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Park MS, Kim J, Kim KH, Yoo HR, Chae I, Lee J, Joo IH, Kim DH. Modern concepts and biomarkers of blood stasis in cardio- and cerebrovascular diseases from the perspectives of Eastern and Western medicine: a scoping review protocol. JBI Evid Synth 2023; 21:214-222. [PMID: 35946908 DOI: 10.11124/jbies-22-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of this review is to provide a modern definition and identify potential biomarkers of blood stasis in cardio- and cerebrovascular diseases by mapping, comparing, and combining Eastern and Western concepts. INTRODUCTION Blood stasis is a pathological concept found in both Eastern and Western medical literature. In traditional East Asian medicine, blood stasis is a differential syndrome characterized by stagnant blood flow in various parts of the body. Similarly, in Western medicine, various diseases, especially cardio- and cerebrovascular diseases, are known to be accompanied by blood stasis. Numerous scientific studies on blood stasis have been conducted over the last decade, and there is a need to synthesize those results. INCLUSION CRITERIA We will use the keywords "blood stasis," "blood stagnation," "blood stagnant," and "blood congestion" in 3 electronic databases: PubMed, Cochrane CENTRAL, and Google Scholar. In addition, we will use the keywords "어혈" and "혈어" in 4 Korean electronic databases (ie, NDSL, OASIS, KISS, and DBpia). Peer-reviewed articles published from 2010 to the present that focus on blood stasis in cardio- and cerebrovascular diseases in human subjects according to the International Classification of Diseases 11 th revision categories BA00-BE2Z, 8B00-8B2Z, 8E64, and 8E65 will be included. Reviews, opinion articles, in vivo, in vitro, and in silico preclinical studies will be excluded. METHODS We will follow the frameworks by Arksey and O'Malley and Levac et al. as well as JBI guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Two reviewers will independently search and screen titles and abstracts followed by full-text screening of eligible studies. If there are discrepancies between the 2 reviewers, a third reviewer will be consulted to make the final decision. We will use descriptive narrative, tabular, and graphical displays, and content analysis to present the results. SCOPING REVIEW REGISTRATION Open Science Framework https://osf.io/gv4ym.
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Affiliation(s)
- Miso S Park
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea.,Department of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Jihye Kim
- Digital Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Keun Ho Kim
- Digital Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ho-Ryong Yoo
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea.,Department of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Incheol Chae
- Department of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Juho Lee
- Data Convergence Drug Research Center, Korea Research Institute of Chemical Technology (KRICT), University of Science and Technology (UST), Republic of Korea
| | - In Hwan Joo
- Department of Pathology, Daejeon University College of Korean Medicine, Daejeon, Republic of Korea
| | - Dong Hee Kim
- Department of Pathology, Daejeon University College of Korean Medicine, Daejeon, Republic of Korea
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Stroke risk scores for prediction of mortality and hemorrhages in atrial fibrillation patients. ROMANIAN JOURNAL OF INTERNAL MEDICINE 2022; 60:182-192. [DOI: 10.2478/rjim-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Atrial fibrillation (AF) is an emerging epidemic worldwide, responsible for a twofold increase in mortality, independent of other risk factors. Stroke prevention is the cornerstone of AF management. However, oral anticoagulation imposes an increased risk of bleeding. Several risk scores have been developed for estimating both the thromboembolic and the bleeding risks. The aim of the study was to determine the usefulness of different stroke risk scores as predictors of mortality and hemorrhagic events in AF patients.
Methods: We retrospectively enrolled 211 AF patients hospitalized in the Cardiology Ward of our tertiary hospital. The primary endpoints were mortality and non-minor bleeding events. The mean follow-up period was 378 days for bleeding events and 5 years and 1 month for mortality. For each patient, we evaluated the following stroke risk scores: CHADS2, CHA2DS2-VASc, R2CHADS2, ABC, ATRIA, GARFIELD.
Results: The mean age in our cohort is 66, with a slight predominance of women (52.2%). For a CHA2DS2-VASc ≥ 4 as well as for a score of 2-3, 5-year survival was worse than for patients with a score of 0–1(chi-squared=8.13; p=0.01). Similarly, all subgroups of patients with an ABC <2%, had a worse 5-year survival when compared with an ABC score of ≥2% (chi-squared=12.85; p=0.005). C-statistics show a modest predictive value for mortality, for all stroke scores except Garfield, with similar AUCs, the highest being for CHA2DS2-VASc (AUC 0.656; p=0.0001). CHA2DS2-VASc also correlates with bleeding events, having a good predictive ability (AUC 0.723; 95%CI 0.658–0.782, p=0.001), mildly superior to HAS-BLED (AUC 0.674; 95% CI 0.523–0.825; p = 0.04) and very close to Garfield-bleeding (0.765; 95%CI 0.702–0.80; p=0.0001).
Conclusions: CHA2DS2-VASc is comparable to HAS-BLED and Garfield-bleeding in predicting bleeding events in AF patients. CHA2DS2-VASc and ABC correlate directly and consistently with mortality rate. For CHA2DS2-VASc, the AUCs for our endpoints are similar to the ones for stroke prediction, highlighting the potential of extending its applicability to various outcomes.
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Seewöster T, Kosich F, Sommer P, Bertagnolli L, Hindricks G, Kornej J. Prediction of low-voltage areas using modified APPLE score. Europace 2021; 23:575-580. [PMID: 33279992 DOI: 10.1093/europace/euaa311] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/22/2020] [Indexed: 12/25/2022] Open
Abstract
AIMS The presence of low-voltage areas (LVAs) in patients with atrial fibrillation (AF) reflects left atrial (LA) electroanatomical substrate, which is essential for individualized AF management. However, echocardiographic anteroposterior LA diameter included into previous LVAs prediction scores does not mirror LA size accurately and impaired left ventricular ejection fraction (LV-EF) is not directly associated with atrial myopathy. Therefore, we aimed to compare a modified (m)APPLE score, which included LA volume (LAV) and LA emptying fraction (LA-EF) with the regular APPLE score for the prediction of LVAs. METHODS AND RESULTS In patients undergoing first AF catheter ablation, LVAs were determined peri-interventionally using high-density maps and defined as signal amplitude <0.5 mV. All patients underwent cardiovascular magnetic resonance imaging before intervention. The APPLE (one point for Age ≥ 65 years, Persistent AF, imPaired eGFR ≤ 60 mL/min/1.73 m2, LA diameter ≥ 43 mm, and LVEF < 50%) and (m)APPLE (last two variables changed by LAV ≥ 39 mL/m2, and LA-EF < 31%) scores were calculated at baseline. The study population included 219 patients [median age 65 (interquartile range 57-72) years, 41% females, 59% persistent AF, 25% LVAs]. Both scores were significantly associated with LVAs [OR 1.817, 95% CI 1.376-2.399 for APPLE and 2.288, 95% CI 1.650-3.172 for (m)APPLE]. Using receiver operating characteristic curves analysis, the (m)APPLE score [area under the curve (AUC) 0.779, 95% CI 0.702-0.855] showed better LVAs prediction than the APPLE score (AUC 0.704, 95% CI 0.623-0.784), however, without statistically significant difference (P = 0.233). CONCLUSION The modified (m)APPLE score demonstrated good prognostic value for LVAs prediction and was comparable with the regular APPLE score.
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Affiliation(s)
- Timm Seewöster
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Falco Kosich
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Herz-und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Livio Bertagnolli
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Jelena Kornej
- School of Medicine-Cardiovascular Medicine, Boston University, 72 E Concord Street, Boston, MA 02118, USA
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Stroke Risk Scores as Predictors of Severe Outcomes in Atrial Fibrillation: A Comprehensive Review. Am J Ther 2021; 28:e319-e334. [PMID: 33852487 DOI: 10.1097/mjt.0000000000001357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most frequent sustained arrhythmia. It increases the risk of stroke, heart failure, death, hospitalizations, and costs. AREA OF UNCERTAINTY Several scores were introduced to stratify the stroke risk and need for anticoagulation in patients (pts) with AF . CHA2DS2-VASc, the most frequently used score, as well as other stroke risk scores have been additionally applied to estimate outcomes for different other conditions, with inhomogeneous results. To date, there has been no consensus regarding the usefulness of these scores to estimate outcomes outside of thromboembolic risk assessment, and their value in estimating different end-point outcomes is still a subject of debate. We conducted this review to investigate whether the stroke risk scores' utility can be extended for the prediction of other severe outcomes in pts with AF. DATA SOURCES We searched PubMed database and included studies that stratified the outcome of pts with AF by different stroke risk scores. We also included studies with a separate analysis of the pts with AF subpopulation. RESULTS Mortality rates increased with higher CHADS2 [from 2.28% (2.00%-2.58%) to 13.2% (8.24%-20.8%) per year] and CHA2DS2-VASc scores [risk ratio 1.26 (1.21-1.32), P < 0.0001 for score ≥3]. CHADS2 and CHA2DS2-VASc predicted poor outcome in stroke [odds ratio (OR) ranging 1.42-6 for CHADS2 and 1.3-7.3 for CHA2DS2-VASc]. Acute myocardial infarction rates increased with higher CHADS2 [OR 2.120 (1.942-2.315) P < 0.001] and CHA2DS2-VASc [OR 1.63 (1.53-1.75), P < 0.001]. Limited data were reported for ABC( Age, Biomarkers, Clinical histoty) and R2CHADS2. No statistically significant correlation was found for major bleeding. CONCLUSIONS CHADS2 and CHA2DS2-VASc are useful tools in identifying pts with AF at higher risk for all-cause death, regardless of other pathologies. Both scores correlated with the development of acute myocardial infarction, cardiovascular hospitalization, outcome in stroke, major adverse cardiovascular events, and major adverse cardiovascular and cerebral events, but not with serious bleeding.
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Akamatsu K, Ito T, Ozeki M, Miyamura M, Sohmiya K, Hoshiga M. Left atrial spontaneous echo contrast occurring in patients with low CHADS 2 or CHA 2DS 2-VASc scores. Cardiovasc Ultrasound 2020; 18:31. [PMID: 32738924 PMCID: PMC7395968 DOI: 10.1186/s12947-020-00213-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Left atrial spontaneous echo contrast (LASEC) is common in patients with atrial fibrillation (AF), although scarce information exists on LASEC occurring in nonvalvular AF patients who have low thromboembolic risk scores. We therefore examined prevalence and determinants of LASEC under low CHADS2 or CHA2DS2-VASc scores in these patients. Methods Among 713 patients who underwent transesophageal echocardiography, 349 with a CHADS2 score < 2 (CHADS2 group) (93 women, mean age 65 years) and 221 with a CHA2DS2-VASc score < 2 (CHA2DS2-VASc group) (39 women, mean age 62 years) were separately examined for clinical and echocardiographic findings. Results LASEC was found in 77 patients of CHADS2 group (22%) and in 41 of CHA2DS2-VASc group (19%). Multivariate logistic regression analysis, adjusted for several parameters including non-paroxysmal AF, LA enlargement (LA diameter ≥ 50 mm), left ventricular (LV) hypertrophy, and an elevated B-type natriuretic peptide (BNP) (BNP ≥200 pg/mL) revealed that for CHADS2 group, non-paroxysmal AF (Odds ratio 5.65, 95%CI 3.08–10.5, P < 0.001), BNP elevation (Odds ratio 3.42, 95%CI 1.29–9.06, P = 0.013), and LV hypertrophy (Odds ratio 2.26, 95%CI 1.19–4.28, P = 0.013) were significant independent determinants of LASEC, and that for CHA2DS2-VASc group, non-paroxysmal AF (Odds ratio 3.38, 95%CI 1.51–7.54, P = 0.003) and LV hypertrophy (Odds ratio 2.53, 95%CI 1.13–5.70, P = 0.025) were significant independent determinants of LASEC. Conclusions LASEC was present in a considerable proportion of patients with nonvalvular AF under low thromboembolic risk scores. Information on AF chronicity, BNP, and LV hypertrophy might help identify patients at risk for thromboembolism, although large-scale studies are necessary to confirm our observations.
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Affiliation(s)
- Kanako Akamatsu
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan
| | - Takahide Ito
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan.
| | - Michishige Ozeki
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan
| | - Masatoshi Miyamura
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan
| | - Koichi Sohmiya
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan
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Ibebuogu UN, Schafer JH, Schwade MJ, Waller JL, Sharma GK, Robinson VJB. Useful indices of thrombogenesis in the exclusion of intra-cardiac thrombus. Echocardiography 2019; 37:86-95. [PMID: 31854027 PMCID: PMC7027915 DOI: 10.1111/echo.14562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/31/2019] [Accepted: 11/22/2019] [Indexed: 02/03/2023] Open
Abstract
Background Cardioversion in patients with atrial fibrillation (AF) can cause cardioembolic stroke, and effective clinical management is necessary to reduce morbidity and mortality. Currently, transesophageal echocardiography (TEE) is the accepted standard to diagnose cardiogenic thromboemboli; however, a negative TEE does not eliminate the possibility of left atrial thrombus. The objective of this study was to evaluate the diagnostic value of supplementing the TEE with additional noninvasive markers to ensure thrombus absence. Methods A prospective study was conducted on 59 patients who underwent TEE for suspected intra‐cardiac thrombi. The TEE indications included acute ischemic stroke (45.7%) and AF or flutter (59.3%). D‐dimer level and white blood cell counts were assessed. Results A negative D‐dimer level (<200 ng/mL) excluded the presence of intra‐cardiac thrombi. Groups with either negative (n = 14) or positive (n = 45) D‐dimer levels had comparable clinical characteristics. Comparing positive D‐dimer–level patients with thrombus (n = 7) and without thrombus (n = 33), patients with thrombus had reduced left atrial appendage (LAA) velocity (P = .0024), reduced left ventricular ejection fraction (LVEF) (P = .0263), increased neutrophil percent (P = .0261), decreased lymphocyte percent (P = .0216), and increased monocyte counts (P = .0220). The area under the receiver operating characteristic (ROC) curve for thrombus diagnostics was larger for combinations of clinical and biochemical data than for each parameter individually. Conclusions Supplementing the gold standard TEE with the analysis of LAA velocity, noninvasive LVEF, D‐dimer, and hemostatic markers provided additional useful diagnostic information. Larger studies are needed to further validate the efficacy of supplementing the TEE to better assess patients for intra‐cardiac thrombi.
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Affiliation(s)
- Uzoma N Ibebuogu
- Division of Cardiology, Department of Medicine, Augusta University Medical Center, Augusta, GA, USA.,Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Joseph H Schafer
- Division of Cardiology, Department of Medicine, Augusta University Medical Center, Augusta, GA, USA
| | - Mark J Schwade
- Division of Cardiology, Department of Medicine, Augusta University Medical Center, Augusta, GA, USA
| | - Jennifer L Waller
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Augusta University Medical Center, Augusta, GA, USA
| | - Gyanendra K Sharma
- Division of Cardiology, Department of Medicine, Augusta University Medical Center, Augusta, GA, USA
| | - Vincent J B Robinson
- Division of Cardiology, Department of Medicine, Augusta University Medical Center, Augusta, GA, USA
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Ito T, Suwa M. Left atrial spontaneous echo contrast: relationship with clinical and echocardiographic parameters. Echo Res Pract 2019; 6:R65-R73. [PMID: 30959476 PMCID: PMC6499934 DOI: 10.1530/erp-18-0083] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/03/2019] [Indexed: 12/19/2022] Open
Abstract
Spontaneous echo contrast (SEC) indicates blood stasis in cardiac chambers and major vessels, and is a known precursor of thrombus formation. Transesophageal echocardiography plays a pivotal role in detecting and grading SEC in the left atrial (LA) cavity. Assessing LA SEC can identify patients at increased risk for thromboembolic events. LA SEC also develops in patients who have sinus rhythm, especially in those with heart failure. Detection of LA SEC is not uncommon in subjects who have multiple cardiovascular comorbidities, although mechanisms behind this association are not fully understood. In patients with atrial fibrillation, the role of mitral regurgitation in counteracting LA SEC and subsequent thromboembolism is controversial. Moreover, alterations of blood coagulability and elevated levels of certain biological markers in the blood contribute to occurrence of LA SEC. This review describes the pathogenesis and assessment of SEC, in addition to the relationship between LA SEC and clinical, biological and echocardiographic parameters.
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Affiliation(s)
- Takahide Ito
- Department of Cardiology, Osaka Medical College, Takatsuki, Japan
| | - Michihiro Suwa
- Department of Cardiovascular Medicine, Hokusetsu General Hospital, Takatsuki, Japan
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Kizawa S, Ito T, Akamatsu K, Ichihara N, Nogi S, Miyamura M, Kanzaki Y, Sohmiya K, Hoshiga M. Chronic Kidney Disease as a Possible Predictor of Left Atrial Thrombogenic Milieu Among Patients with Nonvalvular Atrial Fibrillation. Am J Cardiol 2018; 122:2062-2067. [PMID: 30293657 DOI: 10.1016/j.amjcard.2018.08.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022]
Abstract
Patients with chronic kidney disease (CKD) experiencing atrial arrhythmia are hypothesized to have elevated CHADS2 and CHA2DS2-VASc scores, thereby predisposed to left atrial (LA) thrombus formation and subsequent thromboembolism. We examined possible association of LA thrombogenic milieu (TM) with CKD in patients with nonvalvular atrial fibrillation. A total of 581 patients (181 women; mean age, 67 years) who underwent transesophageal echocardiography were examined. Patients were divided into 4 groups based on the estimated glomerular filtration rate (eGFR) (ml/min/1.73 m2): eGFR ≥90 (n = 29), 60≤ eGFR <90 (n = 329), 30≤ eGFR <60 (n = 209), and eGFR <30 (n = 14). TM was defined as the presence of LA thrombus, dense spontaneous echo contrast, or LA appendage velocity ≤25 cm/s. Of 581 patients, 147 (25%) had TM. The prevalence of TM increased with decreasing eGFR (4%, 18%, 36%, and 86% for each group, p <0.001). Similar trends were observed for some of the clinical and echocardiographic variables including CHA2DS2-VASc score and LA size. Multivariate logistic regression analysis revealed that every 10 ml/min/1.73 m2 decrement in eGFR was a significant independent correlate of TM (odds ratio 0.80, p = 0.005), along with nonparoxysmal atrial fibrillation (AF) (odds ratio 0.45, p = 0.004), higher CHA2DS2-VASc score (odds ratio 1.24, p = 0.012), every 5 ml/m2 increment in LA volume index (odds ratio 1.57, p <0.001), and every 10% decrement in left ventricular ejection fraction (odds ratio 0.51, p <0.001). In conclusion, CKD may be a significant risk factor for LA thrombus formation in patients with nonvalvular atrial fibrillation.
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Affiliation(s)
- Shun Kizawa
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takahide Ito
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan.
| | - Kanako Akamatsu
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Noboru Ichihara
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shimpei Nogi
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masatoshi Miyamura
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yumiko Kanzaki
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Koichi Sohmiya
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
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O'Neill L, Harrison J, O'Neill M, Williams SE. Clinical, electrophysiological and imaging predictors of atrial fibrillation ablation outcome. Expert Rev Cardiovasc Ther 2017; 15:289-305. [PMID: 28267401 DOI: 10.1080/14779072.2017.1303378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Significant technological advances for catheter ablation of atrial fibrillation (AF) have occurred over the last decade, with a consequent increase in numbers of patients referred for AF ablation worldwide. Despite this, long-term success rates, particularly in those with persistent AF, remain modest. The patient population presenting for AF ablation are heterogeneous with regard to age, type of AF and presence of associated cardiovascular disease. Improved understanding of factors predicting response to AF ablation may therefore help to improve patient selection for ablation procedures. Areas covered: This review outlines the clinical, electrophysiological and imaging predictors of response to radiofrequency ablation for AF in contemporary practice. Recently developed scoring systems incorporating these parameters are examined, as are factors identified thus far which may predict the outcome of cryoballoon ablation. Expert commentary: Traditional clinical factors associated with ablation outcomes serve as surrogates rather than direct measures of the underlying arrhythmia substrate. An improved understanding of this substrate could improve the prediction of response to radiofrequency ablation. Continued development of methods for characterising the arrhythmia substrate, including atrial cardiac magnetic resonance imaging and invasive voltage mapping, may inform patient risk assessment and help guide selection for catheter ablation on an increasingly individualistic basis.
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Affiliation(s)
- Louisa O'Neill
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - James Harrison
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - Mark O'Neill
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - Steven E Williams
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
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Yoshihisa A, Watanabe S, Kanno Y, Takiguchi M, Sato A, Yokokawa T, Miura S, Shimizu T, Abe S, Sato T, Suzuki S, Oikawa M, Sakamoto N, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh SI, Takeishi Y. The CHA 2DS 2-VASc score as a predictor of high mortality in hospitalized heart failure patients. ESC Heart Fail 2016; 3:261-269. [PMID: 27867527 PMCID: PMC5107970 DOI: 10.1002/ehf2.12098] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/03/2016] [Accepted: 05/13/2016] [Indexed: 01/06/2023] Open
Abstract
Aims Atrial fibrillation (AF) is common in patients with heart failure (HF). CHA2DS2‐VASc score was originally employed as a risk assessment tool for stroke in patients with AF; however, it has recently been used to predict not only stroke but also various cardiovascular diseases beyond the original AF field. We aimed to verify the CHA2DS2‐VASc score as a risk assessment tool to predict mortality in patients with HF. Methods and Results Consecutive 1011 patients admitted for treatment of HF were divided into three groups based on their CHA2DS2‐VASc scores: score 1–3 group (n = 317), score 4–6 group (n = 549) and score 7–9 group (n = 145). Of the 1011 HF patients, 387 (38.3%) had AF. We compared patient characteristics among the three groups and prospectively followed for all‐cause mortality. Although left ventricular ejection fraction was similar among all three groups, all‐cause mortality was higher in the score 4–6 group and score 7–9 group than in the score 1–3 group (37.9 and 29.3% vs. 15.1%, log‐rank P < 0.001). In the multivariable Cox proportional hazard analysis, the CHA2DS2‐VASc score 7–9 was an independent predictor of all‐cause mortality (all HF patients: hazard ratio (HR) 1.822, P = 0.011; HF patients with AF: HR 1.951, P = 0.031; HF patients without AF: HR 2.215, P = 0.033). Conclusions The CHA2DS2‐VASc score was an independent predictor of all‐cause mortality in HF patients with or without AF. This comprehensive risk assessment score may help identify HF patients who are at high risk for mortality in HF patient.
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Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Shunsuke Watanabe
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Yuki Kanno
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Mai Takiguchi
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Akihiko Sato
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Tetsuro Yokokawa
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Shunsuke Miura
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Takeshi Shimizu
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Satoshi Abe
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Takamasa Sato
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Satoshi Suzuki
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Masayoshi Oikawa
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Nobuo Sakamoto
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Takayoshi Yamaki
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Koichi Sugimoto
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Hiroyuki Kunii
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Kazuhiko Nakazato
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Hitoshi Suzuki
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Shu-Ichi Saitoh
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
| | - Yasuchika Takeishi
- Department of Cardiology and Hematology Fukushima Medical University Fukushima Japan
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The Predictive Role of Inflammatory Biomarkers in Atrial Fibrillation as Seen through Neutrophil-Lymphocyte Ratio Mirror. J Biomark 2016; 2016:8160393. [PMID: 27446629 PMCID: PMC4947500 DOI: 10.1155/2016/8160393] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 12/25/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and is responsible for significant disease burden worldwide. Current evidence has suggested that systemic inflammatory response plays a crucial role in the initiation, maintenance, and progression of AF. So, recent efforts have been directed in search of measurable inflammatory biomarkers as additional tools in severity and prognosis assessment of AF. A simple, and easily obtainable, inflammatory marker is the neutrophil-lymphocyte ratio (NLR), which has shown good performance in preliminary studies as a potential prognostic biomarker in patients with AF. In this work, we performed a thorough review of clinical studies that evaluated the role of C-reactive protein (CRP), interleukin-6 (IL-6), and NLR as predictors of outcomes in AF. We gave a particular emphasis on the NLR because it is a simpler, widely available, and inexpensive biomarker.
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12
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High CHA2DS2−VASc score predicts left atrial thrombus or spontaneous echo contrast detected by transesophageal echocardiography. Int J Cardiol 2015; 184:540-542. [PMID: 25767011 DOI: 10.1016/j.ijcard.2015.02.109] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 02/27/2015] [Indexed: 11/21/2022]
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13
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Kobayashi Y, Okura H, Kobayashi Y, Okawa K, Banba K, Hirohata A, Tamada T, Obase K, Hayashida A, Yoshida K. Assessment of atrial synchrony in paroxysmal atrial fibrillation and impact of pulmonary vein isolation for atrial dyssynchrony and global strain by three-dimensional strain echocardiography. J Am Soc Echocardiogr 2014; 27:1193-9. [PMID: 25240493 DOI: 10.1016/j.echo.2014.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a risk factor for ischemic stroke and congestive heart failure. AF may cause left atrial (LA) dyssynchrony as well as electrical and mechanical remodeling. The aim of this study was to investigate LA dyssynchrony in patients with paroxysmal AF (PAF) and its recovery after pulmonary vein isolation (PVI), using a three-dimensional strain method. METHODS Thirty patients with PAF who underwent PVI were enrolled. Three-dimensional echocardiography was performed before and 3 months after PVI. Twenty subjects in whom AF had never been detected served as controls. LA dyssynchrony was quantified by the standard deviation of time to peak strain (TP-SD) from end-diastole by area tracking. Serial changes in TP-SD, LA volume, and global strain in three-dimensional echocardiography were investigated. RESULTS In the PAF group, TP-SD was significantly higher (9.19 ± 4.98% vs 4.80 ± 2.30% in controls, P < .02) and global strain significantly lower (48.2 ± 20.2% vs 84.4 ± 32.9% in controls, P = .0003) than in the control group. TP-SD, global strain, and LA volume all improved significantly from before to after PVI (TP-SD, from 9.19 ± 4.98% to 6.31 ± 2.94%, P = .005; global strain, from 48.2 ± 20.2% to 58.1 ± 21.2%, P = .018; LA volume index, 29.5 ± 10.6 to 25.8 ± 7.1 mL/m(2), P = .04). Despite the improvement after PVI, TP-SD was still significantly higher and global strain lower than in controls. CONCLUSIONS In patients with PAF, impaired LA function was documented by three-dimensional echocardiography. Despite early LA structural reverse remodeling, LA dyssynchrony was still observed 3 months after PVI. These results may affect medical therapy after successful PVI.
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Affiliation(s)
- Yukari Kobayashi
- Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan.
| | - Hiroyuki Okura
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Yuhei Kobayashi
- Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Keisuke Okawa
- Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kimikazu Banba
- Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Atsushi Hirohata
- Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Tomoko Tamada
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Kikuko Obase
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | | | - Kiyoshi Yoshida
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
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Hung CY, Hsieh YC, Huang JL, Lin CH, Wu TJ. Statin Therapy for Primary Prevention of Atrial Fibrillation: Guided by CHADS2/CHA2DS2VASc Score. Korean Circ J 2014; 44:205-9. [PMID: 25089130 PMCID: PMC4117839 DOI: 10.4070/kcj.2014.44.4.205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and is associated with increased cardiovascular morbidity and mortality. The anti-arrhythmic effect of statins on AF prevention appears to be highly significant in most clinical studies. However, some discrepancies do exist among different clinical studies. Different clinical settings and types of stains used may explain these differences between trials. The CHADS2 and CHA2DS2VASc scoring systems have been used for stroke risk stratification in AF patients. The recent study suggested that these scores can also be used to guide statin therapy for AF prevention. Patients with higher scores had a higher risk of developing AF and gained more benefits from statins therapy than those with lower scores. This review article focused on the ability of these scores to predict AF prevention by statins.
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Affiliation(s)
- Chen-Ying Hung
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan. ; Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan. ; Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan. ; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan. ; Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan. ; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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15
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Vílchez JA, Roldán V, Hernández-Romero D, Valdés M, Lip GYH, Marín F. Biomarkers in atrial fibrillation: an overview. Int J Clin Pract 2014; 68:434-43. [PMID: 24372915 DOI: 10.1111/ijcp.12304] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Atrial fibrillation (AF) confers a raised risk of stroke and death, and this risk of adverse events is increased by the coexistence of other cardiovascular risk factors. The pathophysiology of AF is complex, involving the role of inflammation, structural remodelling with apoptosis, inflammation or fibrosis. These changes confer a prothrombotic or hypercoagulable state in this arrhythmia. Despite being easy to use for decision-making concerning oral anticoagulant therapy in AF, clinical risk scores used for stratification have shown modest capability in predicting thromboembolic events, and biomarkers may improve our identification of 'high risk' patients. Biomarkers, whether measured in the peripheral blood, urine or imaging-based may improve our knowledge of the pathophysiology of AF. Importantly these biomarkers could help in the assessment of AF prognosis. The aim of this review was to summarise the published data about biomarkers studied in AF, with focus on data from randomised prospective clinical trials and large community-based cohorts. We will also review the application of these biomarkers to prognosis on the main schemes used to help stratify risk in AF.
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Affiliation(s)
- J A Vílchez
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, University of Murcia, Murcia, Spain; Department of Clinical Analysis, Hospital Universitario Virgen de la Arrixaca, University of Murcia, Murcia, Spain
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16
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Uz O, Atalay M, Doğan M, Isilak Z, Yalcin M, Uzun M, Kardesoglu E, Cebeci BS. The CHA2DS2-VASc score as a predictor of left atrial thrombus in patients with non-valvular atrial fibrillation. Med Princ Pract 2014; 23:234-8. [PMID: 24751402 PMCID: PMC5586880 DOI: 10.1159/000361028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 03/03/2014] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To investigate whether or not the CHA2DS2-VASc score predicts left atrial (LA) thrombus detected on pre-cardioversion transoesophageal echocardiography (TEE). MATERIALS AND METHODS The medical records of patients who had undergone TEE were reviewed to assess the presence of LA thrombus prior to direct-current cardioversion for atrial fibrillation (AF). The CHA2DS2-VASc score was calculated for each patient. Clinical TEE reports were reviewed for the presence of LA thrombus. Patients with a valve prosthesis or rheumatic mitral valve disease were excluded from this study. RESULTS A total of 309 patients were identified. The mean age was 70.1 ± 9.8 years and 151 (49%) patients were males and 158 (51%) were females. LA thrombus was seen in 32 (10.3%) of the 309 patients. Fifty (16.2%) patients had a low CHA2DS2-VASc score (0-1), 230 (74.4%) had an intermediate score (2-4) and 29 (9.4%) had a high score (5-9). The incidence of LA thrombus in the low, intermediate and high CHA2DS2-VASc score groups was 0, 4.4 and 68.7%, respectively. The LA thrombus risk increased with increasing CHA2DS2-VASc scores. On multivariate logistic analysis, the CHA2DS2-VASc score (OR 3.26, 95% CI 2.3-4.65; p = 0.001) and age (OR 0.93, 95% CI 0.88-0.98; p = 0.004) were independent risk factors for LA thrombus in patients with non-valvular AF. CONCLUSION A high CHA2DS2-VASc score was independently associated with the presence of LA thrombus in patients with non-valvular AF.
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Affiliation(s)
- Omer Uz
- Cardiology Department, Gulhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey
| | - Murat Atalay
- Merzifon Military Hospital, Merzifon, Turkey
- *Dr. Murat Atalay, Merzifon Military Hospital, Hastanesi Sofular Str., TR–05300 Merzifon, Amasya (Turkey), E-Mail
| | - Mehmet Doğan
- Cardiology Department, Gulhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey
| | - Zafer Isilak
- Cardiology Department, Gulhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey
| | - Murat Yalcin
- Cardiology Department, Gulhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey
| | - Mehmet Uzun
- Cardiology Department, Gulhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey
| | - Ejder Kardesoglu
- Cardiology Department, Gulhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey
| | - Bekir Sitki Cebeci
- Cardiology Department, Gulhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey
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Biancari F, Asim Mahar MA, Kangasniemi OP. CHADS2 and CHA2DS2-VASc Scores for Prediction of Immediate and Late Stroke after Coronary Artery Bypass Graft Surgery. J Stroke Cerebrovasc Dis 2013; 22:1304-11. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/31/2012] [Accepted: 11/05/2012] [Indexed: 01/29/2023] Open
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Senoo K, Suzuki S, Sagara K, Otsuka T, Matsuno S, Uejima T, Oikawa Y, Yajima J, Nagashima K, Kirigaya H, Sawada H, Aizawa T, Lip GYH, Yamashita T. Coronary artery diseases in Japanese patients with nonvalvular atrial fibrillation. J Cardiol 2013; 63:123-7. [PMID: 24070790 DOI: 10.1016/j.jjcc.2013.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/17/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Both the prevalence of atrial fibrillation and coronary artery disease (CAD) is increasing in aged societies. However, limited data are available regarding the prevalence of CAD and the incidence of coronary events in Japanese patients with nonvalvular atrial fibrillation (NVAF). METHODS AND RESULTS The data in this study were derived from Shinken Database 2004-2010, which includes 15,227 new patient visitors to the Cardiovascular Institute between June 2004 and March 2011. In the database, 1835 patients were diagnosed with NVAF (mean age 63 years, mean CHADS2 score 1.1 ± 1.1, and 75% were men). The prevalence of CAD at the initial visit was 118 patients (6.4%). They were older age and had a greater prevalence of men, more history of congestive heart failure and more history of cardiovascular risk factors rather than those without. During the follow-up period of 532 ± 599 days, coronary events (myocardial infarction, unstable angina, and stable angina) occurred in 51 patients (1.9%/year). Multivariate analysis showed that a history of CAD (p<0.001) and older age (p=0.024) were independent predictors of the incidence of future coronary events. CONCLUSIONS In Japanese patients with NVAF, both the presence of CAD and the occurrence of coronary events are not uncommon. History of CAD and older age are strongly associated with the incidence of coronary events.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Gregory Y H Lip
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, United Kingdom
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19
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Hung CY, Lin CH, Wang KY, Huang JL, Hsieh YC, Loh EW, Lan TH, Chou P, Ting CT, Wu TJ. Dosage of statin, cardiovascular comorbidities, and risk of atrial fibrillation: A nationwide population-based cohort study. Int J Cardiol 2013; 168:1131-6. [DOI: 10.1016/j.ijcard.2012.11.087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/09/2012] [Accepted: 11/11/2012] [Indexed: 12/19/2022]
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20
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Yarmohammadi H, Klosterman T, Grewal G, Alraies MC, Varr BC, Lindsay B, Zurick AO, Shrestha K, Tang WW, Bhargava M, Klein AL. Efficacy of the CHADS₂ scoring system to assess left atrial thrombogenic milieu risk before cardioversion of non-valvular atrial fibrillation. Am J Cardiol 2013; 112:678-83. [PMID: 23726178 DOI: 10.1016/j.amjcard.2013.04.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/19/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
The CHADS₂ scoring system was found to be a good predictor for risk stratification of stroke in patients with atrial fibrillation. The effectiveness of this scoring system in assessing thrombogenic milieu before direct-current cardioversion has not yet fully been established on a large scale. In this study, data from 2,369 consecutive patients in whom transesophageal echocardiography was performed for screening before direct-current cardioversion from 1999 to 2008 were analyzed. Left atrial (LA) or LA appendage (LAA) thrombogenic milieu (spontaneous echo contrast, sludge, and thrombus) was investigated. The results were correlated with CHADS₂ score findings. The mean age was 66 ± 13 years, and the ratio of men to women was 2.2:1. CHADS₂ scores of 0, 1, 2, 3, 4, 5 and 6 were present in 11%, 25%, 30%, 22%, 8%, 3%, and 1% of the studies, respectively. The prevalence of LA or LAA sludge or thrombus increased with increasing CHADS₂ scores (2.3%, 7%, 8.5%, 9.9%, 12.3%, and 14.1% for scores of 0, 1, 2, 3, 4, and 5 or 6, respectively, p = 0.01). In a multivariate model, an ejection fraction ≤20% was the best predictor of LA or LAA sludge or thrombus (odds ratio 2.99, p <0.001). In conclusion, transesophageal echocardiographic markers of thrombogenic milieu were highly correlated with increasing CHADS₂ scores in patients who underwent transesophageal echocardiography-guided cardioversion. Giving more value to echocardiographic findings, such as the left ventricular ejection fraction, and its different levels (especially an ejection fraction ≤20%) might improve the precision of the CHADS₂ scoring scheme to predict thrombogenic milieu in the left atrium or LAA as a surrogate to cardioembolic risk in patients with atrial fibrillation.
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21
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Association between CHADS2 score and the preventive effect of statin therapy on new-onset atrial fibrillation in patients with acute myocardial infarction. PLoS One 2013; 8:e74709. [PMID: 23991226 PMCID: PMC3753238 DOI: 10.1371/journal.pone.0074709] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 08/05/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES New-onset atrial fibrillation (AF) commonly occurs in patients with acute myocardial infarction (AMI). Data regarding the value of the CHADS2 score in patients hospitalized for AMI is limited. This study aimed to determine whether the CHADS2 score is associated with new-onset AF and if it can help identify the patients who will benefit most from statin use for the prevention of arrhythmia after AMI. METHODS A total of 724 consecutive AMI patients were enrolled in this study. The patients were divided into 3 groups according to their CHADS2 scores: group 1, score 0; group 2, score 1-2; and group 3, score 3-6. The study endpoint was an episode of new-onset AF that lasted more than 30 seconds during hospitalization at the coronary care unit. RESULTS Seventy-eight (10.8%) patients developed new-onset AF, and 273 (37.7%) were on a statin upon admission. The incidence of new-onset AF increased significantly from 5.8% in group 1 to 11.3% in group 2 and 14.3% in group 3 (χ(2) for linear trend, P = 0.017). Statin use (odds ratio [OR], 0.22; 95% CI, 0.06-0.85) and CHADS2 score (OR, 1.53; 95% CI, 1.02-2.28) were independent predictors of new-onset AF in AMI patients. Patients with CHADS2 score ≤2 had significantly reduced C-reactive protein level and lower risk of developing new-onset AF if they were taking statins (P < 0.05). Multivariate logistic regression analysis demonstrated the benefit of statin use for preventing new-onset AF in patients with CHADS2 scores ≤2 (OR, 0.34; 95% CI, 0.14-0.81). CONCLUSIONS The CHADS2 score is a convenient scoring system for predicting the incidence of new-onset AF and may help in identifying the patients who will benefit most from statin use for the prevention of arrhythmia after AMI.
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Letsas KP, Efremidis M, Giannopoulos G, Deftereos S, Lioni L, Korantzopoulos P, Vlachos K, Xydonas S, Kossyvakis C, Sideris A. CHADS2 and CHA2DS2-VASc scores as predictors of left atrial ablation outcomes for paroxysmal atrial fibrillation. Europace 2013; 16:202-7. [PMID: 23813452 DOI: 10.1093/europace/eut210] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS The selection of patients with atrial fibrillation (AF) that will benefit most by left atrial ablation remains suboptimal. CHADS2 score has been shown to be associated with post-ablation AF recurrences. However, data regarding the CHA2DS2-VASc score are lacking. In addition, there is paucity of data regarding the exact predictive value, in terms of sensitivity and specificity, of each of these scores as to AF recurrence. This study aimed to evaluate the merit of the CHADS2 and CHA2DS2-VASc scores in predicting arrhythmia recurrence after a single ablation procedure for paroxysmal AF. METHODS AND RESULTS One hundred and twenty-six patients (78 males, median age 61 years) with symptomatic paroxysmal AF underwent left atrial ablation. Over 16 months (interquartile range: 10.8-26.0), 89 patients were recurrence-free (70.6%). Larger left atrial volume (P: 0.039), diabetes (P: 0.001), dyslipidemia (P: 0.003), coronary artery disease (P: 0.003), class III antiarrhythmic drugs (P: 0.017), CHADS2 (P: 0.006), and CHA2DS2-VASc (P: 0.016) scores were univariately associated with recurrence. In the multivariate analysis, both CHADS2 (hazard ratio: 1.91, 95% confidence interval 1.09-3.36, P: 0.023) and CHA2DS2-VASc (hazard ratio: 1.97, 95% confidence interval 1.16-3.33, P: 0.012) were independently associated with AF recurrence. Cut-off analysis showed that a score ≥2 for both the CHADS2 (sensitivity = 46% and specificity = 79%, area under the Receiver's operating characteristic curve, AUC = 0.644) and CHA2DS2-VASc score (sensitivity = 57% and specificity = 65%, AUC = 0.627) showed the highest predictive value for AF recurrence. CONCLUSIONS CHA2DS2-VASc score is an independent predictor of left atrial ablation outcomes for paroxysmal AF, with a similar predictive value to CHADS2. However, the predictive accuracy of both is mediocre.
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Affiliation(s)
- Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Greece
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Jover E, Marín F, Roldán V, Montoro-García S, Valdés M, Lip GYH. Atherosclerosis and thromboembolic risk in atrial fibrillation: focus on peripheral vascular disease. Ann Med 2013; 45:274-90. [PMID: 23216106 DOI: 10.3109/07853890.2012.732702] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. It results in a 5-fold increased risk for stroke and thromboembolism and is associated with a high morbidity and mortality. AF shares several risk factors and pathophysiological features with atherosclerosis. Hence AF is often complicated by a variety of other cardiovascular conditions. Indeed, peripheral vascular disease (PVD) is highly prevalent among AF patients and associates with increased mortality. Inclusion of PVD within stroke risk scoring systems such as the CHA2DS2-VASc score improves risk stratification of AF patients. Of note, PVD has not been previously well documented nor looked for in observational studies or clinical trials. The aim of this present review article is to provide an overview of the association between atherosclerosis (with particular focus on PVD) and AF as well as its complications.
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Affiliation(s)
- Eva Jover
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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24
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Birocchi S, Cernuschi G, Podda GM, Costantino G. To anticoagulate or not to anticoagulate? That is the question : A Medline-based quantitative approach to share evidence on common clinical problems. Intern Emerg Med 2013; 8:245-8. [PMID: 22847728 DOI: 10.1007/s11739-012-0816-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 06/23/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Simone Birocchi
- Medicina Interna 2, Az. Ospedaliera Ospedale L. Sacco, Università degli Studi di Milano, Via G.B. Grassi, 74, 20157, Milan MI, Italy.
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Hung CY, Lin CH, Loh EW, Ting CT, Wu TJ. CHADS(2) score, statin therapy, and risks of atrial fibrillation. Am J Med 2013; 126:133-40. [PMID: 23331441 DOI: 10.1016/j.amjmed.2012.06.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Little is known about the effectiveness of statins on primary prevention of atrial fibrillation in elderly patients. This study aimed to evaluate the efficacy of statin treatment for atrial fibrillation prevention in elderly patients with hypertension, and to determine if comorbidity or CHADS(2) (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or transient ischemic attack) score can predict the effectiveness of statin treatment. METHODS Patients aged ≥65 years with hypertension were identified from a National Health Insurance research database (a systemic sampling from 2000 to 2009 with a total of 1,000,000 subjects). Medical records of 27,002 patients were used in this study, in which 2400 (8.9%) were receiving statin therapy. Risk of new-onset atrial fibrillation in statin users and nonusers was analyzed. RESULTS During the 9-year follow-up period, 2241 patients experienced new-onset atrial fibrillation. Statin users were younger than nonusers (72.4 vs 73.4 years) but had a higher prevalence of ischemic heart disease, diabetes mellitus, stroke, and chronic renal disease. Overall, statin therapy reduced the risk of atrial fibrillation by 19% (adjusted hazard ratio 0.81; 95% confidence interval, 0.69-0.95; P=.009). Subgroup analysis showed that statin use was beneficial in patients with or without a particular comorbidity. The effectiveness of statins was significant in patients with CHADS(2) score ≥2 (adjusted hazard ratio 0.69; 95% confidence interval, 0.57-0.85; P <.001). However, statin therapy was not as beneficial in hypertensive patients without other cardiovascular comorbidities (CHADS(2) score =1). CONCLUSION Statin therapy in elderly patients with hypertension reduces the risk of new-onset atrial fibrillation. Statins are more beneficial in patients with CHADS(2) score ≥2 than in those with score of 1.
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Affiliation(s)
- Chen-Ying Hung
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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Hsu HY, Chung CP, Chen SY, Chiang YY, Hu HH. Spontaneous echo contrast in internal jugular veins: a probable indicator for systemic inflammation and a prothrombotic state. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:926-932. [PMID: 22475693 DOI: 10.1016/j.ultrasmedbio.2012.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 01/29/2012] [Accepted: 02/05/2012] [Indexed: 05/31/2023]
Abstract
The hypothesis that spontaneous echo contrast (SEC) in the internal jugular vein (IJV) is a clinical indicator for systemic inflammation and thrombogenesis is investigated in this study. Fifty-two patients with cardiovascular diseases and 25 nondiseased subjects were evaluated. SEC was observed in 96 of 154 IJVs. The visual grading of SEC showed good interobserver agreement on SEC grades (κ value: 0.846, p < 0.001). Generalized estimating equations analysis was used for univariate and multivariate analysis. Univariate analysis showed that peak flow velocity in corresponding IJV (coefficient -0.001 [95% CI -0.019, -0.001], p = 0.031), jugular venous reflux (JVR, -0.010 [-0.019, -0.001], p = 0.002), plasma levels of fibrinogen (0.464 [0.208, 0.719], p < 0.001) and hs-C-reactive protein (hs-CRP) (0.479 [0.184, 0.774], p = 0.001) and previous history of ischemic stroke (0.779 [0.139, 1.417]; p = 0.017) correlated with the grades of SEC in IJV. Increased plasma levels of fibrinogen and hs-CRP, previous ischemic stroke, lower peak velocity in corresponding IJV and JVR were also independent predictors for the higher grades of SEC in IJV in multivariate regression analysis. SEC in IJV could be evaluated easily and semiquantitatively. SEC in IJVs could be a putative marker of cerebral circulation disturbance and an indicator of systemic inflammatory or prothrombotic state.
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Affiliation(s)
- Hung-Yi Hsu
- Department of Neurology, Tungs' Taichung Metro Harbor Hospital, Wuci Township, Taichung County, Taiwan.
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Chao TF, Cheng CC, Lin WS, Tsao HM, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Suenari K, Li CH, Liu SH, Hartono B, Wu TJ, Chen SA. Associations among the CHADS2 score, atrial substrate properties, and outcome of catheter ablation in patients with paroxysmal atrial fibrillation. Heart Rhythm 2011; 8:1155-9. [DOI: 10.1016/j.hrthm.2011.03.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 03/07/2011] [Indexed: 11/26/2022]
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Roldán V, Marín F, Muiña B, Torregrosa JM, Hernández-Romero D, Valdés M, Vicente V, Lip GY. Plasma von Willebrand Factor Levels Are an Independent Risk Factor for Adverse Events Including Mortality and Major Bleeding in Anticoagulated Atrial Fibrillation Patients. J Am Coll Cardiol 2011; 57:2496-504. [DOI: 10.1016/j.jacc.2010.12.033] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/02/2010] [Accepted: 12/14/2010] [Indexed: 10/18/2022]
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