1
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Zhang J, Wang J, Jiang Y, Zheng X, Li W, Li H. Association of Mitral Regurgitation with Postoperative Atrial Fibrillation in Critically Ill Noncardiac Surgery Patients: A Prospective Cohort Study. Int J Gen Med 2023; 16:769-783. [PMID: 36879619 PMCID: PMC9985404 DOI: 10.2147/ijgm.s400122] [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: 12/03/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
Purpose Atrial fibrillation (AF) is common in critically ill patients and can have serious consequences. Postoperative AF (POAF) in critically ill patients following noncardiac surgery has been understudied, contrary to cardiac procedures. Mitral regurgitation (MR) is associated with left ventricular dysfunction, which might contribute to the occurrence of AF in postoperative critically ill patients. This study aimed to investigate the association between MR and POAF in critically ill noncardiac surgery patients and establish a new nomogram for the prediction of POAF in critically ill noncardiac surgery patients. Patients and Methods A prospective cohort of 2474 patients who underwent thoracic and general surgery was enrolled in this study. Data on preoperative transthoracic echocardiography (TTE), electrocardiogram (ECG), and several commonly utilized scoring systems (CHA2DS2-VASc, HATCH, COM-AF, HART, and C2HEST) and baseline clinical data were collected. Independent predictors were selected by univariate and multivariable logistic regression analysis, and a nomogram was constructed for POAF within 7 days after postoperative intensive care unit (ICU) admission. The ability of the MR-nomogram and other scoring systems to predict POAF was compared by receiver operator characteristic (ROC) curve analysis and decision curve analysis (DCA). Additional contributions were evaluated by integrated discrimination improvement (IDI) and net reclassification improvement (NRI) analysis. Results A total of 213 (8.6%) patients developed POAF within 7 days after ICU admission. Compared to CHA2DS2-VASc, HATCH, COM-AF, HART, and C2HEST scoring systems, MR-nomogram showed better predictive ability for POAF with an area under the ROC curve of 0.824 (95% confidence interval: 0.805-0.842, p < 0.001). The improvement of the MR-nomogram in predictive value was supported by NRI and IDI analysis. The net benefit of the MR nomogram was maximal in DCA. Conclusion MR is an independent risk factor of POAF in critically ill noncardiac surgery patients. The nomogram predicted POAF better than other scoring systems.
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Affiliation(s)
- Jin Zhang
- Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jingyi Wang
- Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yijia Jiang
- Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xi Zheng
- Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenxiong Li
- Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hui Li
- Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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Ohmori H, Sakamoto SI, Miyagi Y, Ishii Y, Nitta T. Shunt and pace: a novel experimental model of atrial fibrillation with a volume-loaded left atrium. Gen Thorac Cardiovasc Surg 2022; 71:272-279. [PMID: 36031668 DOI: 10.1007/s11748-022-01866-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is frequently seen in patients with a volume-loaded left atrium (LA) such as mitral valve regurgitation (MR). Previous animal models have incomplete relevance to human AF associated with MR. METHODS A novel experimental model with a combination of volume loading of LA by creating a shunt from the subclavian artery to pulmonary artery and electrical remodeling induced by continuous rapid LA pacing was designed and the electrophysiological effects were examined in 10 canines. Five weeks after the shunt surgery, the entire atrial epicardium was mapped during sustained AF with form-fitted electrode patches with 246 bipolar electrodes and a three-dimensional dynamic mapping system to characterize the induced AF. RESULTS Three animals died of severe heart failure and pacing failure occurred in one. Remaining six animals were subjected to the analysis. The LA diameter increased progressively after the shunt surgery. Sustained AF was induced after 3 weeks of continuous rapid LA pacing in all animals. The activation maps revealed repetitive focal activations arising from the pulmonary veins, right or left atrial regions, and reentrant activations in the RA, which patterns of atrial activations are the same as those seen in human AF. CONCLUSION The animal model with a combination of LA volume load and electrical remodeling was relevant to human AF associated with LA volume load. Studies using the present model may provide further knowledges of AF and may be useful in examining the effects of pharmacological and non-pharmacological therapies.
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Affiliation(s)
- Hiroya Ohmori
- Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shun-Ichiro Sakamoto
- Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yasuo Miyagi
- Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yosuke Ishii
- Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Takashi Nitta
- Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
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3
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Association of RDW, NLR, and PLR with Atrial Fibrillation in Critical Care Patients: A Retrospective Study Based on Propensity Score Matching. DISEASE MARKERS 2022; 2022:2694499. [PMID: 35669502 PMCID: PMC9166973 DOI: 10.1155/2022/2694499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/09/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022]
Abstract
Objective Previous studies have shown inconsistent results in relation to the red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) of atrial fibrillation (AF). This retrospective study is aimed at detecting the association of RDW, NLR, and PLR with AF. Methods A total of 4717 critical care patients were screened from the Medical Information Mart for Intensive Care- (MIMIC-) III database. The patients were separated into the non-AF and AF groups. The imbalances between the groups were reduced using propensity score matching (PSM). ROC curves were generated to detect the diagnostic value of RDW, NLR, and PLR. Logistic regression analysis was used to detect the risk factors for AF. Results A total of 991 non-AF patients paired with 991 AF patients were included after PSM in this study. The RDW level in the AF group was significantly higher than that in the non-AF group (15.09 ± 1.93vs. 14.89 ± 1.91, P = 0.017). Neither NLR nor PLR showed any significant difference between the two groups (P > 0.05 for each). According to ROC curve, RDW showed a very low diagnostic value of AF (AUC = 0.5341), and the best cutoff of RDW was 14.1 (ACU = 0.5257, sensitivity = 0.658, specificity = 0.395). Logistic regression analysis showed that an elevated RDW level increased 1.308-fold (95%CI = 1.077-1.588, P = 0.007) risk of AF. Neither elevated NLR nor elevated PLR was a significant risk factor for AF (OR = 0.993, 95%CI = 0.802-1.228, P = 0.945 for NLR; OR = 0.945, 95%CI = 0.763-1.170, P = 0.603 for PLR). Conclusions Elevated RDW level but not NLR or PLR levels is associated with AF. RDW > 14.1 is a risk factor for AF, but its diagnostic capacity for AF is not of great value.
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4
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Nasciutti PR, Moraes AT, Santos TK, Gonçalves Queiroz KK, Costa APA, Amaral AR, Fernando Gomes Olivindo R, Pontieri CFF, Jeremias JT, Vendramini THA, Brunetto MA, Carvalho RDOA. Protective effects of omega-3 fatty acids in dogs with myxomatous mitral valve disease stages B2 and C. PLoS One 2021; 16:e0254887. [PMID: 34265016 PMCID: PMC8282066 DOI: 10.1371/journal.pone.0254887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/07/2021] [Indexed: 12/02/2022] Open
Abstract
Myxomatous mitral valve disease (MMVD) is characterized by thickening of the valve leaflets and omega-3 (ω-3) supplementation has been associated with modulation of blood pressure (BP) and heart rate, improvement of doppler echocardiographic indices, antiarrhythmic, anti-inflammatory and anti-dislipidemic effects in dogs and humans, although prospective studies of it single use are still absent in the veterinary literature. The objective of this study was to evaluate the influence of ω-3 supplementation in dogs with MMVD. Twenty-nine dogs were followed quarterly for 12 months by clinical evaluation, arterial blood pressure, electrocardiography, doppler echocardiography, thoracic radiography and laboratory tests including inflammatory mediators and cardiac biomarker blood concentrations. The dogs were classified in stages B2 and C, according to the classification proposed by ACVIM 2019. They were randomly assigned to either ω-3 group (ω-3G) or control group (CG). The ingestion of ω-3 reduced the chance of developing arrhythmias by 2.96 times (p = 0.003). The vertebral heart size (VHS) measurements were higher in the control group (p = 0.033). In conclusion, at the dosages used in this study, ω-3 dietary supplementation reduces the volumetric overload, has antiarrhythmic effect and keeps dogs with B2 and C stages of MMVD in milder stages of the disease.
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Affiliation(s)
- Priscilla Regina Nasciutti
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
| | - Aline Tavares Moraes
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
| | - Thaiz Krawczyk Santos
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
| | - Karine Kelly Gonçalves Queiroz
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
| | - Ana Paula Araújo Costa
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
| | - Andressa Rodrigues Amaral
- Nutrition and Production Department, Pet Nutrology Research Center, School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), Pirassununga, Brazil
| | - Rodrigo Fernando Gomes Olivindo
- Nutrition and Production Department, Pet Nutrology Research Center, School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), Pirassununga, Brazil
| | | | - Juliana Toloi Jeremias
- Nutritional Development Center, Grandfood Indústria e Comércio Ltda (Premier Pet), Dourado, Brazil
| | - Thiago Henrique Annibale Vendramini
- Nutrition and Production Department, Pet Nutrology Research Center, School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), Pirassununga, Brazil
| | - Marcio Antonio Brunetto
- Nutrition and Production Department, Pet Nutrology Research Center, School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), Pirassununga, Brazil
| | - Rosângela de Oliveira Alves Carvalho
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
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5
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Ke F, Huang Y, Jin Z, Huang L, Xiong Q, Jia F, Chen Y, Chen G. Association between functional mitral regurgitation and recurrence of paroxysmal atrial fibrillation following catheter ablation: a prospective cohort study. J Int Med Res 2021; 49:3000605211014375. [PMID: 33983087 PMCID: PMC8127776 DOI: 10.1177/03000605211014375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The present study aimed to investigate the effect of functional mitral regurgitation (FMR) on recurrence of paroxysmal atrial fibrillation (PAF) in patients undergoing radiofrequency catheter ablation. METHODS This prospective cohort study comprised 107 patients with PAF. The patients were divided into the FMR and non-FMR groups. FMR was assessed by Doppler echocardiography before index ablation. All patients initially underwent circumferential pulmonary vein isolation (CPVI) and were followed up for 12 months after ablation. PAF, atrial tachycardia, or atrial flutter served as the endpoint indicator. RESULTS The median duration of PAF was 24 (3-60) months. Binary logistic univariate and multivariate analyses showed that FMR was not a risk factor for recurrence of catheter ablation for PAF (hazard ratio=0.758, 95% confidence interval: 0.191-3.004; hazard ratio=0.665, 95% confidence interval: 0.134-3.300, respectively). Kaplan-Meier analysis showed no significant difference in the recurrence rate between the groups. Fifteen (15/107, 14%) cases of PAF were triggered by the pulmonary vein. Three (3/107, 2.8%) cases of PAF were triggered by the superior vena cava. CONCLUSIONS FMR is not an independent risk factor for predicting recurrence of catheter ablation for PAF. FMR does not affect patients undergoing radiofrequency catheter ablation for PAF.
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Affiliation(s)
- Fusheng Ke
- Department of Cardiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yinhui Huang
- Department of Neurology, Jinjiang Municipal Hospital, Jinjiang, China
| | - Zhexiu Jin
- Department of Cardiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Lei Huang
- Department of Cardiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Qiang Xiong
- Department of Emergency, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Fang Jia
- Department of Cardiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yu Chen
- Department of Pediatrics, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Gang Chen
- Department of Cardiology, Shanghai General Hospital, Shanghai, China
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6
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Xiao J, Zhang Y, Tang Y, Dai H, OuYang Y, Li C, Yu M. hsa-miR-4443 inhibits myocardial fibroblast proliferation by targeting THBS1 to regulate TGF-β1/α-SMA/collagen signaling in atrial fibrillation. ACTA ACUST UNITED AC 2021; 54:e10692. [PMID: 33681892 PMCID: PMC7931814 DOI: 10.1590/1414-431x202010692] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/09/2020] [Indexed: 12/25/2022]
Abstract
Fibrosis caused by the increase in extracellular matrix in cardiac fibroblasts plays an important role in the occurrence and development of atrial fibrillation (AF). The aim of this study was to investigate the role of hsa-miR-4443 in AF, human cardiac fibroblast (HCFB) proliferation, and extracellular matrix remodeling. TaqMan Stem-loop miRNA assay was used to measure hsa-miR-4443 expression in patients with persistent AF (n=123) and healthy controls (n=100). Patients with AF were confirmed to have atrial fibrosis by late gadolinium enhancement. At the cellular level, after hsa-miR-4443 mimic and inhibitor were transfected with HCFBs, proliferation, apoptosis, migration, and invasion were analyzed. Lastly, hsa-miR-4443-targeted gene and transforming growth factor (TGF)-β1/α-SMA/collagen pathway were evaluated by dual-luciferase reporter assay and western blot, respectively. In patients with AF, hsa-miR-4443 decreased significantly and collagen metabolism level increased significantly. Logistic regression analysis showed that low hsa-miR-4443 level was a risk factor of AF (P<0.001). The receiver operating characteristic curve revealed that hsa-miR-4443 was useful for predicting AF (area under the curve: 0.828, sensitivity: 0.71, specificity: 0.78, P<0.001). In HCFBs, hsa-miR-4443 targeted thrombospondin-1 (THBS1) and downregulated TGF-β1/α-SMA/collagen pathway. The inhibition of hsa-miR-4443 expression promoted HCFB proliferation, migration, invasion, myofibroblast differentiation, and collagen production. The significant reduction of hsa-miR-4443 can be used as a biomarker for AF. hsa-miR-4443 protected AF by targeting THBS1 and regulated TGF-β1/α-SMA/collagen pathway to inhibit HCFB proliferation and collagen synthesis.
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Affiliation(s)
- Jingwen Xiao
- Department of Cardiovascular Medicine, FuZhou First Hospital, FuZhou, Fujian, China
| | - Yan Zhang
- Department of Cardiovascular Medicine, FuZhou First Hospital, FuZhou, Fujian, China
| | - Yuan Tang
- Cardiac Function Laboratory of Cardiovascular Medicine, FuZhou First Hospital, FuZhou, Fujian, China
| | - Hengfen Dai
- Department of Clinical Pharmacy, FuZhou First Hospital, FuZhou, Fujian, China
| | - Yu OuYang
- Department of Cardiovascular Medicine, FuZhou First Hospital, FuZhou, Fujian, China
| | - Chuanchuan Li
- Department of Cardiovascular Medicine, FuZhou First Hospital, FuZhou, Fujian, China
| | - Meiqin Yu
- Cardiac Function Laboratory of Cardiovascular Medicine, FuZhou First Hospital, FuZhou, Fujian, China
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7
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Li X, Garcia-Elias A, Benito B, Nattel S. The effects of cardiac stretch on atrial fibroblasts: Analysis of the evidence and potential role in atrial fibrillation. Cardiovasc Res 2021; 118:440-460. [PMID: 33576384 DOI: 10.1093/cvr/cvab035] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/27/2020] [Accepted: 02/09/2021] [Indexed: 01/06/2023] Open
Abstract
Atrial fibrillation (AF) is an important clinical problem. Chronic pressure/volume overload of the atria promotes AF, particularly via enhanced extracellular matrix (ECM) accumulation manifested as tissue fibrosis. Loading of cardiac cells causes cell-stretch that is generally considered to promote fibrosis by directly activating fibroblasts, the key cell-type responsible for ECM-production. The primary purpose of this article is to review the evidence regarding direct effects of stretch on cardiac fibroblasts, specifically: (i) the similarities and differences among studies in observed effects of stretch on cardiac-fibroblast function; (ii) the signaling-pathways implicated; and (iii) the factors that affect stretch-related phenotypes. Our review summarizes the most important findings and limitations in this area and gives an overview of clinical data and animal models related to cardiac stretch, with particular emphasis on the atria. We suggest that the evidence regarding direct fibroblast activation by stretch is weak and inconsistent, in part because of variability among studies in key experimental conditions that govern the results. Further work is needed to clarify whether, in fact, stretch induces direct activation of cardiac fibroblasts and if so, to elucidate the determining factors to ensure reproducible results. If mechanical load on fibroblasts proves not to be clearly profibrotic by direct actions, other mechanisms like paracrine influences, the effects of systemic mediators and/or the direct consequences of myocardial injury or death, might account for the link between cardiac stretch and fibrosis. Clarity in this area is needed to improve our understanding of AF pathophysiology and assist in therapeutic development.
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Affiliation(s)
- Xixiao Li
- Department of Medicine and Research Center, Montreal Heart Institute, Montreal, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada
| | - Anna Garcia-Elias
- Department of Medicine and Research Center, Montreal Heart Institute, Montreal, Canada
| | - Begoña Benito
- Vascular Biology and Metabolism Program, Vall d'Hebrón Research Institute (VHIR), Barcelona, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stanley Nattel
- Department of Medicine and Research Center, Montreal Heart Institute, Montreal, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada.,Department of Pharmacology and Physiology of the Université de Montréal Faculty of Medicine, Montreal, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.,IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France
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8
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Abstract
Atrial fibrillation (AF) contributes to morbidity and mortality of millions of individuals. Its molecular, cellular, neurohumoral, and hemodynamic pathophysiological mechanisms are complex, and there is increasing awareness that a wide range of comorbidities can contribute to AF-promoting atrial remodeling. Moreover, recent research has highlighted that AF risk is not constant and that the temporal variation in concomitant conditions contributes to the complexity of AF dynamics. In this review, we provide an overview of fundamental AF mechanisms related to established and emerging comorbidities or risk factors and their role in the AF-promoting effects. We focus on the accumulating evidence for the relevance of temporally dynamic changes in these risk factors and the consequence for AF initiation and maintenance. Finally, we highlight the important implications for future research and clinical practice resulting from the dynamic interaction between AF risk factors and mechanisms.
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Affiliation(s)
- Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands;
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands; .,Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands; .,Department of Cardiology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands.,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5005 Adelaide, South Australia, Australia
| | - Ulrich Schotten
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands; .,Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands;
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9
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Khiabani AJ, Schuessler RB, Damiano RJ. Surgical ablation of atrial fibrillation in patients with heart failure. J Thorac Cardiovasc Surg 2020; 162:1100-1105. [PMID: 32948298 DOI: 10.1016/j.jtcvs.2020.05.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Ali J Khiabani
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo
| | - Richard B Schuessler
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
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10
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R Schill M, S Cuculich P, M Andrews C, Vijayakumar R, Ruaengsri C, C Henn M, S Lancaster T, J Melby S, B Schuessler R, Rudy Y, J Damiano R. The Arrhythmic Substrate for Atrial Fibrillation in Patients with Mitral Regurgitation. J Atr Fibrillation 2020; 13:2304. [PMID: 34950292 DOI: 10.4022/jafib.2304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 11/10/2022]
Abstract
Objective Patients with severe mitral regurgitation commonly develop atrial fibrillation. The precise mechanisms of this relationship remain unknown. The objective of this study was to apply noninvasive electrocardiographic imaging of the atria during sinus rhythm to identify changes in atrial electrophysiology that may contribute to development of atrial fibrillation in patients with severe mitral regurgitation referred for mitral valve surgery. Methods Twenty subjects (9 atrial fibrillation and mitral regurgitation, 11 mitral regurgitation alone) underwent electrocardiographic imaging. Biatrial electrophysiology was imaged with activation maps in sinus rhythm. The reconstructed unipolar electrograms were analyzed for voltage amplitude, number of deflections and conduction heterogeneity. In subjects with mitral regurgitation, left atrial biopsies were obtained at the time of surgery. Results: Subjects with history of atrial fibrillation demonstrated prolonged left atrial conduction times (110±25 ms vs. mitral regurgitation alone (85±21), p=0.025); right atrial conduction times were unaffected. Variable patterns of conduction slowing were imaged in the left atria of most subjects, but those with prior history of atrial fibrillation had more complex patterns of conduction slowing or unidirectional block. The presence of atrial fibrillation was not associated with the extent of fibrosis in atrial biopsies. Conclusions Detailed changes in sinus rhythm atrial electrophysiology can be imaged noninvasively and can be used to assess the impact and evolution of atrial fibrillation on atrial conduction properties in patients with mitral regurgitation. If replicated in larger studies, electrocardiographic imaging may identify patients with mitral regurgitation at risk for atrial fibrillation and could be used to guide treatment strategies.
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Affiliation(s)
- Matthew R Schill
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Phillip S Cuculich
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8086, St. Louis, MO 63110, USA
| | - Christopher M Andrews
- Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Ramya Vijayakumar
- Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Chawannuch Ruaengsri
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Matthew C Henn
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Timothy S Lancaster
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Spencer J Melby
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Richard B Schuessler
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA.,Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Yoram Rudy
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8086, St. Louis, MO 63110, USA.,Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Ralph J Damiano
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
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11
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Kuvvetli A, Bulut A, Sumbul HE, Koca H, Avci A, Avci BS, Koc M. Frequency of postoperative atrial fibrillation and related parameters in patients who underwent sleeve gastrectomy for obesity. Minerva Surg 2020; 76:179-186. [PMID: 32773743 DOI: 10.23736/s2724-5691.20.08358-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In this study, we planned to determine the frequency of postoperative AF and its related parameters in morbidly obese patients who underwent bariatric surgery. METHODS The study included 300 patients with morbidly obese who had no history of AF and underwent successful bariatric surgery. Routine anamnesis, physical examination and laboratory parameters of the patients were recorded. Patients with postoperative AF were detected. The participants were grouped as patients with and without AF. RESULTS Postoperative AF occurred in 19 (6.3%) patients. Age, BMI and LAd diameter parameters independently determined the presence of AF. When the ROC curve was performed to identify patients with AF, the area under the ROC curve was found to be 0.841, 0.785 and 0.902 for age, BMI and LAd diameter, respectively. According to this analysis, 50 years for age, 43 kg/m2 for BMI and 40 mm for LAd were used to determine patients with AF with acceptable sensitivity and specificity (>70% each). CONCLUSIONS The most important determinants of postoperative AF are age, LAd and basal BMI. Therefore, morbidly obese patients with LAd >40 mm, BMI >43 kg/m2 and >50 years of age should be followed up more closely for postoperative AF development and preoperative precautions should be taken to prevent AF development.
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Affiliation(s)
- Adnan Kuvvetli
- Department of General Surgery, Adana Health Practice and Research Center, University of Health Sciences, Adana, Turkey
| | - Atilla Bulut
- Department of Cardiology, Adana Health Practice and Research Center, University of Health Sciences, Adana, Turkey
| | - Hilmi E Sumbul
- Department of Internal Medicine, Adana Health Practice and Research Center, University of Health Sciences, Adana, Turkey
| | - Hasan Koca
- Department of Cardiology, Adana Health Practice and Research Center, University of Health Sciences, Adana, Turkey
| | - Akkan Avci
- Department of Emergency Medicine, Adana Health Practice and Research Center, University of Health Sciences, Adana, Turkey -
| | - Begum S Avci
- Department of Internal Medicine, Adana Health Practice and Research Center, University of Health Sciences, Adana, Turkey
| | - Mevlut Koc
- Department of Cardiology, Adana Health Practice and Research Center, University of Health Sciences, Adana, Turkey
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12
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Mozos I, Gug C, Mozos C, Stoian D, Pricop M, Jianu D. Associations between Intrinsic Heart Rate, P Wave and QT Interval Durations and Pulse Wave Analysis in Patients with Hypertension and High Normal Blood Pressure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124350. [PMID: 32560524 PMCID: PMC7344459 DOI: 10.3390/ijerph17124350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 01/01/2023]
Abstract
The present study aimed to explore the relationship between electrocardiographic (ECG) and pulse wave analysis variables in patients with hypertension (HT) and high normal blood pressure (HNBP). A total of 56 consecutive, middle-aged hypertensive and HNBP patients underwent pulse wave analysis and standard 12-lead ECG. Pulse wave velocity (PWV), heart rate, intrinsic heart rate (IHR), P wave and QT interval durations were as follows: 7.26 ± 0.69 m/s, 69 ± 11 beats/minute, 91 ± 3 beats/minute, 105 ± 22 mm and 409 ± 64 mm, respectively. Significant correlations were obtained between PWV and IHR and P wave duration, respectively, between early vascular aging (EVA) and P wave and QT interval durations, respectively. Linear regression analysis revealed significant associations between ECG and pulse wave analysis variables but multiple regression analysis revealed only IHR as an independent predictor of PWV, even after adjusting for blood pressure variables and therapy. Receiver-operating characteristic (ROC) curve analysis revealed P wave duration (area under curve (AUC) = 0.731; 95% CI: 0.569-0.893) as a predictor of pathological PWV, and P wave and QT interval durations were found as sensitive and specific predictors of EVA. ECG provides information about PWV and EVA in patients with HT and HNBP. IHR and P wave durations are independent predictors of PWV, and P wave and QT interval may predict EVA.
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Affiliation(s)
- Ioana Mozos
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300173 Timisoara, Romania;
- Center for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy, 300173 Timisoara, Romania
| | - Cristina Gug
- Department of Microscopic Morphology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: (C.G.); (M.P.)
| | - Costin Mozos
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300042 Timisoara, Romania;
| | - Dana Stoian
- 2nd Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300723 Timisoara, Romania;
| | - Marius Pricop
- Discipline of Maxillofacial Surgery, Faculty of Dentistry, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300062 Timisoara, Romania
- Correspondence: (C.G.); (M.P.)
| | - Daniela Jianu
- 1st Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Internal Medicine, Military Hospital, 300041 Timisoara, Romania
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13
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Fryer ML, Balsam LB. Commentary: At the heart of the matter-Left atrial volume index in chronic mitral regurgitation. J Thorac Cardiovasc Surg 2019; 160:673-674. [PMID: 31635862 DOI: 10.1016/j.jtcvs.2019.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - Leora B Balsam
- Division of Cardiac Surgery, UMass Memorial Medical Center, Worcester, Mass.
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14
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The new age of atrial fibrillation: Back to the lab. J Thorac Cardiovasc Surg 2018; 156:1880. [DOI: 10.1016/j.jtcvs.2018.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 11/23/2022]
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15
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Hassanabad AF, Fedak PWM. Modify, simplify, apply: Do we need preclinical models for surgical innovation? J Thorac Cardiovasc Surg 2018; 156:1869-1870. [PMID: 30098807 DOI: 10.1016/j.jtcvs.2018.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | - Paul W M Fedak
- Section of Cardiac Surgery, Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
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