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Buchta P, Kalarus Z, Mizia-Stec K, Myrda K, Skrzypek M, Ga Sior M. De novo and pre-existing atrial fibrillation in acute coronary syndromes: impact on prognosis and cardiovascular events in long-term follow-up. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:1129-1139. [PMID: 34718473 DOI: 10.1093/ehjacc/zuab091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
AIMS The aim of the study was to compare in-hospital and long-term prognosis in patients with acute coronary syndromes (ACS) and de novo vs. pre-existing atrial fibrillation (AF). Atrial fibrillation increases the risk of serious adverse events including death in patients with ACS. However, it is unclear whether de novo and pre-existing AF portend a different risk. METHODS AND RESULTS We analysed the incidence, clinical characteristics, and in-hospital and long-term outcomes in patients with AF and ACS based on combined data from Polish Registry of Acute Coronary Syndrome (PL-ACS) (n = 581 843) and SILICARD (n = 852 063) databases. Atrial fibrillation at admission was diagnosed in of 6.16% patients [de novo: 1129 (2.46%); pre-existing: 1691 (3.7%)]. Groups were compared (N = 1023 vs. 1023) after matching for relevant clinical factors. De novo and pre-existing AF differed in in-hospital diuretic (52% vs. 58%; P = 0.008) and aldosterone inhibitor (27.5% vs. 32.5%; P = 0.02) use, Thrombolysis In Myocardial Infarction (TIMI) flow before percutaneous coronary intervention (P = 0.016), and diuretic (52.1% vs. 58%; P = 0.008) and oral anticoagulant (27.5% vs. 32.5%; P = 0.018) use at discharge. In-hospital mortality in the de novo AF group was significantly higher (13.1% vs. 8.31%; P = 0.0005). Post-discharge 12-month survival was similar between groups (14.5% vs. 15.3%, P = 0.63). Long-term re-hospitalization due to heart failure (22.7% vs. 17.2%; P < 0.005) and medical contact due to AF (48.4% vs. 26.1%, P < 0.0001) rates were higher in the group with pre-existing AF, without the difference of stroke or myocardial infarction occurrence. CONCLUSION De novo AF accounts for 40% of all AF cases in ACS patients and is an unfavourable in-hospital prognostic factor. The occurrence of de novo AF during ACS should require special attention and caution in the treatment of these patients.
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Affiliation(s)
- Piotr Buchta
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, ul. Sklodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, ul. Sklodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Center, ul. Ziolowa 47, 40-635 Katowice, Poland
| | - Krzysztof Myrda
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, ul. Sklodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Michał Skrzypek
- Department of Biostatistics, School of Health Sciences in Bytom, Medical University of Silesia, Katowice, ul. Piekarska 18, 41-902 Bytom, Poland
| | - Mariusz Ga Sior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, ul. Sklodowskiej-Curie 9, 41-800 Zabrze, Poland
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2
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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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3
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Konecny T, Khoo M, Covassin N, Edelhofer P, Bukartyk J, Park JY, Venkataraman S, Karim S, Chahal A, Kara T, Orban M, Ludka O, Kautzner J, Ommen SR, Somers VK. Increased heart rate with sleep disordered breathing in hypertrophic cardiomyopathy. Int J Cardiol 2021; 323:155-160. [PMID: 32798627 PMCID: PMC10426808 DOI: 10.1016/j.ijcard.2020.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Current guidelines recommend medications with rate control properties for symptomatic patients with hypertrophic cardiomyopathy (HCM) based on the rationale that lowering heart rate (HR) improves their symptoms. Whether sleep disordered breathing (SDB) is associated with increased HR in HCM patients is not known. METHOD We diagnosed uncontrolled SDB (oxygen desaturation index ≥5) in consecutive echocardiographically confirmed HCM patients seen at Mayo Clinic, Rochester, and analyzed their HR as recorded by a 24-h Holter monitor. We compared mean, minimum, maximum HR between those with vs without SDB. In a pilot subanalysis of HCM patients with SDB who also underwent subsequent diagnostic polysomnography (PSG), we analyzed RR interval changes coinciding with obstructive sleep apnea and hypopnea episodes. RESULTS Of the 230 HCM patients included in this study (age 54 ± 16 years; 138 male; LVOT pressure gradient at rest 45 ± 39 mmHg), 115 (50%) patients had SDB. HCM patients with SDB were recorded to have higher mean HR (71 vs. 67 bpm; p = .002, adjusted p = .001), and this difference was most pronounced during night hours of 10 PM to 5 AM (61 vs. 67 bpm; p < .001). In the pilot analysis of the available PSG data, the release of obstructive sleep apneas and hypopneas coincided with fluctuation of HR. CONCLUSIONS SDB is independently associated with higher mean HR in patients with HCM, and this difference is most significant during sleep. Treatment of SDB, which is readily available, should be tested as a complementary modality to the currently recommended pharmacotherapy aimed at lowering HR in patients with symptomatic HCM.
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Affiliation(s)
- Tomas Konecny
- University of Southern California, Los Angeles, California, United States of America; Mayo Clinic, Rochester, MN, United States of America.
| | - Michael Khoo
- University of Southern California, Los Angeles, California, United States of America
| | | | | | - Jan Bukartyk
- Mayo Clinic, Rochester, MN, United States of America
| | - Jae Yoon Park
- Mayo Clinic, Rochester, MN, United States of America
| | | | - Shahid Karim
- Mayo Clinic, Rochester, MN, United States of America
| | - Anwar Chahal
- University of Southern California, Los Angeles, California, United States of America
| | - Tomas Kara
- Mayo Clinic, Rochester, MN, United States of America; Masaryk University Hospital, Brno, Czech Republic
| | - Marek Orban
- Comenius University and NUSCH, Bratislava, Slovakia
| | - Ondrej Ludka
- Mayo Clinic, Rochester, MN, United States of America; Masaryk University Hospital, Brno, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Steve R Ommen
- Mayo Clinic, Rochester, MN, United States of America
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4
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Han Q, Zhang C, You S, Zheng D, Zhong C, Dong H, Wang X, Pei S, Cao Y, Liu CF. Resting Heart Rate and In-Hospital Mortality in Acute Ischemic Stroke Patients With and Without Atrial Fibrillation. Circ J 2020; 84:656-661. [PMID: 32115469 DOI: 10.1253/circj.cj-19-0946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prognostic role of resting heart rate (RHR) on mortality in acute ischemic stroke (AIS) patients including atrial fibrillation (AF) is unclear. This study evaluated the relationship between RHR and in-hospital mortality among all AIS patients with and without AF.Methods and Results:The study enrolled 3,447 AIS patients from December 2013 to May 2014 across 22 hospitals in Suzhou City. Patients were divided into 2 groups based on median baseline RHR (<76 and ≥76 beats/min). Cox proportional hazard regression models were used to estimate the effects of RHR on all-cause in-hospital mortality. During hospitalization, 124 patients (3.6%) died from all causes. A multivariable model adjusted for potential covariates showed that higher RHR (≥76 beats/min) was associated with an increase in the risk of in-hospital mortality among AIS patients (hazard ratio [HR] 1.63; 95% confidence interval [CI] 1.09-2.45; P=0.018). This relationship was consistent in a subgroup analysis of patients without AF (HR 2.39; 95% CI 1.29-4.45; P=0.006). However, there was no significant association between higher RHR and in-hospital mortality among patients with AF (P=0.654). Similar findings were confirmed in analyses with heart rate as a continuous variable. CONCLUSIONS Higher RHR at admission was independently associated with in-hospital mortality in AIS patients without AF.
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Affiliation(s)
- Qiao Han
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University.,Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine
| | - Chunyuan Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University
| | - Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University
| | - Danni Zheng
- Discipline of Pharmacology, Faculty of Medicine and Health, University of Sydney.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health, Medical College of Soochow University
| | - Hongli Dong
- Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine
| | - Xianhui Wang
- Department of Neurology, Taicang First People's Hospital
| | - Shaofang Pei
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University.,Institutes of Neuroscience, Soochow University
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University.,Institutes of Neuroscience, Soochow University
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Li J, Wyrsch D, Heg D, Stoller M, Zanchin T, Perrin T, Windecker S, Räber L, Roten L. Electrocardiographic predictors of mortality in patients after percutaneous coronary interventions - a nested case-control study. Acta Cardiol 2019; 74:341-349. [PMID: 30328801 DOI: 10.1080/00015385.2018.1494117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: The outcome of patients undergoing percutaneous coronary interventions (PCIs) varies considerably. Several ECG parameters have recently emerged (PQ interval, P-wave, T-peak-to-T-end interval, T-wave, T/R ratio, J-wave) beyond traditional markers (rhythm, QRS, Q-wave, QT interval, ST segment) and were attributed important prognostic value in the setting of coronary artery disease. The present study integrated for the first time these ECG parameters altogether with the aim to determine their role in predicting patients' outcome after a PCI. Methods: A total of 3342 patients were enrolled in the present study between 2009 and 2013. In a nested case-control design, 644 patients who died within a year post-PCI (cases) were matched 1:4 with patients alive at that particular date (controls). Results: Our data showed that only the presence of a longer QT interval (heart rate-corrected using Bazett formula) was associated with increased risk of death after adjusting for multiple clinical and angiographic risk factors (adjusted OR 1.07; 95%CI 1.01-1.12, p = .022). Conclusion: Our study emphasises the prognostic importance of the QT interval in identifying patients at increased risk of death during the first year after PCI. Clinical Trial Registration - URL: https://www.clinicaltrials.gov . Unique identifier: NCT02241291.
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Affiliation(s)
- Jin Li
- Department of Physiology, University of Bern, Bern, Switzerland
| | - Dominic Wyrsch
- Department of Cardiology, Inselspital – Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Department of Clinical Research, CTU Bern, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Michael Stoller
- Department of Cardiology, Inselspital – Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Zanchin
- Department of Cardiology, Inselspital – Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tilman Perrin
- Department of Cardiology, Inselspital – Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital – Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital – Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital – Bern University Hospital, University of Bern, Bern, Switzerland
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Okuno T, Aoki J, Tanabe K, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Yasuda S, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Mano T, Hirata K, Shibata Y, Owa M, Tsujita K, Funayama H, Kokubu N, Kozuma K, Uemura S, Tobaru T, Saku K, Ohshima S, Nishimura K, Miyamoto Y, Ogawa H, Ishihara M. Admission Heart Rate Is a Determinant of Effectiveness of Beta-Blockers in Acute Myocardial Infarction Patients. Circ J 2019; 83:1054-1063. [PMID: 30930346 DOI: 10.1253/circj.cj-18-0995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Beta-blockers are standard therapy for acute myocardial infarction (AMI). However, despite current advances in the management of AMI, it remains unclear whether all AMI patients benefit from β-blockers. We investigated whether admission heart rate (HR) is a determinant of the effectiveness of β-blockers for AMI patients. Methods and Results: We enrolled 3,283 consecutive AMI patients who were admitted to 28 participating institutions in the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) study. According to admission HR, we divided patients into 3 groups: bradycardia (HR <60 beats/min, n=444), normocardia (HR 60 to ≤100 beats/min, n=2,013), and tachycardia (HR >100 beats/min, n=342). The primary endpoint was major adverse cardiac events (MACE), including all-cause death, non-fatal MI, non-fatal stroke, heart failure (HF), and urgent revascularization for unstable angina, at 3-year follow-up. Beta-blocker at discharge was significantly associated with a lower risk of MACE in the tachycardia group (23.6% vs. 33.0%; P=0.033), but it did not affect rates of MACE in the normocardia group (17.8% vs. 18.4%; P=0.681). In the bradycardia group, β-blocker use at discharge was significantly associated with a higher risk of MACE (21.6% vs. 12.7%; P=0.026). Results were consistent for multivariable regression and stepwise multivariable regression. CONCLUSIONS Admission HR might determine the efficacy of β-blockers for current AMI patients.
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Affiliation(s)
- Taishi Okuno
- Division of Cardiology, Mitsui Memorial Hospital
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Kazuteru Fujimoto
- Department of Cardiology, National Hospital Organization Kumamoto Medical Center
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University
| | - Atsushi Hirohata
- Department of Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama
| | | | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University
| | | | | | - Kazuhito Hirata
- Department of Cardiology, Okinawa Prefectural Chubu Hospital
| | | | - Mafumi Owa
- Department of Cardiovascular Medicine, Suwa Red Cross Hospital
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Hiroshi Funayama
- Division of Cardiovascular Medicine, Saitama Medical Center Jichi Medical University
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical School
| | - Ken Kozuma
- Department of Cardiology, Teikyo University
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | | | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine
| | - Shigeru Ohshima
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kunihiro Nishimura
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
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7
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microRNA-212-induced protection of the heart against myocardial infarction occurs via the interplay between AQP9 and PI3K/Akt signaling pathway. Exp Cell Res 2018; 370:531-541. [DOI: 10.1016/j.yexcr.2018.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 01/09/2023]
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8
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Agewall S, Tjessem LH, Rossignol P, Zannad F, Atar D, Lamiral Z, Machu JL, Dickstein K, Kjekshus J, von Lueder TG, Girerd N. Heart rate prediction of outcome in heart failure following myocardial infarction depend on heart rhythm status an analysis from the high-risk myocardial infarction database initiative. Int J Cardiol 2017; 249:274-281. [PMID: 28964557 DOI: 10.1016/j.ijcard.2017.09.182] [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: 01/24/2017] [Revised: 08/22/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Heart rate has been reported to be associated with adverse outcome in heart failure (HF) and myocardial infarction (MI), but conflicting evidence exists regarding its impact in patients with associated atrial fibrillation (AF). OBJECTIVES We investigated the differential impact of heart rate on clinical outcomes according to the presence or absence of AF in patients with reduced systolic function and/or HF after MI. METHODS We studied the association of heart rate with outcome using Cox-models in a merged dataset (n=28,771) of four randomized trials (CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT). RESULTS At baseline, 3736 (13%) patients had AF. We identified a significant interaction between AF and heart rate, and a decreasing effect of heart rate with time, heart rate being less associated with outcome after 1year of follow-up (both p for interaction <0.001). We report associations with outcome separately in patients with and without AF. In addition, as neutral associations with outcome after 1year were estimated after adjustment on confounding factors, only association for the first year follow-up were provided. 10-bpm increase in heart rate conferred increased risk for all-cause mortality (1.27 [1.21 to 1.33], p<0.0001), CV-mortality (1.28 [1.22 to 1.34], p<0.0001), and HF-hospitalisation (1.25 [1.19 to 1.31], p<0.0001) in patients without AF. In contrast, in patients with AF, the incremental risk for 10-bpm increase in heart rate was attenuated for all-cause (1.14 [1.06 to 1.23], p=0.0007), CV-mortality (1.12 [1.03 to 1.22], p=0.006), and HF-hospitalisation (1.16 [1.07 to 1.26], p=0.0006, p for interaction with AF <0.001 for all outcomes). CONCLUSIONS In patients with reduced systolic function and/or HF post-MI, higher heart rate predicts increased major cardiovascular events during the first year following MI in patients without AF. This association is markedly attenuated in subjects with AF.
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Affiliation(s)
- Stefan Agewall
- Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway; Institute of Clinical Sciences, University of Oslo, Oslo, Norway.
| | - Lars H Tjessem
- Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway; Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Patrick Rossignol
- Inserm, Centre, d'Investigations Cliniques- 1433, and Inserm, U1116, Nancy, France; CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France; Université de Lorraine, Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
| | - Faiez Zannad
- Inserm, Centre, d'Investigations Cliniques- 1433, and Inserm, U1116, Nancy, France; CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France; Université de Lorraine, Nancy, France
| | - Dan Atar
- Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway; Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Zohra Lamiral
- Inserm, Centre, d'Investigations Cliniques- 1433, and Inserm, U1116, Nancy, France; CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France; Université de Lorraine, Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
| | - Jean-Loup Machu
- Inserm, Centre, d'Investigations Cliniques- 1433, and Inserm, U1116, Nancy, France; CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France; Université de Lorraine, Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
| | - Kenneth Dickstein
- Stavanger University Hospital, Division of Cardiology, Stavanger, Norway
| | - John Kjekshus
- Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway; Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Thomas G von Lueder
- Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway; Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Nicolas Girerd
- Inserm, Centre, d'Investigations Cliniques- 1433, and Inserm, U1116, Nancy, France; CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France; Université de Lorraine, Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
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9
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Kea B, Alligood T, Manning V, Raitt M. A Review of the Relationship of Atrial Fibrillation and Acute Coronary Syndrome. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016; 4:107-118. [PMID: 28090403 DOI: 10.1007/s40138-016-0105-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered by clinicians. Clinical decision-making focuses on reducing ischemic stroke risk in AF patients; however, AF is also associated with an increased risk of acute coronary syndromes (ACS). Patients with ACS and concurrent AF are less likely to receive appropriate therapies and more likely to experience adverse outcomes than ACS patients in sinus rhythm (SR). Clinicians may be able to stratify ACS patients at increased risk of AF development based on clinical characteristics. Evidence supporting specific therapeutic options for prevention of ACS in AF patients or for prevention of AF in ACS patients is limited, however there is some evidence of differing effects among oral anticoagulant regimens in these populations. Investigations of the relationship of AF with the full spectrum of ACS are not well described and should be the focus of future research.
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Affiliation(s)
- Bory Kea
- Assistant Professor, Department of Emergency Medicine, Oregon Health & Science University School of Medicine, Mailcode CR114, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, 503-494-4430 (p), 503-494-8237 (f)
| | - Tahroma Alligood
- Research Associate, Department of Emergency Medicine, Oregon Health & Science University School of Medicine, Doctoral Student, Department of Public Health & Preventive Medicine, OHSU/PSU School of Public Health, Mailcode CR114, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, 503-494-4566
| | - Vincent Manning
- Medical Student (4 Year), Oregon Health & Science University School of Medicine, 4460 SW Scholls Ferry Road, Apt. #3, Portland, OR 97225
| | - Merritt Raitt
- Professor of Medicine, Oregon Health and Science University, Director Electrophysiology Service, VA Health Center System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, 503-220-8262
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Kim DI, Yang HI, Park JH, Lee MK, Kang DW, Chae JS, Lee JH, Jeon JY. The association between resting heart rate and type 2 diabetes and hypertension in Korean adults. Heart 2016; 102:1757-1762. [DOI: 10.1136/heartjnl-2015-309119] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/23/2016] [Indexed: 11/04/2022] Open
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Scali S, Bertges D, Neal D, Patel V, Eldrup-Jorgensen J, Cronenwett J, Beck A. Heart rate variables in the Vascular Quality Initiative are not reliable predictors of adverse cardiac outcomes or mortality after major elective vascular surgery. J Vasc Surg 2015; 62:710-20.e9. [PMID: 26067200 DOI: 10.1016/j.jvs.2015.03.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Heart rate (HR) parameters are known indicators of cardiovascular complications after cardiac surgery, but there is little evidence of their role in predicting outcome after major vascular surgery. The purpose of this study was to determine whether arrival HR (AHR) and highest intraoperative HR are associated with mortality or major adverse cardiac events (MACEs) after elective vascular surgery in the Vascular Quality Initiative (VQI). METHODS Patients undergoing elective lower extremity bypass (LEB), aortofemoral bypass (AFB), and open abdominal aortic aneurysm (AAA) repair in the VQI were analyzed. MACE was defined as any postoperative myocardial infarction, dysrhythmia, or congestive heart failure. Controlled HR was defined as AHR <75 beats/min on operating room arrival. Delta HR (DHR) was defined as highest intraoperative HR - AHR. Procedure-specific MACE models were derived for risk stratification, and generalized estimating equations were used to account for clustering of center effects. HR, beta-blocker exposure, cardiac risk, and their interactions were explored to determine association with MACE or 30-day mortality. A Bonferroni correction with P < .004 was used to declare significance. RESULTS There were 13,291 patients reviewed (LEB, n = 8155 [62%]; AFB, n = 2629 [18%]; open AAA, n = 2629 [20%]). Rates of any preoperative beta-blocker exposure were as follows: LEB, 66.5% (n = 5412); AFB, 57% (n = 1342); and open AAA, 74.2% (n = 1949). AHR and DHR outcome association was variable across patients and procedures. AHR <75 beats/min was associated with increased postoperative myocardial infarction risk for LEB patients across all risk strata (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.03-1.9; P = .03), whereas AHR <75 beats/min was associated with decreased dysrhythmia risk (OR, 0.42; 95% CI, 0.28-0.63; P = .0001) and 30-day death (OR, 0.50; 95% CI, 0.33-0.77; P = .001) in patients at moderate and high cardiac risk. These HR associations disappeared in controlling for beta-blocker status. For AFB and open AAA repair patients, there was no significant association between AHR and MACE or 30-day mortality, irrespective or cardiac risk or beta-blocker status. DHR and extremes of highest intraoperative HR (>90 or 100 beats/min) were analyzed among all three operations, and no consistent associations with MACE or 30-day mortality were detected. CONCLUSIONS The VQI AHR and highest intraoperative HR variables are highly confounded by patient presentation, operative variables, and beta-blocker therapy. The discordance between cardiac risk and HR as well as the lack of consistent correlation to outcome makes them unreliable predictors. The VQI has elected to discontinue collecting AHR and highest intraoperative HR data, given insufficient evidence to suggest their importance as an outcome measure.
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Affiliation(s)
- Salvatore Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla.
| | - Daniel Bertges
- Division of Vascular Surgery, University of Vermont, Burlington, Vt
| | - Daniel Neal
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Virendra Patel
- Division of Vascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | | | - Jack Cronenwett
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Adam Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
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