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Darlington A, McCauley MD. Atrial Cardiomyopathy: An Unexplored Limb of Virchow's Triad for AF Stroke Prophylaxis. Front Cardiovasc Med 2020; 7:11. [PMID: 32133372 PMCID: PMC7039862 DOI: 10.3389/fcvm.2020.00011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/27/2020] [Indexed: 01/14/2023] Open
Abstract
The most dreaded complication of atrial fibrillation is stroke, and 70–80% of patients with AF-related stroke die or become disabled. The mechanisms of thromboembolism in AF are multifactorial, with evidence demonstrating that all three criteria of Virchow's triad are satisfied in AF: abnormal stasis of blood, endothelial damage, and hypercoagulability. Mechanistic insights into the latter two limbs have resulted in effective stroke prophylactic therapies (left atrial appendage occlusion and oral anticoagulants); however, despite these advances, there remains an excess of stroke in the AF population that may be due, in part, to a lack of mechanistic understanding of atrial hypocontractility resulting in abnormal stasis of blood within the atrium. These observations support the emerging concept of atrial cardiomyopathy as a cause of stroke. In this Review, we evaluate molecular, translational, and clinical evidence for atrial cardiomyopathy as a cause for stroke from AF, and present a rationale for further investigation of this largely unaddressed limb of Virchow's triad in AF.
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Affiliation(s)
- Ashley Darlington
- Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Mark D McCauley
- Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,Jesse Brown VA Medical Center, Chicago, IL, United States.,Department of Physiology and Biophysics, University of Illinois at Chicago, Chicago, IL, United States
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Clauss S, Scherr J, Hanley A, Schneider J, Klier I, Lackermair K, Hoster E, Vogeser M, Nieman DC, Halle M, Nickel T. Impact of polyphenols on physiological stress and cardiac burden in marathon runners – results from a substudy of the BeMaGIC study. Appl Physiol Nutr Metab 2017; 42:523-528. [DOI: 10.1139/apnm-2016-0457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Both physiologic stress and chronic heart disease are associated with increased systemic levels of chromogranin A (CGA) and NT-proBNP. Marathon running causes physiological stress and imposes a significant cardiac burden. Polyphenol-rich Mediterranean and Asian diets have been demonstrated to exert beneficial effects on the cardiovascular system. In this study we investigated whether pretreatment with a polyphenol beverage could attenuate the physiological and cardiac stress associated with a marathon. In the BeMaGIC trial, 277 athletes were randomized into 2 groups in a double-blinded fashion, receiving 1–1.5 L/day of the same beverages either with (study beverage) or without (placebo) polyphenol enrichment (approximately 400 mg of gallic acid equivalents per day of a complex mixture of polyphenols). Blood samples were taken 3 weeks and 1 day before, and immediately, 24 h, and 72 h after running a marathon. In our current substudy, CGA and NT-proBNP levels were analyzed by ELISA in the fastest 18 and the slowest 22 runners. CGA and NT-proBNP levels increased significantly immediately after the marathon and returned to baseline at 72 h after the marathon. Neither CGA nor NT-proBNP differed significantly between athletes receiving study beverage versus placebo. Separating our cohort into fast and slow runners did not reveal any significant difference regarding CGA or NT-proBNP levels between groups. Our study provides no evidence that polyphenol supplementation attenuates marathon running-induced physiological stress and cardiac burden in fast or slow runners.
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Affiliation(s)
- Sebastian Clauss
- Medizinische Klinik und Poliklinik I, University Hospital of Munich, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), DE-81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, DE-80802 Munich, Germany
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Johannes Scherr
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar (MRI), Technische Universität München, DE-80992 Munich, Germany
| | - Alan Hanley
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Jens Schneider
- Department of Cardiology and Angiology II, Universitäts Herz-Zentrum Freiburg−Bad Krozingen, Südring.15, DE-79189 Bad Krozingen, Germany
| | - Ina Klier
- Medizinische Klinik und Poliklinik I, University Hospital of Munich, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), DE-81377 Munich, Germany
| | - Korbinian Lackermair
- Medizinische Klinik und Poliklinik I, University Hospital of Munich, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), DE-81377 Munich, Germany
| | - Eva Hoster
- Institute for Medical Informatics Biometry and Epidemiology, Ludwig-Maximilians-University Munich, DE-81377 Munich, Germany
| | - Michael Vogeser
- Institute for Laboratory Medicine, University Hospital of Munich, Campus Grosshadern, LMU, DE-81377 Munich, Germany
| | - David C. Nieman
- Human Performance Laboratory, Appalachian State University and North Carolina Research Campus, Kannapolis, NC 28081, USA
| | - Martin Halle
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, DE-80802 Munich, Germany
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar (MRI), Technische Universität München, DE-80992 Munich, Germany
| | - Thomas Nickel
- Medizinische Klinik und Poliklinik I, University Hospital of Munich, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), DE-81377 Munich, Germany
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