1
|
Maslova V, Demming T, Pantlik R, Geczy T, Falk P, Remppis BA, Frank D, Lian E. Omitting transesophageal echocardiography before catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01825-8. [PMID: 38761295 DOI: 10.1007/s10840-024-01825-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Data about necessity of performing transesophageal echocardiography (TOE) prior to every catheter ablation (CA) of atrial fibrillation (AF) is scarce. We aimed to evaluate the safety of an individualized risk-based approach to TOE with respect to thromboembolic cerebrovascular events (CVE) in patients undergoing CA for AF or left atrial tachycardia (AT). METHODS We performed a retrospective clinical study based on our institutional registry database. Patients undergoing CA for AF or left-sided AT following initial AF ablation at two participating centers were enrolled. Prior to the procedure, patients were scheduled for TOE only if they had a history of thromboembolic stroke, left atrial appendage (LAA) thrombus, or inappropriate anticoagulation regimen in the previous 3 to 4 weeks. The incidence of periprocedural cerebrovascular thromboembolic events was assessed. RESULTS We analyzed 1155 patients (median age 70 years, 54.8% male, 48.1% had persistent AF/AT). In 261 patients, a TOE was performed; in 2 patients (0.7%), an LAA thrombus was detected, which led to cancellation of the catheter ablation; in 894 patients, the TOE was omitted. Of the 1153 (0.35%) patients who underwent ablation, 4 (0.35%) experienced a CVE (one TIA and three strokes). The rate of CVE in our study does not exceed that reported in most multicenter trials. The low event rates limited statistical analysis of possible risk factors for CVE. In all 4 patients with CVE, post-CVE imaging showed the absence of LAA thrombus. CONCLUSIONS An individualized selective approach to TOE before catheter ablation of AF or left AT showed a very low risk of overt intraprocedural thromboembolic events for the population in our study. A further randomized controlled study is needed to determine whether TOE prior to catheter ablation without ICE could be omitted in patients with uninterrupted OAC without previous thromboembolic events or a history of left atrial thrombus.
Collapse
Affiliation(s)
- Vera Maslova
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Thomas Demming
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Robert Pantlik
- Department of Cardiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany
| | - Tamas Geczy
- Department of Cardiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany
| | - Peter Falk
- Department of Cardiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany
| | | | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Evgeny Lian
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.
| |
Collapse
|
2
|
Li XL, Adi D, Wu Y, Aizezi A, Li YP, Kerem M, Wei X, Liu F, Ma X, Ma YT. A nomogram to predict ventricular thrombus in dilated cardiomyopathy patients. J Thromb Thrombolysis 2024; 57:29-38. [PMID: 37351822 PMCID: PMC10830674 DOI: 10.1007/s11239-023-02846-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND VT (Ventricular Thrombus) is a serious complication of dilated cardiomyopathy (DCM). Our goal is to develop a nomogram for personalized prediction of incident VT in DCM patients. METHODS 1267 patients (52.87 ± 11.75 years old, 73.8% male) were analyzed retrospectively from January 01, 2015, to December 31, 2020. A nomogram model for VT risk assessment was established using minimum absolute contraction and selection operator (LASSO) and multivariate logistic regression analysis, and its effectiveness was validated by internal guidance. The model was evaluated by the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). We compared the performance in predicting VT between nomogram and CHA2DS2, CHA2DS2- VASc or ATRIA by AUC, akaike information criterion (AIC), bayesian information criterion (BIC), net reclassification index (NRI), and integrated discrimination index (IDI). RESULTS 89 patients (7.02%) experienced VT. Multivariate logistic regression analysis revealed that age, left ventricular ejection fraction (LVEF), uric acid (UA), N-terminal precursor B-type diuretic peptide (NT-proBNP), and D-dimer (DD) were important independent predictors of VT. The nomogram model correctly separates patients with and without VT, with an optimistic C score of 0.92 (95%CI: 0.90-0.94) and good calibration (Hosmer-Lemeshow χ2 = 11.51, P = 0.12). Our model showed improved prediction of VT compared to CHA2DS2, CHA2DS2-VASc or ATRIA (all P < 0.05). CONCLUSIONS The novel nomogram demonstrated better than presenting scores and showed an improvement in predicting VT in DCM patients.
Collapse
Affiliation(s)
- Xiao-Lei Li
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Dilare Adi
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yun Wu
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of General Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Aibibanmu Aizezi
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yan-Peng Li
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Munawar Kerem
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Xian Wei
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Fen Liu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Xiang Ma
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
| | - Yi-Tong Ma
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
| |
Collapse
|
3
|
Baroni M, Fortuna M, Maloberti A, Leidi F, Ciampi CM, Carbonaro M, Testoni A, Vargiu S, Varrenti M, Paolucci M, Gigli L, Giannattasio C, Mazzone P. Uric acid significantly correlates with the presence of low-voltage areas at the endocardial mapping in patients with non-valvular atrial fibrillation. Nutr Metab Cardiovasc Dis 2023; 33:1323-1329. [PMID: 37248142 DOI: 10.1016/j.numecd.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND AIMS Interest in the role of atrial substrate in maintaining Atrial Fibrillation (AF) is growing. Fibrosis is the culprit in the electrical derangement of the myocytes. Many cardiovascular risk factors are known to be linked to atrial scarring; among them Uric Acid (UA) is emerging. The purpose of our study is to find whether UA is associated with Left Atrium (LA) with pathological substrate. METHODS AND RESULTS 81 patients who underwent radiofrequency transcatheter ablation for nonvalvular AF at the cardiological department of the Niguarda Hospital were enrolled in an observational, cross-sectional, single-center study. UA levels were analysed before the procedure. High density electroanatomic mapping of the LA was performed and patients were divided according to the presence or not of areas of pathological substrate (bipolar voltage <0.5 mV in sinus rhythm). 19 patients showed a LA with pathological substrate. These subjects showed a significant higher prevalence of persistent phenotype of AF (84.2 vs. 25.8%, p < 0.001). UA levels were significantly higher in the group of patients with LA with pathological substrate (6.8 ± 1.9 vs 5.3 ± 1.4 mg/dL, p < 0.001) as well as the prevalence of hyperuricemia (26.5 vs. 6.5%, p = 0.021). The association between uric acid LA with pathological substrate remains significant even after correction for confounding factors (age, left ventricular dysfunction, valvular disease, arrythmia phenotype and furosemide use) and also when the ratio UA/creatinine was evaluated. CONCLUSIONS In a population of patients who underwent AF ablation, higher UA levels were significantly associated with pathological LA substrate at electro-anatomical mapping.
Collapse
Affiliation(s)
- Matteo Baroni
- Cardiology 3, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Matteo Fortuna
- Department of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Alessandro Maloberti
- Department of Medicine, University of Milano-Bicocca, Milan, Italy; Cardiology 4, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy.
| | - Filippo Leidi
- Department of Medicine, University of Milano-Bicocca, Milan, Italy
| | | | - Marco Carbonaro
- Cardiology 3, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Alessio Testoni
- Cardiology 3, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Sara Vargiu
- Cardiology 3, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Marisa Varrenti
- Cardiology 3, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Marco Paolucci
- Cardiology 3, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Lorenzo Gigli
- Cardiology 3, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Cristina Giannattasio
- Department of Medicine, University of Milano-Bicocca, Milan, Italy; Cardiology 4, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Patrizio Mazzone
- Cardiology 3, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| |
Collapse
|
4
|
Construction of a Clinical Predictive Model of Left Atrial and Left Atrial Appendage Thrombi in Patients with Nonvalvular Atrial Fibrillation. J Interv Cardiol 2022; 2022:7806027. [DOI: 10.1155/2022/7806027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/19/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Background. The purpose of this study was to investigate the risk factors of left atrial (LA) or left atrial appendage (LAA) thrombi in patients with nonvalvular atrial fibrillation (NVAF) and to establish and validate relevant predictive models. It might improve thromboembolic risk stratification in patients with NVAF. Methods. This study retrospectively included 1210 consecutive patients with NVAF undergoing transesophageal echocardiography (TEE), of whom 139 patients had thrombi in LA or in LAA. Through literature review and the ten events per variable (10EPV) principle, 13 variables were finally identified for inclusion in multivariate analysis. Models were constructed by multivariate logistic stepwise regression and least absolute shrinkage and selection operator (lasso) regression. Results. After logistic regression, five variables (AF type, age, B-type natriuretic peptide, E/e’ ratio, and left atrial diameter) were finally screened out as model 1. After Lasso regression, AF type, age, gender, B-type natriuretic peptide, E/e’ ratio, left atrial diameter, and left ventricular ejection fraction were finally screened as model 2. After comparing the two models, the simpler model 1 was finally selected. The area under the ROC curve (AUC) of the model 1 was 0.865 (95% CI: 0.838–0.892), the Hosmer–Lemeshow test = 0.898, and the AUC = 0.861 after internal validation. The clinical decision curve showed that the new clinical prediction model could achieve a net clinical benefit when the expected threshold was between 0 and 0.6. Conclusion. This study constructed a new clinical prediction model of LA or LAA thrombi, with a higher discriminative degree than the CHADS2 and CHA2DS2-VASc scoring systems (AUC: 0.865 vs. 0.643; AUC: 0.865 vs 0.652).
Collapse
|
5
|
Yang J, Lou L, Zhang X, Chen Y, Zhou W, Zhang C, Guo X, Hu S. The Relationship between Uric Acid and the Development, Complication, and Prognosis of Atrial Fibrillation: The Views from a Clinical Study. Int J Endocrinol 2022; 2022:9355504. [PMID: 36340931 PMCID: PMC9633180 DOI: 10.1155/2022/9355504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
A large number of studies suggest that uric acid (UA) is related to the occurrence, complications, and prognosis of atrial fibrillation (AF). However, the guidelines did not clearly elaborate on this issue. The current research results need to be summarized to analyze the association between UA and AF. This study found that in the current clinical research on the relationship between UA and AF, studies mainly focus on the development or complications of AF. A lot of repetitive work does not deepen awareness of this question. In contrast, studies investigating the effects of UA-lowering therapy on the management of AF are limited. The only reports deny the protective effect of UA-lowering therapy. For now, we suggest that UA is close to the occurrence and progression of AF; therefore, it may have important significance as a clinical marker. The role of UA-lowering therapy in the management of AF is one of the next key issues to be explored. It will be a meaningful topic to focus on the latest research on AF ablation and to conduct a secondary analysis to explore the prognostic impact of UA on the latest treatment methods for AF. Multiomics techniques may allow us to have a deeper understanding of the role of UA in AF management in the future.
Collapse
Affiliation(s)
- Jian Yang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lian Lou
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuan Zhang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxiao Chen
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weier Zhou
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chi Zhang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaogang Guo
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shenjiang Hu
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
6
|
Li F, Sun JY, Wu LD, Hao JF, Wang RX. The long-term efficacy and safety of combining ablation and left atrial appendage closure: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2021; 32:3068-3081. [PMID: 34453379 DOI: 10.1111/jce.15230] [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: 05/04/2021] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Combined ablation and left atrial appendage closure (LAAC) is an alternative for atrial fibrillation patients with a high risk of stroke. However, the long-term outcomes of this combined procedure remain elusive. METHODS PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included. RESULTS A total of 16 studies comprising 1428 patients were enrolled. The pooled long-term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI]: 0.59-0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI: 1.00-1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow-up was 0.01 (95% CI: 0.00-0.02). Meanwhile, of the periprocedural adverse events, phrenic nerve palsy, intracoronary air embolus, device embolization, and periprocedural death had a rate of 0.00 (95% CI: 0.00-0.00), procedure-related bleeding events of 0.03 (95% CI: 0.02-0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI: 0.00-0.01). Moreover, for the long-term adverse events, device dislocation, intracranial bleeding, pericardial effusion requiring or not requiring intervention, and all-cause mortality had a rate of 0.00 (95% CI: 0.00-0.00), device embolization of 0.01 (95% CI: 0.00-0.01), and other bleeding events of 0.01 (95% CI: 0.00-0.03). CONCLUSION This meta-analysis suggests that the combined atrial ablation and LAAC is an effective and safe strategy with long-term benefits.
Collapse
Affiliation(s)
- Feng Li
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Jin-Yu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li-Da Wu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Jian-Feng Hao
- Department of Cardiopulmonary Rehabilitation, Wuxi Tongren Rehabilitation Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Ru-Xing Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| |
Collapse
|
7
|
Shang L, Zhang L, Guo Y, Sun H, Zhang X, Bo Y, Zhou X, Tang B. A Review of Biomarkers for Ischemic Stroke Evaluation in Patients With Non-valvular Atrial Fibrillation. Front Cardiovasc Med 2021; 8:682538. [PMID: 34277733 PMCID: PMC8281032 DOI: 10.3389/fcvm.2021.682538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/03/2021] [Indexed: 01/06/2023] Open
Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and results in a significantly increased ischemic stroke (IS) risk. IS risk stratification tools are widely being applied to guide anticoagulation treatment decisions and duration in patients with non-valvular AF (NVAF). The CHA2DS2-VASc score is largely validated and currently recommended by renowned guidelines. However, this score is heavily dependent on age, sex, and comorbidities, and exhibits only moderate predictive power. Finding effective and validated clinical biomarkers to assist in personalized IS risk evaluation has become one of the promising directions in the prevention and treatment of NVAF. A number of studies in recent years have explored differentially expressed biomarkers in NVAF patients with and without IS, and the potential role of various biomarkers for prediction or early diagnosis of IS in patients with NVAF. In this review, we describe the clinical application and utility of AF characteristics, cardiac imaging and electrocardiogram markers, arterial stiffness and atherosclerosis-related markers, circulating biomarkers, and novel genetic markers in IS diagnosis and management of patients with NVAF. We conclude that at present, there is no consensus understanding of a desirable biomarker for IS risk stratification in NVAF, and enrolling these biomarkers into extant models also remains challenging. Further prospective cohorts and trials are needed to integrate various clinical risk factors and biomarkers to optimize IS prediction in patients with NVAF. However, we believe that the growing insight into molecular mechanisms and in-depth understanding of existing and emerging biomarkers may further improve the IS risk identification and guide anticoagulation therapy in patients with NVAF.
Collapse
Affiliation(s)
- Luxiang Shang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, China
| | - Ling Zhang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yankai Guo
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Huaxin Sun
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaoxue Zhang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yakun Bo
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xianhui Zhou
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Baopeng Tang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| |
Collapse
|
8
|
Haddadin F, Arevalo AB, Jabri A, Beydoun H, Fram F, Munoz Estrella A, Karim S, Virani S, Ali Y. The risk and severity of stroke in patients with atrial fibrillation and gout: A National Representative Database study. J Arrhythm 2021; 37:394-399. [PMID: 33850581 PMCID: PMC8021996 DOI: 10.1002/joa3.12505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/27/2020] [Accepted: 12/31/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND It has been shown that gout is associated with left atrium remodeling and a pro-inflammatory state leading to the development of atrial fibrillation (AF). There is limited evidence whether gout increases the risk of stroke in patients with AF. We assessed the incidence of gout and the risk of stroke in patients with AF. METHODS This is a retrospective cohort study using the 2016 US National Inpatient Sample (NIS) based on ICD-10 codes. The outcomes of the study were the risk and severity of new stroke in patients with pre-existing AF and gout. RESULTS In 2016, we identified 3 844 057 patients admitted to the hospitals in NIS with history of AF, of which 240 875 had history of gout. Patients with AF and gout have higher risk of new stroke (OR 2.07 [1.97-2.19], P < .001), and this risk remains significantly elevated after adjusting for CHADS2VASC score variables, chronic kidney disease, dyslipidemia, obesity, and race (OR 1.10 [1.01-1.11], P = .041). However, presence of gout in patients with AF was not associated with all-cause in-hospital mortality, need for mechanical ventilation, percutaneous gastrostomy tube insertion, or discharge to skilled nursing facility. CONCLUSION Subjects with AF and gout compared to AF alone had an increased risk of new stroke, but presence of gout was not associated with stroke severity. There is a potential role of gout as a risk factor or a risk marker for stroke in subjects with AF.
Collapse
Affiliation(s)
- Faris Haddadin
- Section of CardiologyBaylor College of MedicineHoustonTXUSA
| | - Ana B. Arevalo
- Department of MedicineIcahn School of Medicine at Mount Sinai MorningsideNew YorkNYUSA
| | - Ahmad Jabri
- Heart and Vascular CenterMetrohealth Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Hassan Beydoun
- Department of CardiologyUniversity of Arizona COM‐PhoenixPhoenixAZUSA
| | - Farah Fram
- Faculty of MedicineUniversity of JordanAmmanJordan
| | | | - Saima Karim
- Heart and Vascular CenterMetrohealth Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Salim Virani
- Section of CardiologyMichael E. DeBakey Veterans Affairs Medical CenterSection of Cardiovascular ResearchDepartment of MedicineBaylor College of MedicineHoustonTXUSA
| | - Yousaf Ali
- Department of RheumatologyThe Mount Sinai HospitalNew YorkNYUSA
| |
Collapse
|
9
|
Deng Y, Liu F, Yang X, Xia Y. The Key Role of Uric Acid in Oxidative Stress, Inflammation, Fibrosis, Apoptosis, and Immunity in the Pathogenesis of Atrial Fibrillation. Front Cardiovasc Med 2021; 8:641136. [PMID: 33718459 PMCID: PMC7952317 DOI: 10.3389/fcvm.2021.641136] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/03/2021] [Indexed: 12/26/2022] Open
Abstract
Atrial fibrillation (AF) is a highly prevalent cardiac arrhythmia that leads to numerous adverse outcomes including stroke, heart failure, and death. Hyperuricemia is an important risk factor that contributes to atrium injury and AF, but the underlying molecular mechanism remains to be elucidated. In this review, we discussed the scientific evidence for clarifying the role of hyperuricemia in the pathogenesis of AF. Experimental and Clinical evidence endorse hyperuricemia as an independent risk factor for the incidence of AF. Various in vivo and in vitro investigations showed that hyperuricemia might play a critical role in the pathogenesis of AF at different UA concentrations through the activation of oxidative stress, inflammation, fibrosis, apoptosis, and immunity.
Collapse
Affiliation(s)
- Yawen Deng
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fei Liu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaolei Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
10
|
CHA 2DS 2-VASc Score as a Predictor for Left Atrial Thrombus or Spontaneous Echo Contrast in Patients with Nonvalvular Atrial Fibrillation: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2679539. [PMID: 32733935 PMCID: PMC7369682 DOI: 10.1155/2020/2679539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/08/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
Objective This meta-analysis aimed at exploring the predictive value of CHA2DS2-VASc score for the left atrial thrombus (LAT) or left atrial spontaneous echo contrast (LASEC) in patients with nonvalvular atrial fibrillation (NVAF). Methods PubMed, Embase, Web of Science, ScienceDirect, Cochrane Library, and Chinese core journals of the CNKI and Wanfang databases were searched to identify all the relevant papers that were published up to January 2020. The data were extracted for pooled odds ratios (ORs) with 95% confidence intervals (CIs), heterogeneity, subgroup, publication bias, and sensitivity analysis. Results Overall, 15 studies containing 6223 patients with NVAF were enrolled. All studies were evaluated for LAT, and 12 studies were evaluated for LASEC. The pooled analysis using a random-effects model showed that a high CHA2DS2-VASc score was related with LAT/LASEC (pooled OR = 1.59, 95% CI: 1.35–1.88, P < 0.001) with high heterogeneity (I2 = 76.9%, P < 0.001) and LAT (pooled OR = 1.83, 95% CI: 1.44–2.33, P < 0.001) with high heterogeneity (I2 = 79.4%, P < 0.001). The subgroup analysis demonstrated that the sample size may be the main source of heterogeneity. Although the Begg's funnel plot based on 15 studies for LAT/LASEC (P = 0.029) and 12 studies for LAT (P = 0.046) indicated the presence of publication bias among the included studies, the trim-and-fill method verified the stability of the pooled outcomes. In addition, sensitivity analysis indicated that all effects were stable. Conclusion The results of this meta-analysis showed that the CHA2DS2-VASc score is related with LAT and LASEC in patients with NVAF. However, more studies are warranted to address this issue.
Collapse
|
11
|
Zhang X, Hu M, Wang X, Zhang C, Chen W, Chen S, Zhou J, Chen Y, Lou L, Chen G, Dong F, Hu S, Zheng L, Yang J. New perspective on the risk markers for left atrial thrombosis in patients with atrial fibrillation. Eur J Prev Cardiol 2020; 28:641-647. [PMID: 33611443 DOI: 10.1177/2047487320912084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/19/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anticoagulant therapy is one of the important aspects of atrial fibrillation (AF) management, which can effectively reduce the formation of left atrial thrombosis (LAT) and the occurrence of embolic events. The CHA2DS2-VASc score is a commonly used risk assessment tool for embolic events, and it has guiding significance for anticoagulant therapy. However, a large number of recent studies have clearly shown that some of the markers that are not included in the score affect the formation of LAT. OBJECTIVE This single-center study probed for risk markers for LAT by analyzing the clinical features of patients who experienced AF. METHODS We reviewed patients with AF who had undergone a transesophageal echocardiography exam over the past 6 years and used binary logistic regression analysis to identify risk markers other than CHA2DS2-VASc score. For the risk markers found, the propensity score matching (PSM) was used to further evaluate whether it was an independent risk marker for LAT. The newly discovered markers were added to the score, and receiver operating characteristic analysis was used to evaluate whether the ability of the model to predict LAT was improved. RESULTS A total of 2246 patients were included in the study. In total, 838 of them were anticoagulated (314 with rivaroxaban, 57 with dabigatran, and 467 with warfarin) and 30 patients (1.33%) had LAT. Regression analysis revealed abnormal uric acid metabolism (abUA) and obesity were risk markers for LAT. Further PSM analysis found that abUA was an independent risk marker for LAT. After including abUA, the CHA2DS2-VASc score was more accurate for LAT prediction (area under the curve difference is 0.0651, 95% confidence interval: 0.0247, 0.1050, Z = 3.158, P = 0.0016). CONCLUSIONS AbUA is an independent risk marker for LAT. After considering abUA, the CHA2DS2-VASc score for LAT is more accurate.
Collapse
Affiliation(s)
- Xuan Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Mengjie Hu
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiying Wang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chi Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wanwan Chen
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Songzan Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jintao Zhou
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yuxiao Chen
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lian Lou
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Guoping Chen
- Department of Endocrinology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fanghong Dong
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shenjiang Hu
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liangrong Zheng
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Yang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
12
|
Shi W, Xing L, Jing L, Tian Y, Liu S. Usefulness of Triglyceride-glucose Index for estimating Hyperuricemia risk: Insights from a general Population. Postgrad Med 2019; 131:348-356. [PMID: 31132018 DOI: 10.1080/00325481.2019.1624581] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objectives: Hyperuricemia is a metabolic abnormality that has cast an enormous burden on global healthcare. Previous studies have revealed the close association between insulin resistance and hyperuricemia. Therefore, monitoring insulin sensitivity may be a possible way to prevent hyperuricemia. Recent studies have demonstrated the usefulness of triglyceride-glucose index (TyG) as a simple surrogate of insulin resistance. Hence, our study aimed to explore the impact of TyG on hyperuricemia and its value to improve the risk stratification and prevention of hyperuricemia. Methods: This cross-sectional study included 6466 subjects (mean age: 59.57 years, 60.19% females) from northeast China between September 2017 to May 2018. TyG was determined as ln[fasting TG(mg/dL)×FPG(mg/dL)/2]. Hyperuricemia was defined as serum uric acid ≥ 357 μmol/L for females and ≥ 417 μmol/L for males. Results: The prevalence of hyperuricemia was 5.24%. In the full model, each SD increment of TyG caused a 12.528 μmol/L elevation of serum urate concentration and a 54.1% additional risk for hyperuricemia. When dividing TyG into quartiles, the top quartile had a 2.730 times risk for hyperuricemia than the bottom one. Moreover, smooth curve fitting demonstrated this association was linear. Additionally, subgroup analysis revealed the association was robust to several risk factors of hyperuricemia. Finally, AUC displayed an improvement when introducing TyG into clinical risk factors (0.751 vs 0.772, p < 0.001), category-free net reclassification index (0.304, 95% CI: 0.195-0.413, P < 0.001) and integrated discrimination index (0.009, 95% CI: 0.004-0.013, P < 0.001) also showed the improvement from TyG. Conclusion: Our work revealed the linear and robust association between TyG and hyperuricemia. Furthermore, our results suggest the importance of simultaneous glycemic and lipids control in the prevention of hyperuricemia. Most importantly, our findings implicate the value of TyG to optimize the risk stratification and prevention of hyperuricemia.
Collapse
Affiliation(s)
- Wenrui Shi
- a Department of Cardiology , The First Affiliated Hospital of China Medical University , Shenyang , Liaoning , People's Republic of China
| | - Liying Xing
- b Department of Cardiovascular Diseases Prevention , Liaoning Provincial Center for Disease Control and Prevention , Shenyang , Liaoning , People's Republic of China
| | - Li Jing
- b Department of Cardiovascular Diseases Prevention , Liaoning Provincial Center for Disease Control and Prevention , Shenyang , Liaoning , People's Republic of China
| | - Yuanmeng Tian
- b Department of Cardiovascular Diseases Prevention , Liaoning Provincial Center for Disease Control and Prevention , Shenyang , Liaoning , People's Republic of China
| | - Shuang Liu
- c Department of Cardiovascular Ultrasound , The First Affiliated Hospital of China Medical University , Shenyang , Liaoning , People's Republic of China
| |
Collapse
|
13
|
Wei W, Shehata M, Wang X, Rao F, Zhan X, Guo H, Fang X, Liao H, Liu J, Deng H, Liu Y, Xue Y, Wu S. Invasive therapies for patients with concomitant heart failure and atrial fibrillation. Heart Fail Rev 2019; 24:821-829. [PMID: 31049749 DOI: 10.1007/s10741-019-09795-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Atrial fibrillation (AF) and heart failure (HF) are two clinical entities that can present either separately or concurrently. One entity can lead to the other and vice versa as AF can not only be the underlying etiology of HF but also exacerbate HF due to other cardiac diseases. Besides prevention of cerebral and systemic embolism and elimination of AF-related symptoms, restoration of sinus rhythm for AF patients helps to avoid or reduce HF, irrespective of their underlying heart disease. Successful rates of medical therapy for AF are low in persistent AF, and much lower in long-standing AF, while invasive procedures for AF yield promising results. In this review, the authors evaluate the value of invasive therapies for HF patients complicated with non-valvular AF. We examine this clinical problem by interpreting the relationships between these two entities: the mechanism of tachycardia-induced cardiomyopathy (TIC), past opinions about rhythm control and rate control of AF, discrimination of HF-related AF and AF-induced HF, how to identify the AF patients that could benefit from invasive therapies, and how to select invasive therapies for different AF patients and peri-operative treatments.
Collapse
Affiliation(s)
- Wei Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Michael Shehata
- Heart Institute Los Angeles, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Xunzhang Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Heart Institute Los Angeles, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Fang Rao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China.,Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Xianzhan Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Huiming Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China
| | - Xianhong Fang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Hongtao Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Jian Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Yang Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China. .,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China.
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China. .,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China.
| |
Collapse
|
14
|
Bell DSH, Goncalves E. Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti-diabetic therapies. Diabetes Obes Metab 2019; 21:210-217. [PMID: 30144274 DOI: 10.1111/dom.13512] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/14/2018] [Accepted: 08/21/2018] [Indexed: 12/15/2022]
Abstract
New-onset atrial fibrillation (NAF) is increased in the type 2 diabetic patient because of the presence of the metaboli syndrome and increased sympathetic activity. This results in inflammation, endothelial dysfunction and myocardial steatosis which, in turn, lead to atrial fibrosis and dilatation. The end result is the development of structural and electrical atrial remodeling. Drugs that lower insulin resistance, particularly pioglitazone, decrease the incidence of NAF while drugs that, through hypoglycaemia, stimulate the sympathetic nervous system, insulin and secretagogues, increase the incidence of NAF. Currently there is no evidence that GLP-1 agonists, SGLT2 inhibitors and DPP-4 inhibitors either accelerate or decelerate the development of NAF.
Collapse
Affiliation(s)
- David S H Bell
- Southside Endocrinology and Diabetes and Thyroid Associates, Birmingham, Alabama
| | - Edison Goncalves
- Southside Endocrinology and Diabetes and Thyroid Associates, Birmingham, Alabama
| |
Collapse
|
15
|
Liu FZ, Lin WD, Liao HT, Peng J, Xue YM, Zhan XZ, Zhu JM, Yiu KH, Li YF, Tse HF, Shi L, Fang XH, Wu SL. Mid-term outcomes of concomitant left atrial appendage closure and catheter ablation for non-valvular atrial fibrillation: a multicenter registry. Heart Vessels 2019; 34:860-867. [DOI: 10.1007/s00380-018-1312-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
|
16
|
Zhan XZ, Lin WD, Liu FZ, Xue YM, Liao HT, Li X, Fang XH, Deng H, Huang J, Li YQ, Hai JJ, Tse HF, Wu SL. Predictive value of red cell distribution width on left atrial thrombus or left atrial spontaneous echo contrast in patients with non-valvular atrial fibrillation. J Geriatr Cardiol 2018; 15:408-412. [PMID: 30108612 PMCID: PMC6087520 DOI: 10.11909/j.issn.1671-5411.2018.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/27/2018] [Accepted: 03/20/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the predictive value of red cell distribution width (RDW) on left atrial thrombus (LAT) or left atrial spontaneous echo contrast (LASEC) in patients with non-valvular atrial fibrillation (AF). METHODS We reviewed 692 patients who were diagnosed as non-valvular AF and underwent transesophageal echocardiography (TEE) in Guangdong Cardiovascular Institute from April 2014 to December 2015. The baseline clinical characteristics, laboratory test of blood routine, electrocardiograph measurements were analyzed. RESULTS Eighty-four patients were examined with LAT/LASEC under TEE. The mean RDW level was significantly higher in LAT/LASEC patients compared with the non-LAT/LASEC patients (13.59% ± 1.07% vs. 14.34% ± 1.34%; P < 0.001). Receiver-operating characteristic curve analysis was performed and indicated the best RDW cut point was 13.16%. Furthermore, multivariate logistic regression analysis indicated that RDW level > 13.16% could be an independent risk factor for LAT/LASEC in patients with AF. CONCLUSION Elevated RDW level is associated with the presence of LAT/LASEC and could be with moderate predictive value for LAT/LASEC in patients with non-valvular AF.
Collapse
Affiliation(s)
- Xian-Zhang Zhan
- Department of Hematology, the First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Cardiology, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei-Dong Lin
- Department of Cardiology, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fang-Zhou Liu
- Department of Cardiology, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-Mei Xue
- Department of Cardiology, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-Tao Liao
- Department of Cardiology, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin Li
- Department of Cardiology, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xian-Hong Fang
- Department of Cardiology, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hai Deng
- Department of Cardiology, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jun Huang
- Department of Cardiology, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yang-Qiu Li
- Department of Hematology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jo-Jo Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Shu-Lin Wu
- Department of Hematology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| |
Collapse
|