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Ahmed H, Ismayl M, Palicherla A, Kashou A, Dufani J, Goldsweig A, Anavekar N, Aboeata A. Outcomes of Device-detected Atrial High-rate Episodes in Patients with No Prior History of Atrial Fibrillation: A Systematic Review and Meta-analysis. Arrhythm Electrophysiol Rev 2024; 13:e09. [PMID: 38984148 PMCID: PMC11231819 DOI: 10.15420/aer.2024.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/24/2024] [Indexed: 07/11/2024] Open
Abstract
Background Outcomes of device-detected AF remain unclear in individuals without a prior history of AF. Methods A meta-analysis was conducted to evaluate outcomes in individuals with no prior history of AF who experienced device-detected AF. Outcomes assessed were clinical AF, thromboembolism and all-cause mortality. A fixed-effects model was used to calculate RRs with 95% CI. Results Compared to individuals who did not experience device-detected AF, those who did had increased risks of clinical AF (RR 3.33, 95% CI [1.99.5.57]; p<0.0001) and thromboembolic events (RR 2.21; 95% CI [1.72.2.85]; p<0.0001). The risk of all-cause mortality was similar between both groups (RR 1.19; 95% CI [0.95.1.49]; p=0.13). Subgroup analysis revealed an increased risk of thromboembolic events among device-detected AF .24 hours (RR 12.34; 95% CI [2.70.56.36]). Conclusion While there is an increased risk of clinical AF and thromboembolism in individuals with device-detected AF, mortality was insignificant.
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Affiliation(s)
- Hasaan Ahmed
- Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine Omaha, NE, US
| | - Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN, US
| | - Anirudh Palicherla
- Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine Omaha, NE, US
| | - Anthony Kashou
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN, US
| | - Jalal Dufani
- Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine Omaha, NE, US
| | - Andrew Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center Springfield, MA, US
| | - Nandan Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN, US
| | - Ahmed Aboeata
- Department of Medicine, Division of Cardiovascular Disease, Creighton University School of Medicine Omaha, NE, US
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2
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Clinical and Laboratory Biomarkers in Paroxysmal Atrial Fibrillation: A Single Center Cross-Sectional Study. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7012377. [PMID: 35845733 PMCID: PMC9259273 DOI: 10.1155/2022/7012377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022]
Abstract
The clinical risk profile of paroxysmal atrial fibrillation (pAF) patients is inconclusive. We aimed to identify clinical and laboratory biomarkers in patients with pAF and the differences in biomarkers among genders. A cross-sectional study was conducted with a total of 181 participants in a single center in Beijing Anzhen Hospital. The participants were grouped according to the presence of pAF and sex differences, and clinical and laboratory results were collected and compared. The 181 participants had a mean age of 52.9 ± 15.1 years (pAF group, 60.4 ± 9.9 years, SR group, 48.3 ± 15.9 years, P < 0.05). Patients with pAF had significantly higher rates of age, left atrial (LA) diameter, haemoglobin (Hb) levels, tissue inhibitor of metalloproteinase-1 (TIMP-1), soluble tumour suppressor-2 (sST2), B-type natriuretic peptide (BNP) and indirect bilirubin (Ibil), mean haemoglobin concentration (MCHC), and hypertension (HTN) and smoking (P < 0.05). Multivariable logistic regression analysis revealed that age (OR = 1.075, 95% CI: 1.035–1.118, P < 0.0001), smoking (OR = 4.538, 95% CI: 1.559–13.205, P = 0.006), and MCHC (OR = 1.062, 95% CI: 1.019–1.106, P = 0.004) were independent predictive factors for pAF. Multivariable logistic regression analysis found that age (OR = 1.107, 95% CI: 1.016–1.206, P = 0.02) and Ibil level (OR = 2.303, 95% CI: 1.158–4.582, P = 0.017) were independent predictive factors of the occurrence of pAF in females; BNP (OR = 1.015, 95% CI: 1.002–1.029, P = 0.029) was an independent predictive variable of pAF in males. Age, smoking, and MCHC were independent predictive factors of pAF. BNP was an independent predictive biomarker of pAF in males, while in females, age and Ibil were independent predictive factors.
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3
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Sun WP, Du X, Chen JJ. Biomarkers for Predicting the Occurrence and Progression of Atrial Fibrillation: Soluble Suppression of Tumorigenicity 2 Protein and Tissue Inhibitor of Matrix Metalloproteinase-1. Int J Clin Pract 2022; 2022:6926510. [PMID: 36683600 PMCID: PMC9825235 DOI: 10.1155/2022/6926510] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Soluble suppression of tumorigenicity 2 protein (sST2) and tissue inhibitor of matrix metalloproteinase (TIMP)-1 are involved in multiple pathogenic pathways, including cardiac remodeling, which is the main pathology of atrial fibrillation (AF). This study aims to investigate the previously unexplored relationship between the serum levels of sST2, TIMP-1, and AF. METHODS This was a prospective cross-sectional study conducted at the Capital Medical University Affiliated Beijing Anzhen Hospital between June 2019 and July 2020, with a total of 359 participants. The clinical characteristics and laboratory results of the patients were compared, and multivariable ordinal logistic regression was used to evaluate the relationship between serum sST2, TIMP-1, and AF. RESULTS The participants included 110 patients with sinus rhythm (SR), 113 with paroxysmal AF (the paroxysmal AF group), and 136 with persistent AF (the persistent AF group). It was found that the sST2 levels gradually increased in these three groups, from 9.1 (6.7-12.4 pg/ml) in the SR group to 14.0 (10.4-20.8 pg/ml) in the paroxysmal AF group and to 19.0 (13.1-27.8) pg/ml) in the persistent AF group (p < 0.001). The multivariable ordinal logistic regression model for sST2 and TIMP-1 demonstrated that sST2 had an area under the receiver operating characteristic (ROC) curve (AUC) of 0.797 (95% confidence interval (CI) 0.749-0.846, p < 0.001) and TIMP-1 had an AUC of 0.795 (95% CI 0.750-0.841, p=0.000). The multivariable ordinal logistic regression model for sST2 and TIMP-1 showed good discrimination between SR and AF, with an AUC of 0.846, and the addition of clinical factors, such as brain natriuretic peptide (BNP), left atrial diameter, age, and gender, to the biomarker model improved the detection of SR and AF (AUC 0.901). CONCLUSIONS In this cohort study, sST2 and TIMP-1 were associated with AF progression, independent of clinical characteristics and biomarkers. Soluble ST2 and TIMP-1 combined with age, elevated N-terminal-pro hormone BNP(NT-BNP), and an enlarged left atrium were able to demonstrate the progression of AF reliably.
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Affiliation(s)
- Wei-Ping Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Xiao Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Jun-Jun Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
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4
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Norby FL, Tang W, Pankow JS, Lutsey PL, Alonso A, Steffen BT, Chen LY, Zhang M, Shippee ND, Ballantyne CM, Boerwinkle E, Coresh J, Folsom AR. Proteomics and Risk of Atrial Fibrillation in Older Adults (From the Atherosclerosis Risk in Communities [ARIC] Study). Am J Cardiol 2021; 161:42-50. [PMID: 34794617 PMCID: PMC8608272 DOI: 10.1016/j.amjcard.2021.08.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 12/19/2022]
Abstract
Plasma proteomic profiling may aid in the discovery of novel biomarkers upstream of the development of atrial fibrillation (AF). We used data from the Atherosclerosis Risk in Communities study to examine the relation between large-scale proteomics and incident AF in a cohort of older-aged adults in the United States. We quantified 4,877 plasma proteins in Atherosclerosis Risk in Communities participants at visit 5 (2011-2013) using an aptamer-based proteomic profiling platform. We used Cox proportional hazards models to assess the association between protein levels and incident AF, and explored relation of selected protein biomarkers using annotated pathway analysis. Our study included 4,668 AF-free participants (mean age 75 ± 5 years; 59% female; 20% Black race) with proteomic measures. A total of 585 participants developed AF over a mean follow-up of 5.7 ± 1.7 years. After adjustment for clinical factors associated with AF, N-terminal pro-B-type natriuretic peptide (NT-proBNP) was associated with the risk of incident AF (hazard ratio, 1.82; 95% CI, 1.68 to 1.98; p, 2.91 × 10-45 per doubling of NT-proBNP). In addition, 36 other proteins were also significantly associated with incident AF after Bonferroni correction. We further adjusted for medication use and estimated glomerular filtration rate and found 17 proteins, including angiopoietin-2 and transgelin, that remained significantly associated with incident AF. Pathway analyses implicated the inhibition of matrix metalloproteases as the top canonical pathway in AF pathogenesis. In conclusion, using a large-scale proteomic platform, we identified both novel and established proteins associated with incident AF and explored mechanistic pathways of AF development.
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Affiliation(s)
- Faye L Norby
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California.
| | | | | | | | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Lin Y Chen
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Michael Zhang
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Nathan D Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics and Environmental Science, University of Texas Health Science Center, Houston, Texas
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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5
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Sepehri Shamloo A, Arya A, Darma A, Nedios S, Döring M, Bollmann A, Dagres N, Hindricks G. Atrial fibrillation: is there a role for cardiac troponin? Diagnosis (Berl) 2021; 8:295-303. [PMID: 31913848 DOI: 10.1515/dx-2019-0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/06/2019] [Indexed: 11/15/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia, and its prevalence rate is expected to be doubled over the next decades. Despite the wide use of biomarkers in the management of different cardiac diseases such as myocardial infarction and heart failure, utilization of biomarkers in AF management is not routinely recommended by current guidelines. There is also growing evidence that higher levels of cardiac-specific troponin, as an intracellular protein involved in cardiomyocyte contraction, may be associated with the risk of incident and recurrent AF and its complications. In the present paper, we review the association between troponin and AF and propose clinical suggestions for use of troponin in the management of AF patients.
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Affiliation(s)
- Alireza Sepehri Shamloo
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Angeliki Darma
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Döring
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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6
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Pericardial NT-Pro-BNP and GDF-15 as Biomarkers of Atrial Fibrillation and Atrial Matrix Remodeling in Aortic Stenosis. Diagnostics (Basel) 2021; 11:diagnostics11081422. [PMID: 34441356 PMCID: PMC8392313 DOI: 10.3390/diagnostics11081422] [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: 07/01/2021] [Revised: 07/17/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022] Open
Abstract
Aims: This study aimed to evaluate the association of GDF-15 and NT-pro-BNP in two different biological matrices with AF in severe aortic stenosis patients undergoing aortic valve replacement surgery (AVR), its association with atrial matrix remodeling, as well as with 30-day postoperative outcomes. Main Methods: One hundred and twenty-six patients between 2009 and 2019 with severe aortic stenosis undergoing AVR surgery in a tertiary hospital were assessed. Key Findings: pericardial fluid GDF-15 and pericardial fluid and serum NT-pro-BNP were increased in AF patients with aortic stenosis. COL1A1 and COL3A1 gene expression increased when pericardial fluid NT-pro-BNP values were higher. TIMP4 was positively correlated with pericardial fluid GDF-15. Significance: GDF-15 and NT-pro-BNP in the pericardial fluid are biomarkers of atrial fibrillation in aortic stenosis and correlate with atrial matrix remodeling. AKI is predicted by both serum and pericardial fluid GDF-15.
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7
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Sepehri Shamloo A, Bollmann A, Dagres N, Hindricks G, Arya A. Natriuretic peptides: biomarkers for atrial fibrillation management. Clin Res Cardiol 2020; 109:957-966. [DOI: 10.1007/s00392-020-01608-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/21/2020] [Indexed: 01/04/2023]
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8
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Jesel L, Abbas M, Park SH, Matsushita K, Kindo M, Hasan H, Auger C, Sato C, Ohlmann P, Mazzucotelli JP, Toti F, Kauffenstein G, Schini-Kerth V, Morel O. Atrial Fibrillation Progression Is Associated with Cell Senescence Burden as Determined by p53 and p16 Expression. J Clin Med 2019; 9:jcm9010036. [PMID: 31878008 PMCID: PMC7019631 DOI: 10.3390/jcm9010036] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/07/2019] [Accepted: 12/19/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Whilst the link between aging and thrombogenicity in atrial fibrillation (AF) is well established, the cellular underlying mechanisms are unknown. In AF, the role of senescence in tissue remodeling and prothrombotic state remains unclear. Aims: We investigated the link between AF and senescence by comparing the expression of senescence markers (p53 and p16), with prothrombotic and inflammatory proteins in right atrial appendages from patients in AF and sinus rhythm (SR). Methods: The right atrial appendages of 147 patients undergoing open-heart surgery were harvested. Twenty-one non-valvular AF patients, including paroxysmal (PAF) or permanent AF (PmAF), were matched with 21 SR patients according to CHA2DS2-VASc score and treatment. Protein expression was assessed by tissue lysates Western blot analysis. Results: The expression of p53, p16, and tissue factor (TF) was significantly increased in AF compared to SR (0.91 ± 0.31 vs. 0.58 ± 0.31, p = 0.001; 0.76 ± 0.32 vs. 0.35 ± 0.18, p = 0.0001; 0.88 ± 0.32 vs. 0.68 ± 0.29, p = 0.045, respectively). Expression of endothelial NO synthase (eNOS) was lower in AF (0.25 ± 0.15 vs. 0.35 ± 0.12, p = 0.023). There was a stepwise increase of p53, p16, TF, matrix metalloproteinase-9, and an eNOS progressive decrease between SR, PAF, and PmAF. AF was the only predictive factor of p53 and p16 elevation in multivariate analysis. Conclusions: The study brought new evidence indicating that AF progression is strongly related to human atrial senescence burden and points at a link between senescence, thrombogenicity, endothelial dysfunction and atrial remodeling.
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Affiliation(s)
- Laurence Jesel
- INSERM UMR 1260–Regenerative Nanomedecine, FMTS, Université de Strasbourg-Faculté de Pharmacie, 67401 Illkirch-Graffenstaden, France; (L.J.); (M.A.); (S.-H.P.); (K.M.); (H.H.); (C.A.); (C.S.); (F.T.); (G.K.)
- Hôpitaux Universitaires de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, 67000 Strasbourg, France; (M.K.); (P.O.); (J.-P.M.)
| | - Malak Abbas
- INSERM UMR 1260–Regenerative Nanomedecine, FMTS, Université de Strasbourg-Faculté de Pharmacie, 67401 Illkirch-Graffenstaden, France; (L.J.); (M.A.); (S.-H.P.); (K.M.); (H.H.); (C.A.); (C.S.); (F.T.); (G.K.)
| | - Sin-Hee Park
- INSERM UMR 1260–Regenerative Nanomedecine, FMTS, Université de Strasbourg-Faculté de Pharmacie, 67401 Illkirch-Graffenstaden, France; (L.J.); (M.A.); (S.-H.P.); (K.M.); (H.H.); (C.A.); (C.S.); (F.T.); (G.K.)
| | - Kensuke Matsushita
- INSERM UMR 1260–Regenerative Nanomedecine, FMTS, Université de Strasbourg-Faculté de Pharmacie, 67401 Illkirch-Graffenstaden, France; (L.J.); (M.A.); (S.-H.P.); (K.M.); (H.H.); (C.A.); (C.S.); (F.T.); (G.K.)
- Hôpitaux Universitaires de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, 67000 Strasbourg, France; (M.K.); (P.O.); (J.-P.M.)
| | - Michel Kindo
- Hôpitaux Universitaires de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, 67000 Strasbourg, France; (M.K.); (P.O.); (J.-P.M.)
| | - Hira Hasan
- INSERM UMR 1260–Regenerative Nanomedecine, FMTS, Université de Strasbourg-Faculté de Pharmacie, 67401 Illkirch-Graffenstaden, France; (L.J.); (M.A.); (S.-H.P.); (K.M.); (H.H.); (C.A.); (C.S.); (F.T.); (G.K.)
| | - Cyril Auger
- INSERM UMR 1260–Regenerative Nanomedecine, FMTS, Université de Strasbourg-Faculté de Pharmacie, 67401 Illkirch-Graffenstaden, France; (L.J.); (M.A.); (S.-H.P.); (K.M.); (H.H.); (C.A.); (C.S.); (F.T.); (G.K.)
| | - Chisato Sato
- INSERM UMR 1260–Regenerative Nanomedecine, FMTS, Université de Strasbourg-Faculté de Pharmacie, 67401 Illkirch-Graffenstaden, France; (L.J.); (M.A.); (S.-H.P.); (K.M.); (H.H.); (C.A.); (C.S.); (F.T.); (G.K.)
- Hôpitaux Universitaires de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, 67000 Strasbourg, France; (M.K.); (P.O.); (J.-P.M.)
| | - Patrick Ohlmann
- Hôpitaux Universitaires de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, 67000 Strasbourg, France; (M.K.); (P.O.); (J.-P.M.)
| | - Jean-Philippe Mazzucotelli
- Hôpitaux Universitaires de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, 67000 Strasbourg, France; (M.K.); (P.O.); (J.-P.M.)
| | - Florence Toti
- INSERM UMR 1260–Regenerative Nanomedecine, FMTS, Université de Strasbourg-Faculté de Pharmacie, 67401 Illkirch-Graffenstaden, France; (L.J.); (M.A.); (S.-H.P.); (K.M.); (H.H.); (C.A.); (C.S.); (F.T.); (G.K.)
| | - Gilles Kauffenstein
- INSERM UMR 1260–Regenerative Nanomedecine, FMTS, Université de Strasbourg-Faculté de Pharmacie, 67401 Illkirch-Graffenstaden, France; (L.J.); (M.A.); (S.-H.P.); (K.M.); (H.H.); (C.A.); (C.S.); (F.T.); (G.K.)
| | - Valérie Schini-Kerth
- INSERM UMR 1260–Regenerative Nanomedecine, FMTS, Université de Strasbourg-Faculté de Pharmacie, 67401 Illkirch-Graffenstaden, France; (L.J.); (M.A.); (S.-H.P.); (K.M.); (H.H.); (C.A.); (C.S.); (F.T.); (G.K.)
- Correspondence: (V.S.-K.); (O.M.); Tel.: +33-368-854-127 (V.S.-K.); +33-369-550-948 (O.M.); Fax: +33-368-854-313 (V.S.-K.); +33-369-551-788 (O.M.)
| | - Olivier Morel
- INSERM UMR 1260–Regenerative Nanomedecine, FMTS, Université de Strasbourg-Faculté de Pharmacie, 67401 Illkirch-Graffenstaden, France; (L.J.); (M.A.); (S.-H.P.); (K.M.); (H.H.); (C.A.); (C.S.); (F.T.); (G.K.)
- Hôpitaux Universitaires de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, 67000 Strasbourg, France; (M.K.); (P.O.); (J.-P.M.)
- Correspondence: (V.S.-K.); (O.M.); Tel.: +33-368-854-127 (V.S.-K.); +33-369-550-948 (O.M.); Fax: +33-368-854-313 (V.S.-K.); +33-369-551-788 (O.M.)
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9
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Palà E, Bustamante A, Clúa-Espuny JL, Acosta J, Gonzalez-Loyola F, Ballesta-Ors J, Gill N, Caballero A, Pagola J, Pedrote A, Muñoz MA, Montaner J. N-Terminal Pro B-Type Natriuretic Peptide's Usefulness for Paroxysmal Atrial Fibrillation Detection Among Populations Carrying Cardiovascular Risk Factors. Front Neurol 2019; 10:1226. [PMID: 31849809 PMCID: PMC6896906 DOI: 10.3389/fneur.2019.01226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Atrial fibrillation (AF) systematic screening studies have not shown a clear usefulness in stroke prevention, as AF might present as paroxysmal and asymptomatic. This study aims to determine the usefulness of some blood-biomarkers to identify paroxysmal atrial fibrillation in the context of a screening programme. Methods: A total of 100 subjects aged 65-75 years with hypertension and diabetes were randomly selected. AF was assessed by conventional electrocardiogram (ECG) and 4 weeks monitoring with a wearable Holter device (Nuubo™). N-terminal pro B-type natriuretic peptide (NT-proBNP), apolipoprotein CIII (ApoC-III), von Willebrand factor (vWF), ADAMTS13, urokinase plasminogen activator surface receptor (uPAR), and urokinase plasminogen activator (uPA) were determined in serum/plasma samples and the levels were compared depending on AF presence and mode of detection. Results: The AF prevalence in the studied population was found to be 20%. In seven subjects, AF was only detected after 1 month of Holter monitoring (hAF group). NT-proBNP levels were higher in subjects with AF compared with subjects with no AF (p < 0.0001), even when only taking into account the hAF group (p = 0.031). No significant differences were found in the other biomarkers. The NT-proBNP >95 pg/ml cut-off showed high sensitivity and specificity to detect AF (95%, 66.2%) or hAF (85.72%, 66.2%) and was found to be an independent predictor of AF and hAF in a logistic regression analysis. NT-proBNP correlated with AF burden (r = 0.597, p = 0.024). Conclusion: NT-proBNP was elevated in AF cases not identified by ECG; thus, it may be used as a screening biomarker in asymptomatic high-risk populations, with a promising cut-off point of 95 pg/ml that requires further validation.
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Affiliation(s)
- Elena Palà
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain.,Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Josep Lluis Clúa-Espuny
- Equip d'Atenció Primària Tortosa Est, SAP Terres de l'Ebre, Institut Català de la Salut, Tortosa, Spain.,Unitat de Suport a la Recerca de Barcelona, Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Barcelona, Spain
| | - Juan Acosta
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Felipe Gonzalez-Loyola
- Unitat de Suport a la Recerca de Barcelona, Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Barcelona, Spain.,Gerència Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Juan Ballesta-Ors
- Equip d'Atenció Primària Tortosa Est, SAP Terres de l'Ebre, Institut Català de la Salut, Tortosa, Spain.,Unitat de Suport a la Recerca de Barcelona, Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Barcelona, Spain
| | - Natalia Gill
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Andrea Caballero
- Biochemical Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jorge Pagola
- Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alonso Pedrote
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Miguel Angel Muñoz
- Unitat de Suport a la Recerca de Barcelona, Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Barcelona, Spain.,Gerència Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain
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10
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Hohendanner F, Messroghli D, Bode D, Blaschke F, Parwani A, Boldt L, Heinzel FR. Atrial remodelling in heart failure: recent developments and relevance for heart failure with preserved ejection fraction. ESC Heart Fail 2018; 5:211-221. [PMID: 29457877 PMCID: PMC5880666 DOI: 10.1002/ehf2.12260] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Felix Hohendanner
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Daniel Messroghli
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
- Department of Internal Medicine—CardiologyDeutsches Herzzentrum BerlinBerlinGermany
| | - David Bode
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Florian Blaschke
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Abdul Parwani
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Leif‐Hendrik Boldt
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Frank R. Heinzel
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
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11
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Kawakami H, Nagai T, Saito M, Inaba S, Seike F, Nishimura K, Inoue K, Okura T, Sumimoto T, Uemura S, Higaki J, Ikeda S. Clinical significance of atrial high-rate episodes for thromboembolic events in Japanese population. HEART ASIA 2017; 9:e010954. [PMID: 29177015 PMCID: PMC5692098 DOI: 10.1136/heartasia-2017-010954] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/10/2017] [Accepted: 10/23/2017] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The clinical significance of atrial high-rate episodes (AHREs) detected by cardiac devices among patients with implantable pacemakers has recently emerged. However, the relationship between AHREs and ischaemic stroke and systemic embolism (SE) is not well understood in the Japanese population. METHODS This study included 343 patients with pacemakers capable of continuous atrial rhythm monitoring (167 males; mean age, 80±7 years). Atrial tachyarrhythmia detection was programmed to the nominal setting of each device, and AHRE was defined as any episode of sustained atrial tachyarrhythmia lasting for more than 6 min. Thromboembolic risk was defined based on the CHADS2 score. RESULTS During the follow-up period (52±30 months), 165 (48%) patients had at least one episode of AHREs, and 19 (6%) patients experienced stroke/SE. Among patients who experienced stroke/SE, 14 had AHREs before the stroke/SE. AHREs were significantly associated with stroke/SE (HR 2.87; 95% CI 1.10 to 8.90; p=0.03). Subgroup analysis conducted to investigate the impact of the CHADS2 score severity on stroke/SE revealed that AHREs were not associated with stroke/SE in patients with low or intermediate thromboembolic risk (CHADS2 score 0-2; n=217). In contrast, among patients with high thromboembolic risk (CHADS2 score>2; n=126), there was a significant association between AHREs and the incidence of stroke/SE (HR 3.73; 95% CI 1.06 to 13.1; p=0.04). CONCLUSION AHREs detected by pacemaker were associated with ischaemic stroke/SE in the Japanese population. However, this association was observed only in the high thromboembolic risk group.
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Affiliation(s)
- Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Takayuki Nagai
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Makoto Saito
- Division of Cardiology, Kitaishikai Hospital, Ehime, Japan
| | - Shinji Inaba
- Division of Cardiology, Kitaishikai Hospital, Ehime, Japan
| | - Fumiyasu Seike
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Kazuhisa Nishimura
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Takafumi Okura
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | | | - Shigeki Uemura
- Division of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Jitsuo Higaki
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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12
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García-Fernández A, Roldán V, Marín F. Strategies for prediction and early detection of atrial fibrillation: present and future. Europace 2017; 19:515-517. [PMID: 28431067 DOI: 10.1093/europace/euw131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Amaya García-Fernández
- Arrhythmia Unit, Cardiology Department, General University Hospital of Alicante, Alicante, Spain
| | - Vanessa Roldán
- Hematology and Medical Oncology Unit, Morales Meseguer University Hospital, University of Murcia, Virgen de la Arrixaca Biosanitary Investigation Institute, IMIB-Arrixaca, Murcia, Spain
| | - Francisco Marín
- Department of Cardiology, Virgen de la Arrixaca University Hospital, University of Murcia, Virgen de la Arrixaca Biosanitary Investigation Institute, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain
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