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Fundere A, Rose A, Xiong F, Muthukumarasamy KM, Altuntas Y, Dasari H, Villeneuve L, Sirois MG, Tanguay JF, Tardif JC, Hiram R. Daily exposure to chlordecone, an organochlorine pesticide, increases cardiac fibrosis and atrial fibrillation vulnerability. JOURNAL OF HAZARDOUS MATERIALS 2024; 478:135533. [PMID: 39173376 DOI: 10.1016/j.jhazmat.2024.135533] [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: 04/03/2024] [Revised: 08/13/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024]
Abstract
CONTEXT Chlordecone (CLD) is a carcinogenic organochlorine pesticide. CLD was shown to disturb the activity of cardiac Na+-K+-ATPase and Ca2+-Mg2+-ATPase. Conditions affecting these transmembrane pumps are often associated with cardiac arrhythmias (CA). However, little is known about the role of CLD on atrial fibrillation (AF) incidence, the most common type of CA. HYPOTHESES 1) Daily ingestion of CLD induces arrhythmogenic cardiac remodeling. 2) A phase of CLD withdrawal can reduce CLD-induced AF susceptibility. METHODS Adult male Wistar rats (250 g-275 g) ingested daily-doses of CLD (0 μg/L, 0.1 μg/L, or 1 μg/L) diluted in their quotidian water for 4 weeks. From day (D)29 to D56, all rats received CLD-free water. Vulnerability to AF and cardiac function were evaluated at D28 and D56 by electrophysiological study, echocardiography, and optical-mapping. Levels of genes and proteins related to inflammation, fibrosis, and senescence were quantified by qPCR and immunoassays. RESULTS Twenty-eight days of CLD exposure were associated with significantly increased AF vulnerability compared to CLD-free rats. Contamination with 1 μg/L CLD significantly reduced atrial conduction velocity (ERP, APD). CLD-weaning normalized food consumption and weight intake. However, after the CLD-withdrawal period of 28 days, AF inducibility, atrial inflammation (IL6, IL1β), and atrial fibrosis (Masson's trichrome staining) remained significantly higher in rats exposed to 1 μg/L CLD compared to 0 μg/L. CONCLUSIONS Prolonged CLD ingestion provokes atrial conduction slowing and increased risk of AF. Although CLD-weaning, some persistent damages occurred in the atrium like atrial fibrosis and atrial senescence signals, which are accompanied by atrial inflammation and arrhythmogenicity.
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Affiliation(s)
- Alexia Fundere
- Faculty of Pharmacy, University of Montpellier, Montpellier, France; Université des Antilles, Guadeloupe, Pointe-à-Pitre, France; Montreal Heart Institute, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Andrew Rose
- Department of Pharmacology and Therapeutics, McGill University, Canada
| | - Feng Xiong
- Department of Pharmacology and Therapeutics, McGill University, Canada; Montreal Heart Institute, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Kalai Mangai Muthukumarasamy
- Department of Pharmacology and Therapeutics, McGill University, Canada; Montreal Heart Institute, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Yasemin Altuntas
- Montreal Heart Institute, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Harika Dasari
- Montreal Heart Institute, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Louis Villeneuve
- Montreal Heart Institute, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Martin G Sirois
- Montreal Heart Institute, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Jean-François Tanguay
- Montreal Heart Institute, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Roddy Hiram
- Montreal Heart Institute, Faculty of Medicine, University of Montreal, Montreal, Canada.
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Zhang X, Wu Y, Smith CER, Louch WE, Morotti S, Dobrev D, Grandi E, Ni H. Enhanced Ca 2+-Driven Arrhythmogenic Events in Female Patients With Atrial Fibrillation: Insights From Computational Modeling. JACC Clin Electrophysiol 2024:S2405-500X(24)00717-5. [PMID: 39340505 DOI: 10.1016/j.jacep.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/10/2024] [Accepted: 07/29/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Substantial sex-based differences have been reported in atrial fibrillation (AF), but the underlying mechanisms are poorly understood. OBJECTIVES This study sought to gain a mechanistic understanding of Ca2+-handling disturbances and Ca2+-driven arrhythmogenic events in male vs female atrial cardiomyocytes and establish their responses to Ca2+-targeted interventions. METHODS We integrated reported sex differences and AF-associated changes (ie, expression and phosphorylation of Ca2+-handling proteins, cardiomyocyte ultrastructural characteristics, and dimensions) into our human atrial cardiomyocyte model that couples electrophysiology with spatially detailed Ca2+-handling processes. Sex-specific responses of atrial cardiomyocytes to arrhythmia-provoking protocols and Ca2+-targeted interventions were evaluated. RESULTS Simulated quiescent cardiomyocytes showed increased incidence of Ca2+ sparks in female vs male myocytes in AF, in agreement with previous experimental reports. Additionally, our female model exhibited elevated propensity to develop pacing-induced spontaneous Ca2+ releases (SCRs) and augmented beat-to-beat variability in action potential (AP)-elicited Ca2+ transients compared with the male model. Sensitivity analysis uncovered distinct arrhythmogenic contributions of each component involved in sex and/or AF alterations. Specifically, increased ryanodine receptor phosphorylation emerged as the major SCR contributor in female AF cardiomyocytes, whereas reduced L-type Ca2+ current was protective against SCRs for male AF cardiomyocytes. Furthermore, simulated Ca2+-targeted interventions identified potential strategies (eg, t-tubule restoration, and inhibition of ryanodine receptor and sarcoplasmic/endoplasmic reticulum Ca2⁺-ATPase) to attenuate Ca2+-driven arrhythmogenic events in women, and revealed enhanced efficacy when applied in combination. CONCLUSIONS Sex-specific modeling uncovers increased Ca2+-driven arrhythmogenic events in female vs male atria in AF, and suggests combined Ca2+-targeted interventions are promising therapeutic approaches in women.
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Affiliation(s)
- Xianwei Zhang
- Department of Pharmacology, University of California Davis, Davis, California, USA. https://twitter.com/xianweizhang1
| | - Yixuan Wu
- Department of Pharmacology, University of California Davis, Davis, California, USA
| | - Charlotte E R Smith
- Department of Pharmacology, University of California Davis, Davis, California, USA. https://twitter.com/Char_Smith3
| | - William E Louch
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway. https://twitter.com/IEMRLouch
| | - Stefano Morotti
- Department of Pharmacology, University of California Davis, Davis, California, USA. https://twitter.com/MorottiLab
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany; Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada; Department of Integrative Physiology, Baylor College of Medicine, Houston, Texas, USA. https://twitter.com/dr_dobrev
| | - Eleonora Grandi
- Department of Pharmacology, University of California Davis, Davis, California, USA.
| | - Haibo Ni
- Department of Pharmacology, University of California Davis, Davis, California, USA.
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Geurts S, Bos MM, van der Toorn JE, Stricker BHC, Ghanbari M, Kors JA, Deckers JW, Ikram MA, Bos D, Kavousi M. Arteriosclerotic Calcification and Atrial Fibrillation in the General Population: The Rotterdam Study. Am J Cardiol 2024; 231:62-69. [PMID: 39241977 DOI: 10.1016/j.amjcard.2024.09.002] [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: 08/29/2024] [Accepted: 09/01/2024] [Indexed: 09/09/2024]
Abstract
Limited population-based data on the gender differences and association between arteriosclerotic calcification at different sites and atrial fibrillation (AF) exist. We aimed to investigate the (gender-specific) associations between arteriosclerotic calcification at different sites with the risk of AF in the general population. Arteriosclerotic calcification was quantified using computed tomography examinations between 2003 and 2006 in 2,259 participants free of AF from the population-based Rotterdam Study. Cox proportional hazards models, adjusted for cardiovascular risk factors, were used to assess the associations of volumes of coronary artery calcification (CAC), aortic arch calcification (AAC), extracranial and intracranial carotid arteries, vertebrobasilar arteries, and the aortic valve with incident AF. During a median follow-up of 8.6 years, 182 incident AF cases occurred. A larger CAC was associated with incident AF (hazard ratio [HR], 95% confidence interval [CI] 1.25 1.09 to 1.44, p = 0.0019). The gender-stratified analyses showed that larger CAC in men (HR 1.43, 95% CI 1.10 to 1.86, p = 0.0068) and larger AAC in women were associated with incident AF (HR1.44, 95% CI 1.04 to 2.01, p = 0.0299). In conclusion, CAC in the general population, especially in men, and AAC in women were significantly associated with new-onset AF. Our findings imply that interventions to lower arteriosclerotic calcification, particularly, CAC, carry potential for the prevention of AF in the general population, especially in men.
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Affiliation(s)
- Sven Geurts
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maxime M Bos
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Janine E van der Toorn
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H C Stricker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jaap W Deckers
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Jiang X, Ling J, Xiong Q, Chen W, Zou L, Ling Z. Global, regional, and national burden of atrial fibrillation/flutter related to metabolic risks over three decades: estimates from the global burden of disease study 2019. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:391-401. [PMID: 38710536 DOI: 10.1093/ehjqcco/qcae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/16/2024] [Accepted: 05/04/2024] [Indexed: 05/08/2024]
Abstract
AIMS Atrial fibrillation/atrial flutter (AF/AFL) remains a significant public health concern on a global scale, with metabolic risks playing an increasingly prominent role. This study aimed to investigate comprehensive epidemiological data and trends concerning the metabolic risks related-AF/AFL burden based on the data from the Global Burden of Disease study in 2019. METHODS AND RESULTS The analysis of disease burden focused on numbers, age-standardized rates of deaths, disability-adjusted life years (DALYs), and estimated annual percentage change, while considering factors of age, sex, sociodemographic index (SDI), and locations. In 2019, there was a culmination of 137 179 deaths and 4 099 146 DALYs caused by metabolic risks related-AF/AFL worldwide, with an increase of 162.95% and 120.30%, respectively from 1990. High and high-middle SDI regions predominantly carried the burden of AF/AFL associated with metabolic risks, while a shift towards lower SDI regions had been occurring. Montenegro had the highest recorded death rate (7.6 per 100 000) and DALYs rate (146.3 per 100 000). An asymmetrically inverted V-shaped correlation was found between SDI and deaths/DALYs rates. Moreover, females and the elderly exhibited higher AF/AFL burdens, and young adults (over 40 years old) also experienced an annual increase. CONCLUSION The global AF/AFL burden related to metabolic risks has significantly increased over the past three decades, with considerable spatiotemporal, gender-based, and age-related heterogeneity. These findings shed valuable light on the trends in the burden of metabolic risks related-AF/AFL and offered insights into corresponding strategies.
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Affiliation(s)
- Xi Jiang
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Jianen Ling
- College of Medical Informatics, Chongqing Medical University, Chongqing 400010, China
| | - Qingsong Xiong
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Weijie Chen
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Lili Zou
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Zhiyu Ling
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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Fang S, Zhang W. Heart-Brain Axis: A Narrative Review of the Interaction between Depression and Arrhythmia. Biomedicines 2024; 12:1719. [PMID: 39200183 PMCID: PMC11351688 DOI: 10.3390/biomedicines12081719] [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: 05/21/2024] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 09/02/2024] Open
Abstract
Arrhythmias and depression are recognized as diseases of the heart and brain, respectively, and both are major health threats that often co-occur with a bidirectional causal relationship. The autonomic nervous system (ANS) serves as a crucial component of the heart-brain axis (HBA) and the pathway of interoception. Cardiac activity can influence emotional states through ascending interoceptive pathways, while psychological stress can precipitate arrhythmias via the ANS. However, the HBA and interoception frameworks are often considered overly broad, and the precise mechanisms underlying the bidirectional relationship between depression and arrhythmias remain unclear. This narrative review aims to synthesize the existing literature, focusing on the pathological mechanisms of the ANS in depression and arrhythmia while integrating other potential mechanisms to detail heart-brain interactions. In the bidirectional communication between the heart and brain, we emphasize considering various internal factors such as genes, personality traits, stress, the endocrine system, inflammation, 5-hydroxytryptamine, and behavioral factors. Current research employs multidisciplinary knowledge to elucidate heart-brain relationships, and a deeper understanding of these interactions can help optimize clinical treatment strategies. From a broader perspective, this study emphasizes the importance of considering the body as a complex, interconnected system rather than treating organs in isolation. Investigating heart-brain interactions enhance our understanding of disease pathogenesis and advances medical science, ultimately improving human quality of life.
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Affiliation(s)
- Shuping Fang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Wei Zhang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu 610041, China;
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Maas AHEM. Female-specific risk variables: From innocent bystanders to key players in cardiovascular risk prediction. Maturitas 2024; 186:107970. [PMID: 38580554 DOI: 10.1016/j.maturitas.2024.107970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/07/2024]
Abstract
There is an increasing interest among professionals in cardiovascular medicine in women-specific risk variables related to gynecologic conditions over the life span. Although adverse lifestyle factors, hypertension, dyslipidemia and insulin resistance are recognized as the most important risk factors in older women, there is still uncertainty over how to account for other risk variables. For instance, migraine from puberty onwards, chronic inflammatory conditions and mental stress affect cardiovascular risk in women. As prevention should start as early in life as possible, appropriate risk estimation in women at middle age is crucial. In case of doubt, a coronary artery calcium score with a computed tomography scan at a radiology department can be helpful to discriminate between low and high risk for an individual. This may also pave the way for safe menopausal hormone therapy if needed. In this paper we summarize the current status of women-specific and other relevant risk variables from the perspective of the cardiologist.
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Affiliation(s)
- Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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7
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Heo GY, Park JT, Kim HJ, Kim KW, Kwon YU, Kim SH, Kim GO, Han SH, Yoo TH, Kang SW, Kim HW. Adequacy of Dialysis and Incidence of Atrial Fibrillation in Patients Undergoing Hemodialysis. Circ Cardiovasc Qual Outcomes 2024; 17:e010595. [PMID: 38873761 DOI: 10.1161/circoutcomes.123.010595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) can lead to stroke, heart failure, and mortality and has a greater prevalence in dialysis patients than in the general population. Several studies have suggested that uremic toxins may contribute to the development of AF. However, the association between dialysis adequacy and incident AF has not been well established. METHODS In this retrospective nationwide cohort study, we analyzed data from the Korean National Periodic Hemodialysis Quality Assessment from 2013 to 2015 of patients who received outpatient maintenance hemodialysis 3× a week. The main exposure was single pooled Kt/V (spKt/V), which is the dialysis adequacy index, and the primary outcome was the development of AF. For the primary analysis, patients were categorized into quartiles according to baseline spKt/V. The lowest quartile, representing the lowest adequacy, was used as the reference group. Fine-Gray subdistribution hazard models were used, treating all-cause mortality as a competing risk. RESULTS Of 25 173 patients, the mean age was 60 (51-69) years, and 14 772 (58.7%) were men. During a median follow-up of 5.7 years, incident AF occurred in a total of 3883 (15.4%) patients. Participants with a higher spKt/V tended to have lower AF incidence. In survival analysis, a graded association was observed between the risk of incident AF and spKt/V quartiles: subdistribution hazard ratios and 95% CIs for the second, third, and the highest quartile compared with the lowest quartile were 0.90 (95% CI, 0.82-0.98), 0.84 (95% CI, 0.77-0.93), and 0.79 (95% CI, 0.72-0.88), respectively. CONCLUSIONS This nationwide cohort study showed that a higher spKt/V is associated with a reduced risk of incident AF. These findings suggests that reducing uremic toxin burden through enhanced dialysis clearance may be associated with a lower risk of AF development in patients undergoing maintenance hemodialysis.
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Affiliation(s)
- Ga Young Heo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Hyo Jeong Kim
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea (H.J.K.)
| | - Kyung Won Kim
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (K.W.K.)
| | - Yong Uk Kwon
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, South Korea (Y.U.K.)
| | - Soo Hyun Kim
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea (S.H.K.)
| | - Gui Ok Kim
- Quality Assessment Management Division, Health Insurance Review and Assessment Service, Wonju, South Korea (G.O.K.)
| | - Seung Hyeok Han
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Shin-Wook Kang
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Hyung Woo Kim
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea (H.W.K.)
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8
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Lu Z, Ntlapo N, Tilly MJ, Geurts S, Aribas E, Ikram MK, de Groot NMS, Kavousi M. Burden of cardiometabolic disorders and lifetime risk of new-onset atrial fibrillation among men and women: the Rotterdam Study. Eur J Prev Cardiol 2024; 31:1141-1149. [PMID: 38307013 DOI: 10.1093/eurjpc/zwae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/14/2024] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
AIMS To examine the association between the burden of cardiometabolic disorders with new-onset atrial fibrillation (AF) and lifetime risk of AF incidence among men and women. METHODS AND RESULTS Four thousand one hundred and one men and 5421 women free of AF at baseline (1996-2008) from the population-based Rotterdam Study were included. Sex-specific Cox proportional-hazards regression models were used to assess the association between the burden of cardiometabolic disorders and risk of new-onset AF. The remaining lifetime risk for AF was estimated at index ages of 55, 65, and 75 years up to age 108. Mean age at baseline was 65.5 ± 9.4 years. Median follow-up time was 12.8 years. In the fully adjusted model, a stronger association was found between a larger burden of cardiometabolic disorders and incident AF among women [hazard ratio (HR): 1.33% and 95% conference interval (CI): 1.22-1.46], compared to men [1.18 (1.08-1.29)] (P for sex-interaction <0.05). The lifetime risk for AF significantly increased with the number of cardiometabolic disorders among both sexes. At an index age of 55 years, the lifetime risks (95% CIs) for AF were 27.1% (20.8-33.4), 26.5% (22.8-30.5), 29.9% (26.7-33.2), 30.8% (25.7-35.8), and 33.3% (23.1-43.6) among men, for 0, 1, 2, 3, and ≥4 comorbid cardiometabolic disorders. Corresponding risks were 15.8% (10.5-21.2), 23.0% (19.8-26.2), 29.7% (26.8-32.6), 26.2% (20.8-31.6), and 34.2% (17.3-51.1) among women. CONCLUSION We observed a significant combined impact of cardiometabolic disorders on AF risk, in particular among women. Participants with cardiometabolic multimorbidity had a significantly higher lifetime risk of AF, especially at a young index age.
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Affiliation(s)
- Zuolin Lu
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Noluthando Ntlapo
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Martijn J Tilly
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Sven Geurts
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Elif Aribas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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9
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Eroglu TE, Coronel R, Souverein PC. Sodium-glucose cotransporter-2 inhibitors and the risk of atrial fibrillation in patients with type 2 diabetes: a population-based cohort study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024; 10:289-295. [PMID: 38520149 DOI: 10.1093/ehjcvp/pvae022] [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: 01/03/2024] [Revised: 02/19/2024] [Accepted: 03/21/2024] [Indexed: 03/25/2024]
Abstract
AIMS Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) have a direct cardiac effect that is likely to be independent of its glucose lowering renal effect. Previous research has shown that SGLT2-is mitigate heart failure and prevent arrhythmic cardiac death. Our objective is to determine whether SGLT-2is reduce atrial fibrillation (AF) in comparison to other second-to third-line antidiabetic drugs in type 2 diabetes. METHODS AND RESULTS We conducted a population-based, new-user active comparator cohort study using data from the UK Clinical Practice Research Datalink. We identified a cohort of patients initiating a new antidiabetic drug class between January 2013 and September 2020. This cohort included patients initiating their first ever non-insulin antidiabetic drug, as well as those who switched to or added-on an antidiabetic drug class not previously used in their treatment history. Individuals with a diagnosis of AF or atrial flutter at any time before cohort entry were excluded. Cox regression analysis with time-dependent covariates was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of AF comparing SGLT-2-is with other second-line to third-line antidiabetic drugs. Stratified analyses were performed according to sex, diabetes duration (<5 or ≥ 5 years), body mass index (BMI), HbA1c, and presence of heart failure.The cohort comprised 142 447 patients. SGLT-2is were associated with a statistically significant reduced hazard of AF compared to other second-line to third-line antidiabetic drugs (adjusted HR: 0.77 [95% CI: 0.68-0.88]). This reduced risk was present in both sexes but was more prominently among women (adjusted HRwomen: 0.60 [95% CI: 0.45-0.79]; HRmen: 0.85 [95% CI: 0.73-0.98]; P-value interaction: 0.012). There was no evidence for effect modification when stratifying on duration of diabetes, BMI, HbA1c, or presence of heart failure. CONCLUSION SGLT-2is were associated with a reduced risk of AF in patients with type 2 diabetes compared to other second-line to third-line antidiabetic drugs. This reduced risk occurs in both sexes but more prominently among women.
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Affiliation(s)
- Talip E Eroglu
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 6, PO Box 635, DK-2900 Hellerup, Denmark
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Ruben Coronel
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
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Yaghoubi M, Roumiani PH, Nozari F, Simiyari S, Azarboo A, Zadeh Tabatabaei MSH, Khadembashiri MM, Khadembashiri MA. The burden of atrial fibrillation/flutter in the Middle East and North Africa region and its associated risk factors from 1990 to 2019. BMC Cardiovasc Disord 2024; 24:366. [PMID: 39014302 PMCID: PMC11251306 DOI: 10.1186/s12872-024-04019-2] [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: 04/15/2024] [Accepted: 06/27/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Atrial fibrillation and flutter (AFF) are the most common cardiac arrhythmias globally, contributing to substantial morbidity and mortality. The Middle East and North Africa (MENA) region face unique challenges in managing cardiovascular diseases, including AFF, due to diverse sociodemographic factors and healthcare infrastructure variability. This study aims to comprehensively evaluate the burden of AFF in MENA from 1990 to 2019. METHODS Data were obtained from the Global Burden of Diseases Study 2019, a comprehensive source incorporating diverse data inputs. The study collected global, regional, and national Age-Standardized Incidence Rate (ASIR), Age-Standardized Mortality Rate (ASMR), and Age-Standardized Disability-Adjusted Rate (ASDR), Mortality across sex, age groups, and years. LOESS regression was employed to determine the relationship between age-standardized rates attributed to AFF and Socio-Demographic Index (SDI). RESULTS The study found minimal change in ASIR of AFF in MENA from 1990 to 2019, with a slight increase observed in ASMR and ASDR during the same period. Notably, AFF burden was consistently higher in females compared to males, with age showing a direct positive relationship with AFF burden. Iraq, Iran, and Turkey exhibited the highest ASIR, while Qatar, Bahrain, and Oman had the highest ASMR and ASDR in 2019. Conversely, Kuwait, Libya, and Turkey displayed the lowest ASMR and ASDR rates. CONCLUSION This study underscores the persistent burden of AFF in MENA and identifies significant disparities across countries. High systolic blood pressure emerged as a prominent risk factor for mortality in AFF patients. Findings provide crucial insights for policy-making efforts, resource allocation, and intervention strategies aimed at reducing the burden of cardiovascular diseases in the MENA region.
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Affiliation(s)
- Mohammad Yaghoubi
- Cardiology Department, Azerbaijan Medical University, Baku, Azerbaijan
| | | | - Fateme Nozari
- Cardiology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Simiyari
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Azarboo
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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11
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Cheng S, He J, Han Y, Han S, Li P, Liao H, Guo J. Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2021. Europace 2024; 26:euae195. [PMID: 38984719 PMCID: PMC11287210 DOI: 10.1093/europace/euae195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/05/2024] [Indexed: 07/11/2024] Open
Abstract
AIMS To devise effective preventive measures, a profound understanding of the evolving patterns and trends in atrial fibrillation (AF) and atrial flutter (AFL) burdens is pivotal. Our study was designed to quantify the burden and delineate the risk factors associated with AF and AFL across 204 countries and territories spanning 1990-2021. METHODS AND RESULTS Data pertaining to AF and AFL were sourced from the Global Burden of Disease Study 2021. The burden of AF/AFL was evaluated using metrics such as incidence, disability-adjusted life years (DALYs), deaths, and their corresponding age-standardized rates (ASRs), stratified by age, sex, socio-demographic index (SDI), and human development index (HDI). The estimated annual percentage change was employed to quantify changes in ASRs. Population attributable fractions were calculated to determine the proportional contributions of major risk factors to age-standardized AF/AFL deaths. This analysis encompassed the period from 1990 to 2021. Globally, in 2021, there were 4.48 million incident cases [95% uncertainty interval (UI): 3.61-5.70], 8.36 million DALYs (95% UI: 6.97-10.13) and 0.34 million deaths (95% UI: 0.29-0.37) attributed to AF/AFL. The AF/AFL burden in 2021, as well as its trends from 1990 to 2021, displayed substantial variations based on gender, SDI quintiles, and geographical regions. High systolic blood pressure emerged as the leading contributor to age-standardized AF/AFL incidence, prevalence, death, and DALY rate globally among all potential risk factors, followed closely by high body mass index. CONCLUSION Our study underscores the enduring significance of AF/AFL as a prominent public health concern worldwide, marked by profound regional and national variations. Despite the substantial potential for prevention and management of AF/AFL, there is a pressing imperative to adopt more cost-effective strategies and interventions to target modifiable risk factors, particularly in areas where the burden of AF/AFL is high or escalating.
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Affiliation(s)
- Siyuan Cheng
- Department of Cardiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong 510630, China
| | - JinZheng He
- Department of Cardiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong 510630, China
| | - Yuchen Han
- Department of Cardiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong 510630, China
| | - Shaojie Han
- Department of Cardiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong 510630, China
| | - Panpan Li
- Department of Cardiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong 510630, China
| | - Huanyan Liao
- Department of Cardiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong 510630, China
| | - Jun Guo
- Department of Cardiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong 510630, China
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12
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Zhang F, Geng L, Zhang J, Han S, Guo M, Xu Y, Chen C. miR-486-5p diagnosed atrial fibrillation, predicted the risk of left atrial fibrosis, and regulated angiotensin II-induced cardiac fibrosis via modulating PI3K/Akt signaling through targeting FOXO1. Mol Cell Biochem 2024:10.1007/s11010-024-05027-8. [PMID: 38782834 DOI: 10.1007/s11010-024-05027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/04/2024] [Indexed: 05/25/2024]
Abstract
This study focused on miR-486-5p in atrial fibrillation (AF) evaluating its clinical significance and revealing its regulatory mechanism in cardiac fibroblasts, aiming to explore a novel biomarker for AF. The study enrolled 131 AF patients and 77 non-AF individuals. With the help of polymerase chain reaction (PCR), the expression of miR-486-5p was evaluated. The significance of miR-486-5p in the diagnosis of AF and the occurrence of left atrial fibrosis (LAF) was assessed by receiver operating curve (ROC) and logistic analyses. The regulatory effect and mechanism of miR-486-5p on cardiac fibrosis were investigated in human cardiac fibroblasts treated with angiotensin II. miR-486-5p was significantly upregulated in AF patients and discriminated AF patients from non-AF individuals. Increasing miR-486-5p showed a significant association with decreasing left ventricular ejection fraction (LVEF), increasing left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVEDd), and the high incidence of LAF in AF patients. Moreover, miR-486-5p was identified as a risk factor for LAF and could distinguish AF patients with LAF and without LAF. In cardiac fibroblasts, angiotensin II induced the upregulation of miR-486-5p and promoted cell proliferation, migration, and collagen synthesis. miR-486-5p negatively regulated forkhead box O1 (FOXO1) and its knockdown could reverse the promoted effect of angiotensin II. FOXO1 alleviated the effect of miR-486-5p, and the miR-486-5p/FOXO1 could activate PI3K/Akt signaling. The activation of PI3K/Akt signaling alleviated the enhanced proliferation, migration, and collagen synthesis of cardiac fibroblasts induced by angiotensin II, and its inhibition showed opposite effects. Increased miR-486-5p served as a biomarker for the diagnosis and development prediction of AF. miR-486-5p regulated cardiac fibroblast viability and collagen synthesis via modulating the PI3K/Akt signaling through targeting FOXO1.
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Affiliation(s)
- Fang Zhang
- Department of Cardiology, Affiliated Hospital of Hebei University, No. 212, Yuhua East Road, Baoding, 071000, People's Republic of China
| | - Lu Geng
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Jing Zhang
- Department of Cardiology, Affiliated Hospital of Hebei University, No. 212, Yuhua East Road, Baoding, 071000, People's Republic of China
| | - Siliang Han
- Department of Cardiology, Affiliated Hospital of Hebei University, No. 212, Yuhua East Road, Baoding, 071000, People's Republic of China
| | - Mengya Guo
- Department of Cardiology, Affiliated Hospital of Hebei University, No. 212, Yuhua East Road, Baoding, 071000, People's Republic of China
| | - Yaxin Xu
- Department of Cardiology, Affiliated Hospital of Hebei University, No. 212, Yuhua East Road, Baoding, 071000, People's Republic of China
| | - Chunhong Chen
- Department of Cardiology, Affiliated Hospital of Hebei University, No. 212, Yuhua East Road, Baoding, 071000, People's Republic of China.
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13
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Alrabadi N, Al-Nusair M, Haddad R, Alghizzawi BS, Al-Nusair N, Alhaj Mohammad S, Shteiwi SM, El-Zubi MK, Marie Z, Alnsour A, Jarrah M, Alzoubi KH, Hammoudeh A. Sex differences in clinical features, utilization of oral anticoagulant agents, and 1-year outcome in Middle Eastern patients with atrial fibrillation. Curr Med Res Opin 2024; 40:745-752. [PMID: 38507072 DOI: 10.1080/03007995.2024.2332440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Studies have revealed that sex can predict differences in multiple aspects of atrial fibrillation (AF). These differences are underreported in the Middle East. This study aims to describe sex-specific differences in risk factors, symptomatology, management, and outcomes in Middle Eastern patients with AF. METHODS The JoFib (Jordan-Atrial-Fibrillation) study is an observational, prospective, multicenter, nationwide registry in AF. Comparisons were made between female and male patients using Pearson chi-square and Mann-Whitney U tests. Multivariable regression models were constructed to investigate whether the female sex was predictive of any AF-related outcomes (all-cause death, cardiovascular death, ischemic stroke or systemic embolism [IS/SE], major bleeding, and clinically relevant non-major bleeding). RESULTS Of 2,020 patients with AF, 54% (n = 1091) were females. Females with AF were older (median age 71 vs. 69, p <.001), but had less heart failure (20.9% vs. 27.2%, p = .001) and coronary artery disease (7.5% vs. 14.7%, p <.001). Females with AF were more symptomatic (74.7% vs. 66.5%, p <.001) and frequently received anticoagulant therapy (84.4% vs. 78.9%, p = .001). Rhythm control was pursued less frequently in females (23.4% vs. 27.3%, p = .04). All studied outcomes occurred with similar frequencies in females and males, and sex was not significantly predictive of any outcome. CONCLUSION Females with AF are more symptomatic, yet they are treated less with rhythm control. Despite higher risk, females have similar risk-adjusted all-cause cardiovascular death and stroke rates compared to males. Future studies should explore how treatments and interventions can influence quality-of-life and cardiovascular outcomes in females with AF.
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Affiliation(s)
- Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Al-Nusair
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Razan Haddad
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Jadara University, Irbid, Jordan
| | - Basheer S Alghizzawi
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nashmi Al-Nusair
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Saleh Alhaj Mohammad
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Saif M Shteiwi
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Maryam K El-Zubi
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Zaid Marie
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ayham Alnsour
- Faculty of Medicine, Al-Balqa' Applied University, Salt, Jordan
| | - Mohamad Jarrah
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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14
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Zhang F, Zhang Y, Zhou Q, Shi Y, Gao X, Zhai S, Zhang H. Using machine learning to identify proteomic and metabolomic signatures of stroke in atrial fibrillation. Comput Biol Med 2024; 173:108375. [PMID: 38569232 DOI: 10.1016/j.compbiomed.2024.108375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 04/05/2024]
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia, with stroke being its most detrimental comorbidity. The exact mechanism of AF related stroke (AFS) still needs to be explored. In this study, we integrated proteomics and metabolomics platform to explore disordered plasma proteins and metabolites between AF patients and AFS patients. There were 22 up-regulated and 31 down-regulated differentially expressed proteins (DEPs) in AFS plasma samples. Moreover, 63 up-regulated and 51 down-regulated differentially expressed metabolites (DEMs) were discovered in AFS plasma samples. We integrated proteomics and metabolomics based on the topological interactions of DEPs and DEMs, which yielded revealed several related pathways such as arachidonic acid metabolism, serotonergic synapse, purine metabolism, tyrosine metabolism and steroid hormone biosynthesis. We then performed a machine learning model to identify potential biomarkers of stroke in AF. Finally, we selected 6 proteins and 6 metabolites as candidate biomarkers for predicting stroke in AF by random forest, the area under the curve being 0.976. In conclusion, this study provides new perspectives for understanding the progressive mechanisms of AF related stroke and discovering innovative biomarkers for determining the prognosis of stroke in AF.
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Affiliation(s)
- Fan Zhang
- NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Ying Zhang
- Beidahuang Industry Group General Hospital, Harbin, 150001, China
| | - Qi Zhou
- Research Management Office, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Yuanqi Shi
- Key Laboratory of Cardiovascular Disease Acousto-Optic Electromagnetic Diagnosis and Treatment in Heilongjiang Province, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xiangyuan Gao
- NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Siqi Zhai
- NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Haiyu Zhang
- Key Laboratory of Cardiovascular Disease Acousto-Optic Electromagnetic Diagnosis and Treatment in Heilongjiang Province, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
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15
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Bugiardini R, Gulati M. Closing the sex gap in cardiovascular mortality by achieving both horizontal and vertical equity. Atherosclerosis 2024; 392:117500. [PMID: 38503147 DOI: 10.1016/j.atherosclerosis.2024.117500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
Addressing sex differences and disparities in coronary heart disease (CHD) involves achieving both horizontal and vertical equity in healthcare. Horizontal equity in the context of CHD means that both men and women with comparable health statuses should have equal access to diagnosis, treatment, and management of CHD. To achieve this, it is crucial to promote awareness among the general public about the signs and symptoms of CHD in both sexes, so that both women and men may seek timely medical attention. Women often face inequity in the treatment of cardiovascular disease. Current guidelines do not differ based on sex, but their applications based on gender do differ. Vertical equity means tailoring healthcare to allow equitable care for all. Steps towards achieving this include developing treatment protocols and guidelines that consider the unique aspects of CHD in women. It also requires implementing guidelines equally, when there is not sex difference rather than inequities in application of guideline directed care.
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Affiliation(s)
- Raffaele Bugiardini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
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16
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Wagner CM, Theurer PF, Clark MJ, He C, Ling C, Murphy E, Martin J, Bolling SF, Likosky DS, Thompson MP, Pagani FD, Ailawadi G, Hawkins RB. Evaluation of sex differences in the receipt of concomitant atrial fibrillation procedures during nonmitral cardiac surgery. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00309-X. [PMID: 38692480 DOI: 10.1016/j.jtcvs.2024.04.011] [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: 02/06/2024] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Women are less likely to receive guideline-recommended cardiovascular care, but evaluation of sex-based disparities in cardiac surgical procedures is limited. Receipt of concomitant atrial fibrillation (AF) procedures during nonmitral cardiac surgery was compared by sex for patients with preoperative AF. METHODS Patients with preoperative AF undergoing coronary artery bypass grafting and/or aortic valve replacement at any of the 33 hospitals in Michigan from 2014 to 2022 were included. Patients with prior cardiac surgery, transcatheter AF procedure, or emergency/salvage status were excluded. Hierarchical logistic regression identified predictors of concomitant AF procedures, account for hospital and surgeon as random effects. RESULTS Of 5460 patients with preoperative AF undergoing nonmitral cardiac surgery, 24% (n = 1291) were women with a mean age of 71 years. Women were more likely to have paroxysmal (vs persistent) AF than men (80% vs 72%; P < .001) and had a higher mean predicted risk of mortality (5% vs 3%; P < .001). The unadjusted rate of concomitant AF procedure was 59% for women and 67% for men (P < .001). After risk adjustment, women had 26% lower adjusted odds of concomitant AF procedure than men (adjusted odds ratio, 0.74; 95% CI, 0.64-0.86; P < .001). Female sex was the risk factor associated with the lowest odds of concomitant AF procedure. CONCLUSIONS Women are less likely to receive guideline recommended concomitant AF procedure during nonmitral surgery. Identification of barriers to concomitant AF procedure in women may improve treatment of AF.
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Affiliation(s)
- Catherine M Wagner
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, Ann Arbor, Mich
| | - Patricia F Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - Melissa J Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - Chang He
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - Carol Ling
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - Edward Murphy
- SHMG Cardiothoracic Surgery, Corewell Health, Grand Rapids, Mich
| | - James Martin
- Center for Cardiovascular and Thoracic Surgery, McLaren Flint Hospital, Flint, Mich
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | | | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
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Förster CY, Künzel SR, Shityakov S, Stavrakis S. Synergistic Effects of Weight Loss and Catheter Ablation: Can microRNAs Serve as Predictive Biomarkers for the Prevention of Atrial Fibrillation Recurrence? Int J Mol Sci 2024; 25:4689. [PMID: 38731908 PMCID: PMC11083177 DOI: 10.3390/ijms25094689] [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: 02/26/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
In atrial fibrillation (AF), multifactorial pathologic atrial alterations are manifested by structural and electrophysiological changes known as atrial remodeling. AF frequently develops in the context of underlying cardiac abnormalities. A critical mechanistic role played by atrial stretch is played by abnormal substrates in a number of conditions that predispose to AF, including obesity, heart failure, hypertension, and sleep apnea. The significant role of overweight and obesity in the development of AF is known; however, the differential effect of overweight, obesity, cardiovascular comorbidities, lifestyle, and other modifiable risk factors on the occurrence and recurrence of AF remains to be determined. Reverse remodeling of the atrial substrate and subsequent reduction in the AF burden by conversion into a typical sinus rhythm has been associated with weight loss through lifestyle changes or surgery. This makes it an essential pillar in the management of AF in obese patients. According to recently published research, microRNAs (miRs) may function as post-transcriptional regulators of genes involved in atrial remodeling, potentially contributing to the pathophysiology of AF. The focus of this review is on their modulation by both weight loss and catheter ablation interventions to counteract atrial remodeling in AF. Our analysis outlines the experimental and clinical evidence supporting the synergistic effects of weight loss and catheter ablation (CA) in reversing atrial electrical and structural remodeling in AF onset and in recurrent post-ablation AF by attenuating pro-thrombotic, pro-inflammatory, pro-fibrotic, arrhythmogenic, and male-sex-associated hypertrophic remodeling pathways. Furthermore, we discuss the promising role of miRs with prognostic potential as predictive biomarkers in guiding approaches to AF recurrence prevention.
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Affiliation(s)
- Carola Y. Förster
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University of Würzburg, 97080 Würzburg, Germany
| | - Stephan R. Künzel
- Institute for Transfusion Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany;
- Institute for Transfusion Medicine, German Red Cross Blood Donation Service North-East, 01307 Dresden, Germany
| | - Sergey Shityakov
- Laboratory of Chemoinformatics, Infochemistry Scientific Center, ITMO University, 197101 Saint-Petersburg, Russia;
| | - Stavros Stavrakis
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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18
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Zhang X, Wu Y, Smith C, Louch WE, Morotti S, Dobrev D, Grandi E, Ni H. Enhanced Ca2+-Driven Arrhythmias in Female Patients with Atrial Fibrillation: Insights from Computational Modeling. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.04.583217. [PMID: 38496584 PMCID: PMC10942295 DOI: 10.1101/2024.03.04.583217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND AIMS Substantial sex-based differences have been reported in atrial fibrillation (AF), with female patients experiencing worse symptoms, increased complications from drug side effects or ablation, and elevated risk of AF-related stroke and mortality. Recent studies revealed sex-specific alterations in AF-associated Ca2+ dysregulation, whereby female cardiomyocytes more frequently exhibit potentially proarrhythmic Ca2+-driven instabilities compared to male cardiomyocytes. In this study, we aim to gain a mechanistic understanding of the Ca2+-handling disturbances and Ca2+-driven arrhythmogenic events in males vs females and establish their responses to Ca2+-targeted interventions. METHODS AND RESULTS We incorporated known sex differences and AF-associated changes in the expression and phosphorylation of key Ca2+-handling proteins and in ultrastructural properties and dimensions of atrial cardiomyocytes into our recently developed 3D atrial cardiomyocyte model that couples electrophysiology with spatially detailed Ca2+-handling processes. Our simulations of quiescent cardiomyocytes show increased incidence of Ca2+ sparks in female vs male myocytes in AF, in agreement with previous experimental reports. Additionally, our female model exhibited elevated propensity to develop pacing-induced spontaneous Ca2+ releases (SCRs) and augmented beat-to-beat variability in action potential (AP)-elicited Ca2+ transients compared with the male model. Parameter sensitivity analysis uncovered precise arrhythmogenic contributions of each component that was implicated in sex and/or AF alterations. Specifically, increased ryanodine receptor phosphorylation in female AF cardiomyocytes emerged as the major SCR contributor, while reduced L-type Ca2+ current was protective against SCRs for male AF cardiomyocytes. Furthermore, simulations of tentative Ca2+-targeted interventions identified potential strategies to attenuate Ca2+-driven arrhythmogenic events in female atria (e.g., t-tubule restoration, and inhibition of ryanodine receptor and sarcoplasmic/endoplasmic reticulum Ca2+-ATPase), and revealed enhanced efficacy when applied in combination. CONCLUSIONS Our sex-specific computational models of human atrial cardiomyocytes uncover increased propensity to Ca2+-driven arrhythmogenic events in female compared to male atrial cardiomyocytes in AF, and point to combined Ca2+-targeted interventions as promising approaches to treat AF in female patients. Our study establishes that AF treatment may benefit from sex-dependent strategies informed by sex-specific mechanisms.
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Guo X, Li J. Risk and Protective Factors of Recurrence after Catheter Ablation for Atrial Fibrillation. Rev Cardiovasc Med 2024; 25:81. [PMID: 39076956 PMCID: PMC11263837 DOI: 10.31083/j.rcm2503081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/04/2023] [Accepted: 10/27/2023] [Indexed: 07/31/2024] Open
Abstract
Atrial fibrillation (AF) is a common disease and is effectively managed through catheter ablation (CA). However, post-ablation AF recurrence can compromise patient outcomes, making the identification of associated risk factors crucially important. Factors influencing poor clinical outcomes include age, female sex, body mass index (BMI), non-paroxysmal AF, and comorbidities including diabetes mellitus (DM) and obstructive sleep apnea (OSA). Furthermore, the selected ablation strategy and employed technology are pivotal to long-term success in maintaining sinus rhythm control. The mechanisms of AF recurrence are complex and multifactorial; no single predictor is definitive. Thus, a personalized assessment of each patient should be tailored to the individual situation. A high risk of relapse does not preclude the option of ablation therapy, but rather underscores the necessity to address and manage underlying conditions contributing to AF pathogenesis, aiming to mitigate the risk of recurrence.
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Affiliation(s)
- Xinwei Guo
- Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200233 Shanghai, China
| | - Jingbo Li
- Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200233 Shanghai, China
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Rus M, Ardelean AI, Crisan S, Marian P, Pobirci OL, Huplea V, Judea Pusta C, Osiceanu GA, Stanis CE, Andronie-Cioara FL. Optimizing Atrial Fibrillation Care: Comparative Assessment of Anticoagulant Therapies and Risk Factors. Clin Pract 2024; 14:344-360. [PMID: 38391413 PMCID: PMC10888395 DOI: 10.3390/clinpract14010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/27/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Atrial fibrillation (AF) is a common arrhythmia associated with various risk factors and significant morbidity and mortality. MATERIALS AND METHODS This article presents findings from a study involving 345 patients with permanent AF. This study examined demographics, risk factors, associated pathologies, complications, and anticoagulant therapy over the course of a year. RESULTS The results showed a slight predominance of AF in males (55%), with the highest incidence in individuals aged 75 and older (49%). Common risk factors included arterial hypertension (54%), dyslipidemia, diabetes mellitus type 2 (19.13%), and obesity (15.65%). Comorbidities such as congestive heart failure (35.6%), mitral valve regurgitation (60%), and dilated cardiomyopathy (32%) were prevalent among the patients. Major complications included congestive heart failure (32%), stroke (17%), and myocardial infarction (5%). Thromboembolic and bleeding risk assessment using CHA2DS2-VASc and HAS-BLED scores demonstrated a high thromboembolic risk in all patients. The majority of patients were receiving novel oral anticoagulants (NOACs) before admission (73%), while NOACs were also the most prescribed antithrombotic therapy at discharge (61%). CONCLUSIONS This study highlights the importance of risk factor management and appropriate anticoagulant therapy in patients with AF, to reduce complications and improve outcomes. The results support the importance of tailored therapeutic schemes, for optimal care of patients with AF.
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Affiliation(s)
- Marius Rus
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Adriana Ioana Ardelean
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Simina Crisan
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Paula Marian
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Oana Lilliana Pobirci
- Department of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Veronica Huplea
- Department of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Claudia Judea Pusta
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Gheorghe Adrian Osiceanu
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | | | - Felicia Liana Andronie-Cioara
- Department of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
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Nurkkala JM, Aittokallio J, Kauko A, Niiranen T. Sex-specific genetic risks for adverse outcomes after coronary revascularization procedures. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae006. [PMID: 38216540 PMCID: PMC10799751 DOI: 10.1093/icvts/ivae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/04/2023] [Accepted: 01/11/2024] [Indexed: 01/14/2024]
Abstract
Men and women have differing risks of adverse events after revascularization procedures and these differences could be partially driven by genetics. We studied the sex-specific differences in associations of polygenic risk scores (PRSs) with atrial fibrillation (AF), ischaemic stroke (STR), intracranial haemorrhage (ICH), myocardial infarction (MI) and gastrointestinal haemorrhage (GIH) in coronary revascularization patients. The study cohort comprised 5561 and 17 578 revascularized women and men. All participants underwent genotyping and register-based follow-up from 1961 to 2021. We calculated PRSs for all individuals and used Cox models with interaction term to examine the sex-specific associations between the PRSs and adverse outcomes after revascularization. The AF-PRS was more strongly associated with AF in men [hazard ratio (HR) per 1 standard deviation increase, 1.16; 95% confidence interval (CI), 1.12-1.19; P = 7.6 × 10-22) than in women (P for interaction 0.006). Conversely, ICH-PRS was more strongly associated with ICH after revascularization in women (HR, 1.32; 95% CI, 1.08-1.62; P = 0.008) than in men (P for interaction 0.008). We observed no sex-specific differences for the associations of PRSs with STR, MI or GIH. The genetic risk of AF after revascularization is greater in men than in women, and vice versa for ICH. Sex-specific PRSs could be used to identify individuals in high genetic risk for these complications.
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Affiliation(s)
- Jouko Marko Nurkkala
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
- Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland
| | - Jenni Aittokallio
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
- Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland
| | - Anni Kauko
- Department of Internal Medicine, University of Turku, Turku, Finland
| | - Teemu Niiranen
- Department of Internal Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland
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22
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Ibrahim R, Singh VJ, Singh SJ, Hussein A, Lee JZ. Atrial fibrillation mortality trends in individuals with heart failure. J Investig Med 2024; 72:13-16. [PMID: 37840189 DOI: 10.1177/10815589231208478] [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] [Indexed: 10/17/2023]
Abstract
Atrial fibrillation (AF) frequently occurs concurrently with heart failure (HF). The two conditions can exacerbate each other, resulting in higher morbidity and mortality. In our analysis, we evaluated mortality trends related to AF in individuals with underlying HF. Cross-sectional analyses were performed using publicly available data from the Center for Disease Control and Prevention database to compare AF-related age-adjusted mortality rates across age, gender, racial/ethnic, and geographic subgroups. Mortality trends were evaluated by fitting log-linear regression models followed by calculation of the average annual percentage change (AAPC) using the Monte Carlo permutation test. We identified a total of 55,917 deaths within the United States from AF with comorbid HF between 1999 and 2020. Males, older adults, White populations, and non-metropolitan regions had higher age-adjusted mortality compared to females, younger adults, Black populations, and metropolitan regions, respectively. The AAPC among younger adults was significantly higher compared to older adults. Our results demonstrate existing disparities among age, gender, racial, and geographic subgroups related to AF mortality among individuals with comorbid HF. Although decreased overall mortality was observed within younger populations compared to older populations, the prominent AAPC seen in younger populations warrants further investigation. Detection of AF among younger adults with comorbid HF should prompt the intensification of preventative and treatment measures.
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Affiliation(s)
- Ramzi Ibrahim
- Department of Medicine, University of Arizona-Banner University Medical Center, Tucson, AZ, USA
| | - Vikram J Singh
- Department of Medicine, University of Arizona-Banner University Medical Center, Tucson, AZ, USA
| | - Simar J Singh
- Department of Medicine, University of Arizona-Banner University Medical Center, Tucson, AZ, USA
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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23
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Middeldorp ME, Sandhu RK, Mao J, Gencer B, Danik JS, Moorthy V, Cook NR, Albert CM. Risk Factors for the Development of New-Onset Persistent Atrial Fibrillation: Subanalysis of the VITAL Study. Circ Arrhythm Electrophysiol 2023; 16:651-662. [PMID: 38018439 PMCID: PMC10852030 DOI: 10.1161/circep.123.012334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Sustained forms of atrial fibrillation (AF) are associated with lower treatment success rates and poorer prognosis compared with paroxysmal AF. Yet, little is known about risk factors that predispose to persistent AF on initial presentation. Our objective was to define risk factors associated with new-onset persistent AF. METHODS We prospectively examined the differential associations between lifestyle, clinical, and socioeconomic risk factors and AF pattern (persistent versus paroxysmal) at the time of diagnosis among 25 119 participants without a history of cardiovascular disease, AF, or cancer in the VITAL rhythm study (Vitamin D and Omega-3). RESULTS During a median follow-up of 5.3 years, 900 participants developed AF and 346 (38.4%) were classified as persistent at the time of diagnosis. In multivariable competing risk models, increasing age, male sex, White race, height, weight, body mass index ≥30 kg/m2, hypertension, current or past smoking, alcohol intake ≥2 drinks/day, postcollege education, and randomized treatment with vitamin D were significantly associated with incident persistent AF. Compared with paroxysmal AF, increasing age, male sex, weight, body mass index ≥30 kg/m2, and postcollege education were more strongly associated with persistent AF in multivariable models regardless of whether interim cardiovascular disease and heart failure events were censored. CONCLUSIONS In a prospective cohort without baseline AF or cardiovascular disease, over one-third of AF at the time of diagnosis is persistent. Older age, male sex, postcollege education, and obesity were preferentially associated with persistent AF and represent a high-risk AF subset for population-based intervention.
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Affiliation(s)
- Melissa E. Middeldorp
- Dept of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Roopinder K. Sandhu
- Dept of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Jessica Mao
- Dept of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Baris Gencer
- Cardiology Division, Geneva University Hospitals, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jacqueline S. Danik
- Division of Cardiovascular Medicine, Dept of Medicine, Massachusetts General Hospital, Harvard Medical School
| | - Vinayaga Moorthy
- Harvard Division of Preventive Medicine, Dept of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Nancy R. Cook
- Harvard Division of Preventive Medicine, Dept of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Christine M. Albert
- Dept of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
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24
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Ayinde H, Markson F, Ogbenna UK, Jackson L. Addressing racial differences in the management of atrial fibrillation: Focus on black patients. J Natl Med Assoc 2023:S0027-9684(23)00142-6. [PMID: 38114334 DOI: 10.1016/j.jnma.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting between 3 and 6 million people in the United States. It is associated with a reduced quality of life and increased risk of stroke, cognitive decline, heart failure and death. Black patients have a lower prevalence of AF than White patients but are more likely to suffer worse outcomes with the disease. It is important that stakeholders understand the disproportionate burden of disease and management gaps that exists among Black patients living with AF. Appropriate treatments, including aggressive risk factor control, early referral to cardiovascular specialists and improving healthcare access may bridge some of the gaps in management and improve outcomes.
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Affiliation(s)
- Hakeem Ayinde
- Cardiology Associates of Fredericksburg, Fredericksburg, VA, USA.
| | - Favour Markson
- Department of Medicine, Lincoln Medical Center, Bronx, NY, USA
| | - Ugonna Kevin Ogbenna
- Department of Medicine, Michigan State University College of Osteopathic Medicine, Lansing, MI, USA
| | - Larry Jackson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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25
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Fan X, Li Y, He Q, Wang M, Lan X, Zhang K, Ma C, Zhang H. Predictive Value of Machine Learning for Recurrence of Atrial Fibrillation after Catheter Ablation: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2023; 24:315. [PMID: 39076446 PMCID: PMC11272879 DOI: 10.31083/j.rcm2411315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 07/31/2024] Open
Abstract
Background Accurate detection of atrial fibrillation (AF) recurrence after catheter ablation is crucial. In this study, we aimed to conduct a systematic review of machine-learning-based recurrence detection in the relevant literature. Methods We conducted a comprehensive search of PubMed, Embase, Cochrane, and Web of Science databases from 1980 to December 31, 2022 to identify studies on prediction models for AF recurrence risk after catheter ablation. We used the prediction model risk of bias assessment tool (PROBAST) to assess the risk of bias, and R4.2.0 for meta-analysis, with subgroup analysis based on model type. Results After screening, 40 papers were eligible for synthesis. The pooled concordance index (C-index) in the training set was 0.760 (95% confidence interval [CI] 0.739 to 0.781), the sensitivity was 0.74 (95% CI 0.69 to 0.77), and the specificity was 0.76 (95% CI 0.72 to 0.80). The combined C-index in the validation set was 0.787 (95% CI 0.752 to 0.821), the sensitivity was 0.78 (95% CI 0.73 to 0.83), and the specificity was 0.75 (95% CI 0.65 to 0.82). The subgroup analysis revealed no significant difference in the pooled C-index between models constructed based on radiomics features and those based on clinical characteristics. However, radiomics based showed a slightly higher sensitivity (training set: 0.82 vs. 0.71, validation set: 0.83 vs. 0.73). Logistic regression, one of the most common machine learning (ML) methods, exhibited an overall pooled C-index of 0.785 and 0.804 in the training and validation sets, respectively. The Convolutional Neural Networks (CNN) models outperformed these results with an overall pooled C-index of 0.862 and 0.861. Age, radiomics features, left atrial diameter, AF type, and AF duration were identified as the key modeling variables. Conclusions ML has demonstrated excellent performance in predicting AF recurrence after catheter ablation. Logistic regression (LR) being the most widely used ML algorithm for predicting AF recurrence, also showed high accuracy. The development of risk prediction nomograms for wide application is warranted.
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Affiliation(s)
- Xingman Fan
- Graduate School, Hebei North University, 075000 Zhangjiakou, Hebei, China
- Department of Cardiology, Air Force Medical Center, Air Force Medical
University, PLA,100142 Beijing, China
| | - Yanyan Li
- Department of Cardiology, Air Force Medical Center, Air Force Medical
University, PLA,100142 Beijing, China
| | - Qiongyi He
- Air Force Clinical medical college, Fifth Clinical College of Anhui
Medical University, 230032 Hefei, Anhui, China
| | - Meng Wang
- Graduate School, Hebei North University, 075000 Zhangjiakou, Hebei, China
- Department of Cardiology, Air Force Medical Center, Air Force Medical
University, PLA,100142 Beijing, China
| | - Xiaohua Lan
- Graduate School, Hebei North University, 075000 Zhangjiakou, Hebei, China
| | - Kaijie Zhang
- Graduate School, Hebei North University, 075000 Zhangjiakou, Hebei, China
| | - Chenyue Ma
- Air Force Clinical medical college, Fifth Clinical College of Anhui
Medical University, 230032 Hefei, Anhui, China
| | - Haitao Zhang
- Graduate School, Hebei North University, 075000 Zhangjiakou, Hebei, China
- Department of Cardiology, Air Force Medical Center, Air Force Medical
University, PLA,100142 Beijing, China
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26
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Iliodromitis K, Tzeis S, Xintarakou A, Pyrgakis V, Zarifis I, Patsilinakos S, Draganigos A, Triposkiadis F, Hahalis G, Karanasios A, Goudevenos I, Michalis L, Karvounis C, Parthenakis F, Kanakakis I, Tousoulis D, Iliodromitis E, Vardas P. The burden of atrial fibrillation and heart failure in hospitalized patients: A real-world survey in a nationwide snapshot. Hellenic J Cardiol 2023; 74:18-23. [PMID: 37141945 DOI: 10.1016/j.hjc.2023.04.008] [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: 10/12/2022] [Revised: 02/09/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSE Atrial fibrillation (AF) and heart failure (HF) are common and commonly coexisting cardiovascular diseases in hospitalized patients. We report the absolute number and interrelation between AF and HF, assess the daily burden of both diseases on the healthcare system, and describe the medical treatment in a real-world, nationwide conducted snapshot survey. METHODS A questionnaire was equally distributed to various healthcare institutions. Data on the baseline characteristics, prior hospitalizations, and medical treatments of all hospitalized patients with AF and HF at a predefined date were collected and analyzed. RESULTS Seventy-five cardiological departments participated in this multicenter Greek nationwide study. A total of 603 patients (mean age, 74.5 ± 11.4 years) with AF, HF, or the combination of both were nationwide admitted. AF, HF, and the combination of both were registered in 122 (20.2%), 196 (32.5%), and 285 (47.3%) patients, respectively. First-time hospital admission was recorded in 273 (45.7%) of 597 patients, whereas 324 (54.3%) of 597 patients had readmissions in the past 12 months. Of the entire population, 453 (75.1%) were on beta-blockers (BBs), and 430 (71.3%) were on loop diuretics. Furthermore, 315 patients with AF (77.4%) were on oral anticoagulation, of whom 191 (46.9%) were on a direct oral anticoagulant and 124 (30.5%) were on a vitamin K antagonist. CONCLUSION Hospitalized patients with AF and/or HF have more than one admission within a year. Coexistence of AF and HF is more common. BBs and loop diuretics are the most commonly used drugs. More than three-quarters of the patients with AF were on oral anticoagulation.
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Affiliation(s)
- Konstantinos Iliodromitis
- Clinic for Cardiology and Electrophysiology, Evangelical Hospital Hagen-Haspe, Germany & Hellenic Cardioresearch Foundation, Greece; School of Medicine, Witten/Herdecke University, Witten, Germany.
| | - Stylianos Tzeis
- Cardiology Department, Mitera General Hospital, Athens, Greece
| | | | - Vlasios Pyrgakis
- Cardiology Department, G. Gennimatas General Hospital, Athens, Greece
| | - Ioannis Zarifis
- Cardiology Department, Papanicolaou General Hospital, Thessaloniki, Greece
| | | | | | - Filippos Triposkiadis
- Department of Cardiology, Larissa University General Hospital, 413 34, Larissa, Greece
| | - George Hahalis
- Department of Cardiology Medical School, University Hospital of Patra, Patra, Greece
| | | | - Ioannis Goudevenos
- Department of Cardiology Medical School, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros Michalis
- Department of Cardiology Medical School, University Hospital of Ioannina, Ioannina, Greece
| | - Charalampos Karvounis
- First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Fraggiskos Parthenakis
- Department of Cardiology, Medical School, University Hospital of Heraklion, Crete, Greece
| | | | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panos Vardas
- Professor Emeritus of Cardiology, University of Crete, Former President of the European Society of Cardiology, Mitera General Hospital, HYGEIA Group, Greece & Hellenic Cardioresearch Foundation, Athens, Greece
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Garg PK, Wilson N, Yuan Y, Howard VJ, Judd S, Howard G, Soliman EZ. Association of hypertension severity and control with risk of incident atrial fibrillation: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Clin Cardiol 2023; 46:1418-1425. [PMID: 37605862 PMCID: PMC10642317 DOI: 10.1002/clc.24135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The association of hypertension (HTN) severity and control with the risk of incident atrial fibrillation (AF) is unclear. HYPOTHESIS Increased HTN severity and poorer blood pressure control would be associated with an increased risk of incident AF. METHODS This analysis included 9485 participants (mean age 63 ± 8 years; 56% women; 35% Black). Participants were stratified into six mutually exclusive groups at baseline-normotension (n = 1629), prehypertension (n = 704), controlled HTN (n = 2224), uncontrolled HTN (n = 4123), controlled apparent treatment-resistant hypertension (aTRH) (n = 88), and uncontrolled aTRH (n = 717). Incident AF was ascertained at the follow-up visit, defined by either electrocardiogram or self-reported medical history of a physician diagnosis. Multivariable logistic regression analyses adjusted for demographic and clinical variables. RESULTS Over an average of 9.3 years later, 868 incident AF cases were detected. Compared to those with normotension, incident AF risk was highest for those with aTRH (controlled aTRH: odds ratio (OR) 2.95; 95% confidence interval (CI) 1.60, 5.43, & uncontrolled aTRH: OR 2.47; 95% CI 1.76, 3.48). The increase in AF risk was smaller for those on no more than three antihypertensive agents regardless of their blood pressure control (controlled OR 1.72; 95% CI 1.30, 2.29 and uncontrolled OR 1.56; 95% CI 1.14, 2.13). CONCLUSIONS The risk of developing AF is increased in all individuals with HTN. Risk is highest in those aTRH regardless of blood pressure control. A more aggressive approach that focuses on lifestyle and pharmacologic measures to either prevent HTN or better control HTN during earlier stages may be particularly beneficial in reducing related AF risk.
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Affiliation(s)
- Parveen K. Garg
- Division of CardiologyUSC Keck School of MedicineLos AngelesCaliforniaUSA
| | - Nicole Wilson
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Ya Yuan
- School of Public HealthUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Virginia J. Howard
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Suzanne Judd
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - George Howard
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Elsayed Z. Soliman
- Department of MedicineEpidemiological Cardiology Research Center (EPICARE), Section of Cardiovascular Medicine, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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Xin Y, Hang F, Wu Y. Predictors of Low Voltage Zone and Sex Differences in Low Voltage Zone Distribution in Patients with Atrial Fibrillation. Rev Cardiovasc Med 2023; 24:324. [PMID: 39076443 PMCID: PMC11272876 DOI: 10.31083/j.rcm2411324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 07/31/2024] Open
Abstract
Background Previous studies have revealed the left atrial (LA) low voltage zone (LVZ) are tightly linked to the recurrence of atrial fibrillation (AF). Furthermore ablation that targets the LA LVZ can improve patient prognosis. The aim of this study was to identify potential clinical predictors of the LA LVZ, to investigate possible sex differences in the distribution of LA LVZ, and to examine the relationship between LA LVZ and AF recurrence. Methods A total of 108 patients who underwent AF catheter ablation and LA high-density electro-anatomic mapping were enrolled in the study. Of these, 56 patients with LA LVZ ≥ 5% were assigned to the LVZ group, while the remaining 52 patients with LA LVZ < 5% were assigned to the non-LVZ group. Clinical characteristics and laboratory results for all patients were collected and compared between the two groups. Results Multivariate logistic regression analysis revealed that persistent AF (odds ratio [OR] = 4.563, 95% confidence interval [CI]: 1.194-17.431, p = 0.026), left atrial volume (LAV, OR = 1.030, 95% CI: 1.001-1.061, p = 0.044) and brain natriuretic peptide (BNP, OR = 1.010, 95% CI: 1.002-1.019, p = 0.015) were independent predictors for the presence of LA LVZ. In addition, female sex (OR = 7.161, 95% CI: 1.518-33.792, p = 0.013), LAV (OR = 1.028, 95% CI: 1.002-1.055, p = 0.035) and BNP (OR = 1.009, 95% CI: 1.001-1.016, p = 0.018) were independent predictors of severe LA LVZ (LA LVZ > 20%). The extent of LVZ was significantly greater in females than in males (32.8% ± 15.5% vs. 23.5% ± 12.7%, p = 0.021), especially in the anterior (34.5% ± 16.7% vs. 20.0% ± 16.4%, p = 0.003) and septal (44.9% ± 17.1% vs. 29.0% ± 18.9%, p = 0.004) walls. During follow-up, AF recurrence was significantly higher in patients with LA LVZ than in those without LA LVZ (31.3% vs. 12.8%, respectively, p = 0.023). Conclusions In this study cohort, persistent AF, LAV and BNP were independent predictors of LA LVZ. Furthermore, female sex, LAV and BNP were independent predictors of severe LA LVZ. Females had a significantly greater extent of LVZ than males, especially in the anterior and septal walls. Patients with LA LVZ had a higher risk of recurrent AF.
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Affiliation(s)
- Yu Xin
- Department of Cardiovascular Medicine, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Fei Hang
- Department of Cardiovascular Medicine, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Yongquan Wu
- Department of Cardiovascular Medicine, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
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29
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Naser JA, Michelena HI, Lin G, Scott CG, Lee E, Kennedy AM, Noseworthy PA, Pellikka PA, Nkomo VT, Pislaru SV. Incidence, risk factors, and outcomes of atrial functional mitral regurgitation in patients with atrial fibrillation or sinus rhythm. Eur Heart J Cardiovasc Imaging 2023; 24:1450-1457. [PMID: 37556366 DOI: 10.1093/ehjci/jead199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/17/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
AIMS Atrial functional mitral regurgitation (AFMR) has been associated with atrial fibrillation (AF) and heart failure with preserved ejection fraction. However, data on incident AFMR are scarce. We aimed to study the incidence, risk factors, and clinical significance of AFMR in AF or sinus rhythm (SR). METHODS AND RESULTS Adults with new diagnosis of AF and adults in SR were identified. Patients with >mild MR at baseline, primary mitral disease, cardiomyopathy, left-sided valve disease, previous cardiac surgery, or with no follow-up echocardiogram were excluded. Diastolic dysfunction (DD) was indicated by ≥2/4 abnormal diastolic function parameters [mitral medial e', mitral medial E/e', tricuspid regurgitation velocity, left atrial volume index (LAVI)]. Overall, 1747 patients with AF and 29 623 in SR were included. Incidence rate of >mild AFMR was 2.6 per 100 person-year in new-onset AF and 0.7 per 100 person-year in SR, P < 0.001. AF remained associated with AFMR in a propensity score-matched analysis based on age, sex, and comorbidities between AF and SR [hazard ratio: 3.80 (95% confidence interval 3.04-4.76)]. Independent risk factors associated with incident AFMR were age ≥65 years, female sex, LAVI, and DD in both AF and SR, in addition to rate (vs. rhythm) control in AF. Incident AFMR was independently associated with all-cause death in both groups (both P < 0.001). CONCLUSIONS AF conferred a three-fold increase in the risk of incident AFMR. DD, older age, left atrial size, and female sex were independent risk factors in both SR and AF, while rhythm control was protective. AFMR was universally associated with worse mortality.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Eunjung Lee
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Austin M Kennedy
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Lin J, Wu XY, Long DY, Jiang CX, Sang CH, Tang RB, Li SN, Wang W, Guo XY, Ning M, Sun ZQ, Yang N, Hao YC, Liu J, Liu J, Du X, Fonarow GC, Smith SC, Lip GYH, Zhao D, Dong JZ, Ma CS. Asymptomatic atrial fibrillation among hospitalized patients: clinical correlates and in-hospital outcomes in Improving Care for Cardiovascular Disease in China-Atrial Fibrillation. Europace 2023; 25:euad272. [PMID: 37712716 PMCID: PMC10551228 DOI: 10.1093/europace/euad272] [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: 06/13/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS The clinical correlates and outcomes of asymptomatic atrial fibrillation (AF) in hospitalized patients are largely unknown. We aimed to investigate the clinical correlates and in-hospital outcomes of asymptomatic AF in hospitalized Chinese patients. METHODS AND RESULTS We conducted a cross-sectional registry study of inpatients with AF enrolled in the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation Project between February 2015 and December 2019. We investigated the clinical characteristics of asymptomatic AF and the association between the clinical correlates and the in-hospital outcomes of asymptomatic AF. Asymptomatic and symptomatic AF were defined according to the European Heart Rhythm Association score. Asymptomatic patients were more commonly males (56.3%) and had more comorbidities such as hypertension (57.4%), diabetes mellitus (18.6%), peripheral artery disease (PAD; 2.3%), coronary artery disease (55.5%), previous history of stroke/transient ischaemic attack (TIA; 17.9%), and myocardial infarction (MI; 5.4%); however, they had less prevalent heart failure (9.6%) or left ventricular ejection fractions ≤40% (7.3%). Asymptomatic patients were more often hospitalized with a non-AF diagnosis as the main diagnosis and were more commonly first diagnosed with AF (23.9%) and long-standing persistent/permanent AF (17.0%). The independent determinants of asymptomatic presentation were male sex, long-standing persistent AF/permanent AF, previous history of stroke/TIA, MI, PAD, and previous treatment with anti-platelet drugs. The incidence of in-hospital clinical events such as all-cause death, ischaemic stroke/TIA, and acute coronary syndrome (ACS) was higher in asymptomatic patients than in symptomatic patients, and asymptomatic clinical status was an independent risk factor for in-hospital all-cause death, ischaemic stroke/TIA, and ACS. CONCLUSION Asymptomatic AF is common among hospitalized patients with AF. Asymptomatic clinical status is associated with male sex, comorbidities, and a higher risk of in-hospital outcomes. The adoption of effective management strategies for patients with AF should not be solely based on clinical symptoms.
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Affiliation(s)
- Jing Lin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xue-Ying Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Zhao-Qing Sun
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Na Yang
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yong-Chen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Gregg C Fonarow
- Division of Cardiology, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sidney C Smith
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
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Inoue K, Guo R, Lee ML, Ebrahimi R, Neverova NV, Currier JW, Bashir MT, Leung AM. Iodine-Induced Hyperthyroidism and Long-term Risks of Incident Atrial Fibrillation and Flutter. J Clin Endocrinol Metab 2023; 108:e956-e962. [PMID: 37146179 PMCID: PMC10584637 DOI: 10.1210/clinem/dgad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
CONTEXT Although iodine-induced hyperthyroidism is a potential consequence of iodinated radiologic contrast administration, its association with long-term cardiovascular outcomes has not been previously studied. OBJECTIVE To investigate the relationships between hyperthyroidism observed after iodine contrast administration and incident atrial fibrillation/flutter. METHODS Retrospective cohort study of the U.S. Veterans Health Administration (1998-2021) of patients age ≥18 years with a normal baseline serum thyrotropin (TSH) concentration, subsequent TSH <1 year, and receipt of iodine contrast <60 days before the subsequent TSH. Cox proportional hazards regression was employed to ascertain the adjusted hazard ratio (HR) with 95% CI of incident atrial fibrillation/flutter following iodine-induced hyperthyroidism, compared with iodine-induced euthyroidism. RESULTS Iodine-induced hyperthyroidism was observed in 2500 (5.6%) of 44 607 Veterans (mean ± SD age, 60.9 ± 14.1 years; 88% men) and atrial fibrillation/flutter in 10.4% over a median follow-up of 3.7 years (interquartile range 1.9-7.4). Adjusted for sociodemographic and cardiovascular risk factors, iodine-induced hyperthyroidism was associated with an increased risk of atrial fibrillation/flutter compared with those who remained euthyroid after iodine exposure (adjusted HR 1.19, 95% CI 1.06-1.33). Females were at greater risk for incident atrial fibrillation/flutter than males (females, HR 1.81, 95% CI 1.12-2.92; males, HR 1.15, 95% CI 1.03-1.30; P for interaction = .04). CONCLUSION Hyperthyroidism following a high iodine load was associated with an increased risk of incident atrial fibrillation/flutter, particularly among females. The observed sex-based differences should be confirmed in a more sex-diverse study sample, and the cost-benefit analysis of long-term monitoring for cardiac arrhythmias following iodine-induced hyperthyroidism should be evaluated.
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Affiliation(s)
- Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Rong Guo
- Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Martin L. Lee
- Veterans Affairs Health Services Research & Development Center for the Study of Health Care Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA 90095, USA
| | - Ramin Ebrahimi
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Natalia V. Neverova
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Jesse W. Currier
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Muhammad T. Bashir
- Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Angela M. Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Endocrinology, Diabetes, and Metabolism, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
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Preda A, Giordano F, Giani V, Guarracini F, Mazzone P. Accelerated Adverse Atrial Remodeling in Women With Atrial Fibrillation: Results from Studies Using Electroanatomic Mapping Systems. Am J Cardiol 2023; 203:524-525. [PMID: 37574354 DOI: 10.1016/j.amjcard.2023.07.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Alberto Preda
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Giordano
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valentina Giani
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Patrizio Mazzone
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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Feinberg JB, Nielsen EE, Kjeldsen SE, Devereux RB, Gerdts E, Wachtell K, Olsen MH. Sex Differences in Atrial Fibrillation and Associated Complications in Hypertensive Patients with Left Ventricular Hypertrophy: The LIFE Study. Am J Hypertens 2023; 36:536-541. [PMID: 37382177 DOI: 10.1093/ajh/hpad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND There is no consensus on whether biological differences account for the higher risk of stroke seen in females compared to males with atrial fibrillation (AF). METHODS Capitalizing on The Losartan Intervention for Endpoint study, a multicenter randomized clinical trial randomizing 9,193 patients and followed for at least four years, we aimed to identify sex differences in the risk of stroke in the presence of AF in patients with hypertension and left ventricular hypertrophy (LVH). RESULTS 342 Patients had a history of AF, and 669 developed new-onset AF. History of AF and new-onset AF were more prevalent among males (5.0% vs. 2.9% and 3.0% vs. 0.9%) in patients aged 55-63 years, but the relative difference decreased with age. Females with new-onset AF tended to have a higher risk of stroke than males (HR 1.52 [95% CI 0.95-2.43]). However, females with a history of AF did not have a higher risk than males (HR 0.88 [95% CI 0.5-1.6]). In patients with new-onset AF, the relative higher stroke risk in females increased with age. Among patients with a history of AF, stroke risk was comparable and increased with age in both sexes. CONCLUSIONS Among patients with hypertension and LVH, females with new-onset AF had a higher risk of stroke than males, especially in patients above 64 years. However, the risk did not differ between the sexes among patients with a history of AF.
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Affiliation(s)
- Joshua B Feinberg
- Department of Internal Medicine, Cardiology Section, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Emil E Nielsen
- Department of Internal Medicine, Cardiology Section, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sverre E Kjeldsen
- Department of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, Oslo, Norway
| | - Richard B Devereux
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kristian Wachtell
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Michael H Olsen
- Department of Internal Medicine, Cardiology Section, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Zhao SX, Tindle HA, Larson JC, Woods NF, Crawford MH, Hoover V, Salmoirago‐Blotcher E, Shadyab AH, Stefanick ML, Perez MV. Association Between Insomnia, Stress Events, and Other Psychosocial Factors and Incident Atrial Fibrillation in Postmenopausal Women: Insights From the Women's Health Initiative. J Am Heart Assoc 2023; 12:e030030. [PMID: 37646212 PMCID: PMC10547347 DOI: 10.1161/jaha.123.030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/23/2023] [Indexed: 09/01/2023]
Abstract
Background The association between psychosocial factors and atrial fibrillation (AF) is poorly understood. Methods and Results Postmenopausal women from the Women's Health Initiative were retrospectively analyzed to identify incident AF in relation to a panel of validated psychosocial exposure variables, as assessed by multivariable Cox proportional hazard regression and hierarchical cluster analysis. Among the 83 736 women included, the average age was 63.9±7.0 years. Over an average of 10.5±6.2 years follow-up, there were 23 954 cases of incident AF. Hierarchical cluster analysis generated 2 clusters of highly correlated psychosocial variables: the Stress Cluster included stressful life events, depressive symptoms, and insomnia, and the Strain Cluster included optimism, social support, social strain, cynical hostility, and emotional expressiveness. Incident AF was associated with higher values in the Stress Cluster (hazard ratio [HR], 1.07 per unit cluster score [95% CI, 1.05-1.09]) and the Strain Cluster (HR, 1.03 per unit cluster score [95% CI, 1.00-1.05]). Of the 8 individual psychosocial predictors that were tested, insomnia (HR, 1.04 [95% CI, 1.03-1.06]) and stressful life events (HR, 1.02 [95% CI, 1.01-1.04]) were most strongly associated with increased incidence of AF in Cox regression analysis after multivariate adjustment. Subgroup analyses showed that the Strain Cluster was more strongly associated with incident AF in those with lower traditional AF risks (P for interaction=0.02) as determined by the cohorts for heart and aging research in genomic epidemiology for atrial fibrillation score. Conclusions Among postmenopausal women, 2 clusters of psychosocial stressors were found to be significantly associated with incident AF. Further research is needed to validate these associations.
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Affiliation(s)
- Susan X. Zhao
- Division of Cardiology, Department of MedicineSanta Clara Valley Medical CenterSan JoseCAUSA
| | - Hilary A. Tindle
- Division of Internal Medicine & Public Health, Vanderbilt Ingram Cancer CenterVanderbilt UniversityNashvilleTNUSA
| | - Joseph C. Larson
- Data Coordinating CenterFred Hutchinson Cancer Research CenterSeattleWAUSA
| | | | - Michael H. Crawford
- Division of Cardiology, Department of MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Valerie Hoover
- Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCAUSA
| | - Elena Salmoirago‐Blotcher
- Department of Medicine, Department of Psychiatry and Human BehaviorBrown University School of MedicineProvidenceRIUSA
- Department of EpidemiologyBrown University School of Public HealthProvidenceRIUSA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California, San DiegoLa JollaCAUSA
| | | | - Marco V. Perez
- Division of Cardiovascular Medicine and Department of MedicineStanford UniversityStanfordCAUSA
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Wood KA, Han F, Ko YA, Wharton WW. Is the association between cognitive disease progression and atrial fibrillation modified by sex? Alzheimers Dement 2023; 19:4163-4173. [PMID: 37350284 PMCID: PMC10524524 DOI: 10.1002/alz.13060] [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: 09/19/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION It is unclear if sex differences exist in cognitive disease progression in mild cognitive impairment (MCI) and dementia associated with atrial fibrillation (AF). METHODS Using a variety of statistical methods, we examined sex differences between AF and neuropsychological tests and cognitive disease progression, using the National Alzheimer's Coordinating Center data (N = 43,630). RESULTS AF is associated with higher odds of dementia (odds ratio [OR] 3.00, 95% confidence interval [CI] [1.22, 7.37] in women and MCI in women (OR 3.43, 95% CI [1.55, 7.55]) versus men. Women with AF and normal baseline cognition had a higher risk of disease progression (hazard ratio [HR] 1.26, 95% CI [1.06, 1.50]) from normal to MCI and from MCI to vascular dementia (HR3.27, 95% CI [1.89, 5.65]) than men with AF or men and women without AF. DISCUSSION AF was associated with more rapid progression to MCI and dementia in women, but more research is needed to confirm these findings.
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Affiliation(s)
- Kathryn A Wood
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Feier Han
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Whitney W Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Marzak H, Ringele R, Matsushita K, Marchandot B, Fitouchi S, Cardi T, Kanso M, Schatz A, Hammann J, Ohlmann P, Morel O, Jesel L. Impact of gender on left atrial low-voltage zones in patients with persistent atrial fibrillation: results of a voltage-guided ablation. Front Cardiovasc Med 2023; 10:1229345. [PMID: 37692044 PMCID: PMC10484507 DOI: 10.3389/fcvm.2023.1229345] [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: 05/26/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
Background Gender-related differences have been reported in atrial fibrotic remodeling and prognosis of atrial fibrillation (AF) patients after ablation. We assessed in persistent AF the regional distribution of left atrial (LA) bipolar voltage and the extent of low-voltage zones (LVZ) according to gender as well as the results of a voltage-guided substrate ablation. Methods Consecutive patients who underwent a voltage-guided AF ablation were enrolled. LA endocardial voltage maps were obtained using a 3D electro-anatomical mapping system in sinus rhythm. LVZ was defined as <0.5 mV. Results A total of 115 patients were enrolled (74 men, 41 women). The LA bipolar voltage amplitude was twice lower in the whole LA (p < 0.01) and in each atrial region in women compared with men, whereas the LA indexed volume was similar. LVZ were found in 56.1% of women and 16.2% of men (p < 0.01). LVZ were also more extensive in women (p = 0.01), especially in the anterior LA. Atrial voltage alteration occurred earlier in women than in men. In a multivariate analysis, the female sex (OR 12.99; 95% CI, 3.23-51.63, p = 0.0001) and LA indexed volume (OR 1.09; 95% CI, 1.04-1.16, p = 0.001) were predictive of LVZ. Atrial arrhythmia-free survival was similar in men and women 36 months after a single ablation procedure. Conclusion The study reports a strong relationship between the female gender and atrial substrate remodeling. The female gender was significantly associated with higher incidence, earlier occurrence, and greater extent of LVZ compared with men. Despite the female-specific characteristics in atrial remodeling, LVZ-guided ablation may improve the AF ablation outcome in women.
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Affiliation(s)
- Halim Marzak
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Romain Ringele
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- Regenerative Nanomedicine, Faculty of Pharmacy, UMR 1260 INSERM (French National Institute of Health and Medical Research), University of Strasbourg, Strasbourg, France
| | - Benjamin Marchandot
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Simon Fitouchi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Thomas Cardi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Mohamad Kanso
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Alexandre Schatz
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Justine Hammann
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- Regenerative Nanomedicine, Faculty of Pharmacy, UMR 1260 INSERM (French National Institute of Health and Medical Research), University of Strasbourg, Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- Regenerative Nanomedicine, Faculty of Pharmacy, UMR 1260 INSERM (French National Institute of Health and Medical Research), University of Strasbourg, Strasbourg, France
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Cofiño-Fabres C, Passier R, Schwach V. Towards Improved Human In Vitro Models for Cardiac Arrhythmia: Disease Mechanisms, Treatment, and Models of Atrial Fibrillation. Biomedicines 2023; 11:2355. [PMID: 37760796 PMCID: PMC10525681 DOI: 10.3390/biomedicines11092355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/29/2023] Open
Abstract
Heart rhythm disorders, arrhythmias, place a huge economic burden on society and have a large impact on the quality of life of a vast number of people. Arrhythmias can have genetic causes but primarily arise from heart tissue remodeling during aging or heart disease. As current therapies do not address the causes of arrhythmias but only manage the symptoms, it is of paramount importance to generate innovative test models and platforms for gaining knowledge about the underlying disease mechanisms which are compatible with drug screening. In this review, we outline the most important features of atrial fibrillation (AFib), the most common cardiac arrhythmia. We will discuss the epidemiology, risk factors, underlying causes, and present therapies of AFib, as well as the shortcomings and opportunities of current models for cardiac arrhythmia, including animal models, in silico and in vitro models utilizing human pluripotent stem cell (hPSC)-derived cardiomyocytes.
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Affiliation(s)
- Carla Cofiño-Fabres
- Department of Applied Stem Cell Technologies, TechMed Centre, University of Twente, Drienerlolaan 5, 7500 AE Enschede, The Netherlands;
| | - Robert Passier
- Department of Applied Stem Cell Technologies, TechMed Centre, University of Twente, Drienerlolaan 5, 7500 AE Enschede, The Netherlands;
- Department of Anatomy and Embryology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Verena Schwach
- Department of Applied Stem Cell Technologies, TechMed Centre, University of Twente, Drienerlolaan 5, 7500 AE Enschede, The Netherlands;
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Trohman RG, Huang HD, Sharma PS. Atrial fibrillation: primary prevention, secondary prevention, and prevention of thromboembolic complications: part 1. Front Cardiovasc Med 2023; 10:1060030. [PMID: 37396596 PMCID: PMC10311453 DOI: 10.3389/fcvm.2023.1060030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/14/2023] [Indexed: 07/04/2023] Open
Abstract
Atrial fibrillation (AF), is the most common sustained cardiac arrhythmia. It was once thought to be benign as long as the ventricular rate was controlled, however, AF is associated with significant cardiac morbidity and mortality. Increasing life expectancy driven by improved health care and decreased fertility rates has, in most of the world, resulted in the population aged ≥65 years growing more rapidly than the overall population. As the population ages, projections suggest that the burden of AF may increase more than 60% by 2050. Although considerable progress has been made in the treatment and management of AF, primary prevention, secondary prevention, and prevention of thromboembolic complications remain a work in progress. This narrative review was facilitated by a MEDLINE search to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2021. Atrial fibrillation was searched via the terms primary prevention, hyperthyroidism, Wolff-Parkinson-White syndrome, catheter ablation, surgical ablation, hybrid ablation, stroke prevention, anticoagulation, left atrial occlusion and atrial excision. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. In these two manuscripts, we discuss the current strategies available to prevent AF, then compare noninvasive and invasive treatment strategies to diminish AF recurrence. In addition, we examine the pharmacological, percutaneous device and surgical approaches to prevent stroke as well as other types of thromboembolic events.
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Affiliation(s)
- Richard G. Trohman
- Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
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Jiao M, Liu C, Liu Y, Wang Y, Gao Q, Ma A. Estimates of the global, regional, and national burden of atrial fibrillation in older adults from 1990 to 2019: insights from the Global Burden of Disease study 2019. Front Public Health 2023; 11:1137230. [PMID: 37377555 PMCID: PMC10291625 DOI: 10.3389/fpubh.2023.1137230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/12/2023] [Indexed: 06/29/2023] Open
Abstract
Background Atrial fibrill ation (AF) is a predominant public health concern in older adults. Therefore, this study aimed to explore the global, regional, and national burden of AF in older adults aged 60-89 between 1990 and 2019. Methods The morbidity, mortality, disability-adjusted life years (DALYs), and age-standardized rates of AF were refined from the Global Burden of Diseases study 2019. The epidemiological characteristics were assessed based on numerical values, age-standardized rates per 100,000 person-years, and estimated annual percentage changes (EAPC). Results Globally, a total of 33.31 million AF cases, 219.4 thousand deaths, and 65.80 million DALYs were documented in 2019. There were no appreciable changes in EAPC from 1990 to 2019. The disease burden of AF differed significantly across different territories and countries. At the national level, China exhibited the highest number of incident cases [818,493 (562,871-1,128,695)], deaths [39,970 (33,722-46,387)], and DALYs [1,383,674 (1,047,540-1,802,516)]. At the global level, high body mass index (BMI) and high systolic blood pressure (SBP) were two predominant risk factors contributing to the proportion of AF-related deaths. Conclusion AF in older adults remains a major public health concern worldwide. The burden of AF varies widely at both national and regional levels. From 1990 to 2019, the cases of incidences, deaths, and DALYs have shown a global increase. The ASIR, ASMR, and ASDR have declined in the high-moderate and high SDI regions; however, the burden of AF increased promptly in the lower SDI regions. Special attention should be paid to the main risk factors for high-risk individuals with AF, which can help control systolic blood pressure and body mass index within normal limits. Over all, it is necessary to illustrate the features of the global AF burden and develop more effective and targeted prevention and treatment strategies.
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Affiliation(s)
- Min Jiao
- School of Public Health, Weifang Medical University, Weifang, China
| | - Chenglin Liu
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yongwen Liu
- School of Public Health, Weifang Medical University, Weifang, China
| | - Yan Wang
- School of Public Health, Weifang Medical University, Weifang, China
| | - Qianqian Gao
- School of Management, Weifang Medical University, Weifang, China
| | - Anning Ma
- School of Public Health, Weifang Medical University, Weifang, China
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Liu YM, Wang W, Zhang X, Lei F, Qin JJ, Huang X, Li R, Lin L, Chen M, Ji YX, Zhang P, Zhang XJ, She ZG, Cai J, Xu C, Shen Z, Li H. The rising death burden of atrial fibrillation and flutter in low-income regions and younger populations. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1122790. [PMID: 38455885 PMCID: PMC10910937 DOI: 10.3389/fepid.2023.1122790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/16/2023] [Indexed: 03/09/2024]
Abstract
Objective The aim of the study was to depict the global death burden of atrial fibrillation and/or flutter (AFF) between 1990 and 2019 and predict this burden in the next decade. Methods We retrieved annual death data on cases and rates of AFF between 1990 and 2019 from the Global Burden of Disease (GBD) Study 2019 and projected the trends for 2020-2029 by developing the Bayesian age-period-cohort model. Results The global number of deaths from AFF increased from 117,038.00 in 1990 to 315,336.80 in 2019. This number is projected to reach 404,593.40 by 2029. The age-standardized mortality rates (ASMRs) of AFF have increased significantly in low- to middle-sociodemographic index (SDI) regions, which will surpass that in high SDI regions and reach above 4.60 per 100,000 by 2029. Globally, women have a higher ASMR than men, which is largely attributed to disproportionately higher mortality in women than men in lower SDI regions. Notably, AFF-related premature mortality continues to worsen worldwide. A pandemic of high systolic blood pressure and high body mass index (BMI) largely contributes to AFF-associated death. In particular, low- to middle-SDI regions and younger populations are increasingly affected by the rapidly growing current and future risk of high BMI. Conclusion The global death burden of AFF in low-income countries and younger generations have not been sufficiently controlled in the past and will continue growing in the future, which is largely attributed to metabolic risks, particularly for high BMI. There is an urgent need to implement effective measures to control AFF-related mortality.
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Affiliation(s)
- Ye-Mao Liu
- Department of Cardiology, Huanggang Central Hospital, Huanggang, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Wenxin Wang
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Xingyuan Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Fang Lei
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Juan-Juan Qin
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Xuewei Huang
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Ruyan Li
- Northfield Mount Hermon School, Gill, MA, United States
| | - Lijin Lin
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Mingming Chen
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Yan-Xiao Ji
- Institute of Model Animal, Wuhan University, Wuhan, China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Peng Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiao-Jing Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Zhi-Gang She
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Chengsheng Xu
- Department of Cardiology, Huanggang Central Hospital, Huanggang, China
| | - Zhengjun Shen
- Department of Cardiology, Huanggang Central Hospital, Huanggang, China
| | - Hongliang Li
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China
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Geurts S, Tilly MJ, Kors JA, Deckers JW, Stricker BHC, de Groot NMS, Ikram MA, Kavousi M. Electrocardiographic parameters and the risk of new-onset atrial fibrillation in the general population: the Rotterdam Study. Europace 2023; 25:euad164. [PMID: 37369558 PMCID: PMC10299895 DOI: 10.1093/europace/euad164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/14/2023] [Indexed: 06/29/2023] Open
Abstract
AIMS We aimed to assess the (shape of the) association and sex differences in the link between electrocardiographic parameters and new-onset atrial fibrillation (AF). METHODS AND RESULTS A total of 12 212 participants free of AF at baseline from the population-based Rotterdam Study were included. Up to five repeated measurements of electrocardiographic parameters including PR, QRS, QT, QT corrected for heart rate (QTc), JT, RR interval, and heart rate were assessed at baseline and follow-up examinations. Cox proportional hazards- and joint models, adjusted for cardiovascular risk factors, were used to determine the (shape of the) association between baseline and longitudinal electrocardiographic parameters with new-onset AF. Additionally, we evaluated potential sex differences. During a median follow-up of 9.3 years, 1282 incident AF cases occurred among 12 212 participants (mean age 64.9 years, 58.2% women). Penalized cubic splines revealed that associations between baseline electrocardiographic measures and risk of new-onset AF were generally U- and N-shaped. Sex differences in terms of the shape of the various associations were most apparent for baseline PR, QT, QTc, RR interval, and heart rate in relation to new-onset AF. Longitudinal measures of higher PR interval [fully adjusted hazard ratio (HR), 95% confidence interval (CI), 1.43, 1.02-2.04, P = 0.0393] and higher QTc interval (fully adjusted HR, 95% CI, 5.23, 2.18-12.45, P = 0.0002) were significantly associated with new-onset AF, in particular in men. CONCLUSION Associations of baseline electrocardiographic measures and risk of new-onset AF were mostly U- and N-shaped. Longitudinal electrocardiographic measures of PR and QTc interval were significantly associated with new-onset AF, in particular among men.
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Affiliation(s)
- Sven Geurts
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Martijn J Tilly
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jaap W Deckers
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Bruno H C Stricker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Marott JL, Jensen MT, Benn M, Knegt MCD, O'Keefe JH, Lavie CJ, Schnohr P, Nordestgaard BG, Jensen GB. Height Explains Sex Difference in Atrial Fibrillation Risk: Copenhagen General Population Study. Mayo Clin Proc 2023; 98:846-855. [PMID: 37270270 DOI: 10.1016/j.mayocp.2022.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/29/2022] [Accepted: 12/23/2022] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To test the hypothesis that the increased risk of atrial fibrillation (AF) in men compared with women is explained by height. METHODS From the Copenhagen General Population Study, we included 106,207 individuals (47,153 men and 59,054 women) from 20 to 100 years of age, without a prior diagnosis of AF, examined between November 25, 2003, and April 28, 2015. The main outcome was AF incidence from national hospital registers until April 2018. The association of risk factors with AF incidence was assessed by cause-specific Cox proportional hazards regression and Fine-Gray subdistribution hazards regression analysis. RESULTS During a maximum of 14.4 years of follow-up (median, 8.9 years), incident AF was observed in 3449 men and 2772 women with 845 (95% CI, 815 to 875) and 514 (95% CI, 494 to 535) events per 100,000 person-years, respectively. The age-adjusted hazard of incident AF was 63% (95% CI, 55% to 72%) higher in men compared with women. Risk factors for AF were generally similar in men and women, except men were taller than women (179 cm vs 166 cm, respectively; P<.001). When controlling for height, the difference in hazard of incident AF between sexes disappeared. For population attributable risk of AF, height was the most important risk factor investigated and explained 21% and 19% of the risk of incident AF in men and women, respectively. CONCLUSION A 63% higher risk of incident AF in men compared with women is explained by differences in height.
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Affiliation(s)
- Jacob Louis Marott
- Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Magnus T Jensen
- Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Amager and Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Marianne Benn
- Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Martina Chantal de Knegt
- Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, and Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - James H O'Keefe
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MI, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
| | - Peter Schnohr
- Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Børge Grønne Nordestgaard
- Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Gorm Boje Jensen
- Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Wesselink R, Mossink B, Meulendijks ER, van den Berg NWE, Neefs J, Kawasaki M, Fabrizi B, Piersma FR, Al-Shama RFM, de Vries TAC, de Jong JSSG, van Boven WJP, Driessen AHG, de Groot JR. Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors. J Clin Med 2023; 12:jcm12072650. [PMID: 37048733 PMCID: PMC10095488 DOI: 10.3390/jcm12072650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction. Atrial fibrillation (AF) is more prevalent in men than in women. However, women with AF are more symptomatic, have a worse quality of life, a higher stroke risk and may therefore benefit most from ablation. In this study we aim to identify the risk of recurrent AF after thoracoscopic ablation, and assess the differential impact of the risk factors for recurrence between women and men. Method. This is a single center cohort study, including patients undergoing thoracoscopic ablation for advanced AF between 2008 and 2019. All patients were clinically followed up for two years with quarterly 24 h Holter monitoring and ECGs for the detection of recurrent AF. Left atrial appendage (LAA) tissue was collected for collagen analysis. Results. We included 571 patients, of whom 143 (25%) were women. Women were older than men (63 ± 8.3 y vs. 59 ± 8.5, p < 0.001), but had fewer cardiovascular risk factors, myocardial infarctions (1.4% vs. 6.5%, p = 0.03) and, in particular, vascular disease (7.0% vs. 16.1%, p = 0.01). Women suffered more from AF recurrence, driven by more atrial tachycardias, and sex was an independent risk factor for recurrence (HR1.41 [1.04–1.91], p = 0.028]). The presence of vascular disease was associated with an increased risk for AF recurrence in women, but not in men. In LAA histology, women had more collagen than men, as had patients with persistent compared to paroxysmal AF. Conclusion. Women had 15% more recurrences, driven by more atrial tachycardias, which may be explained by a more fibrotic atrial substrate. What’s new? Women undergoing thoracoscopic AF ablation have a higher risk of recurrent AF, driven by more atrial tachycardias. Among patients with left atrial enlargement or persistent AF, women have worse outcomes than men. Vascular disease was a risk factor for recurrence in women, but not in men. In a histopathologic analysis of the left atrial appendage, women had more collagen than men, as had patients with persistent compared to paroxysmal AF.
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Affiliation(s)
- Robin Wesselink
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Bente Mossink
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Eva R. Meulendijks
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nicoline W. E. van den Berg
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jolien Neefs
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Makiri Kawasaki
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Benedetta Fabrizi
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Femke R. Piersma
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rushd F. M. Al-Shama
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Tim A. C. de Vries
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Cardiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
| | - Jonas S. S. G. de Jong
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Wim Jan P. van Boven
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Antoine H. G. Driessen
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Joris R. de Groot
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Pauly V, Vlcek J, Zhang Z, Hesse N, Xia R, Bauer J, Loy S, Schneider S, Renner S, Wolf E, Kääb S, Schüttler D, Tomsits P, Clauss S. Effects of Sex on the Susceptibility for Atrial Fibrillation in Pigs with Ischemic Heart Failure. Cells 2023; 12:973. [PMID: 37048048 PMCID: PMC10093477 DOI: 10.3390/cells12070973] [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: 02/25/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Atrial fibrillation (AF) is the most prevalent arrhythmia, often caused by myocardial ischemia/infarction (MI). Men have a 1.5× higher prevalence of AF, whereas women show a higher risk for new onset AF after MI. However, the underlying mechanisms of how sex affects AF pathophysiology are largely unknown. In 72 pigs with/without ischemic heart failure (IHF) we investigated the impact of sex on ischemia-induced proarrhythmic atrial remodeling and the susceptibility for AF. Electrocardiogram (ECG) and electrophysiological studies were conducted to assess electrical remodeling; histological analyses were performed to assess atrial fibrosis in male and female pigs. IHF pigs of both sexes showed a significantly increased vulnerability for AF, but in male pigs more and longer episodes were observed. Unchanged conduction properties but enhanced left atrial fibrosis indicated structural rather than electrical remodeling underlying AF susceptibility. Sex differences were only observed in controls with female pigs showing an increased intrinsic heart rate, a prolonged QRS interval and a prolonged sinus node recovery time. In sum, susceptibility for AF is significantly increased both in male and female pigs with ischemic heart failure. Differences between males and females are moderate, including more and longer AF episodes in male pigs and sinus node dysfunction in female pigs.
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Affiliation(s)
- Valerie Pauly
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Julia Vlcek
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Zhihao Zhang
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Nora Hesse
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Ruibing Xia
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Julia Bauer
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Simone Loy
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Sarah Schneider
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Simone Renner
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Feodor-Lynen-Strasse 25, D-81377 Munich, Germany
- Center for Innovative Medical Models (CiMM), Department of Veterinary Sciences, LMU Munich, Hackerstrasse 27, D-85764 Oberschleissheim, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany
| | - Eckhard Wolf
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Feodor-Lynen-Strasse 25, D-81377 Munich, Germany
- Center for Innovative Medical Models (CiMM), Department of Veterinary Sciences, LMU Munich, Hackerstrasse 27, D-85764 Oberschleissheim, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany
- Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, Grosshadern Campus, LMU Munich, Feodor-Lynen-Stasse 25, D-81377 Munich, Germany
| | - Stefan Kääb
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
| | - Dominik Schüttler
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Philipp Tomsits
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Sebastian Clauss
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
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Guo Y, Corica B, Romiti GF, Proietti M, Zhang H, Lip GYH. Efficacy of mobile health-technology integrated care based on the 'Atrial fibrillation Better Care' (ABC) pathway in relation to sex: a report from the mAFA-II randomized clinical trial. Intern Emerg Med 2023; 18:449-456. [PMID: 36630000 PMCID: PMC10017580 DOI: 10.1007/s11739-022-03188-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/24/2022] [Indexed: 01/12/2023]
Abstract
The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) cluster-randomized trial showed that a mobile health (mHealth)-implemented 'Atrial fibrillation Better Care' (ABC) pathway approach reduced the risk of adverse events in atrial fibrillation (AF) patients. Whether this benefit can be applied to both males and females is unclear, especially given the suboptimal management and poorer cardiovascular outcomes in females with AF. In this post-hoc analysis, we performed a sex-stratified analysis of the mAFA-II trial. Between June 2018 and August 2019, adult AF patients were enrolled across 40 centers in China. The primary outcome was the composite of stroke, thromboembolism, all-cause death, and re-hospitalization. The effect of mAFA intervention according to sex was evaluated through adjusted Cox-regression models. Among the 3,324 patients enrolled in the trial, 2,062 (62.0%) patients were males (mean age: 67.5 ± 14.3 years; 1,021 allocated to mAFA intervention) and 1,262 (38.0%) were females (mean age: 70.2 ± 13.0; 625 allocated to mAFA intervention). A significant risk reduction of the primary composite outcome in patients allocated to mAFA intervention was observed in both males (adjusted hazard ratio [aHR] and 95% confidence interval [CI] 0.30 [0.17-0.52]) and females (aHR [95%CI] 0.50 [0.27-0.92]), without statistically significant interaction (p = 0.225). Sex-based interactions were observed for other secondary outcomes, including all-cause death (p = 0.026) and bleeding events (p = 0.032). A mHealth-technology implemented ABC pathway was similarly effective in reducing the risk of adverse clinical events both in male and female patients. Secondary outcomes showed greater benefits of mAFA intervention in men.
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Affiliation(s)
- Yutao Guo
- Department of Pulmonary Vessel and Thrombotic Disease, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Bernadette Corica
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Hui Zhang
- Department of Pulmonary Vessel and Thrombotic Disease, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Gregory Y H Lip
- Department of Pulmonary Vessel and Thrombotic Disease, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Mathai SV, Sohal S, Flatow E, Nagaraj S, Hajra A, Chugh Y, Palaiodimos L, Lee HJ, Ansari J, Cohen M, Volgman AS, Faillace R. Sex Differences in Periprocedural and Long-Term Outcomes Following Transcatheter Left Atrial Appendage Occlusion: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 48:23-31. [PMID: 36336589 DOI: 10.1016/j.carrev.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is among the most common arrhythmias associated with an increased risk of cardioembolic phenomena, including stroke. Percutaneous left atrial appendage occlusion (LAAO) has proven beneficial in reducing stroke and mortality in patients with atrial fibrillation who have contraindications to anticoagulation. However, the sex differences in outcomes following LAAO have not been studied systematically. METHODS Electronic databases PUBMED, Embase, and Web of Science were systematically searched until March 2022 for studies evaluating patient outcomes following LAAO for AF. The primary outcomes of interest were the risks of periprocedural stroke, major bleeding, pericardial complications, and all-cause mortality. Secondary outcomes included stroke risks, major bleeding, device-related thrombus, cardiovascular and all-cause mortality on long-term follow-up. A random-effects model meta-analysis was conducted, and heterogeneity was assessed using the I-squared test. RESULTS Sixteen studies were included in the final analysis encompassing 111,775 patients, out of which 45,441 (40.7 %) were women. Women had a significantly higher risk of peri-procedural complications including all-cause mortality [relative risk (RR), 95 % confidence intervals (CI); RR 1.94, 95 % CI 1.40-2.69], stroke [RR 1.85, 95 % CI 1.29-2.67], major bleeding [RR 1.63, 95 % CI 1.08-2.44], and pericardial events [RR 1.80, 95 % CI 1.58-2.05]. However, there were no statistically significant differences between sexes in terms of risk of stroke, major bleeding, device-related thrombus, cardiovascular and all-cause mortality on long-term follow-up. CONCLUSION Among patients undergoing LAAO implantation, women were at higher risk of periprocedural complications than men. This risk was not significant on long-term follow-up.
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Affiliation(s)
- Sheetal Vasundara Mathai
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America.
| | - Sumit Sohal
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Elie Flatow
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Sanjana Nagaraj
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Adrija Hajra
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Yashasvi Chugh
- Division of Interventional and Structural Cardiology, Department of Medicine, Minneapolis Heart Institute, Minneapolis, MN, United States of America
| | - Leonidas Palaiodimos
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Hyon Jae Lee
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Julia Ansari
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Marc Cohen
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Annabelle Santos Volgman
- Division of Cardiology, Department of Medicine, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States of America
| | - Robert Faillace
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
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Perrier J, Renard M, Pariente A, Bezin J. Systematic review on sex differences for drug use after stroke. Therapie 2023; 78:213-224. [PMID: 36517302 DOI: 10.1016/j.therap.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Systematic reviews and meta-analyses have synthetized the existing knowledge on sex-differences for the risk of stroke, the most recent ones highlighting an increased risk of stroke for women. However, whether there are sex differences in post stroke treatment in real world setting is not known. We therefore conducted a systematic review on this subject. MATERIAL AND METHODS All observational studies on sex-differences in poststroke drug use published until 20/04/2021 were identified from PubMed and Scopus. Articles were selected and assessed by two independent readers; a third resolved disagreements. Data extraction was performed using a standardized form; articles quality was assessed using the STROBE guidelines. The study is registered on PROSPERO: CRD42021250256. RESULTS Of the 604 identified articles, 33 were included. Most were published before 2015 and presented methodological limitations. These limitations differentially affected studies with statistically significant and non-significant results, questioning the reliability of conflicting results. The exploration of sex-differences in drug use varied between therapeutic classes (articles focusing on thrombolytics: 25; antithrombotics: 23; on antihypertensive: 13; lipid-lowering drugs: 9). After stroke, women were found less likely to be prescribed antithrombotics in 48% of the articles investigating this class, and lipid-lowering drugs in 56%. Thirty-one percent of the studies concerning antihypertensive drugs reported the opposite. DISCUSSION/CONCLUSION In women, a lack of use of antithrombotics and lipid-lowering drugs after stroke seem to emerge from this review. Conflicting results regarding sex-differences might relate to methodological limitations in studies with no statistical differences, and advocate for the conduct of newer and more comprehensive research.
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Affiliation(s)
- Julia Perrier
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France.
| | - Mathilde Renard
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France
| | - Antoine Pariente
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
| | - Julien Bezin
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
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Tilly MJ, Geurts S, Pezzullo AM, Bramer WM, de Groot NMS, Kavousi M, de Maat MPM. The association of coagulation and atrial fibrillation: a systematic review and meta-analysis. Europace 2023; 25:28-39. [PMID: 35942591 PMCID: PMC9907526 DOI: 10.1093/europace/euac130] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/30/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS While atrial fibrillation (AF) is suggested to induce a prothrombotic state, increasing thrombotic risk, it is also hypothesized that coagulation underlies AF onset. However, conclusive evidence is lacking. With this systematic review and meta-analysis, we aimed to summarize and combine the evidence on the associations between coagulation factors with AF in both longitudinal and cross-sectional studies. METHODS AND RESULTS We systematically searched for longitudinal cohort and cross-sectional studies investigating AF and thrombosis. For longitudinal studies, pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. For cross-sectional studies, we determined pooled standardized mean differences (SMDs) and 95% CIs. A total of 17 longitudinal and 44 cross-sectional studies were included. In longitudinal studies, we found significant associations between fibrinogen (HR 1.05, 95% CI 1.00-1.10), plasminogen activator inhibitor 1 (PAI-1) (HR 1.06, 95% CI 1.00-1.12), and D-dimer (HR 1.10, 95% CI 1.02-1.19) and AF incidence. In cross-sectional studies, we found significantly increased levels of fibrinogen (SMD 0.47, 95% CI 0.20-0,74), von Willebrand factor (SMD 0.96, 95% CI 0.28-1.66), P-selectin (SMD 0.31, 95% CI 0.08-0.54), ß-thromboglobulin (SMD 0.82, 95% CI 0.61-1.04), Platelet Factor 4 (SMD 0.42, 95% CI 0.12-0.7), PAI-1 (1.73, 95% CI 0.26-3.19), and D-dimer (SMD 1.74, 95% CI 0.36-3.11) in AF patients, as opposed to controls. CONCLUSION These findings suggest that higher levels of coagulation factors are associated with prevalent and incident AF. These associations are most pronounced with prevalent AF in cross-sectional studies. Limited evidence from longitudinal studies suggests a prothrombotic state underlying AF development.
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Affiliation(s)
- Martijn J Tilly
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Sven Geurts
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Angelo M Pezzullo
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Moniek P M de Maat
- Department of Hematology, Erasmus MC, University Medical Center, Office Nc-823, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Cherian L. Women and Ischemic Stroke. Neurol Clin 2023; 41:265-281. [PMID: 37030957 DOI: 10.1016/j.ncl.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Although men are at higher risk of stroke throughout most of their lifespan, the incidence of stroke in women climbs with age, increasing after menopause and rising sharply after 85 years. This, combined with women's longer life expectancy, results in most of the stroke deaths occurring in women. In addition to accounting for a larger proportion of strokes, women may also suffer a survival disadvantage, which may be due to several factors. In many families, women are the primary caretakers. When they become disabled, there may be limited options to care for them. Others suggest that some of the disparities in stroke outcomes in women may be related to age, pre-stroke functional status, and comorbidities. Regardless of the cause, the increased disability and post-stroke care requirements of women, particularly in our aging population, highlight the importance of determining successful strategies for stroke prevention, acute stroke treatments, optimization of stroke rehabilitation, and effective secondary prevention measures in women.
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Gender Differences in Atrial Fibrillation: From the Thromboembolic Risk to the Anticoagulant Treatment Response. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020254. [PMID: 36837457 PMCID: PMC9963174 DOI: 10.3390/medicina59020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 01/31/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with an increased thromboembolic risk. The impact of the female sex as an independent risk factor for thromboembolic events in AF is still debated. Background and Objectives: The aim of this review is to evaluate the gender-related differences in cardioembolic risk and response to anticoagulants among AF patients. Materials and Methods: The PubMed database is used to review the reports about gender differences and thromboembolic risk in atrial fibrillation. Results: Non-vitamin K oral anticoagulants (NOACs) represent the gold standard for thromboembolic risk prevention in patients with non-valvular atrial fibrillation (NVAF). Despite a similar rate of stroke and systemic embolism (SE) among men and women in NOACs or vitamin K antagonists (VKAs) treatment, the use of NOACs in AF women is associated with a lower risk of intracranial bleeding, major bleeding, and all-cause mortality than in men. Conclusions: The female sex can be defined as a stroke risk modifier rather than a stroke risk factor since it mainly increases the thromboembolic risk in the presence of other risk factors. Further studies about the efficacy and safety profile of NOACs according to sex are needed to support clinicians in performing the most appropriate and tailored anticoagulant therapy, either in male or female AF patients.
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