1
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Tu J, Ye Z, Cao Y, Xu M, Wang S. Establishment and evaluation of a nomogram for in-hospital new-onset atrial fibrillation after percutaneous coronary intervention for acute myocardial infarction. Front Cardiovasc Med 2024; 11:1370290. [PMID: 38562185 PMCID: PMC10982328 DOI: 10.3389/fcvm.2024.1370290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Background New-onset atrial fibrillation (NOAF) is prognostic in acute myocardial infarction (AMI). The timely identification of high-risk patients is essential for clinicians to improve patient prognosis. Methods A total of 333 AMI patients were collected who underwent percutaneous coronary intervention (PCI) at Zhejiang Provincial People's Hospital between October 2019 and October 2020. Least absolute shrinkage and selection operator regression (Lasso) and multivariate logistic regression analysis were applied to pick out independent risk factors. Secondly, the variables identified were utilized to establish a predicted model and then internally validated by 10-fold cross-validation. The discrimination, calibration, and clinical usefulness of the prediction model were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow test decision curve analyses, and clinical impact curve. Result Overall, 47 patients (14.1%) developed NOAF. Four variables, including left atrial dimension, body mass index (BMI), CHA2DS2-VASc score, and prognostic nutritional index, were selected to construct a nomogram. Its area under the curve is 0.829, and internal validation by 10-fold cross-folding indicated a mean area under the curve is 0.818. The model demonstrated good calibration according to the Hosmer-Lemeshow test (P = 0.199) and the calibration curve. It showed satisfactory clinical practicability in the decision curve analyses and clinical impact curve. Conclusion This study established a simple and efficient nomogram prediction model to assess the risk of NOAF in patients with AMI who underwent PCI. This model could assist clinicians in promptly identifying high-risk patients and making better clinical decisions based on risk stratification.
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Affiliation(s)
- Junjie Tu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Ziheng Ye
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yuren Cao
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Mingming Xu
- Department of Cardiovascular Medicine, Zhejiang Greentown Cardiovascular Hospital, Hangzhou, China
| | - Shen Wang
- Department of Cardiovascular Medicine, Zhejiang Greentown Cardiovascular Hospital, Hangzhou, China
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2
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Kwok CS, Abbas KS, Qureshi AI, Lip GYH. Outcomes for patients hospitalized with acute myocardial infarction and cerebral infarction in the United States: insights from the National Inpatient Sample. Intern Emerg Med 2023; 18:375-383. [PMID: 36746890 DOI: 10.1007/s11739-022-03172-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/04/2022] [Indexed: 02/08/2023]
Abstract
This study aims to determine the frequency and impact of concomitant cerebral infarction and acute myocardial infarction (AMI) and association with in-hospital outcomes. We analyzed the nationally representative data from National Inpatient Sample between 2016 and 2019. We used multiple logistic regressions to determine the impact of sustaining a cerebral infarction or AMI on in-hospital mortality and linear regression to evaluate length of stay and hospitalization costs. A total of 2,396,450 admissions for cerebral infarction, 4,098,904 admissions for AMI and 130,635 admissions for both conditions were identified. The in-hospital mortality was 7.2% overall: 5.6% for patients with cerebral infarction, 7.7% for patients with AMI and 19.9% for patients with both conditions (p < 0.001). The median length of stay was 4 days, 3 days and 7 days for cerebral infarction, AMI and when both occurred together, respectively (p < 0.001). The median total healthcare cost for cerebral infarction, AMI and when both occurred was US$10,647, $15,735 and $23,290, respectively (p < 0.001). After adjustments for potential confounders, in-hospital mortality [adjusted odds ratio (aOR) 4.07, 95% CI 3.93-4.21], length of stay (aOR 3.95 95% CI 3.85-4.04), and hospitalization cost (regression coefficient 15,480 95% CI 15,135-15,825) were greater for patients with AMI and cerebral infarction compared to admission for cerebral infarction only. Cerebral infarction and AMI during the same hospitalization occurs in 5% of admissions with cerebral infarction and 3% of admission with AMI and is associated with significant increase in mortality, length of stay and cost compared to admissions with either condition alone.
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Affiliation(s)
- Chun Shing Kwok
- Department of Post-Qualifying Healthcare Practice, Birmingham City University, Seacole Building, Westbourne Road, Edgbaston, Birmingham, B15 3TN, UK.
| | | | - Adnan Iqbal Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Gregory Yoke Hong Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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3
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Braukyliene R, Aldujeli A, Haq A, Maciulevicius L, Jankauskaite D, Jurenas M, Unikas R, Zabiela V, Lesauskaite V, Simonyte S, Zaliaduonytė D. Impact of Mineralocorticoid Receptor Gene NR3C2 on the Prediction of Functional Classification of Left Ventricular Remodeling and Arrhythmia after Acute Myocardial Infarction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:12. [PMID: 36612333 PMCID: PMC9819824 DOI: 10.3390/ijerph20010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Background: The NR3C2 gene encodes the mineralocorticoid receptor, which is present on cardiomyocytes. Prior studies reported an association between the presence of NR3C2 single-nucleotide polymorphisms (SNPs) and an increased cortisol production during a stress response such as acute myocardial infarction (AMI), which may lead to adverse cardiac remodeling. Objective: To study the impact of the NR3C2 rs2070950, rs4635799 and rs5522 gene polymorphisms on left ventricular (LV) remodeling, rhythm and conduction disorders in AMI patients. Methods: A cohort of 301 AMI patients who underwent revascularization was included. SNPs of the NR3C2 gene (rs2070950, rs4635799 and rs5522) were evaluated. A total of 127 AMI patients underwent transthoracic echocardiography follow-up after 72 h and 6 months. Results: The rs2070950 GG genotype and rs4635799 TT genotype were most common in patients who had LV end-diastolic volume increase < 20% and the same or increased LV ejection fraction, indicating a possible protective effect of these SNPs. The rs5522 TT genotype was associated with a higher frequency of arrhythmias, while the presence of at least one rs5522 C allele was associated with a lower risk of arrhythmias. Conclusion: SNPs of the NR3C2 gene appear to correlate with better ventricular remodeling and a reduced rate of arrhythmias post-AMI, possibly by limiting the deleterious effects of cortisol on cardiomyocytes.
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Affiliation(s)
- Rima Braukyliene
- Department of Cardiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307 Kaunas, Lithuania
- Kaunas Region Lithuanian Society of Cardiology, Eiveniu Str. 2, 50009 Kaunas, Lithuania
| | - Ali Aldujeli
- Department of Cardiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307 Kaunas, Lithuania
- Kaunas Region Lithuanian Society of Cardiology, Eiveniu Str. 2, 50009 Kaunas, Lithuania
- Laboratory of Molecular Cardiology, Lithuanian University of Health Sciences, Sukileliu 15, 50162 Kaunas, Lithuania
| | - Ayman Haq
- Minneapolis Heart Institute, 800 E 28th St Heart Hospital Minneapolis, Minneapolis, MN 55407, USA
| | - Laurynas Maciulevicius
- Department of Cardiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307 Kaunas, Lithuania
| | - Darija Jankauskaite
- Department of Cardiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307 Kaunas, Lithuania
| | - Martynas Jurenas
- Department of Cardiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307 Kaunas, Lithuania
- Kaunas Region Lithuanian Society of Cardiology, Eiveniu Str. 2, 50009 Kaunas, Lithuania
| | - Ramunas Unikas
- Department of Cardiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307 Kaunas, Lithuania
- Kaunas Region Lithuanian Society of Cardiology, Eiveniu Str. 2, 50009 Kaunas, Lithuania
| | - Vytautas Zabiela
- Department of Cardiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307 Kaunas, Lithuania
- Kaunas Region Lithuanian Society of Cardiology, Eiveniu Str. 2, 50009 Kaunas, Lithuania
| | - Vaiva Lesauskaite
- Laboratory of Molecular Cardiology, Lithuanian University of Health Sciences, Sukileliu 15, 50162 Kaunas, Lithuania
| | - Sandrita Simonyte
- Laboratory of Molecular Cardiology, Lithuanian University of Health Sciences, Sukileliu 15, 50162 Kaunas, Lithuania
| | - Diana Zaliaduonytė
- Department of Cardiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307 Kaunas, Lithuania
- Kaunas Region Lithuanian Society of Cardiology, Eiveniu Str. 2, 50009 Kaunas, Lithuania
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4
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Ayinde H, Riedle B, Ojo A, Abugroun A, Girotra S, Polgreen L. Prognostic Significance of Newly Diagnosed Atrial Fibrillation After Acute Myocardial Infarction: A Study of 184,980 Medicare Patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 44:37-43. [PMID: 35835653 PMCID: PMC10776021 DOI: 10.1016/j.carrev.2022.06.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/28/2022] [Accepted: 06/24/2022] [Indexed: 11/26/2022]
Abstract
We aimed to determine whether newly diagnosed atrial fibrillation (AF) predicted cardiovascular events and death after myocardial infarction (AMI) in a large nationwide cohort of patients. All Medicare beneficiaries aged >65 years who were discharged alive after a diagnosis of AMI between January 1, 2007 and December 31, 2008 were identified. Main exposure was a diagnosis of AF during admission or within 90 days after discharge. Primary outcome was a composite of recurrent AMI, stroke and all-cause mortality. Secondary outcomes were each of recurrent AMI, stroke and all-cause mortality. We used Cox proportional hazards regression to assess the relationship between AF and time-to-event outcomes with follow up ending at 3 years. Of 184,980 patients, 9.1 % had AF; 40.6 % were male; 82.8 % were non-Hispanic whites. Mean age was 79.1 ± 8.1 years. Overall, 15.7 % had subsequent AMI, 5.7 % had stroke and 43.9 % died during a mean follow up of 26.4 months. AF was associated with a significantly increased risk of the primary outcome (Hazard ratio (HR) = 1.10; 95 % confidence interval (CI): 1.07-1.12). AF was also separately associated with significantly increased risk of recurrent AMI (HR = 1.09; 95 % CI: 1.04-1.14), stroke (HR = 1.29; 95 % CI: 1.21-1.37), and death (HR = 1.09; 95 % CI: 1.06-1.12). Neither age, race nor sex modified the effects of AF on primary or secondary outcomes. In conclusion, AF is a significant predictor of adverse cardiovascular outcomes and mortality after AMI. Further studies are needed to understand mechanisms by which AF alters outcomes in survivors of AMI.
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Affiliation(s)
- Hakeem Ayinde
- Division of Cardiology, Novant Health Heart & Vascular Institute, Charlotte, NC, USA.
| | - Benjamin Riedle
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Amole Ojo
- Division of Cardiovascular Diseases, University of Rochester Medical Center, Rochester, NY, USA
| | - Ashraf Abugroun
- Department of Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Saket Girotra
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Linnea Polgreen
- Department of Pharmacy Practice and Science/Division of Health Services Research, University of Iowa, Iowa City, IA, USA
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5
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Gozalo AS, Lambert LE, Zerfas PM, Elkins WR. Detection of early myocardial cell death in owl monkeys (Aotus nancymai) using complement component C9 immunohistochemistry in formalin-fixed paraffin-embedded heart tissues: A retrospective study. J Med Primatol 2021; 51:93-100. [PMID: 34971004 DOI: 10.1111/jmp.12567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 12/20/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Owl monkeys are commonly used in biomedical research which is affected by the high incidence of cardiomyopathy in this species. Occasionally, owl monkeys with no clinical signs of heart disease are found dead and at necropsy show no, or very mild, cardiomyopathy. A possible explanation for sudden death is acute myocardial infarction; however, early myocardial changes may be difficult to assess by conventional stains and light microscopy. METHODS Complement component C9 immunohistochemistry was performed in paraffin-embedded heart tissue samples from owl monkeys who died suddenly, or were euthanized due to sickness, to determine whether these animals suffered from acute myocardial infarcts. RESULTS AND CONCLUSION C9 deposits were found in the myocardium of 19 out of 20 (95%) animals. The findings in this study suggest owl monkeys suffer from acute myocardial infarcts, and complement component C9 immunohistochemistry may be a useful diagnostic tool.
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Affiliation(s)
- Alfonso S Gozalo
- Comparative Medicine Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Lynn E Lambert
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Patricia M Zerfas
- Pathology Service, Office of Research Services, National Institutes of Health, Bethesda, Maryland, USA
| | - William R Elkins
- Comparative Medicine Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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6
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Shi Y, Ji J, Wang C. Exploring the NT-proBNP expression in Premature Infants with Patent Ductus Arteriosus (PDA) by Echocardiography. Pak J Med Sci 2021; 37:1615-1619. [PMID: 34712293 PMCID: PMC8520382 DOI: 10.12669/pjms.37.6-wit.4853] [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: 04/03/2021] [Revised: 06/08/2021] [Accepted: 07/06/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: To investigate the correlation between echocardiographic indicators and the expression level of N-terminal pro-brain natriuretic peptide (NT-proBNP) in premature infants (PIs) with patent ductus arteriosus (PDA) and the value of NT-proBNP in diagnosing symptomatic PDA (sPDA) in PIs whose gestational age (GA) was less than 32 weeks. Methods: Ninty premature infants were selected as the research objects, including 52 in the non-PDA group and 38 in the PDA group (26 sPDA cases and 12 cases with asymptomatic PDA (asPDA)) from February 2019 to March 2020. The general information of these infants was recorded, including gender, delivery method, maternal infection, and serum NT-proBNP level on the 3rd day after birth. They were screened by echocardiographic indicators under an artificial intelligence convolutional neural network (AI-CNN). The Receiver Operating Characteristic (ROC) curves were illustrated to decide serum NT-proBNP expression levels, thereby determining specificity and sensitivity of sPDA and the correlation between serum sPDA NT-proBNP expression and echocardiographic indicators. Results: The expression level of serum NT-proBNP in the sPDA group was greater than that in the asPDA group and the non-PDA group (P<0.001). The serum NT-proBNP expression level was positively correlated with the diameter of the ductus arteriosus in the sPDA group (r=0.462, P<0.001); it was also positively correlated with the ratio of left atrium/aorta (LA/AO) (r=0.573, P<0.001), but was not correlated with left ventricular ejection fraction (LVEF) (r=-0.015, P=0.747). Conclusion: The combination of serum NT-proBNP expression and echocardiography had clinical values in early diagnosis of PDA.
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Affiliation(s)
- Yunlong Shi
- Yunlong Shi, Attending Physician. Department of Neonatology, Yiwu Central Hospital, No. 519 Nanmen Road, Yiwu City, Zhejiang Province, 322000, China
| | - Jianwei Ji
- Jianwei Ji, Attending Physician. Department of Neonatology, Yiwu Central Hospital, No. 519 Nanmen Road, Yiwu City, Zhejiang Province, 322000, China
| | - Chunying Wang
- Chunying Wang, Attending Physician. Department of Neonatology, Yiwu Central Hospital, No. 519 Nanmen Road, Yiwu City, Zhejiang Province, 322000, China
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7
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Li M, Gao Y, Guo K, Wu Z, Lao Y, Li J, Huang X, Feng L, Dong J, Yuan Y. Association Between Fasting Hyperglycemia and New-Onset Atrial Fibrillation in Patients With Acute Myocardial Infarction and the Impact on Short- and Long-Term Prognosis. Front Cardiovasc Med 2021; 8:667527. [PMID: 34277729 PMCID: PMC8280294 DOI: 10.3389/fcvm.2021.667527] [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: 02/13/2021] [Accepted: 05/27/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The relationship between fasting hyperglycemia (FHG) and new-onset atrial fibrillation (AF) in patients with acute myocardial infarction (AMI) is unclear, and whether their co-occurrence is associated with a worse in-hospital and long-term prognosis than FHG or AF alone is unknown. Objective: To explore the correlation between FHG and new-onset AF in patients with AMI, and their impact on in-hospital and long-term all-cause mortality. Methods: We performed a retrospective cohort study comprising 563 AMI patients. The patients were divided into the FHG group and the NFHG group. The incidence of new-onset AF during hospitalization was compared between the two groups and sub-groups under different Killip grades. Logistic regression was used to assess the association between FHG and new-onset AF. In-hospital mortality and long-term all-cause mortality were compared among patients with FHG, AF, and with both FHG and AF according to 10 years of follow-up information. Results: New-onset AF occurred more frequently in the FHG group than in the NFHG group (21.6 vs. 9.2%, p < 0.001). This trend was observed for Killip grade I (16.6 vs. 6.5%, p = 0.002) and Grade II (17.1 vs. 6.9%, p = 0.005), but not for Killip grade III–IV (40 vs. 33.3%, p = 0.761). Logistic regression showed FHG independently correlated with new-onset AF (OR, 2.56; 95% CI, 1.53–4.30; P < 0.001), and 1 mmol/L increased in fasting glucose was associated with a 5% higher rate of new-onset AF, after adjustment for traditional AF risk factors. AMI patients complicated with both fasting hyperglycemia and AF showed the highest in-hospital mortality and long-term all-cause mortality during an average of 11.2 years of follow-up. Multivariate Cox regression showed FHG combined with AF independently correlated with long-term all-cause mortality after adjustment for other traditional risk factors (OR = 3.13, 95% CI 1.64–5.96, p = 0.001), compared with the group with neither FHG nor new-onset AF. Conclusion: FHG was an independent risk factor for new-onset AF in patients with AMI. AMI patients complicated with both FHG and new-onset AF showed worse in-hospital and long-term all-cause mortality than with FHG or AF alone.
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Affiliation(s)
- Mingxing Li
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Yingying Gao
- School of Nursing and Health, Henan University, Kaifeng, China
| | - Kai Guo
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Zidi Wu
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Yi Lao
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Jiewen Li
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Xuansheng Huang
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Li Feng
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Jianting Dong
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Yong Yuan
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
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8
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Zhang J, Feng R, Ferdous M, Dong B, Yuan H, Zhao P. Effect of 2 Different Dosages of Rosuvastatin on Prognosis of Acute Myocardial Infarction Patients with New-Onset Atrial Fibrillation in Jinan, China. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020; 26:e925666. [PMID: 32785210 PMCID: PMC7444617 DOI: 10.12659/msm.925666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) often occurs in patients with acute myocardial infarction (AMI). This study aimed to observe the influence of different dosages of rosuvastatin on the prognosis of AMI patients with AF. MATERIAL AND METHODS We performed an observational, retrospective cohort study in Jinan, China, in which 323 AMI patients were recruited. All patients were randomized to receive optimal medication treatment and 10 mg or 20 mg of rosuvastatin. Holter monitor results, serum lipid levels, and heart function were recorded. We used multivariate Cox and Kaplan-Meier analyses to assess the independent factors and differences in AF and ischemia events and safety of rosuvastatin administered at different dosages. RESULTS TC, LDL-C, and TG at 1 and 12 months were significantly lower compared with those observed prior to treatment in both groups. The heart function of both groups was significantly improved after 12 months of treatment, especially in the 20 mg group. Multivariate Cox analysis showed that different dosages of rosuvastatin, age, smoking, drinking alcohol, and diabetes are independent factors related to the occurrence of AF and ischemic events. In addition, according to Kaplan-Meier analysis, no significant difference in adverse clinical events existed at different dosages of rosuvastatin. CONCLUSIONS Treatment with rosuvastatin can reduce the serum lipid level and improve cardiac function. Different dosages of rosuvastatin, age, smoking, drinking alcohol, and diabetes are independent risk factors for AF and ischemia events. The results suggested it is safe to use 20 mg rosuvastatin in the 12 months after hospital admission.
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Affiliation(s)
- Jie Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland).,Department of Nutrition, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China (mainland)
| | - Ruiqi Feng
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Misbahul Ferdous
- Department of Cardiology, Fuwai Hospital, Beijing, China (mainland).,Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China (mainland)
| | - Bo Dong
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China (mainland)
| | - Haitao Yuan
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China (mainland)
| | - Peng Zhao
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China (mainland)
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9
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Yesin M, Kalçık M, Çağdaş M, Karabağ Y, Rencüzoğulları İ, Gürsoy MO, Efe SÇ, Karakoyun S. Fragmented QRS may predict new onset atrial fibrillation in patients with ST-segment elevation myocardial infarction. J Electrocardiol 2017; 51:27-32. [PMID: 28939175 DOI: 10.1016/j.jelectrocard.2017.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fragmented QRS (fQRS) has been shown to be a marker of local myocardial conduction abnormalities, cardiac fibrosis in previous studies. It was also reported to be a predictor of sudden cardiac death and increased morbidity and mortality in selected populations. However, there is no study investigating the role of fQRS in the development of atrial fibrillation in patients with ST segment elevation myocardial infarction (STEMI). In this study we aimed to investigate the relationship between the presence of fQRS after primary percutaneous coronary intervention (pPCI) and in-hospital development of new-onset atrial fibrilation (AF) in patients with STEMI. MATERIAL AND METHODS This study enrolled 171 patients undergoing pPCI for STEMI. Among these patients 24 patients developed AF and the remaining 147 patients were designated as the controls. All clinical, demographical and laboratory parameters were entered into a dataset and compared between AF group and the controls. RESULTS The presence of fQRS was higher in the AF group than in the controls (P=0.001). Diabetes mellitus and fQRS was significantly more common in the AF group (P=0.003 and P=0.001 respectively) Logistic regression analysis demonstrated that the presence of fQRS was the independent determinant of AF (OR: 3.243, 95% CI 1.016-10.251, P=0.042). CONCLUSIONS Increased atrial fibrillation was observed more frequently in STEMI patients with fQRS than in patients without fQRS. fQRS is an important determinant of AF in STEMI after pPCI.
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Affiliation(s)
- Mahmut Yesin
- Department of Cardiology, Kars Harakani State Hospital, Kars, Turkey.
| | - Macit Kalçık
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Metin Çağdaş
- Department of Cardiology, Kars Kafkas University, Faculty of Medicine, Kars, Turkey
| | - Yavuz Karabağ
- Department of Cardiology, Kars Kafkas University, Faculty of Medicine, Kars, Turkey
| | | | | | | | - Süleyman Karakoyun
- Department of Cardiology, Kars Kafkas University, Faculty of Medicine, Kars, Turkey
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10
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Vukmirović M, Bošković A, Tomašević Vukmirović I, Vujadinovic R, Fatić N, Bukumirić Z, Vukmirović F. Predictions and Outcomes of Atrial Fibrillation in the Patients with Acute Myocardial Infarction. Open Med (Wars) 2017; 12:115-124. [PMID: 28730170 PMCID: PMC5444404 DOI: 10.1515/med-2017-0018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/28/2017] [Indexed: 12/20/2022] Open
Abstract
The large epidemiological studies demonstrated that atrial fibrillation is correlated with high mortality and adverse events in patients with acute myocardial infarction. The aim of this study was to determinate predictors of atrial fibrillation develop during the hospital period in patients with acute myocardial infarction as well as short- and long-term mortality depending on the atrial fibrillation presentation. The 600 patients with an acute myocardial infarction were included in the study and follow-up 84 months. Atrial fibrillation develops during the hospital period was registered in 48 patients (8%). After adjustment by logistic regression model the strongest predictor of atrial fibrillation develop during the hospital period was older age, particularly more than 70 years (odds ratio 2.37, CI 1.23-4.58, p=0.010), followed by increased of Body Mass Index (odds ratio 1.17, CI 1.04-1.33, p=0.012), enlarged diameter of left atrium (LA) (odds ratio 1,18, CI 1,03-1,33, p=0,015) presentation of mitral regurgitation (odds ratio 3.56, CI 1.25-10.32, p=0.018) and B-type natriuretic peptide (odds ratio 2.12, CI 1.24-3.33, p=0.048).Patients with atrial fibrillation develop during the hospital period had a higher mortality during the hospital course (10.4% vs. 5.6%) p=0.179. as well as follow-up period of 84 months than patients without it (64.6% vs. 39.1%) p=0.569, than patients without it, but without statistically significance. Patients with AF develop during the hospital period had higher mortality during the hospital course as well as follow up period of 84 months than patients without it, but without statistically significance.
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Affiliation(s)
- Mihailo Vukmirović
- Department of Cardiology, Clinical Center of Montenegro, Montenegro, 20000 Podgorica
| | - Aneta Bošković
- Department of Cardiology, Clinical Center of Montenegro, Montenegro, 20000 Podgorica
| | | | - Radoje Vujadinovic
- Faculty of mechanical engineering, University of Montenegro, Montenegro, 20000 Podgorica
| | - Nikola Fatić
- Department of Vascular Surgery, Clinical Centre of Montenegro, Ljubljanska 1, Montenegro, 20000 Podgorica
| | - Zoran Bukumirić
- Institute of Medical Statistics and Informatics, Medical School, Belgrade, Serbia
| | - Filip Vukmirović
- Department of Pathology Clinical Centre of Montenegro, Montenegro, 20000 Podgorica
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Dilaveris PE, Kennedy HL. Silent atrial fibrillation: epidemiology, diagnosis, and clinical impact. Clin Cardiol 2017; 40:413-418. [PMID: 28273368 DOI: 10.1002/clc.22667] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/23/2016] [Indexed: 11/05/2022] Open
Abstract
Silent or subclinical asymptomatic atrial fibrillation (SAF) has currently gained wide interest in the epidemiologic, neurologic, and cardiovascular communities. It is well known that the electrophysiological and mechanical effects of symptomatic and silent atrial fibrillation (AF) are the same. It is probable that because "AF begets AF," progression from paroxysmal to persistent or permanent AF might be more rapid in patients with long-term unrecognized and untreated SAF, because no treatment is sought by or provided to such patients. Moreover, SAF is common and has significant clinical implications. The clinical consequences of SAF, which include emboli (silent or symptomatic), heart failure, and early mortality, are of paramount importance. Consequently, SAF should be considered in estimating the prevalence of the disease and its impact on morbidity, mortality, and quality of life. Several diagnostic methods of arrhythmia detection utilizing the surface electrocardiogram (ECG), subcutaneous ECG, or intracardiac devices have been utilized to seek meaningful arrhythmic markers of SAF. Whereas a wide range of clinical risk factors of SAF have been validated in the literature, there is an ongoing search for those arrhythmic risk factors that precisely identify and prognosticate outcome events in diverse populations at risk of SAF. Modern diagnostic modalities for the identification of SAF exist, but should be further explored, validated, and tailored to each patient needs. The scientific community should undertake the clinical challenge of identifying and treating SAF.
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Affiliation(s)
| | - Harold L Kennedy
- Department of Medicine & Cardiovascular Diseases, University of Missouri, Columbia, Missouri.,The Cardiovascular Research Foundation, St. Louis, Missouri
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Fedeli U, Avossa F, Ferroni E, Saugo M, Pengo V. Contemporary Burden of Atrial Fibrillation and Associated Mortality in Northeastern Italy. Am J Cardiol 2016; 118:720-4. [PMID: 27389566 DOI: 10.1016/j.amjcard.2016.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 11/17/2022]
Abstract
Based on different estimation methods, mortality attributable to atrial fibrillation (AF) has been demonstrated to increase over time in developed countries, reaching a share ranging from 1% to 5% of overall deaths. To assess the whole burden of AF-associated mortality, all diseases mentioned in death certificates of subjects aged ≥45 years resident in the Veneto Region (Northeastern Italy) were analyzed for the 2008 to 2013 period. The prevalence of common chronic co-morbidities was compared between deaths with mention of AF and a sample of age-matched deaths without reported AF. The disease was mentioned among conditions contributing to death in 25,834 subjects, corresponding to 9.8% of all regional deaths. Rates of AF-associated mortality were higher in men and increased steeply with age, being above 1 per 100 among residents aged ≥85 years. Compared with non-AF-associated deaths, the strongest associations were observed between AF and hypertensive diseases (prevalence ratio 1.62, 95% CI 1.57 to 1.67), cardiac valve disorders (2.43, 2.25 to 2.61), cardiomyopathies (1.93, 1.70 to 2.19), cerebrovascular diseases (1.55, 1.50 to 1.60), and chronic obstructive pulmonary disease (1.49, 1.42 to 1.57). AF-associated mortality resulted higher than previously reported, probably due to aging of the population with multiple predisposing diseases, an increased recognition of AF among the elderly, and a raised awareness of certifying physicians about the importance of AF. Analyses of all diseases mentioned in death certificates underscored the interaction of AF with several other circulatory and respiratory disorders in pathologic networks leading to an increased risk of death.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Veneto Region, Italy.
| | | | | | - Mario Saugo
- Epidemiological Department, Veneto Region, Italy
| | - Vittorio Pengo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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13
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Violi F, Soliman EZ, Pignatelli P, Pastori D. Atrial Fibrillation and Myocardial Infarction: A Systematic Review and Appraisal of Pathophysiologic Mechanisms. J Am Heart Assoc 2016; 5:e003347. [PMID: 27208001 PMCID: PMC4889200 DOI: 10.1161/jaha.116.003347] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/28/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND A growing body of evidence suggests that atrial fibrillation (AF) is associated with myocardial infarction (MI). However, incidence and management of MI in AF is still undefined. METHODS AND RESULTS We searched MEDLINE via PubMed and Cochrane database between 1965 and 2015. All observational clinical studies and interventional trials reporting 1-year incidence of MI in AF were included. We also discussed pathophysiological mechanisms, predictors, and therapeutic approaches to reduce the risk of MI in AF. Twenty-one observational studies and 10 clinical trials were included. The annual rate of MI in observational studies including AF patients ranged from 0.4% to 2.5%. Higher rates of MI were reported in AF patients with stable coronary artery disease (11.5%/year), vascular disease (4.47%/year), heart failure (2.9%/year), and in those undergoing coronary artery interventions (6.3%/year). However, lower annual rates have been described in AF patients from Eastern countries (0.2-0.3%/year), and in those enrolled in clinical trials (from 0.4 to 1.3%/year). CONCLUSIONS AF patients had a significant residual risk of MI despite anticoagulant treatment. Coexistence of atherosclerotic risk factors and platelet activation account for the increased risk of MI in AF. Identification of high-risk AF patients is a needed first step to develop cost-effective approaches for prevention. A new score, the 2MACE score, has been recently developed to stratify MI risk in AF, and may help not only in allocating resources to high-risk groups, but also in design of studies examining novel therapies for prevention of MI in AF.
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Affiliation(s)
- Francesco Violi
- Department of Internal Medicine and Medical Specialties, I Clinica Medica, Atherothrombosis Centre, Sapienza University of Rome, Italy
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC Department of Internal Medicine-Cardiology Section, Wake Forest School of Medicine, Winston-Salem, NC
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical Specialties, I Clinica Medica, Atherothrombosis Centre, Sapienza University of Rome, Italy
| | - Daniele Pastori
- Department of Internal Medicine and Medical Specialties, I Clinica Medica, Atherothrombosis Centre, Sapienza University of Rome, Italy
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