1
|
Agarwal S, Farhat K, Khan MS, DeSimone CV, Deshmukh A, Munir MB, Asad ZUA, Stavrakis S. Sex differences in atrial fibrillation ablation outcomes in patients with heart failure. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01833-8. [PMID: 38811501 DOI: 10.1007/s10840-024-01833-8] [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: 03/25/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND There is a lack of data on the impact of sex on the outcomes of patients with heart failure (HF) undergoing atrial fibrillation (AF) ablation. We aimed to analyze the association of sex with outcomes of atrial fibrillation ablation in patients with heart failure. METHODS The National Readmissions Database (NRD) was analyzed from 2016 to 2019 to identify patients ≥ 18 years old with heart failure (HF) undergoing AF ablation. The outcomes of interest included peri-procedural complications, in-hospital mortality, resource utilization, and unplanned 1-year readmissions. The final cohort was divided into patients with HFrEF and HFpEF and outcomes were compared between males and females in both cohorts. RESULTS A total of 23,277 patients with HF underwent AF ablation between 2016 and 2019, of which 14,480 had HFrEF and 8,797 had HFpEF. Among patients with HFrEF, 61.6% were males and 38.4% were females whereas, among patients with HFpEF, 35.4% were males and 64.6% were females. On a multivariable-adjusted analysis, in patients with HFrEF, there was no difference in the odds of in-hospital mortality, peri-procedural complications, or 1-year HF-related/AF-related/all-cause readmissions between males and females. In patients with HFpEF, females had a higher risk 1-year HF-related readmissions (adjusted hazards ratio: 1.46; 95% CI: 1.13-1.87; p = 0.01), without any difference in the 1-year AF-related/all-cause readmissions, in-hospital mortality, or peri-procedural complications. CONCLUSION Our results show that females with HFrEF undergoing AF ablation have similar outcomes whereas females with HFpEF have higher 1-year HF readmissions with no difference in the other outcomes, compared to males.
Collapse
Affiliation(s)
- Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kassem Farhat
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT, USA
| | - Muhammad Salman Khan
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Zain Ul Abideen Asad
- Department of Cardiology, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Suite 5400, Oklahoma City, OK, 73104, USA
| | - Stavros Stavrakis
- Department of Cardiology, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Suite 5400, Oklahoma City, OK, 73104, USA.
| |
Collapse
|
2
|
Zuin M, Bertini M, Vitali F, Turakhia M, Boriani G. Heart Failure-Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020. J Am Heart Assoc 2024; 13:e033897. [PMID: 38686875 PMCID: PMC11179935 DOI: 10.1161/jaha.123.033897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/15/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Population-based data on heart failure (HF)-related death in patients with atrial fibrillation (AF) are lacking. We assessed HF-related death in people with AF in the United States over the past 21 years and examined differences by age, sex, race, ethnicity, urbanization, and census region. METHODS AND RESULTS Data were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to determine trends in age-adjusted mortality rates per 100 000 people, due to HF-related death among subjects with AF aged ≥15 years. To calculate nationwide annual trends, we assessed the average annual percent change (AAPC) and annual percent change with relative 95% CIs using joinpoint regression. Between 1999 and 2020, 916 685 HF-related deaths (396 205 men and 520 480 women) occurred among US adults having a concomitant AF. The overall age-adjusted mortality rates increased (AAPC: +4.1% [95% CI, 3.8-4.4]; P<0.001), especially after 2011 (annual percent change, +6.8% [95% CI, 6.2-7.4]; P<0.001) in men (AAPC, +4.8% [95% CI, 4.4-5.1]; P<0.001), in White subjects (AAPC: +4.2% [95% CI, 3.9 to 4.6]; P<0.001) and in subjects aged <65 years (AAPC: +7.5% [95% CI, 6.7-8.4]; P<0.001). The higher percentage of deaths were registered in the South (32.8%). During the first year of the COVID-19 pandemic, a significant excess in HF-related deaths among patients with AF aged >65 years was observed. CONCLUSIONS A worrying increase in the HF-related mortality rate among patients with AF has been observed in the United States over the past 2 decades.
Collapse
Affiliation(s)
- Marco Zuin
- Cardiology Unit, Department of Translational Medicine Sant'Anna University Hospital, University of Ferrara Ferrara Italy
| | - Matteo Bertini
- Cardiology Unit, Department of Translational Medicine Sant'Anna University Hospital, University of Ferrara Ferrara Italy
| | - Francesco Vitali
- Cardiology Unit, Department of Translational Medicine Sant'Anna University Hospital, University of Ferrara Ferrara Italy
| | - Mintu Turakhia
- Division of Cardiovascular Medicine, The Center for Digital Health Stanford University Stanford CA USA
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences Italy University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
| |
Collapse
|
3
|
Alonso A, Morris AA, Naimi AI, Alam AB, Li L, Subramanya V, Chen LY, Lutsey PL. Use of Sodium-Glucose Cotransporter-2 Inhibitors and Angiotensin Receptor-Neprilysin Inhibitors in Patients With Atrial Fibrillation and Heart Failure From 2021 to 2022: An Analysis of Real-World Data. J Am Heart Assoc 2024; 13:e032783. [PMID: 38456406 PMCID: PMC11010035 DOI: 10.1161/jaha.123.032783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/16/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Contemporary use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor-neprilysin inhibitors (ARNi) in patients with atrial fibrillation (AF) and heart failure (HF) has not been described. METHODS AND RESULTS We analyzed the MarketScan databases for the period January 1, 2021 to July 30, 2022. Validated algorithms were used to identify patients with AF and HF, and to classify patients into HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF). We assessed the prevalence of SGLT2i and ARNi use overall and by HF type. Additionally, we explored correlates of lower use, including demographics and comorbidities. The study population included 60 927 patients (mean age, 75 years; 43% women) diagnosed with AF and HF (85% with HFpEF, 15% with HFrEF). Prevalence of ARNi use was 11% overall (30% in HFrEF, 8% in HFpEF), whereas the corresponding figure was 6% for SGLT2i (13% in HFrEF, 5% in HFpEF). Use of both medications increased over the study period: ARNi from 9% to 12% (22%-29% in HFrEF, 6%-8% in HFpEF), and SGLT2i from 3% to 9% (6%-16% in HFrEF, 2%-7% in HFpEF). Female sex, older age, and specific comorbidities were associated with lower use of these 2 medication types overall and by HF type. CONCLUSIONS Use of ARNi and SGLT2i in patients with AF and HF is suboptimal, particularly among women and older individuals, though use is increasing. These results underscore the need for understanding reasons for these disparities and developing interventions to improve adoption of evidence-based therapies among patients with comorbid AF and HF.
Collapse
Affiliation(s)
- Alvaro Alonso
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Alanna A. Morris
- Department of Medicine, School of MedicineEmory UniversityAtlantaGAUSA
| | - Ashley I. Naimi
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Aniqa B. Alam
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Linzi Li
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Vinita Subramanya
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Lin Yee Chen
- Lillete Heart Institute and Department of MedicineUniversity of Minnesota School of MedicineMinneapolisMNUSA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMNUSA
| |
Collapse
|
4
|
Razaghizad A, Huynh T, Sharma A. The controversy between atrial fibrillation subtypes and worsening heart failure. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024:qcae018. [PMID: 38449340 DOI: 10.1093/ehjqcco/qcae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
- Amir Razaghizad
- Centre for Outcomes Research and Evaluation Research Institute of the McGill University Health Centre Montreal, QC, Canada
- Division of Cardiology, McGill University Health Centre McGill University Montreal Quebec Canada
| | - Thao Huynh
- Division of Cardiology, McGill University Health Centre McGill University Montreal Quebec Canada
| | - Abhinav Sharma
- Centre for Outcomes Research and Evaluation Research Institute of the McGill University Health Centre Montreal, QC, Canada
- Division of Cardiology, McGill University Health Centre McGill University Montreal Quebec Canada
| |
Collapse
|
5
|
El Zein S, Fawaz M, Al-Shloul MN, Rayan A, ALBashtawy MS, Khader IA, Jallad M, Al-Kharabsheh M, ALBashtawy S, Alshloul DM. Perceptions of Bedside Nurses Caring for Patients with Left Ventricular Assist Devices (LVAD): A Qualitative Study. SAGE Open Nurs 2024; 10:23779608241252249. [PMID: 38746075 PMCID: PMC11092549 DOI: 10.1177/23779608241252249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 03/17/2024] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Bedside nurses in the intensive care units are exposed to multiple challenges in their regular practice and recently have taken in ventricular assist device care in Lebanon since its introduction as a fairly new practice. Objectives To explore the experiences of nursing staff who work in Lebanese hospitals with Left Ventricular Assist Devices (LVAD). Methods This study employed a qualitative phenomenological research design, where semi-structured interviews were carried out among fifteen LVAD nurses in an acute care hospital. Results The qualitative data analysis produced six main themes. The first theme prevalent was "LVAD incompetence and shortage" and it reflected the deficit in properly structured training and the number of specialized LVAD nurses. The second theme that resulted from the analysis was titled, "Patient and family knowledge", which indicated the misconceptions that families and patients usually hold about LVAD which usually sugarcoats the situation. This was followed by "Burden of complications", "LVAD patient selection", "Perception of the LVAD team as invulnerable", and "High workload and patient frailty" which reflected the perspectives of LVAD nurses. Conclusion This study shows that the Lebanese LVAD nurses who participated in this study perceived inadequate competence, yet lacked proper training and induction. The nurses reported multiple challenges relating to care tasks, workload, and patient and family interactions which need to be addressed by coordinators.
Collapse
Affiliation(s)
- Sara El Zein
- MSN Student, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Mirna Fawaz
- Assistant professor, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Mohammad N. Al-Shloul
- Associated Professor, Applied Medical Sciences Department, Al-Balqa' Applied University, Prince Al Hussein Bin Abdduallah II Academy for Civil Protection, Amman, Jordan
| | - Ahmad Rayan
- Associate professor, Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | - Mohammed S ALBashtawy
- Professor, Department of Community and Mental Health, Princess Salma Faculty of Nursing, AL Al-Bayt University, Mafraq, Jordan
| | - Imad Abu Khader
- Assistance Professor, Adult Health Nursing, Faculty of Graduate Studies Arab American University, Jenin, Palestine
| | - Mohammed Jallad
- Associate Professor, Adult Health Nursing, Faculty of Graduate Studies Arab American University, Jenin, Palestine
| | - Muna Al-Kharabsheh
- Assistance Professor, Nursing College, Al-Balqa Applied University, Salt, Jordan
| | | | - Doha M. Alshloul
- Internship Medicine Student, Ministry of Health, Princess Basma Teaching Hospital/Irbid, Irbid, Jordan
| |
Collapse
|
6
|
Alonso A, Morris AA, Naimi AI, Alam AB, Li L, Subramanya V, Chen LY, Lutsey PL. Use of SGLT2i and ARNi in patients with atrial fibrillation and heart failure in 2021-2022: an analysis of real-world data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.08.23295280. [PMID: 37732232 PMCID: PMC10508822 DOI: 10.1101/2023.09.08.23295280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Objective To evaluate utilization of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor neprilysin inhibitors (ARNi) in patients with atrial fibrillation (AF) and heart failure (HF). Methods We analyzed the MarketScan databases for the period 1/1/2021 to 6/30/2022. Validated algorithms were used to identify patients with AF and HF, and to classify patients into HF with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF). We assessed the prevalence of SGLT2i and ARNi use overall and by HF type. Additionally, we explored correlates of lower utilization, including demographics and comorbidities. Results The study population included 60,927 patients (mean age 75, 43% female) diagnosed with AF and HF (85% with HFpEF, 15% with HFrEF). Prevalence of ARNi use was 11% overall (30% in HFrEF, 8% in HFpEF), while the corresponding figure was 6% for SGLT2i (13% in HFrEF, 5% in HFpEF). Use of both medications increased over the study period: ARNi from 9% to 12% (from 22% to 29% in HFrEF, from 6% to 8% in HFpEF), and SGLT2i from 3% to 9% (from 6% to 16% in HFrEF, from 2% to 7% in HFpEF). Female sex, older age, and specific comorbidities were associated with lower utilization of these two medication types overall and by HF type. Conclusion Use of ARNi and SGLT2i in patients with AF and HF is suboptimal, particularly among females and older individuals, though utilization is increasing. These results underscore the need for understanding reasons for these disparities and developing interventions to improve adoption of evidence-based therapies among patients with comorbid AF and HF.
Collapse
Affiliation(s)
- Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Alanna A. Morris
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Ashley I. Naimi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Aniqa B. Alam
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Linzi Li
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Vinita Subramanya
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lin Yee Chen
- Lillehei Heart Institute and Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| |
Collapse
|
7
|
Vijan A, Daha IC, Delcea C, Dan GA. The complex interplay between right ventricular dysfunction and atrial fibrillation - a narrative review. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2023; 61:77-83. [PMID: 36762789 DOI: 10.2478/rjim-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 05/10/2023]
Abstract
Atrial fibrillation (AF) is one of the most common sustained arrhythmias in clinical practice, associated with multiple comorbidities and complication. The potential predictors of AF onset and perpetuation or specific drivers of complications need future investigation. Right ventricular (RV) dysfunction plays an important role in the development of new-onset AF warranting in-depth analysis in relation to AF. RV may play a significant role in a better characterization of the cardiac substrate of AF patients. The relation between RV dysfunction and AF is bidirectional as AF may be one of the causes of RV dysfunction and their coexistence worsens the overall patient prognosis. Our aim is to present in a narrative review the most relevant data regarding the complex relationship between AF and RV dysfunction.
Collapse
Affiliation(s)
- Ancuta Vijan
- 1Carol Davila University of Medicine and Pharmacy, Bucharest
- 2Colentina Clinical Hospital, Bucharest, Romania
| | - Ioana Cristina Daha
- 1Carol Davila University of Medicine and Pharmacy, Bucharest
- 2Colentina Clinical Hospital, Bucharest, Romania
| | - Caterina Delcea
- 1Carol Davila University of Medicine and Pharmacy, Bucharest
- 2Colentina Clinical Hospital, Bucharest, Romania
| | - Gheorghe-Andrei Dan
- 1Carol Davila University of Medicine and Pharmacy, Bucharest
- 2Colentina Clinical Hospital, Bucharest, Romania
- 3Joint senior author
| |
Collapse
|
8
|
Ayub MT, Rangavajla G, Thoma F, Mulukutla S, Aronis K, Bhonsale A, Kancharla K, Voigt A, Shalaby A, Estes NAM, Jain S, Saba S. Relative Contribution of Atrial Fibrillation to Outcomes of Patients With Cardiomyopathy Based on Severity of Left Ventricular Dysfunction. Am J Cardiol 2023; 198:9-13. [PMID: 37182255 DOI: 10.1016/j.amjcard.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 05/16/2023]
Abstract
In patients with left ventricular (LV) dysfunction, the risk of death or heart failure hospitalizations (HFHs) increases with worsening ejection fraction (EF). Whether the relative contribution of atrial fibrillation (AF) to outcomes is more pronounced in patients with worse EF is not confirmed. The present study aimed to investigate the relative influence of AF on the outcome of cardiomyopathy patients by severity of LV dysfunction. In this observational study, data from 18,003 patients with EF ≤50% seen at a large academic institution between 2011 and 2017 were analyzed. Patients were stratified by EF quartiles (EF<25%, 25%≤EF<35%, 35%≤EF<40%, and EF≥40%, for quartiles 1, 2, 3, and 4, respectively). and followed to the end point of death or HFH. Outcomes of AF versus non-AF patients were compared within each EF quartile. During a median follow-up of 3.35 years, 8,037 patients (45%) died and 7,271 (40%) had at least 1 HFH. Rates of HFH and all-cause mortality increased as EF decreased. The hazard ratios (HRs) of death or HFH for AF versus non-AF patients increased steadily with increasing EF (HR of 1.22, 1.27, 1.45, 1.50 for quartiles 1, 2, 3, and 4, respectively, p = 0.045) driven primarily by the risk of HFH (HR of 1.26, 1.45, 1.59, 1.69 for quartiles 1, 2, 3, and 4, respectively, p = 0.045). In conclusion, in patients with LV dysfunction, the detrimental influence of AF on the risk of HFH is more pronounced in those with more preserved EF. Mitigation strategies for AF with the goal of decreasing HFH may be more impactful in patients with more preserved LV function.
Collapse
Affiliation(s)
- Mumammad Talha Ayub
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gautam Rangavajla
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Suresh Mulukutla
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Konstantinos Aronis
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Aditya Bhonsale
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Krishna Kancharla
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrew Voigt
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alaa Shalaby
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nathan Anthony Mark Estes
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sandeep Jain
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Samir Saba
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| |
Collapse
|
9
|
Huang Y, Zhang R, Li H, Xia Y, Yu X, Liu S, Yang Y. A multi-label learning prediction model for heart failure in patients with atrial fibrillation based on expert knowledge of disease duration. APPL INTELL 2023. [DOI: 10.1007/s10489-023-04487-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
|
10
|
Zhou Z, Gao Y, Zhang W, Bo K, Zhang N, Wang H, Wang R, Du Z, Firmin D, Yang G, Zhang H, Xu L. Artificial intelligence-based full aortic CT angiography imaging with ultra-low-dose contrast medium: a preliminary study. Eur Radiol 2023; 33:678-689. [PMID: 35788754 DOI: 10.1007/s00330-022-08975-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/16/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To further reduce the contrast medium (CM) dose of full aortic CT angiography (ACTA) imaging using the augmented cycle-consistent adversarial framework (Au-CycleGAN) algorithm. METHODS We prospectively enrolled 150 consecutive patients with suspected aortic disease. All received ACTA scans of ultra-low-dose CM (ULDCM) protocol and low-dose CM (LDCM) protocol. These data were randomly assigned to the training datasets (n = 100) and the validation datasets (n = 50). The ULDCM images were reconstructed by the Au-CycleGAN algorithm. Then, the AI-based ULDCM images were compared with LDCM images in terms of image quality and diagnostic accuracy. RESULTS The mean image quality score of each location in the AI-based ULDCM group was higher than that in the ULDCM group but a little lower than that in the LDCM group (all p < 0.05). All AI-based ULDCM images met the diagnostic requirements (score ≥ 3). Except for the image noise, the AI-based ULDCM images had higher attenuation value than the ULDCM and LDCM images as well as higher SNR and CNR in all locations of the aorta analyzed (all p < 0.05). Similar results were also seen in obese patients (BMI > 25, all p < 0.05). Using the findings of LDCM images as the reference, the AI-based ULDCM images showed good diagnostic parameters and no significant differences in any of the analyzed aortic disease diagnoses (all K-values > 0.80, p < 0.05). CONCLUSIONS The required dose of CM for full ACTA imaging can be reduced to one-third of the CM dose of the LDCM protocol while maintaining image quality and diagnostic accuracy using the Au-CycleGAN algorithm. KEY POINTS • The required dose of contrast medium (CM) for full ACTA imaging can be reduced to one-third of the CM dose of the low-dose contrast medium (LDCM) protocol using the Au-CycleGAN algorithm. • Except for the image noise, the AI-based ultra-low-dose contrast medium (ULDCM) images had better quantitative image quality parameters than the ULDCM and LDCM images. • No significant diagnostic differences were noted between the AI-based ULDCM and LDCM images regarding all the analyzed aortic disease diagnoses.
Collapse
Affiliation(s)
- Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yifeng Gao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Weiwei Zhang
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Kairui Bo
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Zhiqiang Du
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - David Firmin
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW3 6NP, UK.,National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW3 6NP, UK.,National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Heye Zhang
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China.
| |
Collapse
|
11
|
Mitral Annular Plane Systolic Excursion (MAPSE) as a Predictor of Atrial Fibrillation Recurrence in Patients after Pulmonary Vein Isolation. Cardiol Res Pract 2022; 2022:2746304. [PMID: 36203496 PMCID: PMC9532161 DOI: 10.1155/2022/2746304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Catheter ablation (CA) with pulmonary vein isolation (PVI) has become widely used in the past years for the treatment of atrial fibrillation (AF). Mitral annular plane systolic excursion (MAPSE) is the parameter that measures left ventricular longitudinal function, and it appears to be a good early marker of LV dysfunction. It is practically independent of poor image quality. The aim of our study was to analyse the role of echocardiographic variables, especially MAPSE in predicting the outcome of CA in patients with AF. Materials and Methods We prospectively included 40 patients with paroxysmal and persistent AF that were referred for CA. All patients underwent radiofrequency CA with PVI. Standard transthoracic two-dimensional echocardiography was conducted one day after CA. Demographic data and the patients' characteristics were noted. The endpoint of our study was to estimate the AF recurrence rate diagnosed by ECG within 6 months of the follow-up period. Results 40 patients, mainly male (67.5%) with an average age of 61.43 ± 8.96 years were included in our study. The majority of patients had paroxysmal AF prior to ablation (77.5%). The AF recurrence rate was 20% after 6 months of follow-up. Lateral MAPSE in the AF-free group was greater than those who relapsed (1.57 ± 0.24 vs. 1.31 ± 0.25; p = 0.012). Patients who remained AF-free after a 6-month follow-up period had a significantly smaller left ventricular volume index (LAVI) than those who relapsed (34.29 ± 6.91 ml/m2 vs. 42.90 ± 8.43 ml/m2; p = 0.05). We found a significant reverse relationship between LAVI and MAPSE (p = 0.020). Conclusion MAPSE and LAVI present risk factors for AF recurrence, specifically reduced MAPSE and larger LAVI, are related to AF recurrence after CA. In the future, MAPSE could play a significant role when predicting the CA outcome in patients with AF.
Collapse
|
12
|
Screening and Bioinformatics Analysis of Crucial Gene of Heart Failure and Atrial Fibrillation Based on GEO Database. Medicina (B Aires) 2022; 58:medicina58101319. [DOI: 10.3390/medicina58101319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/31/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: In clinical practice, we observed that the prognoses of patients with heart failure and atrial fibrillation were worse than those of patients with only heart failure or atrial fibrillation. The study aims to get a better understanding of the common pathogenesis of the two diseases and find new therapeutic targets. Materials and Methods: We downloaded heart failure datasets and atrial fibrillation datasets from the gene expression omnibus database. The common DEGs (differentially expressed genes) in heart failure and atrial fibrillation were identified by a series of bioinformatics methods. To better understand the functions and possible pathways of DEGs, we performed Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. Results: We identified 22 up-regulated genes and 14 down-regulated genes in two datasets of heart failure and 475 up-regulated and 110 down-regulated genes in atrial fibrillation datasets. In addition, two co-upregulated (FRZB, SFRP4) and three co-downregulated genes (ENTPPL, AQP4, C1orf105) were identified. GO enrichment results showed that these common differentially expressed genes were mainly concentrated in the signal regulation of the Wnt pathway. Conclusions: We found five crucial genes in heart failure and atrial fibrillation, which may be potential therapeutic targets for patients with heart failure and atrial fibrillation.
Collapse
|
13
|
Oraii A, Healey JS, Benz AP, Pandey AK, Wong JA, Fonguh S, Wang J, Conen D, Gerstein HC, Connolly SJ, McIntyre WF. Association of Eligibility for a Sodium-Glucose Cotransporter 2 Inhibitor and Cardiovascular Events in Patients With Atrial Fibrillation. Can J Cardiol 2022; 38:1434-1441. [PMID: 35562018 DOI: 10.1016/j.cjca.2022.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce heart failure (HF) in a broad range of populations, but they have not been studied specifically in patients with atrial fibrillation (AF). We aimed to examine the association between SGLT2i eligibility and cardiovascular events in patients with AF to evaluate the potential utility of SGLT2is for AF management. METHODS We pooled data from 2 randomized controlled trials (RCTs) of patients with AF (RE-LY and ACTIVE-W). Among patients assigned to anticoagulation arms, those meeting the enrollment criteria from at least 1 of the phase 3 SGLT2i RCTs were classified as "SGLT2i eligible" and the remainder as "SGLT2i ineligible." The primary outcome was the composite of HF hospitalization or cardiovascular death. RESULTS A total of 21,484 patients with AF (mean age: 71.2 ± 8.8, 36.1% women, median CHA2DS2-VASc Score = 3) were included. The proportion of patients with AF eligible for SGLT2i was 41.2%. SGLT2i-eligible patients had higher rates of cardiovascular death or hospitalization for HF (5.8 vs 3.2 per 100 person-years, Plog-rank < 0.001), cardiovascular death (3.9 vs 1.5 per 100 person-years, Plog-rank < 0.001), and hospitalization for HF (2.5 vs 1.9 per 100 person-years, Plog-rank < 0.001). The age- and sex-adjusted model showed that SGLT2i-eligible patients were at a higher risk of cardiovascular death and hospitalization for HF (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.79-2.17; P < 0.001), cardiovascular death (HR, 2.75; 95% CI, 2.41-3.13; P < 0.001), and hospitalization for HF (HR, 1.41; 95% CI, 1.23-1.62; P < 0.001) than ineligible patients. CONCLUSIONS Most patients with AF do not currently have indications for SGLT2is but still have substantial risk of cardiovascular events. Future randomized trials should evaluate the efficacy of SGLT2is in patients with AF.
Collapse
Affiliation(s)
- Alireza Oraii
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Arjun K Pandey
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jorge A Wong
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sylvanus Fonguh
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jia Wang
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - David Conen
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, Hamilton, Ontario, Canada; Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - William F McIntyre
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
14
|
Kwon CH, Kim YJ, Kim MJ, Cha MJ, Cho MS, Nam GB, Choi KJ, Kim J. Effect of Sodium-Glucose Cotransporter Inhibitors on Major Adverse Cardiovascular Events and Hospitalization for Heart Failure in Patients With Type 2 Diabetes Mellitus and Atrial Fibrillation. Am J Cardiol 2022; 178:35-42. [PMID: 35810007 DOI: 10.1016/j.amjcard.2022.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023]
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to lower cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) and high cardiovascular risks. Here, we aimed to evaluate the effect of SGLT2 inhibitors on major adverse cardiovascular events (MACE), a composite of cardiovascular mortality, myocardial infarction, or ischemic stroke and hospitalization for heart failure in patients with T2DM and atrial fibrillation (AF). Using the Korean National Health Insurance Service database, we identified 40,268 patients with T2DM and AF who were newly prescribed oral hypoglycemic drugs (2,977 patients with SGLT2 inhibitors and 37,291 patients without SGLT2 inhibitors) between 2014 and 2018. After 1: 4 propensity score matching, patients who received SGLT2 inhibitors (n = 2,958) and those who did not receive SGLT2 inhibitors (n = 10,691) were enrolled, and followed up until December 31, 2018. During a mean follow-up duration of 2.1 ± 1.4 years, the risk of major adverse cardiovascular events was similar between the 2 groups (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.76 to 1.21). There were no significant differences between the 2 groups for cardiovascular mortality, myocardial infarction, or ischemic stroke. However, patients who received SGLT2 inhibitors had significantly lower risks of hospitalization for heart failure (HR 0.70, 95% CI 0.53 to 0.93) and all-cause mortality (HR 0.74, 95% CI 0.56 to 0.98) than those who did not receive SGLT2 inhibitors. In conclusion, in this real-world cohort of Asian patients with T2DM and AF, use of SGLT2 inhibitors was associated with a lower risk of hospitalization for heart failure.
Collapse
Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Jin Cha
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Soo Cho
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Byoung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Joon Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
15
|
Goni L, Razquin C, Toledo E, Guasch-Ferré M, Clish CB, Babio N, Wittenbecher C, Atzeni A, Li J, Liang L, Dennis C, Alonso-Gómez Á, Fitó M, Corella D, Gómez-Gracia E, Estruch R, Fiol M, Lapetra J, Serra-Majem L, Ros E, Arós F, Salas-Salvadó J, Hu FB, Martínez-González MA, Ruiz-Canela M. Arginine catabolism metabolites and atrial fibrillation or heart failure risk: 2 case-control studies within the Prevención con Dieta Mediterránea (PREDIMED) trial. Am J Clin Nutr 2022; 116:653-662. [PMID: 35575609 PMCID: PMC9437981 DOI: 10.1093/ajcn/nqac139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/25/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Arginine-derived metabolites are involved in oxidative and inflammatory processes related to endothelial functions and cardiovascular risks. OBJECTIVES We prospectively examined the associations of arginine catabolism metabolites with the risks of atrial fibrillation (AF) or heart failure (HF), and evaluated the potential modifications of these associations through Mediterranean diet (MedDiet) interventions in a large, primary-prevention trial. METHODS Two nested, matched, case-control studies were designed within the Prevención con Dieta Mediterránea (PREDIMED) trial. We selected 509 incident cases and 547 matched controls for the AF case-control study and 326 cases and 402 matched controls for the HF case-control study using incidence density sampling. Fasting blood samples were collected at baseline and arginine catabolism metabolites were measured using LC-tandem MS. Multivariable conditional logistic regression models were applied to test the associations between the metabolites and incident AF or HF. Interactions between metabolites and intervention groups (MedDiet groups compared with control group) were analyzed with the likelihood ratio test. RESULTS Inverse association with incident AF was observed for arginine (OR per 1 SD, 0.83; 95% CI: 0.73-0.94), whereas a positive association was found for N1-acetylspermidine (OR for Q4 compared with Q1 1.58; 95% CI: 1.13-2.25). For HF, inverse associations were found for arginine (OR per 1 SD, 0.82; 95% CI: 0.69-0.97) and homoarginine (OR per 1 SD, 0.81; 95% CI: 0.68-0.96), and positive associations were found for the asymmetric dimethylarginine (ADMA) and symmetric dimethlyarginine (SDMA) ratio (OR per 1 SD, 1.19; 95% CI: 1.02-1.41), N1-acetylspermidine (OR per 1 SD, 1.34; 95% CI: 1.12-1.60), and diacetylspermine (OR per 1 SD, 1.20; 95% CI: 1.02-1.41). In the stratified analysis according to the dietary intervention, the lower HF risk associated with arginine was restricted to participants in the MedDiet groups (P-interaction = 0.044). CONCLUSIONS Our results suggest that arginine catabolism metabolites could be involved in AF and HF. Interventions with the MedDiet may contribute to strengthen the inverse association between arginine and the risk of HF. This trial was registered at controlled-trials.com as ISRCTN35739639.
Collapse
Affiliation(s)
- Leticia Goni
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,IdiSNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain,Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Razquin
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,IdiSNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain,Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Estefanía Toledo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,IdiSNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain,Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Guasch-Ferré
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, MA, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Nancy Babio
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain,Institut d'Investigació Sanitària Pere i Virgili, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Clemens Wittenbecher
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Alessandro Atzeni
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain,Institut d'Investigació Sanitària Pere i Virgili, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Jun Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Ángel Alonso-Gómez
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain,University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
| | - Montserrat Fitó
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Dolores Corella
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Enrique Gómez-Gracia
- Department of Preventive Medicine, University of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Ramón Estruch
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Miquel Fiol
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Plataforma de Ensayos Clínicos, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Jose Lapetra
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | - Lluis Serra-Majem
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Nutrition Research Group, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Emilio Ros
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Lipid Clinic, Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Fernando Arós
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain,University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
| | - Jordi Salas-Salvadó
- Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain,Institut d'Investigació Sanitària Pere i Virgili, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, MA, USA
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,IdiSNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain,Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | |
Collapse
|
16
|
Mork C, Amacher SA, Gahl B, Koechlin L, Miazza J, Schaeffer T, Schmuelling L, Bremerich J, Berdajs D, Cueni N, Kühne M, Mueller C, Osswald S, Reuthebuch O, Schurr U, Sticherling C, Kopp Lugli A, Marsch S, Pargger H, Siegemund M, Eckstein F, Hollinger A, Santer D. Non-invasive evaluation of new-onset atrial fibrillation after cardiac surgery: a protocol for the BigMap study. ESC Heart Fail 2022; 9:2703-2712. [PMID: 35438261 PMCID: PMC9288739 DOI: 10.1002/ehf2.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/30/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022] Open
Abstract
Aims New‐onset atrial fibrillation (NOAF) is the most common complication after cardiac surgery, occurring in 25–50% of patients. It is associated with post‐operative stroke, increased mortality, prolonged hospital length of stay, and higher treatment costs. Previous small observational studies have identified the left atrium as a source of the electrical rotors and foci maintaining NOAF, but confirmation by a large prospective clinical study is still missing. The aim of the proposed study is to investigate whether the source of NOAF lies in the left atrium. The correct identification of NOAF‐maintaining structures in cardiac surgical patients might offer potential therapeutic targets for prophylactic perioperative ablation strategies. Methods and results This is a prospective single‐centre observational study of patients developing NOAF after cardiac surgery. The primary outcome is the description of NOAF‐maintaining structures within the atria. Key secondary outcomes include overall mortality, intensive care unit length of stay, hospital–ventilator‐free days, and proportion of persistent NOAF. In NOAF patients, the non‐invasive electrophysiological mapping will be conducted using a 252‐electrode electrocardiogram vest. After mapping, a low‐dose computed tomography scan of the chest will be performed to integrate the electrophysiological mapping results into a 3D picture of the heart. The study will include approximately 570 patients, of whom 30% (n = 170) are expected to develop NOAF. Sample size calculation revealed that 157 NOAF patients are necessary to assess the primary outcome. Patients will be tracked for a total of 5 years. Conclusions This is the largest prospective study to date describing the electrophysiological mechanisms of NOAF using non‐invasive mapping.
Collapse
Affiliation(s)
- Constantin Mork
- Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Cardiovascular Research Institute (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Cardiovascular Research Institute (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jules Miazza
- Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Thibault Schaeffer
- Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Lena Schmuelling
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Denis Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Nadine Cueni
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Ulrich Schurr
- Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Christian Sticherling
- Cardiovascular Research Institute (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Andrea Kopp Lugli
- Medical Faculty of the University of Basel, Basel, Switzerland.,Intermediate Care Unit, University Hospital Basel, Basel, Switzerland
| | - Stephan Marsch
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Alexa Hollinger
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - David Santer
- Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| |
Collapse
|
17
|
Moula AI, Parrini I, Tetta C, Lucà F, Parise G, Rao CM, Mauro E, Parise O, Matteucci F, Gulizia MM, La Meir M, Gelsomino S. Obstructive Sleep Apnea and Atrial Fibrillation. J Clin Med 2022; 11:jcm11051242. [PMID: 35268335 PMCID: PMC8911205 DOI: 10.3390/jcm11051242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/14/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia, increasing with age and comorbidities. Obstructive sleep apnea (OSA) is a chronic sleep disorder more common in older men. It has been shown that OSA is linked to AF. Nonetheless, the prevalence of OSA in patients with AF remains unknown because OSA is significantly underdiagnosed. This review, including 54,271 patients, carried out a meta-analysis to investigate the association between OSA and AF. We also performed a meta-regression to explore cofactors influencing this correlation. A strong link was found between these two disorders. The incidence of AF is 88% higher in patients with OSA. Age and hypertension independently strengthened this association, indicating that OSA treatment could help reduce AF recurrence. Further research is needed to confirm these findings. Atrial Fibrillation (AF) is the most common arrhythmia, increasing with age and comorbidities. Obstructive sleep apnea (OSA) is a regulatory respiratory disorder of partial or complete collapse of the upper airways during sleep leading to recurrent pauses in breathing. OSA is more common in older men. Evidence exists that OSA is linked to AF. Nonetheless, the prevalence of OSA in patients with AF remains unknown because OSA is underdiagnosed. In order to investigate the incidence of AF in OSA patients, we carried out a meta-analysis including 20 scientific studies with a total of 54,271 subjects. AF was present in 4801 patients of whom 2203 (45.9%) had OSA and 2598 (54.1%) did not. Of a total of 21,074 patients with OSA, 2203 (10.5%) had AF and 18,871 (89.5%) did not. The incidence of AF was 88% higher in patients with OSA. We performed a meta-regression to explore interacting factors potentially influencing the occurrence of AF in OSA. Older age and hypertension independently strengthened this association. The clinical significance of our results is that patients with OSA should be referred early to the cardiologist. Further research is needed for the definition of the mechanisms of association between AF and OSA.
Collapse
Affiliation(s)
- Amalia Ioanna Moula
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | - Iris Parrini
- Cardiology Department, Mauriziano Umberto I Hospital, 10128 Torino, Italy; (I.P.); (C.M.R.)
| | - Cecilia Tetta
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | - Fabiana Lucà
- Cardiology Department, Big Metropolitan Hospital, 89129 Reggio Calabria, Italy;
| | - Gianmarco Parise
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | | | - Emanuela Mauro
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | - Orlando Parise
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | - Francesco Matteucci
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
| | - Michele Massimo Gulizia
- Cardiology Department, Garibaldi Nesima Hospital, 95122 Catania, Italy;
- Heart Care Foundation, 50121 Firenze, Italy
| | - Mark La Meir
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
- Cardiothoracic Department, Brussels University Hospital, 1099 Jette, Belgium
| | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands; (A.I.M.); (C.T.); (G.P.); (E.M.); (O.P.); (F.M.); (M.L.M.)
- Cardiothoracic Department, Brussels University Hospital, 1099 Jette, Belgium
- Correspondence:
| |
Collapse
|
18
|
Tereshchenko SN, Uskach TM. Treatment strategies for patients with atrial fibrillation and chronic heart failure. TERAPEVT ARKH 2022; 93:1545-1550. [DOI: 10.26442/00403660.2021.12.201205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/16/2022] [Indexed: 11/22/2022]
Abstract
Atrial fibrillation (AF) is associated with significant morbidity and mortality and may lead to the development of chronic heart failure (CHF). Each condition predisposes to the other, requiring a careful choice of the treatment strategy. This article is devoted to the prevalence and prognostic implications of both diseases. The article presents data from meta-analyzes related to the management of this group of patients. The aspects of rhythm control strategy in AF and concomitant CHF are described according to the recent studies and clinical guidelines. The features of anticoagulant therapy in patients with AF and CHF are outlined. Much attention is given to the importance of the safety profile of the anticoagulant therapy in terms of the bleeding risk in patients with concomitant AF and CHF.
Collapse
|
19
|
Singkham N, Wongsalap Y, Poolpun D, Phetnoo S, Somkhon C. Utilization of Digoxin among Hospitalized Older Patients with Heart Failure and Atrial Fibrillation in Thailand: Prevalence, Associated Factors, and Clinical Outcomes. Ann Geriatr Med Res 2021; 25:260-268. [PMID: 34958732 PMCID: PMC8749041 DOI: 10.4235/agmr.21.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Digoxin is used to control heart rate in patients with heart failure (HF) and atrial fibrillation (AF). However, its use is often limited in older patients, as they are prone to digoxin toxicity. This study aimed to determine the prevalence of digoxin use, investigate the factors associated with digoxin use, and explore the association between digoxin use and clinical outcomes in older Thai patients with HF and AF. Methods This cross-sectional study used data obtained from an electronic medical records database. We performed logistic regression analysis to determine the prevalence of digoxin use at index discharge and the factors associated with its use. The Cox proportional hazard model was used to determine the association of all-cause mortality and HF rehospitalization with digoxin use. Results Of the 640 patients assessed, 107 (16.72%) were prescribed digoxin before discharge. The factors negatively associated with digoxin use included high serum creatinine level (adjusted odds ratio [AOR]=0.38; 95% confidence interval [CI], 0.22–0.65) and ischemic heart disease (IHD) (AOR=0.52; 95% CI, 0.30–0.88). The factors positively associated with digoxin use were the use of diuretics (AOR=2.65; 95% CI, 1.60–4.38) and mineralocorticoid receptor antagonists (MRAs) (AOR=2.24; 95% CI, 1.18–4.27). We observed no significant association between digoxin use and clinical outcomes (adjusted hazard ratio=1.00; 95% CI, 0.77–1.30). Conclusion Digoxin use was prevalent among older patients with HF and AF. Patients with high serum creatinine or IHD were less likely to be prescribed digoxin, whereas those using diuretics or MRAs were more likely to be prescribed digoxin. Although digoxin use was not uncommon among older patients, it was prescribed with caution among Thai patients hospitalized with HF and AF.
Collapse
Affiliation(s)
- Noppaket Singkham
- Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Unit of Excellence on Pharmacogenomic Pharmacokinetic and Pharmacotherapeutic Researches (UPPER), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Yuttana Wongsalap
- Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Unit of Excellence on Pharmacogenomic Pharmacokinetic and Pharmacotherapeutic Researches (UPPER), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | | | - Sirichok Phetnoo
- Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Chuthalak Somkhon
- Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| |
Collapse
|
20
|
Yan H, Du YX, Wu FQ, Lu XY, Chen RM, Zhang Y. Effects of nurse-led multidisciplinary team management on cardiovascular hospitalization and quality of life in patients with atrial fibrillation: Randomized controlled trial. Int J Nurs Stud 2021; 127:104159. [DOI: 10.1016/j.ijnurstu.2021.104159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
|
21
|
Liu T, Zhou Z, Bo K, Gao Y, Wang H, Wang R, Liu W, Chang S, Liu Y, Sun Y, Firmin D, Yang G, Dong J, Xu L. Association Between Left Ventricular Global Function Index and Outcomes in Patients With Dilated Cardiomyopathy. Front Cardiovasc Med 2021; 8:751907. [PMID: 34869657 PMCID: PMC8635067 DOI: 10.3389/fcvm.2021.751907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Left ventricular global function index (LVGFI) assessed using cardiac magnetic resonance (CMR) seems promising in the prediction of clinical outcomes. However, the role of the LVGFI is uncertain in patients with heart failure (HF) with dilated cardiomyopathy (DCM). To describe the association of LVGFI and outcomes in patients with DCM, it was hypothesized that LVGFI is associated with decreased major adverse cardiac events (MACEs) in patients with DCM. Materials and Methods: This prospective cohort study was conducted from January 2015 to April 2020 in consecutive patients with DCM who underwent CMR. The association between outcomes and LVGFI was assessed using a multivariable model adjusted with confounders. LVGFI was the primary exposure variable. The long-term outcome was a composite endpoint, including death or heart transplantation. Results: A total of 334 patients (mean age: 55 years) were included in this study. The average of CMR-LVGFI was 16.53%. Over a median follow-up of 565 days, 43 patients reached the composite endpoint. Kaplan-Meier analysis revealed that patients with LVGFI lower than the cutoff values (15.73%) had a higher estimated cumulative incidence of the endpoint compared to those with LVGFI higher than the cutoff values (P = 0.0021). The hazard of MACEs decreased by 38% for each 1 SD increase in LVGFI (hazard ratio 0.62[95%CI 0.43-0.91]) and after adjustment by 46% (HR 0.54 [95%CI 0.32-0.89]). The association was consistent across subgroup analyses. Conclusion: In this study, an increase in CMR-LVGFI was associated with decreasing the long-term risk of MACEs with DCM after adjustment for traditional confounders.
Collapse
Affiliation(s)
- Tong Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, Beijing, China,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kairui Bo
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yifeng Gao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, Beijing, China,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Sanshuai Chang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, Beijing, China,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Yuanyuan Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, Beijing, China,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Yuqing Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, Beijing, China,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - David Firmin
- Cardiovascular Research Centre, Royal Brompton Hospital, London, United Kingdom,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, London, United Kingdom,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, Beijing, China,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China,Jianzeng Dong
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China,*Correspondence: Lei Xu
| |
Collapse
|
22
|
Nji MAM, Solomon SD, Chen LY, Shah AM, Soliman EZ, Alam AB, Subramanya V, Alonso A. Association of heart failure subtypes and atrial fibrillation: Data from the Atherosclerosis Risk in Communities (ARIC) study. Int J Cardiol 2021; 339:47-53. [PMID: 34246724 PMCID: PMC8419094 DOI: 10.1016/j.ijcard.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 11/21/2022]
Abstract
AIMS To determine the prevalence and incidence of AF among HF subtypes in a biracial community-based cohort. METHODS We studied 6496 participants in the Atherosclerosis Risk in Community study (mean age, 75.8 ± 5.3, 59% women, 23% black) who attended the 2011-2013 visit. HF was identified from physician adjudicated diagnosis, hospital discharges, and self-report. HF subtypes were based on echocardiography. A left ventricular ejection fraction <40% represents HF with reduced ejection fraction (HFrEF), 40%-49% for HF with midrange ejection fraction (HFmEF), and ≥ 50% for HF with preserved ejection fraction (HFpEF). AF was ascertained through 2017 from study electrocardiograms, hospital discharges, and death certificates. Confounder-adjusted logistic regression and Cox models were used to estimate associations of HF subtype with prevalent and incident AF. RESULTS Among eligible participants, 393 had HF (HFpEF = 232, HFmEF = 41, HFrEF = 35 and unclassified HF = 85) and 735 had AF. Compared to those without HF, all HF subtypes were more likely to have prevalent AF [odds ratio (95% confidence interval (CI)) 7.4 (5.6-9.9) for HFpEF, 8.1 (4.3-15.3) for HFmEF, 10.0 (5.0-20.2) for HFrEF, 8.8 (5.6-14.0) for unclassified HF]. Among participants without AF at baseline (n = 5761), 610 of them developed AF. Prevalent HF was associated with increased risk of AF [hazard ratio (95%CI) 2.3 (1.6-3.2) for HFpEF, 5.0 (2.7-9.3) for HFmEF, 3.5 (1.7-7.6) for HFrEF, 1.9 (0.9-3.7) for unclassified HF]. CONCLUSION AF and HF frequently co-occur, with small differences by HF subtype, underscoring the importance of understanding the interplay of these two epidemics and evaluating shared preventive and therapeutic strategies.
Collapse
Affiliation(s)
- Miriam A M Nji
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Aniqa B Alam
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Vinita Subramanya
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| |
Collapse
|
23
|
Vîjan AE, Daha IC, Delcea C, Dan GA. Determinants of Prolonged Length of Hospital Stay of Patients with Atrial Fibrillation. J Clin Med 2021; 10:jcm10163715. [PMID: 34442009 PMCID: PMC8396858 DOI: 10.3390/jcm10163715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Aim: The increasing prevalence and high hospitalization rates make atrial fibrillation (AF) a significant healthcare strain. However, there are limited data regarding the length of hospital stay (LOS) of AF patients. Our purpose was to determine the main drivers of extended LOS of AF patients. Methods: All AF patients, hospitalized consecutively in a tertiary cardiology center, from January 2018 to February 2020 were included in this retrospective cohort study. Readmissions were excluded. Prolonged LOS was defined as more than seven days (the upper limit of the third quartile). Results: Our study included 949 AF patients, 52.9% females. The mean age was 72.5 ± 10.3 years. The median LOS was 4 days. A total of 28.7% had an extended LOS. Further, 82.9% patients had heart failure (HF). In multivariable analysis, the independent predictors of extended LOS were: acute coronary syndromes (ACS) (HR 4.60, 95% CI 1.66–12.69), infections (HR 2.61, 95% CI 1.44–3.23), NT-proBNP > 1986 ng/mL (HR 1.96, 95% CI 1.37–2.82), acute decompensated HF (ADHF) (HR 1.76, 95% CI 1.23–2.51), HF with reduced ejection fraction (HFrEF) (HR 1.69, 95% CI 1.15–2.47) and the HAS-BLED score (HR 1.42, 95% CI 1.14–1.78). Conclusion: ACS, ADHF, HFrEF, increased NT-proBNP levels, infections and elevated HAS-BLED were independent predictors of extended LOS, while specific clinical or therapeutical AF characteristics were not.
Collapse
Affiliation(s)
- Ancuța Elena Vîjan
- Internal Medicine and Cardiology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.E.V.); (I.C.D.); (G.-A.D.)
- Cardiology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Ioana Cristina Daha
- Internal Medicine and Cardiology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.E.V.); (I.C.D.); (G.-A.D.)
- Cardiology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Caterina Delcea
- Internal Medicine and Cardiology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.E.V.); (I.C.D.); (G.-A.D.)
- Cardiology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Correspondence:
| | - Gheorghe-Andrei Dan
- Internal Medicine and Cardiology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.E.V.); (I.C.D.); (G.-A.D.)
- Cardiology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| |
Collapse
|
24
|
Vinter N, Frost L, Benjamin EJ. Heart failure and atrial fibrillation - does heart failure subtype matter? Int J Cardiol 2021; 341:46-47. [PMID: 34371032 DOI: 10.1016/j.ijcard.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Nicklas Vinter
- Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Frost
- Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Emelia J Benjamin
- Department of Medicine, Boston University School of Medicine, MA, USA; Department of Epidemiology, Boston University School of Public Health, MA, USA
| |
Collapse
|
25
|
Gopinathannair R, Chen LY, Chung MK, Cornwell WK, Furie KL, Lakkireddy DR, Marrouche NF, Natale A, Olshansky B, Joglar JA. Managing Atrial Fibrillation in Patients With Heart Failure and Reduced Ejection Fraction: A Scientific Statement From the American Heart Association. Circ Arrhythm Electrophysiol 2021; 14:HAE0000000000000078. [PMID: 34129347 DOI: 10.1161/hae.0000000000000078] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation and heart failure with reduced ejection fraction are increasing in prevalence worldwide. Atrial fibrillation can precipitate and can be a consequence of heart failure with reduced ejection fraction and cardiomyopathy. Atrial fibrillation and heart failure, when present together, are associated with worse outcomes. Together, these 2 conditions increase the risk of stroke, requiring oral anticoagulation in many or left atrial appendage closure in some. Medical management for rate and rhythm control of atrial fibrillation in heart failure remain hampered by variable success, intolerance, and adverse effects. In multiple randomized clinical trials in recent years, catheter ablation for atrial fibrillation in patients with heart failure and reduced ejection fraction has shown superiority in improving survival, quality of life, and ventricular function and reducing heart failure hospitalizations compared with antiarrhythmic drugs and rate control therapies. This has resulted in a paradigm shift in management toward nonpharmacological rhythm control of atrial fibrillation in heart failure with reduced ejection fraction. The primary objective of this American Heart Association scientific statement is to review the available evidence on the epidemiology and pathophysiology of atrial fibrillation in relation to heart failure and to provide guidance on the latest advances in pharmacological and nonpharmacological management of atrial fibrillation in patients with heart failure and reduced ejection fraction. The writing committee's consensus on the implications for clinical practice, gaps in knowledge, and directions for future research are highlighted.
Collapse
|
26
|
Lin DW, Jiang F, Wu C, Li YG, Zhang X, Wang YS. Association of furosemide or hydrochlorothiazide use with risk of atrial fibrillation post pacemaker implantation among elderly patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:855. [PMID: 34164489 PMCID: PMC8184456 DOI: 10.21037/atm-21-1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Atrial fibrillation (AF) induced by artificial pacing is directly related to atrial remodeling. Previous basic research has shown that furosemide aggravates pathologic myocardial remodeling while hydrochlorothiazide alleviates it. However, whether furosemide or hydrochlorothiazide plays a role in developing AF after pacemaker implantation remains unknown. The study aims to investigate the association between oral furosemide or hydrochlorothiazide and the risk of developing AF after pacemaker implantation. Methods After a review of electronic medical records, elderly patients with pacemaker implantation and without a known baseline history of AF were included and information on their use of daily oral furosemide or hydrochlorothiazide was extracted. New incident AF cases were confirmed via the records of outpatient visits. A Cox proportional-hazards model was used to evaluate the association between daily oral furosemide or hydrochlorothiazide and risk of developing AF after pacemaker implantation, after adjustment for potential confounders. Results Among a total of 551 patients aged more than 65 years, 157 AF cases were identified after pacemaker implantation during a maximum follow up of 3.0±1.6 years. Of these, 242 had used furosemide and 97 had used hydrochlorothiazide therapy. Patients taking daily oral furosemide had a relatively higher risk of AF after pacemaker implantation [hazard ratio (HR): 1.507, 95% confidence interval (CI): 1.036–2.192; P=0.032] after being adjusted for related disease and prescribed medications, while oral taking of hydrochlorothiazide was shown to be a non-effective factor (HR: 0.666, 95% CI: 0.413–1.074), which had no statistical significance. Conclusions Daily oral furosemide might increase the risk of developing AF after pacemaker implantation in elderly patients, while hydrochlorothiazide has no detrimental effect.
Collapse
Affiliation(s)
- Da-Wei Lin
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Jiang
- Chongming Branch, Clinical Research & Innovation Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Wu
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Zhang
- Clinical Research & Innovation Unit, Xinhua Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yao-Sheng Wang
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research & Innovation Unit, Xinhua Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
27
|
Bakhai A, Petri H, Vahidnia F, Wolf C, Ding Y, Foskett N, Sculpher M. Real-world data on the incidence, mortality, and cost of ischaemic stroke and major bleeding events among non-valvular atrial fibrillation patients in England. J Eval Clin Pract 2021; 27:119-133. [PMID: 32314853 PMCID: PMC7891325 DOI: 10.1111/jep.13400] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 12/23/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Several novel oral anticoagulants (NOACs) are licensed for atrial fibrillation (AF) treatment in the United Kingdom. We describe the incidence and mortality from ischaemic stroke and major bleeding in non-valvular atrial fibrillation (NVAF) patients in England, including treatment patterns before/following introduction of NOACs, healthcare resource utilization (HRU), and costs post-onset of these events. METHOD Data were extracted from the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics secondary care and Office for National Statistics mortality data. RESULTS Of 42 966 patients with a first AF record between 2011 and 2016, 9143 patients (21.3%) remained without AF (antiplatelets/antithrombotics) treatment post-index diagnosis. The proportion of patients receiving aspirin for ≥3 months post-index declined during the study (50.6%-5.5%), irrespective of CHA2 DS2 -VASc score, while the proportion prescribed NOACs increased (2.0%-70.1%). Rates of ischaemic stroke per 1000 patient-years (95% CI) were 9.4 (3.8-15.0) with NOACs, 10.4 (8.0-12.9) with warfarin, 20.1 (16.4-23.8) with aspirin, 21.3 (5.3-37.2) with other antiplatelets and 43.6 (39.3-47.8) in patients without AF prescription. Major bleeding occurred at a similar rate with different treatments. All-cause mortality rates were 42.8 (31.4-54.3) with NOACs, 46.3 (41.1-51.5) with warfarin, 56.5 (50.5-62.4) with aspirin, 102.2 (76.2-128.3) with other antiplatelets and 412.8 (399.6-426.0) with no AF prescription. Mean annual National Health Service healthcare costs up to 1 year post-index were lowest in patients receiving aspirin plus other antiplatelets without an event (£6152), and highest in patients with an event without AF prescriptions (£17 957). By extrapolation, national AF HRU in the United Kingdom in 2016 was estimated at £8-16 billion annually. CONCLUSIONS These data provide temporal insights into AF treatment patterns and outcomes for NVAF patients in England and highlight the need to review higher stroke risk AF patients not receiving antiplatelet/antithrombotic prescriptions.
Collapse
Affiliation(s)
- Ameet Bakhai
- Royal Free London NHS Foundation Trust, Barnet General Hospital, Cardiology Department, Barnet, and Amore Health Ltd, London, UK
| | | | - Farnaz Vahidnia
- Real-World Data Group, Diagnostics Information Solutions, Pleasanton, California, USA
| | - Cyrill Wolf
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | | | | | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| |
Collapse
|
28
|
Identification of Circulating lncRNA Expression Profiles in Patients with Atrial Fibrillation. DISEASE MARKERS 2020; 2020:8872142. [PMID: 33299500 PMCID: PMC7704132 DOI: 10.1155/2020/8872142] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/24/2020] [Accepted: 10/30/2020] [Indexed: 12/13/2022]
Abstract
Purpose To investigate the expression profiles of long noncoding RNAs (lncRNAs) in patients with atrial fibrillation (AF). Methods The peripheral blood monocytes of a total of 20 patients with AF and 20 healthy subjects were collected for gene chip technology to detect differentially expressed lncRNAs from 2017.01 to 2017.08. Reverse transcription polymerase chain reaction (RT-PCR) was applied for further verification. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to identify the functions of differentially expressed genes and related pathways. Results There were 19 lncRNAs differentially expressed (FC ≥ 2, P < 0.05), of which 6 were upregulated and 13 were downregulated. Two of three upregulated lncRNAs (P = 0.014 and 0.006 for HNRNPU-AS1 and LINC00861, respectively) and two of three downregulated lncRNAs (P = 0.028 and 0.032 for RP11-443B7.3 and CTD-2616J11.14, respectively) were randomly confirmed by RT-PCR and showed a significantly different expression with the RNA-seq results. GO analysis showed that differentially expressed genes enriched in differentially expressed transcripts in biological process were mainly involved in metabolic process, catabolic process, and biosynthetic process. Differentially expressed transcripts in cellular component were mainly involved in nuclear lumen, organelle lumen, and cytoplasm. Differentially expressed transcripts in molecular function were mainly involved in protein binding, RNA binding, and molecular function. KEGG enrichment pathway analysis showed that some of the enrichment pathways associated with differentially expressed lncRNAs include calcium signaling pathway, NF-kappa B signaling pathway, cytokine-cytokine receptor interaction, and Toll-like receptor signaling pathway. HNRNPU-AS1 was the highest positive correlated lncRNA in the networks. Conclusions The expression of lncRNA in peripheral blood of AF patients is different from that of normal people. The physiological functions of these differentially expressed lncRNAs may be related to the pathogenesis of AF, which provide experimental basis and new therapeutic target for prognosis and treatment of patients with AF. HNRNPU-AS1 may play an important role in the pathophysiology and mechanisms of AF.
Collapse
|
29
|
Tsuji A, Masuda M, Asai M, Iida O, Okamoto S, Ishihara T, Nanto K, Kanda T, Tsujimura T, Matsuda Y, Okuno S, Hata Y, Mano T. Impact of the Temporal Relationship Between Atrial Fibrillation and Heart Failure on Prognosis After Ablation. Circ J 2020; 84:1467-1474. [PMID: 32684540 DOI: 10.1253/circj.cj-20-0191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The purpose of this study was to elucidate the effect of the temporal relationship between atrial fibrillation (AF) and heart failure (HF) on clinical outcomes after catheter ablation.Methods and Results:We included 129 consecutive patients with AF and HF who underwent catheter ablation in hospital from December 2014 to September 2017. The patients were divided into 2 groups based on the temporal relationship between AF and HF. Group 1 consisted of 42 patients with AF following HF while Group 2 consisted of 87 patients with AF preceding HF or those who developed both of them simultaneously at the timing of first visit to a doctor. The primary endpoint was a composite of death and hospitalization due to HF during a 2-year follow-up. AF recurrence was more common in Group 1 (45% vs. 23%; hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.25-4.94; P=0.009). Death and HF hospitalization were more frequent in Group 1 (19 [45%], 6 [7%] patients, respectively, P<0.0001). After adjustment for several covariates, patients in Group 1 were independently associated with poorer outcomes after AF ablation (HR, 8.66; 95% CI, 2.942-5.5; P<0.0001). CONCLUSIONS Adverse clinical outcomes of death, HF hospitalization and AF recurrence were more frequent in patients with AF following HF than in those with AF preceding HF.
Collapse
Affiliation(s)
- Aki Tsuji
- Division of Internal Medicine, Moriguchi Keijinkai Hospital
| | | | | | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Jin H, Zhu K, Wang L, Zhou W, Zhi H. Efficacy and safety of non-vitamin K anticoagulants and warfarin in patients with atrial fibrillation and heart failure: A network meta-analysis. Thromb Res 2020; 196:109-119. [PMID: 32861151 DOI: 10.1016/j.thromres.2020.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/28/2020] [Accepted: 08/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND To recommend the proper anticoagulant drug and its dose for patients with atrial fibrillation (AF) and heart failure (HF), we conducted a network meta-analysis (NMA) to make the comparisons among non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin with regard to efficacy (stroke or systemic embolism) and safety (major bleeding). METHODS We searched PubMed, EMBASE, Web of Science and Cochrane Library with the items: "dabigatran, edoxaban, apixaban, rivaroxaban, warfarin, atrial fibrillation and heart failure" through April 14, 2020, focusing on the RCTs comparing the effect of NOACs to warfarin in patients with AF and HF. The NMA was performed based on R (version3.5.1) recalling JAGS (version4.3.0) with gemtc package. Moreover, NetMetaXL (version1.6.1) and winBUGS (version1.4.3) were employed to obtain the cumulative ranking curve area (SUCRA) of the anticoagulants. RESULT There was a high probability that dabigatran150 (SUCRA 0.82) ranked the first for the most effective drug, followed by apixaban (SUCRA 0.81), edoxaban60 (SUCRA 0.57) and rivaroxaban (SUCRA 0.52). However, with respect to safety for preventing major bleeding, edoxaban30 (SUCRA 0.99) ranked as the safest drug, followed by apixaban (SUCRA 0.71), edoxaban 60 (SUCRA 0.59) and dabigatran150 (SUCRA 0.55). CONCLUSION Apixaban, edoxaban60 and dabigatran150 were more likely to become the choice for preventing stroke or systemic embolism and major bleeding in patients with AF and HF. Nevertheless, more trials need to be performed to focus on the effect of NOACs on the efficacy outcome due to the sparse data. In addition, caution should be excised over selecting the NOAC and its dose on account of the lacking head-to-head comparisons.
Collapse
Affiliation(s)
- Hao Jin
- School of Medicine, Southeast University, Nanjing 210009, China
| | - Kongbo Zhu
- Department of Cardiology, Affiliated ZhongDa Hospital of Southeast University (HZ), Nanjing 210009, China
| | - Lina Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Wangjuan Zhou
- School of Medicine, Southeast University, Nanjing 210009, China
| | - Hong Zhi
- Department of Cardiology, Affiliated ZhongDa Hospital of Southeast University (HZ), Nanjing 210009, China.
| |
Collapse
|
31
|
Extracellular vesicles in atrial fibrillation and stroke. Thromb Res 2020; 193:180-189. [PMID: 32717643 DOI: 10.1016/j.thromres.2020.07.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/08/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with a 5-fold increased risk of thromboembolic stroke. Extracellular vesicles (EVs) convey pathophysiological information and are possible biomarkers for risk of stroke. METHODS EVs were measured in 836 patients with AF (of which 280 were stroke cases) selected from the ARISTOTLE trial and in a cohort of unselected 70 year old individuals (n = 1007, reference material). EVs from platelets, leukocytes, erythrocytes and inflammatory endothelial cells were measured using flow cytometry and a solid-phase proximity ligation assay. RESULTS Concentrations of EVs were higher in the ARISTOTLE patients than in the PIVUS cohort for all the EV groups except EVs from endothelial cells (p < 0.0001). The distributions of the concentrations of the EVs were similar among the control group and the stroke cases for all of the sources of EVs in the ARISTOTLE study. EVs were modestly correlated with the levels of NT-ProBNP, Cystatin C, GDF-15 and D-dimer. Stronger correlations were found for platelet EVs as well as phosphatidyl serine positive EVs that were correlated with CD40 ligand in the ARISTOTLE study. Leukocyte EVs were correlated with IL-6 in both the ARISTOTLE and the PIVUS study, implicating them in different physiological processes. CONCLUSIONS Higher levels of EVs were found in anticoagulated patients with AF and a higher risk of stroke than in a general population of similar age, possibly due to the high disease burden in AF patients. Our data with EVs representing a broad repertoire of activated blood cells in AF patients suggest that EVs are likely not a key mediator of occurrence of stroke in this population.
Collapse
|
32
|
Maggioni AP, Dondi L, Andreotti F, Pedrini A, Calabria S, Ronconi G, Piccinni C, Martini N. Four-year trends in oral anticoagulant use and declining rates of ischemic stroke among 194,030 atrial fibrillation patients drawn from a sample of 12 million people. Am Heart J 2020; 220:12-19. [PMID: 31759279 DOI: 10.1016/j.ahj.2019.10.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/30/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Administrative data were used to investigate changes in hospitalizations for atrial fibrillation (AF), AF-related stroke, and treatment patterns between 2012 and 2016. METHODS From the 'Ricerca e Salute' database, a population- and patient-based repository involving >12 million inhabitants and linking demographics, prescriptions, and hospital discharge records, all patients discharged alive with a diagnosis of AF between 2012 and 2015 were followed for 1 year. RESULTS A total of 194,030 AF patients were included. The number of AF cases increased ~10% over time, from 4.0 per 1,000 inhabitants in 2012 to 4.4 per 1,000 in 2015. At 1 year, hospitalizations for ischemic stroke decreased from 21.3 per 1,000 patients with AF in 2012-2013 to 14.7 per 1,000 in 2015-2016 (-31%, 95% CI -18 to -41). Over the same period, oral anticoagulant (OAC) use increased from 56.7% to 64.4% (+14%, 95% CI +8 to +26), vitamin K antagonist use decreased (from 55.9 to 36.7%; -34%, 95% CI -21 to -44), whereas direct OACs (DOACs) increased (from <1% in 2012 to 27.7% in 2015). Antiplatelet prescriptions fell from 42.6% in 2012 to 28.1% in 2015. Hospitalizations for major bleeds, mainly gastrointestinal, increased from 1.5‰ in 2012-2013 to 2.3‰ in 2015-2016, whereas hemorrhagic stroke admissions decreased from 6.5‰ to 4.1‰. CONCLUSIONS There was a slight increase in the prevalence of AF between 2012 and 2015, whereas the overall use of antiplatelet agents decreased and that of OAC, particularly DOACs, increased. Over the same period, 1-year hospitalizations for ischemic stroke declined substantially, with a declining rate of hemorrhagic strokes.
Collapse
Affiliation(s)
- Aldo P Maggioni
- Fondazione ReS (Ricerca e Salute)-Research and Health Foundation, Rome, Italy; ANMCO Research Center, Florence, Italy.
| | - Letizia Dondi
- Fondazione ReS (Ricerca e Salute)-Research and Health Foundation, Rome, Italy
| | - Felicita Andreotti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Antonella Pedrini
- Fondazione ReS (Ricerca e Salute)-Research and Health Foundation, Rome, Italy
| | - Silvia Calabria
- Fondazione ReS (Ricerca e Salute)-Research and Health Foundation, Rome, Italy
| | - Giulia Ronconi
- Fondazione ReS (Ricerca e Salute)-Research and Health Foundation, Rome, Italy
| | - Carlo Piccinni
- Fondazione ReS (Ricerca e Salute)-Research and Health Foundation, Rome, Italy
| | - Nello Martini
- Fondazione ReS (Ricerca e Salute)-Research and Health Foundation, Rome, Italy
| |
Collapse
|
33
|
Coppini R, Santini L, Palandri C, Sartiani L, Cerbai E, Raimondi L. Pharmacological Inhibition of Serine Proteases to Reduce Cardiac Inflammation and Fibrosis in Atrial Fibrillation. Front Pharmacol 2019; 10:1420. [PMID: 31956307 PMCID: PMC6951407 DOI: 10.3389/fphar.2019.01420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/07/2019] [Indexed: 12/18/2022] Open
Abstract
Systemic inflammation correlates with an increased risk of atrial fibrillation (AF) and thrombogenesis. Systemic inflammation alters vessel permeability, allowing inflammatory and immune cell migration toward target organs, including the heart. Among inflammatory cells infiltrating the atria, macrophages and mast cell have recently attracted the interest of basic researchers due to the pathogenic mechanisms triggered by their activation. This chemotactic invasion is likely implicated in short- and long-term changes in cardiac cell-to-cell communication and in triggering fibrous tissue accumulation in the atrial myocardium and electrophysiological re-arrangements of atrial cardiomyocytes, thus favoring the onset and progression of AF. Serine proteases are a large and heterogeneous class of proteases involved in several processes that are important for cardiac function and are involved in cardiac diseases, such as (i) coagulation, (ii) fibrinolysis, (iii) extracellular matrix degradation, (iv) activation of receptors (i.e., protease-activated receptors [PPARs]), and (v) modulation of the activity of endogenous signals. The recognition of serine proteases substrates and their involvement in inflammatory/profibrotic mechanisms allowed the identification of novel cardio-protective mechanisms for commonly used drugs that inhibit serine proteases. The aim of this review is to summarize knowledge on the role of inflammation and fibrosis as determinants of AF. Moreover, we will recapitulate current findings on the role of serine proteases in the pathogenesis of AF and the possible beneficial effects of drugs inhibiting serine proteases in reducing the risk of AF through decrease of cardiac inflammation and fibrosis. These drugs include thrombin and factor Xa inhibitors (used as oral anticoagulants), dipeptidyl-peptidase 4 (DPP4) inhibitors, used for type-2 diabetes, as well as novel experimental inhibitors of mast cell chymases.
Collapse
Affiliation(s)
- Raffaele Coppini
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Lorenzo Santini
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Chiara Palandri
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Laura Sartiani
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Elisabetta Cerbai
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Laura Raimondi
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| |
Collapse
|
34
|
Feygina EE, Katrukha AG, Semenov AG. Neutral Endopeptidase (Neprilysin) in Therapy and Diagnostics: Yin and Yang. BIOCHEMISTRY (MOSCOW) 2019; 84:1346-1358. [PMID: 31760922 DOI: 10.1134/s0006297919110105] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Neprilysin (NEP) is a zinc-dependent metalloproteinase that exists in organisms in both transmembrane and soluble forms. NEP substrates are involved in regulating the cardiovascular and nervous systems. In this review, we discuss some of the biochemical characteristics and physiological functions of this enzyme with special emphasis on the use of NEP as a therapeutic target. The history and various physiological aspects of applying NEP inhibitors for treating heart failure and attempts to increase NEP activity when treating Alzheimer's disease using gene and cell therapies are described. Another important issue discussed is the role of NEP as a potential marker for predicting the risk of cardiovascular disease complications. The diagnostic and prognostic performance of soluble NEP in various types of heart failure is analyzed and presented. We also discuss the methods and approaches for measuring NEP activity for prognosis and diagnosis, as well as a possible new role of natriuretic peptides (NEP substrates) in cardiovascular diagnostics.
Collapse
Affiliation(s)
- E E Feygina
- HyTest Ltd., Turku, 20520, Finland. .,Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119991, Russia
| | - A G Katrukha
- HyTest Ltd., Turku, 20520, Finland.,Lomonosov Moscow State University, Faculty of Biology, Moscow, 119991, Russia
| | - A G Semenov
- HyTest Ltd., Turku, 20520, Finland.,Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119991, Russia
| |
Collapse
|