Clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma

Abstract Purpose To describe the visual acuity and anatomic outcomes of intravitreal methotrexate (MTX) for the treatment of primary vitreoretinal lymphoma (PVRL). Methods Single-center retrospective case series of patients with a diagnosis of PVRL treated with intravitreal MTX. Patient records were reviewed for demographic information, ocular exam findings, and treatment regimens including number of MTX injections. Clinical outcomes recorded included visual acuity (VA), time to partial (PR) or complete response (CR), disease-free survival, time to relapse, and any CNS progression. Results Ten eyes of 7 patients (4 male, 6 female) were reviewed. The mean age ± standard deviation (SD) was 70 ± 12 years. Five patients had prior or concomitant diagnosis of primary CNS lymphoma with a history of systemic chemotherapy including MTX. Three eyes (30%) exhibited isolated vitreous involvement, four (40%) had subretinal lesions, and three (30%) presented with both vitreous and subretinal disease. Mean initial logMAR VA was 0.38 ± 0.52 (Snellen visual equivalent 20/50), while mean final logMAR VA ± SD was 0.34 ± 0.27 (Snellen visual equivalent 20/40) with a mean follow-up time of 26 months (Range, 3–49 months). Patients received an average of 6 intravitreal MTX injections (Range 1–10) over the course of treatment. Two patients received concomitant systemic chemotherapy. Mean time to either PR or CR was 57 days, and 6 eyes (60%) exhibited regression with no relapse after local treatment. For the 4 eyes that eventually relapsed, the mean time ± SD to first relapse was 193 days ± 155 days, and one eye experienced a second relapse. Two of 3 patients with subretinal disease showed complete regression with extended follow-up of 1 and 4 years following treatment with less than 3 doses of intravitreal MTX. One patient with PVRL developed CNS lymphoma during the study period. VA remained stable overall between the initial treatment visit, 3, 6, and 12-months (P > 0.05 for paired comparisons of VA over time). Conclusions Intravitreal methotrexate was well-tolerated and led to local disease response in the majority of patients at approximately 2 months after initiation of treatment of intraocular lymphoma. Further studies on the efficacy of intravitreal treatment alone versus combined systemic and intravitreal treatment are warranted.

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The effect of amblyopia on clinical outcomes of children with astigmatism

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211040898 ◽

2021 ◽

Vol 13 ◽

pp. 251584142110408

Author(s):

Burçin Çakır ◽

Nilgün Özkan Aksoy ◽

Sedat Özmen ◽

Özlem Bursalı

Keyword(s):

Visual Acuity ◽

Clinical Outcomes ◽

Medical Records ◽

Convergence Insufficiency ◽

Corrected Visual Acuity ◽

Ocular Deviation ◽

The Mean ◽

The Difference ◽

Best Corrected Visual Acuity

Background: Amblyopia is more common in children with high astigmatism, but factors contributing to development of amblyopia and visual outcomes are not fully understood. Objective: To evaluate the effect of amblyopia on the clinical outcomes in children with ⩾1.75 diopter (D) astigmatism. Methods: We reviewed the medical records of children with ⩾1.75 D astigmatism with and without amblyopia (amblyopes group and non-amblyopes group). The mean age, gender, amount and type of ocular deviation, presence of convergence insufficiency (CI), stereopsis, time of initial spectacle use and follow-up time, differences in best-corrected visual acuity (VoD) and spherical equivalent (SE) between eyes were assessed and compared between the groups. Best-corrected visual acuity (BCVA), mean SE, astigmatism measurements were assessed and compared between amblyopic, fellow, and non-amblyopic eyes. Results: The records included 68 eyes of 34 children with amblyopia and 56 eyes of 28 children without amblyopia. The mean age, gender, amount and type of ocular deviation, presence of CI, stereopsis, time of initial spectacle use, follow-up time, and the difference in SE did not differ between groups. In amblyopes, exodeviation was more common and statistically greater in near (33 cm) than at distance (6 m) (p = 0.005). The mean BCVA and astigmatism values were statistically different between amblyopic, fellow, and non-amblyopic eyes. Conclusion: A greater near than distance exodeviation and higher mean astigmatism value were found in amblyopic children with astigmatism.

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Clinical Outcomes of Small Incision Lenticule Extraction with Accelerated Cross-Linking (ReLEx SMILE Xtra) in Patients with Thin Corneas and Borderline Topography

Journal of Ophthalmology ◽

10.1155/2015/263412 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 17

Author(s):

Sri Ganesh ◽

Sheetal Brar

Keyword(s):

Visual Acuity ◽

Clinical Outcomes ◽

Corneal Thickness ◽

Cross Linking ◽

Small Incision Lenticule Extraction ◽

Uncorrected Visual Acuity ◽

Distant Visual Acuity ◽

Lenticule Extraction ◽

The Mean

Purpose. To study the safety and clinical outcomes of ReLEx SMILE with accelerated cross-linking in individuals with thinner corneas, borderline topography, and higher refractive errors.Methods. Eligible patients first underwent SMILE procedure for correction of myopic refractive error. Following the removal of lenticule, 0.25% riboflavin in saline was injected into the interface and allowed to diffuse for 60 seconds. Finally, eye was exposed to UV-A radiation of 45 mW/cm2for 75 seconds through the cap. Total energy delivered was 3.4 J/cm2.Results. 40 eyes of 20 patients with mean age of 26.75 ± 5.99 years were treated. Mean follow-up was 12 months ± 28.12 days. Mean spherical equivalent (SE) was −5.02 ± 2.06 D preoperatively and −0.24 ± 0.18 D postoperatively. The mean central corneal thickness (CCT) and keratometry changed from 501 ± 25.90 µm to 415 ± 42.26 µm and 45.40 ± 1.40 D to 41.2 ± 2.75 D, respectively. Mean uncorrected visual acuity (UCVA) was 20/25 or better in all eyes. No eyes lost lines of corrected distant visual acuity (CDVA). There were no complications like haze, keratitis, ectasia, or regression.Conclusion. Based on the initial clinical outcome it appears that SMILE Xtra may be a safe and feasible modality to prevent corneal ectasia in susceptible individuals.

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Lenalidomide and Rituximab Regimen Combined With Intravitreal Methotrexate Followed by Lenalidomide Maintenance for Primary Vitreoretinal Lymphoma: A Prospective Phase II Study

Frontiers in Oncology ◽

10.3389/fonc.2021.701507 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yan Zhang ◽

Xiao Zhang ◽

Dongmei Zou ◽

Jingjing Yin ◽

Li Zhang ◽

...

Keyword(s):

Treatment Options ◽

Progression Free Survival ◽

Common Adverse Event ◽

Cns Lymphoma ◽

Primary Vitreoretinal Lymphoma ◽

Single Center Study ◽

Vitreoretinal Lymphoma ◽

Prospective Phase ◽

Grade 3

Primary vitreoretinal lymphoma (PVRL) is a rare variant of primary central nervous system (CNS) lymphoma, for which currently there are no optimal treatment options. This prospective single-center study enrolled immunocompetent patients with newly diagnosed PVRL between August 2018 and January 2020. Patients received local and systemic therapies: intravitreal methotrexate (MTX, 400 μg, 0.1 mL) injections for 1 year (total 16 injections) and six cycles of the rituximab (375 mg/m2 on day 1) and lenalidomide (25 mg on day 1–21; R2) regimen. Lenalidomide was maintained for 2 years in patients who had achieved a response. We enrolled 11 patients with a mean age of 58 (range, 48–70) years, of which 10 achieved complete remission at the first evaluation. The median follow-up period was 18.3 (range, 10.6–27.8) months, and the median progression-free survival was 12.7 months. Moreover, a total of eight patients relapsed. The most common adverse event (AE) was neutropenia, which occurred in seven patients (63.6%), followed by grade 3 ocular toxicities, including cataract formation, in six patients (54%). These findings suggest that the R2 regimen combined with intravitreal MTX, followed by lenalidomide maintenance, is a safe option for PVRL with moderate efficacy. This trial is registered with ClinicalTrials.gov (number NCT 03746223).

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Primary Vitreoretinal Lymphoma Therapy Monitoring: Significant Vitreous Haze Reduction After Intravitreal Rituximab

Neurosignals ◽

10.33594/000000367 ◽

2021 ◽

Vol 29 (S1) ◽

pp. 1-7

Keyword(s):

Visual Acuity ◽

Side Effects ◽

Intravitreal Injection ◽

Therapy Monitoring ◽

Safety Data ◽

Intravitreal Therapy ◽

Primary Vitreoretinal Lymphoma ◽

Vitreoretinal Lymphoma ◽

Vitreous Haze

BACKGROUND/AIMS: Intravitreal rituximab is an off-label treatment option for primary vitreoretinal lymphoma (PVRL). The objective of this study was to monitor the therapeutic response and safety profile of intravitreal rituximab in a cohort of PVRL patients. METHODS: In this retrospective, uncontrolled, open label, multicentre study, 20 eyes from 15 consecutive patients diagnosed with PRVL received at least one intravitreal injection of 1mg in 0.1ml rituximab. Biodata of the PVRL patients was recorded as well as visual acuity and vitreous haze score immediately before rituximab intravitreal injection and at follow-up examinations. Intravitreal rituximab safety data was also recorded. Additional rituximab injections were made during control visits on a pro re nata (PRN) regime using increased vitreous haze to indicate recurrence. RESULTS: There was significant vitreous haze reduction (p=0.0002) followed by significant improvement of visual acuity (mean best visual acuity before therapy 0.57 logMAR, after therapy 0.20 logMAR (p=0.0228) during the follow-up time up to 4 years. Only mild ocular side effects were reported. Median follow-up time was 565 days (range, 7-1253 days). CONCLUSION: Intravitreal rituximab therapy shows promising PVRL regression without any severe side effects. Although our clinical data support rituximab as intravitreal therapy in PVRL disease, further study is warranted.

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Meniscal Repair: Failure rate and clinical outcomes with minimum two years follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00194 ◽

2018 ◽

Vol 6 (12_suppl5) ◽

pp. 2325967118S0019

Author(s):

Juan Pablo Zicaro ◽

Carlos Yacuzzi ◽

Nicolas Garrido ◽

Ignacio Garcia-Mansilla ◽

Matias Costa-Paz

Keyword(s):

Clinical Outcomes ◽

Failure Rate ◽

Meniscal Repair ◽

Posterior Horn ◽

Return To Sports ◽

Before And After ◽

The Mean ◽

Mean Time ◽

Bucket Handle

Objectives The purpose of our study was to evaluate the clinical outcomes and failure rate of a series of patients who underwent meniscal repair with a minimum two-years of follow-up. Methods We retrospectively reviewed patients treated with meniscal repair between 2004 and 2016. We included patients with at least 2 years of follow-up. Surgical details such as the affected menisci, type of rupture and meniscal repair technique used were analyzed. Clinical and functional outcomes were evaluated using Lysholm and IKDC scores. Patients were studied with x-rays and magnetic resonance imaging (MRI). We analyzed the failure rate (defined as a re-rupture that required surgery). We compared failure rate for isolated meniscal repair vs associated with Anterior cruciate ligament reconstruction (ACLR). Also we compared patients operated before and after 2014. Results One hundred sixty nine patients were operated during that period of time. Ten patients did not meet inclusion criteria and forty were lost in follow-up. Out of the 119 patients evaluated, 35 had bucket-handle lesions, 25 tears in the posterior horn treated with all inside sutures and 59 body and posterior horn lesions treated with a combined suture technique. The mean postoperative Lysholm score was 85 (SD 14) and IKDC 70 (SD 10). The mean return to sports time was 8 months (range 2-19). An MRI was performed in 71 patients. The overall failure rate was 21% (24 /119) at a mean time of 20 months (range 2-60 months) and 26% (9/35) for bucket-handle lesions at a mean time of 21 months (range 2-60 months). Failure rate for the 48 isolated lesions was 20% at a mean of 23 months and 19% for 70 associated to ACLR at a mean of 17 months (p=0.53). Isolated bucket-handle lesions had failure rate of 27% at a mean of 27 months and when associated to ACLR this was 23% at a mean of 12 months (p=1.0) Overall failure rate for patients treated before 2014 was 27% (18/67) and 12% after 2014 (6/52) (p=0.03). For bucket-handle lesions before 2014 was 36% (8/23) and 8% after 2014 (1/12) (p=0.03). Isolated bucket-handle lesions failure rate was 45% (5/11) before 2014 and 0% (0/7) after 2014 (p=0.01) and when associated to ACLR, it was 25% (3/12) before 2014 and 20% (1/5) after 2014 (p=0.09). Conclusion Overall failure rate of our series was 21%. We found no differences between isolated lesions and associated to ACLR. There was a statistically significant difference regarding failure rate results for those operated before and after 2014. This might be the result of an improvement in the surgical devices, modifications in the technique and the number of sutures for each procedure.

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Clinical Outcomes at 1 Year following Corneal Ectasia Treatment with Accelerated Transepithelial Cross-linking

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1128 ◽

2016 ◽

Vol 5 (3) ◽

pp. 93-98 ◽

Cited By ~ 1

Author(s):

Rafael J Pérez-Cambrodí ◽

Pedro Ruiz-Fortes ◽

Alberto Artola

Keyword(s):

Visual Acuity ◽

Clinical Outcomes ◽

Statistical Significance ◽

Cross Linking ◽

Corneal Ectasia ◽

Significant Difference ◽

Corrected Distance Visual Acuity ◽

The Mean

ABSTRACT Objective To assess the clinical outcomes in ectatic corneas following accelerated transepithelial cross-linking (CXL) over 1 year of follow-up. Materials and methods Twenty-one eyes diagnosed with progressive corneal ectasia (19 keratoconus, 2 post-laser in situ keratomileusis ectasias) in 14 patients aged between 26 and 69 years were enrolled. All cases were treated with accelerated transepithelial CXL using the Avedro KXL® system (Waltham, MA, United States). Changes at visual, refractive, corneal topographic, and corneal aberrometric level were evaluated over a 12-month follow-up period. The demarcation was also determined using optical coherence tomography (OCT). Results The mean depth of the demarcation line measured by OCT was 202.72 µm, varying between 153 and 230 µm. One month postsurgery, a change was noted at the limit of statistical significance in sphere (p = 0.05) and in spherical equivalent (p = 0.05). Likewise, a statistically significant difference was observed in corrected distance visual acuity (CDVA) (p = 0.01). There were no significant changes in either visual acuity or refraction between 1 and 6 months (p ≥ 0.35). Although changes in trend were observed in corneal topographic and aberrometric parameters after surgery, none reached statistical significance (p ≥ 0.08). A significant change was observed only in astigmatism of the posterior surface between 1 and 12 months (p = 0.02). Conclusion Accelerated transepithelial CXL may be a useful technique for the management of progressive corneal ectasia, as it is able to maintain the topographic and aberrometric profile of the cornea with no significant changes. Longer-term studies are required to confirm this finding How to cite this article Piñero DP, Artola A, Ruiz-Fortes P, Soto-Negro R, Pérez-Cambrodi RJ. Clinical Outcomes at 1 Year following Corneal Ectasia Treatment with Accelerated Transepithelial Cross-linking. Int J Kerat Ect Cor Dis 2016;5(3):93-98.

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Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

Journal of Neuromuscular Diseases ◽

10.3233/jnd-200625 ◽

2021 ◽

pp. 1-7

Author(s):

Naomi Vather-Wu ◽

Matthew D. Krasowski ◽

Katherine D. Mathews ◽

Amal Shibli-Rahhal

Keyword(s):

Vitamin D ◽

Retrospective Cohort ◽

Vitamin D Supplementation ◽

Hydroxyvitamin D ◽

Frequent Monitoring ◽

25 Hydroxyvitamin D ◽

The Mean ◽

Stable Maintenance ◽

Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to < 30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

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Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽

10.1186/s12893-021-01255-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chunxiao Wang ◽

Yao Zhang ◽

Xiaojie Tang ◽

Haifei Cao ◽

Qinyong Song ◽

...

Keyword(s):

Blood Loss ◽

Learning Curve ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Operation Duration ◽

The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

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Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06630-8 ◽

2021 ◽

Author(s):

Quinten G. H. Rikken ◽

Jari Dahmen ◽

Sjoerd A. S. Stufkens ◽

Gino M. M. J. Kerkhoffs

Keyword(s):

Bone Marrow ◽

Clinical Outcomes ◽

Degenerative Changes ◽

Osteochondral Lesions ◽

Ankle Osteoarthritis ◽

Bone Marrow Stimulation ◽

Marrow Stimulation ◽

The Mean

Abstract Purpose The purpose of the present study was to evaluate the clinical and radiological outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLTs) at long-term follow-up. Methods A literature search was conducted from the earliest record until March 2021 to identify studies published using the PubMed, EMBASE (Ovid), and Cochrane Library databases. Clinical studies reporting on arthroscopic BMS for OLTs at a minimum of 8-year follow-up were included. The review was performed according to the PRISMA guidelines. Two authors independently conducted the article selection and conducted the quality assessment using the Methodological index for Non-randomized Studies (MINORS). The primary outcome was defined as clinical outcomes consisting of pain scores and patient-reported outcome measures. Secondary outcomes concerned the return to sport rate, reoperation rate, complication rate, and the rate of progression of degenerative changes within the tibiotalar joint as a measure of ankle osteoarthritis. Associated 95% confidence intervals (95% CI) were calculated based on the primary and secondary outcome measures. Results Six studies with a total of 323 ankles (310 patients) were included at a mean pooled follow-up of 13.0 (9.5–13.9) years. The mean MINORS score of the included studies was 7.7 out of 16 points (range 6–9), indicating a low to moderate quality. The mean postoperative pooled American Orthopaedic Foot and Ankle Society (AOFAS) score was 83.8 (95% CI 83.6–84.1). 78% (95% CI 69.5–86.8) participated in sports (at any level) at final follow-up. Return to preinjury level of sports was not reported. Reoperations were performed in 6.9% (95% CI 4.1–9.7) of ankles and complications related to the BMS procedure were observed in 2% (95% CI 0.4–3.0) of ankles. Progression of degenerative changes was observed in 28% (95% CI 22.3–33.2) of ankles. Conclusion Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. These findings indicate that OLTs treated with BMS may be at risk of progressing towards end-stage ankle osteoarthritis over time in light of the incremental cartilage damage cascade. The findings of this study can aid clinicians and patients with the shared decision-making process when considering the long-term outcomes of BMS. Level of evidence Level IV.

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Plasma natriuretic peptide level is an independent determinant of major clinical outcomes in atrial fibrillation patients without heart failure: the Fushimi AF Registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.0673 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Hamatani ◽

M Iguchi ◽

Y Aono ◽

K Ishigami ◽

S Ikeda ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Clinical Outcomes ◽

Prognostic Marker ◽

Oral Anticoagulants ◽

Systemic Embolism ◽

The Mean

Abstract Background Atrial fibrillation (AF) increases the risk of death, stroke/systemic embolism and heart failure (HF). Plasma natriuretic peptide (NP) level is an important prognostic marker in HF patients. However, little is known regarding the prognostic significance of plasma NP level in AF patients without HF. Purpose The aim of this study is to investigate the relationship between plasma NP level and clinical outcomes such as all-cause death, stroke/systemic embolism and HF hospitalization during follow-up period in AF patients without HF. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in our city. The inclusion criterion of the registry is the documentation of AF at 12-lead electrocardiogram or Holter monitoring at any time, and there are no exclusion criteria. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. From the registry, we excluded 1,220 patients without a pre-existing HF (defined as having one of the following; prior hospitalization for HF, New York Heart Association class ≥2, or left ventricular ejection fraction <40%). Among 3,246 AF patients without HF, we investigated 1,189 patients with the data of plasma BNP (n=401) or N-terminal pro-BNP (n=788) level at the enrollment. We divided the patients according to the quartile of each plasma BNP or NT-pro BNP level and compared the backgrounds and outcomes between these 4 groups stratified by plasma NP level. Results Of 1,189 patients, the mean age was 72.1±10.2 years, 454 (38%) were female and 684 (58%) were paroxysmal AF. The mean CHADS2 and CHA2DS2-VASc score were 1.6±1.1 and 2.9±1.5, respectively. Oral anticoagulants were prescribed in 671 (56%) at baseline. The median (interquartile range) BNP and N-terminal pro-BNP level were 84 (38, 176) and 500 (155, 984) pg/ml, respectively. Patients with high plasma NP level were older, and demonstrated lower prevalence of paroxysmal AF, higher CHADS2 and CHA2DS2-VASc scores and higher prevalence of chronic kidney disease and oral anticoagulants prescription (all P<0.01). A total of 165 all-cause death, 114 stroke/systemic embolism and 103 HF hospitalization occurred during the median follow-up period of 5.0 years. Kaplan-Meier curves demonstrated that higher plasma NP level was significantly associated with the incidences of all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF (Figure 1A). Multivariable Cox regression analysis revealed that plasma NP level could stratify the risk of clinical outcomes even after adjustment by type of AF, CHA2DS2-VASc score, chronic kidney disease and oral anticoagulant prescription (Figure 1B). Conclusion Plasma NP level is a significant prognostic marker for all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF, suggesting the importance of measuring plasma NP level in AF patients even without HF. Figure 1 Funding Acknowledgement Type of funding source: None

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