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Shao JM, Shen B, Zhou ZX, D’Angelo L, James SM, Lin JF, Zheng C. Bilirubin Elevation During Hospitalization Post Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation: Variation Trend, Related Factors, and Relevance to 1-Year Recurrence. Clin Interv Aging 2024; 19:817-825. [PMID: 38765794 PMCID: PMC11102068 DOI: 10.2147/cia.s461832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024] Open
Abstract
Background The role of total bilirubin (TBIL) in cardiovascular disease has been increasingly recognized in recent decades. Studies have shown a correlation between total bilirubin levels and the prognosis of patients after heart surgery. This study aimed to investigate the clinical significance of bilirubin elevation in persistent atrial fibrillation (PAF) patients who received radiofrequency catheter ablation (RFCA). Methods and Results A total of 184 patients with PAF who received RFCA were retrospectively studied. Laboratory examinations and demographic data were analyzed to identify independent predictors of TBIL elevation. The relationship between TBIL and prognosis was further investigated. Our results indicated that TBIL increased significantly after RFCA. Multiple linear regression analysis showed that TBIL elevation owned a negative correlation with the percentile of low voltage areas (LVAs) in left atria (β=-0.490, P<0.001). In contrast, a positive correlation was observed with the white blood cell (WBC) ratio (β=0.153, P=0.042) and left atrial diameter (LAD) (β=0.232, P=0.025). It was found that postoperative TBIL levels increased and then gradually decreased to baseline within 5 days without intervention. The bilirubin ratio <1.211 indicated the possibility of 1-year AF recurrence after ablation with a predictive value of 0.743 (specificity = 75.00%, sensitivity = 66.67%). Conclusion Bilirubin elevation post PAF RFCA was a common phenomenon and was associated with 1-year recurrence of AF in PAF patients after RFCA.
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Affiliation(s)
- Jia-Meng Shao
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Bing Shen
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Zhi-Xiang Zhou
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Lucia D’Angelo
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Shea Michaela James
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Jia-Feng Lin
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Cheng Zheng
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
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Wang Q, Liu Z, Dong Y, Yang X, Chen M, Gao Y. Leukocyte Telomere Length Predicts Progression From Paroxysmal to Persistent Atrial Fibrillation in the Long Term After Catheter Ablation. Front Cardiovasc Med 2022; 8:813390. [PMID: 35141296 PMCID: PMC8818686 DOI: 10.3389/fcvm.2021.813390] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background Aging is significantly associated with the incidence and progression of atrial fibrillation (AF) incidence. This study aimed to evaluate the potential predictive value of leukocyte telomere length (LTL) for progression from paroxysmal AF (PAF) to persistent AF (PsAF) after catheter ablation. Methods and Results A total of 269 patients with AF (154 patients with PAF and 115 patients with PsAF, respectively) were prospectively enrolled, and all patients with PAF at baseline were regularly followed up to determine whether and when they should progress to PsAF after catheter ablation therapy. Baseline relative LTL was measured by quantitative real-time PCR (rt-PCT). There was a significant negative association between LTL and age (r = −0.23, p < 0.001). Patients with PsAF had significantly shorter LTL than those with PAF. After a mean follow-up of 854.9 ± 18.7 d, progression events occurred in 35 out of the 154 patients with PAF. Those progressed patients with PAF were older (70.9 ± 8.0 vs. 62.3 ± 10.3, p < 0.001) and had shorter LTL (1.2 ± 0.3 vs. 1.5 ± 0.3, p < 0.001) than those who did not. The receiver operating characteristic (ROC) curve analysis showed a significant value of LTL in distinguishing patients with PAF from patients with PsAF, with an area under the ROC curve (AUC) of 0.63 (95% CI 0.56–0.70, p < 0.001), and the optimal cut-off value of LTL was 1.175, with a sensitivity and specificity of 56.03 and 82.04%, respectively. All patients with PAF were divided into two subgroups according to the optimal cut-off point of LTL calculated by the ROC curve analysis: high LTL group (≥1.175) and low LTL group (<1.175). Kaplan-Meier curve analysis showed that PAF patients with shorter LTL had a significantly higher rate of progression after catheter ablation (40.5% vs. 18.8%, log-rank test p < 0.001). Multivariate Cox proportional-hazards model indicated that LTL [hazard ratio (HR): 2.71, 95% CI 1.36–5.42, p = 0.005] was an independent predictor for progression from PAF to PsAF after catheter ablation therapy, but HATCH score was not (HR: 1.02, 95% CI: 0.68–1.52, p = 0.923). Conclusion Leukocyte telomere length was significantly associated with AF types. LTL was independently associated with progression from PAF to PsAF after catheter ablation therapy. Chinese Clinical Trial Registry, Registration Number: ChiCTR1900021341.
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The Impact of Clinical, Biochemical, and Echocardiographic Parameters on the Quality of Life in Patients with Heart Failure with Reduced Ejection Fraction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312448. [PMID: 34886173 PMCID: PMC8657062 DOI: 10.3390/ijerph182312448] [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: 10/12/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022]
Abstract
Despite significant advances in HF diagnosis and treatment over the recent decades, patients still characterize poor long-term prognosis with many recurrent hospitalizations and reduced health-related quality of life (HRQoL). We aimed to check the potential relationship between clinical, biochemical, or echocardiographic parameters and HRQoL in patients with HF with reduced ejection fraction (HFrEF). We included 152 adult patients hospitalized due to chronic HFrEF. We used the WHOQoL-BREF questionnaire to assess HRQoL and GNRI to evaluate nutritional status. We also analyzed several biochemical parameters and left ventricle ejection fraction. Forty (26.3%) patients were hospitalized due to HF exacerbation and 112 (73.7%) due to planned HF evaluation. The median age was 57 (48–62) years. Patients with low somatic HRQoL score had lower transferrin saturation (23.7 ± 11.1 vs. 29.7 ± 12.5%; p = 0.01), LDL (2.40 (1.80–2.92) vs. 2.99 (2.38–3.60) mmol/L; p = 0.001), triglycerides (1.18 (0.91–1.57) vs. 1.48 (1.27–2.13) mmol/L; p = 0.006) and LVEF (20 (15–25) vs. 25 (20–30)%; p = 0.003). TIBC (64.9 (58.5–68.2) vs. 57.7 (52.7–68.6); p = 0.02) was significantly higher in this group. We observed no associations between HRQoL and age or gender. The somatic domain of WHOQoL-BREF in patients with HFrEF correlated with the clinical status as well as biochemical and echocardiographic parameters. Assessment of HRQoL in HFrEF seems important in everyday practice and can identify patients requiring a special intervention
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Ribeiro JM, Sousa PA, António N, Baptista R, Elvas L, Barra S, Gonçalves L. Impact of catheter ablation for atrial fibrillation in patients with heart failure and left ventricular systolic dysfunction. Rev Port Cardiol 2021; 40:437-444. [PMID: 34274085 DOI: 10.1016/j.repce.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 08/09/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND AIMS Catheter ablation has been shown to improve left ventricular (LV) ejection fraction (LVEF) in patients with atrial fibrillation (AF) and heart failure (HF). Our aim was to assess the impact of AF ablation on the outcome of patients with HF and LV systolic dysfunction. METHODS We performed a retrospective observational cohort study of all patients with HF and LVEF <50% and with no apparent cause for systolic dysfunction other than AF who underwent catheter ablation in a tertiary referral center between July 2016 and November 2018. The primary endpoint was a ≥5% improvement in LVEF. Secondary endpoints included improvement in New York Heart Association (NYHA) class and reduction in LV end-diastolic diameter (LVEDD) and left atrial diameter (LAD). RESULTS Of 153 patients who underwent AF ablation in this period, 22 (77% male, median age 61 [IQR 54-64] years) fulfilled the inclusion criteria. Median follow-up was 11.1 months (IQR 6.1-19.0). After ablation, median LVEF increased from 40% (IQR 33-41) to 58% (IQR 55-62) (p<0.01), mean NYHA class improved from 2.35±0.49 to 1.3±0.47 (p<0.001), and median LAD and LVEDD decreased from 48.0 (IQR 43.5-51.5) mm to 44 (IQR 40-49) mm (p<0.01) and from 61.0 (IQR 54.0-64.8) mm to 55.0 (52.2-58.0) mm (p<0.01), respectively. CONCLUSION In patients with HF and LV systolic dysfunction, AF ablation is associated not only with improved functional status but also with favorable structural remodeling, including improvement in LVEF and decreases in LAD and LVEDD.
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Affiliation(s)
- Joana Maria Ribeiro
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro A Sousa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Natália António
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Rui Baptista
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; iCRB, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Luís Elvas
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sérgio Barra
- Cardiology Department, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal; Cardiology Department, Centro Hospitalar Vila Nova de Gaia - Espinho, Vila Nova de Gaia, Portugal; Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Lino Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Impact of catheter ablation for atrial fibrillation in patients with heart failure and left ventricular systolic dysfunction. Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2020.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Long-Term Outcomes and Improvements in Quality of Life in Patients with Atrial Fibrillation Treated with Catheter Ablation vs. Antiarrhythmic Drugs. Am J Cardiovasc Drugs 2021; 21:299-320. [PMID: 33000397 DOI: 10.1007/s40256-020-00435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Catheter ablation (CA) is a recognized first-line treatment for atrial fibrillation (AF) in selected patients; however, the differences between CA and antiarrhythmic drugs (AADs) in terms of long-term outcomes and quality of life (QoL) have not often been compared. OBJECTIVES We performed a meta-analysis of randomized controlled trials (RCTs) to compare long-term outcomes and QoL with CA and AADs in the treatment of AF. METHODS We searched the MEDLINE database for English-language RCTs of CA or AADs in AF from 1 January 2005 to 30 October 2019 with no other restrictions. We included studies that reported sample sizes and the long-term outcomes of interest as well as sample size, mean ± standard deviation or 95% confidence intervals (CIs) for QoL outcomes with CA and AADs. RESULTS We identified 20 RCTs involving 5425 participants. Compared with patients who received only AADs, patients receiving CA had a significantly decreased risk of all-cause death (relative risk [RR] 0.72; 95% CI 0.58-0.90) and cardiovascular hospitalization (RR 0.85; 95% CI 0.79-0.91). We found a significant increase in the risk of cardiac tamponade (RR 5.86; 95% CI 1.77-19.44) but no difference in the risk of heart failure, stroke or transient ischemic attack, atrial tachycardia, bleeding or hematoma, and pulmonary vein stenosis. For long-term QoL after treatment, both therapies resulted in improved scores on the Medical Outcomes Study 36-Item Short Form Survey (SF-36): weighted mean differences (WMDs) for the physical component score (PCS) were 5.89 for CA and 4.26 for AADs and for the mental component score (MCS) were 7.12 for CA and 5.06 for AADs. At the end of follow-up, groups receiving CA had significantly higher scores in both areas. The change in PCS and MCS between baseline and end of follow-up was also significantly higher in the CA groups: WMD 1.51 for change in PCS and 1.49 for change in MCS. All eight SF-36 subscale scores improved for patients receiving CA, whereas patients receiving AADs recorded no improvement in the general health and bodily pain subscales. At the end of follow-up, CA groups had significantly higher scores than AAD groups in the following subscales: physical functioning, role limitations due to physical health problems, bodily pain, general health, vitality, and role limitations due to emotional problems. CONCLUSIONS In the treatment of AF, CA appeared to be superior to AADs, decreasing the risk of all-cause death and cardiovascular hospitalization and improving the long-term QoL of patients with AF. CA was better tolerated and more effective than pharmacological therapy and allowed for improved QoL.
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Okumura K, Yamashita T, Akao M, Atarashi H, Ikeda T, Koretsune Y, Shimizu W, Tsutsui H, Toyoda K, Hirayama A, Yasaka M, Yamaguchi T, Teramukai S, Kimura T, Kaburagi J, Takita A, Inoue H. Characteristics and anticoagulant treatment status of elderly non-valvular atrial fibrillation patients with a history of catheter ablation in Japan: Subanalysis of the ANAFIE registry. J Cardiol 2020; 76:446-452. [PMID: 32624299 DOI: 10.1016/j.jjcc.2020.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Benefits of catheter ablation (CA) have been shown for patients with atrial fibrillation (AF), including elderly patients. However, data in patients aged ≥75 years who have undergone CA for non-valvular AF (NVAF) are lacking. This cross-sectional subanalysis of the ANAFIE registry determined the characteristics and status of anticoagulant treatment in elderly NVAF patients with a history of CA at enrollment. METHOD The ANAFIE registry was a multicenter, prospective, non-interventional cohort study in which elderly ambulatory patients (≥75 years) diagnosed with NVAF by electrocardiogram were enrolled between October 2016 and January 2018. Treatment was prescribed per routine clinical practice by individual treating physicians. The patients were stratified into two groups: the CA and No-CA groups. RESULTS Among 32,726 NVAF patients aged ≥75 years, 3002 (9.2%) underwent CA before enrollment. Patients who underwent CA were significantly younger (78.9 years vs 81.7 years; p < 0.0001), had significantly greater height and body weight, as well as creatinine clearance rate (CCr) compared with those who did not undergo CA. In both the CA and No-CA groups, the most common type of AF was paroxysmal AF (72.9% and 38.9%). In the CA group, a significantly larger proportion of patients did not receive anticoagulant therapy compared with the No-CA group (13.3% vs 7.6%; p < 0.0001). Direct oral anticoagulant (DOAC) use was similar in the CA (69.9%) and No-CA (66.0%) groups, and standard doses of DOACs were administered more frequently in the CA group than in the No-CA group. A lower proportion of patients in the CA group received warfarin (16.9% vs 26.4%) compared with the No-CA group. CONCLUSIONS This ANAFIE registry subanalysis showed that patients with NVAF in the CA group tended to have paroxysmal AF; be significantly younger; have greater weight, height, and CCr; receive standard doses of DOACs; and have not used anticoagulant medication compared with No-CA patients.
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Affiliation(s)
- Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
| | | | - Masaharu Akao
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | | | | | | | | | | | | | - Masahiro Yasaka
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | | | | | - Tetsuya Kimura
- Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Jumpei Kaburagi
- Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Atsushi Takita
- Biostatistics and Data Management Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
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Muhammad ZK, Safi U K, Adeel A, Muhammad SZ, Muhammad U K, Muhammad SK, Edo K, Mohamad A. Meta-Analysis of Catheter Ablation versus Medical Therapy in Patients with Atrial Fibrillation Without Heart Failure. J Atr Fibrillation 2020; 12:2266. [PMID: 33024486 DOI: 10.4022/jafib.2266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/11/2019] [Accepted: 10/12/2019] [Indexed: 01/01/2023]
Abstract
Introduction Catheter ablation has shown to reduce mortality in patient with atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction. Its effect on mortality in patients without HF has not been well elucidated. Methods Thirteen randomized controlled trials encompassing 3856 patients were selected using PubMed, Embase and the CENTRAL till April 2019. Estimates were reported as random effects risk ratio (RR) with 95% confidence intervals (CI). Results Compared with medical therapy, catheter ablation did not reduce the risk of all-cause mortality (RR, 0.86, 95% CI, 0.62-1.19, P=0.36; I2=0), stroke (RR, 0.55, 95% CI, 0.18-1.66, P=0.29; I2=0), need for cardioversion (RR, 0.84, 95% CI, 0.66-1.08, P=0.17; I2=0) or pacemaker (RR, 0.59, 95% CI, 0.34-1.01, P=0.06; I2=0). However, ablation reduced the RR of cardiac hospitalization (0.37, 95% CI, 0.18-0.77, P=0.01; I2=86), and recurrent atrial arrhythmia (0.46, 95% CI, 0.35-0.60, P<0.001; I2=87). There were non-significant differences among treatment groups with respect to major bleeding (RR, 1.89, 95% CI, 0.59-6.08, P=0.29; I2=15), and pulmonary vein stenosis (RR, 3.00, 95% CI, 0.83-10.87, P=0.09; I2=0), but had significantly higher rates of pericardial tamponade (RR, 4.46, 95 % CI, 1.70-11.72, P<0.001; I2=0). Conclusions Catheter ablation did not improve survival compared with medical therapy in patients with AF without HF. Catheter ablation reduced cardiac hospitalization and recurrent atrial arrhythmia at the expense of pericardial tamponade.
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Affiliation(s)
- Zia Khan Muhammad
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Khan Safi U
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Arshad Adeel
- Rochester Regional Health/Unity Hospital, Rochester, NY
| | | | - Khan Muhammad U
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Shahzeb Khan Muhammad
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Kaluski Edo
- Department of Medicine, Guthrie/Robert Packer Hospital, Sayre, PA, USA
| | - Alkhouli Mohamad
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN
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Long S, Xi Y, Gao L, Chen Q, Cheng J, Yang Y, Xia Y, Yin X. Safety and efficacy of catheter ablation in atrial fibrillation patients with left ventricular dysfunction. Clin Cardiol 2019; 43:305-314. [PMID: 31808172 PMCID: PMC7068063 DOI: 10.1002/clc.23314] [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: 10/15/2019] [Revised: 11/17/2019] [Accepted: 11/21/2019] [Indexed: 01/14/2023] Open
Abstract
Background Catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF) patients reduced the mortality but may increase complications and raise the safety concern. Hypothesis CA for AF in HF patients may not increase the complications vs medical treatment, and it may reduce hospitalizations and mortality and improve heart function. Methods Three groups of AF patients were included in the study: 120 congestive HF for their first CA (AFHF‐CA), 150 congestive HF who were undergoing medical therapy (AFHF‐Med), and 150 patients with normal left ventricular (LV) ejection fraction (LVEF) (AF‐CA). Results After 30 ± 6 months of follow up, 45.8% of patients in the AFHF‐CA and 61.3% of patients in the AF‐CA groups maintained sinus rhythm (SR) in comparison with 2.7% in AFHF‐Med (P < .01). Hospitalization for HF was significantly lower in AFHF‐CA than in AFHF‐Med groups (P < .01). Death occurred in 7.5% of patients in the AFHF‐CA group, which was lower than 18% in the AFHF‐Med group (P < .01). Significant improvements in heart function were shown in the AFHF‐CA group compared to the AFHF‐Med group, including LVEF (P < .01), LV end‐diastolic diameter (P < .01), and New York Heart Association classification (P < .01), as well as the left atrial diameter (P < .01). AFHF‐CA patients required additional ablation more often (P < .05). CA had a better prognosis in paroxysmal AF and tachycardia‐related diseases. Conclusion CA for AF reduced hospitalizations and mortality and improved heart function, vs medical treatment, and was as safe as CA in those with normal heart function.
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Affiliation(s)
- Songbing Long
- Department of Cardiovascular, The Central Hospital of Shaoyang, Shaoyang, China
| | - Yutao Xi
- Department of Cardiovascular, Texas Heart Institute, Houston, Texas
| | - Lianjun Gao
- Department of Cardiovascular, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qi Chen
- Department of Cardiovascular, Texas Heart Institute, Houston, Texas
| | - Jie Cheng
- Department of Cardiovascular, Texas Heart Institute, Houston, Texas
| | - Yanzong Yang
- Department of Cardiovascular, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiovascular, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaomeng Yin
- Department of Cardiovascular, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Packer M. Methodological and Clinical Heterogeneity and Extraction Errors in Meta-Analyses of Catheter Ablation for Atrial Fibrillation in Heart Failure. J Am Heart Assoc 2019; 8:e013779. [PMID: 31625420 PMCID: PMC6898828 DOI: 10.1161/jaha.119.013779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Meta‐analyses are expected to follow a standardized process, and thus, they have become highly formulaic, although there is little evidence that such regimentation yields high‐quality results. Methods and Results This article describes the results of a critical examination of 14 published meta‐analyses of catheter ablation for atrial fibrillation in heart failure that were based on a nearly identical core set of 4 to 6 primary trials. Methodological issues included (1) the neglect of primary data or the failure to report any primary data; (2) the inaccurate recording of the number of randomized patients; (3) the lack of attention to data missingness or baseline imbalances; (4) the failure to contact investigators of primary trials for additional data; (5) the incorrect extraction of data, the misidentification of events, and the assignment of events to the wrong treatment groups; (6) the calculation of summary estimates based on demonstrably heterogenous data, methods of differing reliability, or unrelated end points; and (7) the development of conclusions based on sparse numbers of events or overly reliant on the results of 1 dominant trial. Conclusions These findings reinforce existing concerns about the methodological validity of meta‐analyses and their current status in the hierarchy of medical evidence, and they raise new questions about the process by which meta‐analyses undergo peer review by medical journals.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute Baylor University Medical Center Dallas TX.,Imperial College London United Kingdom
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Yamashita K, Ranjan R. Imaging for Risk Stratification in Atrial Fibrillation with Heart Failure. Cardiol Clin 2019; 37:147-156. [PMID: 30926016 PMCID: PMC6446587 DOI: 10.1016/j.ccl.2019.01.007] [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] [Indexed: 11/20/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac rhythm disorder and is associated with heart failure (HF). Cardiac imaging modalities play an important role in risk assessment and managing AF. This article reviews the use of cardiac imaging for risk assessment and to optimize treatment strategy in patients with AF and HF. First, the clinical role of echocardiography, computed tomography, and cardiac magnetic resonance for risk stratification is provided. Second, the value of imaging in catheter ablation is reviewed, including preoperative assessment, optimizing patient selection for ablation, use during the ablation procedure, and postoperative scar assessment.
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Affiliation(s)
- Kennosuke Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, 30 N 1900 E, Room 4A100, Salt Lake City, Utah 84132, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 South 2000 East, Salt Lake City, UT 84112, USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, 30 N 1900 E, Room 4A100, Salt Lake City, Utah 84132, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 South 2000 East, Salt Lake City, UT 84112, USA; Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112, USA.
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Abstract
Atrial fibrillation often occurs as a cause or consequence of heart failure. Clinical outcomes are worse when atrial fibrillation and heart failure coexist. There are important sex-related differences in the incidence, prevalence, pathophysiology, treatment, and outcomes of these patients. Women with heart failure are at greater risk of developing atrial fibrillation than men, and more women with atrial fibrillation develop heart failure. More women die of atrial fibrillation-related strokes. Despite significant morbidity and mortality, current treatments for women are inadequate. This review explores sex differences in atrial fibrillation and heart failure, emphasizing risk stratification and treatments to improve clinical outcomes.
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Affiliation(s)
- Nidhi Madan
- Department of Medicine, Cardiology Division, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
| | - Dipti Itchhaporia
- Department of Medicine, Cardiology Division, Hoag Memorial Hospital, University of California, Irvine, 520 Superior Avenue, Newport Beach, CA 92663, USA
| | - Christine M Albert
- Department of Medicine, Cardiology Division, Brigham and Women's Medical Center, 75 Francis Street Towers 3a, Boston, MA 02115, USA
| | - Neelum T Aggarwal
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison, Suite 1000, Chicago, IL 60612, USA
| | - Annabelle Santos Volgman
- Department of Medicine, Cardiology Division, Rush University Medical Center, 1725 W. Harrison Street, Room 1159, Chicago, IL 60612, USA.
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Vrachatis D, Deftereos S, Kekeris V, Tsoukala S, Giannopoulos G. Catheter Ablation for Atrial Fibrillation in Systolic Heart Failure Patients: Stone by Stone, a CASTLE. Arrhythm Electrophysiol Rev 2018; 7:265-272. [PMID: 30588315 DOI: 10.15420/aer.2018.41.2] [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] [Received: 07/11/2018] [Accepted: 10/28/2018] [Indexed: 11/04/2022] Open
Abstract
Heart failure (HF) and AF frequently coexist and are involved in a vicious cycle of adverse pathophysiologic interactions. Applying treatment algorithms that have been validated in the general AF population to patients with AF and HF may be fraught with risks and lack effectiveness. While firm recommendations on using catheter ablation for AF do exist, the subset of patients also suffering from HF needs to be further evaluated. Observational data indicate that a significant number of ablation procedures are performed in patients with coexistent HF. Initial randomised data on outcomes are encouraging. Apart from sinus rhythm maintenance, benefits have been observed in terms of other significant endpoints, including left ventricular ejection fraction, quality of life, exercise capacity and hospital readmissions for HF. Limited existing data on survival are also promising. In the present article, observational and randomised studies along with current practice guidelines are summarised.
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Affiliation(s)
| | - Spyridon Deftereos
- Section of Cardiovascular Medicine, Yale University School of Medicine CT, USA.,Second Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens Greece
| | - Vasileios Kekeris
- Department of Cardiology, 'G Gennimatas' General Hospital of Athens Greece
| | - Styliani Tsoukala
- Department of Cardiology, 'G Gennimatas' General Hospital of Athens Greece
| | - Georgios Giannopoulos
- Department of Cardiology, 'G Gennimatas' General Hospital of Athens Greece.,Section of Cardiovascular Medicine, Yale University School of Medicine CT, USA
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The Timing and Role of Atrial Fibrillation Ablation in Heart Failure Patients. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0587-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ahn J, Kim HJ, Choe JC, Park JS, Lee HW, Oh JH, Choi JH, Lee HC, Cha KS, Hong TJ, Kim YH. Treatment Strategies for Atrial Fibrillation With Left Ventricular Systolic Dysfunction - Meta-Analysis. Circ J 2018; 82:1770-1777. [PMID: 29709893 DOI: 10.1253/circj.cj-17-1423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) frequently coexists with heart failure (HF) with reduced ejection fraction (EF). This meta-analysis compared AF control strategies, that is, rhythm vs. rate, and catheter ablation (CA) vs. anti-arrhythmic drugs (AAD) in patients with AF combined with HF.Methods and Results:The MEDLINE, EMBASE, and CENTRAL databases were searched, and 13 articles from 11 randomized controlled trials with 5,256 patients were included in this meta-analysis. The outcomes were echocardiographic parameters (left ventricular EF, LVEF), left atrial (LA) size, and left ventricular end-systolic volume, LVESV), clinical outcomes (mortality, hospitalization, and thromboembolism), exercise capacity, and quality of life (QOL). In a random effects model, rhythm control was associated with higher LVEF, better exercise capacity, and better QOL than the rate control. When the 2 different rhythm control strategies were compared (CA vs. AAD), the CA group had significantly decreased LA size and LVESV, and improved LVEF and 6-min walk distance, but mortality, hospitalization, and thromboembolism rates were not different between the rhythm and rate control groups. CONCLUSIONS In AF combined with HF, even though mortality, hospitalization and thromboembolism rates were similar, a rhythm control strategy was superior to rate control in terms of improvement in LVEF, exercise capacity, and QOL. In particular, the CA group was superior to the AAD group for reversal of cardiac remodeling.
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Affiliation(s)
- Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital.,Biomedical Research Institute, Pusan National University Hospital
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine
| | - Jeong Cheon Choe
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
| | - Jin Sup Park
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
| | - Hye Won Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
| | - Jun-Hyok Oh
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
| | - Han Cheol Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
| | - Taek Jong Hong
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center
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The Clinical Benefits and Mortality Reduction Associated With Catheter Ablation in Subjects With Atrial Fibrillation. JACC Clin Electrophysiol 2018; 4:626-635. [DOI: 10.1016/j.jacep.2018.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/23/2018] [Accepted: 03/01/2018] [Indexed: 12/21/2022]
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Bazoukis G, Letsas KP, Tse G, Naka KK, Korantzopoulos P, Ntzani E, Vlachos K, Saplaouras A, Pagkalidou E, Michalis LK, Sideris A, Efremidis M. Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation. Clin Cardiol 2018; 41:63-67. [PMID: 29356016 PMCID: PMC6489697 DOI: 10.1002/clc.22850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/01/2017] [Accepted: 11/04/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) ablation is increasingly used in patients with reduced left ventricular ejection fraction (LVEF). The aim of the present study was to evaluate the long-term results of a single radiofrequency catheter ablation procedure in heart failure (HF) patients with AF. HYPOTHESIS We tested the hypothesis that left atrial ablation is an effective therapeutic modality in patients with heart failure. METHODS Our study included HF patients with LVEF <50% who underwent catheter ablation for AF at our department between January 2010 and March 2017. All patients underwent our institution's protocol for follow-up post-ablation. RESULTS The study enrolled a total of 38 patients (mean age, 54.1 ± 12.2 years; 28 [73.7%] males; mean LVEF, 38.2% ± 6.3%). After a mean follow-up period of 38.2 months (range, 5-92 months), 28 patients (73.7%) were free from arrhythmia recurrence. In multivariate analysis, early arrhythmia recurrence (P = 0.03) and amiodarone antiarrhythmic drug administration (P = 0.003) remained independent predictors of arrhythmia recurrence. CONCLUSIONS The main findings of this study are that (1) a single radiofrequency catheter ablation procedure is an effective and safe modality for AF in patients with concomitant HF; (2) after a mean 3.3 years of follow-up, 73.7% of HF patients remained in sinus rhythm; and (3) early arrhythmia recurrence was a significant predictor of arrhythmia recurrence after the blanking period.
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Affiliation(s)
- George Bazoukis
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
| | - Konstantinos P. Letsas
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Li Ka Shing Institute of Health Sciences, Faculty of MedicineChinese University of Hong KongHong KongSARP.R. China
| | - Katerina K. Naka
- Second Department of CardiologyUniversity of Ioannina, School of MedicineIoanninaGreece
| | | | - Evangelia Ntzani
- Department of Hygiene and EpidemiologyUniversity of Ioannina, School of MedicineIoanninaGreece
| | - Konstantinos Vlachos
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
| | - Athanasios Saplaouras
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
| | - Eirini Pagkalidou
- Department of Hygiene and Epidemiology, School of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Lampros K. Michalis
- Director of the Second Department of CardiologyUniversity of Ioannina, School of MedicineIoanninaGreece
| | - Antonios Sideris
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
| | - Michael Efremidis
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
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Geng J, Zhang Y, Wang Y, Cao L, Song J, Wang B, Song W, Li J, Xu W. Catheter ablation versus rate control in patients with atrial fibrillation and heart failure: A multicenter study. Medicine (Baltimore) 2017; 96:e9179. [PMID: 29245366 PMCID: PMC5728981 DOI: 10.1097/md.0000000000009179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Many trials have shown improvements in left ventricular function, exercise capacity, and quality of life after catheter ablation (CA) of atrial fibrillation (AF) in patients with heart failure (HF). We sought to evaluate the impact of CA on hard outcomes in a retrospective cohort study. AF patients with symptomatic HF from 3 hospitals were included. Our primary endpoint was major adverse cardiac events (MACEs), a composite of all-cause mortality, stroke, and unplanned hospitalization. In total, 90 patients underwent CA and 304 ones received rate control (RaC) were included. After a mean follow-up of 13.5 ± 5.3 months, 82.2% of patients in CA group got freedom from AF; all patients in RaC group remained in AF. CA group had a significant decreased risk of MACEs compared with RaC group (13.3% vs 29.3%, hazard ratio [HR] 0.51, 95% confidence interval [CI]: 0.32-0.82, P = .005). After propensity score matched for confounding factors, difference in MACEs remained significant between groups (13.3% vs 25.6%, HR 0.50, 95% CI: 0.26-0.98, P = .044). Multivariate regression analysis also indicated that CA was significantly associated with a lower risk of MACEs in overall cohort (HR 0.486, 95% CI: 0.253-0.933, P = .030) and in propensity-matched cohort (HR 0.482, 95% CI: 0.235-0.985, P = .045). Besides, age and NYHA class were associated with an increased risk of MACEs. In conclusion, the present study demonstrated that CA for AF in HF patients could reduce the risk of MACEs in a mid-term follow-up. Thus, CA may be a reasonable option for this population.
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Affiliation(s)
- Jin Geng
- Department of Cardiology, Huai’an First People's Hospital, Nanjing Medical University
| | - Yanchun Zhang
- Department of Cardiology, Huai’an Second People's Hospital, the Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu
| | - Yanhan Wang
- Department of Cardiology, Nanjing Jiangning Hospital
| | - Lijuan Cao
- Department of Cardiology, Huai’an Second People's Hospital, the Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu
| | - Jie Song
- Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bingjian Wang
- Department of Cardiology, Huai’an First People's Hospital, Nanjing Medical University
| | - Wei Song
- Department of Cardiology, Huai’an First People's Hospital, Nanjing Medical University
| | - Ju Li
- Department of Cardiology, Huai’an First People's Hospital, Nanjing Medical University
| | - Wei Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Margulescu AD, Mont L. Persistent atrial fibrillation vs paroxysmal atrial fibrillation: differences in management. Expert Rev Cardiovasc Ther 2017; 15:601-618. [PMID: 28724315 DOI: 10.1080/14779072.2017.1355237] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common human arrhythmia. AF is a progressive disease, initially being nonsustained and induced by trigger activity, and progressing towards persistent AF through alteration of the atrial myocardial substrate. Treatment of AF aims to decrease the risk of stroke and improve the quality of life, by preventing recurrences (rhythm control) or controlling the heart rate during AF (rate control). In the last 20 years, catheter-based and, less frequently, surgical and hybrid ablation techniques have proven more successful compared with drug therapy in achieving rhythm control in patients with AF. However, the efficiency of ablation techniques varies greatly, being highest in paroxysmal and lowest in long-term persistent AF. Areas covered: In this review, we discuss the fundamental differences between paroxysmal and persistent AF and the potential impact of those differences on patient management, emphasizing the available therapeutic strategies to achieve rhythm control. Expert commentary: Treatment to prevent AF recurrences is suboptimal, particularly in patients with persistent AF. Emerging technologies, such as documentation of atrial fibrosis using magnetic resonance imaging and documentation of electrical substrate using advanced electrocardiographic imaging techniques are likely to provide valuable insights about patient-specific tailoring of treatments.
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Affiliation(s)
- Andrei D Margulescu
- a University of Medicine and Pharmacy 'Carol Davila' Bucharest , Bucharest , Romania.,b Department of Cardiology , University and Emergency Hospital of Bucharest , Bucharest , Romania.,c Unitat de Fibril·lació Auricular (UFA), Hospital Clinic , Universitat de Barcelona , Barcelona , Spain
| | - Lluis Mont
- c Unitat de Fibril·lació Auricular (UFA), Hospital Clinic , Universitat de Barcelona , Barcelona , Spain.,d Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS) , Barcelona , Spain.,e Centro de Investigación Biomédica en Red (CIBER Cardiovascular) , Barcelona , Spain
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