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Dankar R, Wehbi J, Atasi MM, Alam S, Refaat MM. Coronary microvascular dysfunction, arrythmias, and sudden cardiac death: A literature review. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 41:100389. [PMID: 38584700 PMCID: PMC10998042 DOI: 10.1016/j.ahjo.2024.100389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
The coronary vascular system has a unique structure and function that is adaptive to myocardial demand. It is composed of a continuous network of vessels receding in size from epicardial arteries to the microvascular circulation. Failure to meet myocardial demand results in ischemia, angina, and adverse myocardial outcomes. It is evident that 50 % of patients with angina have a non-obstructive coronary disease and 66 % of these patients have coronary microvascular dysfunction (CMD). The impact of CMD on the atria and ventricles is exhibited through its association with atrial fibrillation and distortion of ventricular repolarization. Ultimately, this influence increases the risk of mortality, morbidity, and sudden cardiac arrest. CMD serves as an independent risk for atrial fibrillation, increases ventricular electrical inhomogeneity, and contributes to the progression of cardiac disease. The underlying pathogenesis may be attributed to oxidative stress evident through reactive oxygen species, impaired vasoactive function, and structural disorders such as fibrotic changes. Myocardial ischemia, brought about by a demand-supply mismatch in CMD, may create a milieu for ventricular arrythmia and sudden cardiac arrest through distortion of ventricular repolarization parameters such as QT dispersion and corrected QT dispersion.
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Affiliation(s)
- Razan Dankar
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jad Wehbi
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Montaser Atasi
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samir Alam
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M. Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Pagonas N, Mueller R, Weiland L, Jaensch M, Dammermann W, Seibert FS, Hillmeister P, Buschmann I, Christ M, Ritter O, Westhoff TH, Sasko B, Kelesidis T. Oxidized high-density lipoprotein associates with atrial fibrillation. Heart Rhythm 2024; 21:362-369. [PMID: 38040404 PMCID: PMC11073573 DOI: 10.1016/j.hrthm.2023.11.024] [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: 08/17/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common heart arrhythmia and considered to be a progressive chronic disease associated with increased morbidity and mortality. Recent data suggest a link between inflammation, oxidative stress, and AF, although the underlying mechanisms are not fully understood. Because oxidized lipoproteins cause structural damage and electrophysiologic changes in cardiomyocytes, it is feasible that the transformation of atheroprotective high-density lipoprotein (HDL) into dysfunctional HDL contributes to the development of AF. OBJECTIVE The purpose of this study was to determine whether a reduced antioxidant function of HDL is associated with the presence of AF. METHODS In this multicenter cross-sectional cohort study, we assessed HDL function in sera of 1206 participants. Patients were divided into groups according to the presence of AF (n = 233) or no AF (n = 973). A validated cell-free biochemical assay was used to determine reduced HDL antioxidant function as assessed by increased normalized HDL lipid peroxide content (nHDLox). RESULTS Participants with AF had a 9% higher mean relative nHDLox compared to persons without AF (P = .025). nHDLox was strongly associated with AF in all models of logistic regression, including the analysis adjusted for age, sex, and risk factors for AF (all P ≤.01). CONCLUSION Reduced antioxidant HDL function is associated with the presence of AF, which supports growing evidence that impaired lipoprotein function is linked to electrophysiological changes in cardiomyocytes. nHDLox is one of several contributors to the initiation and perpetuation of AF.
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Affiliation(s)
- Nikolaos Pagonas
- Department of Cardiology, University Hospital Ruppin-Brandenburg, Medical School Theodor Fontane, Neuruppin, Germany; Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany.
| | - Rhea Mueller
- Department of Cardiology, University Medical Center Brandenburg an der Havel, Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Linda Weiland
- Department of Cardiology, University Hospital Ruppin-Brandenburg, Medical School Theodor Fontane, Neuruppin, Germany
| | - Monique Jaensch
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany; Department of Cardiology, University Medical Center Brandenburg an der Havel, Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Werner Dammermann
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany; Center for Internal Medicine II, University Medical Center Brandenburg an der Havel, Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Felix S Seibert
- Medical Department I, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Philipp Hillmeister
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany; Department of Angiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Ivo Buschmann
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany; Department of Angiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Martin Christ
- Department of Cardiology, Knappschaftskrankenhaus Bottrop, Academic Teaching Hospital, University Duisburg-Essen, Bottrop, Germany
| | - Oliver Ritter
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The (MHB) Theodor Fontane and the University of Potsdam, Potsdam, Germany; Department of Cardiology, University Medical Center Brandenburg an der Havel, Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Timm H Westhoff
- Medical Department I, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Benjamin Sasko
- Department of Cardiology, University Medical Center Brandenburg an der Havel, Medical School Theodor Fontane, Brandenburg an der Havel, Germany; Medical Department II, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Theodoros Kelesidis
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
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Gupta D, Rienstra M, van Gelder IC, Fauchier L. Atrial fibrillation: better symptom control with rate and rhythm management. THE LANCET REGIONAL HEALTH. EUROPE 2024; 37:100801. [PMID: 38362560 PMCID: PMC10866934 DOI: 10.1016/j.lanepe.2023.100801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 02/17/2024]
Abstract
Atrial fibrillation (AF) is often associated with limiting symptoms, and with significant impairment in quality of life. As such, treatment strategies aimed at symptom control form an important pillar of AF management. Such treatments include a wide variety of drugs and interventions, including, increasingly, catheter ablation. These strategies can be utilised either singly or in combination, to improve and restore quality of life for patients, and this review covers the current evidence base underpinning their use. In this Review, we discuss the pros and cons of rate vs. rhythm control, while offering practical tips to non-specialists on how to utilise various treatments and counsel patients about all relevant treatment options. These include antiarrhythmic and rate control medications, as well as interventions such as cardioversion, catheter ablation, and pace-and-ablate.
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Affiliation(s)
- Dhiraj Gupta
- Liverpool Heart & Chest Hospital, Thomas Drive, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool, United Kingdom
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Isabelle C. van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Laurent Fauchier
- Faculté de Médecine, Centre Hospitalier Universitaire Trousseau, Université François Rabelais, Tours, France
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Bandorski D, Höltgen R, Wieczorek M, Ghofrani HA, Bogossian H, Iliodromitis K. Evaluation of troponin I serum levels in patients with arrhythmias with and without coronary artery disease. Med Klin Intensivmed Notfmed 2024; 119:39-45. [PMID: 37266667 DOI: 10.1007/s00063-023-01011-0] [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: 11/05/2022] [Revised: 02/11/2023] [Accepted: 03/23/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Elevated levels of cardiac enzymes in the blood are an indicator of ongoing cardiac ischemia. Persistent tachycardia may lead to myocardial ischemia due to oxygen supply-demand mismatch. OBJECTIVES We sought to evaluate the probability of underlying coronary artery disease (CAD) in patients with symptomatic supraventricular (SVT) or ventricular tachyarrhythmias (VT) based on cardiac enzyme level fluctuation. MATERIALS AND METHODS Troponin I (TNI) levels were measured twice and coronary angiography was also performed in patients without a history of cardiovascular disease and symptomatic SVT or VT. RESULTS Of the 114 (group A: CAD (n = 40), group B: no CAD (n = 74)) patients eligible for the study, 34 patients in group A and 64 patients in group B had SVT, while 6 patients in group A and 10 patients in group B had VT. All patients with underlying CAD developed a significantly elevated TNI level compared to baseline, irrespective of arrhythmia type (2.02 ± 7.98 ng/ml vs. 5.64 ± 13.38, p = 0.031). In patients without CAD, TNI level was not significantly elevated compared to the baseline level, irrespective of arrhythmia type (0.34 ± 1.38 ng/ml vs. 0.48 ± 1.48 ng/ml, p = 0.158). Most patients with normal TNI levels (46 of 47 patients; 98 %) had SVT. CAD was present in 13 of 47 patients (27 %) with tachycardia, despite normal TNI levels. CONCLUSIONS Elevated TNI levels are not helpful to discriminate between SVT and VT. An increase in TNI level in repeated blood sampling can help identify patients with higher probability of underlying CAD. Patients with VT demonstrated higher increases in TNI levels, compared to patients with SVT.
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Affiliation(s)
- Dirk Bandorski
- Faculty of Medicine, Semmelweis University Campus Hamburg, Lohmühlenstraße 5/Haus P, 20099, Hamburg, Germany.
- Neurological Clinic Bad Salzhausen, Am Hasensprung 6, 63667, Nidda, Germany.
| | - Reinhard Höltgen
- St. Agnes-Hospital Bocholt Rhede, Medical Clinic, Cardiology/Electrophysiology, Klinikum Westmünsterland, Barloer Weg 125, 46397, Bocholt, Germany
| | - Marcus Wieczorek
- St. Agnes-Hospital Bocholt Rhede, Medical Clinic, Cardiology/Electrophysiology, Klinikum Westmünsterland, Barloer Weg 125, 46397, Bocholt, Germany
| | - Hossein Ardeschir Ghofrani
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Harilaos Bogossian
- Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Brusebrinkstr. 20, 58135, Hagen, Germany
- School of Medicine, Witten/Herdecke University, 58455, Witten, Germany
| | - Konstantinos Iliodromitis
- Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Brusebrinkstr. 20, 58135, Hagen, Germany
- School of Medicine, Witten/Herdecke University, 58455, Witten, Germany
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Yang N, Zhang R, Zhao C, Sun B, Wang B, Song Y, Qi S, Liu J, Sun Y, Liu H, An H, Zhang X, Xiang F, Yang Q, Han W. Association between Troponin Elevation and Decreased Myocardial Blood Flow Reserve in Patients without Obstructive Coronary Artery Disease. Cardiology 2023; 149:40-50. [PMID: 37944497 PMCID: PMC11251656 DOI: 10.1159/000534867] [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: 01/15/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION To study the prognostic factors of patients with chest pain and without obstructive coronary artery disease is of great significance for the management of such patients. We assessed whether a high-sensitivity troponin I (hs-TnI) is associated with prognosis in patients with chest pain and without obstructive coronary artery disease. METHODS From 2011 to 2017, 489 consecutively hospitalized patients with chest pain and without significant coronary artery stenosis (<50%) were tested for hs-TnI and underwent stress myocardial contrast echocardiography (MCE). Myocardial blood flow reserve (MBFR) was measured by stress MCE. Patients were followed (median, 41 months) for composite endpoints, including cardiovascular death and non-fatal myocardial infarction. Cox proportional hazards models were performed to determine associations between hs-TnI and the composite endpoints. RESULTS Among 489 patients with chest pain and without significant coronary artery stenosis, 257 patients (52.6%) had elevated hs-TnI. Compared to patients with normal hs-TnI, patients with elevated hs-TnI were older (p = 0.013) and had a higher prevalence of atrial fibrillation (p = 0.003), higher left ventricular mass index (p = 0.002) and E/e' septal (p < 0.001), and a lower MBFR (p < 0.001). After adjustment, there was still a significant association between hs-TnI and MBFR (odds ratio = 1.145; 95% confidence interval [CI], 1.079-1.214; p < 0.001). Compared with patients with normal hs-TnI, patients with elevated hs-TnI had a greater cumulative event rate (log-rank p = 0.002). Males (hazard ratio [HR], 4.770; 95% CI, 1.175-19.363; p = 0.029) and reduced MBFR (HR, 2.496; 95% CI, 1.446-4.311; p = 0.001) were risk factors associated with composite endpoints in patients with elevated hs-TnI. CONCLUSIONS In patients with chest pain and without obstructive coronary artery disease, elevated hs-TnI is associated with decreased myocardial perfusion by contrast echocardiography as well as a higher incidence of cardiovascular events.
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Affiliation(s)
- Ning Yang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - Rongzhen Zhang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, PR China
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Chaoqun Zhao
- Department of Cardiology, Heart Center, Qingdao Fuwai Cardiovascular Hospital, Qingdao, PR China
| | - Bochen Sun
- Department of Cardiology, Qingdao Third People’s Hospital, Qingdao, PR China
| | - Biyu Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - Yuwei Song
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - Shuhan Qi
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - Jianan Liu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Yujia Sun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - Hui Liu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - Huanhuan An
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - Xingyue Zhang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - Fei Xiang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - Qinghui Yang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Wei Han
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, PR China
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, PR China
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Jung J, Seo Y, Her SH, Lee JH, Lee K, Yoo KD, Moon KW, Moon D, Lee SN, Jang WY, Choi IJ, Lee JH, Lee SR, Lee SW, Yun KH, Lee HJ. Prognostic Impact of Atrial Fibrillation in Patients with Heavily Calcified Coronary Artery Disease Receiving Rotational Atherectomy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1808. [PMID: 37893526 PMCID: PMC10608542 DOI: 10.3390/medicina59101808] [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: 08/08/2023] [Revised: 09/02/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Although both rotational atherectomy (RA) and atrial fibrillation (AF) have a high thrombotic risk, there have been no previous studies on the prognostic impact of AF in patients who undergo percutaneous coronary intervention (PCI) using RA. Thus, the aim of the present study was to determine the prognostic impact of AF in patients undergoing PCI using RA. Materials and Methods: A total of 540 patients who received PCI using RA were enrolled between January 2010 and October 2019. Patients were divided into AF and sinus rhythm groups according to the presence of AF. The primary endpoint was net adverse clinical events (NACEs) defined as a composite outcome of all-cause death, myocardial infarction, target vessel revascularization, cerebrovascular accident, or total bleeding. Results: Although in-hospital adverse events showed no difference between those with AF and those without AF (in-hospital events, 54 (11.0%) vs. 6 (12.2%), p = 0.791), AF was strongly associated with an increased risk of NACE at 3 years (NACE: hazard ratio, 1.880; 95% confidence interval, 1.096-3.227; p = 0.022). Conclusions: AF in patients who underwent PCI using RA was strongly associated with poor clinical outcomes. Thus, more attention should be paid to thrombotic and bleeding risks.
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Affiliation(s)
- Jin Jung
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Yeonjoo Seo
- Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea;
| | - Sung-Ho Her
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Jae-Hwan Lee
- Department of Cardiology in Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea
| | - Kyusup Lee
- Department of Cardiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 34943, Republic of Korea;
| | - Ki-Dong Yoo
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Keon-Woong Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Donggyu Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Su-Nam Lee
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Won-Young Jang
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Ik-Jun Choi
- Department of Cardiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea;
| | - Jang-Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea;
| | - Sang-Rok Lee
- Department of Cardiology, Chonbuk National University Hospital, Jeonju 54907, Republic of Korea;
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Kyeong-Ho Yun
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan 54538, Republic of Korea;
| | - Hyun-Jong Lee
- Department of Internal Medicine, Sejong General Hospital, Bucheon 14754, Republic of Korea;
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Ntaios G, Sagris D, Buckley BJR, Harrison SL, Abdul-Rahim A, Austin P, Lip GYH. Risk of myocardial infarction and ischemic stroke in individuals with first-diagnosed paroxysmal vs. non-paroxysmal atrial fibrillation under anticoagulation. Europace 2023; 25:euad143. [PMID: 37285483 PMCID: PMC10246817 DOI: 10.1093/europace/euad143] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
AIMS There is conflicting evidence on whether the type of atrial fibrillation (AF) is associated with risk of cardiovascular events, including acute myocardial infarction (MI) and ischemic stroke. The aim of the present study was to investigate whether the risk of MI and ischemic stroke differs between individuals with first-diagnosed paroxysmal vs. non-paroxysmal AF treated with anticoagulants. METHODS AND RESULTS De-identified electronic medical records from the TriNetX federated research network were used. Individuals with a new diagnosis of paroxysmal AF who had no evidence of other types of AF in their records were 1:1 propensity score-matched with individuals with non-paroxysmal AF, defined as persistent or chronic AF, who had no evidence of other types of AF in their records. All patients were followed for three years for the outcomes of MI and ischemic stroke. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). In the propensity-matched cohort, among 24 848 well-matched AF individuals [mean age 74.4 ± 10.4; 10 101 (40.6%) female], 410 (1.7%) were diagnosed with acute MI and 875 (3.5%) with ischemic stroke during the three-year follow-up. Individuals with paroxysmal AF had significantly higher risk of acute MI (HR: 1.65, 95%CI: 1.35-2.01) compared to those with non-paroxysmal AF. First diagnosed paroxysmal AF was associated with higher risk of non-ST elevation MI (nSTEMI) (HR: 1.89, 95%CI: 1.44-2.46). No significant association was observed between the type of AF and risk of ischemic stroke (HR: 1.09, 95%CI: 0.95-1.25). CONCLUSION Patients with first-diagnosed paroxysmal AF had higher risk of acute MI compared to individuals with non-paroxysmal AF, attributed to the higher risk of nSTEMI among patients with first-diagnosed paroxysmal AF. There was no significant association between type of AF and risk of ischemic stroke.
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Affiliation(s)
- George Ntaios
- Liverpool Centre of Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Sagris
- Liverpool Centre of Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Benjamin J R Buckley
- Liverpool Centre of Cardiovascular Science, University of Liverpool, Liverpool, UK
- Liverpool Centre of Cardiovascular Science, Liverpool John Moores University and Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Stephanie L Harrison
- Liverpool Centre of Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - Azmil Abdul-Rahim
- Liverpool Centre of Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | | | - Gregory Y H Lip
- Liverpool Centre of Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Liverpool Centre of Cardiovascular Science, Liverpool John Moores University and Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Ferdinandy P, Andreadou I, Baxter GF, Bøtker HE, Davidson SM, Dobrev D, Gersh BJ, Heusch G, Lecour S, Ruiz-Meana M, Zuurbier CJ, Hausenloy DJ, Schulz R. Interaction of Cardiovascular Nonmodifiable Risk Factors, Comorbidities and Comedications With Ischemia/Reperfusion Injury and Cardioprotection by Pharmacological Treatments and Ischemic Conditioning. Pharmacol Rev 2023; 75:159-216. [PMID: 36753049 PMCID: PMC9832381 DOI: 10.1124/pharmrev.121.000348] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/07/2022] [Accepted: 09/12/2022] [Indexed: 12/13/2022] Open
Abstract
Preconditioning, postconditioning, and remote conditioning of the myocardium enhance the ability of the heart to withstand a prolonged ischemia/reperfusion insult and the potential to provide novel therapeutic paradigms for cardioprotection. While many signaling pathways leading to endogenous cardioprotection have been elucidated in experimental studies over the past 30 years, no cardioprotective drug is on the market yet for that indication. One likely major reason for this failure to translate cardioprotection into patient benefit is the lack of rigorous and systematic preclinical evaluation of promising cardioprotective therapies prior to their clinical evaluation, since ischemic heart disease in humans is a complex disorder caused by or associated with cardiovascular risk factors and comorbidities. These risk factors and comorbidities induce fundamental alterations in cellular signaling cascades that affect the development of ischemia/reperfusion injury and responses to cardioprotective interventions. Moreover, some of the medications used to treat these comorbidities may impact on cardioprotection by again modifying cellular signaling pathways. The aim of this article is to review the recent evidence that cardiovascular risk factors as well as comorbidities and their medications may modify the response to cardioprotective interventions. We emphasize the critical need for taking into account the presence of cardiovascular risk factors as well as comorbidities and their concomitant medications when designing preclinical studies for the identification and validation of cardioprotective drug targets and clinical studies. This will hopefully maximize the success rate of developing rational approaches to effective cardioprotective therapies for the majority of patients with multiple comorbidities. SIGNIFICANCE STATEMENT: Ischemic heart disease is a major cause of mortality; however, there are still no cardioprotective drugs on the market. Most studies on cardioprotection have been undertaken in animal models of ischemia/reperfusion in the absence of comorbidities; however, ischemic heart disease develops with other systemic disorders (e.g., hypertension, hyperlipidemia, diabetes, atherosclerosis). Here we focus on the preclinical and clinical evidence showing how these comorbidities and their routine medications affect ischemia/reperfusion injury and interfere with cardioprotective strategies.
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Affiliation(s)
- Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Ioanna Andreadou
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Gary F Baxter
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Hans Erik Bøtker
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Sean M Davidson
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Dobromir Dobrev
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Bernard J Gersh
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Gerd Heusch
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Sandrine Lecour
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Marisol Ruiz-Meana
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Coert J Zuurbier
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Derek J Hausenloy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Rainer Schulz
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
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The Impact of Cardiac Comorbidity Sequence at Baseline and Mortality Risk in Type 2 Diabetes Mellitus: A Retrospective Population-Based Cohort Study. Life (Basel) 2022; 12:life12121956. [PMID: 36556321 PMCID: PMC9781363 DOI: 10.3390/life12121956] [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: 10/09/2022] [Revised: 11/02/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: The presence of multiple comorbidities increases the risk of all-cause mortality, but the effects of the comorbidity sequence before the baseline date on mortality remain unexplored. This study investigated the relationship between coronary heart disease (CHD), atrial fibrillation (AF) and heart failure (HF) through their sequence of development and the effect on all-cause mortality risk in type 2 diabetes mellitus. Methods: This study included patients with type 2 diabetes mellitus prescribed antidiabetic/cardiovascular medications in public hospitals of Hong Kong between 1 January 2009 and 31 December 2009, with follow-up until death or 31 December 2019. The Cox regression was used to identify comorbidity sequences predicting all-cause mortality in patients with different medication subgroups. Results: A total of 249,291 patients (age: 66.0 ± 12.4 years, 47.4% male) were included. At baseline, 7564, 10,900 and 25,589 patients had AF, HF and CHD, respectively. Over follow-up (3524 ± 1218 days), 85,870 patients died (mortality rate: 35.7 per 1000 person-years). Sulphonylurea users with CHD developing later and insulin users with CHD developing earlier in the disease course had lower mortality risks. Amongst insulin users with two of the three comorbidities, those with CHD with preceding AF (hazard ratio (HR): 3.06, 95% CI: [2.60−3.61], p < 0.001) or HF (HR: 3.84 [3.47−4.24], p < 0.001) had a higher mortality. In users of lipid-lowering agents with all three comorbidities, those with preceding AF had a higher risk of mortality (AF-CHD-HF: HR: 3.22, [2.24−4.61], p < 0.001; AF-HF-CHD: HR: 3.71, [2.66−5.16], p < 0.001). Conclusions: The sequence of comorbidity development affects the risk of all-cause mortality to varying degrees in diabetic patients on different antidiabetic/cardiovascular medications.
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Hou J, Yuan Y, Chen P, Lu K, Tang Z, Liu Q, Xu W, Zheng D, Xiong S, Pei H. Pathological Roles of Oxidative Stress in Cardiac Microvascular Injury. Curr Probl Cardiol 2022; 48:101399. [PMID: 36103941 DOI: 10.1016/j.cpcardiol.2022.101399] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 01/06/2023]
Abstract
Cardiac microvascular injury can be a fundamental pathological process that causes high incidence cardiovascular diseases such heart failure, diabetic cardiomyopathy, and hypertension. It is also an independent risk factor for cardiovascular disease. Oxidative stress is a significant pathological process in which the body interferes with the balance of the endogenous antioxidant defense system by producing reactive oxygen species, leading to property changes and dysfunction. It has been demonstrated that oxidative stress is one of the major causes of cardiac microvascular disease. Therefore, additional investigation into the relationship between oxidative stress and cardiac microvascular injury will direct clinical management in the future. In order to give suggestions and support for future in-depth studies, we give a basic overview of the cardiac microvasculature in relation to physiopathology in this review. We also summarize the role of oxidative stress of mitochondrial and non-mitochondrial origin in cardiac microvascular injury and related drug studies.
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Affiliation(s)
- Jun Hou
- Department of Cardiology, Chengdu Third People's Hospital/Affiliated Hospital of Southwest Jiao Tong University, Chengdu 610031, China
| | - Yuan Yuan
- Department of Pharmacy, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Peiwen Chen
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu 611130, China
| | - Keji Lu
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu 611130, China
| | - Zhaobing Tang
- Department of Rehabilitation Medicine, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Qing Liu
- Department of medical engineering, The 950th Hospital of PLA, Yecheng 844900, China
| | - Wu Xu
- Department of Urology, The Fifth Afliated Hospital of Southern Medical University, Guangzhou 510900, China
| | - Dezhi Zheng
- Department of Cardiovascular Surgery, the 960th Hospital of the PLA Joint Logistic Support Force, Jinan 250031, China
| | - Shiqiang Xiong
- Department of Cardiology, Chengdu Third People's Hospital/Affiliated Hospital of Southwest Jiao Tong University, Chengdu 610031, China
| | - Haifeng Pei
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu 610083, China.
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11
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Goette A, Borof K, Breithardt G, Camm AJ, Crijns HJGM, Kuck KH, Wegscheider K, Kirchhof P. Presenting Pattern of Atrial Fibrillation and Outcomes of Early Rhythm Control Therapy. J Am Coll Cardiol 2022; 80:283-295. [PMID: 35863844 DOI: 10.1016/j.jacc.2022.04.058] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Whether atrial fibrillation (AF) pattern or timing of AF therapy modifies the effectiveness of early rhythm control (ERC) is not known. OBJECTIVES This study sought to compare clinical characteristics and outcomes in patients presenting with different AF patterns on ERC vs usual care. METHODS The effects of ERC were compared in first-diagnosed AF (FDAF), paroxysmal AF (paroxAF), and persistent AF (persAF) in this prespecified analysis of the EAST-AFNET 4 (Early treatment of atrial fibrillation for stroke prevention) trial. Associations between AF pattern and primary outcomes (first primary outcome: cardiovascular death, stroke, and hospitalization for heart failure and acute coronary syndrome; second primary outcome: nights spent in hospital per year) were compared over a mean follow-up of 5.1 years. Changes in health-related quality of life were assessed by the EQ-5D. RESULTS FDAF patients (n = 1,048, enrolled 7 days after diagnosing AF) were slightly older (71 years of age, 48.0% female) than patients with paroxAF (n = 994, 70 years of age, 50.0% female) and persAF (n = 743, 70 years of age, 38.0% female). ERC reduced the primary outcome in all 3 AF patterns. Hospitalizations for acute coronary syndrome were highest in FDAF (incidence rate ratio [IRR]: 1.50; 95% CI: 0.83-2.69; P for interaction = 0.032) compared with paroxAF (IRR: 0.64; 95% CI: 0.32-1.25) and persAF (IRR: 0.50; 95% CI: 0.25-1.00). FDAF patients spent more nights in hospital (IRR: 1.38; 95% CI: 1.12-1.70; P for interaction = 0.004) than paroxAF (IRR: 0.84; 95% CI: 0.67-1.03), and persAF (IRR: 1.02; 95% CI: 0.80-1.30) patients. ERC improved health-related quality of life (EQ-5D score) in patients with paroxAF and persAF but not in patients with FDAF (P = 0.019). CONCLUSIONS ERC reduces the first primary composite outcome in all AF patterns. Patients with FDAF are at high risk for hospitalization and acute coronary syndrome, particularly on ERC. (Early treatment of atrial fibrillation for stroke prevention trial; ISRCTN04708680; Early Treatment of Atrial Fibrillation for Stroke Prevention Trial [EAST]; NCT01288352; Early treatment of Atrial fibrillation for Stroke prevention Trial [EAST]; EudraCT2010-021258-20).
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Affiliation(s)
- Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, Paderborn, Germany; AFNET e.V., Münster, Germany.
| | - Katrin Borof
- AFNET e.V., Münster, Germany; Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Günter Breithardt
- AFNET e.V., Münster, Germany; Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany
| | - A John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | - Karl Wegscheider
- Institute for Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
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12
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Hanna-Rivero N, Tu SJ, Elliott AD, Pitman BM, Gallagher C, Lau DH, Sanders P, Wong CX. Anemia and iron deficiency in patients with atrial fibrillation. BMC Cardiovasc Disord 2022; 22:204. [PMID: 35508964 PMCID: PMC9066804 DOI: 10.1186/s12872-022-02633-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/13/2022] [Indexed: 12/11/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac tachyarrhythmia and has a rising global prevalence. Given the increasing burden of AF-related symptoms and complications, new approaches to management are required. Anemia and iron deficiency are common conditions in patients with AF. Furthermore, emerging evidence suggests that the presence of anemia may be associated with worse outcome in these patients. The role of anemia and iron deficiency has been extensively explored in other cardiovascular states, such as heart failure and ischemic heart disease. In particular, the role of iron repletion amongst patients with heart failure is now an established treatment modality. However, despite the strong bidirectional inter-relationship between AF and heart failure, the implications of anemia and iron-deficiency in AF have been scarcely studied. This area is of mechanistic and clinical relevance given the potential that treatment of these conditions may improve symptoms and prognosis in the increasing number of individuals with AF. In this review, we summarise the current published literature on anemia and iron deficiency in patients with AF. We discuss AF complications such as stroke, bleeding, and heart failure, in addition to AF-related symptoms such as exercise intolerance, and the potential impact of anemia and iron deficiency on these. Finally, we summarize current research gaps on anemia, iron deficiency, and AF, and underscore potential research directions.
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Affiliation(s)
- Nicole Hanna-Rivero
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Samuel J Tu
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Bradley M Pitman
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia.
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13
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Disentangling the association between kidney function and atrial fibrillation: A bidirectional Mendelian randomization study. Int J Cardiol 2022; 355:15-22. [DOI: 10.1016/j.ijcard.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
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14
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Goette A. Pathophysiological differences between atrial fibrillation subgoups: Is there a fibrillatory-induced atherosclerotic disease progression? IJC HEART & VASCULATURE 2021; 37:100892. [PMID: 34761099 PMCID: PMC8567199 DOI: 10.1016/j.ijcha.2021.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, Am Busdorf 2, 33098 Paderborn, Germany
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15
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Goette A, Lendeckel U. Atrial Cardiomyopathy: Pathophysiology and Clinical Consequences. Cells 2021; 10:cells10102605. [PMID: 34685585 PMCID: PMC8533786 DOI: 10.3390/cells10102605] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 12/18/2022] Open
Abstract
Around the world there are 33.5 million patients suffering from atrial fibrillation (AF) with an annual increase of 5 million cases. Most AF patients have an established form of an atrial cardiomyopathy. The concept of atrial cardiomyopathy was introduced in 2016. Thus, therapy of underlying diseases and atrial tissue changes appear as a cornerstone of AF therapy. Furthermore, therapy or prevention of atrial endocardial changes has the potential to reduce atrial thrombogenesis and thereby cerebral stroke. The present manuscript will summarize the underlying pathophysiology and remodeling processes observed in the development of an atrial cardiomyopathy, thrombogenesis, and atrial fibrillation. In particular, the impact of oxidative stress, inflammation, diabetes, and obesity will be addressed.
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Affiliation(s)
- Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, 33098 Paderborn, Germany
- MAESTRIA Consortium/AFNET, 48149 Münster, Germany
- Correspondence:
| | - Uwe Lendeckel
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, 17475 Greifswald, Germany;
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16
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Dudink EAMP, Bidar E, Jacobs J, van Hunnik A, Zeemering S, Weijs B, Luermans JGLM, Maesen BAE, Cheriex EC, Maessen JG, Hoorntje JCA, Schotten U, Crijns HJGM, Verheule S. The relation between the atrial blood supply and the complexity of acute atrial fibrillation. IJC HEART & VASCULATURE 2021; 34:100794. [PMID: 34095447 PMCID: PMC8164021 DOI: 10.1016/j.ijcha.2021.100794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
Background Patients with a history of myocardial infarction and coronary artery disease (CAD) have a higher risk of developing AF. Conversely, patients with atrial fibrillation (AF) have a higher risk of developing myocardial infarction, suggesting a link in underlying pathophysiology. The aim of this study was to assess whether coronary angiographic parameters are associated with a substrate for AF in patients without a history of AF. Methods During cardiac surgery in 62 patients (coronary artery bypass grafting (CABG;n = 47), aortic valve replacement (AVR;n = 9) or CABG + AVR (n = 6)) without a history of clinical AF (age 65.4 ± 8.5 years, 26.2% female), AF was induced by burst pacing. The preoperative coronary angiogram (CAG) was assessed for the severity of CAD, and the adequacy of atrial coronary blood supply as quantified by a novel scoring system including the location and severity of right coronary artery disease in relation to the right atrial branches. Epicardial mapping of the right atrium (256 unipolar electrodes) was used to assess the complexity of induced AF. Results There was no association between the adequacy of right atrial coronary blood supply on preoperative CAG and AF complexity parameters. Multivariable analysis revealed that only increasing age (B0.232 (0.030;0.433),p = 0.03) and the presence of 3VD (B3.602 (0.187;7.018),p = 0.04) were independently associated with an increased maximal activation time difference. Conclusions The adequacy of epicardial right atrial blood supply is not associated with increased complexity of induced atrial fibrillation in patients without a history of clinical AF, while age and the extent of ventricular coronary artery disease are.
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Affiliation(s)
- Elton A M P Dudink
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Elham Bidar
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiothoracic Surgery, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.,Maastricht University and Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Judith Jacobs
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Arne van Hunnik
- Maastricht University and Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Stef Zeemering
- Maastricht University and Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Bob Weijs
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Justin G L M Luermans
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Bart A E Maesen
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiothoracic Surgery, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Emile C Cheriex
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Jos G Maessen
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiothoracic Surgery, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Jan C A Hoorntje
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Ulrich Schotten
- Maastricht University and Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Harry J G M Crijns
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Sander Verheule
- Maastricht University and Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
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17
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Aguilar M, Rose RA, Takawale A, Nattel S, Reilly S. New aspects of endocrine control of atrial fibrillation and possibilities for clinical translation. Cardiovasc Res 2021; 117:1645-1661. [PMID: 33723575 PMCID: PMC8208746 DOI: 10.1093/cvr/cvab080] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
Hormones are potent endo-, para-, and autocrine endogenous regulators of the function of multiple organs, including the heart. Endocrine dysfunction promotes a number of cardiovascular diseases, including atrial fibrillation (AF). While the heart is a target for endocrine regulation, it is also an active endocrine organ itself, secreting a number of important bioactive hormones that convey significant endocrine effects, but also through para-/autocrine actions, actively participate in cardiac self-regulation. The hormones regulating heart-function work in concert to support myocardial performance. AF is a serious clinical problem associated with increased morbidity and mortality, mainly due to stroke and heart failure. Current therapies for AF remain inadequate. AF is characterized by altered atrial function and structure, including electrical and profibrotic remodelling in the atria and ventricles, which facilitates AF progression and hampers its treatment. Although features of this remodelling are well-established and its mechanisms are partly understood, important pathways pertinent to AF arrhythmogenesis are still unidentified. The discovery of these missing pathways has the potential to lead to therapeutic breakthroughs. Endocrine dysfunction is well-recognized to lead to AF. In this review, we discuss endocrine and cardiocrine signalling systems that directly, or as a consequence of an underlying cardiac pathology, contribute to AF pathogenesis. More specifically, we consider the roles of products from the hypothalamic-pituitary axis, the adrenal glands, adipose tissue, the renin–angiotensin system, atrial cardiomyocytes, and the thyroid gland in controlling atrial electrical and structural properties. The influence of endocrine/paracrine dysfunction on AF risk and mechanisms is evaluated and discussed. We focus on the most recent findings and reflect on the potential of translating them into clinical application.
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Affiliation(s)
- Martin Aguilar
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
| | - Robert A Rose
- Department of Cardiac Sciences, Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, Health Research Innovation Center, University of Calgary, AB, Canada
| | - Abhijit Takawale
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - Stanley Nattel
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada.,Faculty of Medicine, Department of Pharmacology and Physiology, and Research Centre, Montreal Heart Institute and University of Montreal, Montreal, QC, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Germany.,IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France
| | - Svetlana Reilly
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
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18
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Kowalewski M, Pasierski M, Litwinowicz R, Zembala M, Piekuś-Słomka N, Tobota Z, Maruszewski B, Suwalski P. Multiple Versus Single Arterial Coronary Arterial Bypass Grafting Surgery for Multivessel Disease in Atrial Fibrillation. Semin Thorac Cardiovasc Surg 2020; 33:974-983. [DOI: 10.1053/j.semtcvs.2020.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 11/11/2022]
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19
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Clinical risk predictors in atrial fibrillation patients following successful coronary stenting: ENTRUST-AF PCI sub-analysis. Clin Res Cardiol 2020; 110:831-840. [PMID: 33098470 PMCID: PMC8166657 DOI: 10.1007/s00392-020-01760-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022]
Abstract
Aims This subgroup analysis of the ENTRUST-AF PCI trial (ClinicalTrials.gov Identifier: NCT02866175; Date of registration: August 2016) evaluated type of AF, and CHA2DS2-VASc score parameters as predictors for clinical outcome. Methods Patients were randomly assigned after percutaneous coronary intervention (PCI) to either edoxaban (60 mg/30 mg once daily [OD]; n = 751) plus a P2Y12 inhibitor for 12 months or a vitamin K antagonist [VKA] (n = 755) plus a P2Y12 inhibitor and aspirin (100 mg OD, for 1–12 months). The primary outcome was a composite of major/clinically relevant non-major bleeding (CRNM) within 12 months. The composite efficacy endpoint consisted of cardiovascular death, stroke, systemic embolic events, myocardial infarction (MI), and definite stent thrombosis. Results Major/CRNM bleeding event rates were 20.7%/year and 25.6%/year with edoxaban and warfarin, respectively (HR [95% CI]: 0.83 [0.654–1.047]). The event rates of composite outcome were 7.26%/year and 6.86%/year, respectively (HR [95% CI]): 1.06 [0.711–1.587]), and of overall net clinical benefit were 12.48%/year and 12.80%/year, respectively (HR [(95% CI]: 0.99 [(0.730; 1.343]). Increasing CHA2DS2-VASc score was associated with increased rates of all outcomes. CHA2DS2-VASc score ≥ 5 was a marker for stent thrombosis. Paroxysmal AF was associated with a higher occurrence of MI (4.87% versus 2.01%, p = 0.0024). Conclusion After PCI in AF patients, increasing CHA2DS2-VASc score was associated with increased bleeding rates and CHA2DS2-VASc score (≥ 5) predicted the occurrence of stent thrombosis. Paroxysmal AF was associated with MI. These findings may have important clinical implications in AF patients.
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20
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Gargiulo G, Goette A, Tijssen J, Eckardt L, Lewalter T, Vranckx P, Valgimigli M. Safety and efficacy outcomes of double vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of non-vitamin K antagonist oral anticoagulant-based randomized clinical trials. Eur Heart J 2020; 40:3757-3767. [PMID: 31651946 DOI: 10.1093/eurheartj/ehz732] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/04/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS To investigate the safety and efficacy of double vs. triple antithrombotic therapy (DAT vs. TAT) in patients with atrial fibrillation (AF) and acute coronary syndrome or who underwent percutaneous coronary intervention (PCI). METHODS AND RESULTS A systematic review and meta-analysis was performed using PubMed to search for non-vitamin K antagonist oral anticoagulant (NOAC)-based randomized clinical trials comparing DAT vs. TAT in AF patients undergoing PCI. Four trials encompassing 10 234 patients (DAT = 5496 vs. TAT = 4738) were included. The primary safety endpoint (ISTH major or clinically relevant non-major bleeding) was significantly lower with DAT compared with TAT [risk ratio (RR) 0.66, 95% confidence interval (CI) 0.56-0.78; P < 0.0001; I2 = 69%], which was consistent across all available bleeding definitions. This benefit was counterbalanced by a significant increase of stent thrombosis (RR 1.59, 95% CI 1.01-2.50; P = 0.04; I2 = 0%) and a trend towards higher risk of myocardial infarction with DAT. There were no significant differences in all-cause and cardiovascular death, stroke and major adverse cardiovascular events. The comparison of NOAC-based DAT vs. vitamin K antagonist (VKA)-TAT yielded consistent results and a significant reduction of intracranial haemorrhage (RR 0.33, 95% CI 0.17-0.65; P = 0.001; I2 = 0%). CONCLUSION Double antithrombotic therapy, particularly if consisting of a NOAC instead of VKA and a P2Y12 inhibitor, is associated with a reduction of bleeding, including major and intracranial haemorrhages. This benefit is however counterbalanced by a higher risk of cardiac-mainly stent-related-but not cerebrovascular ischaemic occurrences.
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Affiliation(s)
- Giuseppe Gargiulo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern, Switzerland.,Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, Italy
| | - Andreas Goette
- St. Vincenz-Hospital, Am Busdorf 2, Paderborn, Germany.,Working Group of Molecular Electrophysiology, University Hospital Magdeburg, Leipziger Str. 44, Magdeburg, Germany.,Atrial Fibrillation Network (AFNET), Mendel Str.11, Münster, Germany
| | - Jan Tijssen
- Department of Cardiology, Amsterdam UMC - University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands.,Cardialysis B.V., Westblaak 98, KM Rotterdam, The Netherlands
| | - Lars Eckardt
- Atrial Fibrillation Network (AFNET), Mendel Str.11, Münster, Germany.,Department of Cardiology II -Electrophysiology; University of Münster, Albert-Schweitzer-Campus 1, Gebäude A1, D-48149 Münster, Germany
| | - Thorsten Lewalter
- Atrial Fibrillation Network (AFNET), Mendel Str.11, Münster, Germany.,Department of Cardiology and Intensive Care, Peter Osypka Heart Center Munich, Hospital Munich-South, Am Isarkanal 36, Munich/Germany
| | - Pascal Vranckx
- Department of Cardiology and Intensive Care Medicine, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences at the Hasselt University, Stadsomvaart 11, Hasselt, Belgium
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern, Switzerland
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Goette A, Lip GY, Jin J, Heidbuchel H, Cohen AA, Ezekowitz M, Merino JL. Differences in Thromboembolic Complications Between Paroxysmal and Persistent Atrial Fibrillation Patients Following Electrical Cardioversion (From the ENSURE-AF Study). Am J Cardiol 2020; 131:27-32. [PMID: 32753268 DOI: 10.1016/j.amjcard.2020.06.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022]
Abstract
It is unclear if patients with paroxysmal atrial fibrillation (AF) and persistent AF have different outcomes following electrical cardioversion (ECV). ENSURE-AF-a multicenter, prospective, randomized, open-label, blinded-endpoint evaluation trial-compared once-daily edoxaban 60 mg with enoxaparin-warfarin in 2,199 subjects undergoing ECV of nonvalvular AF (NCT02072434). Patients received ≥3 weeks of proper anticoagulation or transesophageal echocardiogram before ECV paroxysmal AF was defined as AF with spontaneous conversion of duration of <7 days; persistent AF was defined as AF lasting ≥7 days without spontaneous conversion. Clinical characteristics and outcomes were compared between subjects based on type of AF present at baseline. In total, 415 subjects had paroxysmal AF; 1,777 had persistent AF. Patients with paroxysmal AF were older (65.8 ± 10.3 vs 63.9 ± 10.5, p = 0.001) with more hypertension (82.7% vs 77.2%, p = 0.01) versus persistent AF patients. Congestive heart failure was more common in persistent AF (46.7%) versus paroxysmal AF (31.3%, p <0.0001). CHA2DS2-VASc (score >2: 52.0% vs 49.5%, p = 0.4375) and prior myocardial infarction (6.5% vs 6.8%, p = 0.91) did not significantly differ between groups. After ECV, primary endpoint events were numerically higher in paroxysmal AF versus persistent AF (1.5% vs 0.6%, p = 0.0571), approaching statistical significance. Of note, myocardial infarction was observed in paroxysmal AF (n = 4 vs 0), whereas persistent AF was accompanied by stroke (n = 0 vs 5; p <0.05). In conclusion, patients with paroxysmal AF had more frequent major cardiovascular events than patients with persistent AF. Composite event rates were driven mainly by myocardial infarction in patients with paroxysmal AF and by stroke in those with persistent AF. Overall, the absolute number of events was low after ECV under anticoagulation.
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22
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Denoix N, Merz T, Unmuth S, Hoffmann A, Nespoli E, Scheuerle A, Huber-Lang M, Gündel H, Waller C, Radermacher P, McCook O. Cerebral Immunohistochemical Characterization of the H 2S and the Oxytocin Systems in a Porcine Model of Acute Subdural Hematoma. Front Neurol 2020; 11:649. [PMID: 32754111 PMCID: PMC7358568 DOI: 10.3389/fneur.2020.00649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022] Open
Abstract
The hydrogen sulfide (H2S) and the oxytocin/oxytocin receptor (OT/OTR) systems interact in trauma and are implicated in vascular protection and regulation of fluid homeostasis. Acute brain injury is associated with pressure-induced edema formation, blood brain barrier disruption, and neuro-inflammation. The similarities in brain anatomy: size, gyrencephalic organization, skull structure, may render the pig a highly relevant model for translational medicine. Cerebral biomarkers for pigs for pathophysiological changes and neuro-inflammation are limited. The current study aims to characterize the localization of OT/OTR and the endogenous H2S producing enzymes together with relevant neuro-inflammatory markers on available porcine brain tissue from an acute subdural hematoma (ASDH) model. In a recent pilot study, anesthetized pigs underwent ASDH by injection of 20 mL of autologous blood above the left parietal cortex and were resuscitated with neuro-intensive care measures. After 54 h of intensive care, the animals were sacrificed, the brain was removed and analyzed via immunohistochemistry. The endogenous H2S producing enzymes cystathionine-ɤ-lyase (CSE) and cystathionine-β-synthase (CBS), the OTR, and OT were localized in neurons, vasculature and parenchyma at the base of sulci, where pressure-induced injury leads to maximal stress in the gyrencephalic brain. The pathophysiological changes in response to brain injury in humans and pigs, we show here, are comparable. We additionally identified modulators of brain injury to further characterize the pathophysiology of ASDH and which may indicate future therapeutic approaches.
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Affiliation(s)
- Nicole Denoix
- Clinic for Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany.,Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University Medical Center, Ulm, Germany
| | - Tamara Merz
- Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University Medical Center, Ulm, Germany
| | - Sarah Unmuth
- Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University Medical Center, Ulm, Germany
| | - Andrea Hoffmann
- Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University Medical Center, Ulm, Germany
| | - Ester Nespoli
- Department of Neurology, Molecular and Translational Neuroscience, Ulm University, Ulm, Germany
| | - Angelika Scheuerle
- Department of Neuropathology, Institute for Pathology, Ulm University Medical Center, Ulm, Germany
| | - Markus Huber-Lang
- Institute for Clinical and Experimental Trauma Immunology, Ulm University Medical Center, Ulm, Germany
| | - Harald Gündel
- Clinic for Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Peter Radermacher
- Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University Medical Center, Ulm, Germany
| | - Oscar McCook
- Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University Medical Center, Ulm, Germany
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Nattel S, Heijman J, Zhou L, Dobrev D. Molecular Basis of Atrial Fibrillation Pathophysiology and Therapy: A Translational Perspective. Circ Res 2020; 127:51-72. [PMID: 32717172 PMCID: PMC7398486 DOI: 10.1161/circresaha.120.316363] [Citation(s) in RCA: 227] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Atrial fibrillation (AF) is a highly prevalent arrhythmia, with substantial associated morbidity and mortality. There have been significant management advances over the past 2 decades, but the burden of the disease continues to increase and there is certainly plenty of room for improvement in treatment options. A potential key to therapeutic innovation is a better understanding of underlying fundamental mechanisms. This article reviews recent advances in understanding the molecular basis for AF, with a particular emphasis on relating these new insights to opportunities for clinical translation. We first review the evidence relating basic electrophysiological mechanisms to the characteristics of clinical AF. We then discuss the molecular control of factors leading to some of the principal determinants, including abnormalities in impulse conduction (such as tissue fibrosis and other extra-cardiomyocyte alterations, connexin dysregulation and Na+-channel dysfunction), electrical refractoriness, and impulse generation. We then consider the molecular drivers of AF progression, including a range of Ca2+-dependent intracellular processes, microRNA changes, and inflammatory signaling. The concept of key interactome-related nodal points is then evaluated, dealing with systems like those associated with CaMKII (Ca2+/calmodulin-dependent protein kinase-II), NLRP3 (NACHT, LRR, and PYD domains-containing protein-3), and transcription-factors like TBX5 and PitX2c. We conclude with a critical discussion of therapeutic implications, knowledge gaps and future directions, dealing with such aspects as drug repurposing, biologicals, multispecific drugs, the targeting of cardiomyocyte inflammatory signaling and potential considerations in intervening at the level of interactomes and gene-regulation. The area of molecular intervention for AF management presents exciting new opportunities, along with substantial challenges.
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Affiliation(s)
- Stanley Nattel
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Canada
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada
- IHU Liryc and Fondation Bordeaux Université, Bordeaux, France
| | - Jordi Heijman
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Liping Zhou
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Canada
| | - Dobromir Dobrev
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Canada
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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24
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Kanorskiy SG, Polischuk LV. [Control of ventricular rate in permanent atrial fibrillation: cardio-protec-tion and tissue hemodynamics]. KARDIOLOGIIA 2020; 60:30-36. [PMID: 32375613 DOI: 10.18087/cardio.2020.3.n870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/19/2019] [Indexed: 06/11/2023]
Abstract
Objective To evaluate myocardial injury and tissue hemodynamics in elderly patients with permanent atrial fibrillation (AF) based on the achieved range of ventricular contraction rate (VCR).Materials and Methods This prospective, randomized, blind study included 75 patients aged ≥60 with permanent AF. All patients were prescribed bisoprolol as a VCR-reducing therapy. Patients were randomized to two groups according to the permuted-block design based on the range of resting VCR goal: group 1, 60-79 bpm (n=38) and group 2, 80-100 bpm (n=37). All patients also received perindopril and apixaban. Troponin I concentration was measured using the high-sensitivity assay (hsTn); parameters of tissue hemodynamics, including the mean blood flow velocity (Vm) and pulsatility index (PI), were measured using high-frequency ultrasound doppler flowmetry; echocardiographic indexes of left heart remodeling were recorded at baseline and after 6 month of VCR monitoring.Results Mean age of patients was 74±7 years. Medians [25th percentile; 75th percentile] of baseline hsTn concentrations were 10.2 [5.25; 21.2] ng / l in group 1 and 10.3 [5.4; 20.4] ng / ml in group 2 (p=0.91). 89.5 % of patients in group 1 and 100 % of patients in group 2 achieved the VCR range goal. At 6 month, resting VCRs were 70±4 bpm in group 1 (n=34) and 88±5 bpm in group 2 (n=37) (p1, p2<0.001). According to echocardiographic data significant progression of myocardial remodeling was not observed. Concentrations of hsTn significantly decreased in both groups but the decrease was more pronounced in group 1, to 8.0 [4.13; 17.23; p1<0.001] ng / l vs. 9.2 [4.8, 17.5] ng / l in group 2 (р1, p2<0.001). A weak direct correlation was found between the VCR decrease and hsTn concentration (rs=0.44; p=0.009 in group 1, and rs=0.41; p=0.01 in group 2); regression coefficient was 0.78 at 95 % confidence interval (CI), from 0.21 to 1.3 (p=0.009) in group 1, and 0.14 at 95 % CI, from 0.04 to 0.24 (p=0.007) in group 2. Vm values were increased to 2.93±0.10 (p<0.001) and 3.21±0.09 cm / sec (p<0.001) and PIs were decreased to 1.42±0.03 conv. units (p<0.01) and to 1.34±0.02 conv. units (p<0.001) in groups 1 and 2, respectively.Conclusion The treatment aimed at VCR control in patients older than 60 with permanent AF was associated with a positive dynamics of myocardial injury (hsTn) and tissue hemodynamics indexes (Vm и РI). This indicates a possibility for using these indexes for further improvement of managing such patients.
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Affiliation(s)
- S G Kanorskiy
- Kuban State Medical University, Ministry of Health of the Russian Federation
| | - L V Polischuk
- Kuban State Medical University, Ministry of Health of the Russian Federation
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25
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Le Goff C, Farré Segura J, Dufour P, Kaux JF, Cavalier E. Intense sport practices and cardiac biomarkers. Clin Biochem 2020; 79:1-8. [PMID: 32097617 DOI: 10.1016/j.clinbiochem.2020.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/05/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022]
Abstract
Biomarkers are well established for the diagnosis of myocardial infarction, heart failure and cardiac fibrosis. Different papers on cardiac biomarker evolution during exercise have been published in the literature and generally show mild to moderate elevations. However, the mechanism responsible for these elevations, reflecting physiological or even pathophysiological changes, still has to be clearly elucidated. There are also indications of higher cardiac risk in poorly trained athletes than in well-trained athletes. Whether regular repetition of intensive exercise might lead, in the longer term, to fibrosis and heart failure remains to be determined. In this review, we summarized the main research about the effects of intense exercise (in particular, running) on cardiac biomarkers (including troponins, natriuretic peptides, etc.). We found that cardiac fibrosis biomarkers seemed to be the most informative regarding the biological impact of intense physical activity.
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Affiliation(s)
- C Le Goff
- Department of Clinical Chemistry, University Hospital of Liege, Belgium.
| | - J Farré Segura
- Department of Clinical Chemistry, University Hospital of Liege, Belgium
| | - P Dufour
- Department of Clinical Chemistry, University Hospital of Liege, Belgium
| | - J F Kaux
- Department of Clinical Chemistry, University Hospital of Liege, Belgium
| | - E Cavalier
- Department of Clinical Chemistry, University Hospital of Liege, Belgium
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26
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Kobalava ZD, Lazarev PV. [Risk of Coronary Events in Atrial Fibrillation]. KARDIOLOGIIA 2020; 60:43-52. [PMID: 32245354 DOI: 10.18087/cardio.2020.1.n828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 10/30/2019] [Indexed: 06/11/2023]
Abstract
It has been established that cardiovascular events due to coronary heart disease are highly prevalent in the population of patients with atrial fibrillation. In this review, pathophysiologic mechanisms explaining this association are detailed along with supporting epidemiological evidence. Various methods for the prediction and prevention of coronary events in atrial fibrillation are iscussed, including modification of shared risk factors, antithrombotic therapy and selection of the optimal direct oral anticoagulant in terms of favourable influence on ischemic cardiac outcomes.
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Affiliation(s)
- Zh D Kobalava
- Peoples Friendship University of Russia (RUDN University)
| | - P V Lazarev
- Peoples Friendship University of Russia (RUDN University)
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27
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Vatasescu R, Bogdan S, Deaconu A. Coronary Microcirculation and Arrhythmias: The Two Faces of a Janus. Microcirculation 2020. [DOI: 10.1007/978-3-030-28199-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Abstract
Hypertension is the most common cardiovascular risk factor and underlies heart failure, coronary artery disease, stroke, and chronic kidney disease. Hypertensive heart disease can manifest as cardiac arrhythmias. Supraventricular and ventricular arrhythmias may occur in the hypertensive patients. Atrial fibrillation and hypertension contribute to an increased risk of stroke. Some antihypertensive drugs predispose to electrolyte abnormalities, which may result in atrial and ventricular arrhythmias. A multipronged strategy involving appropriate screening, aggressive lifestyle modifications, and optimal pharmacotherapy can result in improved blood pressure control and prevent the onset or delay progression of heart failure, coronary artery disease, and cardiac arrhythmias.
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Affiliation(s)
- Muhammad R Afzal
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Salvatore Savona
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Omar Mohamed
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Aayah Mohamed-Osman
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA.
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29
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Mercer BN, Koshy A, Drozd M, Walker AMN, Patel PA, Kearney L, Gierula J, Paton MF, Lowry JE, Kearney MT, Cubbon RM, Witte KK. Ischemic Heart Disease Modifies the Association of Atrial Fibrillation With Mortality in Heart Failure With Reduced Ejection Fraction. J Am Heart Assoc 2019; 7:e009770. [PMID: 30371286 PMCID: PMC6474978 DOI: 10.1161/jaha.118.009770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background The CASTLE‐AF (Catheter Ablation versus Standard Conventional Therapy in Patients With Left Ventricular Dysfunction and Atrial Fibrillation) trial recently reported that catheter ablation of atrial fibrillation (AF) improves survival in heart failure (HF) with reduced ejection fraction (HFrEF). However, established AF was not associated with mortality in trials of contemporary HFrEF pharmacotherapies. We investigated whether HFrEF pathogenesis may influence the conclusions of studies evaluating the prognostic impact of AF. Methods and Results Using a prospective cohort study of 791 patients with HFrEF, with AF determined using 24‐hour ambulatory ECG monitoring, univariable and multivariable Cox regression analyses were used to define the association between AF and mode‐specific mortality (mean follow‐up of 5.4 years). One‐year HF‐related hospitalization was assessed with binary logistic regression analysis. One‐year cardiac remodeling was assessed in a subgroup (n=378) using echocardiography. AF was present in 28.2% of patients, with 9.4% of these being paroxysmal. While AF was associated with increased risk of all‐cause mortality (hazard ratio, 1.27; 95% confidence interval 1.03–1.57), with diverging survival curves after 1 year of follow‐up, this association was lost in age‐sex–adjusted analyses. However, AF was associated with increased risk of age‐sex–adjusted all‐cause mortality in people with ischemic pathogenesis, with a statistically significant interaction between pathogenesis and AF. This was predominantly attributed to progressive HF deaths. After 1 year, HF hospitalization and cardiac remodeling were not associated with AF, even in people with ischemic pathogenesis. Conclusions AF is associated with increased risk of death in HFrEF of ischemic pathogenesis, predominantly due to progressive HF deaths during long‐term follow‐up. HFrEF pathogenesis should be considered in trial design and interpretation.
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Affiliation(s)
- Ben N Mercer
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Aaron Koshy
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Michael Drozd
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Andrew M N Walker
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Peysh A Patel
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Lorraine Kearney
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - John Gierula
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Maria F Paton
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Judith E Lowry
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Mark T Kearney
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Richard M Cubbon
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Klaus K Witte
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
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30
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Liu ZJ, Liu H, Wu C, Xue K. Effect of sepsis on the action potential and cardiac serotonin response in rats. Exp Ther Med 2019; 18:2207-2212. [PMID: 31452710 DOI: 10.3892/etm.2019.7810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/16/2019] [Indexed: 01/22/2023] Open
Abstract
The current study aimed to investigate the effect of sepsis on rat serotonin (5-HT) responses and cardiac action potentials. A total of 20 rats were randomly divided into a sepsis and control group (each, n=10). Rat hearts were harvested and perfused using the Langendorff method 18-h after the induction of sepsis, which was assessed using cecal puncture. Cardiac action potential was subsequently measured using a multichannel electrophysiology instrument. Immunohistochemistry and quantitative analysis were performed to identify the effect of sepsis on myocardial 5-HT expression. The results revealed that mitochondrial changes were present in septic rat hearts. Heart rate (361.10±12.29 bpm vs. 348.60±12.38 bpm; P<0.05) was significantly higher, atrial action potential duration (106.40±2.95 ms vs. 86.60±4.12 ms; P<0.01) was significantly longer and the area (0.62±0.06 µm2 vs. 0.39±0.05 µm2; P<0.05) and number (0.92±0.02/field vs. 0.46±0.01/field; P<0.01) of myocardial cells were significantly higher in the septic compared with the control group. These results demonstrated that 5-HT prolongs the atrial action potential, increases heart rate and aggravates myocardial injury, indicating that it may therefore be one of the factors that leads to cardiac dysfunction in sepsis.
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Affiliation(s)
- Zheng-Jiang Liu
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong 511500, P.R. China
| | - Hua Liu
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong 511500, P.R. China
| | - Changdong Wu
- Intensive Medicine Unit, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region 830001, P.R. China
| | - Kedong Xue
- Intensive Medicine Unit, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region 830001, P.R. China
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31
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González-Del-Hoyo M, Cediel G, Carrasquer A, Bonet G, Vásquez-Nuñez K, Boqué C, Alí S, Bardají A. Prognostic implications of troponin I elevation in emergency department patients with tachyarrhythmia. Clin Cardiol 2019; 42:546-552. [PMID: 30895632 PMCID: PMC6523000 DOI: 10.1002/clc.23175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 01/05/2023] Open
Abstract
Background Tachyarrhythmias are very common in emergency medicine, and little is known about the long‐term prognostic implications of troponin I levels in these patients. Hypothesis This study aimed to investigate the correlation of cardiac troponin I (cTnI) levels and long‐term prognosis in patients admitted to the emergency department (ED) with a primary diagnosis of tachyarrhythmia. Methods A retrospective cohort study was conducted between January 2012 and December 2013, enrolling patients admitted to the ED with a primary diagnosis of tachyarrhythmia and having documented cTnI measurements. Clinical characteristics and 5‐year all‐cause mortality were analyzed. Results Of a total of 222 subjects with a primary diagnosis of tachyarrhythmia, 73 patients had elevated levels of cTnI (32.9%). Patients with elevated cTnI levels were older and presented significantly more cardiovascular risk factors. At the 5‐year follow‐up, mortality was higher among patients with elevated cTnI levels (log‐rank test P < 0.001). In the multivariable Cox regression analysis, elevated cTnI was an independent predictor of all‐cause death (hazard ratio, 1.95, 95% confidence interval: 1.08‐3.50, P = 0.026), in addition to age and prior heart failure. Conclusion Patients admitted to the ED with a primary diagnosis of tachyarrhythmia and high cTnI levels have higher long‐term mortality rates than patients with low cTnI levels. cTnI is thus a biomarker with predictive capacity for mortality in late follow‐up, conferring utility in the risk stratification of this population.
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Affiliation(s)
- Maribel González-Del-Hoyo
- Cardiology Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Germán Cediel
- Cardiology Department, University Hospital Germans Trias Pujol, Badalona, Spain
| | - Anna Carrasquer
- Cardiology Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Gil Bonet
- Cardiology Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Karla Vásquez-Nuñez
- Cardiology Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Carme Boqué
- Emergency Service Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Samuel Alí
- Clinical Analysis Service, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Alfredo Bardají
- Cardiology Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
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Biomarkers of Atrial Fibrillation: Which One Is a True Marker? Cardiol Res Pract 2019; 2019:8302326. [PMID: 31061732 PMCID: PMC6466952 DOI: 10.1155/2019/8302326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/05/2019] [Indexed: 01/15/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmias and associated with the risk of stroke and death. Continuous development of the diagnostic tool and prognostic stratification may lead to optimal management of AF. The use of biomarkers in the management of AF has been grown as an interesting topic. However, the AF biomarkers are not yet well established in the major guidelines. Among these biomarkers, a lot of data show troponin and brain natriuretic peptides are promising for the prediction of future events. The troponin elevation in AF patients may not necessarily be diagnosed as myocardial infarction or significant coronary artery stenosis, and brain natriuretic peptide elevation may not necessarily confirm heart failure. Troponin T and troponin I may predict postoperative AF. Furthermore, troponin and brain natriuretic peptide gave better prognostic performance when compared with the risk score available today.
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Chokesuwattanaskul R, Thongprayoon C, Pachariyanon P, Sharma K, Ungprasert P, Bathini T, Cheungpasitporn W. Erectile dysfunction and atrial fibrillation: A systematic review and meta-analysis. Int J Urol 2018; 25:752-757. [DOI: 10.1111/iju.13725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
- King Chulalongkorn Memorial Hospital; Thai Red Cross Society; Bangkok Thailand
| | - Charat Thongprayoon
- Department of Internal Medicine; Bassett Medical Center; Cooperstown New York USA
| | - Pavida Pachariyanon
- Department of Internal Medicine; Texas Tech University Health Sciences Center; Lubbock Texas USA
| | - Konika Sharma
- Department of Internal Medicine; Bassett Medical Center; Cooperstown New York USA
| | - Patompong Ungprasert
- Clinical Epidemiology Unit; Department of Research and Development; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Tarun Bathini
- Department of Internal Medicine; Bassett Medical Center; Cooperstown New York USA
| | - Wisit Cheungpasitporn
- Division of Nephrology; Department of Medicine; University of Mississippi Medical Center; Jackson Mississippi USA
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34
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Lip GYH, Coca A, Kahan T, Boriani G, Manolis AS, Olsen MH, Oto A, Potpara TS, Steffel J, Marín F, de Oliveira Figueiredo MJ, de Simone G, Tzou WS, Chiang CE, Williams B, Dan GA, Gorenek B, Fauchier L, Savelieva I, Hatala R, van Gelder I, Brguljan-Hitij J, Erdine S, Lovic D, Kim YH, Salinas-Arce J, Field M. Hypertension and cardiac arrhythmias: a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2018; 19:891-911. [PMID: 28881872 DOI: 10.1093/europace/eux091] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 12/23/2022] Open
Abstract
Hypertension is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease, stroke, peripheral artery disease and chronic renal insufficiency. Hypertensive heart disease can manifest as many cardiac arrhythmias, most commonly being atrial fibrillation (AF). Both supraventricular and ventricular arrhythmias may occur in hypertensive patients, especially in those with left ventricular hypertrophy (LVH) or HF. Also, some of the antihypertensive drugs commonly used to reduce blood pressure, such as thiazide diuretics, may result in electrolyte abnormalities (e.g. hypokalaemia, hypomagnesemia), further contributing to arrhythmias, whereas effective control of blood pressure may prevent the development of the arrhythmias such as AF. In recognizing this close relationship between hypertension and arrhythmias, the European Heart Rhythm Association (EHRA) and the European Society of Cardiology (ESC) Council on Hypertension convened a Task Force, with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE), with the remit to comprehensively review the available evidence to publish a joint consensus document on hypertension and cardiac arrhythmias, and to provide up-to-date consensus recommendations for use in clinical practice. The ultimate judgment regarding care of a particular patient must be made by the healthcare provider and the patient in light of all of the circumstances presented by that patient.
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Affiliation(s)
- Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Thomas Kahan
- Karolinska Institutet Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital Corp, Stockholm, Sweden
| | - Giuseppe Boriani
- Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital and Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Denmark
| | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Heart and Health Foundation of Turkey, Ankara, Turkey
| | - Tatjana S Potpara
- School of Medicine, Cardiology Clinic, Clinical Centre of Serbia, Belgrade University, Belgrade, Serbia
| | - Jan Steffel
- Electrophysiology and Cardiac Devices, Department of Cardiology, University Heart Center Zurich; Zurich, Switzerland
| | - Francisco Marín
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | | | - Giovanni de Simone
- Department of Translational Medical Sciences, Federico II University Hospital, via S. Pansini 5, bld # 1, Napoli 80131, Italy
| | - Wendy S Tzou
- Cardiac Electrophysiology, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Chern-En Chiang
- Division of Cardiology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, UK
| | | | - Gheorghe-Andrei Dan
- Colentina University Hospital, Medicine Faculty, University of Medicine "Carol Davila"-Bucharest Romania
| | | | | | | | - Robert Hatala
- National Cardiovascular Institute, NUSCH, Bratislava, Slovak Republic
| | - Isabelle van Gelder
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jana Brguljan-Hitij
- University Medical Centre, Hypertension Department, Hospital Dr. Peter Drzaja, Ljubljana, Slovenia
| | - Serap Erdine
- Istanbul University Cerrahpasa Medical School, Head of Hypertension Department, Istanbul, Turkey
| | - Dragan Lovic
- Clinic for internal disease Intermedica, Cardiology department-Hypertension centere, Serbia
| | | | | | - Michael Field
- University of Wisconsin, Clinical Science Center, Madison, USA
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Fernando H, Adams N, Mitra B. Review article: The utility of troponin and other investigations in patients presenting to the emergency department with supraventricular tachycardia. Emerg Med Australas 2018; 31:35-42. [PMID: 29752780 DOI: 10.1111/1742-6723.12971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
Patients with supraventricular tachycardia commonly present to the ED. There is a lack of consensus regarding assessment of these patients. Our aim was to determine the utility of troponin and four other investigations (full blood examination, electrolyte levels, thyroid function tests and chest X-rays) commonly requested for these patients. MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (January 1992-March 2017) were searched for randomised controlled trials and observational studies (of sample size greater than 10). Our search strategy yielded no randomised controlled trials and seven observational studies with significant statistical heterogeneity among selected studies (I2 87.3%, P < 0.001). Included studies investigated a total of 1155 patients. All studies reported on the utility of troponin testing in this patient population. The pooled proportion of patients investigated with troponin was 0.66 (95% confidence interval 0.44-0.88). The pooled proportion of positive troponin tests was 0.32 (95% confidence interval 0.23-0.41). Only one study reported on the utility of the remaining four investigations with abnormal results as follows: thyroid stimulating hormone 14%, haemoglobin 6%, white cell count 19% and chest X-ray 22%. Investigations are commonly requested for patients presenting with supraventricular tachycardia. Troponin testing is commonly performed with a high proportion of positive findings although these results did not appear to be associated with major adverse cardiac events. Heterogeneity among studies and low levels of evidence precluded conclusions on full blood examinations, electrolyte levels, thyroid testing and utility of chest X-rays in this patient population.
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Affiliation(s)
- Harith Fernando
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Adams
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Tanaka S, Hirai T, Inao K, Fukuda N, Nakagawa K, Inoue H, Kinugawa K. High Cardiac Troponin I Is Associated With Transesophageal Echocardiographic Risk of Thromboembolism and Ischemic Stroke Events in Non-Valvular Atrial Fibrillation Patients. Circ J 2018; 82:1699-1704. [PMID: 29607894 DOI: 10.1253/circj.cj-17-1238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Abnormalities in the left atrium (LA) detected on transesophageal echocardiography (TEE) are reliable predictors of thromboembolism in patients with atrial fibrillation (AF). Cardiac troponin I, a marker of subclinical myocardial damage, may also be a predictor of thromboembolic events in patients with AF. The relationship between cardiac troponin I and thromboembolic risk on TEE, however, remains unclear.Methods and Results:TEE and laboratory data, including high sensitivity cardiac troponin I (hs-cTnI) and CHA2DS2-VASc score, were analyzed in 199 patients with non-valvular AF (NVAF). Patients were stratified into those with or without LA abnormality, defined as LA appendage flow velocity <20 cm/s or dense spontaneous echo contrast. On multiple logistic analysis of the clinical variables, hs-cTnI was associated with LA abnormality (95% CI: 1.0003-1.020, P=0.034). The area under the curve for LA abnormality increased on addition of hs-cTnI to CHA2DS2-VASc score. The incidence rate of ischemic stroke was higher in the high hs-cTnI group than in the low-hs-cTnI group (log-rank test, P<0.05). CONCLUSIONS Elevated hs-cTnI was independently associated with LA abnormality in NVAF patients. hs-cTnI level may be a useful biomarker for risk stratification of thromboembolism in NVAF patients.
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Affiliation(s)
- Shuhei Tanaka
- Second Department of Internal Medicine, University of Toyama
| | - Tadakazu Hirai
- Second Department of Internal Medicine, University of Toyama
| | - Kyoko Inao
- Second Department of Internal Medicine, University of Toyama
| | - Nobuyuki Fukuda
- Second Department of Internal Medicine, University of Toyama
| | - Keiko Nakagawa
- Second Department of Internal Medicine, University of Toyama
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Lieder H, Breithardt G, Heusch G. Fatal attraction — A brief pathophysiology of the interaction between atrial fibrillation and myocardial ischemia. Int J Cardiol 2018; 254:132-135. [DOI: 10.1016/j.ijcard.2017.11.119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 12/26/2022]
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Kotecha D, Breithardt G, Camm AJ, Lip GYH, Schotten U, Ahlsson A, Arnar D, Atar D, Auricchio A, Bax J, Benussi S, Blomstrom-Lundqvist C, Borggrefe M, Boriani G, Brandes A, Calkins H, Casadei B, Castellá M, Chua W, Crijns H, Dobrev D, Fabritz L, Feuring M, Freedman B, Gerth A, Goette A, Guasch E, Haase D, Hatem S, Haeusler KG, Heidbuchel H, Hendriks J, Hunter C, Kääb S, Kespohl S, Landmesser U, Lane DA, Lewalter T, Mont L, Nabauer M, Nielsen JC, Oeff M, Oldgren J, Oto A, Pison L, Potpara T, Ravens U, Richard-Lordereau I, Rienstra M, Savelieva I, Schnabel R, Sinner MF, Sommer P, Themistoclakis S, Van Gelder IC, Vardas PE, Verma A, Wakili R, Weber E, Werring D, Willems S, Ziegler A, Hindricks G, Kirchhof P. Integrating new approaches to atrial fibrillation management: the 6th AFNET/EHRA Consensus Conference. Europace 2018; 20:395-407. [PMID: 29300976 DOI: 10.1093/europace/eux318] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/20/2017] [Indexed: 12/20/2022] Open
Abstract
There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.
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Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Günter Breithardt
- Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | - A John Camm
- St George's University of London, London, UK
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Ulrich Schotten
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- School for Cardiovascular Diseases, Maastricht University, The Netherlands
| | | | - David Arnar
- The National University Hospital, Reykjavik, Iceland
| | - Dan Atar
- Oslo University Hospital, Oslo, Norway
| | | | - Jeroen Bax
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | | - Manuel Castellá
- Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Harry Crijns
- University Hospital Maastricht, Maastricht, The Netherlands
| | | | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
- University Hospital Münster, Münster, Germany
| | | | | | - Andrea Gerth
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Goette
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- St Vincenz Krankenhaus, Paderborn, Germany
| | - Eduard Guasch
- Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Doreen Haase
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | | | - Karl Georg Haeusler
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Craig Hunter
- Boehringer Ingelheim Pharma GmbH & Co. KG, Germany
| | - Stefan Kääb
- Ludwig-Maximilians University Clinic, Munich, Germany & DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Ulf Landmesser
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- HaeuslerCharité-Universitätsmedizin Berlin, Berlin, Germany
| | - Deirdre A Lane
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Thorsten Lewalter
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Hospital-Munich Thalkirchen, Munich, Germany
| | - Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Michael Nabauer
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Ludwig-Maximilians-University, Munich, Germany
| | | | - Michael Oeff
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Städtisches Klinikum Brandenburg, Brandenburg, Germany
| | - Jonas Oldgren
- Department of Cardiology, Institution of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
| | - Laurent Pison
- Maastricht University, Medical Center, Maastricht, The Netherlands
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ursula Ravens
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- University Heart Center Freiburg, Freiburg, Germany
| | | | - Michiel Rienstra
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Moritz F Sinner
- Ludwig-Maximilians University Clinic, Munich, Germany & DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp Sommer
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Atul Verma
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Reza Wakili
- Ludwig-Maximilians-University, Munich, Germany
| | | | - David Werring
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | | | - André Ziegler
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | | | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
- Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
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Lee AS, Xi Y, Lai CH, Chen WY, Peng HY, Chan HC, Chen CH, Chang KC. Human electronegative low-density lipoprotein modulates cardiac repolarization via LOX-1-mediated alteration of sarcolemmal ion channels. Sci Rep 2017; 7:10889. [PMID: 28883612 PMCID: PMC5589822 DOI: 10.1038/s41598-017-10503-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/09/2017] [Indexed: 01/17/2023] Open
Abstract
Dyslipidemia is associated with greater risk of ventricular tachyarrhythmias in patients with cardiovascular diseases. We aimed to examine whether the most electronegative subfraction of low-density lipoprotein (LDL), L5, is correlated with QTc prolongation in patients with coronary artery disease (CAD) and investigate the effects of human L5 on the electrophysiological properties of cardiomyocytes in relation to the lectin-like oxidized LDL receptor (LOX-1). L5 was isolated from the plasma of 40 patients with angiography documented CAD and 13 patients with no CAD to correlate the QTc interval respectively. The mean concentration of L5 was higher and correlated with QTc in patients with CAD compared to controls. To examine the direct effect of L5 on QTc, mice were intravenously injected with L5 or L1. L5-injected wild-type but not LOX-1−/− mice showed longer QTc compared to L1-injected animals in vivo with corresponding longer action potential duration (APD) in cardiomyocytes incubated with L5 in vitro. The APD prolongation was mediated by an increase of L-type calcium current and a decrease of transient outward potassium current. We show that L5 was positively correlated with QTc prolongation in patients with ischemic heart disease. L5 can modulate cardiac repolarization via LOX-1-mediated alteration sarcolemmal ionic currents.
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Affiliation(s)
- An-Sheng Lee
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan.,Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan
| | - Yutao Xi
- Texas Heart Institute/St. Luke's Hospital, Houston, TX, USA
| | - Chin-Hu Lai
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Wei-Yu Chen
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Hsien-Yu Peng
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Hua-Chen Chan
- Center for Lipid Biosciences, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chu-Huang Chen
- Center for Lipid Biosciences, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Vascular and Medicinal Research, Texas Heart Institute, Houston, TX, USA. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Kuan-Cheng Chang
- Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan. .,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan. .,Division of Cardiovascular Medicine, China Medical University Hospital, Taichung, Taiwan.
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Dynamic high-sensitivity troponin elevations in atrial fibrillation patients might not be associated with significant coronary artery disease. BMC Cardiovasc Disord 2017; 17:169. [PMID: 28655300 PMCID: PMC5488365 DOI: 10.1186/s12872-017-0601-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 06/20/2017] [Indexed: 11/18/2022] Open
Abstract
Background Since the introduction of high-sensitivity troponin assays a greater proportion of atrial fibrillation (AF) patients present with dynamic troponin elevations. We hypothesize that significant coronary artery disease (CAD) causes relative ischemia in the setting of a rapid heart rate resulting in dynamic troponin elevation. The aim of this study was to examine if patients without known CAD who present with AF, tachycardia and dynamic high-sensitivity troponin T (hsTnT) change have an increased risk of cardiac events. Methods We retrospectively included AF patients presenting with tachycardia during one year. The primary endpoint was acute coronary syndrome, revascularization or death due to ischemic heart disease during 30 months follow-up. Results Five hundred twenty-two patients without known CAD were included, 300 (57%) had normal hsTnT and 49 (9.5%) had dynamic hsTnT elevation. During follow-up 12 (4%) patients with normal hsTnT reached the primary endpoint and a total of 14 (4.7%) patients died. In the group with dynamic hsTnT the results were 4 (8.2%) and 12 (25%) respectively. The age-adjusted hazard ratio (HR) for the primary endpoint in patients with dynamic hsTnT was 1.9 (95% CI: 0.6 to 6.2; p = 0.28) and for all-cause mortality 3.8 (95% CI: 1.7 to 8.5; p = 0.001). Conclusions Dynamic hsTnT elevation in connection with AF might not be associated with any major increased risk of coronary events, but indicates increased all-cause mortality. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0601-7) contains supplementary material, which is available to authorized users.
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He W, Chu Y. Atrial fibrillation as a prognostic indicator of myocardial infarction and cardiovascular death: a systematic review and meta-analysis. Sci Rep 2017; 7:3360. [PMID: 28611377 PMCID: PMC5469813 DOI: 10.1038/s41598-017-03653-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 05/03/2017] [Indexed: 01/20/2023] Open
Abstract
This study aimed to investigate whether atrial fibrillation (AF) predicts myocardial infarction (MI) or cardiovascular (CV) death. AF is a well-established risk factor for thrombotic stroke and all-cause mortality. PubMed, EmBase, and Cochrane Central were searched for articles comparing the incidence rates of MI, CV death, or CV events between AF and non-AF patients. Relative risk ratio (RR) was used as effect estimate. Crude and adjusted RRs were calculated. Data were pooled using a random-effects model. The meta-analysis included 27 studies. In the unadjusted analysis, AF patients had a nonsignificant trend toward a higher risk of MI compared with non-AF patients; however, a significant association was found. The crude data analysis showed that AF was associated with increased risk of CV death (P < 0.05) and CV events (P < 0.05). These associations remained significant after pooling data from adjusted models (CV death: RR = 1.95, 95% CI 1.51–2.51, P < 0.05; CV events: RR = 2.10, 95% CI 1.50–2.95, P < 0.05). These results showed that AF is an independent risk factor for MI, CV death, and CV events.
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Affiliation(s)
- Wenqi He
- Emergency department, Henan province People's Hospital, Zhengzhou, Henan Province, 450003, China
| | - Yingjie Chu
- Emergency department, Henan province People's Hospital, Zhengzhou, Henan Province, 450003, China.
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Prognostic value of elevated high-sensitivity cardiac troponin T in patients admitted to an emergency department with atrial fibrillation. Europace 2017; 20:582-588. [DOI: 10.1093/europace/eux063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/14/2017] [Indexed: 02/01/2023] Open
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Motloch LJ, Reda S, Larbig R, Wolff A, Motloch KA, Wernly B, Granitz C, Lichtenauer M, Wolny M, Hoppe UC. Characteristics of coronary artery disease among patients with atrial fibrillation compared to patients with sinus rhythm. Hellenic J Cardiol 2017; 58:204-212. [PMID: 28300667 DOI: 10.1016/j.hjc.2017.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/24/2017] [Accepted: 03/03/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND With a high prevalence of coronary artery disease (CAD) among patients with atrial fibrillation (AF), CAD is one of the main risk factors for AF. However, little is known about the characteristics of CAD in AF patients, especially whether a specific anatomical distribution of coronary artery stenoses might predispose an individual to AF via atrial ischemia remains speculative. To address this issue, we evaluated the potential associations between angiographic characteristics of CAD and AF. METHODS In this single-center retrospective analysis, 796 consecutive patients with confirmed CAD and AF (CAD-AF) and 785 patients with CAD and sinus rhythm (CAD-SR) were enrolled. Clinical characteristics and angiographic findings were compared between groups in stable CAD and during acute myocardial infarction (MI). RESULTS Mitral valve disease and chronic heart failure were significantly more common in CAD-AF than in CAD-SR. Clinical condition in CAD-AF was significantly more severe as indicated by New York Heart Association/World Health Organization functional class. Left ventricular ejection fraction was reduced in CAD-AF, reflecting the marked fraction of patients with ischemic cardiomyopathy. No association between anatomical characteristics of CAD and AF was found. However, CAD-AF seemed to be associated with a higher CAD severity (p = 0.06). Additionally, CAD-AF with MI showed a significantly higher number of diseased coronary vessels. CONCLUSION The anatomical distribution of coronary artery stenoses does not contribute to AF in CAD patients. However, AF is linked to a higher CAD severity, which might predispose individuals to AF by driving ischemic heart disease and changes in left ventricular function.
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Affiliation(s)
- Lukas J Motloch
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Sara Reda
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Robert Larbig
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Ariane Wolff
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Karolina A Motloch
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria; Department of Ophthalmology, SALK/University Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christina Granitz
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Martin Wolny
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
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Bayturan O, Puri R, Tuzcu EM, Shao M, Wolski K, Schoenhagen P, Kapadia S, Nissen SE, Sanders P, Nicholls SJ. Atrial fibrillation, progression of coronary atherosclerosis and myocardial infarction. Eur J Prev Cardiol 2016; 24:373-381. [PMID: 27837151 DOI: 10.1177/2047487316679265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Despite atrial fibrillation representing an established risk factor for stroke, the association between atrial fibrillation and both progression of coronary atherosclerosis and major adverse cardiovascular events is not well characterized. We assessed the serial measures of coronary atheroma burden and cardiovascular outcomes in patients with and without atrial fibrillation. Methods Data were analyzed from nine clinical trials involving 4966 patients with coronary artery disease undergoing serial intravascular ultrasonography at 18-24 month intervals to assess changes in percent atheroma volume (PAV). Using a propensity weighted analysis, and following adjustment for baseline variables, patients with ( n = 190) or without ( n = 4776) atrial fibrillation were compared with regard to coronary plaque volume and major adverse cardiovascular events (death, myocardial infarction, and stroke). Results Atrial fibrillation patients demonstrated lower baseline PAV (36.0 ± 8.9 vs. 38.1 ± 8.9%, p = 0.002) and less PAV progression (-0.07 ± 0.34 vs. + 0.23 ± 0.34%, p = 0.001) compared with the non-atrial fibrillation group. Multivariable analysis revealed atrial fibrillation to independently predict both myocardial infarction [HR, 2.41 (1.74,3.35), p<0.001] 2.41 (1.74, 3.35), p < 0.00) and major adverse cardiovascular events [HR, 2.2, (1.66, 2.92), p<0.001] 2.20 (1.66, 2.92), p < 0.001]. Kaplan-Meier analysis showed that atrial fibrillation compared with non-atrial fibrillation patients had a significantly higher two-year cumulative incidence of overall major adverse cardiovascular events (4.4 vs. 2.0%, log-rank p = 0.02) and myocardial infarction (3.3 vs. 1.5%, log-rank p = 0.05). Conclusions The presence of atrial fibrillation independently associates with a heightened risk of myocardial infarction despite a lower baseline burden and progression rate of coronary atheroma. Further studies are necessary to define the pathogenesis of myocardial infarction in the setting of atrial fibrillation.
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Affiliation(s)
- Ozgur Bayturan
- 1 Cleveland Clinic Coordinating Center for Clinical Research (C5R), USA.,2 Department of Cardiology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Rishi Puri
- 1 Cleveland Clinic Coordinating Center for Clinical Research (C5R), USA.,3 Department of Cardiovascular Medicine, Cleveland Clinic, USA
| | - E Murat Tuzcu
- 3 Department of Cardiovascular Medicine, Cleveland Clinic, USA
| | - Mingyuan Shao
- 1 Cleveland Clinic Coordinating Center for Clinical Research (C5R), USA
| | - Kathy Wolski
- 1 Cleveland Clinic Coordinating Center for Clinical Research (C5R), USA
| | | | - Samir Kapadia
- 3 Department of Cardiovascular Medicine, Cleveland Clinic, USA
| | - Steven E Nissen
- 1 Cleveland Clinic Coordinating Center for Clinical Research (C5R), USA.,3 Department of Cardiovascular Medicine, Cleveland Clinic, USA
| | - Prashanthan Sanders
- 4 South Australian Health and Medical Research Institute and Royal Adelaide Hospital, University of Adelaide, South Australia, Australia
| | - Stephen J Nicholls
- 4 South Australian Health and Medical Research Institute and Royal Adelaide Hospital, University of Adelaide, South Australia, Australia
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46
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Plasma levels of oxidative stress-responsive apoptosis inducing protein (ORAIP) in patients with atrial fibrillation. Int J Cardiol 2016; 222:528-530. [DOI: 10.1016/j.ijcard.2016.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/25/2016] [Accepted: 08/02/2016] [Indexed: 11/22/2022]
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Wijesurendra RS, Liu A, Eichhorn C, Ariga R, Levelt E, Clarke WT, Rodgers CT, Karamitsos TD, Bashir Y, Ginks M, Rajappan K, Betts T, Ferreira VM, Neubauer S, Casadei B. Lone Atrial Fibrillation Is Associated With Impaired Left Ventricular Energetics That Persists Despite Successful Catheter Ablation. Circulation 2016; 134:1068-1081. [PMID: 27630135 PMCID: PMC5054971 DOI: 10.1161/circulationaha.116.022931] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 08/23/2016] [Indexed: 01/15/2023]
Abstract
Supplemental Digital Content is available in the text. Lone atrial fibrillation (AF) may reflect a subclinical cardiomyopathy that persists after sinus rhythm (SR) restoration, providing a substrate for AF recurrence. To test this hypothesis, we investigated the effect of restoring SR by catheter ablation on left ventricular (LV) function and energetics in patients with AF but no significant comorbidities.
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Affiliation(s)
- Rohan S Wijesurendra
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Alexander Liu
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Christian Eichhorn
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Rina Ariga
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Eylem Levelt
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - William T Clarke
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Christopher T Rodgers
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Theodoros D Karamitsos
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Yaver Bashir
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Matthew Ginks
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Kim Rajappan
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Tim Betts
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Vanessa M Ferreira
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Stefan Neubauer
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Barbara Casadei
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.).
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48
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication. J Arrhythm 2016; 32:247-78. [PMID: 27588148 PMCID: PMC4996910 DOI: 10.1016/j.joa.2016.05.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hô pitaux de Paris, Pitié-Salpêtrière Hospital, Sorbonne University, INSERM UMR_S1166, Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundació n and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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49
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace 2016; 18:1455-1490. [PMID: 27402624 DOI: 10.1093/europace/euw161] [Citation(s) in RCA: 429] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Sorbonne University; INSERM UMR_S1166; Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundación and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada .,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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50
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EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm 2016; 14:e3-e40. [PMID: 27320515 DOI: 10.1016/j.hrthm.2016.05.028] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 12/21/2022]
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