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Titus A, Syeed S, Baburaj A, Bhanushali K, Gaikwad P, Sooraj M, Saji AM, Mir WAY, Kumar PA, Dasari M, Ahmed MA, Khan MO, Titus A, Gaur J, Annappah D, Raj A, Noreen N, Hasdianda A, Sattar Y, Narasimhan B, Mehta N, Desimone CV, Deshmukh A, Ganatra S, Nasir K, Dani S. Catheter ablation versus medical therapy in atrial fibrillation: an umbrella review of meta-analyses of randomized clinical trials. BMC Cardiovasc Disord 2024; 24:131. [PMID: 38424483 PMCID: PMC10902941 DOI: 10.1186/s12872-023-03670-5] [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] [Accepted: 12/13/2023] [Indexed: 03/02/2024] Open
Abstract
This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.
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Affiliation(s)
- Anoop Titus
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | | | | | | | | | - Mannil Sooraj
- Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Kanakapura, Karnataka, India
| | | | | | | | | | | | | | - Aishwarya Titus
- Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | | | | | - Arjun Raj
- University Hospital of Leicester, Leicester, UK
| | | | - Adrian Hasdianda
- Brigham and Women's Hospital, Harvard University, Cambridge, MA, USA
| | | | - Bharat Narasimhan
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Nishaki Mehta
- Beaumont Hospital Royal Oak, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | | | - Sarju Ganatra
- Department of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, 41 Mall Road, Burlington, MA, 10805, USA
| | - Khurram Nasir
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Sourbha Dani
- Department of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, 41 Mall Road, Burlington, MA, 10805, USA
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Rafaqat S, Sharif S, Majeed M, Naz S, Saqib M, Manzoor F. Association of adiponectin gene expression with atrial fibrillation in a Pakistani populace. Sci Rep 2023; 13:22589. [PMID: 38114533 PMCID: PMC10730827 DOI: 10.1038/s41598-023-46388-2] [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: 04/13/2023] [Accepted: 10/31/2023] [Indexed: 12/21/2023] Open
Abstract
Adiponectin, an adipocytokine produced and secreted by adipose tissue, has anti-diabetic, anti-atherogenic, and anti-inflammatory properties. This case-control study was aimed to assess the expression and serum levels of adiponectin in subject suffereing from atrial fibrillation (AF). The study's subjects (n = 690) were enrolled from the Punjab Institute of Cardiology, Lahore and were grouped into control, AF without Metabolic syndrome (MetS), and AF with MetS groups. Along with the collection of demographic data, an analysis of adiponectin and biochemical parameters were performed. A highly significant difference in serum levels of adiponectin was observed among the control, AF without MetS, and AF with MetS groups (61.61 ± 45.30 ng/ml, 37.20 ± 19.46 ng/ml, 63.78 ± 61.69 ng/ml). The expression analysis of adiponectin was decreased (n-fold = ̴ 0.30) in AF without MetS group as compared to control group (n-fold = ~ 1.16) but increased in AF with MetS group (n-fold = ̴ 6.26). The correlation analysis revealed a highly significant positive relationship between the expression of the adiponectin gene with waist-to-hip ratio (WHR) in AF without MetS group. Whereas, serum adiponectin was negatively related to serum triglycerides (TG) in AF with MetS group. In multiple regression analysis using adiponectin expression as the dependent variable, WHR was a determinant in AF without MetS. Whereas, when serum adiponectin was used as the dependent variable, serum TG was the determinant in group AF with MetS. The present study implicates that decreased expression and serum levels of adiponectin were associated with the development of AF in which WHR and serum TG also contributed towards the onset of atrial fibrillation.
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Affiliation(s)
- Saira Rafaqat
- Department of Zoology, Lahore College for Women University, Lahore, Pakistan
| | - Saima Sharif
- Department of Zoology, Lahore College for Women University, Lahore, Pakistan.
| | - Mona Majeed
- Emergency Department, Punjab Institute of Cardiology, Lahore, Pakistan
| | - Shagufta Naz
- Department of Zoology, Lahore College for Women University, Lahore, Pakistan
| | - Muhammad Saqib
- Department of Medicine, Sir Ganga Ram Hospital, Lahore, Pakistan
| | - Farkhanda Manzoor
- Department of Zoology, Lahore College for Women University, Lahore, Pakistan
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Besin V, Yulianti T, Notopuro PB, Humardani FM. Genetic Polymorphisms of Ischemic Stroke in Asians. Clin Chim Acta 2023; 549:117527. [PMID: 37666385 DOI: 10.1016/j.cca.2023.117527] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
The increasing incidence of ischemic stroke emphasizes the necessity for early detection and preventive strategies. Diagnostic biomarkers currently available for ischemic stroke only become detectable shortly before the manifestation of stroke symptoms. Genetic variants associated with ischemic stroke offer a potential solution to address this diagnostic limitation. However, it is crucial to acknowledge that genetic variants cannot be modified in the same way as epigenetic changes. Nevertheless, individuals carrying risk or protective variants can modify their lifestyle to potentially influence the associated epigenetic factors. This study aims to summarize specific variants relevant to Asian populations that may aid in the early detection of ischemic stroke and explore their impact on the disease's pathophysiology. These variants give us important information about the genes that play a role in ischemic stroke by affecting things like atherosclerosis pathway, blood coagulation pathway, homocysteine metabolism, transporter function, transcription, and the activity of neurons regulation. It is important to recognize the variations in genetic variants among different ethnicities and avoid generalizing the pathogenesis of ischemic stroke.
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Affiliation(s)
- Valentinus Besin
- Faculty of Medicine, University of Surabaya, Surabaya 60292, Indonesia
| | - Trilis Yulianti
- Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia
| | - Paulus Budiono Notopuro
- Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Farizky Martriano Humardani
- Faculty of Medicine, University of Surabaya, Surabaya 60292, Indonesia; Magister in Biomedical Science Program, Faculty of Medicine Universitas Brawijaya, Malang 65112, Indonesia.
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Comparison of catheter ablation and medical therapy for atrial fibrillation in heart failure patients: A meta-analysis of randomized controlled trials. Heart Lung 2023; 57:69-74. [PMID: 36084398 DOI: 10.1016/j.hrtlng.2022.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/12/2022] [Accepted: 08/20/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The results of studies comparing the outcomes of catheter ablation (CA) to those of medical therapy (MT) for atrial fibrillation (AF) in heart failure (HF) patients are contradictory. OBJECTIVES Our objective was to conduct a meta-analysis that included randomized controlled trials (RCTs) that compared these two therapy options for AF in HF patients. METHODS We searched PubMed, Google Scholar, and the Cochrane Library for eligible studies. After reviewing all potential studies, we conducted this meta-analysis with the remaining 10 RCTs. We used a modified Jadad scale to assess the publications' quality, and we used the Risk of Bias 2 tool to assess the RCTs' bias risk. RESULTS The meta-analysis comprised 2,187 patients. Patients treated with CA had a lower risk of all-cause mortality than patients treated with MT (RR=0.64 [0.5, 0.82]; p < 0.01). The CA group had greater improvement in left ventricular ejection fraction (LVEF) than the MT group (mean difference [MD]=5.38 [1.80, 8.97]; p < 0.01). Patients in the CA group had longer 6-min walking distances than patients in the MT group (MD=20.3 [-4.37, 44.9], p < 0.01). Compared to the MT group, the CAD group demonstrated a greater reduction in scores on the Minnesota Living with Heart Failure Questionnaire (MD= -9.59 [-16.72, -2.45], p < 0.01). CONCLUSION This meta-analysis highlights the importance of CA in terms of all-cause mortality and includes the highest number of patients of any study on this topic. Moreover, compared to MT, CA therapy is associated with greater improvements in LVEF and quality of life.
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