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Many blood biomarkers have a positive association with stroke outcome, but adding blood biomarkers to the National Institutes of Health Stroke Scale (NIHSS) did not significantly improve its discriminatory ability. We investigated the association of the CHA2DS2-VASc score with unfavourable functional outcome (defined as a 30-day modified Rankin Scale [mRS] ≥ 3) in patients presenting with acute ischemic stroke (AIS), and examined whether the addition of blood biomarkers (troponin I [TnI], fibrinogen, C-reactive protein [CRP]) affects the model discriminatory ability. We conducted an observational single-centre study of consecutive patients with AIS. All patients were admitted to hospital within 24 hours from the neurological symptoms onset. Of 240 patients (mean age 70.0 ± 8.9 years), unfavourable 30-day outcome occurred in 92 (38.3%). Patients with mRS ≥ 3 were older and more likely to have atrial fibrillation or other comorbidities (all p<0.001). They had higher levels of CRP, fibrinogen, TnI and higher CHA2DS2-VASc and CHADS2 scores (all p<0.05). The adjusted CHA2DS2-VASc score had excellent predictive ability for poor stroke outcome (c-statistic 0.982;95%CI,0.964-1.000, p<0.001). Whilst CRP had the highest sensitivity (83.7%), cardiac TnI was the most specific (97.3%) for prediction of poor stroke outcome (cut-off: >0.09 µg/L). Compared with each of these biomarkers, CHA2DS2-VASc score had significantly better predictive ability for poor stroke outcome (c-statistic for CRP, Fibrinogen and TnI was 0.853;95%CI,0.802-0.895, 0.848;95%CI,0.796-0.891, and 0.792;95%CI,0.736-0.842, all p<0.001, respectively, versus 0.932;95%CI,0.892-0.960, p<0.001 for the CHA2DS2-VASc, all p for the comparisons<0.01). There was no significant difference in the predictive ability of the CHA2DS2-VASc score vs. combinations of the CHA2DS2-VASc and TnI or TnI, fibrinogen and CRP (z statistic 0.369, p = 0.7119; integrated discrimination index 0.00801 and 0.00172, respectively, both p>0.05). The CHA2DS2-VASc score alone reliably predicts 30-day unfavourable outcome of stroke. Adding blood biomarkers to the CHA2DS2-VASc score did not significantly increase the predictive ability of the model.

We compared plasma levels of biomarkers of inflammation (CRP) and oxidation (oxLDL), determined at study inclusion in lone atrial fibrillation (LAF) patients (48.6±11.5 years; 74.0% men) and sinus rhythm controls (49.7±9.3 years; 72.7% men, P>0.05), and investigated the association of baseline CRP and oxLDL levels with the risk for vascular disease (VD) development (hypertension, cerebrovascular disease, coronary/peripheral artery disease, and pulmonary embolism) during prospective follow-up. Baseline CRP (1.2 [0.7–1.9] mg/L versus 1.1 [0.7–1.6] mg/L) and oxLDL levels (66.3±21.2 U/L versus 57.1±14.6 U/L) were higher in LAF patients (both P<0.05). Following a median of 36 months, incident VD occurred in 14 (28.0%) LAF patients, all of whom developed arterial hypertension, and in 5 (11.4%) controls (hypertension, n=4; coronary artery disease, n=1), P<0.05. LAF patients developed VD more frequently and at a younger age. Both CRP (HR, 2.54; 95% CI, 1.26–5.12; P=0.009) and oxLDL (HR, 2.24; 95% CI, 1.14–4.40; P=0.019) were multivariate predictors of incident hypertension in LAF patients, but not in the controls. Further research should clarify clinical relevance of investigated biomarkers for risk stratification and treatment of LAF patients.

Many atrial fibrillation (AF) patients have a poor understanding of the management of this condition. We investigated patient attitudes towards AF and a potential invasive treatment following an average 10-year period of prospective rhythm control in a cohort of newly diagnosed AF patients. This was a prospective registry-based study. At the regular annual visit in 2007, patients were asked at random to answer several AF-related questions. Of 390 patients, 277 (71.0%) reported symptom reduction over time, but only 45 (11.5%) reported that they had \"got used\" to AF; 201 patients (51.5%) stated they would always prefer sinus rhythm, and 280 (71.2%) would accept an invasive AF treatment. Independent predictors for choosing an invasive procedure were younger age, impaired career/working capacity, and male gender (all P < 0.05). Our findings suggest that most AF patients prefer sinus rhythm and would readily accept an invasive procedure if it offered the possibility of a cure for their AF.

Data on the management of atrial fibrillation (AF) in the Balkan Region are limited. The Serbian AF Association (SAFA) prospectively investigated contemporary ‘real-world’ AF management in clinical practice in Albania, Bosnia&Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia through a 14-week (December 2014-February 2015) prospective, multicentre survey of consecutive AF patients. We report the results pertinent to stroke prevention strategies. Of 2712 enrolled patients, 2663 (98.2%) with complete data were included in this analysis (mean age 69.1 ± 10.9 years, female 44.6%). Overall, 1960 patients (73.6%) received oral anticoagulants (OAC) and 762 (28.6%) received antiplatelet drugs. Of patients given OAC, 17.2% received non-vitamin K antagonist oral anticoagulants (NOACs). CHA 2 DS 2 -VASc score was not significantly associated with OAC use. Of the ‘truly low-risk’ patients (CHA 2 DS 2 -VASc = 0 [males], or 1 [females]) 56.5% received OAC. Time in Therapeutic Range (TTR) was available in only 18.7% of patients (mean TTR: 49.5% ± 22.3%). Age ≥ 80 years, prior myocardial infarction and paroxysmal AF were independent predictors of OAC non-use. Our survey shows a relatively high overall use of OAC in AF patients, but with low quality of vitamin K antagonist therapy and insufficient adherence to AF guidelines. Additional efforts are needed to improve AF-related thromboprophylaxis in clinical practice in the Balkan Region.

UVOD: u atrijalnoj fibrilaciji (AF) povišen je rizik od tromboembolijskih (TE) komplikacija praćenih visokim mortalitetom ili trajnim invaliditetom. Poslednjih godina je pokazano da povišenom TE riziku, pored staze krvi u levoj pretkomori (LP), doprinose strukturne i funkcionalne promene endotela LP, kao i povišeni nivoi cirkulišućih medijatora koji odražavaju proinflamatorno (npr. C-reaktivni protein, CRP, fibrinogen), prokoagulantno (npr. D-dimer), prooksidativno stanje (npr. oksidisani lipoproteini male gustine, oxLDL) i neurohormonalnu aktivaciju (npr. B-tip natriuretskog peptida, BNP). Endotelno oštećenje je najčeće povezano sa povišenom koncetracijom von Willebrandovog faktora (vWF) u krvi, za koji se smatra da potiče iz oštećenog endokarda LP. Kod jednog broja obolelih, dokumentovani su i znaci disfunkcije endotela arterijskih krvnih sudova (snižena endotel-zavisna dilatacija, flow-mediated dilation, FMD), a pokazana je i povezanost endotelnog oštećenja, prokoagulantnih medijatora i remodelovanja LP. Međutim, ostalo je nerazjašnjeno da li je endotelna disfunkcija prisutna kod svih obolelih od AF (nezavisno od kliničkog tipa aritmije ili pridruženog kardiovaskularnog oboljenja), da li je endotelna disfunkcja ograničena na LP ili obuhvata i disfunkciju vaskularnog endotela i da li doprinosi prokoagulantnom, proinflamatornom i prooksidativnom stanju. Takođe, prognostički značaj endotelne (dis)funkcije u pogledu uticaja na morbiditet i mortalitet obolelih od AF nedovoljno je ispitan.CILJEVI ISTRAŽIVANJA: (I) Procena vaskularne endotelne funkcije ultrazvučnom metodom endotel-zavisne vazodilatcije brahijalne arterije (FMD) kod obolelih od AF sa i bez strukturnog srčanog oboljenja i kardiovaskularnih (KV) faktora rizika. (II) Poređenje pokazatelja endotelne funkcije obolelih od AF i zdravih osoba. (III) Procena povezanosti pokazatelja endotelne funkcije određenih pomoću FMD metode i laboratorijskih pokazatelja endotelnog oštećenja (vWF), inflamacije (CRP, fibrinogen), tromboze (D-dimer), neurohormonalne aktivacije (BNP) i oksidativnog stresa (oxLDL). (IV) Ispitivanje povezanosti endotelne funkcije (FMD i vWF) i remodelovanja LP, izraženog ehokardiografskom procenom volumena LP. (V) Ispitivanje značaja endotelne funkcije za prognozu različitih oblika AF (paroksizmalne, perzistentne, permanentne) kod osoba sa i bez strukturnog srčanog oboljenja.

Atrial fibrillation (AF) confers a significant risk of ischemic stroke, and oral anticoagulation is the most effective therapy for thromboprophylaxis in AF. Until recently, vitamin K antagonists (VKAs) were the only available oral anticoagulants. However, numerous disadvantages of VKAs and anticipated bleeding risk with treatment have resulted in their substantial underutilization in clinical practice. Recently, the two other classes of oral anticoagulants - direct thrombin inhibitors (e.g., dabigatran) and direct factor Xa inhibitors (e.g., rivaroxaban and apixaban) - have emerged as a viable alternative to VKAs for stroke prevention in AF. In addition, efforts have been made to facilitate the optimal prevention of AF-related stroke by improvement of both stroke and bleeding risk assessment. In this review, we summarize the recent advances and discuss the contemporary practical aspects of stroke prevention in patients with nonvalvular AF.