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Gu XH, Li W, Li H, Guo X, He J, Liu Y, Gong J, Huang Y, Zhang B. β-blockades and the risk of atrial fibrillation in patients with cardiovascular diseases. Front Pharmacol 2024; 15:1418465. [PMID: 38983917 PMCID: PMC11232185 DOI: 10.3389/fphar.2024.1418465] [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: 04/16/2024] [Accepted: 05/30/2024] [Indexed: 07/11/2024] Open
Abstract
Background β-blockers have been widely used in patients with extensive cardiovascular disease (CVD) and have provided benefits. However, they are more likely to cause symptomatic bradycardia, hypotension, or glucose metabolism disorders, which may lead to an increased risk of atrial fibrillation (AF), but evidence is lacking. Aims This study was to analyze the association between the use of β-blockers and the risk of developing AF. Methods This nationwide, prospective cohort study utilized data from the 2013-2020 National Health and Nutrition Examination Survey (NHANES). The patients were stratified into a β-blocker treatment group (n = 2585) and a non-β-blocker treatment group (n = 8525). Univariate and multivariate logistic regression analyses were performed to identify the relationship between β-blockades and the risk of AF. Propensity matching analysis was used to balance patient baseline characteristics and to control for confounders. Results A total of 11,110 subjects were included in this study (mean [SD] age, 59.89 [15.07] years; 5657 [49.7%] males). A total of 111/2585 subjects developed AF in the β-blocker treatment group, and 75/8525 developed AF in the non-β-blocker treatment group (incidence rate, 4.2% vs. 0.8%). Compared with the non-β-blocker group, the β-blocker group had an increased risk of incident AF (aOR, 2.339; 95% CI, 1.614-3.410). Some sensitivity analyses also revealed consistent findings of increased AF risk associated with β-blocker treatment. Conclusion The findings from this study suggest that β-blocker treatment is associated with an increased risk of incident AF and may help physicians select a modest medication for patients while also assessing the risk of AF.
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Affiliation(s)
- Xun-Hu Gu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weichao Li
- Department of Anesthesiology, Affiliated Qingyuan Hospital, Qingyuan People’s Hospital, Guangzhou Medical University, Qingyuan, China
| | - Heng Li
- Department of Anesthesiology, Affiliated Qingyuan Hospital, Qingyuan People’s Hospital, Guangzhou Medical University, Qingyuan, China
| | - Xun Guo
- Department of Anesthesiology, Affiliated Qingyuan Hospital, Qingyuan People’s Hospital, Guangzhou Medical University, Qingyuan, China
| | - Jiang He
- Department of Anesthesiology, Affiliated Qingyuan Hospital, Qingyuan People’s Hospital, Guangzhou Medical University, Qingyuan, China
| | - Yuyan Liu
- Department of Anesthesiology, Affiliated Qingyuan Hospital, Qingyuan People’s Hospital, Guangzhou Medical University, Qingyuan, China
| | - Jianping Gong
- Department of Anesthesiology, Affiliated Qingyuan Hospital, Qingyuan People’s Hospital, Guangzhou Medical University, Qingyuan, China
| | - Yizhou Huang
- Department of Anesthesiology, Affiliated Qingyuan Hospital, Qingyuan People’s Hospital, Guangzhou Medical University, Qingyuan, China
| | - Bin Zhang
- Department of Anesthesiology, Affiliated Qingyuan Hospital, Qingyuan People’s Hospital, Guangzhou Medical University, Qingyuan, China
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Hamatani Y, Enzan N, Iguchi M, Yoshizawa T, Kawaji T, Ide T, Tohyama T, Matsushima S, Abe M, Tsutsui H, Akao M. Atrial fibrillation type and long-term clinical outcomes in hospitalized patients with heart failure: insight from JROADHF. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:193-202. [PMID: 38236704 DOI: 10.1093/ehjqcco/qcae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 05/24/2024]
Abstract
AIMS Atrial fibrillation (AF) type (paroxysmal, persistent, or permanent) is important in determining therapeutic management; however, clinical outcomes by AF type are largely unknown for hospitalized patients with heart failure (HF). METHODS AND RESULTS The Japanese Registry Of Acute Decompensated Heart Failure is a retrospective, multicenter, and nationwide registry of patients hospitalized for acute HF in Japan. Follow-up data were collected up to 5 years after hospitalization. Patients were divided based on diagnosis and AF type into 3 groups [without AF, paroxysmal AF, and sustained AF (defined as a composite of persistent and permanent AF)], and compared the backgrounds and outcomes between the groups. Of 12 895 hospitalized HF patients [mean age: 78 ± 13 years, female: 6077 (47%), and mean left ventricular ejection fraction: 47 ± 17%], 1725 had paroxysmal AF, and 3672 had sustained AF. Compared with patients without AF, sustained AF had a higher risk of the primary composite endpoint of cardiovascular (CV) death or HF hospitalization [hazard ratio (HR): 1.09, 95% confidence interval (CI): 1.01-1.17; P = 0.03], mainly driven by HF hospitalization [HR: 1.16, 95% CI: 1.06-1.26; P < 0.001], whereas the corresponding risk for the primary endpoint in patients with paroxysmal AF was not elevated (HR: 1.03, 95% CI: 0.94-1.13; P = 0.53) after adjustment by multivariable Cox regression analysis. These results were consistent among the subgroups of patients with reduced or preserved ejection fraction (interaction P = 0.74). CONCLUSION Among hospitalized patients with HF, sustained AF, but not paroxysmal AF, was significantly associated with a higher risk for CV death or HF hospitalization, indicating the importance of accounting for AF type in HF patients.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Nobuyuki Enzan
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Takashi Yoshizawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto 615-8087, Japan
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Takeshi Tohyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Hiroyuki Tsutsui
- School of Medicine and Graduate School, International University of Health and Welfare, Fukuoka 814-0001, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
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Suda S, Iguchi Y, Yagita Y, Kanzawa T, Okubo S, Fujimoto S, Kono Y, Kimura K. High brain natriuretic peptide level is associated with severe stroke in patients taking oral anticoagulants: A sub-analysis of the PASTA registry study. J Neurol Sci 2024; 458:122935. [PMID: 38368640 DOI: 10.1016/j.jns.2024.122935] [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: 12/07/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Brain natriuretic peptides (BNP) are an important diagnostic and prognostic marker in patients with heart failure. However, the relationship between BNP levels and stroke severity in patients with atrial fibrillation (AF) remains unelucidated. In this study, we aimed to investigate the association between stroke severity at admission and BNP levels. METHODS In this prospective observational study, we used data from 513 patients with AF and acute ischemic stroke treated with oral anticoagulants (OAC) registered in the Multicenter Prospective Analysis of Stroke Patients Taking Oral Anticoagulants study. The patients were divided into two groups: high-BNP (≥200 pg/mL) and low-BNP level (<200 pg/mL) groups. We compared the clinical characteristics between the two groups and determined the effect of BNP levels on stroke severity on admission. RESULTS Among the 513 enrolled patients, 248 (females, n = 30; median age, 82 years) and 265 (females, n = 76; median age, 71 years) were assigned to the high- and low-BNP level groups, respectively. The high-BNP level group had a higher proportion of patients with severe stroke (National Institutes of Health Stroke Scale score, ≥10) on admission (49.2% vs. 32.8%, p = 0.002) and major vessel occlusion (57.5% vs. 39.2%, p < 0.0001) than that had by the low-BNP level group. Multivariate analysis showed that high BNP level was independently associated with severe stroke on admission (odds ratio 1.07, 95% confidence interval 1.00-1.15; p = 0.0478). CONCLUSIONS High BNP level compared with low BNP level was associated with severe stroke and major vessel occlusion, even before OAC treatment.
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Affiliation(s)
- Satoshi Suda
- Department of Neurology, Nippon Medical School, Tokyo, Japan; Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan
| | - Takao Kanzawa
- Department of Stroke Medicine, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Gunma, Japan; Institute of HM network, Gunyukai Isesaki Clinic, Gunma, Japan
| | - Seiji Okubo
- Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University Hospital, Tochigi, Japan
| | - Yu Kono
- Department of Neurology, Fuji City General Hospital, Shizuoka, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
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Hamatani Y, Iguchi M, Okamoto K, Nakanishi Y, Minami K, Ishigami K, Ikeda S, Doi K, Yoshizawa T, Ide Y, Fujino A, Ishii M, Masunaga N, Esato M, Tsuji H, Wada H, Hasegawa K, Abe M, Akao M. Association of left atrial enlargement with heart failure events in non-valvular atrial fibrillation patients with preserved left ventricular ejection fraction. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae015. [PMID: 38487366 PMCID: PMC10939123 DOI: 10.1093/ehjopen/oeae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/27/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024]
Abstract
Aims Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little is known regarding the risk stratification for incident HF in AF patients, especially with preserved left ventricular ejection fraction (LVEF). Methods and results The Fushimi AF Registry is a community-based prospective survey of AF patients. From the registry, 3002 non-valvular AF patients with preserved LVEF and with the data of antero-posterior left atrial diameter (LAD) at enrolment were investigated. Patients were stratified by LAD (<40, 40-44, 45-49, and ≥50 mm) with backgrounds and HF hospitalization incidences compared between groups. Of 3002 patients [mean age, 73.5 ± 10.7 years; women, 1226 (41%); paroxysmal AF, 1579 (53%); and mean CHA2DS2-VASc score, 3.3 ± 1.7], the mean LAD was 43 ± 8 mm. Patients with larger LAD were older and less often paroxysmal AF, with a higher CHA2DS2-VASc score (all P < 0.001). Heart failure hospitalization occurred in 412 patients during the median follow-up period of 6.0 years. Larger LAD was independently associated with a higher HF hospitalization risk [LAD ≥ 50 mm: hazard ratio (HR), 2.36; 95% confidence interval (CI), 1.75-3.18; LAD 45-49 mm: HR, 1.84; 95% CI, 1.37-2.46; and LAD 40-44 mm: HR, 1.34; 95% CI, 1.01-1.78, compared with LAD < 40 mm) after adjustment by age, sex, AF type, and CHA2DS2-VASc score. These results were also consistent across major subgroups, showing no significant interaction. Conclusion Left atrial diameter is significantly associated with the risk of incident HF in AF patients with preserved LVEF, suggesting the utility of LAD regarding HF risk stratification for these patients.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Keita Okamoto
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Yumiko Nakanishi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Kimihito Minami
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Kenjiro Ishigami
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Syuhei Ikeda
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Kosuke Doi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Takashi Yoshizawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Yuya Ide
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Akiko Fujino
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Nobutoyo Masunaga
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Masahiro Esato
- Department of Arrhythmia, Ogaki Tokushukai Hospital, Gifu, Japan
| | | | - Hiromichi Wada
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
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Ishii S, Hatano M, Minatsuki S, Hirose K, Saito A, Yagi H, Shimbo M, Soma K, Konoeda C, Sato M, Nakajima J, Komuro I. Comprehensive Risk Assessment in Patients With Pulmonary Arterial Hypertension Referred for Lung Transplantation. Circ J 2024:CJ-23-0790. [PMID: 38403681 DOI: 10.1253/circj.cj-23-0790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Whether comprehensive risk assessment predicts post-referral outcome in patients with pulmonary arterial hypertension (PAH) referred for lung transplantation (LT) in Japan is unknown.Methods and Results: We retrospectively analyzed 52 PAH patients referred for LT. Risk status at referral was assessed using 3- and 4-strata models from the 2022 European Society of Cardiology and European Respiratory Society guidelines. The 3-strata model intermediate-risk group was further divided into 2 groups based on the median proportion of low-risk variables (modified risk assessment [MRA]). The primary outcome was post-referral mortality. During follow-up, 9 patients died and 13 patients underwent LT. There was no survival difference among 3-strata model groups. The 4-strata model classified 33, 16, and 3 patients as low intermediate, high intermediate, and high risk, respectively. The 4-strata model identified high-risk patients with a 1-year survival rate of 33%, but did not discriminate survival between the intermediate-risk groups. The MRA classified 15, 28, 8, and 1 patients as low, low intermediate, high intermediate, and high risk, respectively. High intermediate- or high-risk patients had worse survival (P<0.001), with 1- and 3-year survival rates of 64% and 34%, respectively. MRA high intermediate- or high-risk classification was associated with mortality (hazard ratio 12.780; 95% confidence interval 2.583-63.221; P=0.002). CONCLUSIONS Patients classified as high intermediate or high risk by the MRA after treatment should be referred for LT.
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Affiliation(s)
- Satoshi Ishii
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
- Department of Advanced Medical Center for Heart Failure, The University of Tokyo Hospital
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Kazutoshi Hirose
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Akihito Saito
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Hiroki Yagi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Mai Shimbo
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital
| | - Katsura Soma
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Chihiro Konoeda
- Department of Thoracic Surgery, The University of Tokyo Hospital
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Hospital
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Hospital
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
- Department of Frontier Cardiovascular Science, The University of Tokyo Hospital
- International University of Health and Welfare
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Kashimura S, Ikemura N, Kohsaka S, Katsumata Y, Kimura T, Shinmura D, Fukumoto K, Negishi K, Ueda I, Takatsuki S, Ieda M. Clinical Utility of Baseline Brain Natriuretic Peptide Levels on Health Status Outcomes after Catheter Ablation for Atrial Fibrillation in Individuals without Heart Failure. J Clin Med 2024; 13:407. [PMID: 38256541 PMCID: PMC10816027 DOI: 10.3390/jcm13020407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Catheter ablation (CA) benefits atrial fibrillation (AF) patients with heart failure (HF). Brain natriuretic peptide (BNP), a marker of left-ventricular pressure load, may serve as a potential surrogate for predicting quality of life (QOL) in a broader range of patients. METHODS Within the multicenter KiCS-AF registry, 491 AF patients underwent CA without clinical HF (e.g., documented history of HF, left ventricular ejection fraction ≤ 40%, or BNP levels ≥ 100 pg/mL). Participants, aged 61 ± 10 years, were categorized by baseline BNP quartiles. Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaire assessments were assessed at baseline and 1 year. RESULTS A lower baseline BNP correlated with reduced AFEQT scores. Post CA, all groups showed significant AFEQT score improvements. The lower-BNP group displayed notable enhancements (18.2 ± 1.2, 15.0 ± 1.1, 12.6 ± 1.2, 13.6 ± 1.2, p < 0.005), especially in symptom and treatment concern areas. Even those with normal BNP levels (≤18.4 pg/mL) exhibited significant QOL improvements. Comparing paroxysmal AF (PAF) and non-PAF groups, the PAF group, especially with higher BNP levels, showed greater AFEQT score improvements. CONCLUSIONS This study establishes BNP as a predictive marker for QOL enhancement in non-HF patients undergoing CA for AF. BNP levels represent AF stages, with individuals in earlier stages, especially within normal BNP levels, experiencing greater QOL improvements.
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Affiliation(s)
- Shin Kashimura
- Department of Cardiology, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawa-nishicho, Kanagawa-ku, Yokohama 221-0855, Japan (K.N.)
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Yoshinori Katsumata
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Daisuke Shinmura
- Department of Cardiology, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawa-nishicho, Kanagawa-ku, Yokohama 221-0855, Japan (K.N.)
| | - Kotaro Fukumoto
- Department of Cardiology, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawa-nishicho, Kanagawa-ku, Yokohama 221-0855, Japan (K.N.)
| | - Koji Negishi
- Department of Cardiology, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawa-nishicho, Kanagawa-ku, Yokohama 221-0855, Japan (K.N.)
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Masaki Ieda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
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7
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Sakane K, Kanzaki Y, Okuno T, Nakayama S, Hasegawa H, Tokura D, Horai R, Tsuda K, Maeda D, Sakatani Y, Hoshiga M. Left Atrial Remodeling Related to Disproportionately Low B-Type Natriuretic Peptide in Acute Heart Failure Patients with Atrial Fibrillation. Am J Cardiol 2023; 209:128-137. [PMID: 37844875 DOI: 10.1016/j.amjcard.2023.09.071] [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: 07/25/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023]
Abstract
The diagnostic performance of B-type natriuretic peptide (BNP) for acute heart failure (HF) is impaired in patients with atrial fibrillation (AF). Increased AF burden in HF is associated with left atrial (LA) remodeling. Recent studies have revealed that LA remodeling may affect LV filling. We hypothesized that LA remodeling affects BNP secretion in acute HF conditions. The study investigated the clinical impact of LA remodeling on admission BNP levels in acute HF patients with and without AF. Consecutive acute HF hospitalized patients (n = 899) were divided into groups with (n = 382) or without AF (n = 507) and subdivided into disproportionately low BNP (LB) (≤200 pg/ml), medium BNP (200 to 600 pg/ml) and high BNP (≥600 pg/ml) subgroups. The AF group had a higher proportion of patients with LB than the non-AF group (23.6% vs 16.6%, p = 0.009). BNP levels in both groups were positively correlated with LV end-diastolic volume and negatively correlated with LV ejection fraction in both groups. In contrast, BNP was positively correlated with LA volume index in the non-AF group, but negatively correlated in the AF group. The survival rates were significantly higher in the LB group than in the other groups in non-AF. Conversely, there were no significant differences across all groups in AF patients. In conclusion, in patients with acute HF and AF, disproportionately low BNP levels are associated with LA structural remodeling and poor prognosis.
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Affiliation(s)
- Kazushi Sakane
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yumiko Kanzaki
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan.
| | - Takahiro Okuno
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Sayuri Nakayama
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hitomi Hasegawa
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Daisuke Tokura
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ryoto Horai
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kosuke Tsuda
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Daichi Maeda
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yuka Sakatani
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
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8
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Kawaji T, Shizuta S, Aizawa T, Nishiwaki S, Yoshizawa T, Nishiuchi S, Kato M, Yokomatsu T, Miki S. Prognostic Importance of B-Type Natriuretic Peptide Level in Patients Undergoing Catheter Ablation for Atrial Fibrillation. Circ J 2023; 87:1730-1739. [PMID: 37743520 DOI: 10.1253/circj.cj-23-0263] [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] [Indexed: 09/26/2023]
Abstract
BACKGROUND This study assessed the prognostic importance of B-type natriuretic peptide (BNP) concentrations for clinical events after catheter ablation for atrial fibrillation (AF). METHODS AND RESULTS We enrolled 1,750 consecutive patients undergoing initial AF ablation whose baseline BNP data were available from a large-scale multicenter observational cohort (TRANQUILIZE-AF Registry). The prognostic impact of BNP concentration on clinical outcomes, including recurrent tachyarrhythmias and a composite of heart failure (HF) hospitalization or cardiac death, was evaluated. Median baseline BNP was 94.2 pg/mL. During a median follow-up of 2.4 years, low BNP (<38.3 pg/mL) was associated with lower rates of recurrent atrial tachyarrhythmias than BNP concentrations ≥38.3 pg/mL (19.9% vs. 30.6% at 3 years; P<0.001) and HF (0.8% vs. 5.3% at 3 years; P<0.001). Multivariable Cox regression analyses revealed that low BNP was independently associated with lower risks of arrhythmia recurrence (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.47-0.82; P<0.001) and HF (HR 0.17; 95% CI 0.04-0.71; P=0.002). The favorable impact of low BNP on arrhythmia recurrence was prominent in patients with paroxysmal, but not non-paroxysmal, AF, particularly among those with long-standing AF. CONCLUSIONS Low BNP concentrations had a favorable impact on clinical outcomes after AF ablation. The heterogeneous impact of baseline BNP concentrations on arrhythmia recurrence for the subgroups of patients divided by AF type warrants future larger studies with longer follow-up periods.
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Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Shushi Nishiwaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takashi Yoshizawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | | | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital
| | | | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital
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9
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Hamatani Y, Iguchi M, Minami K, Ishigami K, Esato M, Tsuji H, Wada H, Hasegawa K, Ogawa H, Abe M, Lip GY, Akao M. Utility of left ventricular ejection fraction in atrial fibrillation patients without pre-existing heart failure. ESC Heart Fail 2023; 10:3091-3101. [PMID: 37604489 PMCID: PMC10567650 DOI: 10.1002/ehf2.14500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/26/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
AIMS Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little focus has been placed on the prevention of HF in patients with AF. Left ventricular ejection fraction (LVEF) is an established echocardiographic parameter in HF patients. We sought to investigate the association of LVEF with HF events in AF patients without pre-existing HF. METHODS AND RESULTS The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Japan. In this analysis, we excluded patients with pre-existing HF (defined as having one of the following: prior HF hospitalization, New York Heart Association class ≥ 2 in association with heart disease, or LVEF < 40%). Among 3233 AF patients without pre-existing HF, we investigated 2459 patients with the data of LVEF at enrolment. We divided the patients into three groups stratified by LVEF [mildly reduced LVEF (40-49%), below normal LVEF (50-59%), and normal LVEF (≥60%)] and compared the backgrounds and incidence of HF hospitalization between the groups. Of 2459 patients [mean age: 72.4 ± 10.5 years, female: 917 (37%), paroxysmal AF: 1405 (57%), and mean CHA2 DS2 -VASc score: 3.0 ± 1.6], the mean LVEF was 66 ± 8% [mildly reduced LVEF: 114 patients (5%), below normal LVEF: 300 patients (12%), and normal LVEF: 2045 patients (83%)]. Patients with lower LVEF demonstrated lower prevalence of female and paroxysmal AF (both P < 0.01), but age and CHA2 DS2 -VASc score were comparable between the three groups (both P > 0.05). During the median follow-up period of 6.0 years, 255 patients (10%) were hospitalized for HF (annual incidence: 1.9% per person-year). Multivariable Cox regression analysis demonstrated that lower LVEF strata were independently associated with the risk of HF [mildly reduced LVEF (40-49%): hazard ratio = 2.98, 95% confidence interval = 1.99-4.45 and below normal LVEF (50-59%): hazard ratio = 2.01, 95% confidence interval = 1.44-2.82, compared with normal LVEF (≥60%)] after adjustment by age, sex, type of AF, and CHA2 DS2 -VASc score. LVEF < 60% was significantly associated with the higher risk of HF hospitalization across all major subgroups without significant interaction (P for interaction; all P > 0.05). LVEF had an independent and incremental prognostic value for HF hospitalization in addition to natriuretic peptide levels in AF patients without pre-existing HF. CONCLUSIONS Lower LVEF was significantly associated with the higher incidence of HF hospitalization in AF patients without pre-existing HF, leading to the future risk stratification for and prevention of incident HF in AF patients.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Moritake Iguchi
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Kimihito Minami
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Kenjiro Ishigami
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Masahiro Esato
- Department of ArrhythmiaOgaki Tokushukai HospitalGifuJapan
| | | | - Hiromichi Wada
- Division of Translational ResearchNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Koji Hasegawa
- Division of Translational ResearchNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Hisashi Ogawa
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Mitsuru Abe
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Gregory Y.H. Lip
- Liverpool Center for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart and Chest HospitalLiverpoolUK
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Masaharu Akao
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
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10
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Hamatani Y, Nishi H, Iguchi M, Esato M, Tsuji H, Wada H, Hasegawa K, Ogawa H, Abe M, Fukuda S, Akao M. Machine Learning Risk Prediction for Incident Heart Failure in Patients With Atrial Fibrillation. JACC. ASIA 2022; 2:706-716. [PMID: 36444329 PMCID: PMC9700042 DOI: 10.1016/j.jacasi.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/01/2022] [Accepted: 07/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little focus is placed on the risk stratification for, and prevention of, incident HF in patients with AF. OBJECTIVES This study aimed to construct and validate a machine learning (ML) prediction model for HF hospitalization in patients with AF. METHODS The Fushimi AF Registry is a community-based prospective survey of patients with AF in Fushimi-ku, Kyoto, Japan. We divided the data set of the registry into derivation (n = 2,383) and validation (n = 2,011) cohorts. An ML model was built to predict the incidence of HF hospitalization using the derivation cohort, and predictive ability was examined using the validation cohort. RESULTS HF hospitalization occurred in 606 patients (14%) during a median follow-up period of 4.4 years in the entire registry. Data of transthoracic echocardiography and biomarkers were frequently nominated as important predictive variables across all 6 ML models. The ML model based on a random forest algorithm using 7 variables (age, history of HF, creatinine clearance, cardiothoracic ratio on x-ray, left ventricular [LV] ejection fraction, LV end-systolic diameter, and LV asynergy) had high prediction performance (area under the receiver operating characteristics curve [AUC]: 0.75) and was significantly superior to the Framingham HF risk model (AUC: 0.67; P < 0.001). Based on Kaplan-Meier curves, the ML model could stratify the risk of HF hospitalization during the follow-up period (log-rank; P < 0.001). CONCLUSIONS The ML model revealed important predictors and helped us to stratify the risk of HF, providing opportunities for the prevention of HF in patients with AF.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hidehisa Nishi
- Division of Neurosurgery, St. Michael’s Hospital, Toronto, Canada
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masahiro Esato
- Department of Arrhythmia, Ogaki Tokushukai Hospital, Gifu, Japan
| | | | - Hiromichi Wada
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunichi Fukuda
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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11
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Castro-Portillo E, López-Izquierdo R, Sanz-García A, Ortega GJ, Delgado-Benito JF, Castro Villamor MA, Sánchez-Soberón I, Del Pozo Vegas C, Martín-Rodríguez F. Role of prehospital point-of-care N-terminal pro-brain natriuretic peptide in acute life-threatening cardiovascular disease. Int J Cardiol 2022; 364:126-132. [PMID: 35716940 DOI: 10.1016/j.ijcard.2022.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/18/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The evidence about the use of natriuretic peptides (NP) to predict mortality in the pre-hospital setting is limited. The main objective of this study is to assess the ability of point-of-care testing (POCT) N-terminal portion of B-type natriuretic peptide (NT-proBNP) to predict 2-day in-hospital mortality of acute cardiovascular diseases (ACVD). METHODS We conducted a multicentric, prospective, observational study in adults with ACVD transferred by ambulance to emergency departments (ED). The primary outcome was 2-day in-hospital mortality. The discrimination capacity of the NT-proBNP was performed through a prediction model trained using a derivation cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic on a validation cohort. RESULTS A total of 1006 patients were recruited. The median age was 75 (IQR 63-84) years and 421 (41.85%) were females. The 2-day in-hospital mortality was 5.8% (58 cases). The predictive validity of NT-proBNP, for 2-day mortality reached the following AUC: 0.823 (95%CI: 0.758-0.889, p < 0.001), and the optimal specificity and sensitivity were 73.1 and 82.7. Predictive power of NT-proBNP obtained an AUC 0.549 (95%CI: 0.432-0.865, p 0.215) for acute heart failure, AUC 0.893 (95%CI: 0.617-0.97, p < 0.001) for ischemic heart disease, AUC 0.714 (95%CI: 0.55-0.87, p = 0.0069) for arrhythmia and AUC 0.927 (95%CI: 0.877-0.978, p < 0,001) for syncope. CONCLUSION POCT NT-proBNP has proven to be a strong predictor of early mortality in ACVD, showing an excellent predictive capacity in cases of syncope. However, this biomarker does not appear to be useful for predicting outcome in patients with acute heart failure.
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Affiliation(s)
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Ancor Sanz-García
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain; Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain.
| | - Guillermo J Ortega
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain; CONICET, Argentina; Science and Technology department, National University of Quilmes, Argentina
| | - Juan F Delgado-Benito
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Miguel A Castro Villamor
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | | | - Carlos Del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain; Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
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12
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Krittayaphong R, Pumprueg S, Sairat P. Soluble ST2 in the prediction of heart failure and death in patients with atrial fibrillation. Clin Cardiol 2022; 45:447-456. [PMID: 35188278 PMCID: PMC9019881 DOI: 10.1002/clc.23799] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background Biomarkers may be a useful marker for predicting heart failure (HF) or death in patients with atrial fibrillation (AF). Hypothesis Soluble ST2 (sST2) may be a good biomarker for the prediction of HF or death in patients with AF. Methods This is a prospective study of patients with nonvalvular AF. Clinical outcomes were HF or death. Clinical and laboratory data were compared between those with and without clinical outcomes. Univariate and multivariate analysis was performed to determine whether sST2 is an independent predictor for heart failure or death in patients with nonvalvular AF. Results A total of 185 patients (mean age: 68.9 ± 11.0 years) were included, 116 (62.7%) were male. The average sST2 and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels were 31.3 ± 19.7 ng/ml and 2399.5 ± 6853.0 pg/ml, respectively. Best receiver operating characteristic (ROC) cut off of sST2 for predicting HF or death was 30.14 ng/ml. Seventy‐three (39.5%) patients had an sST2 level ≥30.14 ng/ml, and 112 (60.5%) had an sST2 level <30.14 ng/dl. The average follow‐up was 33.1 ± 6.6 months. Twenty‐nine (15.7%) patients died, and 33 (17.8%) developed HF during follow‐up. Multivariate analysis revealed that high sST2 to be an independent risk factor for death or HF with a HR and 95% CI of 2.60 (1.41–4.78). The predictive value of sST2 is better than NT‐proBNP, and it remained significant in AF patients irrespective of history of HF, and NT‐proBNP levels. Conclusions sST2 is an independent predictor of death or HF in patients with AF irrespective of history of HF or NT‐proBNP levels.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Satchana Pumprueg
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Poom Sairat
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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13
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Sato T, Sotomi Y, Hikoso S, Nakatani D, Mizuno H, Okada K, Dohi T, Kitamura T, Sunaga A, Kida H, Oeun B, Furukawa Y, Hirata A, Egami Y, Watanabe T, Minamiguchi H, Miyoshi M, Tanaka N, Oka T, Okada M, Kanda T, Matsuda Y, Kawasaki M, Masuda M, Inoue K, Sakata Y. Sex Differences in the Efficacy of Pulmonary Vein Isolation Alone vs. Extensive Catheter Ablation in Patients With Persistent Atrial Fibrillation. Circ J 2021; 86:1207-1216. [PMID: 34911901 DOI: 10.1253/circj.cj-21-0671] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Women experience more severe arrhythmogenic substrates. This study hypothesized that an extensive ablation strategy, such as linear ablation and/or complex fractionated atrial electrogram (CFAE) ablation in addition to pulmonary vein isolation (PVI-plus), might be effective for women, whereas the PVI alone strategy (PVI-alone) might be sufficient for men to maintain sinus rhythm. The aim of this study was to test this hypothesis.Methods and Results:This study is a post-hoc subanalysis of the EARNEST-PVI trial focusing on sex differences in the efficacies of different ablation strategies. The EARNEST-PVI trial was a prospective, multicenter, randomized, and open-label non-inferiority trial in patients with persistent AF. The primary endpoint was recurrence of AF, atrial flutter, or atrial tachycardia. The EARNEST-PVI trial randomized 376 (76%) men (PVI-alone 186, PVI-plus 190) and 121 (24%) women (PVI-alone 63, PVI-plus 58). The event rate was significantly lower for men and numerically lower for women in the PVI-plus than the PVI-alone group, and there was no interaction between men and women (hazard ratio, 0.641; 95% confidence interval, 0.417-0.985; P value, 0.043 for men vs. hazard ratio, 0.661; 95% confidence interval, 0.352-1.240; P value, 0.197 for women; P value for interaction, 0.989). CONCLUSIONS The superiority of the extensive ablation strategy vs. the PVI-alone strategy for persistent AF was consistent across both sexes.
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Affiliation(s)
- Taiki Sato
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hiroya Mizuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine.,Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital
| | | | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Cente.,Department of Cardiovascular Medicine, Yao Municipal Hospital
| | - Hitoshi Minamiguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine.,Cardiovascular Division, Osaka Police Hospital
| | - Miwa Miyoshi
- Department of Cardiology, Osaka Hospital, Japan Community Healthcare Organization
| | | | - Takafumi Oka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine.,Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Masato Okada
- Cardiovascular Center, Sakurabashi Watanabe Hospital
| | | | | | | | | | - Koichi Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital.,Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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14
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Shang L, Zhang L, Guo Y, Sun H, Zhang X, Bo Y, Zhou X, Tang B. A Review of Biomarkers for Ischemic Stroke Evaluation in Patients With Non-valvular Atrial Fibrillation. Front Cardiovasc Med 2021; 8:682538. [PMID: 34277733 PMCID: PMC8281032 DOI: 10.3389/fcvm.2021.682538] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/03/2021] [Indexed: 01/06/2023] Open
Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and results in a significantly increased ischemic stroke (IS) risk. IS risk stratification tools are widely being applied to guide anticoagulation treatment decisions and duration in patients with non-valvular AF (NVAF). The CHA2DS2-VASc score is largely validated and currently recommended by renowned guidelines. However, this score is heavily dependent on age, sex, and comorbidities, and exhibits only moderate predictive power. Finding effective and validated clinical biomarkers to assist in personalized IS risk evaluation has become one of the promising directions in the prevention and treatment of NVAF. A number of studies in recent years have explored differentially expressed biomarkers in NVAF patients with and without IS, and the potential role of various biomarkers for prediction or early diagnosis of IS in patients with NVAF. In this review, we describe the clinical application and utility of AF characteristics, cardiac imaging and electrocardiogram markers, arterial stiffness and atherosclerosis-related markers, circulating biomarkers, and novel genetic markers in IS diagnosis and management of patients with NVAF. We conclude that at present, there is no consensus understanding of a desirable biomarker for IS risk stratification in NVAF, and enrolling these biomarkers into extant models also remains challenging. Further prospective cohorts and trials are needed to integrate various clinical risk factors and biomarkers to optimize IS prediction in patients with NVAF. However, we believe that the growing insight into molecular mechanisms and in-depth understanding of existing and emerging biomarkers may further improve the IS risk identification and guide anticoagulation therapy in patients with NVAF.
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Affiliation(s)
- Luxiang Shang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, China
| | - Ling Zhang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yankai Guo
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Huaxin Sun
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaoxue Zhang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yakun Bo
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xianhui Zhou
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Baopeng Tang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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15
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Otto CM. Heartbeat: racial and ethnic healthcare disparities in cardiovascular care. Heart 2021; 107:685-687. [PMID: 33846216 DOI: 10.1136/heartjnl-2021-319404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA, USA
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