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Ikeda T, Ogawa S, Kitazono T, Nakagawara J, Minematsu K, Miyamoto S, Murakawa Y, Tachiiri M, Okayama Y, Sunaya T, Hirano K, Hayasaki T. Impact of three major risk factors on clinical outcomes in patients with nonvalvular atrial fibrillation receiving rivaroxaban: Sub-analysis from the XAPASS study. J Arrhythm 2022; 38:369-379. [PMID: 35785372 PMCID: PMC9237294 DOI: 10.1002/joa3.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/20/2022] [Accepted: 03/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background To evaluate the impact of three risk factors (age [≥75 years], renal impairment [creatinine clearance <50 ml/min], and low body weight [≤50 kg]) on the risk of any bleeding events, all-cause mortality, and stroke, non-central nervous system (non-CNS) systemic embolism (SE), and myocardial infarction (MI) in patients with nonvalvular atrial fibrillation (NVAF) treated with rivaroxaban in a real-world clinical setting. Methods The Xarelto Post-Authorization Safety and Effectiveness Study in Japanese Patients with Atrial Fibrillation (XAPASS) is a prospective, single-arm, observational study. Enrolled patients were divided into four subgroups by the number of risk factors. Results Overall, 9823 patients were included: 4299 with low risk, 2816 with moderate risk, 1574 with high risk, and 1134 with very high risk. The hazard ratios (95% confidence interval) (reference: low risk) for the moderate-, high-, and very-high-risk groups were 1.62 (1.19, 2.21) (p = 0.002), 2.15 (1.47, 3.15) (p < 0.001), and 2.49 (1.60, 3.87) (p <0.001) for major bleeding, and 1.98 (1.47, 2.66), 2.29 (1.59, 3.29), and 2.74 (1.81, 4.16) (p <0.001 for all) for stroke/non-CNS SE/MI, respectively. Conclusions Age ≥75 years and renal impairment, but not low body weight, were determinants for major bleeding. The accrual of three risk factors was associated with increased risk for major bleeding and stroke/non-CNS SE/MI in patients with NVAF receiving rivaroxaban; there was no increase in the cumulative risk for these with an increasing number of risk factors.
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Affiliation(s)
- Takanori Ikeda
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Satoshi Ogawa
- International University of Health and WelfareMita HospitalTokyoJapan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Jyoji Nakagawara
- Osaka Namba ClinicOsakaJapan
- National Cerebral and Cardiovascular CenterSuitaJapan
| | - Kazuo Minematsu
- National Cerebral and Cardiovascular CenterSuitaJapan
- Iseikai Medical CorporationOsakaJapan
| | - Susumu Miyamoto
- Department of NeurosurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Yuji Murakawa
- The Fourth Department of Internal MedicineTeikyo University School of Medicine, Mizonokuchi HospitalKawasakiJapan
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Fischer MA, Mahajan A, Cabaj M, Kimball TH, Morselli M, Soehalim E, Chapski DJ, Montoya D, Farrell CP, Scovotti J, Bueno CT, Mimila NA, Shemin RJ, Elashoff D, Pellegrini M, Monte E, Vondriska TM. DNA Methylation-Based Prediction of Post-operative Atrial Fibrillation. Front Cardiovasc Med 2022; 9:837725. [PMID: 35620521 PMCID: PMC9127230 DOI: 10.3389/fcvm.2022.837725] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/17/2022] [Indexed: 12/14/2022] Open
Abstract
BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and post-operative atrial fibrillation (POAF) is a major healthcare burden, contributing to an increased risk of stroke, kidney failure, heart attack and death. Genetic studies have identified associations with AF, but no molecular diagnostic exists to predict POAF based on pre-operative measurements. Such a tool would be of great value for perioperative planning to improve patient care and reduce healthcare costs. In this pilot study of epigenetic precision medicine in the perioperative period, we carried out bisulfite sequencing to measure DNA methylation status in blood collected from patients prior to cardiac surgery to identify biosignatures of POAF.MethodsWe enrolled 221 patients undergoing cardiac surgery in this prospective observational study. DNA methylation measurements were obtained from blood samples drawn from awake patients prior to surgery. After controlling for clinical and methylation covariates, we analyzed DNA methylation loci in the discovery cohort of 110 patients for association with POAF. We also constructed predictive models for POAF using clinical and DNA methylation data. We subsequently performed targeted analyses of a separate cohort of 101 cardiac surgical patients to measure the methylation status solely of significant methylation loci in the discovery cohort.ResultsA total of 47 patients in the discovery cohort (42.7%) and 43 patients in the validation cohort (42.6%) developed POAF. We identified 12 CpGs that were statistically significant in the discovery cohort after correcting for multiple hypothesis testing. Of these sites, 6 were amenable to targeted bisulfite sequencing and chr16:24640902 was statistically significant in the validation cohort. In addition, the methylation POAF prediction model had an AUC of 0.79 in the validation cohort.ConclusionsWe have identified DNA methylation biomarkers that can predict future occurrence of POAF associated with cardiac surgery. This research demonstrates the use of precision medicine to develop models combining epigenomic and clinical data to predict disease.
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Affiliation(s)
- Matthew A. Fischer
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- *Correspondence: Matthew A. Fischer
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Maximilian Cabaj
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Todd H. Kimball
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Marco Morselli
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth Soehalim
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Douglas J. Chapski
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Dennis Montoya
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Colin P. Farrell
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jennifer Scovotti
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Claudia T. Bueno
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Naomi A. Mimila
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Richard J. Shemin
- Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - David Elashoff
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Matteo Pellegrini
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Emma Monte
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Thomas M. Vondriska
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Physiology, University of California, Los Angeles, Los Angeles, CA, United States
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Sehrawat O, Kashou AH, Noseworthy PA. Artificial Intelligence and Atrial Fibrillation. J Cardiovasc Electrophysiol 2022; 33:1932-1943. [PMID: 35258136 PMCID: PMC9717694 DOI: 10.1111/jce.15440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
In the context of atrial fibrillation (AF), traditional clinical practices have thus far fallen short in several domains such as identifying patients at risk of incident AF or patients with concomitant undetected paroxysmal AF. Novel approaches leveraging artificial intelligence have the potential to provide new tools to deal with some of these old problems. In this review we focus on the roles of artificial intelligence-enabled ECG pertaining to AF, potential roles of deep learning (DL) models in the context of current knowledge gaps, as well as limitations of these models. One key area where DL models can translate to better patient outcomes is through automated ECG interpretation. Further, we overview some of the challenges facing AF screening and the harms and benefits of screening. In this context, a unique model was developed to detect underlying hidden AF from sinus rhythm and is discussed in detail with its potential uses. Knowledge gaps also remain regarding the best ways to monitor patients with embolic stroke of undetermined source (ESUS) and who would benefit most from oral anticoagulation. The AI-enabled AF model is one potential way to tackle this complex problem as it could be used to identify a subset of high-risk ESUS patients likely to benefit from empirical oral anticoagulation. Role of DL models assessing AF burden from long duration ECG data is also discussed as a way of guiding management. There is a trend towards the use of consumer-grade wristbands and watches to detect AF from photoplethysmography data. However, ECG currently remains the gold standard to detect arrythmias including AF. Lastly, role of adequate external validation of the models and clinical trials to study true performance is discussed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ojasav Sehrawat
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anthony H Kashou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Oesterle A, Giancaterino S, Van Noord MG, Pellegrini CN, Fan D, Srivatsa UN, Amsterdam EA. Effects of Supervised Exercise Training on Atrial Fibrillation: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Cardiopulm Rehabil Prev 2022; 42:258-265. [PMID: 35235540 DOI: 10.1097/hcr.0000000000000665] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Atrial fibrillation (AF) is associated with the comorbidities of a sedentary lifestyle. Endurance athletes also show an increased incidence of AF. The role of exercise in the treatment of AF is unknown so this study aimed to examine the effects of supervised exercise on AF. METHODS A meta-analysis of randomized controlled trials (RCTs) examining supervised exercise training in participants with AF was performed. The primary outcome was AF recurrence and burden. Secondary outcomes included AF symptoms, quality of life, and cardiorespiratory fitness (CRF). RESULTS Thirteen RCTs, involving 1155 participants, were included. Paroxysmal AF was present in 34% and persistent AF in 64%. The types of exercise were diverse and included cardiac rehabilitation (64%), aerobic training (7%), Qi Gong (4%), interval training (11%), and yoga (15%). Exercise training reduced AF recurrence (relative risk = 0.77: 95% CI, 0.60-0.99), improved quality of life in 5 of the 10 components of the Short Form 36 survey, and improved CRF (standardized mean difference [SMD] = 0.56: 95% CI, 0.27-0.85). The AF burden was reduced only in studies that included continuous ambulatory monitoring (SMD =-0.49: 95% CI, -0.96 to -0.01) but not when all studies were included (SMD =-0.12: 95% CI, -0.61 to 0.38). There was no difference in adverse events between exercise and control. CONCLUSIONS Supervised exercise training is safe, reduces AF recurrence, and improves quality of life and CRF in participants with AF. Further large RCTs with ambulatory monitoring and robust exercise regimens are needed to assess the effects of exercise training on AF burden and AF symptoms.
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Affiliation(s)
- Adam Oesterle
- Department of Cardiology, University of California, San Francisco-Veterans Affairs Medical Center, San Francisco (Drs Oesterle and Pellegrini); Department of Cardiology, University of California, Davis (Drs Giancaterino, Fan, Srivatsa and Amsterdam); and University of California, Davis (Ms Van Noord)
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Jiang X, Luo Y, Wang X, Chen Y, Wang T, He J, Xia Y, Zhao J, Chai X, Yao L, Liu C, Chen Y. Investigating the efficiency and tolerability of traditional Chinese formulas combined with antiarrhythmic agents for paroxysmal atrial fibrillation: A systematic review and Bayesian network meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 94:153832. [PMID: 34781230 DOI: 10.1016/j.phymed.2021.153832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/30/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The combination of antiarrhythmic drugs with traditional Chinese formulas are used treatments for the management of paroxysmal atrial fibrillation (PAF). However, the most effective treatment for PAF has yet to be been determined. A Bayesian network meta-analysis study was thus performed for comparing the relative efficacy and tolerability of different treatment alternatives. METHODS A comprehensive literature review of randomized controlled trials (RCTs) is performed from eight database. Maintenance rate of sinus rhythm (MRSR), p-wave dispersion (Pd), left atrium diameter (LAD), left ventricular ejection fraction (LVEF), and adverse events (AEs) were used as outcomes. We also estimated treatment rank based on the surface under the cumulative ranking curve (SUCRA). This study was performed using a Bayesian network meta-analysis with a random-effects model. FINDINGS After screening, 59 RCTs involving 5,543 patients and 16 treatments were included. The results showed that Shensong-Yangxin capsule (SSYX) plus amiodarone (81%) was the most effective treatment for MRSR according to the value of SUCRA, followed by Wenxin-Keli granules (WXKL) plus amiodarone (73%). Meanwhile, SSYX plus amiodarone (7%) was most likely to reduce Pd, followed by SSYX plus metoprolol (23%), WXKL plus amiodarone (26%), WXKL plus bisoprolol (27%). Furthermore, SSYX plus amiodarone (4%) was more effective in improving LAD. WXKL plus amiodarone was preferred because it had the lowest toxicity. For benefit-risk ratio, amiodarone combined with WXKL or SSYX appeared to be the best option. CONCLUSION Antiarrhythmic agents combined with traditional Chinese formulas had higher efficacy and lower toxicity than other treatment alternatives. This study might provide reference to help find the better treatment options for PAF.
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Affiliation(s)
- Xiumin Jiang
- Research Institute of Acupuncture and Moxibustion,Shandong University of Traditional Chinese Medicine, Jinan, China; South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongxin Luo
- Department of Biostatistics and Preventive Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaotong Wang
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yiming Chen
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Taiyi Wang
- Research Institute of Acupuncture and Moxibustion,Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jun He
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China; Rehabilitation Center, Counseling Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yucen Xia
- Research Institute of Acupuncture and Moxibustion,Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiaying Zhao
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoshu Chai
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lin Yao
- Research Institute of Acupuncture and Moxibustion,Shandong University of Traditional Chinese Medicine, Jinan, China; School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Cunzhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Chaoyang District, Beijing, China.
| | - Yongjun Chen
- Research Institute of Acupuncture and Moxibustion,Shandong University of Traditional Chinese Medicine, Jinan, China; South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Sagris M, Vardas EP, Theofilis P, Antonopoulos AS, Oikonomou E, Tousoulis D. Atrial Fibrillation: Pathogenesis, Predisposing Factors, and Genetics. Int J Mol Sci 2021; 23:ijms23010006. [PMID: 35008432 PMCID: PMC8744894 DOI: 10.3390/ijms23010006] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 02/07/2023] Open
Abstract
Atrial fibrillation (AF) is the most frequent arrhythmia managed in clinical practice, and it is linked to an increased risk of death, stroke, and peripheral embolism. The Global Burden of Disease shows that the estimated prevalence of AF is up to 33.5 million patients. So far, successful therapeutic techniques have been implemented, with a high health-care cost burden. As a result, identifying modifiable risk factors for AF and suitable preventive measures may play a significant role in enhancing community health and lowering health-care system expenditures. Several mechanisms, including electrical and structural remodeling of atrial tissue, have been proposed to contribute to the development of AF. This review article discusses the predisposing factors in AF including the different pathogenic mechanisms, sedentary lifestyle, and dietary habits, as well as the potential genetic burden.
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Affiliation(s)
- Marios Sagris
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
- Correspondence: ; Tel.: +30-213-2088099; Fax: +30-213-2088676
| | - Emmanouil P. Vardas
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
- Department of Cardiology, General Hospital of Athens “G. Gennimatas”, 11527 Athens, Greece
| | - Panagiotis Theofilis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
| | - Alexios S. Antonopoulos
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
| | - Evangelos Oikonomou
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
- 3rd Department of Cardiology, “Sotiria” Thoracic Diseases Hospital of Athens, University of Athens Medical School, 11527 Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
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New evidence of direct oral anticoagulation therapy on cardiac valve calcifications, renal preservation and inflammatory modulation. Int J Cardiol 2021; 345:90-97. [PMID: 34688719 DOI: 10.1016/j.ijcard.2021.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/25/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Rivaroxaban is a direct inhibitor of activated Factor X (FXa), an anti-inflammatory protein exerting a protective effect on the cardiac valve and vascular endothelium. We compare the effect of Warfarin and Rivaroxaban on inflammation biomarkers and their contribution to heart valve calcification progression and renal preservation in a population of atrial fibrillation (AF) patients with chronic kidney disease (CKD) stage 3b - 4. METHODS This was an observational, multicenter, prospective study enrolling 347 consecutive CKD stage 3b - 4 patients newly diagnosed with AF: 247 were treated with Rivaroxaban and 100 with Warfarin. Every 12 months, we measured creatinine levels and cardiac valve calcification via standard trans-thoracic echocardiogram, while plasma levels of inflammatory mediators were quantified by ELISA at baseline and after 24 months. RESULTS Over a follow-up of 24 months, long-term treatment with Rivaroxaban was associated with a significative reduction of cytokines. Patients treated with Rivaroxaban experienced a more frequent stabilization/regression of valve calcifications comparing with patients treated with Warfarin. Rivaroxaban use was related with an improvement in kidney function in 87.4% of patients, while in those treated with Warfarin was reported a worsening of renal clearance in 98% of cases. Patients taking Rivaroxaban experienced lower adverse events (3.2% vs 49%, p-value <0.001). CONCLUSIONS Our findings suggest that Rivaroxaban compared to Warfarin is associated with lower levels of serum markers of inflammation. The inhibition of FXa may exert an anti-inflammatory effect contributing to reduce the risk of cardiac valve calcification progression and worsening of renal function.
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Wang X, Li H, Zhang A, Zhang Y, Li Z, Wang X, Gao M, Zhang Y, Hou Y. Diversity among differentially expressed genes in atrial appendages of atrial fibrillation: The role and mechanism of SPP1 in atrial fibrosis. Int J Biochem Cell Biol 2021; 141:106074. [PMID: 34474184 DOI: 10.1016/j.biocel.2021.106074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Structural remodeling plays an important role in the occurrence and maintenance of atrial fibrillation (AF), but the mechanism is currently unclear. This study was designed to investigate the transcriptomic mechanism of structural remodeling of AF through bioinformatic analysis and in vivo and vitro experiments. METHODS Transcriptomic datasets were retrieved from the Gene Expression Omnibus (GEO) database, and bioinformatics analysis was performed to screen mRNAs associated with AF. Cell and animal models were constructed to verify the bioinformatic findings using RT-qPCR and western blot analysis. Then, SPP1 was screened as the target gene, and the mechanism by which it promotes fibrosis was further studied in human cardiac fibroblasts (HCFs) using western blot analysis. RESULTS After retrieval, the GSE14975, GSE31821, GSE79768, GSE115574 and GSE128188 datasets were used in this study. In total, 147 differentially expressed genes (DEGs) were identified in left atrial appendix tissue and 85 in right atrial appendix tissue. According to the enrichment analysis results, the calcium signaling pathway was found to play an important role in AF, in which EGFR, AGTR1, HTR2B, CD38 and BDKRB1 might be the key genes. Moreover, SPP1 was identified as a key driver through PPI analysis and experimentally proved to reduce the expression of p27 by regulating the PI3K/Akt signaling pathway, sequentially promoting HCF fibrosis. CONCLUSION Bioinformatics analysis showed that the calcium signaling pathway might play an important role in AF, while SPP1 could promote myocardial fibrosis through the PI3K/Akt/p27 signaling axis.
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Affiliation(s)
- Xiao Wang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Huilin Li
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - An Zhang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yujiao Zhang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, Shandong, 250012, China
| | - Zhan Li
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, Shandong, 250012, China
| | - Ximin Wang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, Shandong, 250012, China
| | - Mei Gao
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, Shandong, 250012, China
| | - Yong Zhang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, Shandong, 250012, China.
| | - Yinglong Hou
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, Shandong, 250012, China.
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O'Kane CP, Avalon JCO, Lacoste JL, Fang W, Bianco CM, Davisson L, Piechowski KL. Apixaban and rivaroxaban use for atrial fibrillation in patients with obesity and BMI ≥50 kg/m 2. Pharmacotherapy 2021; 42:112-118. [PMID: 34820876 DOI: 10.1002/phar.2651] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Apixaban and rivaroxaban are increasingly used for thromboembolism prophylaxis in patients with non-valvular atrial fibrillation (NVAF) and commonly in patients with obesity and body mass index (BMI) ≥50 kg/m2 despite the limited data. OBJECTIVES This study aimed to establish the effectiveness and safety of apixaban and rivaroxaban in patients with NVAF and BMI ≥50 kg/m2 . METHODS A single health-system, retrospective cohort study evaluated the effectiveness and safety of apixaban and rivaroxaban initiated in adult patients (≥18 years of age) with BMI ≥50 kg/m2 and NVAF. Outcomes of ischemic stroke, systemic embolic events, and bleeding were compared to a cohort of patients with BMI 18 to 30 kg/m2 . RESULTS After 1619 patient-years worth of follow-up in 595 patients, the primary endpoint of incidence of ischemic stroke was numerically similar in both groups, 1.3 per 100 patient-years in the BMI ≥50 kg/m2 group, compared to 2.0 per 100 patient-years in the BMI <30 kg/m2 group (RR 0.65, 95% CI 0.38-1.82, p = 0.544). Incidence of major bleeding and clinically relevant non-major bleeding was also numerically similar between the two groups. CONCLUSIONS This study demonstrated that apixaban and rivaroxaban in patients with a BMI ≥50 kg/m2 for treatment of NVAF may be safe and effective at preventing thromboembolic events and had no increased risk of bleeding. Although, findings should be interpreted with caution and confirmed with additional studies. This study contributes to the growing body of evidence that direct oral anticoagulants (DOACs) may be effective and safe to use for the treatment of NVAF in patients with BMI ≥50 kg/m2 .
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Affiliation(s)
- Cavan P O'Kane
- Department of Pharmacy, WVU Medicine, Morgantown, West Virginia, USA
| | - Juan Carlo O Avalon
- Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Jordan L Lacoste
- Department of Pharmacy, WVU Medicine, Morgantown, West Virginia, USA
| | - Wei Fang
- West Virginia Clinical and Translational Science Institute, Morgantown, West Virginia, USA
| | - Christopher M Bianco
- Department of Cardiovascular and Thoracic Surgery, WVU Medicine, Morgantown, West Virginia, USA
| | - Laura Davisson
- Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA.,WVU Medicine Medical and Surgical Weight Loss Center's Medical Weight Management Program, Morgantown, West Virginia, USA
| | - Kara L Piechowski
- Department of Pharmacy, WVU Medicine, Morgantown, West Virginia, USA
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60
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Clinical phenotypes of patients with non-valvular atrial fibrillation as defined by a cluster analysis: A report from the J-RHYTHM registry. IJC HEART & VASCULATURE 2021; 37:100885. [PMID: 34692988 PMCID: PMC8515385 DOI: 10.1016/j.ijcha.2021.100885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 01/21/2023]
Abstract
Background Atrial fibrillation (AF) is a heterogeneous condition caused by various underlying disorders and comorbidities. A cluster analysis is a statistical technique that attempts to group populations by shared traits. Applied to AF, it could be useful in classifying the variables and complex presentations of AF into phenotypes of coherent, more tractable subpopulations. Objectives This study aimed to characterize the clinical phenotypes of AF using a national AF patient registry using a cluster analysis. Methods We used data of an observational cohort that included 7406 patients with non-valvular AF enrolled from 158 sites participating in a nationwide AF registry (J-RHYTHM). The endpoints analyzed were all-cause mortality, thromboembolisms, and major bleeding. Results The optimal number of clusters was found to be 4 based on 40 characteristics. They were those with (1) a younger age and low rate of comorbidities (n = 1876), (2) a high rate of hypertension (n = 4579), (3) high bleeding risk (n = 302), and (4) prior coronary artery disease and other atherosclerotic comorbidities (n = 649). The patients in the younger/low comorbidity cluster demonstrated the lowest risk for all 3 endpoints. The atherosclerotic comorbidity cluster had significantly higher adjusted risks of total mortality (odds ratio [OR], 3.70; 95% confidence interval [CI], 2.37–5.80) and major bleeding (OR, 5.19; 95% CI, 2.58–10.9) than the younger/low comorbidity cluster. Conclusions A cluster analysis identified 4 distinct groups of non-valvular AF patients with different clinical characteristics and outcomes. Awareness of these groupings may lead to a differentiated patient management for AF.
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61
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Chen L, Xu C, Chen W, Zhang C. Left atrial appendage orifice area and morphology is closely associated with flow velocity in patients with nonvalvular atrial fibrillation. BMC Cardiovasc Disord 2021; 21:442. [PMID: 34530731 PMCID: PMC8443967 DOI: 10.1186/s12872-021-02242-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/01/2021] [Indexed: 12/26/2022] Open
Abstract
Background Thromboembolic events are the most serious complication of atrial fibrillation (AF), and the left atrial appendage (LAA) is the most important site of thrombosis in patients with AF. During the period of COVID-19, a non-invasive left atrial appendage detection method is particularly important in order to reduce the exposure of the virus. This study used CT three-dimensional reconstruction methods to explore the relationship between LAA morphology, LAA orifice area and its mechanical function in patients with non-valvular atrial fibrillation (NVAF). Methods A total of 81 consecutive patients with NVAF (36 cases of paroxysmal atrial fibrillation and 45 cases of persistent atrial fibrillation) who were planned to undergo catheter radiofrequency ablation were enrolled. All patients were examined by transthoracic echocardiography (TTE), TEE, and computed tomography angiography (CTA) before surgery. The LAA orifice area was obtained according to the images of CTA. According to the left atrial appendage morphology, it was divided into chicken wing type and non-chicken wing type. At the same time, TEE was performed to determine left atrial appendage flow velocity (LAAFV), and the relationship between the left atrial appendage orifice area and LAAFV was analyzed. Results The LAAFV in Non-chicken wing group was lower than that in Chicken wing group (36.2 ± 15.0 cm/s vs. 49.1 ± 22.0 cm/s, p-value < 0.05). In the subgroup analysis, the LAAFV in Non-chicken wing group was lower than that in Chicken wing group in the paroxysmal AF (44.0 ± 14.3 cm/s vs. 60.2 ± 22.8 cm/s, p-value < 0.05). In the persistent AF, similar results were observed (29.7 ± 12.4 cm/s vs. 40.8 ± 17.7 cm/s, p-value < 0.05). The LAAFV in persistent AF group was lower than that in paroxysmal AF group (34.6 ± 15.8 cm/s vs. 49.9 ± 20.0 cm/s, p-value < 0.001). The LAAFV was negatively correlated with left atrial dimension (R = − 0.451, p-value < 0.001), LAA orifice area (R= − 0.438, p-value < 0.001) and left ventricular mass index (LVMI) (R= − 0.624, p-value < 0.001), while it was positively correlated with LVEF (R = 0.271, p-value = 0.014). Multiple linear regression analysis showed that LAA morphology (β = − 0.335, p-value < 0.001), LAA orifice area (β = − 0.185, p-value = 0.033), AF type (β = − 0.167, p-value = 0.043) and LVMI (β = − 0.465, p-value < 0.001) were independent factors of LAAFV. Conclusions The LAA orifice area is closely related to the mechanical function of the LAA in patients with NVAF. The larger LAA orifice area and LVMI, Non-chicken wing LAA and persistent AF are independent predictors of decreased mechanical function of LAA, and these parameters might be helpful for better management of LA thrombosis.
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Affiliation(s)
- Lei Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China
| | - Changjiang Xu
- Department of Cardiology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, 223800, Jiangsu, China
| | - Wensu Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China
| | - Chaoqun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China.
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62
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Ronsoni RM, Saffi MAL, Gonçalves MVM, Nakayama IH, Luz Leiria TL. A New Vision at the Interface of Atrial Fibrillation and Stroke. Front Cardiovasc Med 2021; 8:689313. [PMID: 34434974 PMCID: PMC8380765 DOI: 10.3389/fcvm.2021.689313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Current evidence questions the linear sequence traditionally described in atrial fibrillation, blood stasis, intracavitary thrombus, and embolization to the central nervous system. Currently, new perspectives have been described based on questions from the linearly traditional chronology of events; it is within this scope that the article has its objective. Evidences: The association of the two entities is biologically plausible and supported by different cohorts with a higher risk of developing atrial fibrillation, especially in the cardioembolic form. Concepts (temporal dissociation, biological gradient, etc.) determine the existence of other factors associated with cardioembolism, not exclusively by atrial fibrillation. The entire cascade of events associated with myopathy and atrial remodeling can generate damage to the myocyte and amplify the prothrombotic status. It is important to clarify that atrial myopathy can present itself as atrial fibrillation initially or not, but should always be considered thrombogenic in all the contexts of their clinical presentation. Considering atrial heart disease as a cause of embolic stroke, it could explain that one-third of strokes are considered cryptogenic. Conclusions: The traditional model exclusively associating the presence of atrial fibrillation in the genesis of thromboembolism is incomplete. The concept of atrial cardiopathy where cardioembolism occurs in a non-atrial fibrillation dependent manner fits better with current data. The future challenge is to effectively detect the various manifestations of atrial heart disease, generating direct implications for the identification of patients at risk of stroke and also for better management after a cardioembolic event.
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Affiliation(s)
- Rafael M Ronsoni
- Electrophysiology Department, Instituto de Ritmologia Cardíaca, Joinville, Brazil.,Department of Medicine, Universidade da Região de Joinville, Joinville, Brazil
| | | | | | | | - Tiago Luiz Luz Leiria
- Programa de Pós-Graduação em Ciências da Saúde - Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Brazil
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63
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Bregani ER, Valcarenghi C, Conti M. A survey on a rural in-hospital population diagnosed with Atrial Fibrillation in west Shewa region, Ethiopia. J Public Health (Oxf) 2021; 43:325-332. [PMID: 31774507 DOI: 10.1093/pubmed/fdz140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia seen in clinical practice. It has been extensively studied in Western countries but less is known about developing countries. METHODS We collected data on a rural population afferent to Wolisso hospital in Ethiopia, analysing epidemiology, clinical and cardiac ultrasound profile.We enrolled 54 patients with first diagnosis of AF who undertook cardiac ultrasound and a questionnaire about personal and clinical profile. RESULTS Enrolled patients were younger than reported in the African urban population (mean age 51 years) and females were symptomatic at a younger age than males (61.8% of females were <50 years old versus 30% of males) and had complicated disease (100% of females had CHF). Rheumatic heart disease (RHD) was found in 38.9% of patients, especially in females (41.1%) and young patients, whereas hypertension (HTN) and degenerative valvular disease were predisposing to AF in old patients. CONCLUSION Low socio-economic level may explain findings we observed, particularly male to female ratio, more relevant than in urban subsets. RHD and HTN are many etiological factors of AF in our small population, so low-cost strategies to prevent their complications are surely cost-effective in rural catchment area of Wolisso hospital.
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Affiliation(s)
- Enrico Rino Bregani
- U.O.C. di Medicina Generale, Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milano, Italy.,Medicine Department and Outpatient Department, St. Luke Catholic Hospital, Wolisso, Ethiopia.,Operational Research Unit, Doctors with Africa Cuamm, 35121, Padova, Italy
| | - Caterina Valcarenghi
- S.d.S di Anestesia, Rianimazione, Terapia Intensiva e del Dolore, Università degli Studi di Milano, 20122, Milano, Italy
| | - Matilde Conti
- S.d.S di Medicina di Emergenza e Urgenza, Università degli Studi di Milano-Bicocca, 20126, Milano, Italy
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Sanz-García A, Cecconi A, Vera A, Camarasaltas JM, Alfonso F, Ortega GJ, Jimenez-Borreguero J. Electrocardiographic biomarkers to predict atrial fibrillation in sinus rhythm electrocardiograms. Heart 2021; 107:1813-1819. [PMID: 34088763 DOI: 10.1136/heartjnl-2021-319120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Early prediction of atrial fibrillation (AF) development would improve patient outcomes. We propose a simple and cheap ECG based score to predict AF development. METHODS A cohort of 16 316 patients was analysed. ECG measures provided by the computer-assisted ECG software were used to identify patients. A first group included patients in sinus rhythm who showed an ECG with AF at any time later (n=505). A second group included patients with all their ECGs in sinus rhythm (n=15 811). By using a training set (75% of the cohort) the initial sinus rhythm ECGs of both groups were analysed and a predictive risk score based on a multivariate logistic model was constructed. RESULTS A multivariate regression model was constructed with 32 variables showing a predictive value characterised by an area under the curve (AUC) of 0.776 (95% CI: 0.738 to 0.814). The subsequent risk score included the following variables: age, duration of P-wave in aVF, V4 and V5; duration of T-wave in V3, mean QT interval adjusted for heart rate, transverse P-wave clockwise rotation, transverse P-wave terminal angle and transverse QRS complex terminal vector magnitude. Risk score values ranged from 0 (no risk) to 5 (high risk). The predictive validity of the score reached an AUC of 0.764 (95% CI: 0.722 to 0.806) with a global specificity of 61% and a sensitivity of 55%. CONCLUSIONS The automatic assessment of ECG biomarkers from ECGs in sinus rhythm is able to predict the risk for AF providing a low-cost screening strategy for early detection of this pathology.
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Affiliation(s)
- Ancor Sanz-García
- Data Analysis Unit, Hospital Universitario de la Princesa, Madrid, Spain
| | - Alberto Cecconi
- Cardiology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Alberto Vera
- Cardiology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Guillermo Jose Ortega
- Data Analysis Unit, Hospital Universitario de la Princesa, Madrid, Spain .,CONICET; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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65
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Tavares L, Lador A, Valderrábano M. Sleep Apnea and Atrial Fibrillation: Role of the Cardiac Autonomic Nervous System. Methodist Debakey Cardiovasc J 2021; 17:49-52. [PMID: 34104320 DOI: 10.14797/zyut2951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Sleep apnea is highly associated with atrial fibrillation (AF), and both diseases are highly prevalent in the United States. The mechanistic underpinnings that contribute to their association remain uncertain, but numerous possible mechanisms have been proposed, including dysfunction of the cardiac autonomic nervous system (ANS). Studies have reported that apnea induces hyperactivity of the ANS, leading to increases in AF susceptibility. This review compiles the latest evidence on the role of the ANS in sleep-apnea-induced AF.
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Affiliation(s)
- Liliana Tavares
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Adi Lador
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Miguel Valderrábano
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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Štolbová K, Novodvorský P, Jakubíková I, Dvořáková I, Mráz M, Wichterle D, Kautzner J, Haluzík M. Effect of Complex Weight-Reducing Interventions on Rhythm Control in Obese Individuals with Atrial Fibrillation Following Catheter Ablation: A Study Protocol. Adv Ther 2021; 38:2007-2016. [PMID: 33710588 PMCID: PMC7953371 DOI: 10.1007/s12325-021-01667-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/11/2021] [Indexed: 01/30/2023]
Abstract
Introduction Obesity and atrial fibrillation (AF) pose a significant burden on healthcare systems worldwide. Reduction of body weight has been documented to reduce the risk of AF. Little is known about the effect of different weight-reducing interventions including bariatric surgery in obese individuals on the risk of arrhythmia recurrence following catheter ablation (CA) for AF, and about the pathophysiological mechanisms linking these two conditions. Methods The Effect of complex weigHt-reducing interventiOns on rhythm control in oBese subjects wITh Atrial Fibrillation (HOBIT-AF) is a single-blinded, parallel-group randomised controlled trial with 18-month follow-up to assess the effect of complex weight-reducing interventions supported by the use of smart technologies and bariatric surgery on the arrhythmia burden in obese individuals following CA for AF. One hundred and sixty individuals (age 18–70 years, body mass index ≥ 30 kg/m2) will be randomised in a 1:1 fashion to undergo a structured weight reduction programme and sleeve gastrectomy (when indicated and preferred by the patient) aiming to achieve greater than 10% weight reduction from baseline (intervention group) or standard post-ablation medical care (control group). Two-week continuous ECG monitoring will be used 3 and 18 months after CA to assess the arrhythmia burden. Other investigations will include transthoracic echocardiography with quantification of epicardial adipose tissue, and markers of low-grade inflammation and circulating adipokines. Planned Outcomes The main objective is to assess the effect of complex weight-reducing interventions on the arrhythmia burden and quality of life. Subgroup analyses to identify patient subgroups preferentially benefiting from weight loss related to a decrease in arrhythmia burden will be performed. Exploratory objectives will include investigation of potential mechanisms linking weight reduction with amelioration of arrhythmia burden such as changes in markers of low-grade inflammation, circulating adipokines, cytokines, monocytes or reduction of epicardial adipose tissue volume. Trial Registration NCT04560387
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Affiliation(s)
- Kristýna Štolbová
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Novodvorský
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Iva Jakubíková
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic
| | - Iveta Dvořáková
- Centre for Experimental Medicine, IKEM, Prague, Czech Republic
| | - Miloš Mráz
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Martin Haluzík
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic.
- First Faculty of Medicine, Charles University, Prague, Czech Republic.
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67
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Höskuldsdóttir G, Sattar N, Miftaraj M, Näslund I, Ottosson J, Franzén S, Svensson AM, Eliasson B. Potential Effects of Bariatric Surgery on the Incidence of Heart Failure and Atrial Fibrillation in Patients With Type 2 Diabetes Mellitus and Obesity and on Mortality in Patients With Preexisting Heart Failure: A Nationwide, Matched, Observational Cohort Study. J Am Heart Assoc 2021; 10:e019323. [PMID: 33754795 PMCID: PMC8174344 DOI: 10.1161/jaha.120.019323] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Obesity and diabetes mellitus are strongly associated with heart failure (HF) and atrial fibrillation (AF). The benefits of bariatric surgery on cardiovascular outcomes are known in people with or without diabetes mellitus. Surgical treatment of obesity might also reduce the incidence of HF and AF in individuals with obesity and type 2 diabetes mellitus (T2DM). Methods and Results In this register‐based nationwide cohort study we compared individuals with T2DM and obesity who underwent Roux‐en‐Y gastric bypass surgery with matched individuals not treated with surgery. The main outcome measures were hospitalization for HF and/or AF and mortality in patients with preexisting HF. We identified 5321 individuals with T2DM and obesity who had undergone Roux‐en‐Y gastric bypass surgery between January 2007 and December 2013 and 5321 matched controls. The individuals included were 18 to 65 years old and had a body mass index >27.5 kg/m2. The follow‐up time for hospitalization was until the end of 2015 (mean 4.5 years) and the end of 2016 for death. Our results show a 73% lower risk for HF (hazard ratio [HR], 0.27; CI, 0.19–0.38), 41% for AF (HR, 0.59; CI, 0.44–0.78), and 77% for concomitant AF and HF (HR, 0.23; CI, 0.12–0.46) in the surgically treated group. In patients with preexisting HF we observed significantly lower mortality in the group who underwent surgery (HR, 0.23; 95% CI, 0.12–0.43). Conclusions Bariatric surgery may reduce risk for HF and AF in patients with T2DM and obesity, speculatively via positive cardiovascular and renal effects. Obesity treatment with surgery may also be a valuable alternative in selected patients with T2DM and HF.
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Affiliation(s)
- Gudrún Höskuldsdóttir
- Department of Molecular and Clinical Medicine University of Gothenburg Sweden.,Department of Medicine Sahlgrenska University Hospital Gothenburg Sweden
| | - Naveed Sattar
- The Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom
| | - Mervete Miftaraj
- Centre of Registers National Diabetes Register Gothenburg Sweden
| | - Ingmar Näslund
- Department of Surgery Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Johan Ottosson
- Department of Surgery Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Stefan Franzén
- Centre of Registers National Diabetes Register Gothenburg Sweden.,Health Metrics Unit Sahlgrenska AcademyUniversity of Gothenburg Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine University of Gothenburg Sweden.,Centre of Registers National Diabetes Register Gothenburg Sweden
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine University of Gothenburg Sweden.,Department of Medicine Sahlgrenska University Hospital Gothenburg Sweden
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Murninkas M, Gillis R, Lee DI, Elyagon S, Bhandarkar NS, Levi O, Polak R, Klapper-Goldstein H, Mulla W, Etzion Y. A new implantable tool for repeated assessment of supraventricular electrophysiology and atrial fibrillation susceptibility in freely moving rats. Am J Physiol Heart Circ Physiol 2021; 320:H713-H724. [PMID: 33337966 DOI: 10.1152/ajpheart.00676.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 12/21/2022]
Abstract
The complex pathophysiology of atrial fibrillation (AF) is governed by multiple risk factors in ways that are still elusive. Basic electrophysiological properties, including atrial effective refractory period (AERP) and conduction velocity, are major factors determining the susceptibility of the atrial myocardium to AF. Although there is a great need for affordable animal models in this field of research, in vivo rodent studies are limited by technical challenges. Recently, we introduced an implantable system for long-term assessment of AF susceptibility in ambulatory rats. However, technical considerations did not allow us to perform concomitant supraventricular electrophysiology measurements. Here, we designed a novel quadripolar electrode specifically adapted for comprehensive atrial studies in ambulatory rats. Electrodes were fabricated from medical-grade silicone, four platinum-iridium poles, and stainless-steel fixating pins. Initial quality validation was performed ex vivo, followed by implantation in adult rats and repeated electrophysiological studies 1, 4, and 8 wk postimplantation. Capture threshold was stable. Baseline AERP values (38.1 ± 2.3 and 39.5 ± 2.0 using 70-ms and 120-ms S1-S1 cycle lengths, respectively) confirmed the expected absence of rate adaptation in the unanesthetized state and validated our prediction that markedly higher values reported under anesthesia are nonphysiological. Evaluation of AF substrate in parallel with electrophysiological parameters validated our recent finding of a gradual increase in AF susceptibility over time and demonstrated that this phenomenon is associated with an electrical remodeling process characterized by AERP shortening. Our findings indicate that the miniature quadripolar electrode is a potent new tool, which opens a window of opportunities for better utilization of rats in AF research.NEW & NOTEWORTHY Rodents are increasingly used in AF research. However, technical challenges restrict long-term supraventricular electrophysiology studies in these species. Here, we developed an implantable electrode adapted for such studies in the rat. Our findings indicate that this new tool is effective for long-term follow-up of critical parameters such as atrial refractoriness. Obtained data shed light on the normal electrophysiology and on the increased AF susceptibility that develops in rats with implanted atrial electrodes over time.
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Affiliation(s)
- Michael Murninkas
- Cardiac Arrhythmia Research Laboratory, Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roni Gillis
- Cardiac Arrhythmia Research Laboratory, Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Danielle I Lee
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Canadian Centre for Agri-Food Research in Health and Medicine (CCARM), St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
| | - Sigal Elyagon
- Cardiac Arrhythmia Research Laboratory, Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nikhil S Bhandarkar
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Or Levi
- Cardiac Arrhythmia Research Laboratory, Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rotem Polak
- Cardiac Arrhythmia Research Laboratory, Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hadar Klapper-Goldstein
- Cardiac Arrhythmia Research Laboratory, Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Wesam Mulla
- Cardiac Arrhythmia Research Laboratory, Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoram Etzion
- Cardiac Arrhythmia Research Laboratory, Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Lin Y, Wang X, Li XB, Wu BQ, Zhang ZH, Guo WH, Wu CC, Chen X, Chen ML, Dai Z, Chen FY, Zhu R, Liang CX, Tian YP, Yang G, Yan CQ, Lu J, Wang HY, Li JL, Tu JF, Li HW, Yang DD, Yu FT, Wang Y, Yang JW, Shi GX, Yan SY, Wang LQ, Liu CZ. Acupuncture for persistent atrial fibrillation after catheter ablation: study protocol for a pilot randomized controlled trial. Trials 2021; 22:35. [PMID: 33413569 PMCID: PMC7792186 DOI: 10.1186/s13063-020-04967-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/11/2020] [Indexed: 12/17/2022] Open
Abstract
Background Atrial fibrillation (AF) is a common arrhythmia, which is closely related to cardiovascular morbidity and mortality. Although acupuncture is used in the treatment of AF, the evidence is insufficient. The objective of this pilot trial is to evaluate the feasibility, preliminary efficacy, and safety of acupuncture in reducing AF burden for persistent AF after catheter ablation (CA). Methods and design This will be a multi-center, 3-arm, pilot randomized controlled trial in China. Sixty patients in total will be randomly assigned to the specific acupoints group, the non-specific acupoints group, or the non-acupoints group in a 1:1:1 ratio. The whole study period is 6 months, including a 3-month treatment period and a 3-month follow-up period. All patients will receive 18 sessions of acupuncture over 12 weeks after CA and appropriate post-ablation routine treatment. The primary outcome is AF burden at 6 months after CA measured by electrocardiography patch that can carry out a 7-day continuous ambulatory electrocardiographic monitoring. The secondary outcomes include AF burden at 3 months after CA, recurrence of AF, quality of life, etc. The adverse events will also be recorded. Discussion This pilot study will contribute to evaluating the feasibility, preliminary efficacy, and safety of acupuncture in reducing AF burden for persistent AF after CA. The results will be used for the sample size calculation of a subsequent large-scale trial. Trial registration Chinese Clinical Trial Registry ChiCTR2000030576. Registered on 7 March 2020. Supplementary information Supplementary information accompanies this paper at 10.1186/s13063-020-04967-y.
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Affiliation(s)
- Ying Lin
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Xian Wang
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing University Cardiology Research Institute of Traditional Chinese Medicine, Beijing, 100700, China
| | - Xue-Bin Li
- Department of Cardiology, Peking University People's Hospital, Beijing, 100044, China
| | - Bang-Qi Wu
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Zhao-Hui Zhang
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wei-Hua Guo
- Department of Cardiology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Cun-Cao Wu
- Department of Cardiology, Peking University People's Hospital, Beijing, 100044, China
| | - Xin Chen
- Department of Cardiology, Tianjin First Center Hospital, Tianjin, 300192, China
| | - Ming-Long Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Zhong Dai
- Department of Traditional Chinese Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Fu-Yan Chen
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Rui Zhu
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Chu-Xi Liang
- Department of Traditional Chinese Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yun-Peng Tian
- Department of Cardiology, Tianjin First Center Hospital, Tianjin, 300192, China
| | - Gang Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Chao-Qun Yan
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jing Lu
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Hai-Ying Wang
- Department of Cardiology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jin-Ling Li
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Jian-Feng Tu
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, 100010, China
| | - He-Wen Li
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Dan-Dan Yang
- Department of Cardiology, Peking University People's Hospital, Beijing, 100044, China
| | - Fang-Ting Yu
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Yu Wang
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Jing-Wen Yang
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Guang-Xia Shi
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Shi-Yan Yan
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Li-Qiong Wang
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China.
| | - Cun-Zhi Liu
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
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Watanabe H, Kabutoya T, Hoshide S, Kario K. Atrial fibrillation is associated with cardiovascular events in obese Japanese with one or more cardiovascular risk factors: The Japan Morning Surge Home Blood Pressure (J‐HOP) Study. J Clin Hypertens (Greenwich) 2021; 23:665-671. [PMID: 33405296 PMCID: PMC8029557 DOI: 10.1111/jch.14170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/28/2023]
Abstract
The impacts of atrial fibrillation (AF) and home blood pressure (BP) on the cardiovascular prognosis of obese individuals have not been clarified. We analyzed the differences in the prognosis (including the effect of the home BP of AF patients with/without obesity) in a Japanese population with cardiovascular risk factors. We enrolled 3,586 patients from the J‐HOP study who had at least one cardiovascular risk factor. We conducted 12‐lead electrocardiography, and the group of AF patients was determined as those whose electrocardiography revealed AF. Obesity was defined as a body mass index >25 kg/m2. The primary end points were fatal/nonfatal cardiovascular events (myocardial infarction, stroke, hospitalization for heart failure, and aortic dissection). Among the obese patients, those with AF (n = 36) suffered more significantly cardiovascular events (log rank 7.17, p = .007) compared to the patients with sinus rhythm (n = 1,282), but among the non‐obese patients, the rates of cardiovascular events were similar (log rank 0.006, p = .94) in the AF patients (n = 48) and sinus rhythm patients (n = 2220). After adjusting for age, sex, office/home BP, smoking, diabetes, and creatinine level, AF was an independent predictor of cardiovascular events in the obese group (hazard ratio [HR] 3.05, 95%CI: 1.17‐7.97, p = .023). Home systolic BP was also a predictor of cardiovascular events in the obese group independent of the risk of AF (per 10 mm Hg: HR 1.36, 95%CI: 1.02‐1.83, p = .039). In conclusion, AF was an independent predictor of cardiovascular events in obese patients after adjusting for home BP.
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Affiliation(s)
- Hiroaki Watanabe
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke, Tochigi Japan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke, Tochigi Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke, Tochigi Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke, Tochigi Japan
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71
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Lin D, Chen Y, Yong J, Wu S, Zhou Y, Li W, Tan X, Liu R. Does Warfarin or Rivaroxaban at Low Anticoagulation Intensity Provide a Survival Benefit to Asian Patients With Atrial Fibrillation? Front Cardiovasc Med 2021; 8:768730. [PMID: 34901228 PMCID: PMC8655790 DOI: 10.3389/fcvm.2021.768730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/03/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Low-dose rivaroxaban and low-intensity warfarin are widely used in Asia for patients with atrial fibrillation (AF). However, in Asians, it is unclear whether low-dose rivaroxaban and low-intensity warfarin can improve the prognosis of AF. In this study, we investigate the survival benefits of low-dose rivaroxaban and low-intensity warfarin in Asian patients with AF in clinical practice. Methods: This cohort study used medical records in a single tertiary hospital in China, between 2019 and 2020, to identify patients with AF who used rivaroxaban or warfarin, or had no anticoagulant therapy. Follow-ups were performed through telephone contact or medical record review. Cox proportional hazards models were used to compare the risk of mortality of patients in the anticoagulant-untreated group vs. warfarin-treated groups and rivaroxaban-treated groups. Results: A total of 1727 AF patients, discharged between 2019 and 2020, were enrolled in this cohort, of which 873 patients did not use any anticoagulant, 457 patients received warfarin and 397 patients used rivaroxaban. Multivariable analysis showed that, of all the warfarin groups, patients with an international normalized ratio (INR) below 2, good INR control, or poor INR control had a significantly lower risk of mortality compared with that of patients without anticoagulants (HR 0.309, p = 0.0001; HR 0.387, p = 0.0238; HR 0.363, p < 0.0001). Multivariable Cox proportional hazard analyses also demonstrated that, compared with the no anticoagulant group, all rivaroxaban dosage groups (≤10 mg, HR 0.456, p = 0.0129; 15 mg, HR 0.246, p = 0.0003; 20 mg, HR 0.264, p = 0.0237) were significantly associated with a lower risk of mortality. Conclusion: Despite effects being smaller than observed with recommended optimal anticoagulation, the use of warfarin with an INR below 2, poor INR control and the use of low-dose rivaroxaban may still provide survival benefits, suggesting viable alternatives that enable physicians to better resolve decisional conflicts concerning the risks and benefits of anticoagulant therapies, as well as for patients in need of but unable to receive standard anticoagulant therapy due to bleeding risk or other factors, such as financial burden, concerns of adverse outcomes, as well as low treatment compliance and persistence.
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Affiliation(s)
- Dong Lin
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Yequn Chen
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Clinical Cohort Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jian Yong
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shiwan Wu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yan Zhou
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Weiping Li
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Clinical Cohort Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xuerui Tan
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Clinical Cohort Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- *Correspondence: Xuerui Tan
| | - Ruisheng Liu
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
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72
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Wang W, Norby FL, Rooney MR, Zhang M, Gutierrez A, Garg P, Soliman EZ, Alonso A, Dudley SC, Lutsey PL, Chen LY. Association of Life's Simple 7 with Atrial Fibrillation Burden (From the Atherosclerosis Risk in Communities Study). Am J Cardiol 2020; 137:31-38. [PMID: 32998009 PMCID: PMC7704629 DOI: 10.1016/j.amjcard.2020.09.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 12/23/2022]
Abstract
The American Heart Association's Life's Simple 7 (LS7) metric consists of 7 modifiable risk factors. Although a more favorable LS7 risk factor profile is associated with lower AF incidence, this relation is unknown in regard to AF burden. We assessed the prospective association of overall LS7 score and individual LS7 risk factors in midlife with AF burden in late-life in the Atherosclerosis Risk in Communities Study. LS7 components were assessed at Visit 3 (1993 to 1995) and a composite score ranging from 0 to 14 was calculated. A higher score indicates better cardiovascular health. AF burden was measured at Visit 6 (2016 to 2017) with a 2-week Zio XT Patch. AF burden, defined as the percent of time a participant was in AF, was categorized as none, intermittent (>0 to <100%), or continuous (100%). Weighted multinomial logistic regression was used. Of the 2,363 participants, 58% were female and 24% were black. Participants were aged 57 ± 5 years at Visit 3 and 79 ± 5 years at Visit 6. From the Zio XT Patch, 5% had continuous AF, 4% had intermittent AF, and 91% had none. After multivariable adjustment, each 1-point increase in LS7 score had 0.87 (95% CI: 0.79 to 0.95) higher odds of continuous AF than no AF. Individually, poor levels of physical activity, BMI, and fasting blood glucose were associated with greater AF burden. In conclusion, this population-based prospective cohort study reports that unfavorable cardiovascular health profile in midlife is associated with higher AF burden in late-life and future research to evaluate the effectiveness of optimizing physical activity, BMI, and fasting blood glucose in lowering AF burden is warranted.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Mary R Rooney
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michael Zhang
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Alejandra Gutierrez
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Parveen Garg
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elsayed Z Soliman
- Department of Epidemiology, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Samuel C Dudley
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Estes NAM, Jain SK. Risk Factor Modification for Atrial Fibrillation: An Ounce of Prevention. JACC Clin Electrophysiol 2020; 6:1288-1290. [PMID: 33092756 DOI: 10.1016/j.jacep.2020.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022]
Affiliation(s)
- N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | - Sandeep K Jain
- Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Ward R, Ponamgi S, DeSimone CV, English S, Hodge DO, Slusser JP, Graff-Radford J, Rabinstein AA, Asirvatham SJ, Holmes D. Utility of HAS-BLED and CHA 2DS 2-VASc Scores Among Patients With Atrial Fibrillation and Imaging Evidence of Cerebral Amyloid Angiopathy. Mayo Clin Proc 2020; 95:2090-2098. [PMID: 32829908 PMCID: PMC8635034 DOI: 10.1016/j.mayocp.2020.03.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/18/2020] [Accepted: 03/20/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the utility of the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol concomitantly) and CHA2DS2-VASc (Congestive heart failure, Hypertension, Age, Diabetes, previous Stroke/transient ischemic attack-VAScular disease) scores among patients on anticoagulation (AC) therapy for atrial fibrillation (AF) who have evidence of cerebral amyloid angiopathy (CAA). PATIENTS AND METHODS Patients older than 55 years with a diagnosis of AF who had a nontraumatic intracerebral hemorrhage (ICH) while on AC therapy between 1995 and 2016 were identified using the Rochester Epidemiology Project Database. Medical records were reviewed, including imaging of the brain, to identify baseline characteristics, AC use, and outcomes. RESULTS A total of 65 patients were identified (mean age, 81.3 years); 35 (53.8%) had evidence of possible/probable CAA. Mean HAS-BLED score in the CAA group was significantly lower (2.1) than that of the non-CAA group (2.9; P<.001). Mortality after ICH, adjusted for HAS-BLED scores, was not significantly different among patients with and without CAA. Sixteen patients restarted on AC therapy after ICH; CHA2DS2-VASc scores were no different between this group and those who were not restarted. Among patients with CAA, the overall rate of ICH recurrence was 8.6% over 93.5 person-years of follow-up. Among patients with CAA, the rate of ICH recurrence was 3.2 per 100 patient-years, higher than their HAS-BLED scores would predict (1.9 bleeds/100 patient-years). CONCLUSION HAS-BLED scores were lower in patients who had evidence of CAA compared with those without, suggesting underestimation of ICH risk in patients with CAA. CHA2DS2-VASc scores did not affect resumption of AC therapy. ICH recurrence was higher in patients with CAA than their HAS-BLED scores predicted. Current risk assessment scoring systems do not accurately account for CAA in patients with AF on AC.
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Affiliation(s)
- Robert Ward
- Division of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Shiva Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - David Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Comprehensive Analysis of Differential Immunocyte Infiltration and Potential ceRNA Networks Involved in the Development of Atrial Fibrillation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8021208. [PMID: 33015181 PMCID: PMC7525288 DOI: 10.1155/2020/8021208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 01/12/2023]
Abstract
This study is aimed at identifying potential molecular mechanisms and candidate biomarkers in the left atrial regions for the diagnosis and treatment of valvular atrial fibrillation (VAF). Multibioinformatics methods, including linear models for microarray analysis (LIMMA), an SVA algorithm, CIBERSORT immune infiltration, and DNA methylation analysis, were employed. In addition, the protein-protein interaction (PPI) network, Gene Ontology (GO), and molecular pathways of differentially expressed genes (DEGs) or differential methylation regions were constructed. In all, compared with the normal rhythm group, 243 different mRNAs (29 downregulated and 214 upregulated) and 26 different lncRNAs (3 downregulated and 23 upregulated) were detected in the left atrium (LA) of atrial fibrillation (AF) patients, and the neutrophil and CD8+ T cell were infiltrated. Additionally, 199 different methylation sites (107 downregulated and 92 upregulated) were also identified based on DNA methylation analysis. After integration, ELOVL2, CCR2, and WEE1 were detected for differentially methylated and differentially transcribed genes. Among them, WEE1 was also a core gene identified by the competing endogenous RNA (ceRNA) network that included WEE1-KRBOX1-AS1-hsa-miR-17-5p, in VAF left atrial tissue. We combined the DNA methylation and transcriptional expression differential analysis and found that WEE1 (cg13365543) may well be a candidate gene regulated by DNA methylation modification. Moreover, KRBOX1-AS1 and WEE1 can compete endogenously and may mediate myocardial tissue infiltration into CD8+ T cells and participate in the AF process.
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Shi S, Shi J, Jia Q, Shi S, Yuan G, Hu Y. Efficacy and safety of ShenSongYangXin Capsule combined with antiarrhythmic drugs for atrial fibrillation: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e22367. [PMID: 32957412 PMCID: PMC10545279 DOI: 10.1097/md.0000000000022367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Shen-Song-Yang-Xin Capsule (SSYX), a Chinese patent medicine, combined with antiarrhythmic drugs (AADs) in the treatment of atrial fibrillation (AF) has been widely applied in clinical practice, but the results are controversial. This study aims to conduct a network meta-analysis (NMA) based on data from the randomized controlled trials (RCTs) to evaluate the efficacy and safety of SSYX combined with ADDs in the treatment of AF. METHODS AND ANALYSIS A comprehensive systematic literature search will be conducted in Cochrane Library, PubMed, Web of Science, EMBASE, Chinese Biomedical Literature Database (SinoMed), Chinese National Knowledge Infrastructure (CNKI), and WanFang database for RCTs about SSYX combined with ADDs. The primary outcomes will be the frequency of AF attack and P-wave dispersion, and the secondary outcomes will be the symptom improvements, left atrial diameter, and adverse events. Statistical analyses will be conducted by using WinBUGS software (version 1.4.3), Stata software (version 14.0) and RevMan software (version 5.3). RESULTS The results of this NMA will provide a high-quality evidence for the efficacy of SSYX combined with ADDs in the treatment of AF, and a ranking of the therapeutic classes will also be presented. CONCLUSION The protocol will provide updated evidence for the application of SSYX for AF. INTERNATIONAL PLATFORM OF REGISTERED SYSTEMATIC REVIEW AND META-ANALYSIS PROTOCOLS (INPLASY) REGISTRATION NUMBER:: The protocol of this systematic review and meta-analysis was registered on the INPLASY website (https://inplasy.com/inplasy-2020-8-0075/) and INPLASY registration number is INPLASY202080075.
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Affiliation(s)
- Shuqing Shi
- Cardiovascular Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jingjing Shi
- Cardiovascular Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Qiulei Jia
- Cardiovascular Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Shuai Shi
- Cardiovascular Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Guozhen Yuan
- Cardiovascular Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Yuanhui Hu
- Cardiovascular Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
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Ghattas KN, Ilyas S, Al-Refai R, Maharjan R, Diaz Bustamante L, Khan S. Obesity and Atrial Fibrillation: Should We Screen for Atrial Fibrillation in Obese Individuals? A Comprehensive Review. Cureus 2020; 12:e10471. [PMID: 32953364 PMCID: PMC7494408 DOI: 10.7759/cureus.10471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 11/14/2022] Open
Abstract
Obesity and obesity-related illnesses (ORIs) constitute a significant burden on the healthcare system, with a very high prevalence in the general population. Atrial fibrillation (AF) is the most common arrhythmia seen by healthcare providers. The risk of AF in obese individuals is reported to be high and in correlation with Body Mass Index (BMI), leading to the high prevalence of AF in the general population and the expected epidemic of AF to come. Greater left atrial dimensions and left atrial remodeling together form the AF substrate in the obese population along with the role of epicardial adipose tissue (EAT) in inducing inflammation and fibrosis of the atrial myocardium and thus facilitating the onset of AF. In our paper, we reviewed the literature published on the link between obesity and AF, as well as the potential behind new management approaches. Multiple studies have explored different approaches, either conventional or novel. Considering the impact of prevention in medicine nowadays, we proposed a screening practice for AF in obese individuals. More research is needed to acquire a comprehensive protocol for the management of AF in the obese population that can be applied by primary healthcare providers to combat this evolving matter.
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Affiliation(s)
- Kyrillos N Ghattas
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Shahbakht Ilyas
- Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Reham Al-Refai
- Pathology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Reeju Maharjan
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Liliana Diaz Bustamante
- Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Zangrillo A, Mazzone P, Oriani A, Pieri M, Frau G, D'Angelo G, Sartini C, Capucci R, Belletti A, Bella PD, Monaco F. Noninvasive ventilation during left atrial appendage closure under sedation: Preliminary experience with the Janus Mask. Ann Card Anaesth 2020; 22:400-406. [PMID: 31621676 PMCID: PMC6813712 DOI: 10.4103/aca.aca_145_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Percutaneous left atrial appendage occlusion (LAAO) is indicated in subjects with atrial fibrillation who cannot receive oral anticoagulants. This procedure requires transesophageal echocardiography guidance and is usually performed under general anesthesia. The Janus Mask is a new device designed to allow upper endoscopic procedures during noninvasive ventilation (NIV). Aims: This study aims to assess the possibility of performing LAAO under sedation and NIV. Setting: Cardiac electrophysiology laboratory. Design: Case–control study. Materials and Methods: Data from 11 subjects undergoing LAAO under sedation and NIV with the Janus Mask were retrospectively collected. Procedure duration, outcomes, and physicians' satisfaction were compared with those of 11 subjects who underwent LAAO under general anesthesia in the same period. Statistical Analysis: Univariate analysis and analysis of variance for between-groups comparison. Results: The 11 subjects treated with sedation experienced a good outcome, with a high degree of satisfaction from the medical team. An increase in arterial partial pressure of carbon dioxide in the Janus group (45 [43–62] mmHg vs. 33 [30–35] mmHg in the general anesthesia group, P < 0.001) led to a transient pH decrease 45 min after the beginning of the procedure (7.30 [7.18–7.36] vs. 7.40 [7.39–7.46], P = 0.014). No differences in arterial partial pressure of oxygen, FiO2, and hemodynamic parameters were observed. The subjects' conditions at discharge from the recovery room were comparable. No difference in procedure duration was registered. Conclusions: LAAO procedure under sedation and NIV through the Janus Mask is safe and feasible. This strategy might represent a valuable alternative to manage such a compromised and fragile population.
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Affiliation(s)
- Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizio Mazzone
- Department of Cardio-Thoracic-Vascular, Arrhythmology and Electrophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Oriani
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna Frau
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe D'Angelo
- Department of Cardio-Thoracic-Vascular, Arrhythmology and Electrophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Sartini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Capucci
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Della Bella
- Department of Cardio-Thoracic-Vascular, Arrhythmology and Electrophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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79
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Shi S, Shi J, Jia Q, Shi S, Yuan G, Hu Y. Efficacy of Physical Exercise on the Quality of Life, Exercise Ability, and Cardiopulmonary Fitness of Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis. Front Physiol 2020; 11:740. [PMID: 32792965 PMCID: PMC7393267 DOI: 10.3389/fphys.2020.00740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022] Open
Abstract
Objective: Physical exercise is recommended to help prevent lifestyle diseases. The present study was designed to quantify the efficacy of physical exercise on the quality of life (QoL), exercise ability and cardiopulmonary fitness of patients with atrial fibrillation (AF). Method: A comprehensive systematic literature search was performed in Medline, Embase, Cochrane Library, Web of Science and PubMed databases (from 1970 to December 1st, 2019) for randomized controlled trials (RCTs) comparing physical exercise combined with AF routine treatments to routine treatments alone. The meta-analysis was conducted following PRISMA guidelines. Our main outcomes were QoL (measured by the Short-Form 36 scale, SF-36), exercise ability (measured by the 6-min walk test, 6MWT) and cardiopulmonary fitness (measured by peak oxygen uptake and resting heart rate). Quality assessments were conducted using the Cochrane Collaboration tool. Results: Twelve trials involving 819 patients met the criteria for analysis. The results showed that physical exercise improved the QoL by enhancing physical functioning [standardized mean difference (SMD) = 0.63, 95%CI: 0.18–1.09; p = 0.006], general health perceptions (SMD = 0.64, 95%CI: 0.35–0.93; p < 0.001) and vitality (SMD = 0.51, 95%CI: 0.31–0.71; p < 0.001); increased exercise ability by improving the 6MWT performance (SMD = 0.69, 95%CI: 0.19–1.119; p = 0.007); and enhanced peak VO2 (SMD = 0.37, 95%CI: 0.16–0.57; p < 0.001) while reducing resting heart rate (SMD = −0.39, 95%CI: −0.65 to −0.13; p = 0.004). In addition, meta-regression analysis showed that training mode (pphysicalfunctioning = 0.012, pgeneralhealthperceptions = 0.035) and training duration (p = 0.047) were the main factors of an intervention that influenced the effect size. Following sub-group analysis, we found that aerobics, Yoga and longer training durations (≥60 min) showed larger improvements. Conclusion: In summary, our meta-analysis shows that physical exercise has a positive effect on the QoL, exercise ability and cardiopulmonary fitness in AF patients. When physicians offer exercise recommendations to AF patients, they should consider both the training mode and training duration to achieve maximum results.
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Affiliation(s)
- Shuqing Shi
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Department of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jingjing Shi
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiulei Jia
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Department of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shuai Shi
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guozhen Yuan
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanhui Hu
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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80
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Gorczyca I, Jelonek O, Michalska A, Chrapek M, Wałek P, Wożakowska-Kapłon B. Stroke prevention and guideline adherent antithrombotic treatment in elderly patients with atrial fibrillation: A real-world experience. Medicine (Baltimore) 2020; 99:e21209. [PMID: 32702889 PMCID: PMC7373526 DOI: 10.1097/md.0000000000021209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients aged ≥75 years with the diagnosis of atrial fibrillation (AF) are at a higher risk of stroke and, according to recent recommendations, should receive oral anticoagulant (OAC) therapy. This study aimed to assess the recommended prophylactic antithrombotic therapy among patients with AF aged ≥ 75 years and its compliance with current guidelines. We also aimed to identify predisposing factors associated with the administration of non-vitamin K antagonist oral anticoagulants (NOACs) in elderly patients with AF.This was a retrospective, single-center observational study. Patients with AF aged ≥75 years hospitalized at a reference cardiology center from 2014 to 2017 were included in the analysis.Among the 1236 eligible patients (43.4% male; mean age, 82 years), OACs were recommended in 90.1% of cases. Of these, 59.8% of patients used NOACs and 40.2% used vitamin K antagonists. Additionally, 3.3% of patients received antiplatelet (AP) therapy and 2.5% were administered low molecular weight heparin. Only 4.5% of patients did not receive any anticoagulant treatment. The majority (89.9%) of patients received relevant prophylactic antithrombotic therapy according to current guidelines; only 1.4% were overtreated and 8.7% were undertreated. The significant predictors of NOAC therapy among patients treated with anticoagulants were non-permanent AF (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.30-2.18, P = .0001), age-by 5 years (OR = 1.33, 95% CI = 1.16-1.52, P = .0001), and glomerular filtration rate-by 5 units (OR = 1.06, 95% CI = 1.02-1.10, P = .0066).A high percentage of AF patients aged ≥75 years receive OACs, mainly NOACs. Most patients are treated according to the current guidelines; under treatment is primarily observed in patients receiving AP therapy. Non-permanent AF, age, and preservation of renal function are significant predictors of NOAC use.
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Affiliation(s)
- Iwona Gorczyca
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
- Collegium Medicum, The Jan Kochanowski University
| | - Olga Jelonek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
| | | | - Magdalena Chrapek
- Faculty of Mathematics and Natural Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Paweł Wałek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
- Collegium Medicum, The Jan Kochanowski University
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81
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Remy KE, Verhoef PA, Malone JR, Ruppe MD, Kaselitz TB, Lodeserto F, Hirshberg EL, Slonim A, Dezfulian C. Caring for Critically Ill Adults With Coronavirus Disease 2019 in a PICU: Recommendations by Dual Trained Intensivists. Pediatr Crit Care Med 2020; 21:607-619. [PMID: 32420720 PMCID: PMC7331597 DOI: 10.1097/pcc.0000000000002429] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In the midst of the severe acute respiratory syndrome coronavirus 2 pandemic, which causes coronavirus disease 2019, there is a recognized need to expand critical care services and beds beyond the traditional boundaries. There is considerable concern that widespread infection will result in a surge of critically ill patients that will overwhelm our present adult ICU capacity. In this setting, one proposal to add "surge capacity" has been the use of PICU beds and physicians to care for these critically ill adults. DESIGN Narrative review/perspective. SETTING Not applicable. PATIENTS Not applicable. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The virus's high infectivity and prolonged asymptomatic shedding have resulted in an exponential growth in the number of cases in the United States within the past weeks with many (up to 6%) developing acute respiratory distress syndrome mandating critical care services. Coronavirus disease 2019 critical illness appears to be primarily occurring in adults. Although pediatric intensivists are well versed in the care of acute respiratory distress syndrome from viral pneumonia, the care of differing aged adult populations presents some unique challenges. In this statement, a team of adult and pediatric-trained critical care physicians provides guidance on common "adult" issues that may be encountered in the care of these patients and how they can best be managed in a PICU. CONCLUSIONS This concise scientific statement includes references to the most recent and relevant guidelines and clinical trials that shape management decisions. The intention is to assist PICUs and intensivists in rapidly preparing for care of adult coronavirus disease 2019 patients should the need arise.
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Affiliation(s)
- Kenneth E Remy
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - Philip A Verhoef
- Department of Internal Medicine, University of Hawaii-Manoa, Manoa, HI
- Kaiser Permanente Hawaii, Honolulu, HI
| | - Jay R Malone
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Michael D Ruppe
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Norton Healthcare, University of Louisville, Louisville, KY
| | - Timothy B Kaselitz
- Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Frank Lodeserto
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Danville, PA
- Department of Pediatrics, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Eliotte L Hirshberg
- Division of Pulmonary and Critical Care, Department of Internal Medicine and Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Anthony Slonim
- University of Nevada, Reno School of Medicine, Renown Health System, Reno, NV
| | - Cameron Dezfulian
- Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA
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82
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Duarte RCF, Rios DRA, Figueiredo EL, Caiaffa JRS, Silveira FR, Lanna R, Alves LCV, Martins GL, Reis HJ, Reis EA, Ferreira CN, Sternick EB, Campos FMF, das Graças Carvalho M. Thrombin Generation and other hemostatic parameters in patients with atrial fibrillation in use of warfarin or rivaroxaban. J Thromb Thrombolysis 2020; 51:47-57. [PMID: 32377955 DOI: 10.1007/s11239-020-02126-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patients with atrial fibrillation (AF) present hyperactivation of both platelets and coagulation leading to a hypercoagulable state which contributes to an increased risk of thromboembolism. Therefore, one of the main strategies for treatment of AF is prevention of these events through the use of oral anticoagulants (OAC). The aim of this study was to evaluate hemostasis as a whole in patients with non-valvular AF undergoing warfarin or rivaroxaban by thrombin generation test (TGT), in addition to monocyte-platelet aggregates (MPA), glycoprotein IIb/IIIa (GPIIb/IIIa), and platelet (PMP) and endothelium (EMP) microparticles, compared to age and sex matched controls. PT/INR for OAC use was also determined. In patients taking OAC, compared to control group, a decrease in TGT (p = 0.000 for all parameters) were observed. Patients taking warfarin showed to be more hypocoagulable, presenting lower levels of ETP (p = 0.000) and peak (p = 0.002) than patients using rivaroxaban. Patients on warfarin use with INR > 3 had also lower levels of ETP (p = 0.01) and peak (p = 0.006). A decrease in ETP (p = 0.03) and peak (p = 0.02) values was also observed in patients using rivaroxaban with PT > 21.4 s. Patients using warfarin (p = 0.000) and rivaroxaban (p = 0.000) presented lower levels of MPA in relation to control group. It was also observed in patients using warfarin, lower GPIIb/IIIa levels in relation to control group (p = 0.011). Patients taking rivaroxaban (p = 0.003) and warfarin (p = 0.001) had higher PMP levels compared to control group. There was no difference in levels of EMP between the groups (p = 0.0536). The present study reinforces the usefulness of OAC in AF, which decisively contribute to a better management of the disease preventing possible complications.
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Affiliation(s)
- Rita Carolina Figueiredo Duarte
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Federal, University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, 31270-910, Brazil
| | | | | | | | | | | | - Luan Carlos Vieira Alves
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Federal, University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, 31270-910, Brazil
| | - Gabriela Lopes Martins
- Institute of Biological Sciences of Federal, University of Minas Gerais, Belo Horizonte, Brazil
| | - Helton José Reis
- Institute of Biological Sciences of Federal, University of Minas Gerais, Belo Horizonte, Brazil
| | - Edna Afonso Reis
- Institute of Exact Sciences of Federal, University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Fernanda Magalhães Freire Campos
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Federal, University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, 31270-910, Brazil
| | - Maria das Graças Carvalho
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Federal, University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, 31270-910, Brazil.
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83
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Drum SN, Donath L, Dehlin C, Kashou A, Noseworthy PA, Zacher J. Atrial Fibrillation: Should Lifelong Athletes Be Worried? Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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84
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Mittal VS, Wu B, Song J, Milentijevic D, Ashton V, Mahajan D. Healthcare resource utilization and costs among nonvalvular atrial fibrillation patients initiating rivaroxaban or warfarin in skilled nursing facilities: a retrospective cohort study. Curr Med Res Opin 2020; 36:529-536. [PMID: 31858841 DOI: 10.1080/03007995.2019.1706464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Atrial fibrillation (AF) is present in up to 17% of patients in skilled nursing facilities (SNFs). This study compared healthcare resource utilization (HRU) and costs between AF patients initiating rivaroxaban or warfarin in SNFs.Methods: Using de-identified claims from Optum Clinformatics Extended Data Mart (1 January 2013 to 31 December 2017), this retrospective cohort study indexed AF patients with first SNF admission during which rivaroxaban or warfarin was initiated within 3 days of admission. To adjust for selection bias, inverse probability of treatment weighting (IPTW) was applied for baseline characteristics. Logistic regression and generalized linear models were used to compare HRU and costs.Results: 519 rivaroxaban and 1129 warfarin patients met inclusion criteria. After IPTW, the cohorts were well balanced for baseline characteristics. The average length of index SNF stay was 32.07 and 37.44 days for rivaroxaban and warfarin patients, respectively. During SNF stay, rivaroxaban patients had 27% lower odds of hospitalization (p < .0001), 2.7 fewer international normalized ratio (INR) tests per-patient-per-month (PPPM; p < .001), and 2.3 fewer pathology/laboratory encounters PPPM (p < .0001) than warfarin patients. All-cause healthcare costs were $2638 lower with rivaroxaban versus warfarin (p < .0001) during the index SNF stay, with lower medical costs (p < .0001) but higher pharmacy costs (p < .0001). Total all-cause healthcare costs 100 days post-index SNF were $8746 lower with rivaroxaban versus warfarin (p < .0001).Conclusions: In the SNF setting, AF patients treated with rivaroxaban had 5-day shorter length of stay, lower HRU, and lower all-cause total and medical costs compared to warfarin, despite higher treatment costs. These findings may help inform clinical decision-making to reduce economic burden.
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Affiliation(s)
- V Simon Mittal
- Advanced Health Institute and LTC Professionals, Bloomington, MN, USA
| | - Bingcao Wu
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Ji Song
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Dheeraj Mahajan
- University of Illinois at Chicago and Advocate Illinois Masonic Medical Center, Melrose Park, IL, USA
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85
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van Gorp PRR, Trines SA, Pijnappels DA, de Vries AAF. Multicellular In vitro Models of Cardiac Arrhythmias: Focus on Atrial Fibrillation. Front Cardiovasc Med 2020; 7:43. [PMID: 32296716 PMCID: PMC7138102 DOI: 10.3389/fcvm.2020.00043] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/06/2020] [Indexed: 12/13/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice with a large socioeconomic impact due to its associated morbidity, mortality, reduction in quality of life and health care costs. Currently, antiarrhythmic drug therapy is the first line of treatment for most symptomatic AF patients, despite its limited efficacy, the risk of inducing potentially life-threating ventricular tachyarrhythmias as well as other side effects. Alternative, in-hospital treatment modalities consisting of electrical cardioversion and invasive catheter ablation improve patients' symptoms, but often have to be repeated and are still associated with serious complications and only suitable for specific subgroups of AF patients. The development and progression of AF generally results from the interplay of multiple disease pathways and is accompanied by structural and functional (e.g., electrical) tissue remodeling. Rational development of novel treatment modalities for AF, with its many different etiologies, requires a comprehensive insight into the complex pathophysiological mechanisms. Monolayers of atrial cells represent a simplified surrogate of atrial tissue well-suited to investigate atrial arrhythmia mechanisms, since they can easily be used in a standardized, systematic and controllable manner to study the role of specific pathways and processes in the genesis, perpetuation and termination of atrial arrhythmias. In this review, we provide an overview of the currently available two- and three-dimensional multicellular in vitro systems for investigating the initiation, maintenance and termination of atrial arrhythmias and AF. This encompasses cultures of primary (animal-derived) atrial cardiomyocytes (CMs), pluripotent stem cell-derived atrial-like CMs and (conditionally) immortalized atrial CMs. The strengths and weaknesses of each of these model systems for studying atrial arrhythmias will be discussed as well as their implications for future studies.
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Affiliation(s)
| | | | | | - Antoine A. F. de Vries
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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86
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DE Vecchis R, Paccone A, DI Maio M. Pill-in-the-pocket therapy for paroxysmal atrial fibrillation: a revival of interest for an old approach in the area of antiarrhythmic strategies. Minerva Cardiol Angiol 2020; 69:121-123. [PMID: 32138504 DOI: 10.23736/s2724-5683.20.05217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Renato DE Vecchis
- Medical and Polyspecialist Center, S. Gennaro dei Poveri Hospital, Naples, Italy -
| | - Andrea Paccone
- Department of Cardiology, Aldo Moro University of Bari, Bari, Italy
| | - Marco DI Maio
- Department of Cardiology, Luigi Vanvitelli University of Campania, Naples, Italy
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87
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Noale M, Veronese N, Smith L, Ungar A, Fumagalli S, Maggi S. Associations between cardiac arrhythmia, incident disability in activities of daily living and physical performance: the ILSA study. J Geriatr Cardiol 2020; 17:127-132. [PMID: 32280328 PMCID: PMC7118013 DOI: 10.11909/j.issn.1671-5411.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/24/2020] [Accepted: 03/09/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cardiac arrhythmias are common conditions in older people. Unfortunately, there is limited literature on associations between cardiac arrhythmias and physical performance or disability. We therefore aimed to prospectively investigate associations between cardiac arrhythmias and changes in disability and physical performance during 8 years of follow-up, using data from the Italian Longitudinal Study on Aging (ILSA). METHODS Cardiac arrhythmias diagnosis was posed through a screening phase, confirmed by a physician. The onset of disability in activities of daily living (ADL) and the changes in several physical performance tests during follow-up were considered as outcomes. Fully-adjusted and propensity-score Cox Proportional Hazard models and mixed models were used for exploring associations between cardiac arrhythmia and the outcomes of interest. RESULTS The prevalence of cardiac arrhythmia at baseline was 23.3%. People reporting cardiac arrhythmia at the baseline were significantly older, more frequently male, smokers and reported a higher presence of all medical conditions investigated (hypertension, heart failure, angina, myocardial infarction, diabetes, stroke), but no difference in dementia, Parkinsonism, cognitive or mood disorder. Cardiac arrhythmia at baseline was significantly associated with the incidence of disability in ADL (HR = 1.23; 95%: CI: 1.01-1.50; P = 0.0478 in propensity score analyses; HR = 1.28; 95% CI: 1.01-1.61; P = 0.0401 in fully adjusted models). Cardiac arrhythmia at baseline was also associated with a significant worsening in balance test (P = 0.0436). CONCLUSIONS The presence of cardiac arrhythmia at baseline was associated with a significant higher risk of disability and of worsening in some physical performance tests, particularly those relating to balance. Screening and frequently assessing physical performance in older people affected by cardiac arrhythmia can be important to prevent a loss of physical performance, with further, potential, complications of medical management.
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Affiliation(s)
- Marianna Noale
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Via Giustiniani 2, 35128 Padua, Italy
| | - Nicola Veronese
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Via Giustiniani 2, 35128 Padua, Italy
- Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy
| | - Stefano Fumagalli
- Geriatrics and Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy
| | - Stefania Maggi
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Via Giustiniani 2, 35128 Padua, Italy
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88
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Javed S, Gupta D, Lip GYH. Obesity and atrial fibrillation: making inroads through fat. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:59-67. [PMID: 32096865 DOI: 10.1093/ehjcvp/pvaa013] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/30/2020] [Accepted: 02/18/2020] [Indexed: 12/21/2022]
Abstract
The global prevalence of obesity has reached epidemic proportions, paralleled by a rise in cases of atrial fibrillation (AF). Data from epidemiological cohorts support the role of obesity as an independent risk factor for AF. Increasing evidence indicates that obesity may contribute to the AF substrate through a number of pathways including by altering epicardial adipose tissue biology, inflammatory pathways, structural cardiac remodelling, and inducing atrial fibrosis. Due to changes in pharmacokinetics and pharmacodynamics, specific therapeutic considerations are required to guide management of patients with AF including anticoagulation and rhythm control. Also, weight loss in patients with AF has been associated with reduced progression from paroxysmal to persistent AF and indeed regression from persistent to proximal AF. However, the role of dietary intervention in AF control remains to be fully elucidated and hard prospective outcome data to support weight loss are required in AF to determine its role as part of a comprehensive risk factor management strategy for AF in obese patients.
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Affiliation(s)
- Saad Javed
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, UK
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Estes NAM. Improving Outcomes in Patients With Atrial Fibrillation and Hypertension. JAMA 2020; 323:221-222. [PMID: 31961401 DOI: 10.1001/jama.2019.20144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- N A Mark Estes
- UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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90
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Wingerter R, Steiger N, Burrows A, Estes NAM. Impact of Lifestyle Modification on Atrial Fibrillation. Am J Cardiol 2020; 125:289-297. [PMID: 31761147 DOI: 10.1016/j.amjcard.2019.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
Atrial Fibrillation (AF) is the most common arrhythmia in adults, and the rapid increase in AF prevalence has been classified by experts as an epidemic. The mechanisms of AF are complex and incompletely understood. While many aspects of management are now based on high quality evidence, other clinical decisions are based on experience and judgment. This article provides an up to date review relating to lifestyle modification and its effect on AF to inform clinical treatment. This comprehensive review used PubMed and Google Scholar to perform keyword searches of articles published between 1998 and the present, with the exception of the 1978 "Holiday Heart" article. Robust data has emerged identifying multiple risk factors for development of AF, including age, sex, hypertension, diabetes mellitus, obesity, alcohol consumption, exercise, and obstructive sleep apnea. Recent evidence indicates that lifestyle modification has a significant role in mitigating the risk and burden of AF. In conclusion, based on the available evidence, an interdisciplinary approach to lifestyle modification will likely reduce risk and/or symptom burden of AF.
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Affiliation(s)
- Rebecca Wingerter
- College of Medicine at University of Central Florida, Orlando, Florida
| | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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91
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Stepanović-Petrović R, Nastić K. Direct oral anticoagulants: A new chapter in anticoagulation therapy. ARHIV ZA FARMACIJU 2020. [DOI: 10.5937/arhfarm2005249s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Thromboembolic events are the leading cause of morbidity and mortality worldwide. From the second half of the 20th century, vitamin K antagonists (VKAs), warfarin and acenocoumarol, were the only anticoagulants taken orally. The major reform in anticoagulation therapy was made by the advent of direct oral anticoagulants (DOACs), about 10 years ago. Direct thrombin inhibitor (dabigatran) and direct inhibitors of factor Xa (rivaroxaban, apixaban, edoxaban, and betrixaban) have demonstrated favorable risk/benefit ratio. Compared to warfarin, DOACs are associated with a predictable pharmacokinetic profile, lower severe bleeding complications, particularly intracranial hemorrhages, and minimal drug interactions. Moreover, DOACs achieve a rapid onset of action and have shown comparable efficacy with warfarin and low molecular weight heparin (LMWH) in clinical trials. As a result, DOACs are now replacing VKAs and LMWH for many indications including stroke and systemic embolism prevention in nonvalvular atrial fibrillation, prevention, and treatment of venous thromboembolism and thromboprophylaxis following total knee/hip replacement surgery. In addition, rivaroxaban (in combination with aspirin alone or aspirin and clopidogrel) is used in the prevention of atherothrombotic events following acute coronary syndrome with elevated cardiac biomarkers. In case of severe bleeding complications under DOACs treatment, antidotes are available; idarucizumab for dabigatran reversal and andexanet alfa for rivaroxaban and apixaban.
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92
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Shi S, Shi J, Shi S, Jia Q, Yuan G, Wei Y, Wang D, Hu Y. Global research productions pertaining to atrial fibrillation from 2004 to 2018: A bibliometric analysis. Medicine (Baltimore) 2020; 99:e18971. [PMID: 32000426 PMCID: PMC7004637 DOI: 10.1097/md.0000000000018971] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/25/2019] [Accepted: 01/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We analyzed the scientific outputs of global atrial fibrillation (AF) researches, developed a model to qualitatively and quantitatively evaluate the AF research productions from 2004 to 2018. METHODS The data was retrieved from the Web of Science Core Collection (WOSCC) on June 15, 2019. Bibliometrics tools-CiteSpace V (Drexel university, Chaomei Chen) and VOSviewer (Leiden University, van Eck NJ) --were used for bibliometric analyzing published outputs and finding research hotspots. RESULTS There were a total of 21,839 research articles on AF, and the annual publication rate increased over time from 2004 to 2018. The Journal of Cardiovascular Electrophysiology published the greatest number of articles, and the leading country was the United States. The leading institution was the Mayo Clinic, and the most productive researchers were: LIP GYH, Natale A, Chen SA, DI Biase L, and Kuck KH. The keywords analysis showed that catheter ablation, risk, heart failure, stroke, and management were research hotspots. CONCLUSION Bibliometric analysis of the literature shows that research on AF continues to be a hot spot, and the clinical treatment of AF is an important research frontier. However, further research and collaboration are needed worldwide. Our findings aim to provide valuable information for the editors of journals that publish research on arrhythmia, and to help researchers identify new perspectives for future researches.
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Affiliation(s)
- Shuqing Shi
- Graduate School, Beijing University of Chinese Medicine
- Department of cardiovascular, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingjing Shi
- Department of cardiovascular, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuai Shi
- Department of cardiovascular, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiulei Jia
- Graduate School, Beijing University of Chinese Medicine
- Department of cardiovascular, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guozhen Yuan
- Department of cardiovascular, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi Wei
- Department of cardiovascular, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dandan Wang
- Department of cardiovascular, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanhui Hu
- Department of cardiovascular, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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93
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Improving outcomes after left atrial appendage closure. Heart Rhythm 2019; 17:734-735. [PMID: 31883995 DOI: 10.1016/j.hrthm.2019.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022]
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94
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Wang K, Liu Y, Huang S, Li H, Hou J, Huang J, Chen J, Feng K, Liang M, Chen G, Wu Z. Does an imbalance in circulating vascular endothelial growth factors (VEGFs) cause atrial fibrillation in patients with valvular heart disease? J Thorac Dis 2019; 11:5509-5516. [PMID: 32030270 DOI: 10.21037/jtd.2019.11.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The pathogenesis of atrial fibrillation (AF) remains unclear. Vascular endothelial growth factors (VEGFs) can stimulate fibrosis within the atrium and ventricle. We hypothesized that there is a relationship between the serum VEGFs/soluble vascular endothelial growth factor receptor (sVEGFRs) levels and AF in patients with valvular heart disease (VHD). This provides a new paradigm for studying AF. Methods The plasma levels of VEGF-A, VEGF-C, sVEGFR-1 and sVEGFR-2 were detected by enzyme-linked immunosorbent assay (ELISA). A total of 100 people, consisting of AF patients (long-standing, persistent AF; n=49), sinus rhythm (SR) patients (n=31) and healthy controls (n=20), were included in this study. Results The plasma levels of VEGF-A were significantly higher in AF patients compared to healthy control (P<0.05). The plasma levels of sVEGFR-1 were significantly higher in AF compared to SR (P<0.05). The plasma levels of sVEGFR-2 were significantly lower in AF patients compared to SR patients and healthy controls (both P<0.05). There was a significant and negative correlation between AF and the sVEGFR-2 levels in the groups (r=-0.432, P=0.000). Conclusions An imbalance in VEGFs and sVEGFRs may contribute to AF by breaking the balance of angiogenesis and lymphangiogenesis. Additionally, sVEGFR-2 may be an important biomarker of AF.
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Affiliation(s)
- Keke Wang
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Department of Emergency, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yanyan Liu
- Department of Pathology, The First Affiliated Hospital of Traditional Medicine University, Guangzhou 510405, China
| | - Suiqing Huang
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory of Assisted Circulation, Ministry of Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Huayang Li
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jian Hou
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory of Assisted Circulation, Ministry of Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jiaxing Huang
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jiantao Chen
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Kangni Feng
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Mengya Liang
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Guangxian Chen
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory of Assisted Circulation, Ministry of Health, Sun Yat-sen University, Guangzhou 510080, China
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95
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Efficacy and safety of edoxaban compared with warfarin according to the burden of diseases in patients with atrial fibrillation: insights from the ENGAGE AF-TIMI 48 trial. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 6:167-175. [DOI: 10.1093/ehjcvp/pvz061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Non-vitamin K antagonist oral anticoagulants represent a new option for prevention of embolic events in patients with atrial fibrillation (AF). However, little is known about the impact of non-cardiac comorbidities on the efficacy and safety profile of these drugs.
Methods and results
In a post hoc analysis of the ENGAGE AF-TIMI 48 trial, we analysed 21 105 patients with AF followed for an average of 2.8 years and randomized to either a higher-dose edoxaban regimen (HDER), a lower-dose edoxaban regimen, or warfarin. We used the updated Charlson Comorbidity Index (CCI) to stratify the patients according to the burden of concomitant disease (CCI = 0, 1, 2, 3, and ≥4). The treatment groups were then compared for safety, efficacy, and net clinical outcomes across CCI categories. There were 32.0%, 7.3%, 42.1%, 12.7%, and 6.0% of patients with CCI scores of 0, 1, 2, 3, and ≥4, respectively. A CCI score ≥4 was associated with significantly higher rates of thromboembolic events, bleeding, and death compared to CCI = 0 (P < 0.05 for each). The annualized rates of the primary net clinical outcome (stroke/systemic embolism, major bleeding, or death) for CCI = 0, 1, 2, 3, or ≥4 were 5.9%, 8.7%, 6.6%, 10.3%, and 13.6% (Ptrend < 0.001). There were no significant interactions between treatment with HDER vs. warfarin and efficacy, safety, and net outcomes across the CCI groups (P-interaction > 0.10 for each).
Conclusion
Although increasing CCI scores are associated with worse outcomes, the efficacy, safety, and net clinical outcomes of edoxaban vs. warfarin were independent of the degree of comorbidity present.
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96
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Piccirillo F, Carpenito M, Verolino G, Chello C, Nusca A, Lusini M, Spadaccio C, Nappi F, Di Sciascio G, Nenna A. Changes of the coronary arteries and cardiac microvasculature with aging: Implications for translational research and clinical practice. Mech Ageing Dev 2019; 184:111161. [PMID: 31647940 DOI: 10.1016/j.mad.2019.111161] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 10/09/2019] [Accepted: 10/14/2019] [Indexed: 12/28/2022]
Abstract
Aging results in functional and structural changes in the cardiovascular system, translating into a progressive increase of mechanical vessel stiffness, due to a combination of changes in micro-RNA expression patterns, autophagy, arterial calcification, smooth muscle cell migration and proliferation. The two pivotal mechanisms of aging-related endothelial dysfunction are oxidative stress and inflammation, even in the absence of clinical disease. A comprehensive understanding of the aging process is emerging as a primary concern in literature, as vascular aging has recently become a target for prevention and treatment of cardiovascular disease. Change of life-style, diet, antioxidant regimens, anti-inflammatory treatments, senolytic drugs counteract the pro-aging pathways or target senescent cells modulating their detrimental effects. Such therapies aim to reduce the ineluctable burden of age and contrast aging-associated cardiovascular dysfunction. This narrative review intends to summarize the macrovascular and microvascular changes related with aging, as a better understanding of the pathways leading to arterial aging may contribute to design new mechanism-based therapeutic approaches to attenuate the features of vascular senescence and its clinical impact on the cardiovascular system.
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Affiliation(s)
| | | | | | - Camilla Chello
- Dermatology, Università "La Sapienza" di Roma, Rome, Italy
| | | | - Mario Lusini
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Francesco Nappi
- Cardiac surgery, Centre Cardiologique du Nord de Saint Denis, Paris, France
| | | | - Antonio Nenna
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
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97
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Morin DP, Bernard ML, Madias C, Rogers PA, Thihalolipavan S, Estes NAM. In reply-Atrial Fibrillation and Morbidity and Mortality in Stress-Induced Cardiomyopathy. Mayo Clin Proc 2019; 94:2148-2149. [PMID: 31585590 DOI: 10.1016/j.mayocp.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/02/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel P Morin
- Ochsner Medical Center and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA
| | - Michael L Bernard
- Ochsner Medical Center and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA
| | | | - Paul A Rogers
- Ochsner Medical Center and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA
| | - Sudarone Thihalolipavan
- Ochsner Medical Center and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA
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98
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Bandyopadhyay D, Jain V, Herzog E, Lavie CJ. Atrial Fibrillation and Morbidity and Mortality in Stress-Induced Cardiomyopathy. Mayo Clin Proc 2019; 94:2146-2148. [PMID: 31585589 DOI: 10.1016/j.mayocp.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/16/2019] [Accepted: 08/02/2019] [Indexed: 11/21/2022]
Affiliation(s)
| | | | - Eyal Herzog
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
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99
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Samuel M, Brophy JM. Challenges in Assessing the Incidence of Atrial Fibrillation Hospitalizations. Can J Cardiol 2019; 35:1291-1293. [PMID: 31500888 DOI: 10.1016/j.cjca.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Michelle Samuel
- Division of Clinical Epidemiology, McGill University Health Centre Research Institute, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - James M Brophy
- Division of Clinical Epidemiology, McGill University Health Centre Research Institute, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Centre Research Institute, Montreal, Quebec, Canada.
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100
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Düzen IV, Yavuz F, Vuruskan E, Saracoglu E, Poyraz F, Cekici Y, Alıcı H, Göksülük H, Candemir B, Sucu M, Demiryürek AT. Investigation of leukocyte RHO/ROCK gene expressions in patients with non-valvular atrial fibrillation. Exp Ther Med 2019; 18:2777-2782. [PMID: 31572525 PMCID: PMC6755446 DOI: 10.3892/etm.2019.7929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/08/2019] [Indexed: 12/29/2022] Open
Abstract
Atrial fibrillation (AF) is an arrhythmia caused by disorganized electrical activity in the atria, and it is an important cause of mortality and morbidity. There is a limited data about Rho/Rho-kinase (ROCK) pathway contribute to AF development. The aim of the present study was to elucidate leukocyte RHO/ROCK gene expressions in patients with non-valvular AF (NVAF). A total of 37 NVAF patients and 47 age and sex-matched controls were included in this study. mRNA was extracted from leukocytes, and real-time polymerase chain reaction was used for gene expression analysis. A marked increase in ROCK1 and ROCK2 gene expressions in patients with NVAF was observed (P<0.0001). The present study detected significant elevations in RHOBTB2, RND3 (RHOE), RHOC, RHOG, RHOH, RAC3, RHOB, RHOD, RHOV, RHOBTB1, RND2, RND1 and RHOJ gene expressions (P<0.01). However, there were marked decreases in CDC42, RAC2, and RHOQ gene expressions in patients with NVAF. No significant modifications were seen in the other Rho GTPase proteins RHOA, RAC1, RHOF, RHOU and RHOBTB3. To the best of our knowledge, the present study is the first to provide data that gene expression of leukocyte RHO/ROCK may contribute to the NVAF pathogenesis through activated leukocytes, which promotes the immune or inflammatory cascade.
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Affiliation(s)
- Irfan V Düzen
- Department of Cardiology, Faculty of Medicine, University of Gaziantep, Gaziantep 27310, Turkey
| | - Fethi Yavuz
- Department of Cardiology, Adana City Hospital, Adana 01060, Turkey
| | - Ertan Vuruskan
- Department of Cardiology, Faculty of Medicine, University of Gaziantep, Gaziantep 27310, Turkey
| | - Erhan Saracoglu
- Department of Cardiology, Dr Ersin Arslan Education and Research Hospital, Gaziantep 27310, Turkey
| | - Fatih Poyraz
- Department of Cardiology, Defa Life Hospital, Gaziantep 27310, Turkey
| | - Yusuf Cekici
- Department of Cardiology, Dr Ersin Arslan Education and Research Hospital, Gaziantep 27310, Turkey
| | - Hayri Alıcı
- Department of Cardiology, Hatem Hospital, Gaziantep 27310, Turkey
| | - Hüseyin Göksülük
- Department of Cardiology, Faculty of Medicine, Ankara University, Ankara 06340, Turkey
| | - Basar Candemir
- Department of Cardiology, Faculty of Medicine, Ankara University, Ankara 06340, Turkey
| | - Murat Sucu
- Department of Cardiology, Faculty of Medicine, University of Gaziantep, Gaziantep 27310, Turkey
| | - Abdullah T Demiryürek
- Department of Medical Pharmacology, Faculty of Medicine, University of Gaziantep, Gaziantep 27310, Turkey
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