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Marano M, Senigalliesi L, Cocola R, Fontana M, Parente E, Russo V. Advanced Interatrial Block across the Spectrum of Renal Function. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1001. [PMID: 38929618 PMCID: PMC11205515 DOI: 10.3390/medicina60061001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
Background and Objective: Interatrial block (IAB) is defined as a conduction delay between the right and left atria. No data are available about the prevalence of both partial IAB and advanced IAB among the different stages of chronic kidney disease. The aim of this study was to describe the prevalence and type of advanced IAB across the spectrum of renal function, including patients on dialysis and the clinical characteristics associated with advanced IAB. Materials and Methods: Retrospective, single-center study of 151 patients consecutively admitted to the Nephrology and Ophthalmology Unit for 3 months. The study population was divided into three groups according to stages of chronic kidney disease. We evaluated the prevalence and pattern of IAB among the groups and the clinical characteristics associated with advanced IAB. Results: The prevalence of partial IAB was significantly lower in end-stage kidney disease (ESKD) group compared to control group (36.7% vs. 59.6%; p = 0.02); in contrast the prevalence of advanced IAB was significantly higher in both chronic kidney disease (CKD) (17.8% vs. 5.3%, p = 0.04) and ESKD group (24.5% vs. 5.3%, p = 0.005) compared to control group. The atypical pattern of advanced IAB was more frequent in both the ESKD and CKD group than in the control group (100% and 75% vs. 33.3%; p = 0.02). Overall, among patients that showed advanced IAB, 17 (73.9%) showed an atypical pattern by morphology and 2 (8.7%) showed an atypical pattern by duration of advanced IAB. The ESKD group was younger than the control group (65.7 ± 12.3 years vs. 71.3 ± 9.9 years; p = 0.01) and showed a higher prevalence of beta blockers (42.9% vs. 19.3%; p = 0.009), as in the CKD group (37.8% vs. 19.3%; p= 0.04). Conclusions: The progressive worsening of renal function was associated with an increasing prevalence of advanced IAB. Advanced IAB may be a sign of uremic cardiomyopathy and may suggest further evaluation with long-term follow-up to investigate its prognostic significance in chronic kidney disease.
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Affiliation(s)
- Marco Marano
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Luigi Senigalliesi
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Rossella Cocola
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Mariarosaria Fontana
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Erika Parente
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80126 Naples, Italy;
| | - Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80126 Naples, Italy;
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Ninni S, Algalarrondo V, Brette F, Lemesle G, Fauconnier J. Left atrial cardiomyopathy: Pathophysiological insights, assessment methods and clinical implications. Arch Cardiovasc Dis 2024; 117:283-296. [PMID: 38490844 DOI: 10.1016/j.acvd.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 03/17/2024]
Abstract
Atrial cardiomyopathy is defined as any complex of structural, architectural, contractile or electrophysiological changes affecting atria, with the potential to produce clinically relevant manifestations. Most of our knowledge about the mechanistic aspects of atrial cardiomyopathy is derived from studies investigating animal models of atrial fibrillation and atrial tissue samples obtained from individuals who have a history of atrial fibrillation. Several noninvasive tools have been reported to characterize atrial cardiomyopathy in patients, which may be relevant for predicting the risk of incident atrial fibrillation and its related outcomes, such as stroke. Here, we provide an overview of the pathophysiological mechanisms involved in atrial cardiomyopathy, and discuss the complex interplay of these mechanisms, including aging, left atrial pressure overload, metabolic disorders and genetic factors. We discuss clinical tools currently available to characterize atrial cardiomyopathy, including electrocardiograms, cardiac imaging and serum biomarkers. Finally, we discuss the clinical impact of atrial cardiomyopathy, and its potential role for predicting atrial fibrillation, stroke, heart failure and dementia. Overall, this review aims to highlight the critical need for a clinically relevant definition of atrial cardiomyopathy to improve treatment strategies.
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Affiliation(s)
- Sandro Ninni
- CHU de Lille, Université de Lille, 59000 Lille, France.
| | - Vincent Algalarrondo
- Department of Cardiology, Bichat University Hospital, AP-HP, 75018 Paris, France
| | - Fabien Brette
- PhyMedExp, University of Montpellier, INSERM, CNRS, 34093 Montpellier, France
| | | | - Jérémy Fauconnier
- PhyMedExp, University of Montpellier, INSERM, CNRS, 34093 Montpellier, France
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Zagoridis K, Koutalas E, Intzes S, Symeonidou M, Zagoridou N, Karagogos K, Spanoudakis E, Kanoupakis E, Kochiadakis G, Dinov B, Dagres N, Hindricks G, Bollmann A, Nedios S. P-wave duration and interatrial block as predictors of new-onset atrial fibrillation: A systematic review and meta-analysis. Hellenic J Cardiol 2023; 72:57-64. [PMID: 37028490 DOI: 10.1016/j.hjc.2023.03.007] [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: 12/12/2022] [Revised: 03/09/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Early detection of atrial fibrillation (AF) could improve patient outcomes. P-wave duration (PWD) and interatrial block (IAB) are known predictors of new-onset AF and could improve selection for AF screening. This meta-analysis reviews the published evidence and offers practical implications. METHODS Publication databases were systematically searched, and studies reporting PWD and/or morphology at baseline and new-onset AF during follow-up were included. IAB was defined as partial (pIAB) if PWD≥120 ms or advanced (aIAB) if the P-wave was biphasic in the inferior leads. After quality assessment and data extraction, random-effects analysis calculated odds ratio (OR) and confidence intervals (CI). Subgroup analysis was performed for those with implantable devices (continuous monitoring). RESULTS Among 16,830 patients (13 studies, mean 66 years old), 2,521 (15%) had new-onset AF over a median of 44 months. New-onset AF was associated with a longer PWD (mean pooled difference: 11.5 ms, 13 studies, p < 0.001). The OR for new-onset AF was 2.05 (95% CI: 1.3-3.2) for pIAB (5 studies, p = 0.002) and 3.9 (95% CI: 2.6-5.8) for aIAB (7 studies, p < 0.001). Patients with pIAB and devices had higher AF-detection risk (OR: 2.33, p < 0.001) than those without devices (OR: 1.36, p = 0.56). Patients with aIAB had similarly high risk regardless of device presence. There was significant heterogeneity but no publication bias. CONCLUSION Interatrial block is an independent predictor of new-onset AF. The association is stronger for patients with implantable devices (close monitoring). Thus, PWD and IAB could be used as selection criteria for intensive screening, follow-up or interventions.
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Affiliation(s)
| | - Emmanuel Koutalas
- Cardiology Department, Heraklion University Hospital, Crete, Greece.
| | - Stergios Intzes
- Democritus University of Thrace, Medical School, Alexandroupoli, Greece
| | | | | | | | | | | | | | - Borislav Dinov
- Electrophysiology Department, Heart Center, University of Leipzig, Germany
| | - Nikolaos Dagres
- Electrophysiology Department, Heart Center, University of Leipzig, Germany
| | - Gerhard Hindricks
- Electrophysiology Department, Heart Center, University of Leipzig, Germany
| | - Andreas Bollmann
- Electrophysiology Department, Heart Center, University of Leipzig, Germany
| | - Sotirios Nedios
- Electrophysiology Department, Heart Center, University of Leipzig, Germany
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Zhang MJ, Ji Y, Wang W, Norby FL, Parikh R, Eaton AA, Inciardi RM, Alonso A, Soliman EZ, Mosley TH, Johansen MC, Gottesman RF, Shah AM, Solomon SD, Chen LY. Association of Atrial Fibrillation With Stroke and Dementia Accounting for Left Atrial Function and Size. JACC. ADVANCES 2023; 2:100408. [PMID: 37954510 PMCID: PMC10634508 DOI: 10.1016/j.jacadv.2023.100408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/11/2023] [Accepted: 05/01/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with higher risks of ischemic stroke (IS) and dementia. Whether alterations in left atrial (LA) function or size-atrial myopathy-confound these associations remains unknown. OBJECTIVES The purpose of this study was to examine the association of prevalent and incident AF with ischemic stroke and dementia in the ARIC (Atherosclerosis Risk In Communities) study, adjusting for LA function and size. METHODS Participants at visit 5 (2011-2013) with echocardiographic LA function (reservoir, conduit, contractile strain, and emptying fraction) and size (maximal, minimal volume index) data, and without prevalent stroke or dementia were followed through 2019. For analysis, we used time-varying Cox regression. RESULTS Among 5,458 participants (1,193 with AF, mean age of 76 years) in the stroke analysis and 5,461 participants (1,205 with AF, mean age of 75 years) in the dementia analysis, 209 participants developed ischemic stroke, and 773 developed dementia over 7.1 years (median). In a demographic and risk factor-adjusted model, AF was significantly associated with ischemic stroke (HR, 1.63; 95% CI: 1.11-2.37) and dementia (HR: 1.38, 95% CI: 1.13-1.70). After additionally adjusting for LA reservoir strain, these associations were attenuated and no longer statistically significant (stroke [HR: 1.33, 95% CI: 0.88-2.00], dementia [HR: 1.15, 95% CI: 0.92-1.43]). Associations with ischemic stroke and dementia were also attenuated and not statistically significant after adjustment for LA contractile strain, emptying fraction, and minimal volume index. CONCLUSIONS AF-ischemic stroke and AF-dementia associations were not statistically significant after adjusting for measures of atrial myopathy. This proof-of-concept analysis does not support AF as an independent risk factor for ischemic stroke and dementia.
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Affiliation(s)
- Michael J. Zhang
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Yuekai Ji
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Faye L. Norby
- Department of Cardiology, Center for Cardiac Arrest Prevention, Cedars-Sinai Smidt Heart Institute, Los Angeles, California
| | - Romil Parikh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Anne A. Eaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Riccardo M. Inciardi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Brescia, Italy
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Elsayed Z. Soliman
- Cardiovascular Medicine Section, Department of Internal Medicine, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Thomas H. Mosley
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michelle C. Johansen
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, NIH, Bethesda, Maryland
| | - Amil M. Shah
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Scott D. Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota
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Russo V, Albani S, Caturano A, Weisz SH, Parisi V, Conte M, Zaccaro L, D'Andrea A, Al-Turky A, Marchel M, Marano M, Sasso FC, Attena E. The prognostic role of interatrial block among COVID-19 patients hospitalized in medicine wards. Eur J Clin Invest 2022; 52:e13781. [PMID: 35342933 PMCID: PMC9111721 DOI: 10.1111/eci.13781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Some abnormal electrocardiographic findings were independently associated with increased mortality in patients admitted for COVID-19; however, no studies have focussed on the prognosis impact of the interatrial block (IAB) in this clinical setting. The aim of our study was to assess the prevalence and clinical implications of IAB, both partial and advanced, in hospitalized COVID-19 patients. MATERIALS We retrospectively evaluated 300 consecutive COVID-19 patients (63.22 ± 15.16 years; 70% males) admitted to eight Italian Hospitals from February 2020 to April 2020 who underwent twelve lead electrocardiographic recording at admission. The study population has been dichotomized into two groups according to the evidence of IAB at admission, both partial and advanced. The differences in terms of ARDS in need of intubation, in-hospital mortality and thromboembolic events (a composite of myocardial infarction, stroke and transient ischaemic attack) have been evaluated. RESULTS The presence of IAB was noticed in 64 patients (21%). In the adjusted logistic regression model, the partial interatrial block was found to be an independent predictor of ARDS in need of intubation (HR: 1.92; p: .04) and in-hospital mortality (HR: 2.65; p: .02); moreover, the advanced interatrial block was an independent predictor of thrombotic events (HR: 7.14; p < .001). CONCLUSIONS Among COVID-19 patients hospitalized in medical wards, the presence of interatrial block is more frequent than in the general population and it might be useful as an early predictor for increased risk of incident thrombotic events, ARDS in need of intubation and in-hospital mortality.
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Affiliation(s)
- Vincenzo Russo
- Division of Cardiology, Department of Translational Medical Sciences, Monaldi and Cotugno Hospital, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Stefano Albani
- Cardiology Department, Aosta Valley Health Authority, Aosta, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Lorenzo Zaccaro
- Cardiology Department, Aosta Valley Health Authority, Aosta, Italy
| | | | - Ahmed Al-Turky
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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6
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Martínez-Sellés M. Interatrial block, atrial fibrillation, and thrombotic events in COVID-19. Eur J Clin Invest 2022; 52:e13800. [PMID: 35474208 PMCID: PMC9111789 DOI: 10.1111/eci.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
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Myers SJ, Jiménez-Ruiz A, Sposato LA, Whitehead SN. Atrial cardiopathy and cognitive impairment. Front Aging Neurosci 2022; 14:914360. [PMID: 35942230 PMCID: PMC9355976 DOI: 10.3389/fnagi.2022.914360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment involves complex interactions between multiple pathways and mechanisms, one of which being cardiac disorders. Atrial cardiopathy (AC) is a structural and functional disorder of the left atrium that may be a substrate for other cardiac disorders such as atrial fibrillation (AF) and heart failure (HF). The association between AF and HF and cognitive decline is clear; however, the relationship between AC and cognition requires further investigation. Studies have shown that several markers of AC, such as increased brain natriuretic peptide and left atrial enlargement, are associated with an increased risk for cognitive impairment. The pathophysiology of cognitive decline in patients with AC is not yet well understood. Advancing our understanding of the relationship between AC and cognition may point to important treatable targets and inform future therapeutic advancements. This review presents our current understanding of the diagnosis of AC, as well as clinical characteristics and potential pathways involved in the association between AC and cognitive impairment.
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Affiliation(s)
- Sarah J. Myers
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Amado Jiménez-Ruiz
- Department of Clinical Neurological Sciences, University Hospital, Western University, London, ON, Canada
| | - Luciano A. Sposato
- Department of Clinical Neurological Sciences, University Hospital, Western University, London, ON, Canada
| | - Shawn N. Whitehead
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- *Correspondence: Shawn N. Whitehead,
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Isaksen JL, Ghouse J, Skov MW, Olesen MS, Holst AG, Pietersen A, Nielsen JB, Maier A, Graff C, Frikke-Schmidt R, Kanters JK. Associations between primary care electrocardiography and non-Alzheimer dementia. J Stroke Cerebrovasc Dis 2022; 31:106640. [PMID: 35830834 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/22/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To determine whether electrocardiogram (ECG) markers are associated with incident non-Alzheimer's dementia (non-AD) and whether these markers also improve risk prediction for non-AD. MATERIALS AND METHODS We retrospectively included 170,605 primary care patients aged 60 years or older referred for an ECG by their general practitioner and followed them for a median of 7.6 years. Using Cox regression, we reported hazard ratios (HRs) for electrocardiogram markers. Subsequently, we evaluated if addition of these electrocardiogram markers to a clinical model improved risk prediction for non-AD using change in area under the receiver-operator characteristics curve (AUC). RESULTS The 5-year cumulative incidence of non-AD was 3.4 %. Increased heart rate (HR=1.06 pr. 10 bpm [95% confidence interval: 1.04-1.08], p<0.001), shorter QRS duration (HR=1.07 pr. 10 ms [1.05-1.09], p<0.001), elevated J-amplitude (HR=1.16 pr. mm [1.08-1.24], p<0.001), decreased T-peak amplitude (HR=1.02 pr. mm [1.01-1.04], p=0.002), and increased QTc (HR=1.08 pr. 20 ms [1.05-1.10], p<0.001) were associated with an increased rate of non-AD. Atrial fibrillation on the ECG (HR=1.18 [1.08-1.28], p<0.001) Sokolow-Lyon index > 35 mm (HR=1.31 [1.18-1.46], p<0.001) and borderline (HR=1.18 [1.11-1.26], p<0.001) or abnormal (HR=1.40 [1.27-1.55], p<0.001) QRS-T angle were also associated with an increased rate of non-AD. Upon addition of ECG markers to the Cox model, 5-year and 10-year C-statistic (AUC) improved significantly (delta-AUC, 0.36 [0.18-0.50] and 0.20 [0.03-0.35] %-points, respectively). CONCLUSIONS ECG markers typical of an elevated cardiovascular risk profile were associated with non-AD and improved both 5-year and 10-year risk predictions for non-AD.
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Affiliation(s)
- Jonas L Isaksen
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Jonas Ghouse
- Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Morten W Skov
- Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Morten S Olesen
- Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Anders G Holst
- Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Adrian Pietersen
- Copenhagen General Practitioners' Laboratory, Copenhagen, Denmark
| | - Jonas B Nielsen
- Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Anja Maier
- Department of Technology, Management and Economics, Technical University of Denmark, Kgs. Lyngby, Denmark; Department of Design, Manufacturing and Engineering Management, University of Strathclyde, Glasgow, United Kingdom
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen K Kanters
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Chen LY, Ribeiro ALP, Platonov PG, Cygankiewicz I, Soliman EZ, Gorenek B, Ikeda T, Vassilikos VP, Steinberg JS, Varma N, Bayés-de-Luna A, Baranchuk A. P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research-A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. CIRCULATION. ARRHYTHMIA AND ELECTROPHYSIOLOGY 2022; 15:e010435. [PMID: 35333097 PMCID: PMC9070127 DOI: 10.1161/circep.121.010435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Atrial cardiomyopathy, characterized by abnormalities in atrial structure and function, is associated with increased risk of adverse cardiovascular and neurocognitive outcomes, independent of atrial fibrillation. There exists a critical unmet need for a clinical tool that is cost-effective, easy to use, and that can diagnose atrial cardiomyopathy. P wave parameters (PWPs) reflect underlying atrial structure, size, and electrical activation; alterations in these factors manifest as abnormalities in PWPs that can be readily ascertained from a standard 12-lead ECG and potentially be used to aid clinical decision-making. PWPs include P wave duration, interatrial block, P wave terminal force in V1, P wave axis, P wave voltage, P wave area, and P wave dispersion. PWPs can be combined to yield an index (P wave index), such as the morphology-voltage-P-wave duration ECG risk score. Abnormal PWPs have been shown in population-based cohort studies to be independently associated with higher risks of atrial fibrillation, ischemic stroke, sudden cardiac death, and dementia. Additionally, PWPs, either individually or in combination (as a P wave index), have been reported to enhance prediction of atrial fibrillation or ischemic stroke. To facilitate translation of PWPs to routine clinical practice, additional work is needed to standardize measurement of PWPs (eg, via semiautomated or automated measurement), confirm their reliability and predictive value, leverage novel approaches (eg, wavelet analysis of P waves and machine learning algorithms), and finally, define the risk-benefit ratio of specific interventions in high-risk individuals. Our ultimate goal is to repurpose the ubiquitous 12-lead ECG to advance the study, diagnosis, and treatment of atrial cardiomyopathy, thus overcoming critical challenges in prevention of cardiovascular disease and dementia.
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Affiliation(s)
- Lin Yee Chen
- Lillehei Heart Institute & Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis' MN (L.Y.C.)
| | - Antonio Luiz Pinho Ribeiro
- Centro de Telessaúde, Hospital das Clínicas, & Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.P.R.)
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund' Sweden (P.G.P.)
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Poland (I.C.)
| | - Elsayed Z Soliman
- Institute of Global Health & Human Ecology, American University in Cairo, Cairo, Egypt (E.Z.S.).,Epidemiological Cardiology Research Center (EPICARE), Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
| | - Bulent Gorenek
- Department of Cardiology, Eskişehir Osmangazi University, Eskisehir, Turkey (B.G.)
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo' Japan (T.I.)
| | - Vassilios P Vassilikos
- Third Cardiology Department, Hippokrateio General Hospital, Medical School, Aristotle University of Thessaloniki, Greece (V.P.V.)
| | - Jonathan S Steinberg
- Clinical Cardiovascular Research Center, Univ of Rochester School of Medicine & Dentistry, Rochester, NY (J.S.S.)
| | - Niraj Varma
- Cardiac Electrophysiology, Heart & Vascular Institute, Cleveland Clinic, Cleveland' OH (N.V.)
| | - Antoni Bayés-de-Luna
- Cardiovascular Research Foundation. Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (A.B.-d.-L.)
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science, Center, Queen's University, Kingston, Ontario, Canada (A.B.)
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10
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Wang W, Zhang MJ, Inciardi RM, Norby FL, Johansen MC, Parikh R, Van’t Hof JR, Alonso A, Soliman EZ, Mosley TH, Gottesman RF, Shah AM, Solomon SD, Chen LY. Association of Echocardiographic Measures of Left Atrial Function and Size With Incident Dementia. JAMA 2022; 327:1138-1148. [PMID: 35315884 PMCID: PMC8941355 DOI: 10.1001/jama.2022.2518] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Atrial myopathy-characterized by alterations in left atrial (LA) function and size-is associated with ischemic stroke, independent of atrial fibrillation (AF). Electrocardiographic markers of atrial myopathy are associated with dementia, but it is unclear whether 2-dimensional echocardiographic (2DE)-defined LA function and size are associated with dementia. OBJECTIVE To examine the association of LA function and size with incident dementia. DESIGN, SETTING, AND PARTICIPANTS The Atherosclerosis Risk in Communities (ARIC) study is a community-based prospective cohort. An exploratory, retrospective analysis was conducted. ARIC centers are located in Forsyth County, North Carolina; Jackson, Mississippi; Washington County, Maryland; and suburban Minneapolis, Minnesota. For this analysis, visit 5 (2011-2013) served as the baseline. Participants without prevalent AF and stroke and who had 2DEs in 2011-2013 were included and surveilled through December 31, 2019. EXPOSURES LA function (reservoir strain, conduit strain, contractile strain, emptying fraction, passive emptying fraction, and active emptying fraction), and LA size (maximal and minimal volume index) as evaluated by 2DE. MAIN OUTCOMES AND MEASURES Dementia cases were identified using in-person and phone cognitive assessments, hospitalization codes, and death certificates. Cox proportional hazards models were used. RESULTS Among 4096 participants (mean [SD] age, 75 [5] years; 60% women; 22% Black individuals), 531 dementia cases were ascertained over a median follow-up of 6 years. Dementia incidence for the lowest LA quintile was 4.80 for reservoir strain, 3.94 for conduit strain, 3.29 for contractile strain, 4.20 for emptying fraction, 3.67 for passive emptying fraction, and 3.27 for active emptying fraction per 100 person-years. After full-model adjustments, there were statistically significant associations between measures of LA function and dementia; the hazard ratios (HRs) from the lowest vs highest quintile for reservoir strain were 1.98 (95% CI, 1.42-2.75); for conduit strain, 1.50 (95% CI, 1.09-2.06); for contractile strain, 1.57 (95% CI, 1.16-2.14); for emptying fraction, 1.87 (95% CI, 1.31-2.65); and for active emptying fraction, 1.43 (95% CI, 1.04-1.96). LA passive emptying fraction was not significantly associated with dementia (HR, 1.26 [95% CI, 0.93-1.71]). Dementia incidence for the highest LA maximal volume index quintile was 3.18 per 100 person-years (HR for highest vs lowest quintile, 0.77 [95% CI, 0.58-1.02]) and for the highest minimal volume index quintile was 3.50 per 100 person-years (HR for the highest vs lowest quintile, 0.95 [95% CI, 0.71-1.28]). Both measures were not significantly associated with dementia. These findings were robust to sensitivity analyses that excluded participants with incident AF or stroke. CONCLUSIONS AND RELEVANCE In this exploratory analysis of a US community-based cohort, several echocardiographic measures of lower LA function were significantly associated with an increased risk of subsequent dementia. Measures of LA size were not significantly associated with dementia risk. These findings suggest that impaired LA function may be a risk factor associated with dementia.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Michael J. Zhang
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Riccardo M. Inciardi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Faye L. Norby
- Center for Cardiac Arrest Prevention, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California
| | | | - Romil Parikh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Jeremy R. Van’t Hof
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center, Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Thomas H. Mosley
- The MIND Center, University of Mississippi Medical Center, Jackson
| | - Rebecca F. Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland
| | - Amil M. Shah
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Scott D. Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis
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11
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Atrial Fibrillation and Dementia: Epidemiological Insights on an Undervalued Association. Medicina (B Aires) 2022; 58:medicina58030361. [PMID: 35334537 PMCID: PMC8955523 DOI: 10.3390/medicina58030361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/18/2022] Open
Abstract
Background and objectives: Atrial fibrillation (AF) and dementia are growing causes of morbidity and mortality, representing relevant medical and socioeconomic burdens. In this study, based on data from the Global Burden of Disease Injuries and Risk Factors Study (GBD) 2019, we focused on AF and dementia distribution and investigated the potential correlation between the two epidemiological trends. Materials and Methods: Crude and age-standardized incidence, prevalence, mortality rate, and disability-adjusted life years (DALYs) lost, derived from GBD 2019, were reported for AF and dementia. Global features were also stratified by high and low sociodemographic-index (SDI) countries. Granger test analysis was performed to investigate the correlation between AF and dementia incidence time trends. Results: From 1990 to 2019 crude worldwide incidence and prevalence showed a dramatic increase for both conditions (from 43.24 to 61.01 and from 528.72 to 771.51 per 100,000 individuals for AF, respectively; from 54.60 to 93.52 and from 369.88 to 667.2 per 100,000 individuals for dementia, respectively). In the same timeframe, crude mortality rate doubled for AF and dementia (from 2.19 to 4.08, and from 10.49 to 20.98 per 100,000 individuals, respectively). Age-standardized estimate showed a substantial stability over the years, highlighting the key role of the progressively aging population. Crude estimates of all of the investigated metrics are greater in high SDI countries for both conditions. This association was still valid for age-standardized metrics, albeit by a reduced magnitude, suggesting the presence of higher risk factor burden in these countries. Finally, according to Granger test, we found a significant association between the historical trends of AF and dementia incidence (p = 0.004). Conclusions: AF and dementia burden progressively increased in the last three decades. Given the potential association between these two conditions, further clinical data assessing this relationship is needed.
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Abstract
Interatrial blocks like other types of block may be of first degree or partial second degree, also named transient atrial block or atrial aberrancy, and third degree or advanced. In first degree, partial interatrial block (P-IAB), the electrical impulse is conducted to the left atrium, through the Bachmann’s region, but with delay. The ECG shows a P-wave ≥ 120 ms. In third-degree, advanced interatrial block (A-IAB), the electrical impulse is blocked in the upper part of the interatrial septum (Bachmann region); the breakthrough to LA has to be performed retrogradely from the AV junction zone. This explains the p ± in leads II, III and aVF. In typical cases of A-IAB, the P-wave morphology is biphasic (±) in leads II, III and aVF, because the left atrium is activated retrogradely and, therefore, the last part of the atrial activation falls in the negative hemifield of leads II, III and aVF. Recently, some atypical cases of A-IAB have been described. The presence of A-IAB is a risk factor for atrial fibrillation, stroke, dementia, and premature death.
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13
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Martínez-Sellés M, Bruña V, Lacalzada-Almeida J, Díez-Villanueva P, Ruiz-Ortiz M, Alzola E, Arnau MÁ, Tobar J, Hernández JM, Bonet A, Castro V, Rubín JM, García-Martín A, Pérez-David E. Rationale and design of the rigorous atrial analysis in advanced interatrial block (ARABIA) prospective study. J Electrocardiol 2021; 68:135-140. [PMID: 34419649 DOI: 10.1016/j.jelectrocard.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Advanced interatrial block (IAB) is present in 10% of subjects ≥75 years and is associated with the risk of clinical events. METHODS AND RESULTS Prospective multicenter study that will include subjects ≥75 years without exclusion criteria (indication for anticoagulation, cardiac devices, severe valve disease, systolic dysfunction, moderate or severe cognitive impairment, poor echocardiographic window, non-sinus rhythm or partial IAB, stroke, and life expectancy <2 years). A total of 356 subjects, 178 patients with advanced IAB (exposed) and 178 matched individuals with normal P-wave (non-exposed) will be included. Electrocardiogram and advanced transthoracic echocardiography will be performed. Two substudies will include magnetic resonance imaging: cardiac (86 subjects, 43 exposed, and 43 non-exposed) and brain (86 subjects, 43 exposed, and 43 non-exposed). The follow-up will be 2 years. Our main objective is to determine the association of advanced IAB, P-wave duration, and atrial imaging parameters (I] atrial global longitudinal strain, II] maximal left atrial volume index, III] left atrial ejection fraction, IV] left atrial fibrosis - % total left atrial area V] inter- and intra-atrial asynchrony/dyssynchrony) with clinical events (atrial fibrillation, stroke, cognitive impairment, and mortality). The secondary objective is to assess the association of the P-wave duration with atrial imaging parameters and of both with cerebral microemboli in magnetic resonance imaging. CONCLUSION Our study will provide data regarding the association of advanced IAB, P-wave duration, and atrial imaging parameters with clinical events. We will also assess the association P-wave duration-atrial imaging parameters-cerebral microemboli.
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Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain.
| | - Vanesa Bruña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain; Servicio de Cardiología, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Juan Lacalzada-Almeida
- Laboratorio de Imagen Cardíaca, Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | | | - Martin Ruiz-Ortiz
- Servicio de Cardiología, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Elisabete Alzola
- Servicio de Cardiología, Hospital Universitario de Cruces, Baracaldo, Bilbao, Spain
| | - Miguel Ángel Arnau
- Servicio de Cardiología, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Javier Tobar
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Jesús Manuel Hernández
- Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Ana Bonet
- Servicio de Cardiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Victor Castro
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Jose Manuel Rubín
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ana García-Martín
- Servicio de Cardiología. Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Esther Pérez-David
- Servicio de Cardiología, Hospital Universitario de la Paz, Madrid, Spain
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14
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Sanna GD, Argiolas D, Franca P, Saderi L, Sotgiu G, Parodi G. Relationship between electrocardiographic interatrial blocks and echocardiographic indices of left atrial function in acute heart failure. Heart Vessels 2021; 37:50-60. [PMID: 34091737 DOI: 10.1007/s00380-021-01886-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/28/2021] [Indexed: 12/21/2022]
Abstract
The presence of an interatrial block (IAB) on surface ECG should be considered as a hallmark of atrial electrical remodelling. This is often accompanied by morphological abnormalities. We aimed to investigate the frequency of IAB and its relationship with the echocardiographic indices of left atrial (LA) remodelling in patients hospitalised with acute HF. Ninety-four consecutive HF patients underwent 12-lead ECG, transthoracic echocardiogram including a detailed study of the LA, and blood tests (including NT-proBNP) on the same day. Thirty-six patients were excluded from the analysis because of atrial fibrillation or rhythms other than sinus. Twenty-eight over 58 (48%) were males. Median age was 72 (IQR 60-82) years. The majority of patients (72%) were diagnosed as having an HF with reduced ejection fraction. Overall, 27 (46%) patients presented with an advanced III or IV NYHA functional class. Median plasma NT-proBNP was 3046 (IQR 1066-5460) pg/ml. Nearly, all the enrolled patients (90%) showed LA dilation. Nineteen patients (33%) presented with advanced IAB. There was a trend toward a more advanced age in patients with advanced IAB (median age 79 vs 68, p = 0.051). Moreover, they were more frequently treated with anticoagulants (42% vs 13%, p = 0.01), and they exhibited greater LA structural and functional remodelling documented by larger area (28 vs 26 cm2, p = 0.04) and greater minimum LA volume index-LAVi (43 ± 16 vs 36 ± 10, p = 0.04). Advanced IAB resulted to be an independent determinant of LA area (Beta 3.49 (0.37-6.60), p = 0.03) and minimum LAVi (Beta 7.22 (0.15-14.30), p = 0.045), and vice versa. LA electrical and structural remodelling is highly prevalent in a non-selected cohort of patients with acute HF. Advanced IAB on surface ECG is present in a high percentage of cases. Patients with advanced IAB tend to be older, and they exhibit higher degrees of LA structural and functional remodelling.
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Affiliation(s)
- Giuseppe D Sanna
- Cardiovascular Department, Sassari University Hospital, Via Enrico De Nicola, 07100, Sassari, Italy.
| | - Dario Argiolas
- Cardiovascular Department, Sassari University Hospital, Via Enrico De Nicola, 07100, Sassari, Italy
| | - Paolo Franca
- Cardiovascular Department, Sassari University Hospital, Via Enrico De Nicola, 07100, Sassari, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Guido Parodi
- Cardiovascular Department, Sassari University Hospital, Via Enrico De Nicola, 07100, Sassari, Italy
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15
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Gentille-Lorente DI, Scott L, Escobar-Robledo LA, Mesa-Maya MA, Carreras-Costa F, Baranchuk A, Martínez-Sellés M, Elosua R, Bayés-Genís A, Bayés-de-Luna A. Atypical advanced interatrial block due to giant atrial lipoma. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:737-739. [PMID: 33675233 DOI: 10.1111/pace.14210] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/25/2022]
Affiliation(s)
| | - Laura Scott
- Division of Cardiology, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Luis Alberto Escobar-Robledo
- Cardiovascular Research Foundation. Cardiovascular ICCC- Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - María Antonia Mesa-Maya
- Cardiovascular Research Foundation. Cardiovascular ICCC- Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Francesc Carreras-Costa
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto Investigación Biomédica Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Cardiovascular Diseases (CIBERCV), Barcelona, Spain.,Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC) Vic, Barcelona, Spain
| | - Antoni Bayés-Genís
- Heart Institute (iCor), University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Antoni Bayés-de-Luna
- Cardiovascular Research Foundation. Cardiovascular ICCC- Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
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16
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Iomini PA, Martínez-Sellés M, Elosua R, Bayés-de-Luna A, Baranchuk A. [Bayés Syndrome, Stroke and Dementia]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:27-39. [PMID: 37727263 PMCID: PMC10506554 DOI: 10.47487/apcyccv.v2i1.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/03/2021] [Indexed: 09/21/2023]
Abstract
Bayés's syndrome is a clinical entity based on the association between advanced interatrial block and the development of supraventricular tachyarrhythmia, being atrial fibrillation (AF) the most frequent. This association was discovered by Prof. Antoni Bayés de Luna in the '80s. Further studies by other groups found a strong relationship between Bayés's syndrome and thromboembolic phenomena, being stroke the most serious. Moreover, patients with this syndrome have an increased incidence of cognitive impairment and dementia. This observation triggered the question about whether the use of anticoagulation therapy prior to the documentation of AF could prevent A-IAB associated thromboembolic events. There are ongoing studies in different phases of development aiming to compare the efficacy of anticoagulation in patients with A-IAB with no prior documentation of AF. The outcomes of these studies will allow determining the efficacy of this early therapeutic intervention, and help deciding the role of anticoagulation in patients with A-IAB and no demonstrated AF.
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Affiliation(s)
- Pablo A. Iomini
- *Correspondencia: Balcarce 434, Morón (CP 1708), Buenos Aires, Argentina. Correo
| | - Manuel Martínez-Sellés
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV). EspañaCentro de InvestigaciónRed de Enfermedades Cardiovasculares (CIBERCV)España
- Hospital General Universitario Gregorio Marañón. Madrid, EspañaHospital General Universitario Gregorio MarañónMadridEspaña
- Universidad Europea de Madrid y Universidad Complutense de Madrid, EspañaUniversidad Europea de MadridUniversidad Europea de Madrid y Universidad Complutense de MadridSpain
| | - Roberto Elosua
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV). EspañaCentro de InvestigaciónRed de Enfermedades Cardiovasculares (CIBERCV)España
- Facultad de Medicina, Universidad de Vic-Universidad Central de Catalunya. Barcelona, EspañaFacultad de MedicinaUniversidad Central de CatalunyaBarcelonaEspaña
- Fundación Investigación Cardiovascular, Programa Cardiovascular-ICCC, Institut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant Pau. Barcelona, EspañaFundación Investigación CardiovascularPrograma Cardiovascular-ICCCInstitut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant PauBarcelonaEspaña
| | - Antoni Bayés-de-Luna
- Fundación Investigación Cardiovascular, Programa Cardiovascular-ICCC, Institut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant Pau. Barcelona, EspañaFundación Investigación CardiovascularPrograma Cardiovascular-ICCCInstitut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant PauBarcelonaEspaña
| | - Adrián Baranchuk
- Division of cardiology, Kingston Health Science Center, Kingston.Ontario, CanadaDivision of cardiologyKingston Health Science CenterOntarioCanada
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17
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Bayés-de-Luna A, Bayés-Genís A. Clinical implications of advanced interatrial block: Bayés syndrome. Med Clin (Barc) 2020; 156:233-234. [PMID: 33309044 DOI: 10.1016/j.medcli.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Antoni Bayés-de-Luna
- Fundación Investigación Cardiovascular, Programa Cardiovascular-ICCC, Institut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant Pau, Barcelona, España; Hospital Universitari Quiron, Barcelona, España.
| | - Antoni Bayés-Genís
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, España, Universitat Autònoma de Barcelona; y; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), España
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18
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Herrera C, Bruña V, Abizanda P, Díez-Villanueva P, Formiga F, Torres R, Carreras J, Ayala R, Martin-Sánchez FJ, Bayés-Genis A, Elosua R, Bayés-de-Luna A, Martínez-Sellés M. Relation of Interatrial Block to Cognitive Impairment in Patients ≥ 70 Years of Age (From the CAMBIAD Case-control Study). Am J Cardiol 2020; 136:94-99. [PMID: 32946858 DOI: 10.1016/j.amjcard.2020.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 01/14/2023]
Abstract
The association between atrial fibrillation, stroke, and interatrial block (IAB) (P-wave duration ≥120 ms) is well recognized, particularly in the case of advanced IAB. We aimed to assess the association of IAB with mild cognitive impairment. Advanced Characterization of Cognitive Impairment in Elderly with Interatrial Block was a case-control multicenter study, conducted in subjects aged ≥70 years in sinus rhythm without significant structural heart disease. Diagnosis of mild cognitive impairment was performed by an expert geriatrician, internist, or neurologist in the presence of changes in cognitive function (Mini Mental State Examination score 20 to 25) without established dementia. A total of 265 subjects were included. Mean age was 79.6 ± 6.3 years and 174 (65.7%) were women; there were 143 cases with mild cognitive impairment and 122 controls with normal cognitive function. Compared with controls, cases had longer P-wave duration (116.2 ± 13.8 ms vs 112.5 ± 13.3 ms, p = 0.028), higher prevalence of IAB (73 [51.0%] vs 38 [31.1%], p = 0.001), higher prevalence of advanced IAB (28 [19.6%] vs 10 [8.2%], p = 0.002), and higher MVP ECG risk score (2.7 ± 1.4 vs 2.2 ± 1.3, p = 0.004). IAB was independently associated with mild cognitive impairment, both for partial (odds ratio 2.0, 95% CI: 1.1 to 3.9) and advanced IAB (odds ratio 2.8, 95% CI: 1.1 to 6.7). In conclusion, in subjects aged ≥70 years without significant structural heart disease, IAB is independently associated with mild cognitive impairment. This association is stronger in the case of advanced IAB.
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