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Chung HG, Park J, Park JK, Kang KW, Shim J, Kim JB, Kim J, Choi EK, Park HW, Lee YS, Joung B. Rhythm Control and Cardiovascular or Cerebrovascular Outcomes in Patients with Atrial Fibrillation: A Study of the CODE-AF Registry. J Clin Med 2023; 12:4579. [PMID: 37510693 PMCID: PMC10380641 DOI: 10.3390/jcm12144579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND It is not clear whether the data regarding rhythm control during atrial fibrillation (AF) contained in AF registries is prognostically significant. Thus, this study investigated the relationship between rhythm control and cardiovascular outcomes in patients in contemporary AF registries. METHODS This study was conducted using data from 6670 patients with AF receiving oral anticoagulation in the CODE-AF registry. We used propensity overlap weighting to account for differences in baseline characteristics between the rhythm control and rate control groups. The primary outcome was a composite of the rate of death due to cardiovascular causes, stroke, acute coronary syndrome, and heart failure. The secondary outcomes were individual components of the primary outcome. RESULTS In the CODE-AF registry, 5407 (81.1%) patients were enrolled three months after AF diagnosis. During a median follow-up period of 973 days (interquartile range: 755-1089 days), a primary outcome event occurred in 72 patients in the rhythm control group (1.4 events per 100 person-years) and in 211 patients in the rate control group (1.8 events per 100 person-years). However, after overlap weighting, the incidence rates were 1.4 and 1.5 events per 100 person-years, respectively. No significant difference was found in either the primary outcome (weighted HR: 0.87; 95% CI: 0.66-1.17; p = 0.363) or secondary outcomes between the rhythm control and rate control groups. CONCLUSION In a prospective AF registry in which most of the population was enrolled at least three months after AF diagnosis, no difference in the risk of cardiovascular or cerebrovascular outcomes was found between the rhythm control and rate control groups, suggesting the early rhythm control should be considered to improve the outcome of patients.
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Affiliation(s)
- Ho-Gi Chung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, School of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Jin-Kyu Park
- Department of Cardiology, Hanyang University Seoul Hospital, Seoul 04763, Republic of Korea
| | - Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon 35233, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul 02841, Republic of Korea
| | - Jin-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea
| | - Jun Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Hyung Wook Park
- Department of Cardiology, School of Medicine, Chonnam National University, Gwangju 61469, Republic of Korea
| | - Young Soo Lee
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu 42472, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul 03722, Republic of Korea
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Chaulin A. Clinical and Diagnostic Value of Highly Sensitive Cardiac Troponins in Arterial Hypertension. Vasc Health Risk Manag 2021; 17:431-443. [PMID: 34366667 PMCID: PMC8336985 DOI: 10.2147/vhrm.s315376] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/02/2021] [Indexed: 12/13/2022] Open
Abstract
In modern laboratory diagnostics of cardiovascular diseases (CVD), there is a clear tendency toward an increase in the sensitivity of methods for determining key CVD biomarkers, among which highly sensitive cardiac troponins (hs-Tn) deserve special attention. The introduction of the latter into clinical practice made it possible not only to improve the early diagnosis of acute myocardial infarction but also to open up a number of additional valuable opportunities for the use of hs-Tn, including the assessment of the risk of developing CVD in a healthy population, detection and monitoring of early myocardial injuries in the early stages of CVD development (for example, with ischemic heart disease and arterial hypertension), with noncardiac pathologies (for example, sepsis, chronic obstructive pulmonary disease, chronic renal failure, stroke, cancer, etc), and diagnostics of CVD by using biological fluids that can be obtained by noninvasive methods. This article discusses in detail the diagnostic value of hs-Tn in serum and urine in cases of arterial hypertension. Also, the paper pays considerable attention to the consideration of the mechanisms underlying the increase in hs-Tn in serum and urine in cases of arterial hypertension.
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Affiliation(s)
- Aleksey Chaulin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, Samara, 443099, Russia.,Department of Histology and Embryology, Samara State Medical University, Samara, 443099, Russia
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Oblavatckii DV, Boldueva SA, Soloveva MV, Vinnichuk SA, Mikhailov RR. [The Frequency of Type 2 Myocardial Infarction in the Structure of Hospital Mortality According to 7-Years Data of a State University Clinic]. ACTA ACUST UNITED AC 2020; 60:896. [PMID: 32720620 DOI: 10.18087/cardio.2020.6.n896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/08/2020] [Accepted: 03/20/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate the proportion of type 2 myocardial infarction (MI) in the structure of mortality at a multidisciplinary hospital; to describe major causes for MI development, and characteristics of patients with a verified diagnosis of type 2 MI by data of postmortem examination.Material and methods 1574 protocols of the autopsies performed at the Central Pathology Department of the I.I. Mechnikov North-West State Medical University from 01.01.10 through 31.12.16 were studied retrospectively by the continuous sampling method. A group with verified diagnosis of type 2 MI was isolated from the total sample of autopsies. Major causes for and the proportion of type 2 MI among the causes of death were studied. Also, major demographic parameters, hospitalization profile, and condition of coronary arteries (CA) were compared in patients with fatal type 2 MI and those who died from atherothrombotic type 1 MI.Results Analysis of 1574 fatal cases among patients of the multidisciplinary hospital showed that in 360 cases (22.87 %), the cause of death was MI, including 137 cases of fatal type 2 MI. Proportions of men and women among the patients with postmortem verification of type 2 MI were comparable. Analysis of the age structure showed the highest incidence of type 2 MI in elderly (48.2 %) and senile (34.3 %) age. Mean age of patients with type 2 MI was 71.7 years (68.2 years for men and 75.3 years for women), which was comparable with the age range of patients with fatal type 1 MI. In both groups, men with fatal MI were significantly younger than women. Analysis of causes for type 2 MI demonstrated that the most frequent ones were tachysystolic arrhythmias (59.12 %) and severe hypoxia of different origin (35.04 %). Analysis of the type of CA lesions showed that significant lesions were significantly more frequently absent in type 2 MI (32.85 %) while in type 1 MI, the proportion of patients with unchanged CA was 1.84 %. In the group of patients with fatal type 1 MI, 67.29 % had multivascular lesions, and one in two patients had an occlusive lesion. In the group with type 2 MI, multivascular lesions were half as frequent (31.38 %), and only 4.38 % of patients had a complete occlusion of a coronary vessel. Comparison of death rate in different departments of the multidisciplinary hospital showed that only 29.2 % of patients with type 2 MI originally were managed at a specialized cardiological department; 45.3 % of patients were admitted to an internal medicine department for different conditions often not related with ischemic heart disease. Furthermore, 25.5 % of patients with subsequently developed type 2 MI originally even received scheduled or emergency medical care for a leading surgical condition.Conclusion Cardiovascular diseases predominate among causes of mortality in a multidisciplinary hospital. This study showed that almost one in four patients dies from MI, and type 2 MI accounts for more than one third of fatal MIs. Among major causes for type 2 MI, tachysystolic arrhythmias (59.12 %) and pronounced hypoxia associated with anemia and severe respiratory failure (35.04 %) should be noted. Gender and age characteristics of patients with type 2 MI were comparable with those of patients with fatal type 1 MI. Furthermore, surgical patients accounted for 25.5 % of fatal cases of type 2 MI.
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Affiliation(s)
- D V Oblavatckii
- North-Western State Medical University named after Metchnikov, St-Peterburg
| | - S A Boldueva
- North-Western State Medical University named after Metchnikov, St-Peterburg
| | - M V Soloveva
- North-Western State Medical University named after Metchnikov, St-Peterburg
| | - S A Vinnichuk
- North-Western State Medical University named after Metchnikov, St-Peterburg
| | - R R Mikhailov
- North-Western State Medical University named after Metchnikov, St-Peterburg
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