Scientific Concept of the National Cohort (status ... - Nationale Kohorte

A.2 Scientific background and rationale for study elements
wise, knowledge of the possible effects of cardiac dysfunction on cognitive function and risk
of neurodegenerative disease is scarce.
There is a need to better understand the determinants underlying development and progression
of diastolic dysfunction in HFPEF in order to address the epidemic of heart failure
in the population. Identifying modifiable risk factors of HFPEF (in order to improve prevention)
and improved models for predicting progression from subclinical stages of left ventricular
cardiac diastolic dysfunction to clinically overt heart failure are important aims of
the National Cohort. It is also important to help disentangle possible different pathophysiological
mechanisms underlying HFPEF and HFREF and to investigate specific causes of
death in subjects with HFPEF versus subjects with HFREF (e.g., sudden cardiac death,
arrhythmia-related deaths, and other causes of death). In the National Cohort, heart failure
and cardiac (dys)function at baseline will be assessed by symptoms, questionnaires, and
3D-Echocardiography, supplemented by cardiac MRI, according to scientific recommendations
/ guidelines 43 , ESC Task Force 48 .
Assessment of heart failure:
Examinations and questionnaires (at baseline and during reassessment)
Level 1: Questionnaires,
3D-Echocardiography
MRI program: Cardiac MRI
Active follow-up (and medical verification of self-reports):
Self-report of physician-diagnosed heart failure
Atrial fibrillation is the most common cardiac arrhythmia in developed countries, with
an overall prevalence of 1-2% in the general population and a marked age-dependent increase,
with a remaining life-time risk of about 25% in 40-year-old subjects 49 . The ageadjusted
incidence and prevalence of atrial fibrillation seem to be increasing in Europe and
North America 50 , and the prevalence of atrial fibrillation is expected to more than triple in the
next 50 years 51 . Atrial fibrillation is associated with significant morbidity and mortality; it is
a known cause of “cryptogenic” stroke and is associated with cerebral white matter lesions
and cognitive dysfunction 52, 53 . A number of clinical risk factors for atrial fibrillation have been
identified; however, characterization of lifestyle factors, genes, and novel biomarkers for
risk of atrial fibrillation is still in its infancy. Furthermore, the information about risk factors
for asymptomatic atrial fibrillation and regarding progression from paroxysmal to persistent
and permanent atrial fibrillation is insufficient 50 .
Assessment of atrial fibrillation:
Examinations (at baseline and during reassessment)
Level 1: Questionnaire
10-s, 12-lead ECG
Level 2: Long-term ECG
Active follow-up (and medical verification of self-reports):
Self-report of physician-diagnosed arrythmia (and use of antiarrhythmic drugs)
Cerebrovascular diseases such as ischemic or hemorrhagic stroke pertain both to the
group of cardiovascular and neurologic diseases. Owing to their close link to cognitive impairments
originating from vascular changes (including vascular dementia and vascular
depression), the cerebrovascular diseases will be detailed further in Sect. A.2.2.4 on neurologic
and psychiatric diseases, below. In the National Cohort, we will regard the research
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A.2