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Malavasi VL, Muto F, Ceresoli PA, Menozzi M, Righelli I, Gerra L, Vitolo M, Imberti JF, Mei DA, Bonini N, Gargiulo M, Boriani G. Atrial fibrillation in vascular surgery: a systematic review and meta-analysis on prevalence, incidence and outcome implications. J Cardiovasc Med (Hagerstown) 2023; 24:612-624. [PMID: 37605953 PMCID: PMC10754485 DOI: 10.2459/jcm.0000000000001533] [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: 05/26/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 08/23/2023]
Abstract
AIMS To know the prevalence of atrial fibrillation (AF), as well as the incidence of postoperative AF (POAF) in vascular surgery for arterial diseases and its outcome implications. METHODS We performed a systematic review and meta-analysis following the PRISMA statement. RESULTS After the selection process, we analyzed 44 records (30 for the prevalence of AF history and 14 for the incidence of POAF).The prevalence of history of AF was 11.5% [95% confidence interval (CI) 1-13.3] with high heterogeneity (I2 = 100%). Prevalence was higher in the case of endovascular procedures. History of AF was associated with a worse outcome in terms of in-hospital death [odds ratio (OR) 3.29; 95% CI 2.66-4.06; P < 0.0001; I2 94%] or stroke (OR 1.61; 95% CI 1.39-1.86; P < 0.0001; I2 91%).The pooled incidence of POAF was 3.6% (95% CI 2-6.4) with high heterogeneity (I2 = 100%). POAF risk was associated with older age (mean difference 4.67 years, 95% CI 2.38-6.96; P = 0.00007). The risk of POAF was lower in patients treated with endovascular procedures as compared with an open surgical procedure (OR 0.35; 95% CI 0.13-0.91; P = 0.03; I2 = 61%). CONCLUSIONS In the setting of vascular surgery for arterial diseases a history of AF is found overall in 11.5% of patients, more frequently in the case of endovascular procedures, and is associated with worse outcomes in terms of short-term mortality and stroke.The incidence of POAF is overall 3.6%, and is lower in patients treated with an endovascular procedure as compared with open surgery procedures. The need for oral anticoagulants for preventing AF-related stroke should be evaluated with randomized clinical trials.
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Affiliation(s)
- Vincenzo L. Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Federico Muto
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Pietro A.C.M. Ceresoli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Matteo Menozzi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Ilaria Righelli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Luigi Gerra
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena
| | - Jacopo F. Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena
| | - Davide A. Mei
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena
| | - Mauro Gargiulo
- Vascular Surgery, Department of Medical and Surgical Sciences, University of Bologna
- Vascular Surgery Unit, IRCCS University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
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Koraćević G, Stojković M, Stojanović M, Zdravković M, Simić D, Šalinger-Martinović S, Đorđević D, Damjanović M, Đorđević-Radojković D, Koraćević M. Less Known but Clinically Relevant Comorbidities of Atrial Fibrillation: A Narrative Review. Curr Vasc Pharmacol 2022; 20:429-438. [PMID: 35986547 DOI: 10.2174/1570161120666220819095215] [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: 01/11/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The important risk factors for atrial fibrillation (AF) in the general population are not always equally important in specific and relatively prevalent diseases. OBJECTIVE The main goal of this narrative review is to focus attention on the presence and the relationship of AF with several important diseases, such as cancer or sepsis, in order to: 1) stimulate further research in the field, and 2) draw attention to this relationship and search for AF in clinical practice. METHODS We searched PubMed, SCOPUS, Elsevier, Wiley, Springer, Oxford Journals, Cambridge, SAGE, and Google Scholar for less-known comorbidities of AF. The search was limited to publications in English. No time limits were applied. RESULTS AF is widely represented in cardiovascular and other important diseases, even in those in which AF is rarely mentioned. In some specific clinical subsets of AF patients (e.g., patients with sepsis or cancer), the general risk factors for AF may not be so important. Patients with new-onset AF have a several-fold increase in relative risk of cancer, deep vein thrombosis, and pulmonary thromboembolism (PTE) during the follow-up. CONCLUSION AF presence, prognosis, and optimal therapeutic approach are insufficiently recognised in several prevalent diseases, including life-threatening ones. There is a need for a better search for AF in PTE, pulmonary oedema, aortic dissection, sepsis, cancer and several gastrointestinal diseases. Improved AF detection would influence treatment and improve outcomes.
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Affiliation(s)
- Goran Koraćević
- Department of Cardiovascular Diseases, University Clinical Center Niš, Niš, Serbia.,Faculty of Medicine, Niš University, Niš, Serbia
| | - Milan Stojković
- Department of Internal Medicine and Geriatrics, Bethel Clinic (EvKB), Bielefeld, Germany
| | | | - Marija Zdravković
- Department of Cardiology, University Hospital Medical Center Bežanijska kosa and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Simić
- Department of Cardiovascular Diseases, University Clinical Center Niš, Niš, Serbia
| | - Sonja Šalinger-Martinović
- Department of Cardiovascular Diseases, University Clinical Center Niš, Niš, Serbia.,Faculty of Medicine, Niš University, Niš, Serbia
| | - Dragan Đorđević
- Department of Internal Medicine and Geriatrics, Bethel Clinic (EvKB), Bielefeld, Germany
| | - Miodrag Damjanović
- Department of Cardiovascular Diseases, University Clinical Center Niš, Niš, Serbia
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Zhao R, Wang Z, Cao F, Song J, Fan S, Qiu J, Fan X, Yu C. New-Onset Postoperative Atrial Fibrillation After Total Arch Repair Is Associated With Increased In-Hospital Mortality. J Am Heart Assoc 2021; 10:e021980. [PMID: 34533045 PMCID: PMC8649499 DOI: 10.1161/jaha.121.021980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background It is well established that postoperative atrial fibrillation (POAF) is associated with adverse postoperative outcomes after major cardiac operations. The purpose of this study was to investigate the incidence of new‐onset POAF after successful total arch repair surgery and the association between POAF and in‐hospital mortality. Methods and Results All consecutive patients undergoing total arch repair from September 2012 to December 2019 in Fuwai hospital were enrolled (n=1280). Patients diagnosed with preoperative atrial fibrillation were excluded. POAF was diagnosed as the new‐onset atrial fibrillation or flutter for more than 5 minutes based on continuous electrocardiogram monitoring. A logistic regression model was used to determine predictors of in‐hospital mortality. Multivariable adjustment, inverse probability of treatment weighting, and propensity score matching were used to adjust for confounders. POAF was diagnosed in 32.3% (411/1271) of this cohort population. The occurrence of new‐onset POAF was associated with age (odds ratio [OR], 1.05; 95% CI, 1.04–1.06; P<0.001), male sex (OR, 0.72; 95% CI, 0.52–0.98; P=0.035), and surgery duration (OR, 1.2; 95% CI, 1.12–1.28; P<0.001). The in‐hospital mortality was significantly higher in patients with POAF than those without POAF (10.7% versus 2.4%, P<0.001). Inverse probability of treatment weighting and propensity score matching analyses confirmed the results. The increased in‐hospital mortality in POAF group still existed among subgroup analysis based on different age, sex, hypertension, smoking, and hypokalemia, combined with cardiac surgery, and deep hypothermic circulatory arrest. Conclusions More careful attention should be given to POAF after total arch repair surgery. The incidence of POAF after total arch repair surgery was 32.3% and associated with increased in‐hospital mortality. The elderly female patient who experienced longer operation duration was at highest risk for POAF.
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Affiliation(s)
- Rui Zhao
- Department of Vascular Surgery Fuwai HospitalState Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Zhao Wang
- Cardiac Arrhythmia Center Fuwai HospitalState Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Fangfang Cao
- Department of Vascular Surgery Fuwai HospitalState Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jian Song
- Department of Vascular Surgery Fuwai HospitalState Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shuya Fan
- Department of Vascular Surgery Fuwai HospitalState Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Juntao Qiu
- Department of Vascular Surgery Fuwai HospitalState Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xiaohan Fan
- Cardiac Arrhythmia Center Fuwai HospitalState Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Cuntao Yu
- Department of Vascular Surgery Fuwai HospitalState Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Celebi OO, Celebi S, Berkalp B. Appraisal of transthoracic echocardiography for opportunistic screening of abdominal aortic aneurysm. Medicine (Baltimore) 2021; 100:e26171. [PMID: 34087879 PMCID: PMC8183806 DOI: 10.1097/md.0000000000026171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Abdominal aortic aneurysm is a life threatening disease. Most of the patients diagnosed incidentally because of the asymptomatic nature of this disease. This study aimed to determine the frequency of abdominal aortic aneurysm and evaluate the value of opportunistic screening during transthoracic echocardiography.A total of 5138 patients referred for echocardiographic evaluation for any reason were screened for abdominal aortic aneurysm between November 2014 to July 2019. The aneurysm was defined as an abdominal aorta with a diameter greater than 30 mm, or segmental dilatation of more than 50% of its size in non-dilated parts.The overall frequency of abdominal aortic aneurysm was 2.2% (n = 109) in the study population. Male sex (P < .001), older age (P < .001), presence of diastolic dysfunction (P = .036), hypertension (P < .001), coronary artery disease (P < .001), and hyperlipidemia (P < .001) were associated with abdominal aortic aneurysm. Patients with aneurysm had significantly increased diameters of the aortic trunk (P < .001) and ascending aorta (P < .001), significantly thicker interventricular septum (P < .001) and posterior wall (P < .001), significantly increased end-diastolic diameter (P < .001) and enlarged left atrium (P < .001), and significantly decreased ejection fraction (P < .001). The mostly met criteria for screening abdominal aortic aneurysm in international guidelines was the age of the patients.Based on the results of this study, screening patients over 60 years of age who undergo a transthoracic echocardiography for any reason would be beneficial to detect an asymptomatic abdominal aortic aneurysm in Turkish population.
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Affiliation(s)
- Ozlem Ozcan Celebi
- Department of Cardiology, University of Health Sciences, Ankara City Hospital
| | - Savas Celebi
- Department of Cardiology, TOBB Economics and Technology University Medical School, Ankara, Turkey
| | - Berkten Berkalp
- Department of Cardiology, TOBB Economics and Technology University Medical School, Ankara, Turkey
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Cho J, Lee D. Postoperative new-onset atrial fibrillation causing acute embolic occlusion of the superior mesenteric artery: A case report. Medicine (Baltimore) 2021; 100:e25700. [PMID: 33907150 PMCID: PMC8084075 DOI: 10.1097/md.0000000000025700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Postoperative atrial fibrillation following noncardiac surgery increases mortality, length of hospital stay, and medical expenses; moreover, compared to nonvalvular atrial fibrillation, it poses a similar risk of thromboembolic complications. In this report, we discuss our decision-making process for diagnosis and treatment in case with unexpected postoperative new-onset atrial fibrillation causing acute mesenteric ischemia. PATIENT CONCERNS A 78-year-old male patient received varicose vein stripping and ligation in his right leg. The patient was previously healthy with no known comorbidities. The next day after surgery, he complained of sudden epigastric pain unresponsive to conservative treatment, and new-onset atrial fibrillation was observed on electrocardiography. DIAGNOSES An abdominal computed tomography scan revealed acute embolic occlusion of the superior mesenteric artery. INTERVENTIONS Emergent surgical embolectomy was performed successfully. The time to operation from the recognition of abdominal pain was 6 h. Surgical critical care was performed for life-threatening ischemic reperfusion injury. OUTCOMES The patient was discharged from the hospital on the 40th postoperative day. LESSONS Atypical postoperative abdominal pain unresponsive to conservative treatment should be considered a surgical emergency, and a high level of clinical suspicion for acute mesenteric ischemia is required. Preoperative electrocardiography and postoperative telemetry might be helpful in some asymptomatic patients.
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Head and neck surgery is a risk factor for atrial fibrillation: incidence and outcomes. Int J Oral Maxillofac Surg 2020; 49:1535-1541. [DOI: 10.1016/j.ijom.2020.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/08/2020] [Accepted: 04/22/2020] [Indexed: 12/27/2022]
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Predicting Intracerebral Hemorrhage Patients' Length-of-Stay Probability Distribution Based on Demographic, Clinical, Admission Diagnosis, and Surgery Information. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:4571636. [PMID: 30809336 PMCID: PMC6369489 DOI: 10.1155/2019/4571636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/01/2019] [Indexed: 02/05/2023]
Abstract
The vast majority of patients with intracerebral hemorrhage (ICH) suffer from long and uncertain length of stay (LOS). The aim of our study was to provide decision support for discharge and admission plans by predicting ICH patients' LOS probability distribution. The demographics, clinical predictors, admission diagnosis, and surgery information from 3,600 ICH patients were used in this study. We used univariable Cox analysis, multivariable Cox analysis, Cox-variable of importance (Cox-VIMP) analysis, and an intersection analysis to select predictors and used random survival forests (RSF)—a method in survival analysis—to predict LOS probability distribution. The Cox-VIMP method constructed by us effectively selected significant correlation predictors. The Cox-VIMP RSF model can improve prediction performance and is significantly different from the other models. The Cox-VIMP can contribute to the screening of predictors, and the RSF model can be established through those predictors to predict the probability distribution of LOS in each patient.
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