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Walsh HJ, Junejo RT, Lip GYH, Fisher JP. The effect of hypertension on cerebrovascular carbon dioxide reactivity in atrial fibrillation patients. Hypertens Res 2024; 47:1678-1687. [PMID: 38600276 PMCID: PMC11150149 DOI: 10.1038/s41440-024-01662-2] [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: 10/25/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/12/2024]
Abstract
Atrial fibrillation (AF) and hypertension (HTN) are both associated with impaired cerebrovascular carbon dioxide reactivity (CVRCO2), an indicator of cerebral vasodilatory reserve. We hypothesised that CVRCO2 would be lower in patients with both AF and HTN (AF + HTN) compared to normotensive AF patients, due to an additive effect of AF and HTN on CVRCO2. Forty AF (68 ± 9 years) and fifty-seven AF + HTN (68 ± 8 years) patients underwent transcranial Doppler ultrasound measurement of middle cerebral artery blood velocity (MCA Vm) during stepped increases and decreases in end-tidal carbon dioxide (PETCO2). A cerebrovascular conductance index (CVCi) was calculated as the ratio of MCA Vm and mean arterial pressure (MAP). CVRCO2 was determined from the linear slope for MCA Vm and MCA CVCi vs PETCO2. Baseline MAP was higher in AF + HTN than AF (107 ± 9 vs. 98 ± 9 mmHg, respectively; p < 0.001), while MCA Vm was not different (AF + HTN:49.6 [44.1-69.0]; AF:51.7 [45.2-63.3] cm.s-1; p = 0.075), and CVCi was lower in AF + HTN (0.46 [0.42-0.57] vs. 0.54 [0.44-0.63] cm.s-1.mmHg-1; p < 0.001). MCA Vm CVRCO2 was not different (AF + HTN: 1.70 [1.47-2.19]; AF 1.74 [1.54-2.52] cm/s/mmHg-2; p = 0.221), while CVCi CVRCO2 was 13% lower in AF + HTN (0.013 ± 0.004 vs 0.015 ± 0.005 cm.s-1.mmHg-1; p = 0.047). Our results demonstrate blunted cerebral vasodilatory reserve (determined as MCA CVCi CVRCO2) in AF + HTN compared to AF alone. This may implicate HTN as a driver of further cerebrovascular dysfunction in AF that may be important for the development of AF-related cerebrovascular events and downstream cognitive decline. We demonstrated reduced cerebrovascular CO2 responsiveness in atrial fibrillation with hypertension (AF+HTN) vs. atrial fibrillation (AF). Furthermore, AF per se (as opposed to normal sinus rhythm) predicts reduced cerebrovascular CO2 responsiveness. Our findings suggest additional cerebrovascular dysfunction in AF+HTN vs. AF.
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Affiliation(s)
- Harvey J Walsh
- Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rehan T Junejo
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - James P Fisher
- Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
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2
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Rasti SD, Sugiarto AAR, Nuryandi APA, Arvianti MZ, Yomara RT, Nagasastra J, Julario R, Fagi RA, Windrati DMH. Revitalizing brain perfusion: Unveiling advancements through rhythm control strategies in atrial fibrillation-A systematic review. J Arrhythm 2024; 40:411-422. [PMID: 38939785 PMCID: PMC11199798 DOI: 10.1002/joa3.13056] [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] [Received: 01/25/2024] [Revised: 04/18/2024] [Accepted: 04/30/2024] [Indexed: 06/29/2024] Open
Abstract
Background Recent evidence suggests an elevated risk of cognitive impairment and dementia in individuals with atrial fibrillation (AF), irrespective of stroke occurrence. AF, known to reduce brain perfusion, particularly through silent cerebral ischemia, underscores the intricate relationship between cardiac and cerebral health. The heart plays a crucial role in supporting normal brain function, and rhythm control, a standard AF treatment, has demonstrated enhancements in brain perfusion. This systematic review aimed to examine published data concerning the influence of rhythm control on brain perfusion in patients with atrial fibrillation. Methods A systematic search for relevant studies was carried out in Scopus, PubMed, Cochrane Reviews, ProQuest, and EBSCOhost, spanning from their inception until April 30, 2023. Studies that specifically examined brain perfusion following any form of rhythm control in atrial fibrillation were included in the review. Results The review encompassed 10 studies involving 436 participants. Among these, six utilized electrical cardioversion for rhythm control. The majority (8 out of 10) demonstrated that restoring sinus rhythm markedly enhances brain perfusion. In one of the two remaining studies, notable improvement was observed specifically in a region closely linked to cognition. Additionally, both studies reporting data on the Mini-Mental State Examination (MMSE) showed a consistent and significant increase in scores following rhythm control. Conclusion Successful rhythm control in AF emerges as a significant contributor to enhanced brain perfusion, suggesting a potential therapeutic avenue for reducing cognitive impairment incidence. However, further validation through larger prospective studies and randomized trials is warranted.
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Affiliation(s)
| | | | | | | | | | | | - Rerdin Julario
- Department of Cardiology and Vascular MedicineDr. Soetomo General Hospital, Faculty of Medicine, University of AirlanggaSurabayaIndonesia
| | - Rosi Amrilla Fagi
- Department of Cardiology and Vascular MedicineDr. Soetomo General Hospital, Faculty of Medicine, University of AirlanggaSurabayaIndonesia
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3
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Heckbert SR, Jensen PN, Erus G, Nasrallah IM, Rashid T, Habes M, Austin TR, Floyd JS, Schaich CL, Redline S, Bryan RN, Costa MD. Heart rate fragmentation and brain MRI markers of small vessel disease in MESA. Alzheimers Dement 2024; 20:1397-1405. [PMID: 38009395 PMCID: PMC10917025 DOI: 10.1002/alz.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Heart rate (HR) fragmentation indices quantify breakdown of HR regulation and are associated with atrial fibrillation and cognitive impairment. Their association with brain magnetic resonance imaging (MRI) markers of small vessel disease is unexplored. METHODS In 606 stroke-free participants of the Multi-Ethnic Study of Atherosclerosis (mean age 67), HR fragmentation indices including percentage of inflection points (PIP) were derived from sleep study recordings. We examined PIP in relation to white matter hyperintensity (WMH) volume, total white matter fractional anisotropy (FA), and microbleeds from 3-Tesla brain MRI completed 7 years later. RESULTS In adjusted analyses, higher PIP was associated with greater WMH volume (14% per standard deviation [SD], 95% confidence interval [CI]: 2, 27%, P = 0.02) and lower WM FA (-0.09 SD per SD, 95% CI: -0.16, -0.01, P = 0.03). DISCUSSION HR fragmentation was associated with small vessel disease. HR fragmentation can be measured automatically from ambulatory electrocardiogram devices and may be useful as a biomarker of vascular brain injury.
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Affiliation(s)
- Susan R. Heckbert
- Cardiovascular Health Research UnitUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Paul N. Jensen
- Cardiovascular Health Research UnitUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Guray Erus
- Center for AI and Data Science for Integrated Diagnostics and Center for Biomedical Image Computing and AnalyticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ilya M. Nasrallah
- Center for AI and Data Science for Integrated Diagnostics and Center for Biomedical Image Computing and AnalyticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Tanweer Rashid
- Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging CoreGlenn Biggs Institute for Alzheimer's and Neurodegenerative DiseasesUniversity of Texas Health Science Center San AntonioSan AntonioTexasUSA
| | - Mohamad Habes
- Center for AI and Data Science for Integrated Diagnostics and Center for Biomedical Image Computing and AnalyticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging CoreGlenn Biggs Institute for Alzheimer's and Neurodegenerative DiseasesUniversity of Texas Health Science Center San AntonioSan AntonioTexasUSA
| | - Thomas R. Austin
- Cardiovascular Health Research UnitUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - James S. Floyd
- Cardiovascular Health Research UnitUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Christopher L. Schaich
- Department of SurgeryHypertension and Vascular Research CenterWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Susan Redline
- Brigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - R. Nick Bryan
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Madalena D. Costa
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
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4
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Herman D, Javůrková A, Raudenská J, Budera P, Rizov V, Kačer P, Peisker T, Malý M, Osmančík P. Changes in cognitive function after thoracoscopic and catheter ablation for atrial fibrillation. Pacing Clin Electrophysiol 2023; 46:84-90. [PMID: 36428282 DOI: 10.1111/pace.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/30/2022] [Accepted: 11/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Comparative data regarding the effect of percutaneous and thoracoscopic ablation of atrial fibrillation (AF) on cognitive function are very limited. The aim of the study was to determine and compare the effect of both types of ablations on patient cognitive functions in the mid-term. METHODS Patients with AF indicated for ablation procedure were included. Forty-six patients underwent thoracoscopic, off-pump ablation using the COBRA Fusion radiofrequency system, followed by a catheter ablation three months afterward (Hybrid group). A comparative cohort of 53 AF patients underwent pulmonary vein isolation only (PVI group). Neuropsychological examinations were done before and nine months after the surgical or catheter ablation procedure. Neuropsychological testing comprised 13 subtests of seven domains, and the results were expressed as post-operative cognitive dysfunction (POCD) nine months after the procedure. RESULTS Patients in both groups were similar with respect to the baseline clinical characteristics; only non-paroxysmal AF was more common in the hybrid group (98% vs. 34%). Major POCD was present in eight (17.4%) of hybrid patients versus three (5.7%) of PVI patients (p = 0.11), combined (major/minor) worsened cognitive decline was present in 10 (21.7%) hybrid patients versus three (5.6%) PVI patients (p = 0.034). On the other hand, combined (major/minor) improvement was present in 15 (32.6%) hybrid patients versus nine (16.9%) patients in the PVI group (p = 0.099). CONCLUSION Hybrid ablation, a combination of thoracoscopic and percutaneous ablation, is associated with a higher risk of cognitive decline compared to sole percutaneous ablation.
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Affiliation(s)
- Dalibor Herman
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Alena Javůrková
- Department of Clinical Psychology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.,Department of Nursing, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslava Raudenská
- Department of Clinical Psychology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.,Department of Nursing, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Budera
- Department of Cardiac Surgery, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Vitalii Rizov
- Department of Cardiac Surgery, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Kačer
- Department of Cardiac Surgery, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Tomáš Peisker
- Department of Neurology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Marek Malý
- National Institute of Public Health, Prague, Czech Republic
| | - Pavel Osmančík
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
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5
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Blood-Brain Barrier Transporters: Opportunities for Therapeutic Development in Ischemic Stroke. Int J Mol Sci 2022; 23:ijms23031898. [PMID: 35163820 PMCID: PMC8836701 DOI: 10.3390/ijms23031898] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/20/2022] Open
Abstract
Globally, stroke is a leading cause of death and long-term disability. Over the past decades, several efforts have attempted to discover new drugs or repurpose existing therapeutics to promote post-stroke neurological recovery. Preclinical stroke studies have reported successes in identifying novel neuroprotective agents; however, none of these compounds have advanced beyond a phase III clinical trial. One reason for these failures is the lack of consideration of blood-brain barrier (BBB) transport mechanisms that can enable these drugs to achieve efficacious concentrations in ischemic brain tissue. Despite the knowledge that drugs with neuroprotective properties (i.e., statins, memantine, metformin) are substrates for endogenous BBB transporters, preclinical stroke research has not extensively studied the role of transporters in central nervous system (CNS) drug delivery. Here, we review current knowledge on specific BBB uptake transporters (i.e., organic anion transporting polypeptides (OATPs in humans; Oatps in rodents); organic cation transporters (OCTs in humans; Octs in rodents) that can be targeted for improved neuroprotective drug delivery. Additionally, we provide state-of-the-art perspectives on how transporter pharmacology can be integrated into preclinical stroke research. Specifically, we discuss the utility of in vivo stroke models to transporter studies and considerations (i.e., species selection, co-morbid conditions) that will optimize the translational success of stroke pharmacotherapeutic experiments.
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6
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Yang M, Sun D, Wang Y, Yan M, Zheng J, Ren J. Cognitive Impairment in Heart Failure: Landscape, Challenges, and Future Directions. Front Cardiovasc Med 2022; 8:831734. [PMID: 35198608 PMCID: PMC8858826 DOI: 10.3389/fcvm.2021.831734] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/30/2021] [Indexed: 12/20/2022] Open
Abstract
Heart failure (HF) is a major global healthcare problem accounting for substantial deterioration of prognosis. As a complex clinical syndrome, HF often coexists with multi-comorbidities of which cognitive impairment (CI) is particularly important. CI is increasing in prevalence among patients with HF and is present in around 40%, even up to 60%, of elderly patients with HF. As a potent and independent prognostic factor, CI significantly increases the hospitalization and mortality and decreases quality of life in patients with HF. There has been a growing awareness of the complex bidirectional interaction between HF and CI as it shares a number of common pathophysiological pathways including reduced cerebral blood flow, inflammation, and neurohumoral activations. Research that focus on the precise mechanism for CI in HF is still ever insufficient. As the tremendous adverse consequences of CI in HF, effective early diagnosis of CI in HF and interventions for these patients may halt disease progression and improve prognosis. The current clinical guidelines in HF have begun to emphasize the importance of CI. However, nearly half of CI in HF is underdiagnosed, and few recommendations are available to guide clinicians about how to approach CI in patients with HF. This review aims to synthesize knowledge about the link between HF and cognitive dysfunction, issues pertaining to screening, diagnosis and management of CI in patients with HF, and emerging therapies for prevention. Based on data from current studies, critical gaps in knowledge of CI in HF are identified, and future research directions to guide the field forward are proposed.
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Affiliation(s)
- Mengxi Yang
- Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Di Sun
- Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yu Wang
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Mengwen Yan
- Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Jingang Zheng
- Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Jingyi Ren
- Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
- Vascular Health Research Center of Peking University Health Science Center, Beijing, China
- *Correspondence: Jingyi Ren
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7
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Kato N, Muraga K, Hirata Y, Shindo A, Matsuura K, Ii Y, Shiga M, Tabei KI, Satoh M, Fujita S, Fukuma T, Kagawa Y, Fujii E, Umino M, Maeda M, Sakuma H, Ito M, Tomimoto H. Brain magnetic resonance imaging and cognitive alterations after ablation in patients with atrial fibrillation. Sci Rep 2021; 11:18995. [PMID: 34556757 PMCID: PMC8460624 DOI: 10.1038/s41598-021-98484-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022] Open
Abstract
Catheter ablation is an important non-pharmacological intervention for atrial fibrillation (AF), but its effect on the incidence of asymptomatic cerebral emboli and long-term effects on cognitive function remain unknown. We prospectively enrolled 101 patients who underwent AF ablation. Brain magnetic resonance imaging (MRI) (72 patients) and neuropsychological assessments (66 patients) were performed 1–3 days (baseline) and 6 months after ablation. Immediately after ablation, diffusion-weighted MRI and 3-dimensional double inversion recovery (3D-DIR) detected embolic microinfarctions in 63 patients (87.5%) and 62 patients (86.1%), respectively. After 6 months, DIR lesions disappeared in 41 patients. Microbleeds (MBs) increased by 17%, and 65% of the de novo MBs were exactly at the same location as the microinfarctions. Average Mini-Mental State Examination scores improved from 27.9 ± 2.4 to 28.5 ± 1.7 (p = 0.037), and detailed neuropsychological assessment scores showed improvement in memory, constructional, and frontal lobe functions. Ejection fraction, left atrial volume index and brain natriuretic peptide level improved from baseline to 3–6 months after ablation. Despite incidental microemboli, cognitive function was preserved 6 months after ablation.
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Affiliation(s)
- Natsuko Kato
- Department of Neurology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, Japan. .,Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Kanako Muraga
- Department of Neurology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, Japan.,Department of Neurologic Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshinori Hirata
- Department of Neurology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, Japan
| | - Mariko Shiga
- Department of Neurology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, Japan.,Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ken-Ichi Tabei
- Department of Neurology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, Japan.,Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masayuki Satoh
- Department of Neurology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, Japan.,Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Satoshi Fujita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tomoyuki Fukuma
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshihiko Kagawa
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eitaro Fujii
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Maki Umino
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, Japan
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8
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Gardarsdottir M, Sigurdsson S, Aspelund T, Gardarsdottir VA, Forsberg L, Gudnason V, Arnar DO. Improved brain perfusion after electrical cardioversion of atrial fibrillation. Europace 2021; 22:530-537. [PMID: 31860069 DOI: 10.1093/europace/euz336] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 12/04/2019] [Indexed: 01/21/2023] Open
Abstract
AIMS Atrial fibrillation (AF) has been associated with reduced brain volume, cognitive impairment, and reduced cerebral blood flow. The causes of reduced cerebral blood flow in AF are unknown, but no reduction was seen in individuals without the arrhythmia in a previous study. The aim of this study was to test the hypothesis that brain perfusion, measured with magnetic resonance imaging (MRI), improves after cardioversion of AF to sinus rhythm (SR). METHODS AND RESULTS All patients undergoing elective cardioversion at our institution were invited to participate. A total of 44 individuals were included. Magnetic resonance imaging studies were done before and after cardioversion with both brain perfusion and cerebral blood flow measurements. However, 17 did not complete the second MRI as they had a recurrence of AF during the observation period (recurrent AF group), leaving 17 in the SR group and 10 in the AF group to complete both measurements. Brain perfusion increased after cardioversion to SR by 4.9 mL/100 g/min in the whole brain (P < 0.001) and by 5.6 mL/100 g/min in grey matter (P < 0.001). Cerebral blood flow increased by 58.6 mL/min (P < 0.05). Both brain perfusion and cerebral blood flow remained unchanged when cardioversion was unsuccessful. CONCLUSION In this study of individuals undergoing elective cardioversion for AF, restoration, and maintenance of SR for at least 10 weeks after was associated with an improvement of brain perfusion and cerebral blood flow measured by both arterial spin labelling and phase contrast MRI. In those individuals where cardioversion was unsuccessful, there was no change in perfusion or blood flow.
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Affiliation(s)
- Marianna Gardarsdottir
- Department of Radiology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Thor Aspelund
- Icelandic Heart Association, Kopavogur, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Valdis Anna Gardarsdottir
- Department of Medicine, Landspitali-The National University Hospital of Iceland, 14C, Hringbraut, 101 Reykjavik, Iceland
| | | | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - David O Arnar
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Medicine, Landspitali-The National University Hospital of Iceland, 14C, Hringbraut, 101 Reykjavik, Iceland
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9
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Ovsenik A, Podbregar M, Fabjan A. Cerebral blood flow impairment and cognitive decline in heart failure. Brain Behav 2021; 11:e02176. [PMID: 33991075 PMCID: PMC8213942 DOI: 10.1002/brb3.2176] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Cognitive decline is an important contributor to disability in patients with chronic heart failure, affecting 25%-50% of patients. The aim of this review is to stress the importance of understanding pathophysiological mechanisms of heart failure involved in cognitive decline. METHODS An extensive PubMed search was conducted for the literature on the basic mechanisms of cerebral blood flow regulation, the effect of cardiac dysfunction on cerebral blood flow, and possible mechanisms underlying the association between cardiac dysfunction and cognitive decline. RESULTS Published literature supports the thesis that cardiac dysfunction leads to cerebral blood flow impairment and predisposes to cognitive decline. One of the postulated mechanisms underlying cognitive decline in chronic heart failure is chronic regional hypoperfusion of critical brain areas. Cognitive function may be further compromised by microvascular damage due to cardiovascular risk factors. Furthermore, it is implied that cerebral blood flow assessment could enable early recognition of patients at risk and help guide appropriate therapeutic strategies. CONCLUSION Interdisciplinary knowledge in the fields of neurology and cardiology is essential to clarify heart and brain interconnections in chronic heart failure. Understanding and identifying the basic neuropathophysiological changes in chronic heart failure could help with developing methods for early recognition of patients at risk, followed by institution of therapeutic actions to prevent or decrease cognitive decline.
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Affiliation(s)
- Ana Ovsenik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matej Podbregar
- Faculty of Medicine, Department for Internal Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Intensive care, General Hospital Celje, Celje, Slovenia
| | - Andrej Fabjan
- Faculty of Medicine, Institute for Physiology, University of Ljubljana, Ljubljana, Slovenia.,Department of Vascular Neurology and Intensive Care, Neurological Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
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10
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Aryal R, Patabendige A. Blood-brain barrier disruption in atrial fibrillation: a potential contributor to the increased risk of dementia and worsening of stroke outcomes? Open Biol 2021; 11:200396. [PMID: 33878948 PMCID: PMC8059575 DOI: 10.1098/rsob.200396] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Atrial fibrillation (AF) has become one of the most significant health problems worldwide, warranting urgent answers to currently pending questions on the effects of AF on brain function. Recent evidence has emerged to show an association between AF and an increased risk of developing dementia and worsening of stroke outcomes. A healthy brain is protected by the blood–brain barrier (BBB), which is formed by the endothelial cells that line cerebral capillaries. These endothelial cells are continuously exposed to shear stress (the frictional force generated by blood flow), which affects endothelial cell structure and function. Flow disturbances as experienced during AF can disrupt the BBB and leave the brain vulnerable to damage. Investigating the plausible mechanisms in detail, linking AF to cerebrovascular damage is difficult in humans, leading to paucity of available clinical data. Here, we discuss the available evidence for BBB disruption during AF due to altered cerebral blood flow, and how this may contribute to an increased risk of dementia and worsening of stroke outcomes.
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Affiliation(s)
- Ritambhara Aryal
- Brain Barriers Group, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW 2308, Australia.,Brain and Mental Health Research Programme, Hunter Medical Research Institute, Newcastle, Australia
| | - Adjanie Patabendige
- Brain Barriers Group, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW 2308, Australia.,Brain and Mental Health Research Programme, Hunter Medical Research Institute, Newcastle, Australia.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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11
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Junejo RT, Lip GYH, Fisher JP. Cerebrovascular Dysfunction in Atrial Fibrillation. Front Physiol 2020; 11:1066. [PMID: 33013456 PMCID: PMC7509200 DOI: 10.3389/fphys.2020.01066] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/04/2020] [Indexed: 01/13/2023] Open
Abstract
It is now well established that besides being the most common sustained arrhythmia, atrial fibrillation (AF) is a major healthcare burden. Risk of debilitating stroke is increased in AF patients, but even in the absence of stroke, this population is at heightened risk of cognitive decline, depression, and dementia. The reasons for this are complex, multifactorial, and incompletely understood. One potential contributing mechanism is cerebrovascular dysfunction. Cerebral blood flow is regulated by chemical, metabolic, autoregulatory, neurogenic, and systemic factors. The dysfunction in one or more of these mechanisms may contribute to the elevated risk of cognitive decline and cerebrovascular events in AF. This short review presents the evidence for diminished cerebral blood flow, cerebrovascular carbon dioxide reactivity (i.e., cerebrovascular vasodilatory reserve), cerebral autoregulation, and neurovascular coupling in AF patients when compared to control participants in sinus rhythm. Further work is needed to understand the physiological mechanisms underpinning these observations and their clinical significance in atrial fibrillation patients.
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Affiliation(s)
- Rehan T. Junejo
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom
| | - James P. Fisher
- Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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12
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[Atrial fibrillation and impairment of cognition-importance for geriatrics]. Z Gerontol Geriatr 2020; 54:704-707. [PMID: 32627069 DOI: 10.1007/s00391-020-01754-x] [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: 04/07/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022]
Abstract
According to the current study situation an independent association between atrial fibrillation and cognitive impairment is likely. Several pathomechanisms seem to be causative: embolisms in particular appear to cause clinically inapparent cerebral infarction and thus a deterioration of cognitive status but hypoperfusion and possibly subsequent atrophy of the gray matter can also play a role. There are indications but not yet sufficient evidence for protective effects of anticoagulation, rhythm control and possibly frequency regulation.
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13
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Petroni R, Magnano R, Pezzi L, Petroni A, Di Mauro M, Mattei A, Fiasca F, Angelone AM, Gallina S, Penco M, Romano S. Analysis of Risk Factors Independently Associated with Cognitive Impairment in Patients with Permanent Atrial Fibrillation: A Cross-sectional Observational Study. J Stroke Cerebrovasc Dis 2020; 29:104895. [PMID: 32430236 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104895] [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: 01/07/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Atrial Fibrillation (AF) is associated with an increased risk of stroke and development of cognitive impairment. Our cross-sectional study aims to identify risk factors for cognitive impairment in patients with permanent AF. MATERIALS AND METHODS 212 consecutive outpatients with history of permanent AF lasting more than 1 year were enrolled and the Short Portable Mental Status Questionnaire (SPMSQ) was used to assess cognitive impairment (number of errors ≥5). The type of antithrombotic therapy, the time in therapeutic range (TTR) in case of treatment with warfarin and the degree of heart rate (HR) control (upon Holter ECG monitoring) were also assessed. RESULTS ROC curve analysis indicated that TTR was associated with cognitive impairment (AUC 0.85 ± 0.03; 95% CI 0.77-0.88; p < 0.0001). Multivariate logistic regression analysis showed an independent association of previous cerebrovascular or cardiovascular events (OR 7.24, 95% CI 1.37-38.25; p = 0.020), aspirin therapy instead of anticoagulant therapy (OR 24.74, 95% CI 1.27-482.12; p = 0.034), warfarin use with TTR ≤60% (OR 21.71 , 95%CI 4.35-108; p < 0.001) and an average daily HR either <60 bpm or >100 bpm (OR 6.04, 95% 1.09-33.29; p = 0.039) with cognitive impairment. CONCLUSION Among patients with permanent AF, cognitive impairment is more frequent in those with inadequate antithrombotic therapy (aspirin therapy instead of anticoagulant therapy) and with suboptimal oral anticoagulation (TTR ≤60%) or heart rate control. Efforts should be made to optimize therapies related to these parameters.
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Affiliation(s)
- Renata Petroni
- Cardiology, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy; "Di Lorenzo" Clinic, Avezzano, Italy.
| | - Roberta Magnano
- Cardiology, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy.
| | - Laura Pezzi
- Cardiology, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy.
| | | | - Michele Di Mauro
- Cardiology, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy
| | - Antonella Mattei
- Medical Statistical Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy.
| | - Fabiana Fiasca
- Medical Statistical Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy.
| | - Anna Maria Angelone
- Medical Statistical Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy.
| | - Sabina Gallina
- Department of Neuroscience, Imaging, and Clinical Sciences "G. d'Annunzio" University of Chieti-Pescara, Italy.
| | - Maria Penco
- Cardiology, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy.
| | - Silvio Romano
- Cardiology, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy.
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14
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Moazzami K, Shao IY, Chen LY, Lutsey PL, Jack CR, Mosley T, Joyner DA, Gottesman R, Alonso A. Atrial Fibrillation, Brain Volumes, and Subclinical Cerebrovascular Disease (from the Atherosclerosis Risk in Communities Neurocognitive Study [ARIC-NCS]). Am J Cardiol 2020; 125:222-228. [PMID: 31771759 PMCID: PMC6942172 DOI: 10.1016/j.amjcard.2019.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 01/24/2023]
Abstract
The aim of the present study was to investigate the association between atrial fibrillation (AF) and total and regional brain volumes among participants in the community-based Atherosclerosis Risk in Communities Neurocognitive study (ARIC-NCS). A total of 1,930 participants (130 with AF) with a mean age of 76.3 ± 5.2, who underwent 3T brain MRI scans in 2011 to 2013 were included. Prevalent AF was ascertained from study ECGs and hospital discharge codes. Brain volumes were measured using FreeSurfer image analysis software. Markers of subclinical cerebrovascular disease included lobar microhemorrhages, subcortical microhemorrhages, cortical infarcts, subcortical infarcts, lacunar infarcts, and volume of white matter hyperintensities. Linear regression models were used to assess the associations between AF status and brain volumes. In adjusted analyses, AF was not associated with markers of subclinical cerebrovascular disease. However, AF was associated with smaller regional brain volumes (including temporal, occipital, and parietal lobes; deep gray matter; Alzheimer disease signature region; and hippocampus [all p <0.05]) after controlling for demographics, cardiovascular risk factors, prevalent cardiovascular disease, and markers of subclinical cerebrovascular disease. Subgroup analysis revealed a significant interaction between AF and total brain volume with respect to age (p = 0.02), with associations between AF and smaller brain volumes being stronger for older individuals. In conclusion, AF was associated with smaller brain volumes, and the association was stronger among older individuals. This finding may be related to the longer exposure period of the older population to AF or the possibility that older people are more susceptible to the effects of AF on brain volume.
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Affiliation(s)
- Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia.
| | - Iris Yuefan Shao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Thomas Mosley
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi
| | - David A Joyner
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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15
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Ostroumova OD, Kochetkov AI, Korchagina SP, Ostroumova TM, Chernyaeva MS, Kirichenko AA. Anticoagulant Therapy as a Tool for the Prevention of Cognitive Impairment Associated with Atrial Fibrillation. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-5-713-724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in clinical practice and important additional risk factor for the development of cognitive impairment (CI) and dementia as it has been shown in recent studies. According to the Diagnostic and statistical manual of mental disorders latest revision CI refers to a decrease of one or more higher cortical functions that provide the processes of perception, storage, transformation and transmission of information compared to the premorbid level. The main hypothesis that explains the relationship between AF and dementia is the assumption that in the presence of this arrhythmia a brain substance is damaged due to microembolism and cerebral microbleeding. The high clinical significance of AF as well as CI served as a background for the development by European experts several consensus documents concerning the problem of the relationships between these conditions. In addition, they emphasize the role of anticoagulant therapy as a preventing tool for the development of stroke, which can be a factor in the CI progression in patients with AF, with particular priority to direct oral anticoagulants (DOACs). In randomized clinical trials, meta-analyses and systematic reviews have been shown that the use of DOACs, as compared to vitamin K antagonists, is a more rational strategy for preventing stroke associated with AF. Among the DOAC class, rivaroxaban is worth noticing as a drug that has a favorable efficacy profile for primary and secondary stroke prevention. Rivaroxaban distinguishing characteristics are a once daily administration as well as a calendar package which is practically important for patients with CI.
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Affiliation(s)
- O. D. Ostroumova
- Pirogov Russian National Research Medical University, Russian Clinical and Research Center of Gerontology;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. I. Kochetkov
- Pirogov Russian National Research Medical University, Russian Clinical and Research Center of Gerontology
| | | | - T. M. Ostroumova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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16
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Gallinoro E, D'Elia S, Prozzo D, Lioncino M, Natale F, Golino P, Cimmino G. Cognitive Function and Atrial Fibrillation: From the Strength of Relationship to the Dark Side of Prevention. Is There a Contribution from Sinus Rhythm Restoration and Maintenance? ACTA ACUST UNITED AC 2019; 55:medicina55090587. [PMID: 31540311 PMCID: PMC6780629 DOI: 10.3390/medicina55090587] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/07/2019] [Accepted: 09/10/2019] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia with an increasing prevalence over time mainly because of population aging. It is well established that the presence of AF increases the risk of stroke, heart failure, sudden death, and cardiovascular morbidity. In the last two decades several reports have shown an association between AF and cognitive function, ranging from impairment to dementia. Ischemic stroke linked to AF is a well-known risk factor and predictor of cognitive decline. In this clinical scenario, the risk of stroke might be reduced by oral anticoagulation. However, recent data suggest that AF may be a predictor of cognitive impairment and dementia also in the absence of stroke. Cerebral hypoperfusion, reduced brain volume, microbleeds, white matter hyperintensity, neuroinflammation, and genetic factors have been considered as potential mechanisms involved in the pathogenesis of AF-related cognitive dysfunction. However, a cause-effect relationship remains still controversial. Consequently, no therapeutic strategies are available to prevent AF-related cognitive decline in stroke-free patients. This review will analyze the potential mechanisms leading to cognitive dysfunction in AF patients and examine the available data on the impact of a sinus rhythm restoration and maintenance strategy in reducing the risk of cognitive decline.
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Affiliation(s)
- Emanuele Gallinoro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Saverio D'Elia
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Dario Prozzo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Michele Lioncino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Francesco Natale
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Paolo Golino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Giovanni Cimmino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
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17
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Jin MN, Kim TH, Kang KW, Yu HT, Uhm JS, Joung B, Lee MH, Kim E, Pak HN. Atrial Fibrillation Catheter Ablation Improves 1-Year Follow-Up Cognitive Function, Especially in Patients With Impaired Cognitive Function. Circ Arrhythm Electrophysiol 2019; 12:e007197. [PMID: 31442075 DOI: 10.1161/circep.119.007197] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although atrial fibrillation (AF) has a risk of cognitive dysfunction, it is not clear whether AF catheter ablation improves or worsens cognitive function. This prospective case-control study sought to assess the 1-year serial changes in the cognitive function with or without AF catheter ablation. METHODS We evaluated the Montreal Cognitive Assessment score in 308 patients (71.4% male, 60.6±9.1 years of age, 34.1% persistent AF) who underwent AF ablation (ablation group) and 50 AF patients on medical therapy who met the same indication for AF ablation (control group), at baseline and 3 and 12 months after enrollment. Cognitive impairment was defined as a published cutoff score of <23 points. To exclude any learning effects, we used the practice-adjusted reliable change index for assessing the cognitive changes. RESULTS Preablation cognitive impairment was detected in 18.5% (57/308). The Montreal Cognitive Assessment score significantly improved 1 year after radiofrequency catheter ablation in both overall ablation group (24.9±2.9-26.4±2.5; P<0.001) and the propensity-matched ablation group (25.4±2.4-26.5±2.3; P<0.001), but not in the control group (25.4±2.5-24.8±2.5; P=0.012). Preablation cognitive impairment (odds ratio, 13.70; 95% CI, 4.83-38.87; P<0.001) was independently associated with an improvement in the 1-year post-ablation cognitive function. In the reliable change index analyses, 94.7% of propensity-matched ablation group showed an improved/stable cognitive function at the 1-year follow-up. CONCLUSIONS Catheter ablation of AF, at least, does not deteriorate the cognitive function, but rather improves the performance on 1-year follow-up neurocognitive tests, especially in patients with a preablation cognitive impairment.
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Affiliation(s)
- Moo-Nyun Jin
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon (K.-W.K.)
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Eosu Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (E.K.)
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
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18
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Gardarsdottir M, Sigurdsson S, Aspelund T, Rokita H, Launer LJ, Gudnason V, Arnar DO. Atrial fibrillation is associated with decreased total cerebral blood flow and brain perfusion. Europace 2019; 20:1252-1258. [PMID: 29016776 DOI: 10.1093/europace/eux220] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/13/2017] [Indexed: 12/26/2022] Open
Abstract
Aims Atrial fibrillation (AF) has been associated with cognitive impairment. Additionally, brain volume may be reduced in individuals with AF. Potential causes may include cerebral micro-embolism or reduced stroke volume due to the beat-to-beat variation in AF. The aims of this study were to measure cerebral blood flow and estimate whole brain perfusion in elderly individuals with and without AF. Methods and results Blood flow in the cervical arteries was measured with phase contrast MRI and brain perfusion estimated in a large cohort from the AGES-Reykjavik Study. Individuals were divided into three groups at the time of the MRI: persistent AF, paroxysmal AF, and no history of AF. Of 2291 participants (mean age 79.5 years), 117 had persistent AF and 78 had paroxysmal AF but were in sinus rhythm at the time of imaging AF. Those with persistent AF had lower cholesterol and used more anti-hypertensive medication and warfarin. The three groups were similar with regard to other cardiovascular risk factors. Those in the persistent AF group had significantly lower total cerebral blood flow on average, 472.1 mL/min, both when compared with the paroxysmal AF group, 512.3 mL/min (P < 0.05) and the no AF group, 541.0 mL/min (P < 0.001). Brain perfusion was lowest in the persistent AF group, 46.4 mL/100 g/min compared with the paroxysmal AF group, 50.9 mL/100 g/min in (P < 0.05) and those with no AF, 52.8 mL/100 g/min (P < 0.001). Conclusion Persistent AF decreases blood flow to the brain as well as perfusion of brain tissue compared with sinus rhythm.
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Affiliation(s)
- Marianna Gardarsdottir
- Department of Radiology, Landspitali-The National University Hospital of Iceland, Hringbraut, 101 Reykjavik, Iceland
| | | | - Thor Aspelund
- Icelandic Heart Association, Holtasmari 1, 201 Kopavogur, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Vatnsmyrarvegur 16, Reykjavik, Iceland
| | - Hrafnhildur Rokita
- Department of Internal Medicine II, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, Regensburg, Germany
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute of Ageing, National Institutes of Health, 7201 Gateway Building, Bethesda, MD, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Holtasmari 1, 201 Kopavogur, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Vatnsmyrarvegur 16, Reykjavik, Iceland
| | - David O Arnar
- Faculty of Medicine, School of Health Sciences, University of Iceland, Vatnsmyrarvegur 16, Reykjavik, Iceland.,Department of Cardiology, Landspitali - The National University Hospital of Iceland, Hringbraut, Reykjavik, Iceland
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19
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Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Europace 2019; 20:1399-1421. [PMID: 29562326 DOI: 10.1093/europace/euy046] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 01/24/2023] Open
Abstract
Abstract
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Affiliation(s)
- Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, Strümpellstr. 39, Leipzig, Germany
| | - Tze-Fan Chao
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | - Daniel Benhayon
- Cardiac and Vascular Institute, Memorial Health, Hollywood, FL, USA
| | - Emelia J Benjamin
- Boston University Schools of Medicine and Public Health, Framingham Heart Study, Boston, MA, USA
| | | | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Angelo de Paola
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Université François Rabelais, Tours, France
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | - Deirdre A Lane
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Manlio F Márquez
- Departmen of Electrocardiography, Instituto Nacional De Cardiologia, Mexico City, Mexico
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | - Irina Savelieva
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK
| | | | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Atul Verma
- Southlake Regional Health Centre, Ontario, Canada
| | - Shu Zhang
- Beijing Fuwai Hospital, Beijing, People's Republic of China
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20
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Berman JP, Norby FL, Mosley T, Soliman EZ, Gottesman RF, Lutsey PL, Alonso A, Chen LY. Atrial Fibrillation and Brain Magnetic Resonance Imaging Abnormalities. Stroke 2019; 50:783-788. [PMID: 30908155 PMCID: PMC6662638 DOI: 10.1161/strokeaha.118.024143] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/04/2019] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Atrial fibrillation (AF) is associated with dementia independent of clinical stroke. The mechanisms underlying this association remain unclear. In a community-based cohort, the ARIC study (Atherosclerosis Risk in Communities), we evaluated (1) the longitudinal association of incident AF and (2) the cross-sectional association of prevalent AF with brain magnetic resonance imaging (MRI) abnormalities. Methods- The longitudinal analysis included 963 participants (mean age, 73±4.4 years; 62% women; 51% black) without prevalent stroke or AF who underwent a brain MRI in 1993 to 1995 and a second MRI in 2004 to 2006 (mean, 10.6±0.8 years). Outcomes included subclinical cerebral infarctions, sulcal size, ventricular size, and, for the cross-sectional analysis, white matter hyperintensity volume and total brain volume. Results- In the longitudinal analysis, 29 (3.0%) participants developed AF after the first brain MRI. Those who developed AF had higher odds of increase in subclinical cerebral infarctions (odds ratio [OR], 3.08; 95% CI, 1.39-6.83), worsening sulcal grade (OR, 3.56; 95% CI, 1.04-12.2), and worsening ventricular grade (OR, 9.34; 95% CI, 1.24-70.2). In cross-sectional analysis, of 969 participants, 35 (3.6%) had prevalent AF at the time of the 2004 to 2006 MRI scan. Those with AF had greater odds of higher sulcal (OR, 3.9; 95% CI, 1.7-9.1) and ventricular grade (OR, 2.4; 95% CI, 1.0-5.7) after multivariable adjustment and no difference in white matter hyperintensity or total brain volume. Conclusions- AF is independently associated with increase in subclinical cerebral infarction and worsening sulcal and ventricular grade-morphological changes associated with aging and dementia. More research is needed to define the mechanisms underlying AF-related neurodegeneration.
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Affiliation(s)
- Jeremy P. Berman
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Faye L. Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Thomas Mosley
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Rebecca F. Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lin Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
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21
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Kim MY, Kim K, Hong CH, Lee SY, Jung YS. Sex Differences in Cardiovascular Risk Factors for Dementia. Biomol Ther (Seoul) 2018; 26:521-532. [PMID: 30464071 PMCID: PMC6254640 DOI: 10.4062/biomolther.2018.159] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/27/2018] [Accepted: 10/06/2018] [Indexed: 12/16/2022] Open
Abstract
Dementia, characterized by a progressive cognitive decline and a cumulative inability to behave independently, is highly associated with other diseases. Various cardiovascular disorders, such as coronary artery disease and atrial fibrillation, are well-known risk factors for dementia. Currently, increasing evidence suggests that sex factors may play an important role in the pathogenesis of diseases, including cardiovascular disease and dementia. Recent studies show that nearly two-thirds of patients diagnosed with Alzheimer’s disease are women; however, the incidence difference between men and women remains vague. Therefore, studies are needed to investigate sex-specific differences, which can help understand the pathophysiology of dementia and identify potential therapeutic targets for both sexes. In the present review, we summarize sex differences in the prevalence and incidence of dementia by subtypes. This review also describes sex differences in the risk factors of dementia and examines the impact of risk factors on the incidence of dementia in both sexes.
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Affiliation(s)
- Mi-Young Kim
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Kyeongjin Kim
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon 16499, Republic of Korea.,Institute on Aging, Ajou University Medical Center, Suwon 16499, Republic of Korea
| | - Sang Yoon Lee
- Department of Biomedical Sciences, Chronic Inflammatory Disease Research Center, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Yi-Sook Jung
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea.,Research Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon 16499, Republic of Korea
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22
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Damanti S, Pasina L, Cortesi L, Rossi PD, Cesari M. Atrial Fibrillation: Possible Influences of Rate and Rhythm Control Strategy on Cognitive Performance. J Am Geriatr Soc 2018; 66:2178-2182. [PMID: 30281781 DOI: 10.1111/jgs.15568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/16/2018] [Accepted: 07/19/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether rate or rhythm control strategy may affect cognition in older adults with atrial fibrillation (AF). DESIGN Retrospective analysis of the REgistro POliterapie SIMI database. SETTING Italian internal medicine and geriatric wards. PARTICIPANTS Individuals aged 65 and older (N=1,082, mean age 80.6 ± 7; 50% male) with AF before hospital admission (for any cause). MEASUREMENTS Evaluation of cognitive performance using the Short Blessed Test (SBT) according to rhythm and rate control strategy, anticoagulant and antiplatelet therapy, age, education, and comorbidities. RESULTS Two hundred seventy-two participants (25%) received rhythm control therapy, 331 (30.6%) rate control therapy, and 479 (44.3%) no therapy of interest. Four hundred thirty-six (40.3%) in the total sample and in the different rhythm and rate control strategy groups were treated with an oral anticoagulant. Cognitive performance (mean SBT score) was found to be higher in the rhythm control group (7.5 ± 6.6) than in the no therapy (9.9 ± 7.9) and rate control (10.6 ± 8.3) (p<.001) groups. Logistic regression models adjusted for age, sex, education, anticoagulant and antiplatelet therapy, and comorbidities found that the rhythm control strategy (adjusted odds ratio (aOR)=0.56, 95% confidence interval (CI)=0.40-0.79, p=.001) and education (aOR 0.50, 95% CI=0.35-0.62; p<.001) were associated with less likelihood of cognitive impairment CONCLUSION: In the absence of anticoagulation, rhythm control of AF may protect against cognitive decline. J Am Geriatr Soc 66:2178-2182, 2018.
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Affiliation(s)
- Sarah Damanti
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Geriatric Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Pasina
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto di Ricerche Farmacologiche "Mario Negri,", Milan, Italy
| | - Laura Cortesi
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto di Ricerche Farmacologiche "Mario Negri,", Milan, Italy
| | - Paolo D Rossi
- Geriatric Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Cesari
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Geriatric Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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23
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Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK, Bautista-Vargas WF, Chiang CE, Cuesta A, Dan GA, Frankel DS, Guo Y, Hatala R, Lee YS, Murakawa Y, Pellegrini CN, Pinho C, Milan DJ, Morin DP, Nadalin E, Ntaios G, Prabhu MA, Proietti M, Rivard L, Valentino M, Shantsila A. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: What is the best practice? J Arrhythm 2018; 34:99-123. [PMID: 29657586 PMCID: PMC5891416 DOI: 10.1002/joa3.12050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Nikolaos Dagres
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany
| | | | | | | | - Daniel Benhayon
- Cardiac and Vascular Institute Memorial Health Hollywood FL USA
| | - Emelia J Benjamin
- Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA
| | | | - Lin Yee Chen
- Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA
| | | | | | - Angelo de Paola
- Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
| | - Laurent Fauchier
- Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany
| | - Jonathan Kalman
- Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia
| | | | | | - Deirdre A Lane
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | | | - Manlio F Márquez
- Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico
| | - Tatjana Potpara
- School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia
| | | | | | - Irina Savelieva
- Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK
| | | | - Hung-Fat Tse
- Department of Medicine The University of Hong Kong Hong Kong China
| | - Atul Verma
- Southlake Regional Health Centre Newmarket ON Canada
| | - Shu Zhang
- Beijing Fuwai Hospital Beijing China
| | | | - William-Fernando Bautista-Vargas
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Chern-En Chiang
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Alejandro Cuesta
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Gheorghe-Andrei Dan
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - David S Frankel
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Yutao Guo
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Robert Hatala
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Young Soo Lee
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Yuji Murakawa
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Cara N Pellegrini
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Claudio Pinho
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - David J Milan
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Daniel P Morin
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Elenir Nadalin
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - George Ntaios
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Mukund A Prabhu
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Marco Proietti
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Lena Rivard
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Mariana Valentino
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Alena Shantsila
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
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24
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European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Heart Rhythm 2018; 15:e37-e60. [PMID: 29563045 DOI: 10.1016/j.hrthm.2018.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Indexed: 12/18/2022]
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25
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Aldrugh S, Sardana M, Henninger N, Saczynski JS, McManus DD. Atrial fibrillation, cognition and dementia: A review. J Cardiovasc Electrophysiol 2017; 28:958-965. [PMID: 28569383 DOI: 10.1111/jce.13261] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF) is one of the most common types of cardiac arrhythmia, particularly among older adults. AF confers a 5-fold risk for thromboembolic stroke as well as a 2-fold higher risk for congestive heart failure, morbidity, and mortality. Although stroke remains an important and impactful complication of AF, recent studies have shown that AF is independently associated with other neurological disorders, including cognitive impairment and dementia, even after adjusting for prior ischemic stroke. We performed a review of the published literature on the association between AF and cognitive status. Further, we reviewed studies investigating the underlying mechanisms for this association and/or reporting the impact of AF treatment on cognitive function. While most published studies demonstrate associations between AF and impaired cognition, no AF treatment has yet been associated with a reduced incidence of cognitive decline or dementia.
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Affiliation(s)
- Summer Aldrugh
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Mayank Sardana
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jane S Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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26
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Abstract
The past 3 decades have been characterized by an exponential growth in knowledge and advances in the clinical treatment of atrial fibrillation (AF). It is now known that AF genesis requires a vulnerable atrial substrate and that the formation and composition of this substrate may vary depending on comorbid conditions, genetics, sex, and other factors. Population-based studies have identified numerous factors that modify the atrial substrate and increase AF susceptibility. To date, genetic studies have reported 17 independent signals for AF at 14 genomic regions. Studies have established that advanced age, male sex, and European ancestry are prominent AF risk factors. Other modifiable risk factors include sedentary lifestyle, smoking, obesity, diabetes mellitus, obstructive sleep apnea, and elevated blood pressure predispose to AF, and each factor has been shown to induce structural and electric remodeling of the atria. Both heart failure and myocardial infarction increase risk of AF and vice versa creating a feed-forward loop that increases mortality. Other cardiovascular outcomes attributed to AF, including stroke and thromboembolism, are well established, and epidemiology studies have championed therapeutics that mitigate these adverse outcomes. However, the role of anticoagulation for preventing dementia attributed to AF is less established. Our review is a comprehensive examination of the epidemiological data associating unmodifiable and modifiable risk factors for AF and of the pathophysiological evidence supporting the mechanistic link between each risk factor and AF genesis. Our review also critically examines the epidemiological data on clinical outcomes attributed to AF and summarizes current evidence linking each outcome with AF.
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Affiliation(s)
- Laila Staerk
- Cardiovascular Research Centre, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, United States
| | - Jason A. Sherer
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Darae Ko
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Emelia J. Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, United States
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Robert H. Helm
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
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27
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Su YC, Lim SN, Yang FY, Lin SK. Evaluation of cerebral blood flow in acute ischemic stroke patients with atrial fibrillation: A sonographic study. J Formos Med Assoc 2017; 116:287-294. [DOI: 10.1016/j.jfma.2016.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/22/2016] [Accepted: 05/16/2016] [Indexed: 11/30/2022] Open
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Martí-Fàbregas J, Figueroa S, Martínez-Lizana E, Zubizarreta I, Carrera D, Martínez-Domeño A, Prats-Sánchez L, Camps-Renom P, Jiménez-Xarrié E, Delgado-Mederos R. Total Cerebral Blood Flow in Patients with Cardioembolic Stroke: Is It Clinically Meaningful? ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2826-2833. [PMID: 27649877 DOI: 10.1016/j.ultrasmedbio.2016.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/20/2016] [Accepted: 07/31/2016] [Indexed: 06/06/2023]
Abstract
Chronic hypoperfusion may hinder the washout of emboli coming from the heart and facilitate the formation of intra-cavitary thrombi. We investigated whether a decreased total cerebral blood flow (tCBF) resulted in recurrence of stroke and other vascular events in consecutive patients with cardioembolic stroke. We excluded patients with extra-cranial carotid or vertebral stenosis. The recorded tCBF was the sum of blood flow in both the carotid and vertebral extra-cranial arteries as measured with ultrasonography. Patients were followed up to assess stroke recurrence, vascular events and mortality. We also recorded demographic data, vascular risk factors, treatment data, echocardiographic variables and the C congestive heart failure history H Hypertension history A Age D Diabetes S Sex S2 Stroke/TIA/Thromboembolism history Vasc Vascular Disease history (CHA2DS2-VASc) score. We studied 79 patients (age 77.9 ± 8.4 y). Mean tCBF was 65.5 ± 15.7 mL/100 g/min. Cox regression analysis found that CHA2 DS2-VASc score and ejection fraction were associated with tCBF. After a mean follow-up of 22 ± 8.5 mo, 7.6% of patients experienced a recurrent stroke, 12.7% experienced a vascular event and 21.5% of patients died. Clinical outcomes were not predicted by tCBF.
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Affiliation(s)
- Joan Martí-Fàbregas
- Department of Neurology Stroke Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain.
| | - Sebastián Figueroa
- Department of Neurology Stroke Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Eva Martínez-Lizana
- Department of Neurology Stroke Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Irati Zubizarreta
- Department of Neurology Stroke Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - David Carrera
- Department of Neurology Stroke Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Alejandro Martínez-Domeño
- Department of Neurology Stroke Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Luis Prats-Sánchez
- Department of Neurology Stroke Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Pol Camps-Renom
- Department of Neurology Stroke Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Elena Jiménez-Xarrié
- Department of Neurology Stroke Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Raquel Delgado-Mederos
- Department of Neurology Stroke Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
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Respiratory challenge MRI: Practical aspects. NEUROIMAGE-CLINICAL 2016; 11:667-677. [PMID: 27330967 PMCID: PMC4901170 DOI: 10.1016/j.nicl.2016.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/11/2016] [Accepted: 05/03/2016] [Indexed: 11/24/2022]
Abstract
Respiratory challenge MRI is the modification of arterial oxygen (PaO2) and/or carbon dioxide (PaCO2) concentration to induce a change in cerebral function or metabolism which is then measured by MRI. Alterations in arterial gas concentrations can lead to profound changes in cerebral haemodynamics which can be studied using a variety of MRI sequences. Whilst such experiments may provide a wealth of information, conducting them can be complex and challenging. In this paper we review the rationale for respiratory challenge MRI including the effects of oxygen and carbon dioxide on the cerebral circulation. We also discuss the planning, equipment, monitoring and techniques that have been used to undertake these experiments. We finally propose some recommendations in this evolving area for conducting these experiments to enhance data quality and comparison between techniques. Oxygen and carbon dioxide affect cerebral blood flow and metabolism. This can be imaged with various MRI sequences. The practicalities of these techniques are reviewed. Examples of how this has been used to understand disease mechanisms.
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Ameriso SF, Sager P, Fisher M. Atrial Fibrillation, Congestive Heart Failure, and the Middle Cerebral Artery. J Neuroimaging 2016; 2:190-4. [DOI: 10.1111/jon199224190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/1991] [Accepted: 02/01/1992] [Indexed: 11/30/2022] Open
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Jefferson AL, Hohman TJ, Liu D, Haj-Hassan S, Gifford KA, Benson EM, Skinner JS, Lu Z, Sparling J, Sumner EC, Bell S, Ruberg FL. Adverse vascular risk is related to cognitive decline in older adults. J Alzheimers Dis 2015; 44:1361-73. [PMID: 25471188 DOI: 10.3233/jad-141812] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) and related risk factors are associated with Alzheimer's disease (AD). This association is less well-defined in normal cognition (NC) or prodromal AD (mild cognitive impairment, MCI). OBJECTIVE Cross-sectionally and longitudinally relate a vascular risk index to cognitive outcomes among elders free of clinical dementia. METHODS 3,117 MCI (74 ± 8 years, 56% female) and 6,603 NC participants (72 ± 8 years, 68% female) were drawn from the National Alzheimer's Coordinating Center. A composite measure of vascular risk was defined using the Framingham Stroke Risk Profile (FSRP) score (i.e., age, systolic blood pressure, anti-hypertensive medication, diabetes, cigarette smoking, CVD history, atrial fibrillation). Ordinary linear regressions and generalized linear mixed models related baseline FSRP to cross-sectional and longitudinal cognitive outcomes, separately for NC and MCI, adjusting for age, gender, race, education, and follow-up time (in longitudinal models). RESULTS In NC participants, increasing FSRP was related to worse baseline global cognition, information processing speed, and sequencing abilities (p-values <0.0001) and a worse longitudinal trajectory on all cognitive measures (p-values <0.0001). In MCI, increasing FSRP correlated with worse longitudinal delayed memory (p = 0.004). In secondary models using an age-excluded FSRP score, associations persisted in NC participants for global cognition, naming, information processing speed, and sequencing abilities. CONCLUSIONS An adverse vascular risk profile is associated with worse cognitive trajectory, especially global cognition, naming, and information processing speed, among NC elders. Future studies are needed to understand how effective management of CVD and related risk factors can modify cognitive decline to identify the ideal timeframe for primary prevention implementation.
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Affiliation(s)
- Angela L Jefferson
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy J Hohman
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shereen Haj-Hassan
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine A Gifford
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elleena M Benson
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Zengqi Lu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jamie Sparling
- Boston University School of Medicine, Boston, MA, USA Newton Wellesley Hospital, Department of Medicine, Newton, MA, USA
| | - Emily C Sumner
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan Bell
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA Center for Quality Aging, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Frederick L Ruberg
- Boston University School of Medicine, Boston, MA, USA Section of Cardiovascular Medicine, Boston Medical Center, Boston, MA, USA
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Abstract
Abstract
Cerebral blood flow (CBF) is rigorously regulated by various powerful mechanisms to safeguard the match between cerebral metabolic demand and supply. The question of how a change in cardiac output (CO) affects CBF is fundamental, because CBF is dependent on constantly receiving a significant proportion of CO. The authors reviewed the studies that investigated the association between CO and CBF in healthy volunteers and patients with chronic heart failure. The overall evidence shows that an alteration in CO, either acutely or chronically, leads to a change in CBF that is independent of other CBF-regulating parameters including blood pressure and carbon dioxide. However, studies on the association between CO and CBF in patients with varying neurologic, medical, and surgical conditions were confounded by methodologic limitations. Given that CBF regulation is multifactorial but the various processes must exert their effects on the cerebral circulation simultaneously, the authors propose a conceptual framework that integrates the various CBF-regulating processes at the level of cerebral arteries/arterioles while still maintaining autoregulation. The clinical implications pertinent to the effect of CO on CBF are discussed. Outcome research relating to the management of CO and CBF in high-risk patients or during high-risk surgeries is needed.
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Meng L, Weston SD, Chang EF, Gelb AW. Awake craniotomy in a patient with ejection fraction of 10%: considerations of cerebrovascular and cardiovascular physiology. J Clin Anesth 2015; 27:256-61. [DOI: 10.1016/j.jclinane.2015.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 11/13/2014] [Accepted: 01/21/2015] [Indexed: 10/24/2022]
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Tulla H, Hippeläinen M, Turpeinen A, Pitkänen O, Hartikainen J. New-onset atrial fibrillation at discharge in patients after coronary artery bypass surgery: short- and long-term morbidity and mortality. Eur J Cardiothorac Surg 2015; 48:747-52. [DOI: 10.1093/ejcts/ezu526] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/03/2014] [Indexed: 11/12/2022] Open
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35
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Increased late mortality after coronary artery bypass surgery complicated by isolated new-onset atrial fibrillation: A comprehensive propensity-matched analysis. J Thorac Cardiovasc Surg 2014; 148:1860-1868.e2. [DOI: 10.1016/j.jtcvs.2014.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 04/25/2014] [Accepted: 05/08/2014] [Indexed: 11/19/2022]
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Kanmanthareddy A, Vallakati A, Sridhar A, Reddy M, Sanjani HP, Pillarisetti J, Atkins D, Bommana S, Jaeger M, Berenbom L, Lakkireddy D. The Impact of Atrial Fibrillation and Its Treatment on Dementia. Curr Cardiol Rep 2014; 16:519. [DOI: 10.1007/s11886-014-0519-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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38
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Dublin S, Anderson ML, Heckbert SR, Hubbard RA, Sonnen JA, Crane PK, Montine TJ, Larson EB. Neuropathologic changes associated with atrial fibrillation in a population-based autopsy cohort. J Gerontol A Biol Sci Med Sci 2013; 69:609-15. [PMID: 24077599 DOI: 10.1093/gerona/glt141] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with higher risk of dementia and Alzheimer's disease. To better understand the mechanism, we examined neuropathologic changes seen with AF. METHODS We analyzed data from an autopsy series arising from a population-based, prospective cohort study set within Group Health, an integrated health care delivery system. Participants were people aged 65 and older, community-dwelling, and nondemented at study enrollment, who died during follow-up and underwent autopsy. AF was defined from medical records. Permanent AF was defined as having two or more electrocardiograms showing AF between 6 and 36 months apart with no evidence of sinus rhythm in between. The primary study outcomes were gross infarcts, neuritic plaques, and neurofibrillary tangles, ascertained using consensus guidelines. Adjusted relative risks and 95% CIs were calculated using modified Poisson regression, weighted to account for selection into the autopsy cohort. RESULTS Three hundred and twenty-eight participants underwent autopsy; 134 (41%) had AF. People with AF were more likely to have gross infarcts than those without AF (45% vs 31%; relative risk 1.82, 95% CI 1.23-2.71); in 30%, these infarcts were not clinically recognized before death. Alzheimer's disease neuropathologic changes were not associated with ever having AF but were more common in people with permanent AF. Adjusted relative risks for frequent neuritic plaques and neurofibrillary tangles were 1.47 (0.96-2.28) and 1.40 (0.79-2.49), respectively, for people with permanent AF versus no AF. CONCLUSIONS AF is associated with gross infarcts. Permanent AF may contribute to Alzheimer's disease neuropathologic changes, but more study is needed.
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Affiliation(s)
- Sascha Dublin
- Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448.
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Association Between Obesity and Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Operations: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2013; 96:1104-16. [DOI: 10.1016/j.athoracsur.2013.04.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/31/2013] [Accepted: 04/02/2013] [Indexed: 11/22/2022]
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Arboix A, Alio J. Acute cardioembolic cerebral infarction: answers to clinical questions. Curr Cardiol Rev 2013; 8:54-67. [PMID: 22845816 PMCID: PMC3394108 DOI: 10.2174/157340312801215791] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 01/15/2023] Open
Abstract
Cardioembolic cerebral infarction (CI) is the most severe subtype of ischaemic stroke but some clinical aspects of this condition are still unclear. This article provides the reader with an overview and up-date of relevant aspects related to clinical features, specific cardiac disorders and prognosis of CI. CI accounts for 14-30% of ischemic strokes; patients with CI are prone to early and long-term stroke recurrence, although recurrences may be preventable by appropriate treatment during the acute phase and strict control at follow-up. Certain clinical features are suggestive of CI, including sudden onset to maximal deficit, decreased level of consciousness at onset, Wernicke's aphasia or global aphasia without hemiparesis, a Valsalva manoeuvre at the time of stroke onset, and co-occurrence of cerebral and systemic emboli. Lacunar clinical presentations, a lacunar infarct and especially multiple lacunar infarcts, make cardioembolic origin unlikely. The most common disorders associated with a high risk of cardioembolism include atrial fibrillation, recent myocardial infarction, mechanical prosthetic valve, dilated myocardiopathy and mitral rheumatic stenosis. Patent foramen ovale and complex atheromatosis of the aortic arch are potentially emerging sources of cardioembolic infarction. Mitral annular calcification can be a marker of complex aortic atheroma in stroke patients of unkown etiology. Transthoracic and transesophageal echocardiogram can disclose structural heart diseases. Paroxysmal atrial dysrhythmia can be detected by Holter monitoring. Magnetic resonance imaging, transcranial Doppler, and electrophysiological studies are useful to document the source of cardioembolism. In-hospital mortality in cardioembolic stroke (27.3%, in our series) is the highest as compared with other subtypes of cerebral infarction. Secondary prevention with anticoagulants should be started immediately if possible in patients at high risk for recurrent cardioembolic stroke in which contraindications, such as falls, poor compliance, uncontrolled epilepsy or gastrointestinal bleeding are absent. Dabigatran has been shown to be non-inferior to warfarin in the prevention of stroke or systemic embolism. All significant structural defects, such as atrial septal defects, vegetations on valve or severe aortic disease should be treated. Aspirin is recommended in stroke patients with a patent foramen ovale and indications of closure should be individualized. CI is an important topic in the frontier between cardiology and vascular neurology, occurs frequently in daily practice, has a high impact for patients, and health care systems and merits an update review of current clinical issues, advances and controversies.
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Affiliation(s)
- Adria Arboix
- Cerebrovascular Division, Department of Neurology, Capio-Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Spain.
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Abstract
As life expectancy lengthens, dementia is becoming a significant human condition in terms of its prevalence and cost to society worldwide. It is important in that context to understand the preventable and treatable causes of dementia. This article exposes the link between dementia and heart disease in all its forms, including coronary artery disease, myocardial infarction, atrial fibrillation, valvular disease, and heart failure. This article also explores the cardiovascular risk factors and emphasizes that several of them are preventable and treatable. In addition to medical therapies, the lifestyle changes that may be useful in retarding the onset of dementia are also summarized.
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Affiliation(s)
- B Ng Justin
- Departments of Neuroscience and Psychology, McGill University, Montreal, QC, Canada
| | - Michele Turek
- Division of Cardiology, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Antoine M Hakim
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- Canadian Stroke Network, Ottawa, ON, Canada
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Stefansdottir H, Arnar DO, Aspelund T, Sigurdsson S, Jonsdottir MK, Hjaltason H, Launer LJ, Gudnason V. Atrial fibrillation is associated with reduced brain volume and cognitive function independent of cerebral infarcts. Stroke 2013; 44:1020-5. [PMID: 23444303 DOI: 10.1161/strokeaha.12.679381] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Atrial fibrillation (AF) has been associated with cognitive decline independent of stroke, suggesting additional effects of AF on the brain. We aimed to assess the association between AF and brain function and structure in a general elderly population. METHODS This is a cross-sectional analysis of 4251 nondemented participants (mean age, 76 ± 5 years) in the population-based Age, Gene/Environment Susceptibility-Reykjavik Study. Medical record data were collected for the presence, subtype, and time from first diagnosis of AF; 330 participants had AF. Brain volume measurements, adjusted for intracranial volume, and presence of cerebral infarcts were determined with magnetic resonance imaging. Memory, speed of processing, and executive function composites were calculated from a cognitive test battery. In a multivariable linear regression model, adjustments were made for demographic factors, cardiovascular risk factors, and cerebral infarcts. RESULTS Participants with AF had lower total brain volume compared with those without AF (P<0.001). The association was stronger with persistent/permanent than paroxysmal AF and with increased time from the first diagnosis of the disease. Of the brain tissue volumes, AF was associated with lower volume of gray and white matter hyperintensities (P<0.001 and P = 0.008, respectively), but not of white matter hyperintensities (P = 0.49). Participants with AF scored lower on tests of memory. CONCLUSIONS AF is associated with smaller brain volume, and the association is stronger with increasing burden of the arrhythmia. These findings suggest that AF has a cumulative negative effect on the brain independent of cerebral infarcts.
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Gross AF, Stern TA. The cognitive impact of atrial fibrillation. Prim Care Companion CNS Disord 2013; 15:12f01471. [PMID: 23724342 DOI: 10.4088/pcc.12f01471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022] Open
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Saxena A, Shi WY, Bappayya S, Dinh DT, Smith JA, Reid CM, Shardey GC, Newcomb AE. Postoperative atrial fibrillation after isolated aortic valve replacement: a cause for concern? Ann Thorac Surg 2012. [PMID: 23200233 DOI: 10.1016/j.athoracsur.2012.08.077] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several studies have shown that postoperative atrial fibrillation (POAF) is associated with poorer short-term and long-term outcomes after general cardiac operations. There is, however, a paucity of data on the impact of POAF on outcomes after isolated aortic valve replacement (AVR). METHODS Data for all patients undergoing isolated first-time AVR between June 2001 and December 2009 was obtained from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) National Cardiac Surgery Database Program and a retrospective analysis was conducted. Preoperative characteristics, early postoperative outcome, and late survival were compared between patients in whom POAF developed and those in whom it did not. Propensity score matching was performed to correct for differences between the 2 groups. RESULTS Excluding patients with preoperative arrhythmia, isolated first-time AVR was performed in 2,065 patients. POAF developed in 725 (35.1%) of them. Patients with POAF were significantly older (mean age, 72 versus 65 years; p < 0.001) and presented more often with comorbidities, including hypertension, respiratory disease, and hypercholesterolemia (all p < 0.05). From the initial study population, 592 propensity-matched patient pairs were derived; the overall matching rate was 81.7%. In the matched groups, 30-day mortality was not significantly different between the POAF and non-POAF groups (1.5% versus 1%; p = 0.48). Patients with POAF were, however, at an independently increased risk of perioperative complications, including new renal failure, gastrointestinal complications, and 30-day readmission (p < 0.05). Seven-year mortality was not significantly different between POAF and non-POAF groups (78% versus 83%; p = 0.63). CONCLUSIONS POAF is a risk factor for short-term morbidity but is not associated with a higher rate of early or late mortality after isolated AVR.
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Affiliation(s)
- Akshat Saxena
- Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Arboix A, Alió J. Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Curr Cardiol Rev 2011; 6:150-61. [PMID: 21804774 PMCID: PMC2994107 DOI: 10.2174/157340310791658730] [Citation(s) in RCA: 252] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 04/10/2010] [Accepted: 05/25/2010] [Indexed: 12/13/2022] Open
Abstract
This article provides the reader with an overview and up-date of clinical features, specific cardiac disorders and prognosis of cardioembolic stroke. Cardioembolic stroke accounts for 14-30% of ischemic strokes and, in general, is a severe condition; patients with cardioembolic infarction are prone to early and long-term stroke recurrence, although recurrences may be preventable by appropriate treatment during the acute phase and strict control at follow-up. Certain clinical features are suggestive of cardioembolic infarction, including sudden onset to maximal deficit, decreased level of consciousness at onset, Wernicke’s aphasia or global aphasia without hemiparesis, a Valsalva manoeuvre at the time of stroke onset, and co-occurrence of cerebral and systemic emboli. Lacunar clinical presentations, a lacunar infarct and especially multiple lacunar infarcts, make cardioembolic origin unlikely. The more common high risk cardioembolic conditions are atrial fibrillation, recent myocardial infarction, mechanical prosthetic valve, dilated myocardiopathy, and mitral rheumatic stenosis. Transthoracic and transesophageal echocardiogram can disclose structural heart diseases. Paroxysmal atrial dysrhyhtmia can be detected by Holter monitoring. In-hospital mortality in cardioembolic stroke (27.3%, in our series) is the highest as compared with other subtypes of cerebral infarction. In our experience, in-hospital mortality in patients with early embolic recurrence (within the first 7 days) was 77%. Patients with alcohol abuse, hypertension, valvular heart disease, nausea and vomiting, and previous cerebral infarction are at increased risk of early recurrent systemic embolization. Secondary prevention with anticoagulants should be started immediately if possible in patients at high risk for recurrent cardioembolic stroke in which contraindications, such as falls, poor compliance, uncontrolled epilepsy or gastrointestinal bleeding are absent.
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Affiliation(s)
- Adrià Arboix
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain
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Dublin S, Anderson ML, Haneuse SJ, Heckbert SR, Crane PK, Breitner JCS, McCormick W, Bowen JD, Teri L, McCurry SM, Larson EB. Atrial fibrillation and risk of dementia: a prospective cohort study. J Am Geriatr Soc 2011; 59:1369-75. [PMID: 21806558 PMCID: PMC3289545 DOI: 10.1111/j.1532-5415.2011.03508.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To determine whether atrial fibrillation (AF) is associated with risk of incident dementia or Alzheimer's disease (AD), beyond its effect on stroke. DESIGN Prospective cohort study. SETTING An integrated healthcare delivery system. PARTICIPANTS A population-based sample of 3,045 community-dwelling adults aged 65 and older without dementia or clinical stroke followed from 1994 to 2008. MEASUREMENTS AF was identified from health plan electronic data using International Classification of Diseases, Ninth Revision, codes from inpatient and outpatient encounters. Covariates came from self-report, study measures, and health plan data. Participants were screened every 2 years using the Cognitive Abilities Screening Instrument (range 0-100), with detailed neuropsychological and clinical assessment of those scoring less than 86. A multidisciplinary consensus committee determined diagnoses of all-cause dementia and possible or probable AD using standard research criteria. RESULTS AF was present in 132 (4.3%) participants at baseline and was diagnosed in 370 (12.2%) more over a mean of 6.8 years of follow-up; 572 participants (18.8%) developed dementia (449 with AD). The adjusted hazard ratio associated with AF was 1.38 (95% confidence interval (CI)=1.10-1.73) for all-cause dementia and 1.50 (95% CI=1.16-1.94) for possible or probable AD. Results were similar for participants with and without clinically recognized stroke during follow-up and in sensitivity analyses examining only probable AD. CONCLUSION AF is associated with higher risk of developing AD and dementia. Future studies should examine whether specific treatments, including optimal anticoagulation, can decrease this risk.
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Affiliation(s)
- Sascha Dublin
- Group Health Research Institute, Seattle, Washington, USA.
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Attaran S, Shaw M, Bond L, Pullan MD, Fabri BM. Atrial fibrillation postcardiac surgery: a common but a morbid complication☆☆☆. Interact Cardiovasc Thorac Surg 2011; 12:772-7. [DOI: 10.1510/icvts.2010.243782] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS. 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation 2011; 123:e269-367. [PMID: 21382897 DOI: 10.1161/cir.0b013e318214876d] [Citation(s) in RCA: 595] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS. 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. J Am Coll Cardiol 2011; 57:e101-98. [PMID: 21392637 DOI: 10.1016/j.jacc.2010.09.013] [Citation(s) in RCA: 642] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mariscalco G, Engström KG. Postoperative atrial fibrillation is associated with late mortality after coronary surgery, but not after valvular surgery. Ann Thorac Surg 2010; 88:1871-6. [PMID: 19932252 DOI: 10.1016/j.athoracsur.2009.07.074] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 07/22/2009] [Accepted: 07/23/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Numerous studies have attempted to determine the etiology and prophylactic measures concerning atrial fibrillation (AF) after cardiac surgery. However, limited data are available analyzing the association between postoperative AF and late mortality. We sought to determine if AF after cardiac surgery affects postoperative survival. METHODS All cardiac surgery patients (n = 9,495) undergoing cardiac surgery between January 1994 and December 2004 were studied. The study population comprised coronary artery bypass graft surgery (CABG [n = 7,621]), valvular surgeries (n = 995), and their combination (n = 879). Patients affected by postoperative AF were identified, and long-term survival was obtained from Swedish population registry and evaluated using Cox proportional hazards methods to adjust for baseline differences. RESULTS The overall AF incidence was 26.7%, subdivided into 22.9%, 39.8%, and 45.2% for CABG, valve surgery, and combined procedures, respectively. The median follow-up for the entire study population was 7.9 years (maximum, 13.4). Postoperative AF independently affected long-term survival in CABG patients (hazard ratio 1.22; 95% confidence interval: 1.08 to 1.37). For isolated valvular surgery or combined procedures, AF was not significantly associated with long-term survival (hazard ratio 1.21, 95% confidence interval: 0.92 to 1.58; and hazard ratio 1.15, 95% confidence interval: 0.90 to 1.46, respectively). CONCLUSIONS Postoperative AF increases late mortality after isolated CABG surgery only. This finding was not statistically confirmed after isolated or combined valvular procedures. Our results draw the attention to possible AF recurrence after hospital discharge, indicating a strict postoperative surveillance.
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Affiliation(s)
- Giovanni Mariscalco
- Department of Surgical Sciences, Cardiac Surgery Unit, Varese University Hospital, Varese, Italy.
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