1
|
Camkiran V, Yurtseven E, Aslan G, Ozyigit T. The relationship between aerobic capacity and left atrial size in healthy young males: An observational study. Medicine (Baltimore) 2024; 103:e38931. [PMID: 38996121 PMCID: PMC11245229 DOI: 10.1097/md.0000000000038931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
Aerobic capacity, defined as peak oxygen uptake (peakVO2), is a marker for aerobic fitness and is associated with left ventricular (LV) systolic and diastolic function. The aim of the study was to explore the relation between left atrial (LA) volume index (LAVI) and aerobic capacity in healthy young male adults. One hundred three healthy young male subjects (mean age: 34.2 ± 5.5years) were consecutively included in the study. All subjects underwent echocardiography to assess LAVI, LV systolic and diastolic functions. Aerobic capacity was assessed by cardiopulmonary exercise testing. All patients had normal left ventricular ejection fraction (LVEF). One hundred one subjects had normal LAVI (≤34 mL/m2) while 2 subjects had mildly increased LAVI (35-41 mL/m2). Mean peakVO2 predicted was 82.2 ± 14.4%. 64subjects (62.1%) had a peakVO2 < 85% of age-predicted and sex-predicted values and they had higher LAVI compared to those who had a peakVO2 higher than 85% of age-predicted and sex-predicted values (22.0 ± 4.8 mL/m2 vs 20.3 ± 4.1 mL/m2, P = .055). Notably, only LAVI showed a significant correlation with peakVO2 and predicted breathing reserve (BR), while anaerobic threshold correlated with both LAVI and LVEF. Age was also a significant factor, negatively impacting peakVO2 (r = -0.265, P = .007) and predicted BR (r = -0.282, P = .004). Multivariate analysis revealed that both LAVI and age were independent predictors of peakVO2 and predicted BR. This study suggests that LAVI can be a valuable indicator of aerobic capacity in apparently healthy young males.
Collapse
Affiliation(s)
- Volkan Camkiran
- Department of Cardiology, Koc University School of Medicine, Istanbul, Turkey
| | - Ece Yurtseven
- Department of Cardiology, Koc University School of Medicine, Istanbul, Turkey
| | - Gamze Aslan
- Department of Cardiology, Koc University School of Medicine, Istanbul, Turkey
| | - Tolga Ozyigit
- Department of Cardiology, American Hospital, Istanbul, Turkey
| |
Collapse
|
2
|
Çalapkorur B, Demirci E, Baran O, Ulusoy EK, Koçer D, Demirelli S, Gök M, Şimşek Z. The Role of Galectin-3 Levels for Predicting Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source. J Clin Med 2024; 13:3175. [PMID: 38892886 PMCID: PMC11172436 DOI: 10.3390/jcm13113175] [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: 04/23/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Paroxysmal atrial fibrillation (PAF) is an important cause that is thought main potential factor in Embolic stroke of undetermined source (ESUS). Extended Holter ECG is an expensive and time-consuming examination. It needs another tools for predicting PAF in ESUS patients. In this study, serum galectin-3 levels, ECG parameters (PR interval, P wave time and P wave peak time) LA volume index, LA global peak strain and atrial electromechanical conduction time values were investigated for predicting PAF. Methods: 150 patients with ESUS and 30 volunteers for the control group were recruited to study. 48-72 h Holter ECG monitoring was used for detecting PAF. Patients were divided into two groups (ESUS + PAF and ESUS-PAF) according to the development of PAF in Holter ECG monitoring. Results: 30 patients with ESUS whose Holter ECG monitoring showed PAF, were recruited to the ESUS + PAF group. Other 120 patients with ESUS were recruited to the ESUS-PAF group. PA lateral, PA septum, and PA tricuspid were higher in the ESUS + PAF group (p < 0.001 for all). Serum galectin-3 levels were significantly higher in ESUS + PAF than in ESUS-PAF and control groups (479.0 pg/mL ± 435.8 pg/mL, 297.8 pg/mL ± 280.3 pg/mL, and 125.4 ± 87.0 pg/mL, p < 0.001, respectively). Serum galectin-3 levels were significantly correlated with LAVI, PA lateral, and global peak LA strain (r = 0.246, p = 0.001, p = 0.158, p = 0.035, r = -0.176, p = 0.018, respectively). Conclusion: Serum galectin-3 levels is found higher in ESUS patients which developed PAF and Serum galectin-3 levels are associated LA adverse remodeling in patients with ESUS.
Collapse
Affiliation(s)
- Bekir Çalapkorur
- Department of Cardiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey; (E.D.); (O.B.); (S.D.); (M.G.); (Z.Ş.)
| | - Erkan Demirci
- Department of Cardiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey; (E.D.); (O.B.); (S.D.); (M.G.); (Z.Ş.)
| | - Oğuzhan Baran
- Department of Cardiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey; (E.D.); (O.B.); (S.D.); (M.G.); (Z.Ş.)
| | - Ersin Kasım Ulusoy
- Department of Neurology, Ankara City Education and Research Hospital, Ankara 38080, Turkey;
| | - Derya Koçer
- Department of Biochemistry, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey;
| | - Selami Demirelli
- Department of Cardiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey; (E.D.); (O.B.); (S.D.); (M.G.); (Z.Ş.)
| | - Mustafa Gök
- Department of Cardiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey; (E.D.); (O.B.); (S.D.); (M.G.); (Z.Ş.)
| | - Ziya Şimşek
- Department of Cardiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey; (E.D.); (O.B.); (S.D.); (M.G.); (Z.Ş.)
| |
Collapse
|
3
|
Li L, Li L, Yang D, Nong S, Luo C, Gui C. Analysis of the thickness characteristics of the left atrial posterior wall and its correlation with the low and no voltage areas of the left atrial posterior wall in patients with atrial fibrillation. J Cardiothorac Surg 2024; 19:187. [PMID: 38582871 PMCID: PMC10998308 DOI: 10.1186/s13019-024-02658-2] [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: 07/20/2023] [Accepted: 03/19/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVE To analyze the relationship between the thickness of the left atrial posterior wall and the low and no voltage zones in the left atrial posterior wall in patients with atrial fibrillation (AF). METHODS 61 patients admitted to our cardiology department for AF and radiofrequency ablation of AF from January 1, 2020 to May 30, 2022 were enrolled according to inclusion and exclusion criteria. The atrial wall thickness was measured by CT scan. Baseline data, preoperative cardiac ultrasound data, preoperative biochemical parameters, low voltage zone (fibrotic zone) and no voltage zone (scar zone) in the left atrial posterior wall area, and various parameters of posterior left atrial wall thickness were collected. RESULTS The differences of the thickness between the upper, middle and lower mean levels of the left atrial posterior wall were statistically significant (P = 0.004). The results showed that body mass index was weakly positively correlated with the mean level of total left atrial posterior wall thickness (r = 0.426, P = 0.001) and was statistically significant. The remaining indices were positively or negatively correlated with the mean level of total left atrial posterior wall thickness, but none were statistically significant (P > 0.05). CONCLUSIONS Both left atrial posterior wall low-voltage zone and voltage-free zone were positively correlated with the mean total left atrial posterior wall thickness, and left atrial posterior wall low-voltage zone and voltage-free zone were significantly positively correlated. Body mass index was weakly positively correlated with total left atrial posterior wall thickness.
Collapse
Affiliation(s)
- Longchang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
- Department of Cardiology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, 530022, Guangxi, People's Republic of China
| | - Lijun Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
- Department of Cardiology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, 530022, Guangxi, People's Republic of China
| | - Dezhi Yang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
- Department of Cardiology Second Ward, Hechi People's Hospital, Hechi, 547000, Guangxi, People's Republic of China
| | - Shuxiong Nong
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, 530021, Guangxi, People's Republic of China
| | - Cheng Luo
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, 530021, Guangxi, People's Republic of China
| | - Chun Gui
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, 530021, Guangxi, People's Republic of China.
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, 530021, Guangxi, People's Republic of China.
| |
Collapse
|
4
|
Wang M, Wang X, Gao F, Bao P, Huang Z. The effect of high-power short-duration pulmonary vein isolation on PWPT-a predictor of paroxysmal atrial fibrillation. Herz 2024; 49:69-74. [PMID: 37491531 DOI: 10.1007/s00059-023-05198-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/20/2023] [Accepted: 06/12/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The P wave peak time (PWPT) is a predictor of paroxysmal atrial fibrillation (PAF). High-power short-duration ablation has been associated with improved durability of circumferential pulmonary vein electrical isolation (PVI). We investigated the effect of high-power short-duration PVI on PWPT in patients with PAF. METHODS Out of 111 patients with PAF, 91 received radiofrequency ablation (ablation group) and 20 received medication treatment (control group). A VIZIGO sheath and an STSF catheter (Biosense Webster, CA, USA) were used together for high-power short-duration circumferential PVI at ablation index values of 500 and 400 for the anterior and posterior walls, respectively. The patients were followed up for 12 months. RESULTS The preoperative PWPT in the ablation group was similar to that in the control group: PWPT II = 54.38 ± 6.18 ms vs. 54.35 ± 6.12 ms (p > 0.05), PWPT V1 = 54.19 ± 6.21 ms vs. 54.31 ± 6.08 ms (p > 0.05), respectively. Circumferential PVI was achieved for all patients in the ablation group during the operation. At the 12-month follow-up, there were seven cases of AF recurrence. The PWPT in the ablation group 12 months postoperatively was shorter than the preoperative value: PWPT II = 49.39 ± 7.11 ms vs. 54.38 ± 6.18 ms (p < 0.001), PWPT V1 = 47.69 ± 7.01 ms vs. 54.19 ± 6.21 ms (p < 0.001). The PWPT in the patients with AF recurrence was significantly longer than that in the non-recurrence patients: PWPT II = 50.48 ± 7.12 ms vs. 47.33 ± 6.21 ms (p < 0.001), PWPT V1 = 50.84 ± 7.05 ms vs. 47.19 ± 6.27 ms, (p < 0.001). The PWPT of the control group at the 12-month follow-up was similar to the baseline level: PWPT II = 54.32 ± 6.20 ms vs. 54.35 ± 6.12 ms (p > 0.05), PWPT V1 = 53.89 ± 6.01 ms vs. 54.31 ± 6.08 ms (p > 0.05). CONCLUSION The results showed that high-power short-duration PVI had a positive effect on PWPT, which is a predictor of PAF.
Collapse
Affiliation(s)
- Meng Wang
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, 230601, Hefei, China.
| | - Xiaochen Wang
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, 230601, Hefei, China
| | - Feng Gao
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, 230601, Hefei, China
| | - Pei Bao
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, 230601, Hefei, China
| | - Zheng Huang
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, 230601, Hefei, China
| |
Collapse
|
5
|
Cagdas M, Celik AI, Bezgin T, Baytugan NZ, Dagli M, Zengin A, Ozmen C, Karakoyun S. Predictive value of P wave parameters, indices, and a novel electrocardiographic marker for silent cerebral infarction and future cerebrovascular events. J Electrocardiol 2023; 81:186-192. [PMID: 37769455 DOI: 10.1016/j.jelectrocard.2023.09.004] [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: 07/22/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Silent cerebral infarction (SCI) is a neuronal injury without a clinically apparent stroke or transient ischaemic attack. Left atrial cardiomyopathy is closely associated with SCI. P wave changes in the electrocardiogram (ECG) provide significant information about the development of atrial cardiomyopathy. This study evaluated the role of P wave parameters and indices and a novel ECG parameter in predicting SCI, future cerebrovascular events, and atrial fibrillation/flutter. MATERIALS AND METHODS A total of 272 patients were retrospectively screened and divided into two groups according to SCI. Cerebrovascular events and atrial fibrillation/flutter were defined as the study's outcomes. P wave parameters, indices, and a novel ECG parameter called the P wave ratio (PWR) were calculated from ECGs, and the relationship between SCI and outcomes was investigated. RESULTS The maximum P wave duration (PWD), P wave dispersion (PWdisp), PWD measured from the D2 lead (PWDD2), P wave peak time measured from the D2 lead (PWPTD2), PWPT measured from the V1 lead (PWPTV1), and P wave terminal force (PWTFV1) were significantly longer in the SCI group. Both partial and advanced inter atrial block (IAB) were significantly high in the SCI group. The novel parameter P wave ratio (PWR) was significantly longer in the SCI group (0.55 ± 0.08 vs. 0.46 ± 0.09; p < 0.001). In multivariate regression analysis, PWdisp (OR: 1.101, p < 0.001), PWPTD2 (OR: 1.095, p = 0.017), and PWR (OR: 1.231, p < 0.001) were found to be independent predictors of SCI. Cox regression analysis revealed that the PWR (HR 1.077; 95% CI 1.029-1.128; p = 0.001) was associated with cerebrovascular events and atrial fibrillation/flutter. CONCLUSION In our study, we observed that PWR could be a valuable parameter for predicting SCI and future cerebrovascular events.
Collapse
Affiliation(s)
- Metin Cagdas
- Department of Cardiology, Gebze Fatih State Hospital, Heart Center, Kocaeli, Turkey
| | - Aziz Inan Celik
- Department of Cardiology, Gebze Fatih State Hospital, Heart Center, Kocaeli, Turkey.
| | - Tahir Bezgin
- Department of Cardiology, Gebze Fatih State Hospital, Heart Center, Kocaeli, Turkey
| | - Nart Zafer Baytugan
- Department of Cardiology, Gebze Fatih State Hospital, Heart Center, Kocaeli, Turkey
| | - Muharrem Dagli
- Department of Cardiovascular Surgery, Gebze Fatih State Hospital, Heart Center, Kocaeli, Turkey
| | - Ahmet Zengin
- Department of Cardiovascular Surgery, Gebze Fatih State Hospital, Heart Center, Kocaeli, Turkey
| | - Caglar Ozmen
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Suleyman Karakoyun
- Department of Cardiology, Akademi Hospital, Kocaeli, Turkey; Faculty of Health Sciences, Kocaeli Health and Technology University, Kocaeli, Turkey
| |
Collapse
|
6
|
Bielecka B, Gorczyca-Głowacka I, Ciba-Stemplewska A, Wożakowska-Kapłon B. Anticoagulant Treatment in Patients with AF and Very High Thromboembolic Risk in the Era before and after the Introduction of NOAC: Observation at a Polish Reference Centre. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6145. [PMID: 37372735 PMCID: PMC10298142 DOI: 10.3390/ijerph20126145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Atrial fibrillation (AF) is associated with an increased risk of stroke. Therefore, patients with AF require appropriate management and anticoagulant therapy. To balance therapy risks and benefits, oral anticoagulants (OAC) treatment should be 'tailored' in patients at a high risk of stroke and bleeding. However, some studies have demonstrated that certain groups of patients do not receive anticoagulants despite the high risk of stroke or thromboembolism. The study aimed to analyse therapeutic methods of stroke prevention in very high-risk patients (CHA2DS2-VASc score of ≥5 in men and ≥6 in women), identify factors predisposing against the use of OACs and assess the administration of anticoagulants before the introduction of non-vitamin K antagonist OAC (NOAC) in 2004-2011 and beyond (years 2012-2019). The analysis covered 2441 patients with AF at a very high thromboembolic risk who were hospitalised in a reference cardiological centre from 2004 to 2019. Data concerning patients' sex, age, comorbidities, type of AF, renal and echocardiographic parameters, reasons for hospitalisation and applied treatment were collected from medical records. HAS-BLED, CHADS2, and CHA2DS2-VASc scores were calculated for all patients. The treatment with oral anticoagulants was compared in the entire population over 2004-2011 and 2012-2019. In this study, a fifth of patients were not treated with OAC. Most patients hospitalised in the years 2012-2019 were treated with OAC. The predictors of not using OAC turned out to be: age of >74 years, heart failure, cancer, paroxysmal AF, and acute coronary syndrome (ACS) or elective coronary angiography/percutaneous coronary intervention (PCI) as a reason for hospitalisation. The introduction of NOAC was associated with a decline in the use of VKA (from 62% to 19.1%) and APT (from 29.1% to 1.3%). This study outlines reasons to initiate OAC treatment in very high-risk patients in clinical practice.
Collapse
Affiliation(s)
- Bernadetta Bielecka
- 1st Clinic of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Centre, 25-736 Kielce, Poland; (B.B.); (B.W.-K.)
| | | | - Agnieszka Ciba-Stemplewska
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland;
- Clinic of Internal Medicine, 25-736 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Centre, 25-736 Kielce, Poland; (B.B.); (B.W.-K.)
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland;
| |
Collapse
|
7
|
Chousou PA, Chattopadhyay R, Tsampasian V, Vassiliou VS, Pugh PJ. Electrocardiographic Predictors of Atrial Fibrillation. Med Sci (Basel) 2023; 11:medsci11020030. [PMID: 37092499 PMCID: PMC10123668 DOI: 10.3390/medsci11020030] [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: 03/09/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common pathological arrhythmia, and its complications lead to significant morbidity and mortality. However, patients with AF can often go undetected, especially if they are asymptomatic or have a low burden of paroxysms. Identification of those at high risk of AF development may help refine screening and management strategies. METHODS PubMed and Embase databases were systematically searched for studies looking at electrocardiographic predictors of AF from inception to August 2021. RESULTS A total of 115 studies were reported which examined a combination of atrial and ventricular parameters that could be electrocardiographic predictors of AF. Atrial predictors include conduction parameters, such as the PR interval, p-wave index and dispersion, and partial interatrial or advanced interatrial block, or morphological parameters, such as p-wave axis, amplitude and terminal force. Ventricular predictors include abnormalities in QRS amplitude, morphology or duration, QT interval duration, r-wave progression and ST segment, i.e., t-wave abnormalities. CONCLUSIONS There has been significant interest in electrocardiographic prediction of AF, especially in populations at high risk of atrial AF, such as those with an embolic stroke of undetermined source. This review highlights the breadth of possible predictive parameters, and possible pathological bases for the predictive role of each parameter are proposed.
Collapse
Affiliation(s)
- Panagiota Anna Chousou
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Rahul Chattopadhyay
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Vasiliki Tsampasian
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Peter John Pugh
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| |
Collapse
|
8
|
Tracz J, Gorczyca-Głowacka I, Rosołowska A, Wożakowska-Kapłon B. Long-Term Outcomes after Stroke in Patients with Atrial Fibrillation: A Single Center Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3491. [PMID: 36834183 PMCID: PMC9967874 DOI: 10.3390/ijerph20043491] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Atrial fibrillation (AF) is known to be a significant risk factor for poor prognosis after stroke. In this study, we compared differences in long-term outcomes after ischemic stroke among patients with AF and sinus rhythm (SR). We identified patients admitted to the reference Neurology Center between 1 January 2013 and 30 April 2015, inclusive, with acute ischemic stroke. Of the 1959 surviving patients, 892 were enrolled and followed for five years or until death. We analyzed the risk of stroke recurrence and death between patients with AF and SR at 1, 3, and 5 years after stroke. The rates of death and stroke recurrence were estimated using Kaplan-Meier analysis and multivariate Cox regression. During follow-up, 17.8% of patients died and 14.6% had recurrent stroke. The mortality in the AF group increased relative to the SR group with subsequent years. The risk of death was statistically higher in the AF than SR group at 1 year after stroke (13.5 vs. 7%, p = 0.004). After adjusting for age, stroke severity, and comorbidities, there was also no significant effect of AF on mortality in the first year after stroke (OR = 1.59, p = 0.247). There were no significant differences between the groups in stroke recurrence during follow-up. The results of our study showed that post-stroke patients with AF have a more severe prognosis, although AF itself does not have an independent negative effect on long-term outcomes after stroke. Long-term survival after stroke in patients with AF was strongly associated with age, stroke severity, and heart failure. The impact of other factors on prognosis after stroke in patients with AF should be considered.
Collapse
Affiliation(s)
- Justyna Tracz
- Clinic of Neurology, Swietokrzyskie Neurology Center, 25-736 Kielce, Poland
| | - Iwona Gorczyca-Głowacka
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Anita Rosołowska
- Clinic of Neurology, Swietokrzyskie Neurology Center, 25-736 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
| |
Collapse
|
9
|
Wang M, Yu G, Wang X, Xu B. Evaluation of changes in atrial fibrillation predictors(P wave parameters and left atrial diameter) in morbidly obese patients undergoing bariatric surgery. J Electrocardiol 2023; 78:12-16. [PMID: 36696818 DOI: 10.1016/j.jelectrocard.2023.01.001] [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: 10/10/2022] [Revised: 12/20/2022] [Accepted: 01/01/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bariatric surgery has been associated with reduced cardiovascular event in obese patients.In this study, we aimed to investigate the changes between pre-operation and post-operation atrial fibrillation predictors(p-wave parameters and left atrial diameter)in morbidly obese patients who underwent bariatric surgery. METHODS 176 obese patients undergoing bariatric surgery were enrolled. Heart rate, PR, P-wave max, P-wave min,P-wave dispersion (PWdis), average P-axis, P-wave peak time (PWPT) of lead II and lead V1, terminal force of lead V1 (PWTF V1), partial interatrial block (p-IAB), advanced interatrial block(a-IAB), and left atrial diamete were measured both before operation and 8 months post-operation. RESULTS Heart rate, PR, PW max, PW min, PWdis, mean P-axis, PWPT II, PWPT V1, and PWTF V1 were near their upper limits before operation. Left atrial diameter was larger than the upper limit before operation. All parameters showed statistically significant decrease at 8 months post-operation. The most significant changes were observed in PWPT II (55.69 ± 6.87 ms vs 50.43 ± 7.48 ms, p < 0.001), PWPT V1(54.21 ± 7.01 ms vs 48.02 ± 7.13 ms, p < 0.001), PWTF V1(74 [42.0%] vs 41 [23.3%], p < 0.001),p-IAB(41[23.2%]vs11[6.2%],p < 0.001),a-IAB(6[3.4%]vs2[1.1%], p < 0.001), and left atrial diameter(43.25 ± 9.23 mm vs 34.27 ± 6.21 mm,p < 0.001). CONCLUSIONS The results of our study showed that bariatric surgery had a positive effect on the regression of P wave parameters and left atrial diameter which are predictors of atrial fibrillation.
Collapse
Affiliation(s)
- Meng Wang
- Department of Cardiology, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Gang Yu
- Department of Gastroenterology, the Second Affiliated Hospital of Anhui Medical University, China
| | - Xiaochen Wang
- Department of Cardiology, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Banglong Xu
- Department of Cardiology, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
10
|
A novel electrocardiographic parameter for the prediction of atrial fibrillation after coronary artery bypass graft surgery "P wave peak time". Ir J Med Sci 2022; 191:2579-2585. [PMID: 35034275 DOI: 10.1007/s11845-021-02894-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/07/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Patients with postoperative atrial fibrillation (POAF) have increased risk of both short- and long-term mortality and morbidity; therefore, prediction of POAF is crucial in the preoperative period of the patients undergoing coronary artery bypass graft surgery. Electrocardiography (ECG) is the simplest and cost-effective tool in the preoperative workup of the patients for the prediction of POAF. A newly defined ECG parameter P wave peak time (PWPT) has been shown as a marker of atrial fibrillation development in non-surgical patients and we investigated its role in patients undergoing cardiac surgery. METHOD A total of 327 patients undergoing isolated or combined cardiac surgery were involved and the primary endpoint was defined as the development of POAF. The study population was divided into two groups based on the presence or absence of POAF. Groups were compared for both standard P wave parameters and for PWPT on surface ECG. The predictors of POAF were assessed by multivariate regression analysis. RESULTS The frequency of POAF was 20.4% (n = 67). P wave peak time in leads D2 (65.1 ± 11.8 vs 57.2 ± 10, p < 0.01) and V1 (57.8 ± 18 vs 44.8 ± 12.3, p < 0.01) were longer in patients with POAF. In multivariate regression analysis, PWPT in leads DII and V1 were independent predictors of POAF (OR: 1.11, 95%CI: 1.02-1.21, p = 0.01, OR: 1.06, 95%CI: 1.00-1.13, p = 0.03 respectively). CONCLUSION PWPT in leads DII and V1 can predict the development of POAF in patients undergoing cardiac surgery.
Collapse
|
11
|
Hatamnejad MR, Heydari AA, Salimi M, Jahangiri S, Bazrafshan M, Bazrafshan H. The utility of SYNTAX score predictability by electrocardiogram parameters in patients with unstable angina. BMC Cardiovasc Disord 2022; 22:8. [PMID: 35016624 PMCID: PMC8753933 DOI: 10.1186/s12872-022-02455-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background SYNTAX score is one of the risk assessment systems to predict cardiac events in acute coronary syndrome patients. Despite the large number of SYNTAX score benefits, invasive methods such as coronary angiography are necessary to perform the scoring. We hypothesized that ECG parameters could predict the SYNTAX score in unstable angina patients.
Methods During the retrospective cohort study, a total number of 876 patients were diagnosed with unstable angina. After applying the exclusion criteria, 600 patients were divided into tertiles based on the SYNTAX scores as low (0–22), intermediate (23–32), and high (≥ 33). The association between ECG parameters and SYNTAX score was investigated. Results The study included 65% men and 35% women with a mean age of 62.4 ± 9.97 years. The delayed transition zone of QRS complex, ST-depression in inferior-lateral territories or/and in all three territories, and T-wave inversion in lateral territory were significant (p < 0.05) independent predictors of intermediate SYNTAX score. High SYNTAX score was predicted by the presence of prolonged P wave duration, ST-depression in lateral territory or/and anterior-lateral territories, ST-elevation in aVR–III leads or/and aVR–III–V1 leads. Among those, all three territories ST-depression (AUC: 0.611, sensitivity: 75%, specificity: 51%) and aVR + III ST-elevation (AUC: 0.672, sensitivity: 50.12%, specificity: 80.50%) were the most accurate parameters to predict intermediate and high SYNTAX scores, respectively. Conclusion The present study demonstrates that accompanying the STE in the right side leads (aVR, III, V1) with ST-depression in other leads indicates the patients with high SYNTAX score; meanwhile, diffuse ST-depression without ST-elevation is a marker for intermediate SYNTAX score in unstable angina patients and can be applied for early risk stratification and intervention.
Collapse
Affiliation(s)
- Mohammad Reza Hatamnejad
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Cardiology Medicine, Al-Zahra Charity Hospital, Shiraz University of Medical Sciences, Zand St, PO Box: 71348-14336, Shiraz, Iran
| | | | - Maryam Salimi
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodeh Jahangiri
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Bazrafshan
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan
- Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Cardiology Medicine, Al-Zahra Charity Hospital, Shiraz University of Medical Sciences, Zand St, PO Box: 71348-14336, Shiraz, Iran.
| |
Collapse
|
12
|
Ibisoglu E, Boyraz B, Güneş ST, Savur Ü, Naki Tekin DD, Erdoğan A, Özdenkaya Y, Erdoğan E, Çeğilli E, Olgun FE, Güneş HM. Impact of surgical weight loss on novel P-wave-related variables which are nominated as predictors of atrial arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1516-1522. [PMID: 34312874 DOI: 10.1111/pace.14327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric surgery has been associated with reduced cardiovascular mortality and morbidity in obese patients. In this study, we aimed to evaluate the alterations of novel P-wave related atrial arrhythmia predictors in patients who achieved effective weight loss with bariatric surgery. METHODS The study included 58 patients who underwent bariatric surgery. We measured heart rate, PR, P wave (PW) max, PW min, Average P axis, P wave peak time (PWPT) in lead D2 and lead V1, terminal force in lead V1 (V1TF), and we estimated P wave dispersion (PWdis) interval both pre-operation and 6 months after operation. RESULTS Heart rate, PR, PW max, PW min, PWdis, Average P axis, PWPTD2, PWPTV1 and V1TF values, which were close to the upper limit in the pre-op period, showed statistically significant decreases at 6 months after the operation. The most prominent changes were observed in PW dis (51.15 ± 9.70 ms vs. 48.79 ± 9.50 ms, p = .010), PWPTD2 (55.75 ± 6.91 ms vs. 50.59 ± 7.67 ms, p < .001), PWPTV1 (54.10 ± 7.06 ms vs. 48.05 ± 7.64 ms, p < .001) and V1TF (25 [43.1%] vs. 12 [20.7%], p < .001). CONCLUSIONS The results of our study indicated that bariatric surgery has positive effects on the regression of ECG parameters which are predictors of atrial arrhythmias, particularly atrial fibrillation (AF).
Collapse
Affiliation(s)
- Ersin Ibisoglu
- Cardiology Department, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | | | - Saime Turgut Güneş
- Radiology Department, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Ümeyir Savur
- İstanbul Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
| | | | - Aslan Erdoğan
- Cardiology Department, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Yaşar Özdenkaya
- General Surgery Department, İstanbul Medipol University, İstanbul, Turkey
| | - Emrah Erdoğan
- Cardiology Department, Van Yüzüncüyıl University, İstanbul, Turkey
| | - Ercan Çeğilli
- Cardiology Department, Arnavutköy State Hospital, İstanbul, Turkey
| | - Fatih Erkam Olgun
- Cardiology Department, İstanbul Medipol University, İstanbul, Turkey
| | - Hacı Murat Güneş
- Cardiology Department, İstanbul Medipol University, İstanbul, Turkey
| |
Collapse
|
13
|
Wang Z, Cheng L, Zhang J, Liang Z, Dong R, Hang F, Wang X, Wang Z, Wu Y, Du J. Serum-Soluble ST2 Is a Novel Biomarker for Evaluating Left Atrial Low-Voltage Zone in Paroxysmal Atrial Fibrillation. Med Sci Monit 2020; 26:e926221. [PMID: 32898129 PMCID: PMC7500126 DOI: 10.12659/msm.926221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Paroxysmal atrial fibrillation (pAF) recurrence after radiofrequency catheter ablation (RFCA) is linked to low-voltage zone (LVZ). This study explored whether serum soluble ST2 (sST2) levels can predict the size of LVZs in patients with pAF. MATERIAL AND METHODS A total of 177 patients with pAF treated with RFCA were consecutively enrolled in this study. One hundred twenty-five patients (70.6%) with <20% LVZ were assigned to Group A, and 52 patients (29.4%) with a LVZ >20% were assigned to Group B. Levels of soluble ST2 (sST2), growth and differentiation factor (GDF-15) and tissue inhibitor of MMP1 (TIMP-1) were measured. RESULTS The sST2 levels were higher in Group B than in Group A (23.9±3.3 vs. 30.9±5.0 ng/mL, P<0.000). In multivariable logistic regression analysis, sST2 was the only independent parameter for predicting left atrial LVZ (odds ratio, 1.611 [1.379-1.882]; P<0.001). The cut-off value of sST2 obtained by receiver operating characteristic (ROC) analysis was 26.65 ng/mL for prediction of LVZ (sensitivity: 86.5%, specificity: 84.8%). The under-curve area was 0.895 (0.842-0.948) (P<0.001). At 12-month follow-up, patients with sST2 <26.65 ng/mL had more patients free from atrial arrhythmias compared to patients with sST2 >26.65 ng/mL (88.6% vs. 69.8%, P<0.01). CONCLUSIONS We demonstrated that sST2 levels are higher in pAF patients with LVZ >20% compared to those with a smaller LVZ. Also increased sST2 levels can serve as a novel predictor of AF recurrence rate in patients who have undergone RFCA.
Collapse
Affiliation(s)
- Zefeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Liting Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Junmeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Zhuo Liang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Ruiqing Dong
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Fei Hang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Xinlu Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Ziyu Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jie Du
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| |
Collapse
|