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Hijazi EM, Edwan HT, Al-Zoubi NA, Ibdah RK, Rawashdeh SI, Radaideh HA. Preoperative statin associated with a reduced risk of atrial fibrillation after coronary artery bypass surgery. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nomani H, Bayat G, Sahebkar A, Fazelifar AF, Vakilian F, Jomezade V, Johnston TP, Mohammadpour AH. Atrial fibrillation in β‐thalassemia patients with a focus on the role of iron‐overload and oxidative stress: A review. J Cell Physiol 2018; 234:12249-12266. [DOI: 10.1002/jcp.27968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/19/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Homa Nomani
- School of Pharmacy, Mashhad University of Medical Sciences Mashhad Iran
| | - Golnaz Bayat
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center Mashhad University of Medical Sciences Mashhad Iran
- Biotechnology Research Center Pharmaceutical Technology Institute, Mashhad University of Medical Sciences Mashhad Iran
- School of Pharmacy, Mashhad University of Medical Sciences Mashhad Iran
| | - Amir Farjam Fazelifar
- Department of Pacemaker and Electrophysiology Rajaie Cardiovascular, Medical and Research center, Iran University of Medical Sciences Tehran Iran
| | - Farveh Vakilian
- Atherosclerotic Research Center Faculty of Medicine, Mashhad University of Medical Sciences Mashhad Iran
| | - Vahid Jomezade
- Department of Surgery Faculty of Medicine, Mashhad University of Medical Sciences Mashhad Iran
| | - Thomas P. Johnston
- Division of Pharmaceutical Sciences School of Pharmacy, University of Missouri‐Kansas City Kansas City Missouri
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy School of Pharmacy, Mashhad University of Medical Sciences Mashhad Iran
- Pharmaceutical Research Center Pharmaceutical Technology Institute, Mashhad University of Medical Sciences Mashhad Iran
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Atrial Fibrillation and Acute Myocardial Infarction – An Inflammation-Mediated Association. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2018. [DOI: 10.2478/jce-2018-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT
Atrial fibrillation (AF) is an increasingly widespread healthcare problem. AF can frequently present as a complication in acute coronary syndromes (ACS), especially in ST-elevation acute myocardial infarction (AMI), in which case it is the most frequent supraventricular rhythm disturbance with an estimated incidence of 6.8-21%. The presence of AF in ACS heralds worse outcomes in comparison to subjects in sinus rhythm, and several studies have shown that in AMI patients, both new-onset and pre-existing AF are associated with a higher risk of major adverse cardiovascular and cerebrovascular events during hospitalization. The cause of newonset AF in AMI is multifactorial. Although still incompletely understood, the mechanisms involved in the development of AF in acute myocardial ischemic events include the neurohormonal activation of the sympathetic nervous system that accompanies the AMI, ischemic involvement of the atrial myocytes, ventricular dysfunction, and atrial overload. The identification of patients at risk for AF is of great significance as it may lead to prompt therapeutic interventions and closer follow-up, thus improving prognosis and decreasing cardiovascular and cerebrovascular events. The present manuscript aims to summarize the current research findings related to new-onset AF in AMI patients, as well as the predictors and prognostic impact of this comorbid association.
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Genetic variants of interleukin-18 are associated with reduced risk of atrial fibrillation in a population from Northeast China. Gene 2017; 626:269-274. [DOI: 10.1016/j.gene.2017.05.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/25/2017] [Accepted: 05/15/2017] [Indexed: 12/19/2022]
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Sharma G, Shetkar S, Bhasin A, Ramakrishnan L, Juneja R, Naik N, Roy A, Ramakrishnan S, Bhargava B, Bahl VK. High sensitive C-reactive protein and interleukin 6 in atrial fibrillation with rheumatic mitral stenosis from Indian cohort. Indian Heart J 2016; 69:505-511. [PMID: 28822519 PMCID: PMC5560862 DOI: 10.1016/j.ihj.2016.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 11/26/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Presence of chronic low grade inflammation has often been implicated in the etiology of atrial fibrillation (AF). Whether pre-existing inflammatory state promotes AF or initiation of AF activates inflammation is a dilemma among clinicians. This study investigates the role of high sensitive C reactive protein (hs-CRP) and interleukin 6 (IL-6) in AF with rheumatic mitral stenosis (Rh-MS) as markers of chronic inflammation. Methods This case control cohort included sixty five (n = 65) Rh-MS patients having other valve lesions as trivial to mild. Out of them twenty nine (n = 29; group C) had baseline AF and rest were normal sinus rhythm (NSR). A 24 h holter recording was done in NSR patients to diagnose paroxysmal AF/tachyarrhythmia forming group B (n = 12) and not having any tachyarrhythmia were designated as NSR; group A (n = 24). Results hs-CRP and IL6 showed statistically significant increase in group C (permanent AF) compared to group A (95% CI: 4.2–0.9, p = 0.007; 95% CI: 1.2–0.89; p = 0.05 respectively), while it was non significant between group A and group B (p > 0.05). A weak positive correlation was observed with hs-CRP and left atrial volume index (LAVi) (r = 0.45, p = 0.06) in AF group as compared to NSR group. 68.2% of patients in AF group (27/41) had moderate to severe spontaneous echo contrast (SEC) as compared to 37.5% (10/24) in NSR group. Conclusion Increased hs-CRP and IL-6 levels in the paroxysmal and permanent AF group may favour the hypothesis that low grade chronic inflammation could be the cause of atrial fibrillation than a consequence.
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Affiliation(s)
- Gautam Sharma
- Department of Cardiology, Room No 12, 8th floor, All India Institute of Medical Sciences, New Delhi, India.
| | - Sudhir Shetkar
- Department of Cardiology, Apollo Group of Hospitals, Nashik, India.
| | - Ashu Bhasin
- Department of Neurology, All India Institute of Medical Sciences, Room No 708, New Delhi, India.
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, Room No 61 Ground Floor, New Delhi, India.
| | - Rajnish Juneja
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Balram Bhargava
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Vinay Kumar Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
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He H, Guo J, Zhang A. The value of urine albumin in predicting thromboembolic events for patients with non-valvular atrial fibrillation. Int J Cardiol 2016; 221:827-30. [PMID: 27434352 DOI: 10.1016/j.ijcard.2016.07.145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/08/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Accurate risk stratification is important in the management of patients with non-valvular atrial fibrillation (NVAF). However, one cohort study demonstrated an annual ischemic stroke rate of 1.61% in the group of patients classified in "the true low risk" according to CHA2DS2-VASc. We aimed to find out more indicators and evaluate their abilities in predicting thromboembolic events (TE). METHODS We assigned 58 patients with TE to the thrombosis group, and 157 patients without TE to the non-thrombosis group. The clinical parameters of these patients were subjected to univariate analysis and unconditioned logistic regression analysis for screening the risk factor, which was urine albumin (UA) according to the result. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off point of the UA. Then we formed the CHA2DS2-VASc-UA2 score and made a comparison with CHA2DS2-VASc score. RESULTS Mean UA of the thrombosis group was significantly higher than that of the non-thrombosis group (0.1g/L vs 0.0g/L, P<0.01). The results of unconditioned logistic regression analysis showed that OR of UA was 40.98 (95% CI: 3.58-468.88, P<0.01). The Area Under the Curve (AUC) of UA was 0.700 with an optimal cut-off point of 0.03g/L. ROC curve analysis result showed that AUC of CHA2DS2-VASc-UA2 score was larger than that of CHA2DS2-VASc score (0.873 vs 0.860, P<0.01). CONCLUSION UA≥0.03g/L is the independent predictive factor of TE for NVAF patients. And the CHA2DS2-VASc-UA2 score might perform better in predicting TE compared with the CHA2DS2-VASc score.
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Affiliation(s)
- Haohui He
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Jun Guo
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Aidong Zhang
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
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Jiang MH, Su YM, Tang JZ, Shen YB, Deng XT, Yuan DS, Wu J, Pan M, Huang ZW. Angiotensin-converting enzyme gene 2350 G/A polymorphism and susceptibility to atrial fibrillation in Han Chinese patients with essential hypertension. Clinics (Sao Paulo) 2013; 68:1428-32. [PMID: 24270955 PMCID: PMC3812555 DOI: 10.6061/clinics/2013(11)08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/10/2013] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The angiotensin-converting enzyme gene is one of the most studied candidate genes related to atrial fibrillation. Among the polymorphisms of the angiotensin-converting enzyme gene, the 2350 G/A polymorphism (rs4343) is known to have the most significant effects on the plasma angiotensin-converting enzyme concentration. The aim of the present study was to investigate the association of the angiotensin-converting enzyme 2350 G/A polymorphism with atrial fibrillation in Han Chinese patients with essential hypertension. METHODS A total of 169 hypertensive patients were eligible for this study. Patients with atrial fibrillation (n = 75) were allocated to the atrial fibrillation group, and 94 subjects without atrial fibrillation were allocated to the control group. The PCR-based restriction fragment length polymorphism technique was used to assess the genotype frequencies. RESULTS The distributions of the angiotensin-converting enzyme 2350 G/A genotypes (GG, GA, and AA, respectively) were 40.43%, 41.49%, and 18.08% in the controls and 18.67%, 46.67%, and 34.66% in the atrial fibrillation subjects (p = 0.037). The frequency of the A allele in the atrial fibrillation group was significantly greater than in the control group (58.00% vs. 38.83%, p = 0.0007). Compared with the wild-type GG genotype, the GA and AA genotypes had an increased risk for atrial fibrillation. Additionally, atrial fibrillation patients with the AA genotype had greater left atrial dimensions than the patients with the GG or GA genotypes (p<0.01 and p<0.05, respectively). CONCLUSIONS The results obtained in this study indicate that the angiotensin-converting enzyme 2350 G/A polymorphism is associated with atrial fibrillation and that the A allele shows an increased risk for atrial fibrillation in Han Chinese patients with essential hypertension.
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Affiliation(s)
- Min-Hui Jiang
- Department of Cardiology, Hospital of Nantong University, Nantong, China
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8
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Li J, Song J, Jiang MH, Zheng JG, Gao SP, Zhu JH, Pan M. Interleukin-6 promoter polymorphisms and susceptibility to atrial fibrillation in elderly Han Chinese patients with essential hypertension. J Interferon Cytokine Res 2012; 32:542-7. [PMID: 22924939 DOI: 10.1089/jir.2012.0033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is an accumulating body of evidence indicating a strong association between inflammation and the pathogenesis of atrial fibrillation (AF). Interleukin-6 (IL-6) is a pleiotropic cytokine, functions as a mediator of inflammatory response, and has both proinflammatory and anti-inflammatory properties. The aim of the present study was to investigate the association of the -634C/G polymorphism of the IL-6 gene with AF in elderly Han Chinese patients with essential hypertension (EH). A total of 169 elderly patients with EH were eligible for this study. Patients with AF (n=75) were allocated to the AF group, and 94 subjects without AF to the control group. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was used to assess the genotype frequencies. The distribution of the IL-6 -634C/G genotypes (CC, CG, and GG) was 67.02%, 30.85%, and 2.13% in the controls, and 50.67%, 40.00%, and 9.33% in AF subjects, respectively (P=0.0312). The frequency of the G allele in the AF group was significantly higher than that in the control group (29.33% vs. 17.55%, P=0.0103). Compared with the CC and CG genotypes, the GG homozygote had a 4.7353-fold increased risk of AF [95% confidence interval (CI)=0.9537-23.5116, P=0.0382]. These findings suggest that the IL-6 -634C/G polymorphism is associated with AF, and the G allele has increased risk of AF in elderly Han Chinese patients with EH.
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Affiliation(s)
- Jing Li
- Department of Geraeology, Affiliated Hospital of Nantong University, PR China
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Deng XT, Jiang MH, Zhu JH, Ge LJ, Guo J, Gao SP, Zheng JG, Luan H, Shi GL, Wang RX, Shi HF, Pan M. The Association of Interleukin 6−634C/G Polymorphism With Left Atrial Thrombus and Severe Spontaneous Echocontrast in Patients With Atrial Fibrillation. Clin Appl Thromb Hemost 2012; 19:673-8. [PMID: 22914813 DOI: 10.1177/1076029612457706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF) not only is an independent risk factor for death but also confers significant risk of morbidity from stroke associated with left atrial thrombus. The association of interleukin 6 ( IL-6) polymorphism with thrombus in AF has not been investigated before. We carried out a case–control study in Han Chinese. The IL-6 −634C/G genotypes of 31 patients with thrombus and 45 patients without thrombus were detected by polymerase chain reaction and restriction fragment length polymorphism. The frequencies of the IL-6 genotypes (CC, CG, and GG) were 29.03%, 54.54%, and 16.13% for the patients with thrombus, and 55.56%, 40.00%, and 4.44% for the patients without thrombus, respectively ( P = .0391). Compared with the CC genotype, the G allele carriers (CG + GG) had a 2.79-fold increased risk of thrombus or severe spontaneous echocontrast (SEC). These results suggest that IL-6 −634C/G polymorphism is associated with thrombus and severe SEC, and the G allele is an independent risk for thrombus and severe SEC in Han Chinese patients with AF.
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Affiliation(s)
- Xin-Tao Deng
- Department of Cardiology, Xinghua People’s Hospital, Xinghua, China
| | - Min-Hui Jiang
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Jian-Hua Zhu
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Li-Jun Ge
- Department of Cardiology, Ningxia People’s Hospital, Yinchuan, China
| | - Jing Guo
- Department of Cardiology, Fourth People’s Hospital of Wuxi, Wuxi, China
| | - Shu-Ping Gao
- Department of Cardiology, Ningxia People’s Hospital, Yinchuan, China
| | - Jin-Guo Zheng
- Department of Cardiology, Xinghua People’s Hospital, Xinghua, China
| | - Hong Luan
- Department of Cardiology, Ningxia People’s Hospital, Yinchuan, China
| | - Gui-Liang Shi
- Department of Cardiology, Xinghua People’s Hospital, Xinghua, China
| | - Ru-Xing Wang
- Department of Cardiology, Wuxi People’s Hospital, Wuxi, China
| | - Hai-Feng Shi
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Min Pan
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, China
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Lin HL, Ueng KC, Hsieh YS, Chiang WL, Yang SF, Chu SC. Impact of MCP-1 and CCR-2 gene polymorphisms on coronary artery disease susceptibility. Mol Biol Rep 2012; 39:9023-30. [PMID: 22752804 DOI: 10.1007/s11033-012-1773-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 06/09/2012] [Indexed: 12/20/2022]
Abstract
Coronary artery disease (CAD) was the second leading cause of death during the last 3 years in Taiwan. Smooth muscle cells, monocytes/macrophages, and endothelial cells produce monocyte chemoattractant protein-1 (MCP-1) within atherosclerotic plaques following binding to the chemokine receptor-2 (CCR-2). Previous studies have well-documented the association between MCP-1 expression and susceptibility to, or clinicopathological features, of CAD. This study investigated the relationships between MCP-1-2518A/G and CCR-2-V64I genetic polymorphisms and CAD in the Taiwanese population. A total of 608 subjects, including 392 non-CAD controls and 216 patients with CAD, were recruited and subjected to polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to evaluate the effects of these two polymorphic variants on CAD. Results indicated a significant association between MCP-1 -2548 gene polymorphism and susceptibility to CAD. GG genotypes (OR = 1.629; 95 % CI = 1.003-2.644), or individuals with at least one G allele (OR = 1.511; 95 % CI = 1.006-2.270), had a higher risk of CAD as compared with AA genotypes. Results also revealed that subjects with at least one A allele of the V64I CCR2 gene polymorphism had significantly increased risk of CAD. G allele in MCP-1-2518 might contribute to higher prevalence of atrial fibrillation in CAD patients (OR = 4.254; p < 0.05). In conclusion, MCP-1-2518G and CCR-2 64I gene polymorphisms represent important factors in determining susceptibility to CAD, and the contribution of MCP-1-2518G could be through effects on atrial fibrillation in CAD patients.
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Affiliation(s)
- Hsiu-Ling Lin
- Institute of Biochemistry and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
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Gao SP, Deng XT, Ge LJ, Luan H, Zheng JG, Chen C, Jiang MH, Pan M. Is inflammation linked to thrombogenesis in atrial fibrillation? Int J Cardiol 2011; 149:260-261. [DOI: 10.1016/j.ijcard.2011.02.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 02/20/2011] [Indexed: 10/18/2022]
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12
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Inflammation-sensitive proteins and risk of atrial fibrillation: a population-based cohort study. Eur J Epidemiol 2011; 26:449-55. [DOI: 10.1007/s10654-011-9565-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
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Li J, Solus J, Chen Q, Rho YH, Milne G, Stein CM, Darbar D. Role of inflammation and oxidative stress in atrial fibrillation. Heart Rhythm 2009; 7:438-44. [PMID: 20153266 DOI: 10.1016/j.hrthm.2009.12.009] [Citation(s) in RCA: 234] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 12/10/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. Increasing evidence indicates that inflammation and oxidative stress contribute to the pathogenesis of AF, but their role remains poorly defined. In addition, whether inflammation and oxidative stress are associated with particular types of AF is unclear. OBJECTIVE The purpose of this study was to define the role of inflammation and oxidative stress in AF. METHODS Using a case-control study design, 305 patients with AF were compared with 150 control patients. AF was categorized into lone and typical AF and further subcategorized as paroxysmal, persistent, or permanent AF. Serum concentrations of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-alpha, monocyte chemoattractant protein (MCP)-1, vascular endothelial growth factor (VEGF), N-terminal pro-brain (B-type) natriuretic peptide (NTpBNP), and urinary F(2)-isoprostanes, a measure of oxidative stress, were measured. RESULTS IL-6, IL-8, IL-10, TNF-alpha, MCP1, VEGF, and NTpBNP concentrations were independently associated with AF (all P <.05). However, F(2)-isoprostane excretion was not elevated (P = .50). Graded increases in TNF-alpha [median (interquartile range) 6.8 (3.4-11.3), 8.0 (5.6-10.9), 10.1 (5.7-12.4) pg/mL, P <.05] and NTpBNP [170.6 (67.3-481.9), 681.39 (310.3-1,439.0), 1,179.9 (653.1-2,096.0) pg/mL, P <.001] were seen among the subgroups of paroxysmal, persistent, and permanent AF, respectively. CONCLUSION Inflammatory biomarkers were significantly increased in patients with AF, supporting a strong association between inflammation and AF. Surprisingly, urinary F(2)-isoprostanes, a sensitive index of systemic oxidative stress in vivo, were not increased in AF overall or in different subtypes of AF.
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Affiliation(s)
- Jie Li
- Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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14
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Toutouzas K, Drakopoulou M, Dilaveris P, Vaina S, Gatzoulis K, Karabelas J, Riga M, Stefanadi E, Synetos A, Vlasis K, Stefanadis C. Inflammation in lone atrial fibrillation: New insights by coronary sinus thermography. Int J Cardiol 2009; 134:345-50. [DOI: 10.1016/j.ijcard.2008.02.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 01/10/2008] [Accepted: 02/14/2008] [Indexed: 11/28/2022]
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15
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Xu H, Tang Y, Liu DZ, Ran R, Ander BP, Apperson M, Liu XS, Khoury JC, Gregg JP, Pancioli A, Jauch EC, Wagner KR, Verro P, Broderick JP, Sharp FR. Gene expression in peripheral blood differs after cardioembolic compared with large-vessel atherosclerotic stroke: biomarkers for the etiology of ischemic stroke. J Cereb Blood Flow Metab 2008; 28:1320-8. [PMID: 18382470 DOI: 10.1038/jcbfm.2008.22] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There are no biomarkers that differentiate cardioembolic from large-vessel atherosclerotic stroke, although the treatments differ for each and approximately 30% of strokes and transient ischemic attacks have undetermined etiologies using current clinical criteria. We aimed to define gene expression profiles in blood that differentiate cardioembolic from large-vessel atherosclerotic stroke. Peripheral blood samples were obtained from healthy controls and acute ischemic stroke patients (<3, 5, and 24 h). RNA was purified, labeled, and applied to Affymetrix Human U133 Plus 2.0 Arrays. Expression profiles in the blood of cardioembolic stroke patients are distinctive from those of large-vessel atherosclerotic stroke patients. Seventy-seven genes differ at least 1.5-fold between them, and a minimum number of 23 genes differentiate the two types of stroke with at least 95.2% specificity and 95.2% sensitivity for each. Genes regulated in large-vessel atherosclerotic stroke are expressed in platelets and monocytes and modulate hemostasis. Genes regulated in cardioembolic stroke are expressed in neutrophils and modulate immune responses to infectious stimuli. This new method can be used to predict whether a stroke of unknown etiology was because of cardioembolism or large-vessel atherosclerosis that would lead to different therapy. These results have wide ranging implications for similar disorders.
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Affiliation(s)
- Huichun Xu
- Department of Neurology and MIND Institute, University of California at Davis, Sacramento, California 95817, USA.
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Virani SS, Nambi V, Razavi M, Lee VV, Elayda M, Wilson JM, Ballantyne CM. Preoperative statin therapy is not associated with a decrease in the incidence of postoperative atrial fibrillation in patients undergoing cardiac surgery. Am Heart J 2008; 155:541-6. [PMID: 18294494 DOI: 10.1016/j.ahj.2007.10.027] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 10/23/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) after cardiac surgery is associated with significant morbidity. We investigated whether preoperative statin therapy was associated with decreased incidence of postoperative AF in patients undergoing cardiac surgery, including isolated valve surgery and patients with low ejection fraction (EF). METHODS A retrospective study of consecutive patients without history of AF (n = 4044) who underwent cardiac surgeries at St. Luke's Episcopal Hospital (Houston, TX), from January 1, 2003, through April 30, 2006, was conducted. Postoperative AF was assessed by continuous telemetry monitoring during hospitalization for cardiac surgery. RESULTS A total of 2096 patients (52%) received preoperative statins. Atrial fibrillation occurred in 1270 patients (31.4% in both the statin and nonstatin groups). In multivariate regression analysis, age >65 years, history of valvular heart disease, rheumatic disease, pulmonary disease, and New York Heart Association class III/IV were independent predictors of increased risk, whereas female sex was associated with decreased risk. Preoperative statin therapy was not associated with decreased risk in the entire cohort (odds ratio [OR] 1.13, 95% confidence interval [CI] 0.98-1.31) or in subgroups undergoing isolated coronary artery bypass grafting (OR 1.16, 95% CI 0.97-1.43), isolated valve surgery (OR 1.09, 95% CI 0.81-1.46), or both (OR 1.09, 95% CI 0.72-1.65), or the subgroup with EF <35% (OR 1.23, 95% CI 0.84-1.82). After propensity score analysis (n = 867 patients in each group), preoperative statin therapy was not associated with decreased AF incidence (OR 1.14, 95% CI 0.92-1.41). CONCLUSIONS Preoperative statin therapy was not associated with decreased incidence of postoperative AF in patients undergoing cardiac surgery, including patients with low EF.
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Affiliation(s)
- Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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Reduced incidence of new-onset atrial fibrillation with angiotensin II receptor blockade: the VALUE trial. J Hypertens 2008; 26:403-11. [PMID: 18300848 DOI: 10.1097/hjh.0b013e3282f35c67] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Blanchard L, Collard CD. Non-antiarrhythmic agents for prevention of postoperative atrial fibrillation: role of statins. Curr Opin Anaesthesiol 2007; 20:53-6. [PMID: 17211168 DOI: 10.1097/aco.0b013e328013d9fd] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Atrial fibrillation is the most common arrhythmia following cardiac surgery, having both serious medical and socioeconomic consequences. Although there are established antiarrhythmic agents for preventing and treating postoperative atrial fibrillation, these therapies are neither 100% reliable, nor without risks and limitations. Thus, there remains a strong need for non-antiarrhythmic, adjunctive therapies for the prevention of postoperative atrial fibrillation. RECENT FINDINGS Long-term statin administration in ambulatory patients is associated with a reduced risk of adverse cardiovascular events, including death, myocardial infarction, stroke, renal dysfunction and atrial fibrillation. Recent evidence suggests, however, that statins may also reduce the risk of acute adverse outcomes following invasive procedures, including postoperative atrial fibrillation. Although the exact mechanisms by which statins may reduce postoperative atrial fibrillation are unclear, accumulating evidence suggests that statins exert multiple effects independent of their effect on LDL cholesterol. For example, in patients with acute coronary syndromes, statin therapy has been shown to modulate remodeling of the cardiac extracellular matrix and to reduce markers of inflammation, including C-reactive protein, serum amyloid A, tumor necrosis factor-alpha, and IL-6. SUMMARY Perioperative statin therapy may represent an important non-antiarrhythmic, adjunctive therapeutic strategy for the prevention of postoperative atrial fibrillation.
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Affiliation(s)
- Lawrence Blanchard
- Baylor College of Medicine, Division of Cardiovascular Anesthesia, Texas Heart Institute, St Luke's Episcopal Hospital, Houston, Texas 77030, USA
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Rodrigo R, Castillo R, Cereceda M, Asenjo R, Zamorano J, Araya J. Non-hypoxic preconditioning of myocardium against postoperative atrial fibrillation: Mechanism based on enhancement of the antioxidant defense system. Med Hypotheses 2007; 69:1242-8. [PMID: 17548171 DOI: 10.1016/j.mehy.2007.03.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 03/28/2007] [Indexed: 11/17/2022]
Abstract
Oxidative stress underlies postoperative atrial fibrillation and electrophysiological remodelling associated with rapid atrial pacing. An increasing body of evidence indicates that the formation of reactive oxygen species (ROS) released following extracorporeal circulation are involved in the structural and functional myocardial impairment derived from the ischemia-reperfusion cycle. ROS behave as intracellular messengers mediating pathological processes, such as inflammation, apoptosis and necrosis, thereby participating in the pathophysiology of atrial fibrillation. Thus, increased superoxide (O(2)(.-)) production has been found in isolated atrial cardiomyocytes from patients with atrial fibrillation. Therefore, it seems reasonable to assume that the reinforcement of the antioxidant defense system should protect the heart against functional alterations in the cardiac rhythm. On this line, antioxidant enzyme induction through in vivo exposure to moderate concentration of ROS is associated with a reduction in the susceptibility of myocytes to ROS-induced injury. This response could be due to a prevailing effect of survival over apoptotic pathway. Previously, tissue preconditioning caused by prior exposure to an ischemia/reperfusion cycle has been successfully applied in experimental models and clinical settings associated with oxidative damage by ROS. However, such hypoxic preconditioning method is harmful to be applied to many clinical conditions associated with oxidative stress. In turn, experimental studies have revealed that non-enzymatic antioxidants produce a significant functional amelioration in cardiomyocytes subjected to an oxidative challenge. Moreover, clinical studies with patients scheduled for primary coronary artery bypass graft surgery had a reduced incidence of postoperative atrial fibrillation. We present the hypothesis of non-hypoxic preconditioning based on the association of pretreatment with n-3 polyunsaturated fatty acids followed by ascorbate plus alpha-tocoferol supplementation diminishes the incidence of postoperative atrial fibrillation in patients subjected to cardiac surgery with extracorporeal circulation.
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Affiliation(s)
- Ramón Rodrigo
- Laboratory of Renal Pathophysiology, Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Independencia 1027, Santiago 7, Chile.
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Li YB, Hu CL, Liu J, Chen YX, Qu Z, Xu JL, Chen JB, Wan J, Tang QZ, Huang CX. Atrial fibrillation: Rhythm control offers no advantage over rate control for some, but not all. Med Hypotheses 2007; 69:206-8. [PMID: 17011138 DOI: 10.1016/j.mehy.2006.07.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 07/19/2006] [Indexed: 10/24/2022]
Abstract
Atrial fibrillation (AF) is not a benign condition. Although AF is the most common sustained cardiac arrhythmia, the management of AF remains controversial. In recent years, several clinical trials comparing rhythm control with rate control for AF management found that rhythm control offers no advantage over rate control, but the findings may not apply equally to all patients. The main point is the high risk of AF recurrence in these trials and the toxic effects and poor efficacy of presently available antiarrhythmic drugs negate the benefit of rhythm control. Rhythm control should be considered as the preferred initial therapy if sinus rhythm had been maintained in a higher proportion of patients. For the moment, the optimal strategy to treat AF should be individualized, with a bias towards rate control if patients are at high risk for arrhythmias or can be kept asymptomatic. Rhythm control may still be justified in younger patients or patients who still have symptoms despite adequate rate control. In addition, patients with new or first-episode AF often warrant at least an initial trial of rhythm control.
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Affiliation(s)
- Yan Bo Li
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China
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