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Kawaji T, Hamatani Y, Kato M, Yokomatsu T, Miki S, Abe M, Akao M. Clinical significance of ST-segment depression during atrial fibrillation rhythm for subsequent heart failure events. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead060. [PMID: 37359320 PMCID: PMC10287539 DOI: 10.1093/ehjopen/oead060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/28/2023]
Abstract
Aims The clinical significance of ST-segment depression during atrial fibrillation (AF) rhythm has not been fully evaluated. The aim of the present study was to explore the association of ST-segment depression during AF rhythm with subsequent heart failure (HF) events. Methods and results The study enrolled 2718 AF patients whose baseline electrocardiography (ECG) was available from a Japanese community-based prospective survey. We assessed the association of ST-segment depression in baseline ECG during AF rhythm with clinical outcomes. The primary ednpoint was a composite HF endpoint: cardiac death or hospitalization due to HF. The prevalence of ST-segment depression was 25.4% (upsloping 6.6%, horizontal 18.8%, downsloping 10.1%). Patients with ST-segment depression were older and had more comorbidities than those without. During the median follow-up of 6.0 years, the incidence rate of the composite HF endpoint was significantly higher in patients with ST-segment depression than those without (5.3% vs. 3.6% per patient-year, log-rank P < 0.01). The higher risk was present in horizontal or downsloping ST-segment depression, but not in upsloping one. By multivariable analysis, ST-segment depression was an independent predictor for the composite HF endpoint (hazard ratio 1.23, 95% confidence interval 1.03-1.49, P = 0.03). In addition, ST-segment depression at anterior leads, unlike inferior or lateral leads, was not associated with higher risk for the composite HF endpoint. Conclusion ST-segment depression during AF rhythm was associated with subsequent HF risk; however, the association was affected by type and distribution of ST-segment depression.
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Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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Perelshtein Brezinov O, Vorotilina N, Vasilenko L, Kogan Y, Lev EI, Laish-Farkash A. Coronary artery disease among patients admitted with atrial fibrillation and chest pain. Coron Artery Dis 2023; 34:96-101. [PMID: 36515228 DOI: 10.1097/mca.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Patients who present to the emergency department with chest pain during an episode of atrial fibrillation (AF) impose a clinical challenge regarding the source of pain - being coronary artery disease (CAD) or AF in origin. The aim of this study was to identify clinical, imaging or laboratory markers which can predict significant CAD among patients with an AF episode and chest pain. METHODS We included 57 consecutive patients admitted to our hospital with AF and chest pain. All patients underwent coronary evaluation. Significant CAD was defined as >50% stenosis in a major coronary artery by coronary angiography or cardiac CT. We compared CAD and non-CAD groups and analyzed risk factorsby regression analysis. RESULTS Twenty-four patients (42%) were diagnosed with- and 33 patients (58%) without obstructive CAD. In a multivariate analysis of regional wall motion abnormality (RWMA), elevated troponin and hypertension were found to be predictors for CAD [odds ratio (OR), 22.4 (confidence interval (CI), 1.8-272.4; P = 0.02); OR, 5.6 (CI, 1-31.0; P = 0.05) and OR, 21.4 (CI, 1.6-284.6; P = 0.02), respectively]. There were no significant differences regarding the rate of typical chest pain at presentation in the CAD vs. the non-CAD group [13 (54%) vs. 20 (60%), P = 0.374], or in ECG ST-changes [12 (50%) vs.9 (27%), respectively; P = 0.08]. CONCLUSION In patients who present acutely with chest pain and AF, troponin elevation and RWMA appear to be highly predictive of obstructive CAD, whereas clinical symptoms and ECG changes are not predictive. These findings may be helpful for guiding the management of patients admitted with AF and chest pain.
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Affiliation(s)
- Olga Perelshtein Brezinov
- Cardiology Department, Samson Assuta Ashdod University Medical Center, Ashdod, and Ben Gurion University of the Negev, Israel
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Yano M, Egami Y, Kawanami S, Sugae H, Ukita K, Kawamura A, Nakamura H, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Nishino M, Tanouchi J. Relationship between pre-procedural non-ischemic ST-segment depression and the clinical outcomes after catheter ablation in persistent atrial fibrillation patients. J Cardiol 2023; 81:456-463. [PMID: 36822545 DOI: 10.1016/j.jjcc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/18/2023] [Accepted: 02/05/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND ST-segment depression suggests the presence of coronary artery disease (CAD) during sinus rhythm, but the clinical significance, including the outcomes after catheter ablation (CA), in atrial fibrillation (AF) patients remain unknown. METHODS The present study included persistent AF (PerAF) patients from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry who underwent an initial ablation and had no history of CAD. We assigned the patients based on the presence of ST-segment depression before CA and evaluated the impact of relevant factors on ST-segment depression and the relationship between ST-segment depression, including leads locations (anterior leads, inferior leads, and lateral leads) or depression type (upsloping, horizontal, and downsloping) or the degree of ST-segment depression and late recurrence of AF (LRAF). RESULTS This study population included a total of 551 patients of whom 189 had ST-segment depression. The median follow-up duration was 397 days and LRAF occurred in 195 patients. By multiple regression analysis, diabetes mellitus, hemoglobin, brain natriuretic peptide, left ventricular ejection fraction, and left atrial diameter were significant determinants of ST-segment depression before CA. Kaplan-Meier analysis demonstrated that the patients with ST-segment depression had a significantly greater risk of LRAF than those without (p < 0.001). Multivariate Cox proportional hazards analysis showed ST-segment depression was independently and significantly associated with a higher risk of LRAF (p < 0.001). The patients with ST-segment depression ≥0.15 mV had a significantly higher risk of LRAF than those with ST-segment depression ≥0.15 mV (p < 0.001). No significant differences among the ST-segment depression lead locations and ST-segment depression type were observed. CONCLUSION Non-ischemic ST-segment depression during AF rhythm was significantly associated with LRAF post CA in PerAF patients.
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Affiliation(s)
- Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | | | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
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A Newly Defined CHA 2DS 2-VA Score for Predicting Obstructive Coronary Artery Disease in Patients with Atrial Fibrillation-A Cross-Sectional Study of Older Persons Referred for Elective Coronary Angiography. J Clin Med 2022; 11:jcm11123462. [PMID: 35743532 PMCID: PMC9224727 DOI: 10.3390/jcm11123462] [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: 04/28/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Atrial fibrillation (AF) can be a valuable indicator of non-obstructive coronary artery disease (CAD) among older patients indicated for elective coronary angiography (CAG). Appropriate stratification of AF patients is crucial for avoiding unnecessary complications. The objective of this study was to identify independent predictors that can allow diagnosing obstructive CAD in AF patients over 65 years who were indicated to undergo elective CAG. Patients and methods: This cross-sectional study included 452 (23.9%) AF patients over 65 years old who were directed to the Department of Invasive Cardiology at the Medical University of Bialystok for elective CAG during 2014−2016. The participants had CAD and were receiving optimal therapy (median age: 73 years, interquartile range: 69−77 years; 54.6% men). The prevalence and health correlates of obstructive CAD were determined, and a multivariate logistic regression model was generated with predictors (p < 0.1). Predictive performance was analyzed using a receiver-operating characteristic (ROC) curve analysis. Results: Stenosis (affecting ≥ 50% of the diameter of the left coronary artery stem or ≥70% of that of the other important epicardial vessels) was significant in 184 (40.7%) cases. Multivariate regression analysis revealed that only the male sex (odds ratio [OR]: 1.80, 95% confidence interval [CI]: 1.14−2.84, p = 0.01) and the newly created CHA2DS2-VA score (OR: 3.96, 95% CI: 2.96−5.31, p < 0.001) significantly increased the chance of obstructive CAD, while controlling for chronic kidney disease and anemia. The ROC curve analysis indicated that the CHA2DS2-VA scale may be a useful screening tool for the diagnosis of obstructive CAD (area under the ROC curve: 0.79, 95% CI: 0.75−0.84, p < 0.001), with ≥4 being the optimal cutoff value. Conclusions: Our study has proven that several older AF patients who are advised to undergo elective CAG have nonobstructive CAD. The CHA2DS2-VA score can contribute to improving the selection of patients for invasive diagnosis of CAD, but further investigation is required.
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Saglietto A, Fois M, Ridolfi L, De Ferrari GM, Anselmino M, Scarsoglio S. A computational analysis of atrial fibrillation effects on coronary perfusion across the different myocardial layers. Sci Rep 2022; 12:841. [PMID: 35039584 PMCID: PMC8763927 DOI: 10.1038/s41598-022-04897-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/04/2022] [Indexed: 01/06/2023] Open
Abstract
Patients with atrial fibrillation (AF) may present ischemic chest pain in the absence of classical obstructive coronary disease. Among the possible causes, the direct hemodynamic effect exerted by the irregular arrhythmia has not been studied in detail. We performed a computational fluid dynamics analysis by means of a 1D-0D multiscale model of the entire human cardiovascular system, enriched by a detailed mathematical modeling of the coronary arteries and their downstream distal microcirculatory districts (subepicardial, midwall and subendocardial layers). Three mean ventricular rates were simulated (75, 100, 125 bpm) in both sinus rhythm (SR) and atrial fibrillation, and an inter-layer and inter-frequency analysis was conducted focusing on the ratio between mean beat-to-beat blood flow in AF compared to SR. Our results show that AF exerts direct hemodynamic consequences on the coronary microcirculation, causing a reduction in microvascular coronary flow particularly at higher ventricular rates; the most prominent reduction was seen in the subendocardial layers perfused by left coronary arteries (left anterior descending and left circumflex arteries).
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Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, C.so Dogliotti 14, Turin, Italy
| | - Matteo Fois
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, C.so Dogliotti 14, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, C.so Dogliotti 14, Turin, Italy.
| | - Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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Rogalska E, Kuźma Ł, Wojszel ZB, Kurasz A, Napalkov D, Sokolova A, Tomaszuk-Kazberuk A. Atrial fibrillation is a predictor of nonobstructive coronary artery disease in elective angiography in old age: a cross-sectional study in Poland and Russia. Aging Clin Exp Res 2022; 34:175-183. [PMID: 34117626 PMCID: PMC8794909 DOI: 10.1007/s40520-021-01895-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Significant changes in the coronary vessels are not confirmed in a large proportion of patients undergoing cardiac catheterization. AIMS The present study aimed to determine correlates and independent predictors of nonobstructive coronary artery disease (CAD) in older adults referred for elective coronary angiography. METHODS A cross-sectional study was conducted involving 2,214 patients referred to two medical centers (in Poland and Russia) between 2014 and 2016 for elective coronary angiography due to exacerbated angina, despite undergoing optimal therapy for CAD. The median age was 72 years (IQR: 68-76), and 49.5% patients were women. RESULTS Significant stenosis (defined as stenosis of 50% or more of the diameter of the left main coronary artery stem or stenosis of 70% or more of the diameter of the remaining major epicardial vessels) was diagnosed only in 1135 (51.3%) patients. Female sex (odds ratio [OR], 3.01; 95% confidence interval [CI], 2.44-3.72; p < 0.001) and atrial fibrillation (OR, 1.87; 95% CI 1.45-2.40; p < 0.001) were the main independent predictors of nonobstructive CAD. Significantly lower ORs were observed for diabetes (OR, 0.75; 95% CI 0.59-0.95; p = 0.02), chronic kidney disease (OR, 0.76; 95% CI 0.61-0.96; p = 0.02), and anemia (OR, 0.69; 95% CI 0.50-0.95; p = 0.02) after controlling for age, chronic heart failure, BMI, and study center. DISCUSSION AND CONCLUSIONS The results confirmed that nonobstructive CAD occurs in a high percentage of older patients referred for elective coronary angiography. This suggests the need to improve patient stratification for invasive diagnosis of CAD, especially for older women and patients with atrial fibrillation. Trial registration number and date of registration: NCT04537507, September 3, 2020.
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Affiliation(s)
- Ewelina Rogalska
- Department of Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland.
| | - Zyta B Wojszel
- Department of Geriatrics, Medical University of Bialystok, Fabryczna Str. 27, 15-369, Bialystok, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland
| | - Dmitry Napalkov
- Department of Internal Diseases, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19c1, Moscow, Russia, 119146
| | - Anastasiya Sokolova
- Department of Internal Diseases, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19c1, Moscow, Russia, 119146
| | - Anna Tomaszuk-Kazberuk
- Department of Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland
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Atrial Fibrillation and Chronic Kidney Disease-A Risky Combination for Post-Contrast Acute Kidney Injury. J Clin Med 2021; 10:jcm10184140. [PMID: 34575257 PMCID: PMC8471797 DOI: 10.3390/jcm10184140] [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: 08/21/2021] [Revised: 09/05/2021] [Accepted: 09/10/2021] [Indexed: 12/30/2022] Open
Abstract
Atrial fibrillation (AF) symptoms may mimic coronary artery disease (CAD) which reflects the difficulties in qualifying AF patients for invasive diagnostics. A substantial number of coronary angiographies may be unnecessary or even put patients at risk of post-contrast acute kidney injury (PC-AKI), especially patients with chronic kidney disease (CKD). We aimed to investigate the hypothesis indicating higher prevalence of PC-AKI in patients with AF scheduled for coronary angiography. The study population comprised of 8026 patients referred for elective coronarography including 1621 with AF. In the comparison of prevalence of PC-AKI in distinguished groups we can see that kidney impairment was twice more frequent in patients with AF in both groups with CKD (CKD (+)/AF (+) 6.24% vs. CKD (+)/AF (−) 3.04%) and without CKD (CKD (−)/AF (+) 2.32% vs. CKD (−)/AF (−) 1.22%). In our study, post-contrast acute kidney disease is twice more frequent in patients with AF, especially in subgroup with chronic kidney disease scheduled for coronary angiography. Additionally, having in mind results of previous studies stating that AF is associated with non-obstructive coronary lesions on angiography, patients with AF and CKD may be unnecessarily exposed to contrast agent and possible complications.
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Kawaji T, Ogawa H, Hamatani Y, Kato M, Yokomatsu T, Miki S, Abe M, Akao M. Association of inverted T wave during atrial fibrillation rhythm with subsequent cardiac events. Heart 2021; 108:178-185. [PMID: 34039678 DOI: 10.1136/heartjnl-2021-319199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/05/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The clinical significance of ECG abnormalities during atrial fibrillation (AF) rhythm is poorly understood. The aim of the current study was to explore the impact of inverted T wave on cardiac prognosis in patients with AF. METHODS The current study enrolled 2709 patients with AF whose baseline ECG was available from a Japanese community-based prospective survey, the Fushimi AF Registry, and the impact of inverted T wave in baseline ECG at AF rhythm on the composite of cardiac death, myocardial infarction and hospitalisation due to heart failure was examined. RESULTS Intraventricular conduction delay, ST segment depression and inverted T wave were observed in 15.8%, 24.7% and 41.4% of baseline ECG with a mean heart rate of 94.7 beats per minute. The median follow-up duration was 5.0 years. The incidence rate of the composite cardiac endpoint was significantly higher in patients with inverted T wave than those without (5.8% vs 3.3% per patient-year, log-rank p<0.01). The higher risk associated with inverted T wave was consistent even for individual components of the composite cardiac endpoint. By multivariable analysis, inverted T wave was an independent predictor of the composite cardiac endpoint (HR 1.53, 95% CI 1.26 to 1.85, p<0.01). Inverted T wave was detected in 15.7% at anterior leads, 19.8% at inferior leads and 26.6% at lateral leads. The location of inverted T wave was not associated with risk of composite cardiac endpoint. CONCLUSIONS Inverted T wave was commonly observed in patients with AF and its presence during AF rhythm was associated with subsequent cardiac events.
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Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan.,Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hisashi Ogawa
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yasuhiro Hamatani
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Mitsuru Abe
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Pezel T, Sanguineti F, Kinnel M, Landon V, Toupin S, Unterseeh T, Louvard Y, Champagne S, Morice MC, Hovasse T, Garot P, Garot J. Feasibility and Prognostic Value of Vasodilator Stress Perfusion CMR in Patients With Atrial Fibrillation. JACC Cardiovasc Imaging 2020; 14:379-389. [PMID: 33129729 DOI: 10.1016/j.jcmg.2020.07.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/17/2020] [Accepted: 07/29/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this study was to assess the feasibility and prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance (CMR) in patients with atrial fibrillation (AF). BACKGROUND Because most studies have excluded arrhythmic patients, the prognostic value of stress perfusion CMR in patients with AF is unknown. METHODS Between 2008 and 2018, consecutive patients with suspected or stable chronic coronary artery disease and AF referred for vasodilator stress perfusion CMR were included and followed for the occurrence of major adverse cardiovascular event(s) (MACE), defined as cardiovascular death or nonfatal myocardial infarction. The diagnosis of AF was defined by 12-lead electrocardiography before and after CMR. Univariate and multivariate Cox regressions were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR. RESULTS Of 639 patients (mean age 72 ± 9 years, 77% men), 602 (94%) completed the CMR protocol, and 538 (89%) completed follow-up (median 5.1 years); 80 had MACE. Using Kaplan-Meier analysis, the presence of ischemia (hazard ratio [HR]: 7.56; 95% confidence interval [CI]: 4.86 to 11.80) or LGE (HR: 2.41; 95% CI: 1.55 to 3.74) was associated with the occurrence of MACE (p < 0.001 for both). In a multivariate Cox regression including clinical and CMR indexes, the presence of ischemia (HR: 5.98; 95% CI: 3.68 to 9.73) or LGE (HR: 2.61; 95% CI: 1.89 to 3.60) was an independent predictor of MACE (p < 0.001 for both). CONCLUSIONS In patients with AF, stress perfusion CMR is feasible and has good discriminative prognostic value to predict the occurrence of MACE.
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Affiliation(s)
- Théo Pezel
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Marine Kinnel
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Valentin Landon
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | | | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Stéphane Champagne
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Marie Claude Morice
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France.
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Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41:407-477. [PMID: 31504439 DOI: 10.1093/eurheartj/ehz425] [Citation(s) in RCA: 3731] [Impact Index Per Article: 932.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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11
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Koretskiy SN, Drapkina OM, Shukurov FB, Vasiliev DK. Quantitative Assessment of Myocardial Ischemia in Multi-Vessel Coronary Artery Disease by Multimodal Stress Echocardiography with Semi-Supine Bicycle Ergometry. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2019-15-6-813-819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Stress echocardiography is a modern widely used method of noninvasive diagnosis of coronary heart disease and stratification of the risk of cardiovascular complications. In addition, exercise echocardiography is an important tool to clarify the localization of ischemia and establish a symptomassociated artery for management of patient with known coronary angiography data. This is especially important in multivessel lesions, the presence of an occluded artery or borderline stenosis. Currently, various stress agents are used for stress echocardiography in clinical practice: pharmacological drugs (dobutamine or adenosine), transesophageal or endocardial pacing, treadmill, semi-supine bicycle. To detect signs of ischemia usually used only visual estimation of local contractility in the two-dimensional gray-scale mode. Modern modes of myocardial imaging, such as speckletracking echocardiography or three-dimensional visualization, are practically not used. In the presented clinical case, the possibility of combining standard and modern imaging modes to clarify the localization and quantification of ischemia in multivessel coronary lesions, including chronic artery occlusion, is shown. As a stress agent, a semi-supine bicycle was chosen, the use of which allowed to obtain a qualitative image of the left ventricular myocardium at rest and at peak load, suitable for assessing deformation and threedimensional visualization. Evaluation of left ventricular myocardial deformation by speckle-tracking echocardiography was more accurate than standard diagnosis in detecting signs of ischemia in a patient with multivessel lesions. Three-dimensional imaging was inferior in sensitivity to speckletracking stress echocardiography and, at present, seems to have more research value.
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Affiliation(s)
| | - O. M. Drapkina
- National Medical Research Center for Preventive Medicine
| | - F. B. Shukurov
- National Medical Research Center for Preventive Medicine
| | - D. K. Vasiliev
- National Medical Research Center for Preventive Medicine
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Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth Universal Definition of Myocardial Infarction (2018). Circulation 2019; 138:e618-e651. [PMID: 30571511 DOI: 10.1161/cir.0000000000000617] [Citation(s) in RCA: 1688] [Impact Index Per Article: 337.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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13
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Søndergaard MM, Nielsen JB, Mortensen RN, Gislason G, Køber L, Lippert F, Graff C, Haunsø S, Svendsen JH, Kragholm KH, Pietersen AH, Lind BS, Hjortshøj SP, Holst AG, Struijk JJ, Torp-Pedersen C, Hansen SM. Associations between common ECG abnormalities and out-of-hospital cardiac arrest. Open Heart 2019; 6:e000905. [PMID: 31217990 PMCID: PMC6546195 DOI: 10.1136/openhrt-2018-000905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/26/2019] [Accepted: 04/26/2019] [Indexed: 12/25/2022] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is often the first manifestation of unrecognised cardiac disease. ECG abnormalities encountered in primary care settings may be warning signs of OHCA. Objective We examined the association between common ECG abnormalities and OHCA in a primary care setting. Methods We cross-linked individuals who had an ECG recording between 2001 and 2011 in a primary care setting with the Danish Cardiac Arrest Registry and identified OHCAs of presumed cardiac cause. Results A total of 326 227 individuals were included and 2667 (0,8%) suffered an OHCA. In Cox regression analyses, adjusted for age and sex, the following ECG findings were strongly associated with OHCA: ST-depression without concomitant atrial fibrillation (HR 2.79; 95% CI 2.45 to 3.18), left bundle branch block (LBBB; HR 3.44; 95% CI 2.85 to 4.14) and non-specific intraventricular block (NSIB; HR 3.15; 95% CI 2.58 to 3.83). Also associated with OHCA were atrial fibrillation (HR 1.89; 95% CI 1.63 to 2.18), Q-wave (HR 1.75; 95% CI 1.57 to 1.95), Cornell and Sokolow-Lyon criteria for left ventricular hypertrophy (HR 1.56; 95% CI 1.33 to 1.82 and HR 1.27; 95% CI 1.12 to 1.45, respectively), ST-elevation (HR 1.40; 95% CI 1.09 to 1.54) and right bundle branch block (HR 1.29; 95% CI 1.09 to 1.54). The association between ST-depression and OHCA diminished with concomitant atrial fibrillation (HR 1.79; 95% CI 1.42 to 2.24, p < 0.01 for interaction). Among patients suffering from OHCA, without a known cardiac disease at the time of the cardiac arrest, 14.2 % had LBBB, NSIB or ST-depression. Conclusions Several common ECG findings obtained from a primary care setting are associated with OHCA.
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Affiliation(s)
| | - Jonas Bille Nielsen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Gunnar Gislason
- Department of Cardiology, Herlev Hospital, Herlev, Denmark.,National Institute of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Kobenhavn, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Kobenhavns, Denmark
| | - Claus Graff
- Department of Health, Science and Technology, Aalborg Universitet Det Sundhedsvidenskabelige Fakultet, Aalborg, Denmark
| | - Stig Haunsø
- Department of Cardiology, Rigshospitalet, Kobenhavn, Denmark.,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet, Kobenhavn, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Kobenhavn, Denmark.,Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Kobenhavn, Denmark
| | - Kristian Hay Kragholm
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark.,Department of Cardiology, Regionshospital Nordjylland, Hjorring, Nordjylland, Denmark
| | - Adrian Holger Pietersen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hillerod, Denmark
| | - Bent Struer Lind
- Department of Clinical Biochemistry, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Anders Gaarsdal Holst
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Kobenhavn, Denmark
| | - Johannes Jan Struijk
- Department of Health, Science and Technology, Aalborg Universitet Det Sundhedsvidenskabelige Fakultet, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark.,Department of Health, Science and Technology, Aalborg Universitet Det Sundhedsvidenskabelige Fakultet, Aalborg, Denmark
| | - Steen Møller Hansen
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark
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14
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Puljevic M, Danilowicz‐Szymanowicz L, Molon G, Puljevic D, Raczak G, Canali G, Velagic V, Pezo‐Nikolic B, Milicic D. TWARMI pilot trial: The value and optimal criteria of microvolt T-wave alternans in the diagnosis of reversible myocardial ischemia in patients without structural cardiac disease. Ann Noninvasive Electrocardiol 2019; 24:e12610. [PMID: 30383318 PMCID: PMC6931817 DOI: 10.1111/anec.12610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/19/2018] [Accepted: 10/08/2018] [Indexed: 12/13/2022] Open
Abstract
AIMS Microvolt T-wave alternans (MTWA) testing is a beat-to-beat fluctuation in the amplitude of T wave. We investigated whether: (a) MTWA can be new non-invasive tool for detection of reversible ischemia in patients with suspected CAD without structural heart disease, (b) MTWA can detect ischemia earlier and with greater test accuracy compared with exercise ECG ST-segment testing, and (c) threshold value of MTWA and heart rate at which the alternans is estimated can be different compared to standard values. METHODS A total of 101 patients with suspected stable coronary disease, but without structural heart disease, were included. Echocardiography, exercise ECG test, MTWA with classical and modified threshold alternans values, and coronary angiography were performed. RESULTS About 33.3% patients had a false-positive result on exercise ECG test. The sensitivity of exercise ECG ST-segment test in the detection of coronary artery disease was 97.8%, and the specificity was 42.5% (DOR 33.89). In a group of angiographically positive patients, standard MTWA accurately identified 60% of patients, while 40% had a false-negative result. About 91.8% patients with negative angiography result were accurately identified with 8.2% false positives. The sensitivity of MTWA was 59.61% and specificity 91.83%. Best ratio of sensitivity and specificity (86.53% and 95.91%, DOR 151.06) had modified criteria for positive MTWA (MTWA >1.5 µV at heart rate 115-125/min). CONCLUSIONS This study showed that MTWA can be the new non-invasive tool for the detection of reversible ischemia in patients with suspected CAD without structural heart disease. Also, MTWA can detect ischemia earlier and with greater accuracy compared with exercise ECG testing.
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Affiliation(s)
- Mislav Puljevic
- University of Zagreb, School of Medicine, University Hospital Center ZagrebZagrebCroatia
| | | | - Giulio Molon
- Cardiology DepartmentS. Cuore HospitalVeronaItaly
| | - Davor Puljevic
- University of Zagreb, School of Medicine, University Hospital Center ZagrebZagrebCroatia
| | - Grzegorz Raczak
- Department of Cardiology and ElectrotherapyMedical University of GdanskGdanskPoland
| | - Guido Canali
- Cardiology DepartmentS. Cuore HospitalVeronaItaly
| | - Vedran Velagic
- University of Zagreb, School of Medicine, University Hospital Center ZagrebZagrebCroatia
| | - Borka Pezo‐Nikolic
- University of Zagreb, School of Medicine, University Hospital Center ZagrebZagrebCroatia
| | - Davor Milicic
- University of Zagreb, School of Medicine, University Hospital Center ZagrebZagrebCroatia
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Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol 2018; 72:2231-2264. [PMID: 30153967 DOI: 10.1016/j.jacc.2018.08.1038] [Citation(s) in RCA: 2043] [Impact Index Per Article: 340.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Mickley H, Crea F, Van de Werf F, Bucciarelli-Ducci C, Katus HA, Pinto FJ, Antman EM, Hamm CW, De Caterina R, Januzzi JL, Apple FS, Alonso Garcia MA, Underwood SR, Canty JM, Lyon AR, Devereaux PJ, Zamorano JL, Lindahl B, Weintraub WS, Newby LK, Virmani R, Vranckx P, Cutlip D, Gibbons RJ, Smith SC, Atar D, Luepker RV, Robertson RM, Bonow RO, Steg PG, O’Gara PT, Fox KAA, Hasdai D, Aboyans V, Achenbach S, Agewall S, Alexander T, Avezum A, Barbato E, Bassand JP, Bates E, Bittl JA, Breithardt G, Bueno H, Bugiardini R, Cohen MG, Dangas G, de Lemos JA, Delgado V, Filippatos G, Fry E, Granger CB, Halvorsen S, Hlatky MA, Ibanez B, James S, Kastrati A, Leclercq C, Mahaffey KW, Mehta L, Müller C, Patrono C, Piepoli MF, Piñeiro D, Roffi M, Rubboli A, Sharma S, Simpson IA, Tendera M, Valgimigli M, van der Wal AC, Windecker S, Chettibi M, Hayrapetyan H, Roithinger FX, Aliyev F, Sujayeva V, Claeys MJ, Smajić E, Kala P, Iversen KK, El Hefny E, Marandi T, Porela P, Antov S, Gilard M, Blankenberg S, Davlouros P, Gudnason T, Alcalai R, Colivicchi F, Elezi S, Baitova G, Zakke I, Gustiene O, Beissel J, Dingli P, Grosu A, Damman P, Juliebø V, Legutko J, Morais J, Tatu-Chitoiu G, Yakovlev A, Zavatta M, Nedeljkovic M, Radsel P, Sionis A, Jemberg T, Müller C, Abid L, Abaci A, Parkhomenko A, Corbett S. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2018; 40:237-269. [DOI: 10.1093/eurheartj/ehy462] [Citation(s) in RCA: 1047] [Impact Index Per Article: 174.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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17
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Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth Universal Definition of Myocardial Infarction (2018). Glob Heart 2018; 13:305-338. [PMID: 30154043 DOI: 10.1016/j.gheart.2018.08.004] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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18
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Wijesurendra RS, Liu A, Notaristefano F, Ntusi NAB, Karamitsos TD, Bashir Y, Ginks M, Rajappan K, Betts TR, Jerosch‐Herold M, Ferreira VM, Neubauer S, Casadei B. Myocardial Perfusion Is Impaired and Relates to Cardiac Dysfunction in Patients With Atrial Fibrillation Both Before and After Successful Catheter Ablation. J Am Heart Assoc 2018; 7:e009218. [PMID: 30371239 PMCID: PMC6201472 DOI: 10.1161/jaha.118.009218] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023]
Abstract
Background Atrial fibrillation ( AF ) is associated with myocardial infarction, and patients with AF and no obstructive coronary artery disease can present with symptoms and evidence of cardiac ischemia. We hypothesized that microvascular coronary dysfunction underlies these observations. Methods and Results Myocardial blood flow ( MBF ) at baseline and during adenosine stress and left ventricular and left atrial function were evaluated by magnetic resonance in 49 patients with AF (25 paroxysmal, 24 persistent) with no history of epicardial coronary artery disease or diabetes mellitus, before and 6 to 9 months after ablation. Findings were compared with those obtained in matched controls in sinus rhythm (n=25). Before ablation, patients with AF had impaired left atrial function and left ventricular ejection fraction and strain indices (all P<0.05 versus controls). MBF was impaired in patients both under baseline conditions (1.21±0.24 mL/min per g·[mm Hg·bpm/104]-1 versus 1.34±0.28 mL/min per g·[mm Hg·bpm/104]-1 in controls, P=0.044) and during adenosine stress (2.29±0.48 mL/min per g versus 2.73±0.37 mL/min per g in controls, P<0.001). Under baseline conditions, MBF correlated with left ventricular strain and left atrial function (all P≤0.001), so that cardiac function was most impaired in patients with the lowest MBF . Baseline and stress MBF remained unchanged postablation (both P=ns), and baseline MBF showed similar correlations with functional indices to those present preablation (all P≤0.001). Conclusions Baseline and stress MBF are significantly impaired in patients with AF but no epicardial coronary artery disease. Reduction in MBF is proportional to severity of left ventricular and left atrial dysfunction, even after successful ablation. Coronary microvascular dysfunction may be a relevant pathophysiological mechanism in patients with a history of AF .
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Affiliation(s)
- Rohan S. Wijesurendra
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Alexander Liu
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Francesco Notaristefano
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Ntobeko A. B. Ntusi
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Theodoros D. Karamitsos
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Yaver Bashir
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Matthew Ginks
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Kim Rajappan
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Tim R. Betts
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | | | - Vanessa M. Ferreira
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Barbara Casadei
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
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19
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Patients with atrial fibrillation and coronary artery disease – Double trouble. Adv Med Sci 2018; 63:30-35. [DOI: 10.1016/j.advms.2017.06.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 01/06/2023]
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20
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Alghamry A, Hanna J, Pelecanos A, Kyranis S, Khelgi V, O'Rourke P, Carroll O, Oxenford C, Rangaswamaiah S, Tan C. Predictors of significant coronary artery disease in atrial fibrillation: Are cardiac troponins a useful measure. Int J Cardiol 2016; 223:744-749. [PMID: 27573599 DOI: 10.1016/j.ijcard.2016.08.267] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac Troponin I (cTnI) is frequently measured in patients presenting with symptomatic atrial fibrillation (AF). The significance of elevated cTnI levels in this patient cohort is unclear. We investigated the value of cTnI elevation in this setting and whether it is predictive for significant coronary artery disease (sCAD). METHODS We conducted a retrospective, single-center, case-control study of 231 patients who presented with symptomatic AF to The Prince Charles Hospital emergency department, Brisbane, Australia between 2006 and 2014. Patients who underwent serial cTnI testing and assessment for CAD were included. Clinical variables that are known to predict CAD and could potentially predict cTnI elevation were collected. Binary logistic regression was performed to identify predictors of sCAD and cTnI elevation. RESULTS Cardiac Troponin I elevation above standard cut off was not predictive for sCAD after adjustment for other predictors (OR 1.62, 95% CI 0.79-3.32. p=0.19). However, the highest cTnI concentration value (cTnI peak) was predictive for sCAD (OR 2.02, 95% CI 1.02-3.97, p=0.04). Dyspnea on presentation (OR 4.52, 95% CI 1.87-10.91, p=0.001), known coronary artery disease (OR 3.44, 95% CI 1.42-8.32, p=0.006), and ST depression on the initial electrocardiogram (OR 2.57, 95% CI 1.11-5.97, p=0.028) predicted sCAD in our cohort, while heart rate on initial presentation was inversely correlated with sCAD (OR 0.99, 95% CI 0.971-1.00, p=0.034). CONCLUSION Troponin elevation is common in patients presenting to hospital with acute symptomatic AF and it is not a reliable indicator for underlying sCAD in this patient cohort. However, cTnI peak was a predictor of significant coronary artery disease.
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Affiliation(s)
- Alaa Alghamry
- University of Queensland, Australia; Department of Medicine, Redcliffe Hospital, Redcliffe, Australia.
| | - Joseph Hanna
- University of Queensland, Australia; Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Stephen Kyranis
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Vinod Khelgi
- Department of Medicine, Redcliffe Hospital, Redcliffe, Australia
| | - Peter O'Rourke
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Oran Carroll
- Department of Medicine, Redcliffe Hospital, Redcliffe, Australia
| | - Cassie Oxenford
- Department of Medicine, Redcliffe Hospital, Redcliffe, Australia
| | | | - Christopher Tan
- University of Queensland, Australia; Department of Medicine, Redcliffe Hospital, Redcliffe, Australia
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21
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Looking for Coronary Disease in Patients With Atrial Fibrillation. Can J Cardiol 2014; 30:861-3. [DOI: 10.1016/j.cjca.2014.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 11/18/2022] Open
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22
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Diagnostic Accuracy of Electrocardiographic ST-Segment Depression in Patients With Rapid Atrial Fibrillation for the Prediction of Coronary Artery Disease. Can J Cardiol 2014; 30:920-4. [DOI: 10.1016/j.cjca.2014.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 03/19/2014] [Accepted: 03/19/2014] [Indexed: 11/17/2022] Open
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Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Paul Taggart D, van der Wall EE, Vrints CJ, Luis Zamorano J, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Anton Sirnes P, Luis Tamargo J, Tendera M, Torbicki A, Wijns W, Windecker S, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, González-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Dalby Kristensen S, Lancellotti P, Pietro Maggioni A, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Anton Sirnes P, Gabriel Steg P, Timmis A, Wijns W, Windecker S, Yildirir A, Luis Zamorano J. Guía de Práctica Clínica de la ESC 2013 sobre diagnóstico y tratamiento de la cardiopatía isquémica estable. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Androulakis AE, Aznaouridis KA, Stougiannos PN, Vavuranakis MM, Tousoulis D, Stefanadis CI, Kallikazaros IE. Predictors of obstructive coronary artery disease in otherwise 'healthy' individuals with ST-segment depression during paroxysms of atrial fibrillation. Int J Cardiol 2013; 170:e25-7. [PMID: 24176124 DOI: 10.1016/j.ijcard.2013.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 10/05/2013] [Accepted: 10/08/2013] [Indexed: 11/25/2022]
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25
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Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJM, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J 2013; 34:2949-3003. [PMID: 23996286 DOI: 10.1093/eurheartj/eht296] [Citation(s) in RCA: 2900] [Impact Index Per Article: 263.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
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- The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines
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Rubenstein JC, Cinquegrani MP, Wright J. Atrial Fibrillation in Acute Coronary Syndrome. J Atr Fibrillation 2012; 5:551. [PMID: 28496750 DOI: 10.4022/jafib.551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 03/08/2012] [Accepted: 04/05/2012] [Indexed: 01/09/2023]
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia occurring in an estimated 2.7 to 6.1 million people in the United States. The risk factors for the development of AF are very similar to those for developing coronary artery disease, and AF is often associated with acute coronary syndrome (ACS) and acute myocardial infarction (MI). Overall, AF complicates approximately 10% of acute infarcts and the incidence rate is comparable between the thrombolytic and percutaneous coronary intervention (PCI) eras. Prior to widespread use of thrombolysis, the incidence of AF during acute MI was as high as 18%. Moreover, AF is a marker for increased long term mortality post infarct. Over the past 20 years, the relative mortality risk for patients with AF post MI has remained around 2.5 times that for patients without AF. The treatment of AF in the setting of MI and ACS is similar to without; however there is often an increased urgency to limiting rapid heart rates which may exacerbate acute ischemia. Cardioversion and IV amiodarone may be utilized more liberally in this setting than otherwise. Anticoagulation is usually required both for the treatment of MI and possible PCI, as well as for cerebral vascular accident prevention from AF-induced thromboembolism. Often patients require triple-therapy for optimal treatment of both conditions, and special considerations for bleeding risk must be analyzed.
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Affiliation(s)
- Jason C Rubenstein
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael P Cinquegrani
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer Wright
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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