Prevalence of unknown atrial fibrillation in patients with risk factors.

AIMS: Atrial fibrillation (AF) is the most common cardiac arrhythmia. 'Silent', undiagnosed AF is often only detected with the first complication, e.g. a stroke. Detection of 'silent' AF prior to the first cerebrovascular event would be valuable to institute adequate therapy and prevent complications related to AF. We performed a simple electrocardiography (ECG) screening for silent AF in patients at risk for AF. METHODS AND RESULTS: One hundred and thirty-two adult patients (76 male; age: 64 ± 14, mean ± SD) without known AF presenting to the diabetes, hypertension, and dyslipidaemia clinics (76 outpatients in the different clinics), or to the stroke unit (56 stroke survivors) at the University Hospital Muenster were screened for unknown AF using a simple patient-operated, single-channel ECG recorder (Omron hcg-801-e, Germany). Silent AF was found in 7/132 patients (5.3%; four stroke survivors, two diabetics, one patient with hypertension, median CHADS2 score: 2 (25-75 quartiles 1-3). The prevalence of AF was higher in patients with multiple risk factors for stroke and AF: AF was found in 3% (1/32) patient with hypertension and no other risk factors for AF, but in 7% (5/71) patients with two risk factors including stroke patients (diabetes and hypertension, stroke, or stroke and hypertension), and in 11% (1/9) with stroke, hypertension, and diabetes. Standard ECG did not detect further patients with AF. CONCLUSION: A simple ECG screening could help to detect 'silent' AF prior to the first cerebrovascular events, especially in patients with multiple cardiovascular conditions. Larger studies of such a screening are warranted.

Resting energy expenditure and metabolic parameters in small for gestational age moderately preterm infants.

AIMS: The purpose of the present study was to analyze resting energy expenditure (REE), hormonal parameters and lipid profile in small for gestational age (SGA) moderately preterm infants compared to their appropriate for gestational age (AGA) counterparts in the first week after birth. METHODS: REE was measured in all participants using indirect calorimetry. Blood samples of all infants were collected at the same study point together with indirect calorimetry measurements. RESULTS: A total of 32 infants including 16 preterm infants born SGA and 16 AGA preterm neonates were recruited for the study, with a mean gestational age of 35 ± 1 weeks in both groups. REE values in the SGA group were significantly increased compared to the AGA group data after birth (p < 0.002). Low-density lipoprotein levels from the AGA group were significantly higher (p = 0.002) when compared to the SGA infants. No other clinical differences in hormonal parameters, lipid profile or blood pressure levels were identified between the two groups. CONCLUSIONS: In addition to low birth weight, intrauterine growth retardation is associated with a statistically significant increase in REE in SGA moderately premature infants shortly after birth, which requires further investigation when establishing nutritional recommendations in this cohort.