BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.

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The satisfactory diagnostic efficacy of free plasma metanephrines allows their use as a single screening test in cases of suspected pheochromocytoma in the population with a low pretest probability.

Key words: Acute coronary syndrome/Myocardial ischemia/Non-STEMI/Coronary by-pass/Laboratory markers of myocardial ischemia/CAD/GPBB/POCT/ELISABackground: Glycogen Phosphorylase BB (GPBB) is considered an early and specifi c marker of myocardial necrosis and ischemia. A POCT kit GPBB for diagnostic use has recently been approved.Aim: an evaluation of the correspondence of qualitative POCT GBPP measurements with ELISA test results. Material and methodology: 20 individuals with non-ST elevation myocardial infarction (non-STEMI) and 20 probands without acute coronary syndrome (ACS) were tested. GPBB (POCT, ELISA) in venous plasma (lithium-heparin) was assayed in all probands.Results: individuals with non-STEMI had signifi cantly higher GPBB ELISA values (32.3 vs. 6.1 μg/l; p < 0.01). GPBB sensitivity and specifi city for non-STEMI presence 6 hours after chest pain generation were 100 %. No proband was classifi ed in a diff erent subgroup with POCT of GPBB (positive/negative). GPBB POCT correlate with a non-STEMI diagnosis (χ 2 36.1; p < 0.01). Conclusion: GPBB POCT measurement is comparable with ELISA test results. GPBB analysis could expand the diagnostic palette in the fi rst hours after the onset of acute coronary syndrome.

Myosin light chains-1 (MLC-1) have been recently associated with the markers of heart function (NYHA, LVEF, NT-proBNP). Verification of the relationship between markers of heart function (New York Heart Association classification (NYHA), left ventricle ejection fraction determination (LVEF), N terminal prohormone of natriuretic peptide B type BNP (NT-proBNP) and concentrations of myosin light chains-1 (MLC-1) was assesed. Patients examined for dyspnea without signs of acute coronary syndrome. All patients underwent echocardiography (calculation of left ventricle ejection fraction-LVEF) and in the serum of all subjects NT-proBNP (ELEIA) and MLC-1 (ELISA) were determined. In the 38 patients (21 men, 17 women), mean age of 58 years (±12 years as 1 SD), a significant negative correlation was found between NT-proBNP and LVEF (r =-0.47; p = 0.02, Spearman). The median levels of NT pro-BNP were closely associated with NYHA classification (type II-584 ng/l, type III-2792 ng/l, type IV-6400 ng/l; p < 0.05). Individuals with clinical NYHA IV differed significantly in median MLC-1 concentrations from persons with clinical NYHA classification II and III (type II-5.7 ng/l, type III-8.9 ng/l, type IV-17 ng/l; p <0.05). A significant negative correlation between MLC-1 and LVEF (-0.35; p <0.03) and significant positive correlations between MLC-1 and NT-proBNP (-0.42; p <0.012) were found. In conclusion MLC-1 cannot be used as a diagnostic marker in differential diagnosis of dyspnea.