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Zhao X, Huang L, Hu J, Jin N, Hong J, Chen X. The association between systemic inflammation markers and paroxysmal atrial fibrillation. BMC Cardiovasc Disord 2024; 24:334. [PMID: 38961330 PMCID: PMC11223271 DOI: 10.1186/s12872-024-04004-9] [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: 01/16/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Systemic inflammation markers have recently been identified as being associated with cardiac disorders. However, limited research has been conducted to estimate the pre-diagnostic associations between these markers and paroxysmal atrial fibrillation (PAF). Our aim is to identify potential biomarkers for early detection of PAF. METHODS 91 participants in the PAF group and 97 participants in the non-PAF group were included in this study. We investigated the correlations between three systemic inflammation markers, namely the systemic immune inflammation index (SII), system inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), and PAF. RESULTS The proportion of patients with PAF gradually increased with increasing logSII, logSIRI, and logAISI tertiles. Compared to those in the lowest tertiles, the PAF risks in the highest logSII and logSIRI tertiles were 3.2-fold and 2.9-fold, respectively. Conversely, there was no significant correlation observed between logAISI and PAF risk within the highest tertile of logAISI. The restricted cubic splines (RCS) analysis revealed a non-linear relationship between the elevation of systemic inflammation markers and PAF risk. Specifically, the incidence of PAF is respectively increased by 56%, 95%, and 150% for each standard deviation increase in these variables. The ROC curve analysis of logSII, logSIRI and logAISI showed that they had AUC of 0.6, 0.7 and 0.6, respectively. It also demonstrated favorable sensitivity and specificity of these systemic inflammation markers in detecting the presence of PAF. CONCLUSIONS In conclusion, our study reveals significant positive correlations between SII, SIRI, and AISI with the incidence of PAF.
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Affiliation(s)
- Xuechen Zhao
- Department of Cardiology, Ningbo Hangzhou Bay Hospital, 1155 Binhai 2nd Road, Hangzhou Bay New Area, Ningbo, 315336, China
| | - Lei Huang
- Department of Cardiology, Ningbo Hangzhou Bay Hospital, 1155 Binhai 2nd Road, Hangzhou Bay New Area, Ningbo, 315336, China.
| | - Jianan Hu
- Department of Cardiology, Ningbo Hangzhou Bay Hospital, 1155 Binhai 2nd Road, Hangzhou Bay New Area, Ningbo, 315336, China
| | - Nake Jin
- Department of Cardiology, Ningbo Hangzhou Bay Hospital, 1155 Binhai 2nd Road, Hangzhou Bay New Area, Ningbo, 315336, China
| | - Jun Hong
- Department of Cardiology, Ningbo Hangzhou Bay Hospital, 1155 Binhai 2nd Road, Hangzhou Bay New Area, Ningbo, 315336, China
| | - Xudong Chen
- Department of Cardiology, Ningbo Hangzhou Bay Hospital, 1155 Binhai 2nd Road, Hangzhou Bay New Area, Ningbo, 315336, China
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2
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Fioranelli M, Spadafora L, Bernardi M, Roccia MG, Del Buono MG, Cacioli G, Biondi-Zoccai G. Impact of low-dose Brain-Derived Neurotrophic Factor (BDNF) on atrial fibrillation recurrence. Minerva Cardiol Angiol 2023; 71:673-680. [PMID: 37337698 DOI: 10.23736/s2724-5683.23.06324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Atrial fibrillation is the most common arrhythmia worldwide and is associated with significant morbidity and mortality. Despite the effectiveness of catheter-based ablation, periprocedural complication and recurrences remain a concern. In this context, we aim to appraise the potential impact of brain-derived neurotrophic factor (BDNF) on reducing episodes of paroxysmal atrial fibrillation (PAF). METHODS 22 patients with an established diagnosis of PAF and without structural heart disease were considered. Every patient received 20 drops of GUNA-BDNF administered in the morning. During the 24 months of follow-up, the arrhythmic burden was measured by the average monthly duration of PAF episodes. RESULTS At the end of the follow-up period (24 months), data from 22 patients, of whom 17 men and five women, were analyzed. The arrhythmic burden, measured in terms of average monthly duration of PAF episodes, was found significantly reduced after the administration of low dose BDNF (9.5 vs. 65.3 minutes per month, P<0.001). A total of 17 out of 22 patients saw their arrhythmic burden eliminated or consistently reduced, furthermore two patients underwent a drastic reduction of the average monthly duration of AF (more than 200 minutes compared to the baseline). Only four patients, despite the administration of BDNF, still experienced an arrhythmic burden of 20 minutes or more. Considering the age groups, the major reduction was observed in people aged 70 or more, who were also the most represented in the sample. These results are coherent with the poor literature currently available. CONCLUSIONS BDNF low dose therapy has shown to have an impacting role in reducing the arrhythmic burden and recurrences of AF, with a particular effectiveness in patients over 70 and without structural heart disease. We should welcome this work, despite it limitations. Further clinical and molecular studies are needed before-considering BDNF low dose as a tool against PAF.
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Affiliation(s)
| | - Luigi Spadafora
- Department of Clinical Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy -
| | - Marco Bernardi
- Department of Clinical Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Maria G Roccia
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | | | - Giulio Cacioli
- Institute for Systemic Integrated Therapies, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
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3
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C1QC, VSIG4, and CFD as Potential Peripheral Blood Biomarkers in Atrial Fibrillation-Related Cardioembolic Stroke. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2023; 2023:5199810. [PMID: 36644582 PMCID: PMC9837713 DOI: 10.1155/2023/5199810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
Atrial fibrillation (AF) is a major risk factor for ischemic stroke. We aimed to identify novel potential biomarkers with diagnostic value in patients with atrial fibrillation-related cardioembolic stroke (AF-CE).Publicly available gene expression profiles related to AF, cardioembolic stroke (CE), and large artery atherosclerosis (LAA) were downloaded from the Gene Expression Omnibus (GEO). Differentially expressed genes (DEGs) were identified and then functionally annotated. The support vector machine recursive feature elimination (SVM-RFE) and least absolute shrinkage and selection operator (LASSO) regression analysis were conducted to identify potential diagnostic AF-CE biomarkers. Furthermore, the results were validated by using external data sets, and discriminability was measured by the area under the ROC curve (AUC). In order to verify the predictive results, the blood samples of 13 healthy controls, 20 patients with CE, and 20 patients with LAA stroke were acquired for RT-qPCR, and the correlation between biomarkers and clinical features was further explored. Lastly, a nomogram and the companion website were developed to predict the CE-risk rate. Three feature genes (C1QC, VSIG4, and CFD) were selected and validated in the training and the external datasets. The qRT-PCR evaluation showed that the levels of blood biomarkers (C1QC, VSIG4, and CFD) in patients with AF-CE can be used to differentiate patients with AF-CE from normal controls (P < 0.05) and can effectively discriminate AF-CE from LAA stroke (P < 0.05). Immune cell infiltration analysis revealed that three feature genes were correlated with immune system such as neutrophils. Clinical impact curve, calibration curves, ROC, and DCAs of the nomogram indicate that the nomogram had good performance. Our findings showed that C1QC, VSIG4, and CFD can potentially serve as diagnostic blood biomarkers of AF-CE; novel nomogram and the companion website can help clinicians to identify high-risk individuals, thus helping to guide treatment decisions for stroke patients.
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Pujadas ER, Raisi-Estabragh Z, Szabo L, Morcillo CI, Campello VM, Martin-Isla C, Vago H, Merkely B, Harvey NC, Petersen SE, Lekadir K. Atrial fibrillation prediction by combining ECG markers and CMR radiomics. Sci Rep 2022; 12:18876. [PMID: 36344532 PMCID: PMC9640662 DOI: 10.1038/s41598-022-21663-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is associated with a higher risk of important adverse health outcomes such as stroke and death. AF is linked to distinct electro-anatomic alterations. The main tool for AF diagnosis is the Electrocardiogram (ECG). However, an ECG recorded at a single time point may not detect individuals with paroxysmal AF. In this study, we developed machine learning models for discrimination of prevalent AF using a combination of image-derived radiomics phenotypes and ECG features. Thus, we characterize the phenotypes of prevalent AF in terms of ECG and imaging alterations. Moreover, we explore sex-differential remodelling by building sex-specific models. Our integrative model including radiomics and ECG together resulted in a better performance than ECG alone, particularly in women. ECG had a lower performance in women than men (AUC: 0.77 vs 0.88, p < 0.05) but adding radiomics features, the accuracy of the model was able to improve significantly. The sensitivity also increased considerably in women by adding the radiomics (0.68 vs 0.79, p < 0.05) having a higher detection of AF events. Our findings provide novel insights into AF-related electro-anatomic remodelling and its variations by sex. The integrative radiomics-ECG model also presents a potential novel approach for earlier detection of AF.
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Affiliation(s)
- Esmeralda Ruiz Pujadas
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain.
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Liliana Szabo
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Cristian Izquierdo Morcillo
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Víctor M Campello
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Martin-Isla
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Hajnalka Vago
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Bela Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
- Health Data Research UK, London, UK
- Alan Turing Institute, London, UK
| | - Karim Lekadir
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
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5
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A comparative study on neural networks for paroxysmal atrial fibrillation events detection from electrocardiography. J Electrocardiol 2022; 75:19-27. [PMID: 36272352 DOI: 10.1016/j.jelectrocard.2022.10.002] [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: 07/23/2022] [Revised: 09/21/2022] [Accepted: 10/02/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This work conducts a comparative study on the effect of neural networks of different architectures on the detection of paroxysmal atrial fibrillation (PAF) events from dynamic electrocardiography (ECG) recordings, a problem raised in the 4th China Physiological Signal Challenge 2021 (CPSC2021). APPROACH We proposed 3 neural network models and an auxiliary one for QRS detection to tackle the problem. A convolutional recurrent neural network (CRNN) model and a U-Net model that accepts ECG waveform input make sample-wise predictions. This regards the PAF events detection as a segmentation task. A stacked bidirectional long short-term memory (LSTM) model takes the sequence of RR intervals, which is derived from the output of the QRS detection model and makes beat-wise predictions. The QRS detection model also has a CRNN architecture, which is slightly different from the model for the AF segmentation task. Final predictions are merged by outputs from models making sample-wise predictions and making beat-wise predictions. Finally, the locations of QRS complexes are used to filter out segments (both normal and AF) shorter than 5 beats. In order to make the neural network models more sensitive to the critical sample points (onsets and offsets) of the AF events, we proposed a novel masked binary cross-entropy (MaskedBCE) loss function for training the models. This loss function is the conventional BCE loss multiplied by a mask, whose values in a neighbourhood of critical sample points are significantly larger than elsewhere. MAIN RESULTS Our method received a score of 1.9972 on the first part of the hidden test set of CPSC2021 and a score of 3.0907 on the second part. The average score was 2.5440, ranked 5th out of 17 teams with successful official entries. SIGNIFICANCE This work proposed an effective solution to the problem of the detection of PAF events from dynamic ECGs and validated the efficacy of several neural network architectures on this problem.
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6
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Weng W, Choudhury R, Sapp J, Tang A, Healey JS, Nault I, Rivard L, Greiss I, Bernick J, Parkash R. The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial. BMC Cardiovasc Disord 2021; 21:445. [PMID: 34530738 PMCID: PMC8447763 DOI: 10.1186/s12872-021-02254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catheter ablation is an established therapy for atrial fibrillation but is limited by recurrence; efforts have been made to identify biomarkers that predict recurrence. We investigated the effect of baseline NT-proBNP on AF recurrence following catheter ablation in patients randomized to aggressive (< 120/80 mmHg) or standard blood pressure management (< 140/90 mmHg) in the Substrate Modification with Aggressive Blood Pressure Control trial (SMAC-AF). METHODS The SMAC-AF study included 173 patients resistant or intolerant to at least one class I or III antiarrhythmic drug. We studied the effect of baseline NT-proBNP on the primary outcome of AF recurrence > 3 months post-ablation. RESULTS Of the 173 patients, 88 were randomized to the aggressive cohort, and 85 into the standard group. The primary outcome occurred in 61.4% of those in the aggressive arm, versus 61.2% in the standard arm. In the aggressive group, logNT-proBNP predicted recurrence (HR 1.28, p = 0.04, adjusted HR 1.43, p = 0.03), while in the standard cohort, it did not (HR 0.94, p = 0.62, adjusted HR 0.83, p = 0.22). NT-proBNP ≥ 280 pg/mL also predicted occurrence in the aggressive (HR 1.98, p = 0.02) but not the standard cohort (HR 1.00, p = 1.00). CONCLUSION We conclude that pre-ablation NT-proBNP may be useful in predicting recurrence in hypertensive patients and identifying patients who benefit from aggressive blood control and upstream therapies. TRIAL REGISTRATION NCT00438113, registered February 21, 2007.
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Affiliation(s)
- Willy Weng
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rajin Choudhury
- Dalhousie University, 1796 Summer Street, Rm 2501-D, Halifax Infirmary, Halifax, NS, B3H 3A7, Canada
| | - John Sapp
- Dalhousie University, 1796 Summer Street, Rm 2501-D, Halifax Infirmary, Halifax, NS, B3H 3A7, Canada
| | | | | | | | - Lena Rivard
- Montreal Heart Institute, Montreal, QC, Canada
| | - Isabelle Greiss
- Centre Hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | - Jordan Bernick
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ratika Parkash
- Dalhousie University, 1796 Summer Street, Rm 2501-D, Halifax Infirmary, Halifax, NS, B3H 3A7, Canada.
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Huang YH, Alexeenko V, Tse G, Huang CLH, Marr CM, Jeevaratnam K. ECG Restitution Analysis and Machine Learning to Detect Paroxysmal Atrial Fibrillation: Insight from the Equine Athlete as a Model for Human Athletes. FUNCTION (OXFORD, ENGLAND) 2020; 2:zqaa031. [PMID: 35330977 PMCID: PMC8788737 DOI: 10.1093/function/zqaa031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/06/2023]
Abstract
Atrial fibrillation is the most frequent arrhythmia in both equine and human athletes. Currently, this condition is diagnosed via electrocardiogram (ECG) monitoring which lacks sensitivity in about half of cases when it presents in paroxysmal form. We investigated whether the arrhythmogenic substrate present between the episodes of paroxysmal atrial fibrillation (PAF) can be detected using restitution analysis of normal sinus-rhythm ECGs. In this work, ECG recordings were obtained during routine clinical work from control and horses with PAF. The extracted QT, TQ, and RR intervals were used for ECG restitution analysis. The restitution data were trained and tested using k-nearest neighbor (k-NN) algorithm with various values of neighbors k to derive a discrimination tool. A combination of QT, RR, and TQ intervals was used to analyze the relationship between these intervals and their effects on PAF. A simple majority vote on individual record (one beat) classifications was used to determine the final classification. The k-NN classifiers using two-interval measures were able to predict the diagnosis of PAF with area under the receiving operating characteristic curve close to 0.8 (RR, TQ with k ≥ 9) and 0.9 (RR, QT with k ≥ 21 or TQ, QT with k ≥ 25). By simultaneously using all three intervals for each beat and a majority vote, mean area under the curves of 0.9 were obtained for all tested k-values (3-41). We concluded that 3D ECG restitution analysis can potentially be used as a metric of an automated method for screening of PAF.
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Affiliation(s)
- Ying H Huang
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK
| | - Vadim Alexeenko
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Christopher L-H Huang
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK,Physiological Laboratory, University of Cambridge, Cambridge, CB2 1QW, UK
| | - Celia M Marr
- Rossdales Equine Hospital and Diagnostic Centre, Exning, CB8 7NN, Suffolk, UK
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK,Physiological Laboratory, University of Cambridge, Cambridge, CB2 1QW, UK,Address correspondence to K.J. (e-mail: )
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Zhelankin AV, Vasiliev SV, Stonogina DA, Babalyan KA, Sharova EI, Doludin YV, Shchekochikhin DY, Generozov EV, Akselrod AS. Elevated Plasma Levels of Circulating Extracellular miR-320a-3p in Patients with Paroxysmal Atrial Fibrillation. Int J Mol Sci 2020; 21:ijms21103485. [PMID: 32429037 PMCID: PMC7279020 DOI: 10.3390/ijms21103485] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
The potential of extracellular circulating microRNAs (miRNAs) as non-invasive biomarkers of atrial fibrillation (AF) has been confirmed by a number of recent studies. However, the current data for some miRNAs are controversial and inconsistent, probably due to pre-analytical and methodological differences. In this work, we attempted to fulfill the basic pre-analytical requirements provided for circulating miRNA studies for application to paroxysmal atrial fibrillation (PAF) research. We used quantitative PCR (qPCR) to determine the relative plasma levels of circulating miRNAs expressed in the heart or associated with atrial remodeling or fibrillation with reported altered plasma/serum levels in AF: miR-146a-5p, miR-150-5p, miR-19a-3p, miR-21-5p, miR-29b-3p, miR-320a-3p, miR-328-3p, miR-375-3p, and miR-409-3p. First, in a cohort of 90 adult outpatient clinic patients, we found that the plasma level of miR-320a-3p was elevated in PAF patients compared to healthy controls and hypertensive patients without AF. We further analyzed the impact of medication therapies on miRNA relative levels and found elevated miR-320a-3p levels in patients receiving angiotensin-converting-enzyme inhibitors (ACEI) therapy. Additionally, we found that miR-320a-3p, miR-21-5p, and miR-146a-5p plasma levels positively correlated with the CHA2DS2-Vasc score and were elevated in subjects with CHA2DS2-Vasc ≥ 2. Our results indicate that, amongst the analyzed miRNAs, miR-320a-3p may be considered as a potential PAF circulating plasma biomarker, leading to speculation as to whether this miRNA is a marker of platelet state change due to ACEI therapy.
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Affiliation(s)
- Andrey V. Zhelankin
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, 119435 Moscow, Russia; (K.A.B.); (E.I.S.); (E.V.G.)
- Correspondence: or ; Tel.: +7-910-410-7765
| | - Sergey V. Vasiliev
- Department of Cardiology, Functional and Ultrasound Diagnostics, Faculty of Medicine N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119146 Moscow, Russia; (S.V.V.); (D.A.S.); (D.Y.S.); (A.S.A.)
| | - Daria A. Stonogina
- Department of Cardiology, Functional and Ultrasound Diagnostics, Faculty of Medicine N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119146 Moscow, Russia; (S.V.V.); (D.A.S.); (D.Y.S.); (A.S.A.)
| | - Konstantin A. Babalyan
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, 119435 Moscow, Russia; (K.A.B.); (E.I.S.); (E.V.G.)
| | - Elena I. Sharova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, 119435 Moscow, Russia; (K.A.B.); (E.I.S.); (E.V.G.)
| | - Yurii V. Doludin
- FSI National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, 101990 Moscow, Russia;
| | - Dmitry Y. Shchekochikhin
- Department of Cardiology, Functional and Ultrasound Diagnostics, Faculty of Medicine N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119146 Moscow, Russia; (S.V.V.); (D.A.S.); (D.Y.S.); (A.S.A.)
| | - Eduard V. Generozov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, 119435 Moscow, Russia; (K.A.B.); (E.I.S.); (E.V.G.)
| | - Anna S. Akselrod
- Department of Cardiology, Functional and Ultrasound Diagnostics, Faculty of Medicine N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119146 Moscow, Russia; (S.V.V.); (D.A.S.); (D.Y.S.); (A.S.A.)
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9
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Tancin Lambert A, Kong XY, Ratajczak-Tretel B, Atar D, Russell D, Skjelland M, Bjerkeli V, Skagen K, Coq M, Schordan E, Firat H, Halvorsen B, Aamodt AH. Biomarkers Associated with Atrial Fibrillation in Patients with Ischemic Stroke: A Pilot Study from the NOR-FIB Study. Cerebrovasc Dis Extra 2020; 10:11-20. [PMID: 32028277 PMCID: PMC7036587 DOI: 10.1159/000504529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/04/2019] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose Cardioembolic stroke due to paroxysmal atrial fibrillation (AF) may account for 1 out of 4 cryptogenic strokes (CS) and transient ischemic attacks (TIAs). The purpose of this pilot study was to search for biomarkers potentially predicting incident AF in patients with ischemic stroke or TIA. Methods Plasma samples were collected from patients aged 18 years and older with ischemic stroke or TIA due to AF (n = 9) and large artery atherosclerosis (LAA) with ipsilateral carotid stenosis (n = 8) and age- and sex-matched controls (n = 10). Analyses were performed with the Olink technology simultaneously measuring 184 biomarkers of cardiovascular disease. For bioinformatics, acquired data were analyzed using gene set enrichment analysis (GSEA). Selected proteins were validated using ELISA. Individual receiver operating characteristic (ROC) curves and odds ratios from logistic regression were calculated. A randomForest (RF) model with out-of-bag estimate was applied for predictive modeling. Results GSEA indicated enrichment of proteins related to inflammatory response in the AF group. Interleukin (IL)-6, growth differentiation factor (GDF)-15, and pentraxin-related protein PTX3 were the top biomarkers on the ranked list for the AF group compared to the LAA group and the control group. ELISA validated increased expression of all tested proteins (GDF-15, PTX3, and urokinase plasminogen activator surface receptor [U-PAR]), except for IL-6. 19 proteins had the area under the ROC curve (AUC) over 0.85 including all of the proteins with significant evolution in the logistic regression. AUCs were very discriminant in distinguishing patients with and without AF (LAA and control group together). GDF-15 alone reached AUC of 0.95. Based on RF model, all selected participants in the tested group were classified correctly, and the most important protein in the model was GDF-15. Conclusions Our results demonstrate an association between inflammation and AF and that multiple proteins alone and in combination may potentially be used as indicators of AF in CS and TIA patients. However, further studies including larger samples sizes are needed to support these findings. In the ongoing NOR-FIB study, we plan further biomarker assessments in patients with CS and TIA undergoing long-term cardiac rhythm monitoring with insertable cardiac monitors.
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Affiliation(s)
- Anna Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway, .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway,
| | - Xiang Y Kong
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Barbara Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology B, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - David Russell
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Vigdis Bjerkeli
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Bente Halvorsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne H Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway
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10
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Computational Simulation of Cardiac Function and Blood Flow in the Circulatory System under Continuous Flow Left Ventricular Assist Device Support during Atrial Fibrillation. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10030876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Prevalence of atrial fibrillation (AF) is high in heart failure patients supported by a continuous flow left ventricular assist device (CF-LVAD); however, the long term effects remain unclear. In this study, a computational model simulating effects of AF on cardiac function and blood flow for heart failure and CF-LVAD support is presented. The computational model describes left and right heart, systemic and pulmonary circulations and cerebral circulation, and utilises patient-derived RR interval series for normal sinus rhythm (SR). Moreover, AF was simulated using patient-derived unimodal and bimodal distributed RR interval series and patient specific left ventricular systolic functions. The cardiovascular system model simulated clinically-observed haemodynamic outcomes under CF-LVAD support during AF, such as reduced right ventricular ejection fraction and elevated systolic pulmonary arterial pressure. Moreover, relatively high aortic peak pressures and middle arterial peak flow rates during AF with bimodal RR interval distribution, reduced to similar levels as during normal SR and AF with unimodal RR interval distribution under CF-LVAD support. The simulation results suggest that factors such as distribution of RR intervals and systolic left ventricular function may influence haemodynamic outcome of CF-LVAD support during AF.
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11
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Her AY, Shin ES, Zhou Q, Wierzbinski J, Vidal-Lopez S, Saleh A, Kim YH, Garg S, Jung F, Brachmann J. Magnetocardiography detects left atrial dysfunction in paroxysmal atrial fibrillation. Clin Hemorheol Microcirc 2019; 72:353-363. [PMID: 30958336 DOI: 10.3233/ch-180528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Magnetocardiography (MCG) is a non-invasive technique and to characterize the magnetic field, a pseudo-current conversion was used. The role of MCG in detecting left atrial (LA) dysfunction in patients with paroxysmal atrial fibrillation (PAF) is unknown. OBJECTIVE The aim of this study was to evaluate LA function using MCG in patients with PAF and healthy subjects, to identify possible indices to diagnose PAF. METHODS We enrolled a total of 70 subjects including 26 healthy volunteers (group 1) and 22 marathon runners (group 2) who did not exhibit any cardiac abnormalities, and 22 patients with PAF (group 3) which was documented by electrocardiography (ECG). Spatiotemporal activation graph (STAG) in base-apex and left-right direction was reconstructed. The maximum value of LA pseudo-current under rest and peak exercise were measured between the end of the P wave and beginning of the Q wave. RESULTS LA pseudo-current increase at peak exercise in PAF patients was significantly lower than in healthy volunteers and marathon runners (0.4±0.3 pT in group 3 vs. 0.8±0.3 pT in group 1 vs. 1.1±0.5 pT in group 2, p < 0.001). PAF patients had less pseudo-current increase in STAG at peak exercise than healthy volunteers and marathon runners (46% of 26 PAF patients, 81% of 22 healthy subjects vs. 81% of 22 marathon runners, p = 0.002). Sensitivity, specificity, and the area under the receiver-operator characteristics curve of LA pseudo-current increase at peak exercise for differentiating PAF patients from healthy subjects were 77%, 92%, and 0.896. CONCLUSIONS MCG can provide important non-invasive information for detecting LA dysfunction in PAF patients. Therefore, MCG may help in differentiating PAF patients from healthy subjects.
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Affiliation(s)
- Ae-Young Her
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan Medical Center, Ulsan Hospital, Ulsan, South Korea
| | - Qing Zhou
- Department of Medical II., Coburg Hospital, Coburg, Germany
| | - Jan Wierzbinski
- Department of Cardiology, Asklepios Hospital Harburg, Hamburg, Germany
| | | | - Ahmed Saleh
- Department of Medical II., Coburg Hospital, Coburg, Germany
| | - Yong Hoon Kim
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Friedrich Jung
- Institute for Clinical Hemostasiology and Transfusion Medicine, University of Saarland, Saarbrücken, Germany
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12
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Han TS, Fry CH, Fluck D, Affley B, Gulli G, Barrett C, Kakar P, Patel T, Sharma S, Sharma P. Anticoagulation therapy in patients with stroke and atrial fibrillation: a registry-based study of acute stroke care in Surrey, UK. BMJ Open 2018; 8:e022558. [PMID: 29997144 PMCID: PMC6089275 DOI: 10.1136/bmjopen-2018-022558] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Because of their high risk of stroke, anticoagulation therapy is recommended for most patients with atrial fibrillation (AF). The present study evaluated the use of anticoagulants in the community and in a hospital setting for patients with AF and its associations with stroke. METHODS Patients admitted with stroke to four major hospitals in County of Surrey, England were surveyed in the 2014-2016 Sentinel Stroke National Audit Programme. Descriptive statistics was used to summarise subject characteristics and χ² test to assess differences between categorical variables. RESULTS A total of 3309 patients, 1656 men (mean age: 73.1 years±SD 13.2) and 1653 women (79.3 years±13.0) were admitted with stroke (83.3% with ischaemic, 15.7% haemorrhagic stroke and 1% unspecified). AF occurred more frequently (χ2=62.4; p<0.001) among patients admitted with recurrent (30.2%) rather than with first stroke (17.1%). There were 666 (20.1%) patients admitted with a history of AF, among whom 304 (45.3%) were anticoagulated, 279 (41.9%) were untreated and 85 (12.8%) deemed unsuitable for anticoagulation. Of the 453 patients with history of AF admitted with a first ischaemic stroke, 138 (37.2%) were on anticoagulation and 41 (49.6%) were not (χ2 = 6.3; p<0.043) and thrombolysis was given more frequently for those without prior anticoagulation treatment (16.1%) or unsuitable for anticoagulation (23.6%) compared with those already on anticoagulation treatment (8.3%; χ2=10.0; p=0.007). Of 2643 patients without a previous history of AF, 171 (6.5%) were identified with AF during hospitalisation. Of patients with AF who presented with ischaemic stroke who were not anticoagulated or deemed unsuitable for anticoagulation prior to admission, 91.8% and 75.0%, respectively, were anticoagulated on discharge. CONCLUSIONS The study highlights an existing burden for patients with stroke and reflects inadequate treatment of AF which results in an increased stroke burden. There is significant scope to improve the rates of anticoagulation.
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Affiliation(s)
- Thang S Han
- Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK
| | - Christopher Henry Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Brendan Affley
- Department of Stroke, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | - Giosue Gulli
- Department of Stroke, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | | | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK
| | - Tasmin Patel
- Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK
| | - Sapna Sharma
- Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK
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13
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Kazanski V, Mitrokhin VM, Mladenov MI, Kamkin AG. Cytokine Effects on Mechano-Induced Electrical Activity in Atrial Myocardium. Immunol Invest 2016; 46:22-37. [PMID: 27617892 DOI: 10.1080/08820139.2016.1208220] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The role of cytokines as regulators of stretch-related mechanisms is of special importance since mechano-sensitivity plays an important role in a wide variety of biological processes. Here, we elucidate the influence of cytokine application on mechano-sensitivity and mechano-transduction. The atrial myocardial stretch induces production of interleukin (IL)-2, IL-6, IL-13, IL-17A, and IL-18 with exception of tumor necrosis factor α (TNF-α), IL-1β, and vascular endothelial growth factor B (VEGF-B). Positive ionotropic effect was specific for VEGF-B, negative ionotropic effects were specific for TNF-α, IL-1β, IL-2, IL-6, IL-13, IL-17A and IL-18, while IL-1α doesn't show direct ionotropic effect. The IL-2, IL-6, IL-17A, IL-18, and VEGF-B cause elongation of the APD, in comparison with the reduced APD caused by the IL-13. The TNF-α, IL-1β, and IL-18 influences L-type Ca2+ channels, IL-2 has an inhibitory effect on the fast Na+ channels while IL-17A and VEGF-B were specific for Kir channels. With exception of the IL-1α, IL-2, and VEGF-B, all analyzed cytokines include nitric oxide dependent signaling with resultant combined effects on mechano-gated and Ca2+ channels. The relationships between these pathways and the time-dependence of their activation are of important considerations in the evaluation of cytokine-induced electrical abnormality, specific for cardiac dysfunctions. In general, the discussion presented in this review covers research devoted to counterbalance between different cytokines in the regulation of stretch-induced effects in rat atrial myocardium. ABBREVIATIONS APs: action potentials; APD25: action potential durations to 25% of re-polarization; APD50: action potential durations to 50% of repolarization; APD90: action potential durations to 90% of repolarization; MGCs: mechanically gated channels.
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Affiliation(s)
- V Kazanski
- a Department of Fundamental and Applied Physiology , Russian National Research Medical University , Moscow , Russia
| | - V M Mitrokhin
- a Department of Fundamental and Applied Physiology , Russian National Research Medical University , Moscow , Russia
| | - M I Mladenov
- a Department of Fundamental and Applied Physiology , Russian National Research Medical University , Moscow , Russia.,b Faculty of Natural Sciences and Mathematics, Institute of Biology , "Ss. Cyril and Methodius" University , Skopje , Macedonia
| | - A G Kamkin
- a Department of Fundamental and Applied Physiology , Russian National Research Medical University , Moscow , Russia
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Paroxysmal Atrial Fibrillation: Novel Strategies for Monitoring and Implications for Treatment in Stroke. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:52. [DOI: 10.1007/s11936-016-0475-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Jawad-Ul-Qamar M, Kirchhof P. Almanac 2015: atrial fibrillation research in Heart. Heart 2016; 102:573-80. [PMID: 26791994 PMCID: PMC4819630 DOI: 10.1136/heartjnl-2015-307809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/26/2015] [Indexed: 01/21/2023] Open
Abstract
Atrial fibrillation continues to attract interest in the cardiovascular community and in Heart. Over 60 original research and review papers published in Heart in 2014–2015 cover various aspects of atrial fibrillation, from associated conditions and precipitating factors to new approaches to management. Here, we provide an overview of articles on atrial fibrillation published in Heart in 2014–2015, highlighting new developments, emerging concepts and novel approaches to treatment.
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Affiliation(s)
- Muhammad Jawad-Ul-Qamar
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK SWBH NHS Trust, Birmingham, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK SWBH NHS Trust, Birmingham, UK UHB NHS Trust, Birmingham, UK Atrial Fibrillation NETwork (AFNET), Münster, Germany Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany
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