applied in a supervised context, i.e., using a priori knowledge about data usually in the form of labels for classification or quantitative values for regression. For this, genetic algorithms have been largely exploited due to their flexibility and global optimization principle. However, few applications in an unsupervised context have been reported in infrared spectroscopy. The aim of this article is to propose a new unsupervised feature selection method based on a genetic algorithm using a validity index computed from KMeans partitions as a fitness function. Evaluated on a simulated dataset and validated and tested on three real-world infrared spectroscopic datasets, our developed algorithm is able to find the spectral descriptors improving clustering accuracy and simplifying the spectral interpretation of results.

Recent attacks against hospital computer systems by cybercriminals have provoked questions about the risks to the security of cardiac implantable electronic devices (pacemakers and defibrillators), as well as to the communication networks associated with them. In 2017, information released by some media highlighted more than 8600 so-called “vulnerabilities” contained in a single pacemaker, which forced the manufacturer to review and update the software in 460,000 of their devices [1]. In 2019, another manufacturer had cause to revise a telemetry protocol, even though it was little used, for the monitoring of some defibrillators and cardiac resynchronization therapy with defibrillation devices [2]. In these two examples, the supposed potential threat resulted in no documented malicious actions.

Crohn's disease (CD) and spondyloarthritis (SpA) are two inflammatory diseases sharing many common features (genetic polymorphism, armamentarium). Both diseases lack diagnostic markers of certainty. While the diagnosis of CD is made by a combination of clinical, and biological criteria, the diagnosis of SpA may take several years to be confirmed. Based on the hypothesis that CD and SpA alter the biochemical profile of plasma, the objective of this study was to evaluate the analytical capability of Fourier transform infrared spectroscopy (FTIR) in identifying spectral biomarkers. Plasma from 104 patients was analyzed. After data processing of the spectra by Extended Multiplicative Signal Correction and linear discriminant analysis, we demonstrated that it was possible to distinguish CD and SpA from controls with an accuracy of 97% and 85% respectively. Spectral differences were mainly associated with proteins and lipids. This study showed that FTIR analysis is efficient to identify plasma biosignatures specific to CD or SpA.

The objective of our research was to investigate the heat-protecting effect of a product ex vivo and in vivo on human hair fibres.A preparatory study was carried out in order to determine an optimal threshold of thermal stress. For this, the structure of cross-sections of the hair fibre was observed by optical microscopy. Then, Scanning Electron Microscopy (SEM) and Confocal Raman Spectroscopy (CRS) were applied to analyse ex vivo and in vivo morphological and molecular damage in hair structure after heat stress. Finally, in vivo tests were used to collect consumer perception.The preparatory study enabled us to determine an optimal stress threshold of 10 heating cycle for SEM and 5 heating cycle for CRS. Based on spectral hierarchical classification using Ward's clustering algorithm, the ex vivo Raman results show that the spectral signature of the hair treated and heated is very close to the negative control. This shows that the product preserves the keratin structure after thermal stress. These results were also confirmed by an in vivo Raman analysis performed on hair samples from 5 donors. In concordance with Raman results, SEM shows that treated hair presents lesser "bubbles" and "crackling" on the hair surface. Finally, the in vivo studies proved that hair was more protected from heat.The authors concluded that the product shows protective properties with respect to morphological and molecular heat damage. We also demonstrate that the product promotes the α-helix keratin conformation and preserves the S-S disulfide bands.L'objectif de notre étude est d'évaluer ex vivo et in vivo l'effet thermoprotecteur d'un produit sur les fibres capillaires humaines. MÉTHODES: Une étude préparatoire a été réalisée afin de déterminer un seuil optimal du stress thermique. Pour cela, la structure des coupes transversales des cheveux a été observée par microscopie optique. Ensuite, la microscopie électronique à balayage (MEB) et la spectroscopie confocale Raman (SCR) ont été appliquées pour analyser les dommages morphologiques et moléculaires (ex vivo et in vivo) de la structure du cheveu après un stress thermique. Enfin, des tests in vivo ont été réalisés pour recueillir la perception des consommateurs. RÉSULTATS: L'étude préparatoire nous a permis de déterminer un seuil de stress thermique optimal correspondant à 10 cycles de chauffage pour la MEB et 5 cycles de chauffage pour la SCR. Basés sur une classification hiérarchique utilisant l’algorithme de Ward, les résultats Raman « ex vivo » montrent que la signature spectrale des cheveux traités et chauffés est très proche du témoin négatif. Cela montre que le produit préserve la structure de la kératine après un stress thermique. Ces résultats ont également été confirmés par une analyse Raman « in vivo » réalisée sur des échantillons de cheveux de 5 donneurs. En concordance avec les résultats Raman, la MEB montre que les cheveux traités présentent moins de « bulles » et de « craquelures » à la surface des cheveux. Enfin, l’étude in vivo a prouvé que les cheveux sont mieux protégés de la chaleur.Les auteurs ont conclu que le produit présente des propriétés protectrices vis-à-vis des dommages thermiques morphologiques et moléculaires. Nous avons démontré également que le produit favorise la conformation de la kératine en hélice-α et préserve les bandes disulfures S-S.

Background Monitoring the transcutaneous permeation of exogenous molecules using conventional techniques generally requires long pre-analytical preparation or labelling of samples. However, Raman spectroscopy is a label-free and non-destructive method which provides spatial distribution of tracked actives in skin. The aim of our study was to prove the interest of Raman imaging coupled with multivariate curve resolution alternating least square (MCR-ALS) analysis in monitoring retinol penetration into frozen and living human skin. Materials and methods After topical treatment of skin samples by free or encapsulated retinol, thin cross sections were analysed by Raman imaging (up to 100 µm depth). Mann-Whitney test was used to identify retinol spectroscopic markers in skin. MCR-ALS was used to estimate retinol contribution in Raman spectral images. Heat maps were constructed to compare the distribution of free and encapsulated retinol in skin models. Results We identified the bands at 1158, 1196 and 1591 cm-1 as specific features for monitoring retinol in skin. Moreover, our MCR-ALS results showed an improvement of retinol penetration (up to 30 µm depth) with the encapsulated form as well as storage reservoir formation in stratum corneum, for each skin model. Finally, greater retinol penetration into living skin was observed. Conclusion This study shows a proof of concept for the evaluation of retinol penetration in skin using Raman imaging coupled with MCR-ALS. This concept needs to be validated on more subjects to include inter-individual variability but also other factors affecting skin permeation (age, sex, pH, etc). Our study can be extended to other actives.

The WiSE-CRT system delivers leadless endocardial left ventricular (LV) pacing to achieve cardiac resynchronization therapy. The electrode is conventionally placed on the lateral wall, but implanting on the LV septum may have advantages, including capture of the left bundle branch, and improved battery longevity owing to reduced distance from the transmitter.The purpose of this study was to assess the feasibility of leadless LV septal pacing via the WiSE-CRT system.Two pigs underwent electrode implantation on the LV septum with subsequent anatomical and histological examination. Eight patients underwent implantation of the WiSE-CRT system with deployment of the electrode on the LV septum via an interatrial transseptal approach.Deployment of the electrode on the LV septum was successful in both animals. Histological examination demonstrated electrode tines in close proximity to Purkinje tissue. WiSE-CRT implantation with an LV septal electrode was successful in all patients. Biventricular capture was confirmed, with a significant reduction in QRS duration (187.1 ± 33.8 ms vs 149.5 ± 15.7 ms; P = .009). Temporary LV pacing achieved further QRS reduction (139.8 ± 12.4 ms), and in 4 patients the peak LV activation time in lead VLeadless LV septal pacing with the WiSE-CRT system to target the left bundle branch appears feasible. Further study is required to assess the efficacy and safety of this technique.

Aims FRench Attitude reGistry in case of ICD LEad replacement (FRAGILE) registry was set-up to describe the attitude in different French institutions in case of implantable cardioverter-defibrillator (ICD) lead replacement, extraction, or abandonment and to compare outcomes in both groups. Methods and results Prospective observational study comparing two attitudes in case of ICD lead replacement, extraction, or abandonment. Primary endpoint describes the attitude in different French centres, collect parameters that may influence the decision. Secondary endpoint compares early and mid-term (2 years) complications in both groups. Between April 2013 and April 2017, 552 patients were included in 32 centres. 434 (78.6%) were male, mean patient’s age was 60.3 ± 14.4 years. In 56.9% of the cases, the decision was to explant the lead. Patients in the extraction group were younger than in the abandonment group (56.7 ± 14.5 vs. 65 ± 12.7 P Conclusion In this registry, the strategy in case of non-infected ICD lead replacement was mainly influenced by patient’s age and comorbidities and lead dwelling time. No difference was observed in outcomes in both strategies.

Cardiovascular diseases, which are the leading global cause of death, should increase by 40% by 2030, reaching close to 24 million deaths worldwide. Atrial fibrillation is the most common heart rhythm disorder, ahead of conduction disturbances and ventricular arrhythmias. Studies estimate that 7.6 million people aged>65 years in the European Union had atrial fibrillation in 2016, and this figure is predicted to increase by 89% to 14.4 million by 2060. Recent innovations in cardiac arrhythmia care, such as cardiac device miniaturization and smart devices, might revolutionize the future of patient care. Yet, the level of adoption of these breakthroughs will depend on their acceptability by patients and healthcare professionals, and on the pace of transformation of the French healthcare system (encouraged by "Ma Santé 2022"). In this article, we detail the major trends that could impact patients with heart rhythm disorders and their healthcare professionals by 2030. Eight major trends and their associated effects on patient care and healthcare professionals' practices were discussed: technical evolution of cardiac devices; digitalization of the healthcare system, and telecardiology; the rise of smart devices; the rise of "big data" and artificial intelligence; patient empowerment; evolution of healthcare; healthcare transformation with "Ma Santé 2022"; and new funding models. These "multidimensional" changes give us room in this study to outline two scenarios for the evolution of care of patients with heart rhythm disorders in the near future.

International audience; Magnetic resonance imaging (MRI) has become the reference imaging for the management of a large number of diseases. The number of MR examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). A CEID was considered an absolute contraindication for MRI for years. The progressive replacement of conventional pacemakers and defibrillators by MR-conditional CEIDs and recent data on the safety of MRI in patients with "MR-nonconditional" CEIDs have progressively increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with "MR-conditional" devices because these devices are not "MR-safe". A specific programing of the device in "MR-mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) describes the effect and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional nonguaranteed" and MR-nonconditional devices.

Emerging evidence suggests that atrial fibrillation (AF) may be associated with an increased risk of sudden cardiac death (SCD). However, AF shares risk factors with numerous cardiac conditions, including coronary heart disease and heart failure—the 2 most common substrates for SCD—making the AF-SCD relationship particularly challenging to address. A careful consideration of confounding factors is essential, since interventions for AF will be effective in reducing SCD only if there is a causal association between these 2 conditions. In this translational review, we detail the plausible underlying pathophysiological mechanisms through which AF may promote or lead to SCD, as well as the existing epidemiological evidence supporting an association between AF and SCD. While the role of AF in predicting SCD in the general population appears limited and not established, AF might be integrated to improve risk stratification in some specific phenotypes. Optimal AF management, including that of its associated conditions, appears to be of interest to prevent AF-related SCD, especially because the AF-SCD relationship is in part driven by heart failure.

Surface-enhanced Raman scattering (SERS) is a powerful and sensitive technique for the detection of fingerprint sig-nals of molecules and for the investigation of a series of surface chemical reactions. Many studies introduced quantita-tive applications of SERS in various fields and several SERS methods have been implemented for each specific applica- tion, ranging in performance characteristics, analytes used, instruments, and analytical matrices. In general, very few methods have been validated according to international guidelines. As a consequence, the application of SERS in high-ly- regulated environments is still considered risky and the perception of a poorly reproducible and insufficiently robust analytical technique has persistently retarded its routine implementation. Collaborative trials are a type of interlabora-tory study (ILS) frequently performed to ascertain the quality of a single analytical method. The idea of an ILS of quan- tification with SERS arose within the framework of Working Group 1 (WG1) of the COST Action BM1401 Ra-man4Clinics32 in an effort to overcome the problematic perception of quantitative SERS methods. Here we report the first interlaboratory SERS study ever conducted, involving 15 laboratories and 41 researchers. In this study we tried to define a methodology to assess the reproducibility and trueness of a quantitative SERS method, and to compare differ- ent methods. In our opinion, this is a first important step toward a “standardization” process of SERS protocols, not proposed by a single laboratory but by a larger community.

International audience; The literature is rich in proof of concept studies demonstrating the potential of Raman spectroscopy for disease diagnosis. However, few studies are conducted in a clinical context to demonstrate its applicability in current clinical practice and workflow. Indeed, this translational research remains far from the patient's bedside for several reasons. First, samples are often cultured cell lines. Second, they are prepared on non-standard substrates for clinical routine. Third, a unique supervised classification model is usually constructed using inadequate cross-validation strategy. Finally, the implemented models maximize classification accuracy without taking into account the clinician's needs. In this paper, we address these issues through a diagnosis problem in real clinical conditions, i.e., the diagnosis of chronic lymphocytic leukemia from fresh unstained blood smears spread on glass slides. From Raman data acquired in different experimental conditions, a repeated double cross-validation strategy was combined with different cross-validation approaches, a consensus label strategy and adaptive thresholds able to adapt to the clinician's needs. Combined with validation at the patient level, classification results were improved compared to traditional strategies.

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Abbott Vascular Int. (2011–2014), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2017), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2017), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2018). The Atrial Fibrillation NETwork (AFNET), conducting the registry in Germany, received support from The Bristol Myers Squibb/Pfizer Alliance (2014–2018) and the German Centre for Cardiovascular Research (DZHK). Funding from Daiichi-Sankyo and Boehringer-Ingelheim have been received for conducting the registry in Spain. Funding from BMS-Pfizer Alliance was received to support the programme in France Background The 4S-AF scheme (Stroke risk, Symptom severity, Severity of atrial fibrillation [AF] burden, Substrate severity) has recently been described as a novel approach to in-depth characterization of AF, and included in the 2020 European Society of Cardiology guidelines for the management of AF. Purpose In the present study, we validated for the first time the 4S-AF scheme in the Spanish and French cohorts of the EurObservational Research Programme (EORP)-AF Long-Term General Registry. Methods The Spanish and French cohorts of the EORP-AF Long-Term General Registry, were merged and included. The baseline 4S-AF scheme was calculated as follows: Symptom severity (according to EHRA symptom score: 0-2 points), Severity of AF burden (according to AF type: 0-3 points), Substrate severity (according to comorbidities/cardiovascular risk factors: 0-7 points); and related to the primary management strategy (rhythm or rate control). According to the results for these 3 domains, four code colors have been defined. Patients with all domains in "green" should be managed by rhythm control. In patients with one domain in "yellow" or two domains in "green" categories, rhythm control can be attempted. On contrary, for patients with "red" color category, the 4S-AF scheme suggests a rate control strategy. All-cause mortality and the composite of ischemic stroke/transient ischemic attack/systemic embolism, major bleeding and all-cause death, were the primary endpoints. These outcomes were recorded during 1-year of follow-up. Results 1479 patients (36.9% females, median age of 72 [IQR 64-80] years) were included (Table 1). The median 4S-AF scheme score was 5 (IQR 4-7). The 4S-AF scheme, as continuous and as categorical, was associated with the management strategy decided for the patient (both p Conclusion Characterization of AF by using the 4S-AF scheme may aid in identifying AF patients that would be managed by rhythm or rate control, and could also help in identifying high-risk AF patients for worse clinical outcomes in a ‘real-world’ setting. Abstract Table 1 and Figures 1A-1B

International audience; Objectives: This study hypothesized that the association of D-dimer blood level and several clinical items in a new risk score could predict the absence of atrial thrombus.Background: Symptomatic and drug resistant atrial fibrillation (AF) can be treated by catheter ablation. The procedure-related risk of thromboembolism is limited by the pre-operative use of transesophageal echocardiography (TEE) to detect atrial thrombi.Methods: Patients admitted for catheter ablation of AF (n = 2,494) were prospectively included in a multicenter study. TEE was systematically performed before the procedure to search for atrial thrombus (primary endpoint). D-dimer level, CHADS2 score, left ventricular ejection fraction, pre-operative anticoagulation regimen, and medical history were collected. A logistic regression model was used to identify factors associated with the presence of atrial thrombus (hypertension, history of stroke, heart failure, D-dimer level >270 ng/ml). These factors were aggregated in a new score called atrial thrombus exclusion (ATE).Results: The incidence of atrial thrombus was 1.92%. CHADS2 score and D-dimer level were significantly associated with atrial thrombus (p < 0.0001 and p < 0.0001, respectively). A zero CHADS2 score failed to exclude all atrial thrombi (5 false negatives; sensitivity: 89.58%, specificity: 52.2%). No false negative was found with a zero ATE score, which had a specificity of 37% and a higher sensitivity (100%) than the CHADS2 score (p < 0.031) to predict the absence of intra-atrial thrombi on TEE. Conversely, the positive predictive value was poor, and the ATE score should not be used to conclude a positive diagnosis of thrombus.Conclusions: An ATE score of zero was strongly associated with the absence of atrial thrombus. This new score could be useful to rule out a diagnosis of atrial thrombus before catheter ablation of AF.

International audience; Spectral histopathology, based on infrared interrogation of tissue sections, proved a promising tool for helping pathologists in characterizing histological structures in a quantitative and automatic manner. In cancer diagnosis, the use of chemometric methods permits establishing numerical models able to detect cancer cells and to characterize their tissular environment. In this study, we focused on exploiting multivariate infrared data to score the tumour aggressiveness in preneoplastic lesions and squamous cell lung carcinomas. These lesions present a wide range of aggressive phenotypes; it is also possible to encounter cases with various degrees of aggressiveness within the same lesion. Implementing an infrared-based approach for a more precise histological determination of the tumour aggressiveness should arouse interest among pathologists with direct benefits for patient care. In this study, the methodology was developed from a set of samples including all degrees of tumour aggressiveness and by constructing a chain of data processing steps for an automated analysis of tissues currently manipulated in routine histopathology.

ObjectivesThe association between obesity and atrial fibrillation (AF) is well-established. We aimed to evaluate the impact of index body mass index (BMI) on AF recurrence at 12 months following catheter ablation using propensity-weighted analysis. In addition, periprocedural complications and fluoroscopy details were examined to assess overall safety in relationship to increasing BMI ranges.MethodsBaseline, periprocedural and follow-up data were collected on consecutive patients scheduled for AF ablation. There were no specific exclusion criteria. Patients were categorised according to baseline BMI in order to assess the outcomes for each category.ResultsAmong 3333 patients, 728 (21.8%) were classified as normal (BMI 2), 1537 (46.1%) as overweight (BMI 25.5–29.0 kg/m2) and 1068 (32.0%) as obese (BMI ≥30.0 kg/m2). Procedural duration and radiation dose were higher for overweight and obese patients compared with those with a normal BMI (p=0.002 and p2led to a 1.2-fold increased likelihood of experiencing recurrent AF at 12-months follow-up as compared with overweight patients (HR 1.223; 95% CI 1.047 to 1.429; p=0.011), while no significant correlation was found between overweight and normal BMI groups (HR 0.954; 95% CI 0.798 to 1.140; p=0.605) and obese versus normal BMI (HR 1.16; 95% CI 0.965 to 1.412; p=0.112).ConclusionsPatients with a baseline BMI ≥30 kg/m2have a higher recurrence rate of AF following catheter ablation and therefore lifestyle modification to target obesity preprocedure should be considered in these patients.

International audience; The transfer of mid-infrared spectral histopathology to the clinic will be possible conditionally upon easily applicable in clinical practice. The rapid analysis of formalin-fixed paraffin-embedded (FFPE) tissue section is thus a prerequisite. The chemical dewaxing of these samples before image acquisition used by the majority of studies is in contradiction with this principle. Fortunately, the in silico analysis of the images acquired on FFPE samples is possible by using extended multiplicative signal correction (EMSC). However, the removal of pure paraffin pixels is essential to perform a relevant classification of tissue spectra. So far, this task was possible only if using manual and subjective histogram analysis. In this article, we thus propose a new automatic and multivariate methodology based on the analysis of optimized combinations of EMSC regression coefficients by validity indices and KMeans clustering in order to separate paraffin and tissue pixels. The validation of our method is performed using simulated infrared spectral images by measuring the Jaccard index between our partitions and the image model, with values always over 0.90 for diverse baseline complexity and signal to noise ratio. These encouraging results were also validated on real images by comparing our method with classical ones and by computing the Jaccard index between our partitions and the KMeans partitions obtained on the infrared image acquired on the same samples but after chemical dewaxing, with values always over 0.84.

Summary Ventricular tachycardia has a significant recurrence rate after ablation for several reasons, including inaccessible substrate. A non-invasive technique to ablate any defined areas of myocardium involved in arrhythmogenesis would be a potentially important therapeutic improvement if shown to be safe and effective. Early feasibility studies of single-fraction stereotactic body radiotherapy have demonstrated encouraging results, but rigorous evaluation and follow-up are required. In this document, the basic concepts of stereotactic body radiotherapy are summarized, before focusing on stereotactic arrhythmia radioablation. We describe the effect of radioablation on cardiac tissue and its interaction with intracardiac devices, depending on the dose. The different clinical studies on ventricular tachycardia radioablation are analysed, with a focus on target identification, which is the key feature of this approach. Our document ends with the indications and requirements for practicing this type of procedure in 2020. Finally, because of the limited number of patients treated so far, we encourage multicentre registries with long-term follow-up.

The 4S-AF scheme [Stroke risk, Symptom severity, Severity of atrial fibrillation (AF) burden, Substrate severity] has recently been described as a novel approach to in-depth characterization of AF. We aim to determine if the 4S-AF scheme would be useful for AF characterization and provides prognostic information in real-world AF patients.The Spanish and French cohorts of the EORP-AF Long-Term General Registry were included. The baseline 4S-AF scheme was calculated and related to the primary management strategy (rhythm or rate control). Follow-up was performed at 1-year with all-cause mortality and the composite of ischaemic stroke/transient ischaemic attack/systemic embolism, major bleeding, and all-cause death, as primary endpoints. A total of 1479 patients [36.9\ median age 72 interquartile range (IQR 64–80) years] were included. The median 4S-AF scheme score was 5 (IQR 4–7). The 4S-AF scheme, as continuous and as categorical, was associated with the management strategy decided for the patient (both P \lt; 0.001). The predictive performances of the 4S-AF scheme for the actual management strategy were appropriate in its continuous [c-index 0.77, 95\CI) 0.75–0.80] and categorical (c-index 0.75, 95\.72–0.78) forms. Cox regression analyses showed that ‘red category’ classified patients in the 4S-AF scheme had a higher risk of all-cause death (aHR 1.75, 95\.02–2.99) and composite outcomes (aHR 1.60, 95\.05–2.44).Characterization of AF by using the 4S-AF scheme may aid in identifying AF patients that would be managed by rhythm or rate control and could also help in identifying high-risk AF patients for worse clinical outcomes in a ‘real-world’ setting. Aims: The 4S-AF scheme [Stroke risk, Symptom severity, Severity of atrial fibrillation (AF) burden, Substrate severity] has recently been described as a novel approach to in-depth characterization of AF. We aim to determine if the 4S-AF scheme would be useful for AF characterization and provides prognostic information in real-world AF patients. Methods and results: The Spanish and French cohorts of the EORP-AF Long-Term General Registry were included. The baseline 4S-AF scheme was calculated and related to the primary management strategy (rhythm or rate control). Follow-up was performed at 1-year with all-cause mortality and the composite of ischaemic stroke/transient ischaemic attack/systemic embolism, major bleeding, and all-cause death, as primary endpoints. A total of 1479 patients [36.9% females, median age 72 interquartile range (IQR 64-80) years] were included. The median 4S-AF scheme score was 5 (IQR 4-7). The 4S-AF scheme, as continuous and as categorical, was associated with the management strategy decided for the patient (both P < 0.001). The predictive performances of the 4S-AF scheme for the actual management strategy were appropriate in its continuous [c-index 0.77, 95% confidence interval (CI) 0.75-0.80] and categorical (c-index 0.75, 95% CI 0.72-0.78) forms. Cox regression analyses showed that 'red category' classified patients in the 4S-AF scheme had a higher risk of all-cause death (aHR 1.75, 95% CI 1.02-2.99) and composite outcomes (aHR 1.60, 95% CI 1.05-2.44). Conclusion: Characterization of AF by using the 4S-AF scheme may aid in identifying AF patients that would be managed by rhythm or rate control and could also help in identifying high-risk AF patients for worse clinical outcomes in a 'real-world' setting.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease which can lead to a prolonged physical disability. HS diagnosis is exclusively clinical with the absence of biomarkers. Our study aims at assessing the HS-diagnostic potential of infrared spectroscopy from saliva, as a biofluid reflecting the body's pathophysiological state. Infrared spectra from 127 patients (57 HS and 70 non-HS) were processed by multivariate methods: principal component analysis coupled with Kruskal-Wallis or Mann-Whitney tests to identify discriminant spectral wavenumbers and linear discriminant analysis to evaluate the performances of HS-diagnostic approach. Infrared features, mainly in the 1300 cm-1 -1600 cm-1 region, were identified as discriminant for HS and prediction models revealed diagnostic performances of about 80%. Tobacco and obesity, two main HS risk factors, do not seem to alter the infrared diagnosis. This pilot study shows the potential of salivary "liquid biopsy" associated to vibrational spectroscopy to develop a personalized medical approach for HS patients' management.

Background History of atrial fibrillation (HxAF) and new onset atrial fibrillation (NOAF) at acute stage of MI are associated with poorer survival. Whether both entities carry an increased risk of stroke is uncertain. Using data from the FAST-MI 2010 and 2015 registries, we analysed the associations between HxAF and NOAF and risk of 3-year death, nonfatal stroke or combined death or stroke. Methods The FAST-MI registries are nationwide French cohorts consecutively including AMI patients admitted over a 1-month period every 5 years. Baseline characteristics, acute management and medications at discharge are collected. Among 9460 patients with STEMI or NSTEMI, 610 (6.4%) had HxAF, and 626 (6.6%) developed NOAF. Main characteristics Table 1 Overall, NOAF was associated with larger and more severe AMIs. Results In hospital survivors, 3-year death was 8.6% in patients without AF, 23.2% in those with NOAF and 29.2% in those with HxAF. 3-year Kaplan-Meier rates of non-fatal stroke were 1.1%, 0.3% and 3.6%, respectively (Figure). Compared with no AF, NOAF was not associated with non-fatal stroke (Cox HR, 95% CI: 0.17, 0.02–1.21), while HxAF was (HR, 95% CI 2.04, 1.13–3.66, P=0.017). Risk of death or stroke was increased for both NOAF (HR, 95% CI 1.35, 1.10–1.65, P=0.004) and HxAF (HR 95% CI, 1.37, 1.14–1.65, P=0.001). Risk of all-cause death at 3 years was increased for NOAF (HR, 95% CI 1.32, 1.09–1.60) and HxAF (HR, 95% CI 1.30, 1.09–1.55). The results were concordant in patients not receiving oral anticoagulants at discharge. Conclusion Both NOAF and HxAF are associated with increased risk of death at 3 years after AMI. NOAF, however, is not associated with an increased risk of non-fatal stroke. Figure 1. Non-fatal stroke Funding Acknowledgement Type of funding source: Other. Main funding source(s): Pharma companies

Introduction Increasing age is a well-known determinant for incident atrial fibrillation (AF) as well as for adverse outcomes. With a progressively ageing population in Europe (and elsewhere), contemporary data are needed to investigate the impact of age in relation to major adverse events in AF patients. Purpose To evaluate the impact of increasing age on major adverse outcomes in a contemporary European AF cohort. Methods Patients enrolled in the EORP-AF Long Term General Registry were categorized by age: Results Among the 9762 patients included in this analysis, 2946 (30.2%) were Conclusions In a large contemporary cohort of European AF patients, increasing age was a major determinant of major adverse outcomes. Figure 1. Kaplan-Meier Curves for All-Cause Death Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies supported its activities with unrestricted grants.

Non-enzymatic glycation is a post-translational modification of long-lived matrix proteins such as type I collagen. It occurs during aging and leads to the formation of advanced glycation end-products (AGEs). AGE accumulation is associated with severe complications in chronic and age-related diseases. The assessment of modifications induced by this (patho)physiological process represents an interest in biology and medicine for a better patient care. The objective of our work was to position the interest of Raman spectroscopy in the quantification of collagen glycation. Two types of in vitro glycation were used by incubating collagen samples, at different durations, with ribose or glyoxylic acid; these reducing agents acting on the chemical specificity of the glycation reaction. Glycation efficiency was evaluated by the liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) quantification of carboxymethyllysine (CML) and pentosidine, which are among the most studied AGEs. Raman data were processed by PCA coupled to validity indices and Lasso regression as multivariate analysis tools. Regression models were constructed by considering the LC-MS/MS results as reference values. A marked variability was observed within the Raman datasets making difficult the identification of spectral differences between control and ribose-treated collagen samples. By taking advantage of the chemical specificity of the glyoxylic acid treatment leading to CML formation, on one hand, and the feature selection included in the Lasso algorithm, on the other hand, Raman markers associated with glycation were identified. The assigned vibrations corresponded to modifications of side chains of collagen. In addition, a threshold of CML concentration was determined as quantitative indicator of the applicability of Raman spectroscopy for potential patient follow-up purposes. Although lacking in sensitivity to directly detect AGEs in collagen, Raman spectroscopy allows to highlight the molecular modifications of collagen induced by glycation.