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Zagatina A, Ciampi Q, Peteiro JV, Kalinina E, Begidova I, Padang R, Boshchenko A, Merli E, Lisi M, Rodriguez-Zanella H, Kobal S, Agoston G, Varga A, Wierzbowska-Drabik K, Kasprzak JD, Arbucci R, Zhuravleva O, Čelutkienė J, Lowenstein J, Ratanasit NC, Colonna P, Carerj S, Pepi M, Pellikka PA, Picano E. Left atrial function during exercise stress echocardiography as a sign of paroxysmal/persistent atrial fibrillation. Cardiovasc Ultrasound 2024; 22:13. [PMID: 39491022 PMCID: PMC11533336 DOI: 10.1186/s12947-024-00332-0] [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: 06/26/2024] [Accepted: 09/23/2024] [Indexed: 11/05/2024] Open
Abstract
OBJECTIVE Atrial cardiomyopathy is closely associated with atrial fibrillation (AF), and some patients exhibit no dysfunction at rest but demonstrate evident changes in left atrial (LA) function and LA volume during exercise. This study aimed to identify distinguishing signs during exercise stress echocardiography (ESE) among patients in sinus rhythm (SR), with and without history of paroxysmal/persistent AF (PAF). METHODS A prospective cohort of 1055 patients in SR was enrolled across 12 centers. The main study cohort was divided into two groups: the modeling group (n = 513) and the verification group (n = 542). All patients underwent ESE, which included B-lines, LA volume index (LAVi), and LA strain of the reservoir phase (LASr). RESULTS Age, resting and stress LAVi and LASr, and B-lines were identified as a combination of detectors for PAF in both groups. In the entire cohort, aside from resting and stress LAVi and LASr, additional parameters differentiating PAF and non-PAF patients were the presence of systemic hypertension, exercise E/e' > 7, worse right ventricle (RV) contraction during exercise (∆ tricuspid annular plane systolic excursion < 5 mm), a lower left ventricular contractile reserve (< 1.6), and a reduced chronotropic reserve (heart rate reserve < 1.64). The composite score, summing all 9 items, yielded a score of > 4 as the best sensitivity (79%) and specificity (65%). CONCLUSION ESE can complement rest echocardiography in the identification of previous PAF in patients with SR through the evaluation of LA functional reservoir and volume reserve, LV chronotropic, diastolic, and systolic reserve, and RV contractile reserve.
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Affiliation(s)
- Angela Zagatina
- Cardiology Department, Research Cardiocenter "Medika", St. Petersburg, Russian Federation.
| | - Quirino Ciampi
- Fatebenefratelli Hospital of Benevento, Benevento, Italy
| | - Jesus Vazquez Peteiro
- CHUAC- Complexo Hospitalario Universitario A Coruna- University of A Coruna, La Coruna, Spain
| | - Elena Kalinina
- Cardiology Department, Research Cardiocenter "Medika", St. Petersburg, Russian Federation
| | - Irina Begidova
- Cardiology Department, Research Cardiocenter "Medika", St. Petersburg, Russian Federation
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Elisa Merli
- Cardiology Unit, Ospedale Per Gli Infermi, Faenza, Italy
| | - Matteo Lisi
- Department of Cardiovascular Disease, Division of Cardiology, AUSL Romagna, Ospedale S. Maria Delle Croci, Ravenna, Italy
| | | | - Sergio Kobal
- Echocardiography Unit, Soroka University Medical Center, Be'er Sheva, Israel
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Albert Varga
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | | | - Jarosław D Kasprzak
- First Department and Chair of Cardiology, Medical University of Lodz, Bieganski Specialty Hospital, Lodz, Poland
| | | | - Olga Zhuravleva
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Jelena Čelutkienė
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Centre of Innovative Medicine, Vilnius, Lithuania
| | | | | | - Paolo Colonna
- Department of Cardiology, Policlinico Hospital, Bari, Italy
| | - Scipione Carerj
- Divisione Di Cardiologia, Policlinico UniversitarioUniversità Di Messina, Messina, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Eugenio Picano
- Cardiology Clinic, University Center Serbia, Medical School, University of Belgrade, Belgrade, Serbia
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Crea F. New Guidelines and a focus on ischaemic heart disease, atrial fibrillation, innovative treatments of channelopathies. Eur Heart J 2024; 45:3299-3302. [PMID: 39342493 DOI: 10.1093/eurheartj/ehae638] [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] [Indexed: 10/01/2024] Open
Affiliation(s)
- Filippo Crea
- Center of Excellence of Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Oancea AF, Morariu PC, Buburuz AM, Miftode IL, Miftode RS, Mitu O, Jigoranu A, Floria DE, Timpau A, Vata A, Plesca C, Botnariu G, Burlacu A, Scripcariu DV, Raluca M, Cuciureanu M, Tanase DM, Costache-Enache II, Floria M. Spectrum of Non-Obstructive Coronary Artery Disease and Its Relationship with Atrial Fibrillation. J Clin Med 2024; 13:4921. [PMID: 39201063 PMCID: PMC11355151 DOI: 10.3390/jcm13164921] [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: 07/28/2024] [Revised: 08/08/2024] [Accepted: 08/17/2024] [Indexed: 09/02/2024] Open
Abstract
This article aims to analyze the relationship between non-obstructive coronary artery disease (NOCAD) and atrial fibrillation (AF), exploring the underlying pathophysiological mechanisms and implications for clinical management. NOCAD and AF are prevalent cardiovascular conditions that often coexist, yet their interrelation is not well understood. NOCAD can lead to ischemic necrosis of cardiomyocytes and their replacement with fibrous tissue, sustaining focal ectopic activity in atrial myocardium. Atrial fibrillation, on the other hand, the most common sustained cardiac arrhythmia, is able to accelerate atherosclerosis and increase oxygen consumption in the myocardium, creating a mismatch between supply and demand, and thus promoting the development or worsening of coronary ischemia. Therefore, NOCAD and AF seem to be a complex interplay with one begets another.
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Affiliation(s)
- Alexandru-Florinel Oancea
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Paula Cristina Morariu
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Ana Maria Buburuz
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Ionela-Larisa Miftode
- Department of Internal Medicine II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (C.P.)
- St Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Radu Stefan Miftode
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Alexandru Jigoranu
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Diana-Elena Floria
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Amalia Timpau
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Andrei Vata
- Department of Internal Medicine II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (C.P.)
- St Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Claudia Plesca
- Department of Internal Medicine II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (C.P.)
- St Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Gina Botnariu
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
- Unit of Diabetes, Nutrition and Metabolic Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alexandru Burlacu
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Cardiovascular Disease Institute, 700503 Iasi, Romania
| | - Dragos-Viorel Scripcariu
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Regional Institute of Oncology, 700483 Iasi, Romania
| | - Mitea Raluca
- Faculty of Medicine Victor Papilian, University of Lucian Blaga, 550169 Sibiu, Romania;
| | - Magdalena Cuciureanu
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Daniela Maria Tanase
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Irina Iuliana Costache-Enache
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Mariana Floria
- Department of Internal Medicine I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-F.O.); (R.S.M.); (O.M.); (A.J.); (D.-E.F.); (A.T.); (A.B.); (D.-V.S.); (D.M.T.); (I.I.C.-E.); (M.F.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
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Dai H, Ye J, Wang S, Li X, Li W. Myeloperoxidase and its derivative hypochlorous acid combined clinical indicators predict new-onset atrial fibrillation in sepsis: a case-control study. BMC Cardiovasc Disord 2024; 24:377. [PMID: 39030470 PMCID: PMC11264794 DOI: 10.1186/s12872-024-04034-3] [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: 04/21/2024] [Accepted: 07/08/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUD New-onset atrial fibrillation (NOAF) is a common complication of sepsis and linked to higher death rates in affected patients. The lack of effective predictive tools hampers early risk assessment for the development of NOAF. This study aims to develop practical and effective predictive tools for identifying the risk of NOAF. METHODS This case-control study retrospectively analyzed patients with sepsis admitted to the emergency department of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from September 2017 to January 2023. Based on electrocardiographic reports and electrocardiogram monitoring records, patients were categorized into NOAF and non-NOAF groups. Laboratory tests, including myeloperoxidase (MPO) and hypochlorous acid (HOCl), were collected, along with demographic data and comorbidities. Least absolute shrinkage and selection operator regression and multivariate logistic regression analyses were employed to identify predictors. The area under the curve (AUC) was used to evaluate the predictive model's performance in identifying NOAF. RESULTS A total of 389 patients with sepsis were included in the study, of which 63 developed NOAF. MPO and HOCl levels were significantly higher in the NOAF group compared to the non-NOAF group. Multivariate logistic regression analysis identified MPO, HOCl, tumor necrosis factor-α (TNF-α), white blood cells (WBC), and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score as independent risk factors for NOAF in sepsis. Additionally, a nomogram model developed using these independent risk factors achieved an AUC of 0.897. CONCLUSION The combination of MPO and its derivative HOCl with clinical indicators improves the prediction of NOAF in sepsis. The nomogram model can serve as a practical predictive tool for the early identification of NOAF in patients with sepsis.
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Affiliation(s)
- Hui Dai
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Jiawei Ye
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Shangyuan Wang
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xingyao Li
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Wenjie Li
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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Crea F. A new classification of iron-deficient heart failure, sex-related differences in the management of atrial fibrillation and mitral regurgitation, and an update on the genetics of Brugada syndrome. Eur Heart J 2024; 45:2267-2270. [PMID: 38979959 DOI: 10.1093/eurheartj/ehae405] [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] [Indexed: 07/10/2024] Open
Affiliation(s)
- Filippo Crea
- Center of Excellence of Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Manolis AA, Manolis TA, Manolis AS. Managing chronic coronary syndrome: how do we achieve optimal patient outcomes? Expert Rev Cardiovasc Ther 2024; 22:243-263. [PMID: 38757743 DOI: 10.1080/14779072.2024.2357344] [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: 01/06/2024] [Accepted: 05/15/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Chronic coronary syndrome (CCS) remains the leading cause of death worldwide with high admission/re-admission rates. Medical databases were searched on CCS & its management. AREAS COVERED This review discusses phenotypes per stress-echocardiography, noninvasive/invasive testing (coronary computed-tomography angiography-CCTA; coronary artery calcium - CAC score; echocardiography assessing wall-motion, LV function, valvular disease; biomarkers), multidisciplinary management (risk factors/anti-inflammatory/anti-ischemic/antithrombotic therapies and revascularization), newer treatments (colchicine/ivabradine/ranolazine/melatonin), cardiac rehabilitation/exercise improving physical activity and quality-of-life, use of the implantable-defibrillator, and treatment with extracorporeal shockwave-revascularization for refractory symptoms. EXPERT OPINION CCS is age-dependent, leading cause of death worldwide with high hospitalization rates. Stress-echocardiography defines phenotypes and guides prophylaxis and management. CAC is a surrogate for atherosclerosis burden, best for patients of intermediate/borderline risk. Higher CAC-scores indicate more severe coronary abnormalities. CCTA is preferred for noninvasive detection of CAC and atherosclerosis burden, determining stenosis' functional significance, and guiding management. Combining CAC score with CCTA improves diagnostic yield and assists prognosis. Echocardiography assesses LV wall-motion and function and valvular disease. Biomarkers guide diagnosis/prognosis. CCS management is multidisciplinary: risk-factor management, anti-inflammatory/anti-ischemic/antithrombotic therapies, and revascularization. Newer therapies comprise colchicine, ivabradine, ranolazine, melatonin, glucagon-like peptide-1-receptor antagonists. Cardiac rehabilitation/exercise improves physical activity and quality-of-life. An ICD protects from sudden death. Extracorporeal shockwave-revascularization treats refractory symptoms.
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Affiliation(s)
| | - Theodora A Manolis
- Department of Psychiatry, Aiginiteio University Hospital, Athens, Greece
| | - Antonis S Manolis
- First Department of Cardiology, Ippokrateio University Hospital, Athens, Greece
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Crea F. Ischaemic heart disease: prevention, management, mechanisms, and new therapeutic targets. Eur Heart J 2024; 45:637-641. [PMID: 38427947 DOI: 10.1093/eurheartj/ehae114] [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] [Indexed: 03/03/2024] Open
Affiliation(s)
- Filippo Crea
- Centre of Excellence of Cardiovascular Sciences, Gemelli Isola Hospital, Rome, Italy
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Crea F. Anticoagulation in atrial fibrillation and implantable cardioverter defibrillator implantation in arrhythmogenic right ventricular cardiomyopathy: need for improving patient selection. Eur Heart J 2024; 45:491-494. [PMID: 38366819 DOI: 10.1093/eurheartj/ehae070] [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] [Indexed: 02/18/2024] Open
Affiliation(s)
- Filippo Crea
- Centre of Excellence of Cardiovascular Sciences, Gemelli Isola Hospital, Rome, Italy
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