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Zakynthinos GE, Tsolaki V, Oikonomou E, Pantelidis P, Gialamas I, Kalogeras K, Zakynthinos E, Vavuranakis M, Siasos G. Unveiling the Role of Endothelial Dysfunction: A Possible Key to Enhancing Catheter Ablation Success in Atrial Fibrillation. Int J Mol Sci 2024; 25:2317. [PMID: 38396990 PMCID: PMC10889579 DOI: 10.3390/ijms25042317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Atrial fibrillation, a prevalent type of arrhythmia, is increasingly contributing to the economic burden on healthcare systems. The development of innovative treatments, notably catheter ablation, has demonstrated both impressive and promising outcomes. However, these treatments have not yet fully replaced pharmaceutical approaches, primarily due to the relatively high incidence of atrial fibrillation recurrence post-procedure. Recent insights into endothelial dysfunction have shed light on its role in both the onset and progression of atrial fibrillation. This emerging understanding suggests that endothelial function might significantly influence the effectiveness of catheter ablation. Consequently, a deeper exploration into endothelial dynamics could potentially elevate the status of catheter ablation, positioning it as a primary treatment option for atrial fibrillation.
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Affiliation(s)
- George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (E.Z.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Panteleimon Pantelidis
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Ioannis Gialamas
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (E.Z.)
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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The role of the blood-brain barrier during neurological disease and infection. Biochem Soc Trans 2023; 51:613-626. [PMID: 36929707 DOI: 10.1042/bst20220830] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023]
Abstract
A healthy brain is protected by the blood-brain barrier (BBB), which is formed by the endothelial cells that line brain capillaries. The BBB plays an extremely important role in supporting normal neuronal function by maintaining the homeostasis of the brain microenvironment and restricting pathogen and toxin entry to the brain. Dysfunction of this highly complex and regulated structure can be life threatening. BBB dysfunction is implicated in many neurological diseases such as stroke, Alzheimer's disease, multiple sclerosis, and brain infections. Among other mechanisms, inflammation and/or flow disturbances are major causes of BBB dysfunction in neurological infections and diseases. In particular, in ischaemic stroke, both inflammation and flow disturbances contribute to BBB disruption, leading to devastating consequences. While a transient or minor disruption to the barrier function could be tolerated, chronic or a total breach of the barrier can result in irreversible brain damage. It is worth noting that timing and extent of BBB disruption play an important role in the process of any repair of brain damage and treatment strategies. This review evaluates and summarises some of the latest research on the role of the BBB during neurological disease and infection with a focus on the effects of inflammation and flow disturbances on the BBB. The BBB's crucial role in protecting the brain is also the bottleneck in central nervous system drug development. Therefore, innovative strategies to carry therapeutics across the BBB and novel models to screen drugs, and to study the complex, overlapping mechanisms of BBB disruption are urgently needed.
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Watanabe K, Arimoto T, Watanabe T, Otaki Y, Murase T, Nakamura T, Kobayashi Y, Aono T, Saito Y, Koyama K, Hashimoto N, Kutsuzawa D, Kato S, Tamura H, Nishiyama S, Takahashi H, Watanabe M. Prognostic impact of plasma xanthine oxidoreductase activity in patients with heart failure with atrial fibrillation. J Cardiol 2023; 81:469-475. [PMID: 36822544 DOI: 10.1016/j.jjcc.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Xanthine oxidoreductase (XOR) is a rate-limiting enzyme for uric acid (UA) production and plays an important role in generating reactive oxygen species (ROS). Overproduction of ROS is reported to contribute to the pathophysiology of atrial fibrillation (AF), however, the prognostic impact of plasma XOR activity in patients with heart failure (HF) with AF is undetermined. METHODS We measured plasma XOR activity in 475 HF patients, including those with sinus rhythm (HF-SR, n = 211), and those with AF (HF-AF, n = 264). The type of AF included paroxysmal (n = 128) and persistent (n = 136) AF. All patients were prospectively followed up for a median period of 804 days. RESULTS HF-AF patients had significantly higher plasma XOR activity and serum UA levels compared with HF-SR patients. Both plasma XOR activity and serum UA levels were higher in patients with persistent AF than in those with SR and with paroxysmal AF. Multivariate linear regression analysis showed that persistent AF was independently associated with increased XOR activity. During the follow-up period, there were 79 major adverse cardiovascular events (MACEs). HF-AF patients with MACEs had higher plasma XOR activity compared with those without MACEs, while there were no significant differences in serum UA levels. Multivariate Cox proportional analysis showed that high XOR activity was an independent risk factor for MACEs after adjustment for confounding factors. Kaplan-Meier analysis revealed that the high XOR activity group had a higher risk of MACEs than the low XOR activity group. The prediction model was significantly improved by the addition of XOR activity to the basic predictors. CONCLUSIONS HF-AF patients had significantly higher plasma XOR activity compared with HF-SR patients. Plasma XOR activity proved to be a reliable indicator for MACEs in HF-AF patients.
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Affiliation(s)
- Ken Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takayo Murase
- Mie Research Laboratories, Sanwa Kagaku Kenkyusho Co., Ltd., Mie, Japan
| | - Takashi Nakamura
- Mie Research Laboratories, Sanwa Kagaku Kenkyusho Co., Ltd., Mie, Japan
| | - Yuta Kobayashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tomonori Aono
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Yuji Saito
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Kyoko Koyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Naoaki Hashimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Daisuke Kutsuzawa
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Shigehiko Kato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Satoshi Nishiyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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Afrăsânie I, Matei IT, Leancă SA, Chetran A, Costache AD, Afrăsânie VA, Dmour BA, Crișu D, Bădescu MC, Șerban LI, Costache II. Ischemia with Nonobstructive Coronary Artery Disease and Atrial Cardiomyopathy-Two Sides of the Same Story? Life (Basel) 2023; 13:life13020443. [PMID: 36836800 PMCID: PMC9963666 DOI: 10.3390/life13020443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Ischemia with nonobstructive coronary artery disease (INOCA) is increasingly recognized as a significant cause of angina, myocardial remodeling, and eventually heart failure (HF). Coronary microvascular dysfunction (CMD) is a major endotype of INOCA, and it is caused by structural and functional alterations of the coronary microcirculation. At the same time, atrial cardiomyopathy (ACM) defined by structural, functional, and electrical atrial remodeling has a major clinical impact due to its manifestations: atrial fibrillation (AF), atrial thrombosis, stroke, and HF symptoms. Both these pathologies share similar risk factors and have a high comorbidity burden. CMD causing INOCA and ACM frequently coexist. Thus, questions arise whether there is a potential link between these pathologies. Does CMD promote AF or the reverse? Which are the mechanisms that ultimately lead to CMD and ACM? Are both part of a systemic disease characterized by endothelial dysfunction? Lastly, which are the therapeutic strategies that can target endothelial dysfunction and improve the prognosis of patients with CMD and ACM? This review aims to address these questions by analyzing the existing body of evidence, offering further insight into the mechanisms of CMD and ACM, and discussing potential therapeutic strategies.
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Affiliation(s)
- Irina Afrăsânie
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Correspondence: (I.A.); (D.C.); Tel.: +40-76988633 (I.A. & D.C.)
| | - Iulian Theodor Matei
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Sabina Andreea Leancă
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Adriana Chetran
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iași, Romania
| | - Vlad-Adrian Afrăsânie
- Department of Medical Oncology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Oncology, The Regional Institute of Oncology, 700483 Iași, Romania
| | - Bianca-Ana Dmour
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Daniela Crișu
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Correspondence: (I.A.); (D.C.); Tel.: +40-76988633 (I.A. & D.C.)
| | - Minerva Codruța Bădescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Lăcrămioara Ionela Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Irina Iuliana Costache
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
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Arterial stiffness and atrial fibrillation: shared mechanisms, clinical implications and therapeutic options. J Hypertens 2022; 40:1639-1646. [PMID: 35943096 DOI: 10.1097/hjh.0000000000003223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Arterial stiffness (AS) and atrial fibrillation (AF) share commonalities in molecular and pathophysiological mechanisms and numerous studies have analyzed their reciprocal influence. The gold standard for AS diagnosis is represented by aortic pulse wave velocity, whose measurement can be affected by arrhythmias characterized by irregularities in heart rhythm, such as AF. Growing evidence show that patients with AS are at high risk of AF development. Moreover, the subset of AF patients with AS seems to be more symptomatic and rhythm control strategies are less effective in this population. Reducing AS through de-stiffening interventions may be beneficial for patients with AF and can be a new appealing target for the holistic approach of AF management. In this review, we discuss the association between AS and AF, with particular interest in shared mechanisms, clinical implications and therapeutic options.
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Black N, Mohammad F, Saraf K, Morris G. Endothelial function and atrial fibrillation: A missing piece of the puzzle? J Cardiovasc Electrophysiol 2021; 33:109-116. [PMID: 34674346 DOI: 10.1111/jce.15277] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/14/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022]
Abstract
Endothelial dysfunction, a term used to describe both the physical damage and dysregulated physiology of this endothelial lining, is an increasingly recognized pathophysiological state shared by many cardiovascular diseases. Historically, the role of endothelial dysfunction in atrial fibrillation (AF) was thought to be limited to mediating atrial thromboembolism. However, there is emerging evidence that endothelial dysfunction both promotes and maintains atrial arrhythmic substrate, predicts adverse outcomes, and identifies patients at high risk of recurrence following cardioversion and ablation therapy. Treatments targeted at improving endothelial function also represent a promising new therapeutic paradigm in AF. This review summarizes the current understanding of endothelial function in AF.
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Affiliation(s)
- Nicholas Black
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Fahad Mohammad
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Karan Saraf
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Gwilym Morris
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Manchester Heart Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
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Jang GW, Lee JM, Choi SW, Kim J, Lee YS, Kim HO, Chung H, Woo JS, Kim JB, Kim WS, Kim W. Vascular Protective Effects of New Oral Anticoagulants in Patients with Atrial Fibrillation. J Clin Med 2021; 10:jcm10194332. [PMID: 34640348 PMCID: PMC8509820 DOI: 10.3390/jcm10194332] [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: 07/21/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
This study was designed to determine the efficacy of a new oral anticoagulant (NOAC) therapy for the prevention of endothelial dysfunction and atherosclerosis progression in patients with atrial fibrillation (AF). Sixty-five AF patients with a CHA2DS2-VASc score ≥2 without previous history of cardiovascular disease were registered and randomly assigned to either an NOAC group (dabigatran or rivaroxaban) or the warfarin group. Reactive hyperemia peripheral arterial tonometry (RH-PAT) measurements reflecting endothelial function were taken using Endo-PAT2000. Carotid intima–media thickness (IMT) was measured at baseline, 12 months, and 24 months, and several biomarkers were also analyzed. For the primary end point, the reactive hyperemia index (RHI) for the NOAC group was 1.5 ± 0.4 and that for the warfarin group was 1.6 ± 0.5. The left and right carotid IMT was 0.7 mm in the NOAC groups and 0.8 mm in the warfarin group. At 12 months, RHI was 1.6 ± 0.3 for the dabigatran group, 1.6 ± 0.5 for the rivaroxaban group, and 1.6 ± 0.3 for the warfarin group. The three groups did not differ statistically with respect to change in left and right carotid IMT at 12 and 24 months, respectively. The biomarkers for endothelial function and atherosclerosis were not significantly different. There was a trend of reduced P-selectin levels in the NOAC group compared to the warfarin group. In patients with AF, there were no significant differences in the prevention of endothelial dysfunction and atherosclerosis progression between the NOAC and warfarin groups.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Weon Kim
- Correspondence: ; Tel.: +82-2-958-8167; Fax: +82-2-958-8160
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Kanazawa H, Kaikita K, Ito M, Kawahara Y, Hoshiyama T, Kanemaru Y, Kiyama T, Iwashita S, Tabata N, Yamanaga K, Fujisue K, Sueta D, Takashio S, Arima Y, Araki S, Usuku H, Nakamura T, Izumiya Y, Sakamoto K, Suzuki S, Yamamoto E, Soejima H, Matsushita K, Tsujita K. Improvement of Vascular Endothelial Function Reflects Nonrecurrence After Catheter Ablation for Atrial Fibrillation. J Am Heart Assoc 2021; 10:e021551. [PMID: 34423655 PMCID: PMC8649285 DOI: 10.1161/jaha.121.021551] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The clinical implication of vascular endothelial dysfunction in patients with atrial fibrillation (AF) remains unclear. This study aimed to elucidate the correlation between changes in vascular endothelial function assessed by reactive hyperemia-peripheral arterial tonometry and the effect of sinus rhythm restoration after catheter ablation (CA) for AF. Methods and Results Consecutive 214 patients who underwent CA for AF were included in this single center, retrospective study. The natural logarithmic transformed reactive hyperemia-peripheral arterial tonometry index (LnRHI) of all patients was measured before CA as well as 3 and 6 months after CA. LnRHI in sinus rhythm was significantly higher than that in AF before CA. Multivariate logistic regression analysis revealed that the presence of AF was an independent risk factor for lowering of LnRHI (odds ratio, 4.092; P=0.002) before CA. The LnRHI was significantly improved 3 and 6 months after CA in patients without AF recurrence. Multivariate Cox hazard analysis revealed that changes in LnRHI from before to 3 months after CA independently correlated with recurrence of AF (hazard ratio, 0.106; P=0.001). Receiver operating characteristic analysis showed the decrease in LnRHI levels from before to 3 months after CA as a significant marker that suspects AF recurrence (area under the curve, 0.792; log-rank test, P<0.001). Conclusions The presence of AF was independently correlated with the impaired vascular endothelial function assessed by the reactive hyperemia-peripheral arterial tonometry. Long-term sinus rhythm restoration after CA for AF might contribute to the improvement of vascular endothelial function, which may reflect the nonrecurrence of AF.
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Affiliation(s)
- Hisanori Kanazawa
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan.,Department of Cardiac Arrhythmias Kumamoto University Kumamoto Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Miwa Ito
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Yusei Kawahara
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Tadashi Hoshiyama
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan.,Department of Cardiac Arrhythmias Kumamoto University Kumamoto Japan
| | - Yusuke Kanemaru
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Takuya Kiyama
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Satomi Iwashita
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Noriaki Tabata
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Satoshi Araki
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Taishi Nakamura
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Satoru Suzuki
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Hirofumi Soejima
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
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Cui YK, Dong JZ, Du X, Hu R, He L, Jia CQ, Li X, Wu JH, Yu RH, Long DY, Ning M, Sang CH, Jiang CX, Bai R, Wen SN, Liu N, Li SN, Wang W, Guo XY, Zhao X, Zuo S, Chen X, Huang ST, Wu HS, Tang RB, Ma CS. Comparison of prognosis and outcomes of catheter ablation versus drug therapy in patients with atrial fibrillation and stable coronary artery disease: A prospective propensity-score matched cohort study. Clin Cardiol 2021; 44:1422-1431. [PMID: 34318505 PMCID: PMC8495083 DOI: 10.1002/clc.23699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/08/2022] Open
Abstract
Background Atrial fibrillation (AF) and stable coronary artery disease (SCAD) frequently coexist. Hypothesis To investigate the prognosis of catheter ablation versus drug therapy in patients with AF and SCAD. Methods In total, 25 512 patients with AF in the Chinese AF Registry between 2011 and 2019 were screened for SCAD. 815 patients with AF and SCAD underwent catheter ablation therapy were matched with patients by drug therapy in a 1:1 ratio. Primary end point was composite of thromboembolism, coronary events, major bleeding, and all‐cause death. The secondary endpoints were each component of the primary endpoint and AF recurrence. Results Over a median follow‐up of 45 ± 23 months, the patients in the catheter ablation group had a higher AF recurrence‐free rate (53.50% vs. 18.41%, p < .01). In multivariate analysis, there was no significant difference between the strategy of catheter ablation and drug therapy in primary composite end point (adjusted HR 074, 95%CI 0.54–1.002, p = .0519). However, catheter ablation was associated with fewer all‐cause death independently (adjusted HR 0.36, 95%CI 0.22–0.59, p < .01). In subgroup analysis, catheter ablation was an independent risk factor for all‐cause death in the high‐stroke risk group (adjusted HR 0.39, 95%CI 0.23–0.64, p < .01), not in the low‐medium risk group (adjusted HR 0.17, 95%CI 0.01–2.04, p = .17). Conclusions In the patients with AF and SCAD, catheter ablation was not independently associated with the primary composite endpoint compared with drug therapy. However, catheter ablation was an independent protective factor of all‐cause death
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Affiliation(s)
- Yi-Kai Cui
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Rong Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chang-Qi Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xu Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jia-Hui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Song-Nan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xuan Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Shu-Tao Huang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Hao-Sheng Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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10
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Qin S, Boidin M, Buckley BJR, Lip GYH, Thijssen DHJ. Endothelial dysfunction and vascular maladaptation in atrial fibrillation. Eur J Clin Invest 2021; 51:e13477. [PMID: 33452684 DOI: 10.1111/eci.13477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/14/2020] [Accepted: 12/19/2020] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and is associated with worsened morbidity and mortality. The prevalence of AF is estimated to increase with an ageing population resulting in an ever-increasing burden on the healthcare system. Despite improvements in AF treatment, several questions remain unanswered in relation to the development and progression of AF. In this review, we discuss the evidence supporting the presence of vascular dysfunction in the development of AF, but also as a final common pathway explaining why AF constitutes a markedly increased risk of cardiovascular morbidity and mortality. Specifically, we summarise the work performed in humans related to the impact of AF on vascular structure and function, and whether measures of vascular function predict AF progression and the development of cardiovascular events. Subsequently, we discuss the potential mechanisms linking AF to the development of vascular dysfunction. Finally, we propose future perspectives of vascular health and AF, advocating a strong focus on regular exercise training as a safe and effective strategy to improve vascular function and, hence, reduce the risk for development and progression of AF and its associated risk for cardiovascular events.
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Affiliation(s)
- Shuguang Qin
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University and University of Liverpool, Liverpool, UK.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,Institute of Sports and Exercise Biology, School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Maxime Boidin
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University and University of Liverpool, Liverpool, UK.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,Cardiovascular Prevention and Rehabilitation (EPIC) Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, School of Kinesiology and Exercise Science, Université de Montréal, Montreal, QC, Canada
| | - Benjamin J R Buckley
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University and University of Liverpool, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University and University of Liverpool, Liverpool, UK
| | - Dick H J Thijssen
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University and University of Liverpool, Liverpool, UK.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,Department of Physiology, Radboudumc, Nijmegen, The Netherlands
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11
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Akiyama Y, Matoba T, Katsuki S, Takase S, Nakashiro S, Nakano Y, Noma K, Tsutsui H. Comparison of Endothelial Dysfunction in Coronary Arteries with Bare Metal and 2 nd-Generation Drug-Eluting Stents. J Atheroscler Thromb 2021; 29:379-392. [PMID: 33612554 PMCID: PMC8894115 DOI: 10.5551/jat.61366] [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] [Indexed: 11/27/2022] Open
Abstract
Aims:
Previous studies suggested that implantation with a 1st-generation DES was associated with coronary endothelial dysfunction, which was associated with Rho-kinase activation. Second-generation drug-eluting stents (DESs) may preserve coronary endothelial function in stented coronary arteries; however, because of methodological limitations, further study is needed to clarify the association between 2
nd
-generation DESs and coronary endothelial dysfunction.
Methods:
We retrospectively analysed the CuVIC trial database, where we identified 112 patients who underwent coronary stenting in the left coronary arteries with either a bare metal stent (BMS,
n
=53) or 2
nd
-generation DES (
n
=59). We compared vasomotions of target vessels with stents and non-target vessels without stents. Furthermore, we measured the Rho-kinase activation detected in mononucleocytes from aortic and coronary sinus blood.
Results:
ACh-induced vasoconstrictive responses of target vessels were not enhanced with a 2
nd
-generation DES (45±21% vs. 44±20%,
P
=0.56, paired
t
-test), but significantly enhanced in the coronary arteries with a BMS (50±18% vs. 42±20%,
P
=0.002). Rho-kinase activation did not differ between patients with a BMS and 2
nd
-generation DES. In the target vessels with a BMS, large late lumen loss and acute coronary syndrome (ACS) at the index percutaneous coronary intervention (PCI) were associated with ACh-induced enhanced coronary vasoconstrictive responses.
Conclusions:
Evaluation of ACh-induced vasomotion of target vessels comparing with non-target vessels revealed that 2
nd
-generation DESs were not associated with coronary endothelial dysfunction in target vessels, nor activation of Rho-kinase in the coronary sinus blood 6-8 months after stenting.
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Affiliation(s)
- Yusuke Akiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Shunsuke Katsuki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Susumu Takase
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | - Yasuhiro Nakano
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
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12
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Ogurkova ON, Suslova TE, Batalov RE. Research of spontaneous and stimulated functional activity of platelets in patients with different types of atrial fibrillation. Klin Lab Diagn 2021; 66:35-41. [PMID: 33567171 DOI: 10.18821/0869-2084-2021-66-1-35-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Platelet function testing is widely used to diagnose disorders of the cellular link of hemostasis. The study of platelet aggregation activity is relevant for the prevention of thromboembolic complications in atrial fibrillation and monitoring the effectiveness and safety of therapy. In this study, a comparative analysis of spontaneous and stimulated platelet aggregation in groups of patients with two types of atrial fibrillation was performed - paroxysmal and persistent. The effect of β-adrenoblocker therapy on platelet aggregation activity in patients with atrial fibrillation was also studied. Platelet aggregation activity was studied using the method of G. Born in the modification of Z.A. Gabbasov on a two-channel laser analyzer "Biola". Collagen at a concentration of 2 mg / ml and adrenaline in a concentration range of 2.5-10 μg / ml were used as aggregation-promoting agents. It has been established that spontaneous aggregation potential and collagen-induced platelet aggregation depend on the type of atrial fibrillation, as well as on the presence or absence of β-blockers in therapy. The response of platelets to stimulation with adrenaline depends, first of all, on the type of atrial fibrillation and the concentration of adrenaline in the reaction medium. The most significant changes were noted in the group of patients with a paroxysmal form atrial fibrillation, taking β-blockers in therapy.
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Affiliation(s)
- O N Ogurkova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
| | - T E Suslova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
| | - R E Batalov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
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13
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Watts M, Kolluru GK, Dherange P, Pardue S, Si M, Shen X, Trosclair K, Glawe J, Al-Yafeai Z, Iqbal M, Pearson BH, Hamilton KA, Orr AW, Glasscock E, Kevil CG, Dominic P. Decreased bioavailability of hydrogen sulfide links vascular endothelium and atrial remodeling in atrial fibrillation. Redox Biol 2020; 38:101817. [PMID: 33310503 PMCID: PMC7732878 DOI: 10.1016/j.redox.2020.101817] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
Oxidative stress drives the pathogenesis of atrial fibrillation (AF), the most common arrhythmia. In the cardiovascular system, cystathionine γ-lyase (CSE) serves as the primary enzyme producing hydrogen sulfide (H2S), a mammalian gasotransmitter that reduces oxidative stress. Using a case control study design in patients with and without AF and a mouse model of CSE knockout (CSE-KO), we evaluated the role of H2S in the etiology of AF. Patients with AF (n = 51) had significantly reduced plasma acid labile sulfide levels compared to patients without AF (n = 65). In addition, patients with persistent AF (n = 25) showed lower plasma free sulfide levels compared to patients with paroxysmal AF (n = 26). Consistent with an important role for H2S in AF, CSE-KO mice had decreased atrial sulfide levels, increased atrial superoxide levels, and enhanced propensity for induced persistent AF compared to wild type (WT) mice. Rescuing H2S signaling in CSE-KO mice by Diallyl trisulfide (DATS) supplementation or reconstitution with endothelial cell specific CSE over-expression significantly reduced atrial superoxide, increased sulfide levels, and lowered AF inducibility. Lastly, low H2S levels in CSE KO mice was associated with atrial electrical remodeling including longer effective refractory periods, slower conduction velocity, increased myocyte calcium sparks, and increased myocyte action potential duration that were reversed by DATS supplementation or endothelial CSE overexpression. Our findings demonstrate an important role of CSE and H2S bioavailability in regulating electrical remodeling and susceptibility to AF.
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Affiliation(s)
- Megan Watts
- The Departments of Medicine, And Molecular and Cellular Physiology and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - Gopi K Kolluru
- The Departments of Pathology, Molecular and Cellular Physiology, Cellular Biology and Anatomy And Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - Parinita Dherange
- The Departments of Medicine, And Molecular and Cellular Physiology and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - Sibile Pardue
- The Departments of Pathology, Molecular and Cellular Physiology, Cellular Biology and Anatomy And Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - Man Si
- The Departments of Cellular Biology and Anatomy and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States; The Department of Biological Sciences, Southern Methodist University, Dallas, TX, USA
| | - Xinggui Shen
- The Departments of Pathology, Molecular and Cellular Physiology, Cellular Biology and Anatomy And Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - Krystle Trosclair
- The Departments of Cellular Biology and Anatomy and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States; The Department of Neurosurgery and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - John Glawe
- The Departments of Pathology, Molecular and Cellular Physiology, Cellular Biology and Anatomy And Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - Zaki Al-Yafeai
- The Departments of Pathology, Molecular and Cellular Physiology, Cellular Biology and Anatomy And Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - Mazen Iqbal
- The Departments of Medicine, And Molecular and Cellular Physiology and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - Brenna H Pearson
- The Departments of Pathology, Molecular and Cellular Physiology, Cellular Biology and Anatomy And Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - Kathryn A Hamilton
- The Departments of Cellular Biology and Anatomy and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - A Wayne Orr
- The Departments of Pathology, Molecular and Cellular Physiology, Cellular Biology and Anatomy And Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - Edward Glasscock
- The Departments of Cellular Biology and Anatomy and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States; The Department of Biological Sciences, Southern Methodist University, Dallas, TX, USA
| | - Christopher G Kevil
- The Departments of Pathology, Molecular and Cellular Physiology, Cellular Biology and Anatomy And Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States
| | - Paari Dominic
- The Departments of Medicine, And Molecular and Cellular Physiology and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Louisiana, United States.
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14
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Changes in 24-h ambulatory blood pressure following restoration of sinus rhythm in patients with atrial fibrillation. J Hypertens 2020; 39:243-249. [PMID: 32833921 DOI: 10.1097/hjh.0000000000002623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The interplay between atrial fibrillation and blood pressure (BP) is insufficiently studied. In symptomatic patients with persistent atrial fibrillation, electrical cardioversion (ECV) is often used to restore sinus rhythm. In this prospective study, we investigated how restoration of sinus rhythm affected 24-h ambulatory BP. METHODS Ninety-eight patients with persistent atrial fibrillation were examined with 24-h ambulatory BP monitoring before and approximately a week after ECV. RESULTS Sixty-two patients remained in sinus rhythm at the time of the second ambulatory BP monitoring (AF-SR group), whereas 36 patients had relapsed into atrial fibrillation (AF-AF group). In the AF-SR group, there was a significant increase in mean systolic 24-h BP (5.6 mmHg), a significant decrease in mean diastolic 24-h BP (-4.7 mmHg) and accordingly, a significant 25% (10.4 mmHg) increase in mean 24-h pulse pressure. CONCLUSION These findings may reflect the haemodynamic conditions that are prevalent in atrial fibrillation, ambulatory BP measurement bias in atrial fibrillation or a combination of both factors. From a clinical standpoint, our results suggest that an increased attention to BP is needed when sinus rhythm is restored, as underlying hypertension may be masked by BP changes during atrial fibrillation. From a general standpoint, it may be speculated that BP, as indicated by the relatively large difference in pulse pressure, may be inherently different in atrial fibrillation and may therefore not be interpretable in the equivalent manner as BP in sinus rhythm.
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15
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Improvement in renal and endothelial function after catheter ablation in patients with persistent atrial fibrillation. J Cardiol 2020; 76:610-617. [PMID: 32682629 DOI: 10.1016/j.jjcc.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cardiovascular events in patients with atrial fibrillation (AF) can be lowered by catheter ablation. We hypothesized the underlying mechanism was improvement in renal and endothelial function corresponding to AF burden, and investigated whether restoration of sinus rhythm (SR) after ablation affected these functions according to AF type. METHODS AND RESULTS We prospectively measured estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), and reactive hyperemia index (RHI) in 358 consecutive patients with AF before and 6 and 12 months after the ablation. For each AF type [paroxysmal AF (PAF), n = 229, and persistent AF (PeAF), n = 129], we evaluated changes in these markers and influence of chronic kidney disease (CKD). The eGFR and natural logarithm-transformed (ln) UACR improved at 6 months in the PeAF group (68.7 ± 18.7-71.8 ± 18.9 mL/min/1.73 m2, p = 0.003 and 3.1±1.6 to 2.8±1.5, p < 0.001, respectively) and remained unchanged in the PAF group. Among the PeAF patients, recurrent AF was identified in 41, but only transiently in 38 patients. PeAF at baseline independently predicted increased eGFR [odds ratio (OR)=2.13, 95 % confidence interval (CI) 1.35-3.40, p = 0.001] and decreased UACR (OR=1.94, 95 % CI 1.05-3.58, p = 0.033). In the PeAF patients with CKD, ln-RHI significantly increased at 6 months after the ablation, and the change (Δ) in ln-RHI was significantly correlated with the ΔeGFR (r=0.35, p = 0.03). CONCLUSIONS SR restoration after ablation was associated with an improved eGFR and UACR in PeAF patients, but not PAF patients. In PeAF patients with CKD, an improved endothelial function after ablation was associated with an improved renal function.
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16
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Arginine derivatives in atrial fibrillation progression phenotypes. J Mol Med (Berl) 2020; 98:999-1008. [PMID: 32504111 PMCID: PMC8556202 DOI: 10.1007/s00109-020-01932-9] [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: 03/02/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
Arginine, homoarginine (hArg), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) affect nitric oxide metabolism and altered concentrations are associated with cardiovascular morbidity and mortality. We analyzed these metabolites using liquid chromatography-tandem mass spectrometry in patients with atrial fibrillation (AF) (n = 241) with a focus on heart rhythm at blood withdrawal, AF progression phenotypes, and successful sinus rhythm (SR) restoration (n = 22). AF progression phenotypes were defined as paroxysmal AF with/without low voltage areas (LVA) and persistent AF with/without LVA. While arginine, ADMA, and hArg were within reference limits for healthy controls, SDMA was higher in the AF cohort (0.57 ± 0.12 vs. 0.53 μmol/L (97.5th percentile in reference cohort)). SR restoration in AF patients resulted in normalization of SDMA concentrations (0.465 ± 0.082 vs. 0.570 ± 0.134 μmol/L at baseline, p < 0.001). Patients with AF at the time of blood sampling had significantly lower hArg (1.65 ± 0.51 vs. 1.85 ± 0.60 μmol/L, p = 0.006) and higher ADMA concentrations (0.526 ± 0.08 vs. 0.477 ± 0.08 μmol/L, p < 0.001) compared with AF patients in SR. hArg concentrations were lower in patients with advanced AF progression phenotypes (persistent AF with LVA (p = 0.046)) independent of heart rhythm at blood sampling. Summarizing, arginine metabolism imbalance is associated with AF in general and AF progression and may contribute to associated risk. KEY MESSAGES: • Heart rhythm at blood withdrawal affects ADMA and hArg level in AF patients. • SDMA is higher in AF patients. • SDMA levels normalize after sinus rhythm restoration. • hArg levels decrease in advanced AF progression phenotypes.
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17
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Abstract
Atrial fibrillation (AF) is the most common heart arrhythmia and is associated with poor outcomes. The adverse effects of AF are mediated through multiple pathways, including endothelial dysfunction, as measured by flow-mediated dilatation. Flow-mediated dilatation has demonstrated endothelial dysfunction in several conditions and is associated with poor outcomes including mortality, yet can be improved with medical therapy. It is thus a useful tool in assessing endothelial function in patients. Endothelial dysfunction is present in patients with AF and is associated with poor outcomes. These patients are generally older and have other co-morbidities such as hypertension, hypercholesterolaemia and diabetes. The precise process by which AF is affiliated with endothelial damage/dysfunction remains elusive. This review explores the endothelial structure, its physiology and how it is affected in patients with AF. It also assesses the utility of flow mediated dilatation as a technique to assess endothelial function in patients with AF. Key MessagesEndothelial function is affected in patients with atrial fibrillation as with other cardiovascular conditions.Endothelial dysfunction is associated with poor outcomes such as stroke, myocardial infarction and death, yet is a reversible condition.Flow-mediated dilatation is a reliable tool to assess endothelial function in patients with atrial fibrillation.Patients with atrial fibrillation should be considered for endothelial function assessment and attempts made to reverse this condition.
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Affiliation(s)
- Ahsan A Khan
- College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Graham N Thomas
- College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gregory Y H Lip
- Faculty of Health and Life Sciences, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Alena Shantsila
- Faculty of Health and Life Sciences, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
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18
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Namino F, Yamakuchi M, Iriki Y, Okui H, Ichiki H, Maenosono R, Oketani N, Masamoto I, Miyata M, Horiuchi M, Hashiguchi T, Ohishi M, Maruyama I. Dynamics of Soluble Thrombomodulin and Circulating miRNAs in Patients with Atrial Fibrillation Undergoing Radiofrequency Catheter Ablation. Clin Appl Thromb Hemost 2019; 25:1076029619851570. [PMID: 31140290 PMCID: PMC6714917 DOI: 10.1177/1076029619851570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the world and has a high risk of thromboembolism. The most effective approach, catheter ablation, requires evaluation by electrocardiography. The aim of our study was to investigate novel clinical markers that predict restoration of sinus rhythm (SR) after catheter ablation. Seventy-eight consecutive patients with AF underwent catheter ablation and were separated into 2 groups: restored SR and recurrent AF. The levels of 4 blood proteins (serum or plasma) and 3 mature microRNAs (miRNAs) and their primary miRNAs (pri-miRNAs) in serum were measured before and after ablation, and the associations between each parameter were analyzed statistically. Soluble thrombomodulin (s-TM) and plasminogen activator inhibitor-1 (PAI-1) levels increased above baseline after ablation in both the restored SR (s-TM 11.55 [2.92] vs 13.75 [3.38], P < .001; PAI-1 25.74 [15.25] vs 37.79 [19.56], P < .001) and recurrent AF (s-TM 10.28 [2.78] vs 11.67 [3.37], P < .001; PAI-1 26.16 [15.70] vs 40.74 [22.55], P < .001) groups. Levels of C-reactive protein and asymmetric dimethylarginine were not significantly changed. Pri-miR-126 levels significantly decreased after ablation in the recurrent AF group, but the other miRNAs and pri-miRNAs did not. The measurement of s-TM and pri-miR-126 in blood was a useful tool to reflect the condition of AF patients with catheter ablation.
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Affiliation(s)
- Fuminori Namino
- 1 Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan.,2 Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Munekazu Yamakuchi
- 1 Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan.,2 Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasuhisa Iriki
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hideki Okui
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hitoshi Ichiki
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryuichi Maenosono
- 1 Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan
| | - Naoya Oketani
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Izumi Masamoto
- 1 Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan
| | - Masaaki Miyata
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Masahisa Horiuchi
- 4 Department of Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Teruto Hashiguchi
- 1 Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan.,2 Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Ohishi
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ikuro Maruyama
- 5 Department of Systems Biology in Thromboregulation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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19
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Kobayashi H, Okada A, Tabata H, Shoin W, Okano T, Yoshie K, Oguchi Y, Kato K, Shoda M, Kuwahara K. Association between reactive hyperemia peripheral arterial tonometry index and atrial fibrillation recurrence after catheter ablation. IJC HEART & VASCULATURE 2019; 24:100385. [PMID: 31289745 PMCID: PMC6593202 DOI: 10.1016/j.ijcha.2019.100385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/18/2022]
Abstract
Background Vascular endothelial function has recently been recognized as an independent predictor of cardiovascular events. However, studies investigating its association with atrial fibrillation (AF) are lacking. This study aimed to examine association with AF recurrence and vascular endothelial function as assessed using natural logarithmic transformation of reactive hyperemia peripheral arterial tonometry index (LnRHI). Methods Ninety-nine consecutive AF patients who underwent catheter ablation (CA) at Shinshu University Hospital between September 2015 and April 2017 were enrolled. LnRHI was measured 48 to 72 h before CA using the EndoPAT system. The primary outcome was AF recurrence beyond 3 months post-ablation. Results A total of 30 (30.3%) patients experienced AF recurrence after CA over a median follow-up period of 210 days (range: 93–764 days). Female sex and low LnRHI were significantly associated with AF recurrence. In multivariate analysis, LnRHI was an independent predictor of AF recurrence (hazard ratio: 0.087, 95% confidence interval 0.015–0.51, p = 0.007). In comparison in Kaplan-Meier analysis of high LnRHI (LnRHI ≥0.52, n = 52) and low LnRHI (LnRHI ≪0.52, n = 47) groups, AF recurrence rate was significantly higher in the low LnRHI group (log-rank test, p = 0.043). A negative correlation was observed between LnRHI and AF duration, whereby LnRHI was significantly decreased when the duration of AF events exceeded 1 year. Conclusion Decreased LnRHI was associated with AF recurrence after CA and prolonged AF duration.
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Affiliation(s)
- Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Yasutaka Oguchi
- Department of Cardiovascular Medicine, Aizawa Hospital, Nagano, Japan
| | - Ken Kato
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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Noninvasive peripheral vascular function and atrial fibrillation in the general population. J Hypertens 2019; 37:928-934. [DOI: 10.1097/hjh.0000000000002000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Olbers J, Jacobson E, Viberg F, Witt N, Ljungman P, Rosenqvist M, Östergren J. Systolic blood pressure increases in patients with atrial fibrillation regaining sinus rhythm after electrical cardioversion. J Clin Hypertens (Greenwich) 2019; 21:363-368. [DOI: 10.1111/jch.13496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/03/2018] [Accepted: 12/14/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Joakim Olbers
- Department of Clinical Science and Education, Cardiology Unit Södersjukhuset, Karolinska Institutet Stockholm Sweden
| | - Ellen Jacobson
- Department of Medicine, Clinical Medicine Unit, Functional Area of Emergency Medicine at Karolinska University Hospital Karolinska Institutet Solna Sweden
| | - Fredrik Viberg
- Department of Medicine, Clinical Medicine Unit, Functional Area of Emergency Medicine at Karolinska University Hospital Karolinska Institutet Solna Sweden
| | - Nils Witt
- Department of Clinical Science and Education, Cardiology Unit Södersjukhuset, Karolinska Institutet Stockholm Sweden
| | - Petter Ljungman
- Department of Clinical Sciences, Danderyd University Hospital Karolinska Institutet StockholmSweden
| | - Mårten Rosenqvist
- Department of Clinical Sciences, Danderyd University Hospital Karolinska Institutet StockholmSweden
| | - Jan Östergren
- Department of Medicine, Clinical Medicine Unit, Functional Area of Emergency Medicine at Karolinska University Hospital Karolinska Institutet Solna Sweden
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Podzolkov VI, Tarzimanova AI. Endothelial function changes in paroxysmal atrial fibrillation and treatment with propafenone. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-4-40-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To evaluate the changes of endothelial function in arterial hypertension (AH) patients with paroxysmal atrial fibrillation (AF) in treatment with propafenone (Propanorm, PRO.MED.CS Praha a. s.) in comparison with bisoprolol.Material and methods. To the study, 62 AH patients included with paroxysmal AH, age 45-63 y. o. (mean age 54,5±3,7 y. o.). Patients were randomized to 2 groups: 32 of group 1 (main) for rhythm-control were taking propafenone (Propanorm, PRO.MED.CS Praha a. s.) 450 mg daily, and 30 of group 2 (comparison) were taking bisoprolol for rate control. The groups were comparable by gender, age, severity of AH and duration of arrhythmia. Changes in endothelium vascular motion function and biochemical markers of endothelial dysfunction were assessed at inclusion and in 12 months of therapy.Results. Sinus rhythm retention in propafenone group facilitated the improvement of vascular motion function of endothelium — endothelium dependent vasodilatation of brachial artery showed tendency to rise significantly from 5,4±0,3% to 6,9±0,1% (р=0,01). In patients taking bisoprolol for pulse reduction during 12 months, there was negative tendency from 4,8±0,2% to 3,6±0,1% (р=0,003), that points on worsening of endothelial function with persistent AF. Repeat measurement of biochemical markers of endothelial dysfunction revealed that in 12 months there is raise of endothelin concentration in both groups. Value of the collagen-binding activeness of von Willebrand factor in 12 months significantly reduced from 131±12 to 118±6 U/dL (р<0,05) in those retaining sinus rhythm with propafenone, and increased from 135±11 U/dL to 147±12 U/dL in those with rate control by bisoprolol.Conclusion. In AH patients with paroxysmal AF retention of sinus rhythm with propafenone facilitated the improvement of vascular motion function of endothelium and decrease of collagen binding activeness of von Willebrand factor.
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Affiliation(s)
- V. I. Podzolkov
- First Sechenov Moscow State Medical University of the Ministry of Health (the Sechenov University)
| | - A. I. Tarzimanova
- First Sechenov Moscow State Medical University of the Ministry of Health (the Sechenov University)
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Okawa K, Miyoshi T, Tsukuda S, Hara S, Matsuo N, Nishibe N, Sogo M, Okada T, Nosaka K, Sakane K, Doi M, Morita H, Ito H. Differences in endothelial dysfunction induced by paroxysmal and persistent atrial fibrillation: Insights from restoration of sinus rhythm by catheter ablation. Int J Cardiol 2017; 244:180-185. [DOI: 10.1016/j.ijcard.2017.06.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/24/2017] [Accepted: 06/09/2017] [Indexed: 11/25/2022]
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Hansen AS, Butt JH, Holm-Yildiz S, Karlsson W, Kruuse C. Validation of Repeated Endothelial Function Measurements Using EndoPAT in Stroke. Front Neurol 2017; 8:178. [PMID: 28515707 PMCID: PMC5413501 DOI: 10.3389/fneur.2017.00178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/13/2017] [Indexed: 01/22/2023] Open
Abstract
Background Decreased endothelial function (EF) may be a prognostic marker for stroke. Measuring pharmacological effects on EF may be of interest in the development of personalized medicine for stroke prevention. In this study, we assessed the reliability of repeated EF measurements using a pulse amplitude tonometry technology in acute stroke patients. Similarly, reliability was tested in healthy subjects devoid of vascular disease to estimate reactivity and reliability in a younger non-stroke population. Materials and methods EF was assessed using the EndoPAT2000 in 20 healthy volunteers (men 50%, mean age 35.85 ± 3.47 years) and 21 stroke patients (men 52%, mean age 66.38 ± 2.85 years, and mean NIHSS 4.09 ± 0.53) under standardized conditions. EF was measured as the reactive hyperemia index (RHI), logarithm of RHI (lnRHI), and Framingham RHI (fRHI). Measurements were separated by 1.5 and 24 h to assess same-day and day-to-day reliability, respectively. Results Fair to moderate correlations of measurements [intraclass correlation coefficient (ICC)same-day 0.29 and ICCday-to-day 0.52] were detected in healthy subjects. In stroke patients, we found moderate to substantial correlation of both same-day and day-to-day repeated measurements (ICCsame-day 0.40 and ICCday-to-day 0.62). fRHI compared with RHI and lnRHI showed best reliability. Conclusion Repeated measurements of fRHI in stroke patients show moderate reliability on same-day and substantial on day-to-day measurements. Likewise, in healthy subjects there was substantial reliability on day-to-day measurement, but only moderate on same-day measurements. In general, day-to-day correlation of repeated EF measurements was far better than that of same-day measurements, which ranged from poor to moderate depending on the specific outcome measure of EF. A possible carryover effect should be considered if same-day repeated testing of drug effects is applied in future studies.
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Affiliation(s)
- Aina S Hansen
- Department of Neurology, Stroke Unit, Neurovascular Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Jawad H Butt
- Department of Neurology, Stroke Unit, Neurovascular Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Sonja Holm-Yildiz
- Department of Neurology, Stroke Unit, Neurovascular Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - William Karlsson
- Department of Neurology, Stroke Unit, Neurovascular Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Christina Kruuse
- Department of Neurology, Stroke Unit, Neurovascular Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
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Yoshimura A, Iriki Y, Ichiki H, Oketani N, Okui H, Maenosono R, Namino F, Miyata M, Ohishi M. Evaluation of safety and efficacy of periprocedural use of rivaroxaban and apixaban in catheter ablation for atrial fibrillation. J Cardiol 2017; 69:228-235. [DOI: 10.1016/j.jjcc.2016.03.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/16/2016] [Accepted: 03/30/2016] [Indexed: 11/15/2022]
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Matsuzawa Y, Suleiman M, Guddeti RR, Kwon TG, Monahan KH, Lerman LO, Friedman PA, Lerman A. Age-Dependent Predictive Value of Endothelial Dysfunction for Arrhythmia Recurrence Following Pulmonary Vein Isolation. J Am Heart Assoc 2016; 5:JAHA.115.003183. [PMID: 27613771 PMCID: PMC5079006 DOI: 10.1161/jaha.115.003183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The mechanisms of atrial fibrillation (AF) are highly divergent. The prevalence of AF increases significantly with age, and underling mechanisms might vary with age. Endothelial dysfunction may be associated with AF and atrial arrhythmia recurrence after catheter ablation. We tested the hypothesis that the impact of endothelial dysfunction on arrhythmia recurrence following catheter ablation is age dependent. Methods and Results This study enrolled 92 participants with AF undergoing catheter ablation. Endothelial function was assessed by peripheral arterial tonometry before ablation, and the natural logarithmic transformation of reactive hyperemia index was calculated. Endothelial dysfunction was defined as a natural logarithmic transformation of reactive hyperemia index <0.618 (median). Participants were followed for atrial tachycardia, flutter, and fibrillation recurrence for a median of 14 months. The mean age was 57±10 years. There was significant interaction between age and endothelial dysfunction in association with recurrence of AF (P=0.029) and any atrial arrhythmia (P=0.015), and the risk associated with endothelial dysfunction for arrhythmia recurrence was higher in younger versus older participants. Participants were divided into 2 age groups at a threshold of 60 years. Among participants aged ≤60 years, multivariate Cox proportional hazards analysis revealed the independent association between endothelial dysfunction and increased risk of arrhythmia recurrence (hazard ratio for AF 4.18 [95% CI 1.33–15.82], P=0.014, and for any atrial arrhythmia 3.62 [95% CI 1.29–11.81], P=0.014). Kaplan–Meier analysis showed that participants with endothelial dysfunction had significantly higher rates of recurrence of AF (P=0.01) and any atrial arrhythmia (P=0.002). Conclusions The risk associated with endothelial dysfunction for arrhythmia recurrence following catheter ablation was age dependent and was higher in younger participants.
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Affiliation(s)
| | | | | | - Taek-Geun Kwon
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Kim JB, Joung HJ, Lee JM, Woo JS, Kim WS, Kim KS, Lee KH, Kim W. Evaluation of the vascular protective effects of new oral anticoagulants in high-risk patients with atrial fibrillation (PREFER-AF): study protocol for a randomized controlled trial. Trials 2016; 17:422. [PMID: 27558002 PMCID: PMC4997652 DOI: 10.1186/s13063-016-1541-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/05/2016] [Indexed: 12/22/2022] Open
Abstract
Background Atrial fibrillation (AF) is known to be associated with several pathophysiological mechanisms including endothelial dysfunction of the heart and arterial vessels. Recent evidence suggests that new oral anticoagulant (NOAC) treatment may improve endothelial function and the inflammatory process involved in atherosclerosis in AF patients. This study is designed to determine the efficacy of NOAC therapy in the prevention of endothelial dysfunction and the progression of atherosclerosis of AF subjects. Method/design AF patients with a CHA2DS2-VASc score >2 and no previous history of overt coronary disease, severe peripheral arterial disease (PAD) or major stroke will be registered and randomly assigned either to the NOAC group (dabigatran or rivaroxaban) or the warfarin group in this prospective, randomized, 2-year follow-up study. Reactive hyperemia peripheral arterial tonometry (RH-PAT) measurements reflecting endothelial function will be conducted using the Endo-PAT2000 device. Left and right carotid intima-media thickness (IMT) will be measured at baseline, 12 months, and 24 months. The primary endpoint is defined as change in Reactive Hyperemia Index (RHI) at 12 months. Secondary endpoints included changes in the right and left maximum IMT of the common carotid artery (CCA) and internal carotid artery (ICA), the mean IMT of the CCA and ICA at 24 months, and 24-month cardiovascular events including cardiac death, stroke, acute myocardial infarction (AMI), overall cause of death, withdrawal of drug, or bleeding events. Discussion This is the first study to evaluate the efficacy of NOAC therapy for the prevention of endothelial dysfunction and progression of atherosclerosis in AF subjects. These findings are expected to expand the knowledge of NOAC pleotropic action in AF patients. Trial registration ClinicalTrials.gov: NCT02544932, registered on 7 September 2015.
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Affiliation(s)
- Jin-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Hyun Jun Joung
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Jung Myung Lee
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Jong Shin Woo
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Woo-Shik Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Kwon Sam Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Kyung Hye Lee
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Weon Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea.
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Procter NE, Stewart S, Horowitz JD. New-onset atrial fibrillation and thromboembolic risk: Cardiovascular syzygy? Heart Rhythm 2016; 13:1355-61. [DOI: 10.1016/j.hrthm.2015.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Indexed: 11/25/2022]
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Platelet Reactivity Is Independent of Left Atrial Wall Deformation in Patients with Atrial Fibrillation. Mediators Inflamm 2016; 2016:9754808. [PMID: 27069318 PMCID: PMC4812391 DOI: 10.1155/2016/9754808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/11/2016] [Accepted: 02/22/2016] [Indexed: 11/18/2022] Open
Abstract
It has been documented recently that left atrial (LA) deformation in AF patients (while in AF) is predictive of subsequent stroke risk. Additionally, diminished LA deformation during AF correlates with the presence of LA blood stasis. Given that endothelial function is dependent on laminar blood flow, the present study sought to investigate the effect of diminished LA deformation (during AF) on platelet reactivity and inflammation in AF patients. Patients (n = 17) hospitalised with AF underwent echocardiography (while in AF) for determination of peak positive LA strain (LASp). Whole blood impedance aggregometry was used to measure extent of ADP-induced aggregation and subsequent inhibitory response to the nitric oxide (NO) donor, sodium nitroprusside. Platelet thioredoxin-interacting protein (Txnip) content was determined by immunohistochemistry. LASp tended (p = 0.078) to vary inversely with CHA2DS2VASc scores. However, mediators of inflammation (C-reactive protein, Txnip) did not correlate significantly with LASp nor did extent of ADP-induced platelet aggregation or platelet NO response. These results suggest that the thrombogenic risk associated with LA stasis is independent of secondary effects on platelet aggregability or inflammation.
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Fujii A, Inoue K, Nagai T, Uetani T, Nishimura K, Suzuki J, Funada JI, Okura T, Higaki J, Ogimoto A. Clinical Significance of Peripheral Endothelial Function for Left Atrial Blood Stagnation in Nonvalvular Atrial Fibrillation Patients With Low-to-Intermediate Stroke Risk. Circ J 2016; 80:2117-23. [DOI: 10.1253/circj.cj-16-0176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akira Fujii
- Department of Cardiology, Pulmology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Katsuji Inoue
- Department of Cardiology, Pulmology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Takayuki Nagai
- Department of Cardiology, Pulmology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Kazuhisa Nishimura
- Department of Cardiology, Pulmology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Jun Suzuki
- Department of Cardiology, Pulmology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Jun-ichi Funada
- Department of Cardiology, National Hospital Organization, Ehime Medical Center
| | - Takafumi Okura
- Department of Cardiology, Pulmology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Jitsuo Higaki
- Department of Cardiology, Pulmology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Akiyoshi Ogimoto
- Department of Cardiology, Pulmology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
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Namba S, Yamaoka-Tojo M, Hashikata T, Ikeda Y, Kitasato L, Hashimoto T, Shimohama T, Tojo T, Takahira N, Masuda T, Ako J. Long-term warfarin therapy and biomarkers for osteoporosis and atherosclerosis. BBA CLINICAL 2015; 4:76-80. [PMID: 26674156 PMCID: PMC4661704 DOI: 10.1016/j.bbacli.2015.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/01/2015] [Accepted: 08/06/2015] [Indexed: 02/09/2023]
Abstract
Background Stroke prevention by warfarin, a vitamin K antagonist, has been an integral part in the management of atrial fibrillation. Vitamin K-dependent matrix Gla protein (MGP) has been known as a potent inhibitor of arterial calcification and osteoporosis. Therefore, we hypothesized that warfarin therapy affects bone mineral metabolism, vascular calcification, and vascular endothelial dysfunction. Methods We studied 42 atrial fibrillation patients at high-risk for atherosclerosis having one or more coronary risk factors. Twenty-four patients had been treated with warfarin for at least 12 months (WF group), and 18 patients without warfarin (non-WF group). Bone alkaline phosphatase (BAP) and under carboxylated osteocalcin (ucOC) and receptor activator of nuclear factor-kappa B ligand (RANKL) were measured as bone metabolism markers. Reactive hyperemia-peripheral arterial tonometry (RH-PAT) index measured by Endo-PAT2000 was used as an indicator of vascular endothelial function. Results There were no significant differences in patient background characteristics and other clinical indicators between the two groups. In WF group, the ucOC levels were significantly higher than those in the non-WF group (10.3 ± 0.8 vs. 3.4 ± 0.9 ng/mL; P < 0.01), similarly, the RANKL levels in the WF group were higher than those in the non-WF group (0.60 ± 0.06 vs. 0.37 ± 0.05 ng/mL; P = 0.007). Moreover, RH-PAT index was significantly lower in the WF group compared to those in the non-WF group (1.48 ± 0.11 vs. 1.88 ± 0.12; P = 0.017). Conclusions Long-term warfarin therapy may be associated with bone mineral loss and vascular calcification in 60–80 year old hypertensive patients. Stroke prevention by warfarin has been an integral part in the management of atrial fibrillation. Warfarin prevents the activation of vitamin K-dependent proteins, MGP and Gas-6. Long-term warfarin therapy increases the serum levels of ucOC and RANKL. Long-term warfarin therapy is associated with vascular endothelial dysfunction.
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Affiliation(s)
- Sayaka Namba
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan ; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Takehiro Hashikata
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Yuki Ikeda
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Lisa Kitasato
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Takuya Hashimoto
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takao Shimohama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Taiki Tojo
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan ; Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Naonobu Takahira
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan ; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Takashi Masuda
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan ; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Junya Ako
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan ; Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Radiotherapy and prevention of thrombosis in a patient with atrial fibrillation. Int J Cardiol 2014; 173:e18-9. [PMID: 24681012 DOI: 10.1016/j.ijcard.2014.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/09/2014] [Indexed: 11/20/2022]
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Pinho-Gomes AC, Reilly S, Brandes RP, Casadei B. Targeting inflammation and oxidative stress in atrial fibrillation: role of 3-hydroxy-3-methylglutaryl-coenzyme a reductase inhibition with statins. Antioxid Redox Signal 2014; 20:1268-85. [PMID: 23924190 PMCID: PMC3934546 DOI: 10.1089/ars.2013.5542] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
SIGNIFICANCE Atrial fibrillation (AF) is a burgeoning health-care problem, and the currently available therapeutic armamentarium is barely efficient. Experimental and clinical evidence implicates inflammation and myocardial oxidative stress in the pathogenesis of AF. RECENT ADVANCES Local and systemic inflammation has been found to both precede and follow the new onset of AF, and NOX2-dependent generation of reactive oxygen species in human right atrial samples has been independently associated with the occurrence of AF in the postoperative period in patients undergoing cardiac surgery. Anti-inflammatory and antioxidant agents can prevent atrial electrical remodeling in animal models of atrial tachypacing and the new onset of AF after cardiac surgery, suggesting a causal relationship between inflammation/oxidative stress and the atrial substrate that supports AF. CRITICAL ISSUES Statin therapy, by redressing the myocardial nitroso-redox balance and reducing inflammation, has emerged as a potentially effective strategy for the prevention of AF. Evidence indicates that statins prevent AF-induced electrical remodeling in animal models of atrial tachypacing and may reduce the new onset of AF after cardiac surgery. However, whether statins have antiarrhythmic properties in humans has yet to be conclusively demonstrated, as data from randomized controlled trials specifically addressing the relevance of statin therapy for the primary and secondary prevention of AF remain scanty. FUTURE DIRECTIONS A better understanding of the mechanisms underpinning the putative antiarrhythmic effects of statins may afford tailoring AF treatment to specific clinical settings and patient's subgroups. Large-scale randomized clinical trials are needed to support the indication of statin therapy solely on the basis of AF prevention.
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Affiliation(s)
- Ana Catarina Pinho-Gomes
- 1 Department of Cardiovascular Medicine, University of Oxford , John Radcliffe Hospital, Oxford, United Kingdom
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Imbalzano E, Ceravolo R, Di Stefano R, Vatrano M, Saitta A. Treatment failure of low molecular weight heparin bridging therapy in atrial fibrillation after acute coronary syndrome. Int J Cardiol 2014; 171:289-91. [DOI: 10.1016/j.ijcard.2013.11.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/23/2013] [Indexed: 12/19/2022]
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Treatment failure of low molecular weight heparin in post-surgery orthopedic case. Int J Cardiol 2013; 169:e36-7. [DOI: 10.1016/j.ijcard.2013.08.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 08/29/2013] [Indexed: 11/20/2022]
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36
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Tulino D, Imbalzano E, Casale M, D'Angelo M, Coglitore S, Di Bella G, Dattilo G. Treatment failure of low molecular weight heparin in diabetic patient. Int J Cardiol 2013; 168:e63-4. [DOI: 10.1016/j.ijcard.2013.07.064] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 07/03/2013] [Indexed: 11/27/2022]
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Maan A, Mansour M, N Ruskin J, Heist EK. Current Evidence and Recommendations for Rate Control in Atrial Fibrillation. Arrhythm Electrophysiol Rev 2013; 2:30-5. [PMID: 26835037 PMCID: PMC4711525 DOI: 10.15420/aer.2013.2.1.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 04/15/2013] [Indexed: 01/29/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice, which is associated with substantial risk of stroke and thromboembolism. As an arrhythmia that is particularly common in the elderly, it is an important contributor towards morbidity and mortality. Ventricular rate control has been a preferred and therapeutically convenient treatment strategy for the management of AF. Recent research in the field of rhythm control has led to the advent of newer antiarrhythmic drugs and catheter ablation techniques as newer therapeutic options. Currently available antiarrhythmic drugs still remain limited by their suboptimal efficacy and significant adverse effects. Catheter ablation as a newer modality to achieve sinus rhythm (SR) continues to evolve, but data on long-term outcomes on its efficacy and mortality outcomes are not yet available. Despite these current developments, rate control continues to be the front-line treatment strategy, especially in older and minimally symptomatic patients who might not tolerate the antiarrhythmic drug treatment. This review article discusses the current evidence and recommendations for ventricular rate control in the management of AF. We also highlight the considerations for rhythm control strategy in the management of patients of AF.
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Affiliation(s)
| | | | | | - E Kevin Heist
- Assistant Professor of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, US
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