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Guo X, Huang T, Xu Y, Zhao J, Huang Y, Zhou Z, Xing B, Li Y, Meng S, Chen X, Yu L, Wang H. Early inhibition of the ATM/p53 pathway reduces the susceptibility to atrial fibrillation and atrial remodeling following acute myocardial infarction. Cell Signal 2024; 122:111322. [PMID: 39067835 DOI: 10.1016/j.cellsig.2024.111322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
Atrial fibrillation (AF) emerges as a critical complication following acute myocardial infarction (AMI) and is associated with a significant increased risk of heart failure, stroke and mortality. Ataxia telangiectasia mutated (ATM), a key player in DNA damage repair (DDR), has been implicated in multiple cardiovascular conditions, however, its involvement in the development of AF following AMI remains unexplored. This study seeks to clarify the contribution of the ATM/p53 pathway in the onset of AF post-AMI and to investigate the underlying mechanisms. The rat model of AMI was established by ligating left anterior descending coronary artery in the presence or absence of Ku55933 (an ATM kinase inhibitor, 5 mg/kg/d) treatment. Rats receiving Ku55933 were further divided into the early administration group (administered on days 1, 2, 4, and 7 post-AMI) and the late administration group (administered on days 8, 9, 11 and 14 post-AMI). RNA-sequencing was performed 14 days post-operation. In vitro, H2O2-challenged HL-1 atrial muscle cells were utilized to evaluate the potential effects of different ATM inhibition schemes, including earlier, middle, and late periods of intervention. Fourteen days post-AMI injury, the animals exhibited significantly increased AF inducibility, exacerbated atrial electrical/structural remodeling, reduced ventricular function and exacerbated atrial DNA damage, as evidenced by enhanced ATM/p53 signaling as well as γH2AX level. These effects were partially consistent with the enrichment results of bioinformatics analysis. Notably, the deleterious effects were ameliorated by early, but not late, administration of Ku55933. Mechanistically, inhibition of ATM signaling successfully suppressed atrial NLRP3 inflammasome-mediated pyroptotic pathway. Additionally, the results were validated in the in vitro experiments demonstrating that early inhibition of Ku55933 not only attenuated cellular ATM/p53 signaling, but also mitigated inflammatory response by reducing NLRP3 activation. Collectively, hyperactivation of ATM/p53 contributed to the pathogenesis of AF following AMI. Early intervention with ATM inhibitors substantially mitigated AF susceptibility and atrial electrical/structural remodeling, highlighting a novel therapeutic avenue against cardiac arrhythmia following AMI.
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Affiliation(s)
- Xiaodong Guo
- Graduate School of Dalian Medical University, Dalian 116000, Liaoning Province, China; State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Tao Huang
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Yinli Xu
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Jikai Zhao
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Yuting Huang
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Zijun Zhou
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Bo Xing
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Yao Li
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Shan Meng
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Xin Chen
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Liming Yu
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China.
| | - Huishan Wang
- Graduate School of Dalian Medical University, Dalian 116000, Liaoning Province, China; State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China.
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Frederiksen TC, Dahm CC, Preis SR, Lin H, Trinquart L, Benjamin EJ, Kornej J. The bidirectional association between atrial fibrillation and myocardial infarction. Nat Rev Cardiol 2023; 20:631-644. [PMID: 37069297 DOI: 10.1038/s41569-023-00857-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 04/19/2023]
Abstract
Atrial fibrillation (AF) is associated with an increased risk of myocardial infarction (MI) and vice versa. This bidirectional association relies on shared risk factors as well as on several direct and indirect mechanisms, including inflammation, atrial ischaemia, left ventricular remodelling, myocardial oxygen supply-demand mismatch and coronary artery embolism, through which one condition can predispose to the other. Patients with both AF and MI are at greater risk of stroke, heart failure and death than patients with only one of the conditions. In this Review, we describe the bidirectional association between AF and MI. We discuss the pathogenic basis of this bidirectional relationship, describe the risk of adverse outcomes when the two conditions coexist, and review current data and guidelines on the prevention and management of both conditions. We also identify important gaps in the literature and propose directions for future research on the bidirectional association between AF and MI. The Review also features a summary of methodological approaches for the study of bidirectional associations in population-based studies.
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Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Sarah R Preis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ludovic Trinquart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Emelia J Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Jelena Kornej
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
- Framingham Heart Study, Framingham, MA, USA.
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3
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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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Borovac JA, Kwok CS, Mohamed MO, Fischman DL, Savage M, Alraies C, Kalra A, Nolan J, Zaman A, Ahmed J, Bagur R, Mamas MA. The Predictive Value of CHA2DS2-VASc Score on In-Hospital Death and Adverse Periprocedural Events Among Patients With the Acute Coronary Syndrome and Atrial Fibrillation Who Undergo Percutaneous Coronary Intervention: A 10-Year National Inpatient Sample (NIS) Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 29:61-68. [DOI: 10.1016/j.carrev.2020.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/12/2020] [Accepted: 08/04/2020] [Indexed: 01/01/2023]
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3063] [Impact Index Per Article: 1021.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Narasimhan B, Patel N, Chakraborty S, Bandyopadhyay D, Sreenivasan J, Hajra A, Amgai B, Rai D, Krittanawong C, Kaul R, Ho KS, Mehran R, Naidu SS, Mehta D. Impact of Atrial Fibrillation on Acute Coronary Syndrome-Analysis of In-Hospital Outcomes and 30-Day Readmissions. Curr Probl Cardiol 2020; 46:100764. [PMID: 33385750 DOI: 10.1016/j.cpcardiol.2020.100764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022]
Abstract
With an aging population and significant overlap of risk factors, the cohort of patients with acute coronary syndrome (ACS) and concomitant atrial fibrillation (AF) is a sizable and growing one, with implications on cardiac reserve, anticoagulation and antiplatelet therapies, and related complications. The present study uses a large national database to analyze the impact of AF on patients admitted with an ACS. We queried the 2012 to 2014 National Readmissions Database to identify patients admitted with an ACS using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) codes. These patients were then subcategorized based on the presence or absence of AF. Analysis of their initial hospitalization, 30-day readmissions and healthcare utilization and the economic burden was performed. Among 1,558,205 patients with ACS, 270,966 (17.4%) were noted to have concomitant AF. At baseline, these patients were older and more likely female, with a significantly higher burden of comorbidities. Patients with AF had longer and more complicated index hospitalizations with significantly higher mortality rates (8.6% vs 4.6%). Coronary artery bypass graft was the preferred method of revascularization in patients with AF as compared to percutaneous coronary intervention. The 30-day readmissions were higher in the AF group (15.6 vs 10.8%), largely driven by noncardiac causes. This was associated with higher healthcare utilization with longer hospitalizations during index admission. Patients admitted with ACS and concomitant AF is a high-risk population with increased in-hospital complications and mortality, as well as short term readmissions. Coronary artery bypass graft appears favored over percutaneous coronary intervention for revascularization in patients with AF.
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7
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Abstract
Antithrombotic therapy has become increasingly challenging due to the thrombotic and bleeding risk of patients presenting with acute coronary syndrome (ACS) today. Contributing factors include increasing age, underlying comorbidities (e.g., renal failure, atrial fibrillation [AF]), or concomitant interventions including transcatheter valve procedures requiring individualized antithrombotic strategies. Thanks to the development of novel stent platforms with biocompatible polymers and thin strut design allowing for a more rapid endothelialization, shortening or de-escalation of antiplatelet therapies is an attractive option for reducing bleeding events. In fact, several trials have been recently published or are currently underway that address the issue of early monotherapy after short-term dual antiplatelet therapy in ACS patients. Patients with AF and ACS are at a particularly high risk for thromboembolic and bleeding events. An individualized combination approach of antiplatelet therapy plus non-vitamin K oral anticoagulants should be favored in these patients to reduce bleeding risk according to recent randomized trials and guidelines. In contrast to de-escalation strategies in ACS patients at high bleeding risk, in patients with myocardial infarction in whom the long-term risk for ischemic events prevails, prolongation of an intensified antithrombotic therapy on top of acetylsalicylic acid is recommended. This review summarizes the recent evidence and offers practical recommendations to determine patients' bleeding versus thrombo-ischemic risk in order to tailor early and late antithrombotic therapy after ACS.
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Affiliation(s)
- Dominik Rath
- Department of Cardiology and Angiology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany.
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Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction. J Clin Med 2020; 9:jcm9051481. [PMID: 32423138 PMCID: PMC7290762 DOI: 10.3390/jcm9051481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Atrial fibrillation (AF) is common after acute myocardial infarction (AMI) and associated with in-hospital and long-term mortality. However, the pathophysiology of AF in AMI is poorly understood. Heart rate variability (HRV), measured by Holter-ECG, reflects cardiovascular response to the autonomic nervous system and altered (reduced or enhanced) HRV may have a major role in the onset of AF in AMI patients. Objective: We investigated the relationship between autonomic dysregulation and new-onset AF during AMI. Methods: As part of the RICO survey, all consecutive patients hospitalized for AMI at Dijon (France) university hospital between June 2001 and November 2014 were analyzed by Holter-ECG <24 h following admission. HRV was measured using temporal and spectral analysis. Results: Among the 2040 included patients, 168 (8.2%) developed AF during AMI. Compared to the sinus-rhythm (SR) group, AF patients were older, had more frequent hypertension and lower left ventricular ejection fraction LVEF. On the Holter parameters, AF patients had higher pNN50 values (11% vs. 4%, p < 0.001) and median LH/HF ratio, a reflection of sympathovagal balance, was significantly lower in the AF group (0.88 vs 2.75 p < 0.001). The optimal LF/HF cut-off for AF prediction was 1.735. In multivariate analyses, low LF/HF <1.735 (OR(95%CI) = 3.377 (2.047–5.572)) was strongly associated with AF, ahead of age (OR(95%CI) = 1.04(1.01–1.06)), mean sinus-rhythm rate (OR(95%CI) = 1.03(1.02–1.05)) and log NT-proBNP (OR(95%CI) = 1.38(1.01–1.90). Conclusion: Our study strongly suggests that new-onset AF in AMI mainly occurs in a dysregulated autonomic nervous system, as suggested by low LF/HF, and higher PNN50 and RMSSD values.
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Boldueva SA, Soloveva MV, Oblavatckii DV, Feoktistova VS. [Myocardial Infarction in the Group of Patients With Atrial Fibrillation]. ACTA ACUST UNITED AC 2020; 60:53-61. [PMID: 32245355 DOI: 10.18087/cardio.2020.1.n620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022]
Abstract
Prevalence of patients with myocardial infarction (MI) and atrial fibrillation (AF) has been growing every year. These patients represent a highest risk group and, thus, require special attention of clinicians. The article foсused on mechanisms of the AF and MI interaction, special aspects of prediction depending on the type of AF and MI, and the issue of antithrombotic therapy in this patient category. A group of AF-associated, embologenic MIs was isolated, and diagnostic criteria and therapeutic regimens were provided.
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Affiliation(s)
- S A Boldueva
- I.I. Mechnikov North-West State Medical University
| | - M V Soloveva
- I.I. Mechnikov North-West State Medical University
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4802] [Impact Index Per Article: 1200.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5298] [Impact Index Per Article: 1059.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Wang CL, Chen PC, Juang HT, Chang CJ. Adverse Outcomes Associated with Pre-Existing and New-Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome: A Retrospective Cohort Study. Cardiol Ther 2019; 8:117-127. [PMID: 30997660 PMCID: PMC6525230 DOI: 10.1007/s40119-019-0136-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction Atrial fibrillation (AF) often occurs in patients with acute coronary syndrome (ACS). It remains unclear whether pre-existing or new-onset AF confers different risk in patients with ACS. Methods We conducted a retrospective cohort study using Taiwan’s National Health Insurance Research Database. Patients who were hospitalized with a primary diagnosis of ACS from 2005 to 2009 were studied. Major outcomes were mortality, heart failure, and combined ischemic stroke/systemic embolism (IS/SE). The date of the first ACS diagnosis was defined as the index date. Pre-existing AF was defined as AF occurring before the index date. New-onset AF was defined as AF that started after or at the same time as the ACS diagnosis. Results Among 6663 patients with ACS, 488 (7.3%) had pre-existing AF and 479 (7.2%) had new-onset AF. Compared to patients with pre-existing AF, those with new-onset AF were younger, less likely to have co-morbidities, and more likely to receive evidence-based therapy. The un-adjusted risks of adverse outcomes in both groups were similar. Compared to pre-existing AF, new-onset AF was significantly associated with a higher adjusted risk of death (hazard ratio 1.27, 95% confidence interval 1.06–1.52) and IS/SE (hazard ratio 1.49, 95% confidence interval 1.01–2.20). The significant associations between new-onset AF and adverse outcomes were more likely to be observed in elderly patients with ACS. Conclusions New-onset AF during ACS was associated with a significantly increased risk of adverse outcomes, especially in the elderly patients.
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Affiliation(s)
- Chun-Li Wang
- Cardiovascular Department, Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Chun Chen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Public Health, China Medical University, Taizhong, Taiwan
| | - Hsiao-Ting Juang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chee-Jen Chang
- Cardiovascular Department, Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan. .,Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.
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Ogunbayo GO, Messerli AW, Ha LD, Elbadawi A, Olorunfemi O, Darrat Y, Guglin M, Okwechime R, Akanya D, Abdel-Latif A, Smyth SS, Elayi CS. Trends in the Incidence and In-Hospital Outcomes of Patients With Atrial Fibrillation Complicated by Non-ST-Segment Elevation Myocardial Infarction. Angiology 2018; 70:317-324. [PMID: 30231624 DOI: 10.1177/0003319718801087] [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: 11/16/2022]
Abstract
Atrial fibrillation (AF) can present with non-ST-segment elevation myocardial infarction (NSTEMI). The incidence, characteristics, outcomes, and treatment of this subgroup of patients with AF remains poorly studied. Using data from the National Inpatient Sample database, we (1) compared baseline characteristics of patients with AF with/without NSTEMI, (2) evaluated their outcomes and associated trends over the study period (2004-2013), and (3) evaluated revascularization (by percutaneous coronary intervention or coronary artery bypass graft [CABG]) and the impact on patient outcomes. Of the 3 923 436 patients admitted with a primary diagnosis of AF, 47 785 (1.2%) had a secondary diagnosis of NSTEMI. In this subgroup with AF and NSTEMI, there was a significant trend toward a decrease in mortality ( P = .002), stroke ( P < .001), and gastrointestinal bleeding ( P < .001) during the study period. Compared to unrevascularized patients, revascularized patients were more likely to be younger (72.2 ± 10.2 vs 77.0 ± 11.8 years old, P < .001), male (57.8 vs 42.7%, P < .001), and had a much higher incidence of coronary risk factors. Revascularization was associated with increased survival in multivariable analysis (odds ratio: 0.562, 95% confidence interval: 0.334-0.946, P = .03). In conclusion, among patients admitted with AF, 1.2% were diagnosed with NSTEMI. A minority of patients with AF and NSTEMI underwent revascularization and had better in-hospital outcomes.
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Affiliation(s)
- Gbolahan O Ogunbayo
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Adrian W Messerli
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Le Dung Ha
- 2 Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Ayman Elbadawi
- 2 Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Odunayo Olorunfemi
- 2 Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Yousef Darrat
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Maya Guglin
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Remi Okwechime
- 3 Department of Internal Medicine, Wychoff Heights Medical Center, NY, USA
| | - Deborah Akanya
- 4 Department of Internal Medicine, St Vincents Medical Center, Bridgeport, CT, USA
| | - Ahmed Abdel-Latif
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Susan S Smyth
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Claude S Elayi
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
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14
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4499] [Impact Index Per Article: 749.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Reinstadler SJ, Stiermaier T, Eitel C, Fuernau G, Saad M, Pöss J, de Waha S, Mende M, Desch S, Metzler B, Thiele H, Eitel I. Impact of Atrial Fibrillation During ST-Segment–Elevation Myocardial Infarction on Infarct Characteristics and Prognosis. Circ Cardiovasc Imaging 2018; 11:e006955. [DOI: 10.1161/circimaging.117.006955] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Sebastian J. Reinstadler
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
| | - Thomas Stiermaier
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
| | - Charlotte Eitel
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
| | - Georg Fuernau
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
| | - Mohammed Saad
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
| | - Janine Pöss
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
| | - Suzanne de Waha
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
| | - Meinhard Mende
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
| | - Steffen Desch
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
| | - Bernhard Metzler
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
| | - Holger Thiele
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
| | - Ingo Eitel
- From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical
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16
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Xu H, Wang B, Meng Q, Li J, Sun W, Xin L, Chen L. Effectiveness and safety of recombinant human brain natriuretic peptide in the treatment of acute myocardial infarction in elderly in combination with cardiac failure. Pak J Med Sci 2017; 33:540-544. [PMID: 28811767 PMCID: PMC5510099 DOI: 10.12669/pjms.333.12483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To investigate the effects and safety of recombinant human brain natriuretic peptide (rhBNP) in the treatment of elderly acute myocardial infarction induced cardiac failure. Methods: One hundred and forty-six patients who were diagnosed as elderly acute myocardial infarction induced cardiac failure in the hospital from July 2014 to July 2015 were selected. They were divided into a test group and a control group, 73 each. Patients in both groups were given conventional treatment such as stabilization of atherosclerotic plaques, anti-platelet and remodeling and reversion of myocardium. The curative effects and the incidence of adverse reactions of the two groups were observed. Results: The overall efficacy of the test group and the control group was 87.7% and 65.8% respectively, and the difference had statistical significance (P<0.05). The heart rate, urine volume, n-terminal pro-brain natriuretic peptide level and left ventricular ejection fraction (LVEF) of both groups significantly improved after treatment, and the improvement of the test group was superior to that of the control group (P<0.05). The serum creatinine of the test group remarkably reduced after treatment (P<0.05). The incidence of hypotension and arrhythmia of the test group was lower than that of the control group during hospitalization period (P<0.05). Conclusion: rhBNP can effectively relieve the clinical symptoms, cardiac function indexes and hemodynamic indexes of patients with elderly acute myocardial infarction induced cardiac failure, with a high safety. It can be extensively applied in the treatment of acute myocardial infarction in combination with cardiac failure.
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Affiliation(s)
- Hong Xu
- Hong Xu, Department of Cardiology, Tai'an City Central Hospital, Shandong, 271000, China
| | - Bosong Wang
- Bosong Wang, Department of Cardiology, Tai'an City Central Hospital, Shandong, 271000, China
| | - Qingmei Meng
- Qingmei Meng, Department of Pediatric, Tai'an City Central Hospital, Shandong, 271000, China
| | - Jinlong Li
- Jinlong Li, Department of Cardiology, Tai'an City Central Hospital, Shandong, 271000, China
| | - Weidong Sun
- Weidong Sun, Department of Cardiology, Tai'an City Central Hospital, Shandong, 271000, China
| | - Li Xin
- Li Xin, Department of Cardiology, Tai'an City Central Hospital, Shandong, 271000, China
| | - Liping Chen
- Liping Chen, Department of Pediatric, Tai'an City Central Hospital, Shandong, 271000, China
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17
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6056] [Impact Index Per Article: 865.1] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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Norby FL, Soliman EZ, Chen LY, Bengtson LGS, Loehr LR, Agarwal SK, Alonso A. Trajectories of Cardiovascular Risk Factors and Incidence of Atrial Fibrillation Over a 25-Year Follow-Up: The ARIC Study (Atherosclerosis Risk in Communities). Circulation 2016; 134:599-610. [PMID: 27550968 DOI: 10.1161/circulationaha.115.020090] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/22/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Timing and trajectories of cardiovascular risk factor (CVRF) development in relation to atrial fibrillation (AF) have not been described previously. We assessed trajectories of CVRF and incidence of AF over 25 years in the ARIC study (Atherosclerosis Risk in Communities). METHODS We assessed trajectories of CVRF in 2456 individuals with incident AF and 6414 matched control subjects. Subsequently, we determined the association of CVRF trajectories with the incidence of AF among 10 559 AF-free individuals (mean age, 67 years; 52% men; 20% blacks). Risk factors were measured during 5 examinations between 1987 and 2013. Cardiovascular events, including incident AF, were ascertained continuously. We modeled the prevalence of risk factors and cardiovascular outcomes in the period before and after AF diagnosis and the corresponding index date for control subjects using generalized estimating equations. Trajectories in risk factors were identified with latent mixture modeling. The risk of incident AF by trajectory group was examined with Cox models. RESULTS The prevalence of stroke, myocardial infarction, and heart failure increased steeply during the time close to AF diagnosis. All CVRFs were elevated in AF cases compared with controls >15 years before diagnosis. We identified distinct trajectories for all the assessed CVRFs. In general, individuals with trajectories denoting long-term exposure to CVRFs had increased AF risk even after adjustment for single measurements of the CVRFs. CONCLUSIONS AF patients have increased prevalence of CVRF many years before disease diagnosis. This analysis identified diverse trajectories in the prevalence of these risk factors, highlighting their different roles in AF pathogenesis.
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Affiliation(s)
- Faye L Norby
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.).
| | - Elsayed Z Soliman
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Lin Y Chen
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Lindsay G S Bengtson
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Laura R Loehr
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Sunil K Agarwal
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Alvaro Alonso
- From Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.); Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN (L.G.S.B.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.); Icahn School of Medicine, Mount Sinai Heart Center, New York, NY (S.K.A.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
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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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20
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Wang ZC, Ji WH, Ruan CW, Liu XY, Qiu XB, Yuan F, Li RG, Xu YJ, Liu X, Huang RT, Xue S, Yang YQ. Prevalence and Spectrum of TBX5 Mutation in Patients with Lone Atrial Fibrillation. Int J Med Sci 2016; 13:60-7. [PMID: 26917986 PMCID: PMC4747871 DOI: 10.7150/ijms.13264] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/09/2015] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF), the most common type of cardiac rhythm disturbance encountered in clinical practice, is associated with substantially increased morbidity and mortality. Aggregating evidence demonstrates that abnormal cardiovascular development is involved in the pathogenesis of AF. A recent study has revealed that the TBX5 gene, which encodes a T-box transcription factor key to cardiovascular development, was associated with AF and atypical Holt-Oram syndrome. However, the prevalence and spectrum of TBX5 mutation in patients with lone AF remain unclear. In this study, the coding regions and splicing junction sites of TBX5 were sequenced in 192 unrelated patients with lone AF and 300 unrelated ethnically-matched healthy individuals used as controls. The causative potential of the identified TBX5 variation was evaluated by MutationTaster and PolyPhen-2. The functional effect of the mutant TBX5 was assayed by using a dual-luciferase reporter assay system. As a result, a novel heterozygous TBX5 mutation, p.H170D, was identified in a patient, with a mutational prevalence of approximately 0.52%. This mutation, which was absent in the 300 control individuals, altered the amino acid completely conserved evolutionarily across species, and was predicted to be disease-causing. Functional deciphers showed that the mutant TBX5 was associated with significantly reduced transcriptional activity when compared with its wild-type counterpart. Furthermore, the mutation significantly decreased the synergistic activation between TBX5 and NKX2-5 or GATA4. The findings expand the mutational spectrum of TBX5 linked to AF and provide new evidence that dysfunctional TBX5 may contribute to lone AF.
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Affiliation(s)
- Zhan-Cheng Wang
- 1. Department of Cardiology, Shanghai Eighth People's Hospital, 8 Caobao Road, Shanghai 200235, China
| | - Wen-Hui Ji
- 2. Department of Internal Medicine, Huajing Community Health Service Center of Xu Hui Distric, 180 Jianhua Road, Shanghai 200231, China
| | - Chang-Wu Ruan
- 1. Department of Cardiology, Shanghai Eighth People's Hospital, 8 Caobao Road, Shanghai 200235, China
| | - Xing-Yuan Liu
- 3. Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai 200065, China
| | - Xing-Biao Qiu
- 4. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Fang Yuan
- 4. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Ruo-Gu Li
- 4. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Ying-Jia Xu
- 4. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Xu Liu
- 4. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Ru-Tai Huang
- 5. Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Song Xue
- 5. Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yi-Qing Yang
- 4. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai 200030, China;; 6. Department of Cardiovascular Research Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai 200030, China;; 7. Department of Central Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai 200030, China
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3729] [Impact Index Per Article: 414.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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22
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Stamboul K, Zeller M, Fauchier L, Gudjoncik A, Buffet P, Garnier F, Guenancia C, Lorgis L, Beer JC, Touzery C, Cottin Y. Prognosis of silent atrial fibrillation after acute myocardial infarction at 1-year follow-up. Heart 2015; 101:864-9. [PMID: 25903836 DOI: 10.1136/heartjnl-2014-307253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/26/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Silent atrial fibrillation (AF), assessed by continuous ECG monitoring (CEM), has recently been shown to be common in acute myocardial infarction (AMI), and associated with higher hospital mortality. However, the long-term prognosis is still unknown. We aimed to assess 1-year prognosis in patients experiencing silent AF in AMI. METHODS All consecutive patients with AMI who were prospectively analysed by CEM during the first 48 h after admission and who survived at hospital discharge were included. Silent AF was defined as asymptomatic episodes lasting at least 30 s. Patients were followed up at 1 year for cardiovascular (CV) outcomes. RESULTS Among the 737 patients analysed, 106 (14%) developed silent AF and 32 (4%) symptomatic AF. Compared with the no-AF group, patients with silent AF were markedly older (79 vs 62 years, p<0.001), more frequently hypertensive (71% vs 49%, p<0.001) and less likely to be smokers (23% vs 37%, p<0.001). Also, they were more likely to have impaired LVEF (50% vs 55%, p<0.001). Risk factors in patients with silent AF were similar to those in patients with symptomatic AF. However, a history of stroke or AF was less frequent in silent AF than in symptomatic-AF patients (10% vs 25% and 10% vs 38%, respectively). At 1 year, CV events including hospitalisation for heart failure (HF) and CV mortality were markedly higher in silent-AF patients than in no-AF patients (6.6% vs 1.3% and 5.7% vs 2.0%, p<0.001, respectively). CONCLUSIONS Our large prospective study showed for the first time that silent AF is associated with worse 1-year prognosis after AMI. Systematic screening and specific management should be investigated in order to improve outcomes of patients after AMI.
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Affiliation(s)
- Karim Stamboul
- Cardiology Department, University Hospital, Dijon, France
| | - Marianne Zeller
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, University of Burgundy, Dijon, France
| | - Laurent Fauchier
- Cardiology Department, Trousseau University Hospital and François Rabelais University, Tours, France
| | | | | | - Fabien Garnier
- Cardiology Department, University Hospital, Dijon, France
| | | | - Luc Lorgis
- Cardiology Department, University Hospital, Dijon, France
| | | | - Claude Touzery
- Cardiology Department, University Hospital, Dijon, France
| | - Yves Cottin
- Cardiology Department, University Hospital, Dijon, France
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