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Egami Y, Abe M, Osuga M, Nohara H, Kawanami S, Ukita K, Kawamura A, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M. Impact of residual induction number of non-pulmonary vein foci on the 2-year outcomes in patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01820-z. [PMID: 38703331 DOI: 10.1007/s10840-024-01820-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Residual non-pulmonary vein (PV) foci are significantly associated with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). However, we previously reported among patients with non-PV foci induced only once, none experienced AF recurrence. Thus, we aimed to investigate the correlation between the residual induction number of non-PV foci and ablation outcome in paroxysmal AF patients. METHODS AND RESULTS We investigated 55 paroxysmal AF patients with residual non-PV foci after PVI and ablation of non-PV-foci. Study patients were classified into the residual one-time induction of non-PV foci (residual OTI-nPVF) group (n = 23) and residual repeatedly induced non-PV foci (residual RI-nPVF) group (n = 32). Furthermore, the residual RI-nPVF group was divided into the low inducibility group (n = 10) and high inducibility group (n = 22) according to the presence or absence of non-PV foci provoked by two sets of drug induction tests (non-PV foci inducibility). In addition, the latter was divided into the ablation group (n = 14) or observation group (n = 8). The 2-year AF recurrence-free rate in the residual RI-nPVF group was significantly lower compared to the residual OTI-nPVF group (53% vs. 90%, p = 0.018). There was no significant difference of the 2-year AF recurrence-free rates in the inducibility of non-PV foci (p = 0.913) and the presence or absence of ablation (p = 0.812) in the residual RI-nPVF group. CONCLUSIONS Among paroxysmal AF patients, the presence of residual RI-nPVF was associated with higher AF recurrence compared to residual OTI-nPVF. Furthermore, within residual RI-nPVF subgroup, non-PV foci inducibility or ablation of some residual RI-nPVF did not affect ablation outcome.
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Affiliation(s)
- Yasuyuki Egami
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Masaru Abe
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Mizuki Osuga
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Hiroaki Nohara
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Shodai Kawanami
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Kohei Ukita
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Akito Kawamura
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Koji Yasumoto
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Masaki Tsuda
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Naotaka Okamoto
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Yasuharu Matsunaga-Lee
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Masamichi Yano
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan
| | - Masami Nishino
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, Japan.
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Zhang Y, Xu S, Xing W, Chen Q, Liu X, Pu Y, Xin F, Jiang H, Yin Z, Tao D, Zhou D, Zhu Y, Yuan B, Jin Y, He Y, Wu Y, Po SS, Wang H, Benditt DG. Robust Artificial Intelligence Tool for Atrial Fibrillation Diagnosis: Novel Development Approach Incorporating Both Atrial Electrograms and Surface ECG and Evaluation by Head-to-Head Comparison With Hospital-Based Physician ECG Readers. J Am Heart Assoc 2024; 13:e032100. [PMID: 38258658 PMCID: PMC11056178 DOI: 10.1161/jaha.123.032100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/27/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) increases risk of embolic stroke, and in postoperative patients, increases cost of care. Consequently, ECG screening for AF in high-risk patients is important but labor-intensive. Artificial intelligence (AI) may reduce AF detection workload, but AI development presents challenges. METHODS AND RESULTS We used a novel approach to AI development for AF detection using both surface ECG recordings and atrial epicardial electrograms obtained in postoperative cardiac patients. Atrial electrograms were used only to facilitate establishing true AF for AI development; this permitted the establishment of an AI-based tool for subsequent AF detection using ECG records alone. A total of 5 million 30-second epochs from 329 patients were annotated as AF or non-AF by expert ECG readers for AI training and validation, while 5 million 30-second epochs from 330 different patients were used for AI testing. AI performance was assessed at the epoch level as well as AF burden at the patient level. AI achieved an area under the receiver operating characteristic curve of 0.932 on validation and 0.953 on testing. At the epoch level, testing results showed means of AF detection sensitivity, specificity, negative predictive value, positive predictive value, and F1 (harmonic mean of positive predictive value and sensitivity) as 0.970, 0.814, 0.976, 0.776, and 0.862, respectively, while the intraclass correlation coefficient for AF burden detection was 0.952. At the patient level, AF burden sensitivity and positive predictivity were 96.2% and 94.5%, respectively. CONCLUSIONS Use of both atrial electrograms and surface ECG permitted development of a robust AI-based approach to postoperative AF recognition and AF burden assessment. This novel tool may enhance detection and management of AF, particularly in patients following operative cardiac surgery.
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Affiliation(s)
- Yuji Zhang
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Shusheng Xu
- Institute for Interdisciplinary Information Sciences, Tsinghua UniversityBeijingChina
- Shanghai Qi Zhi InstituteShanghaiChina
| | - Wenhui Xing
- Shanghai Yueguang Medical Technologies Ltd.ShanghaiChina
| | - Qiong Chen
- Shanghai Yueguang Medical Technologies Ltd.ShanghaiChina
| | - Xu Liu
- Shanghai Yueguang Medical Technologies Ltd.ShanghaiChina
| | - Yachuan Pu
- Shanghai Yueguang Medical Technologies Ltd.ShanghaiChina
| | - Fangran Xin
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Hui Jiang
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Zongtao Yin
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Dengshun Tao
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Dong Zhou
- Institute for Interdisciplinary Information Sciences, Tsinghua UniversityBeijingChina
- Shanghai Qi Zhi InstituteShanghaiChina
| | - Yan Zhu
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Binhang Yuan
- Department of Computer ScienceETH ZürichZurichSwitzerland
| | - Yan Jin
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Yuanchen He
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Yi Wu
- Institute for Interdisciplinary Information Sciences, Tsinghua UniversityBeijingChina
- Shanghai Qi Zhi InstituteShanghaiChina
| | - Sunny S. Po
- Cardiovascular Diseases and Heart Rhythm Institute, University of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Huishan Wang
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - David G. Benditt
- Cardiovascular DivisionUniversity of Minnesota Medical SchoolMinneapolisMNUSA
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3
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Vandenberk B, Haemers P, Morillo C. The autonomic nervous system in atrial fibrillation-pathophysiology and non-invasive assessment. Front Cardiovasc Med 2024; 10:1327387. [PMID: 38239878 PMCID: PMC10794613 DOI: 10.3389/fcvm.2023.1327387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
The autonomic nervous system plays a crucial role in atrial fibrillation pathophysiology. Parasympathetic hyperactivity result in a shortening of the action potential duration, a reduction of the conduction wavelength, and as such facilitates reentry in the presence of triggers. Further, autonomic remodeling of atrial myocytes in AF includes progressive sympathetic hyperinnervation by increased atrial sympathetic nerve density and sympathetic atrial nerve sprouting. Knowledge on the pathophysiological process in AF, including the contribution of the autonomic nervous system, may in the near future guide personalized AF management. This review focuses on the role of the autonomic nervous system in atrial fibrillation pathophysiology and non-invasive assessment of the autonomic nervous system.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Peter Haemers
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Carlos Morillo
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
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Bashir Z, Chen EW, Wang S, Shu L, Goldstein ED, Rana M, Kala N, Dai X, Mandel D, Has P, Xie M, Wang T, Dickey JB, Poppas A, Simmons J, Song C, Yaghi S, Haines P. Left atrial strain, embolic stroke of undetermined source, and atrial fibrillation detection. Echocardiography 2024; 41:e15738. [PMID: 38284672 DOI: 10.1111/echo.15738] [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: 07/25/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Atrial cardiopathy is a proposed mechanism of embolic stroke of undetermined source (ESUS). Left atrial (LA) strain may identify early atrial cardiopathy prior to structural changes. We aim to study the associations between LA strain, ESUS, and atrial fibrillation (AF) detection in ESUS. METHODS The study population included patients with ESUS and noncardioembolic (NCE) stroke presenting to the Rhode Island Hospital Stroke Center between January 2016 and June 2017 who underwent transthoracic echocardiography. Speckle tracking echocardiography (STE) was used to measure the three phases of LA strain (reservoir, conduit, and contractile). Binary logistic regression analysis was performed to determine the associations between LA strain and stroke subtype (ESUS vs. NCE) as well as follow-up detection of AF in ESUS patients. RESULTS We identified 656 patients, 307 with ESUS and 349 with NCE. In binary logistic regression, the lowest tertiles of LA reservoir (adjusted OR 1.944, 95% CI 1.266-2.986, p = .002), contractile (aOR 1.568, 95% CI 1.035-2.374, p = .034), and conduit strain (aOR 2.288, 95% CI 1.448-3.613, p = .001) were more likely to be significantly associated with ESUS compared to NCE stroke. Among all ESUS patients, the lowest tertiles of LA reservoir strain (OR 2.534, 95% CI 1.029-6.236, p = .043), contractile strain (OR 2.828, 95% CI 1.158-6.903, p = .022), and conduit strain (OR 2.614, 95% CI 1.003-6.815, p = .049) were significantly associated with subsequent detection of AF. CONCLUSION Reduced LA strain is associated with ESUS occurrence and AF detection in ESUS patients. Therefore, quantification of LA strain in ESUS patients may improve risk stratification and guide secondary prevention strategies.
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Affiliation(s)
- Zubair Bashir
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Edward W Chen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shuyuan Wang
- Department of Ultrasound, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liqi Shu
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Eric D Goldstein
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Maheen Rana
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Narendra Kala
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Xing Dai
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel Mandel
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Phinnara Has
- Lifespan Biostatistics, Epidemiology and Research Design, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Mingxing Xie
- Department of Ultrasound, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Stanford Cardiovascular Institute, Stanford University, Palo Alto, California, USA
| | - John B Dickey
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcestor, Massachusetts, USA
| | - Athena Poppas
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James Simmons
- Department of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christopher Song
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shadi Yaghi
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Philip Haines
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Middeldorp ME, Sandhu RK, Mao J, Gencer B, Danik JS, Moorthy V, Cook NR, Albert CM. Risk Factors for the Development of New-Onset Persistent Atrial Fibrillation: Subanalysis of the VITAL Study. Circ Arrhythm Electrophysiol 2023; 16:651-662. [PMID: 38018439 PMCID: PMC10852030 DOI: 10.1161/circep.123.012334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Sustained forms of atrial fibrillation (AF) are associated with lower treatment success rates and poorer prognosis compared with paroxysmal AF. Yet, little is known about risk factors that predispose to persistent AF on initial presentation. Our objective was to define risk factors associated with new-onset persistent AF. METHODS We prospectively examined the differential associations between lifestyle, clinical, and socioeconomic risk factors and AF pattern (persistent versus paroxysmal) at the time of diagnosis among 25 119 participants without a history of cardiovascular disease, AF, or cancer in the VITAL rhythm study (Vitamin D and Omega-3). RESULTS During a median follow-up of 5.3 years, 900 participants developed AF and 346 (38.4%) were classified as persistent at the time of diagnosis. In multivariable competing risk models, increasing age, male sex, White race, height, weight, body mass index ≥30 kg/m2, hypertension, current or past smoking, alcohol intake ≥2 drinks/day, postcollege education, and randomized treatment with vitamin D were significantly associated with incident persistent AF. Compared with paroxysmal AF, increasing age, male sex, weight, body mass index ≥30 kg/m2, and postcollege education were more strongly associated with persistent AF in multivariable models regardless of whether interim cardiovascular disease and heart failure events were censored. CONCLUSIONS In a prospective cohort without baseline AF or cardiovascular disease, over one-third of AF at the time of diagnosis is persistent. Older age, male sex, postcollege education, and obesity were preferentially associated with persistent AF and represent a high-risk AF subset for population-based intervention.
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Affiliation(s)
- Melissa E. Middeldorp
- Dept of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Roopinder K. Sandhu
- Dept of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Jessica Mao
- Dept of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Baris Gencer
- Cardiology Division, Geneva University Hospitals, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jacqueline S. Danik
- Division of Cardiovascular Medicine, Dept of Medicine, Massachusetts General Hospital, Harvard Medical School
| | - Vinayaga Moorthy
- Harvard Division of Preventive Medicine, Dept of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Nancy R. Cook
- Harvard Division of Preventive Medicine, Dept of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Christine M. Albert
- Dept of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
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Nasab Mehrabi E, Toupchi‐Khosroshahi V, Athari SS. Relationship of atrial fibrillation and N terminal pro brain natriuretic peptide in heart failure patients. ESC Heart Fail 2023; 10:3250-3257. [PMID: 37776150 PMCID: PMC10682909 DOI: 10.1002/ehf2.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 07/15/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023] Open
Abstract
N terminal pro brain natriuretic peptide (NT-proBNP) plays an important role in the diagnosis and prognosis of heart failure (HF). The plasma level of NT-proBNP in atrial fibrillation (AF) patients was higher than of sinus rhythm patients. In HF, NT-proBNP levels are affected by the concomitant presence of AF, making it difficult to distinguish between HF and AF in patients with elevated NT-proBNP. Several other diseases, such as renal failure and pulmonary embolism, are known to further increase NT-proBNP levels in patients with concomitant HF. Therefore, NT-proBNP is a sensitive but non-specific marker for the detection of HF. AF is very important in this regard because among patients with HF regardless of ejection fraction, symptoms such as shortness of breath and atrial enlargement develop and can mimic HF. In the present study, we investigated whether the prognostic value of natriuretic peptides in HF holds true for patients with concomitant AF.
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Affiliation(s)
- Entezar Nasab Mehrabi
- Department of Cardiology, School of Medicine, Tehran Heart CenterTehran University of Medical SciencesTehranIran
- Department of Cardiology, School of MedicineValiasr Hospital, Zanjan University of Medical SciencesZanjanIran
| | - Vahid Toupchi‐Khosroshahi
- Department of Cardiology, School of MedicineValiasr Hospital, Zanjan University of Medical SciencesZanjanIran
- Department of Cardiology, School of MedicineAyatollah Mousavi Hospital, Zanjan University of Medical SciencesZanjanIran
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7
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Luviano A, Pandya A. Evolution of Value in American College of Cardiology/American Heart Association Clinical Practice Guidelines. Circ Cardiovasc Qual Outcomes 2023; 16:e010086. [PMID: 37920978 PMCID: PMC10842500 DOI: 10.1161/circoutcomes.123.010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND In January 2014, the American College of Cardiology/American Heart Association released a policy statement arguing for the inclusion of cost-effectiveness analysis (CEA) and value assessments in clinical practice guidelines. It is unclear whether subsequent guidelines changed how they incorporated such concepts. METHODS We analyzed guidelines of cardiovascular disease subconditions with a guideline released before and after 2014. We counted the words (total and per page) for 8 selected value- or CEA-related terms and compared counts and rates of terms per page in the guidelines before and after 2014. We counted the number of recommendations with at least 1 reference to a CEA or a CEA-related article to compare the ratios of such recommendations to all recommendations before and after 2014. We looked for the inclusion of the value assessment system recommended by the writing committee of the American College of Cardiology/American Heart Association policy statement of 2014. RESULTS We analyzed 20 guidelines of 10 different cardiovascular disease subconditions. Seven of the 10 cardiovascular disease subconditions had guidelines with a greater term per page rate after 2014 than before 2014. Across all 20 guidelines, the proportion of recommendations with at least 1 reference to a CEA changed from 0.44% to 1.99% (P<0.01). The proportion of recommendations with at least 1 reference to a CEA-related article changed from 1.02% to 3.34% (P<0.01). Only 3 guidelines used a value assessment system. CONCLUSIONS The proportion of recommendations with at least 1 reference to a CEA or CEA-related article was low before and after 2014 for most of the subconditions, however, with substantial variation in this finding across the guidelines included in our analysis. There is a need to organize existing CEA information better and produce more policy-relevant CEAs so guideline writers can more easily make recommendations that incentivize high-value care and caution against using low-value care.
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Affiliation(s)
- Andrea Luviano
- Harvard University, Ph.D. Program in Health Policy, Cambridge, MA, USA
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA. USA
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Mohtasham Kia Y, Cannavo A, Bahiraie P, Alilou S, Saeedian B, Babajani N, Ghondaghsaz E, Khalaji A, Behnoush AH. Insights into the Role of Galectin-3 as a Diagnostic and Prognostic Biomarker of Atrial Fibrillation. DISEASE MARKERS 2023; 2023:2097012. [PMID: 37849915 PMCID: PMC10578984 DOI: 10.1155/2023/2097012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/02/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023]
Abstract
Atrial fibrillation (AF) is an irregular atrial activity and the most prevalent type of arrhythmia. Although AF is easily diagnosed with an electrocardiogram, there is a keen interest in identifying an easy-to-dose biomarker that can predict the prognosis of AF and its recurrence. Galectin-3 (Gal-3) is a beta-galactoside binding protein from the lectin family with pro-fibrotic and -inflammatory effects and a pivotal role in a variety of biological processes, cell proliferation, and differentiation; therefore, it is implicated in the pathogenesis of many cardiovascular (e.g., heart failure (HF)) and noncardiovascular diseases. However, its specificity and sensitivity as a potential marker in AF patients remain debated and controversial. This article comprehensively reviewed the evidence regarding the interplay between Gal-3 and patients with AF. Clinical implications of measuring Gal-3 in AF patients for diagnosis and prognosis are mentioned. Moreover, the role of Gal-3 as a potential biomarker for the management of AF recurrence is investigated. The association of Gal-3 and AF in special populations (coronary artery disease, HF, metabolic syndrome, chronic kidney disease, and diabetes mellitus) has been explored in this review. Overall, although further studies are needed to enlighten the role of Gal-3 in the diagnosis and treatment of AF, our study demonstrated the high potential of this molecule to be used and focused on by researchers and clinicians.
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Affiliation(s)
| | - Alessandro Cannavo
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Pegah Bahiraie
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanam Alilou
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behrad Saeedian
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd., Tehran 1417613151, Iran
| | - Nastaran Babajani
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd., Tehran 1417613151, Iran
| | - Elina Ghondaghsaz
- Undergraduate Program in Neuroscience, University of British Columbia, Vancouver, BC, Canada
| | - Amirmohammad Khalaji
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd., Tehran 1417613151, Iran
| | - Amir Hossein Behnoush
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd., Tehran 1417613151, Iran
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9
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Egami Y, Nishino M, Nohara H, Kawanami S, Sugae H, Ukita K, Kawamura A, Nakamura H, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M, Tanouchi J. Comparison of advanced generation cryoballoon ablation and ablation index-guided pulmonary vein isolation with non-pulmonary vein trigger induction test and additional ablation in paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2023; 66:1571-1580. [PMID: 36575227 DOI: 10.1007/s10840-022-01459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND An ablation index (AI)-guided pulmonary vein isolation (PVI) or 2nd generation cryoballoon (CB)-PVI has been shown to reduce the atrial fibrillation (AF) burden by 99% despite the absence of ablation of non-pulmonary vein (PV) triggers in patients with paroxysmal AF. The purpose of this study was to investigate the effects of PVI alone strategy using 2nd generation CB compared with AI-guided PVI with an additional induction test and subsequent AF trigger ablation. METHODS AND RESULTS We investigated 223 patients with symptomatic paroxysmal AF who underwent an initial PVI between August 2018 and August 2020. The study patients were divided into 2 groups: CB-PVI without an induction test (CB-PVI alone group, n = 82) and AI-guided PVI with an induction test and subsequent additional ablation of non-PV triggers (AI-PVI plus group, n = 141). In the AI-PVI plus group, a total of 62 non-PV triggers were induced in 38 patients, and non-PV triggers in 22 patients were completely ablated. The procedure time and left atrium dwell time were significantly shorter in the CB-PVI alone group than AI-PVI plus group. There were no significant differences in the incidence of procedural complications between the 2 groups (P = 0.650). The AF free survival rate in the CB-PVI alone group and AI-PVI plus group was 80% vs. 80% at 24 months (P = 0.969). CONCLUSIONS An PVI alone strategy using advanced generation CB did not differ in the clinical outcomes compared with an AI-guided PVI strategy with an induction test and subsequent ablation of non-PV triggers in the patients with paroxysmal AF.
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Affiliation(s)
- Yasuyuki Egami
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Masami Nishino
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan.
| | - Hiroaki Nohara
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Shodai Kawanami
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Hiroki Sugae
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Kohei Ukita
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Akito Kawamura
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Hitoshi Nakamura
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Koji Yasumoto
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Masaki Tsuda
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Naotaka Okamoto
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Yasuharu Matsunaga-Lee
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Masamichi Yano
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
| | - Jun Tanouchi
- Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan
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10
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Shin H, Wang SV, Kim DH, Alt E, Mahesri M, Bessette LG, Schneeweiss S, Najafzadeh M. Predicting Treatment Effects of a New-to-Market Drug in Clinical Practice Based on Phase III Randomized Trial Results. Clin Pharmacol Ther 2023; 114:853-861. [PMID: 37365904 PMCID: PMC10851912 DOI: 10.1002/cpt.2983] [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: 03/30/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
Trial results may not be generalizable to target populations treated in clinical practice with different distributions of baseline characteristics that modify the treatment effect. We used outcome models developed with trial data to predict treatment effects in Medicare populations. We used data from the Randomized Evaluation of Long-Term Anticoagulation Therapy trial (RE-LY), which investigated the effect of dabigatran vs. warfarin on stroke or systemic embolism (stroke/SE) among patients with atrial fibrillation. We developed outcome models by fitting proportional hazards models in trial data. Target populations were trial-eligible Medicare beneficiaries who initiated dabigatran or warfarin in 2010-2011 ("early") and 2010-2017 ("extended"). We predicted 2-year risk ratios (RRs) and risk differences (RDs) for stroke/SE, major bleeding, and all-cause death in the Medicare populations using the observed baseline characteristics. The trial and early target populations had similar mean (SD) CHADS2 scores (2.15 (SD 1.13) vs. 2.15 (SD 0.91)) but different mean ages (71 vs. 79 years). Compared with RE-LY, the early Medicare population had similar predicted benefit of dabigatran vs. warfarin for stroke/SE (trial RR = 0.63, 95% confidence interval (CI) = 0.50 to 0.76 and RD = -1.37%, -1.96% to -0.77%, Medicare RR = 0.73, 0.65 to 0.82 and RD = -0.92%, -1.26% to -0.59%) and risks for major bleeding and all-cause death. The time-extended target population showed similar results. Outcome model-based prediction facilitates estimating the average treatment effects of a drug in different target populations when treatment and outcome data are unreliable or unavailable. The predicted effects may inform payers' coverage decisions for patients, especially shortly after a drug's launch when observational data are scarce.
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Affiliation(s)
- HoJin Shin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Shirley V. Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Dae Hyun Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Medicine, Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ethan Alt
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Mufaddal Mahesri
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Lily G. Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Mehdi Najafzadeh
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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11
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Basu Roy P, Tejani VN, Dhillon SS, Damarlapally N, Winson T, Usman NUB, Panjiyar BK. Efficacy and Safety of Novel Oral Anticoagulants in Atrial Fibrillation: A Systematic Review. Cureus 2023; 15:e46385. [PMID: 37927673 PMCID: PMC10620341 DOI: 10.7759/cureus.46385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
In recent times, novel oral anticoagulants (NOACs)/direct oral anticoagulants (DOACs) have emerged as an alternative to the traditionally used Vitamin K oral antagonists (VKA) like warfarin for the treatment of atrial fibrillation (AF). This systematic review and meta-analysis aims to evaluate the efficacy and safety of NOACs in patients with AF and, thus, the related thromboembolic risks and sequelae. Of the 131 published articles we examined, 11 were included in an in-depth systematic review. The articles we reviewed were from the past ten years, from 2013 onward. The analysis derived the efficacy and safety of NOACs in patients with AF and also included different patients' baseline characteristics and subgroups. This systematic review reiterates previous research findings of superior efficacy and safety of the use of NOACs in the AF population and also illuminates certain head-to-head comparisons of individual NOACs with warfarin. It digressed into subgroups of patients with different baseline characteristics to provide evidence and support the existing guidelines for the use of NOACs in the treatment of AF. Overall, there is marked efficacy and safety of NOACs in patients with AF, be they elderly or Asian, with decreased renal function, or with other comorbidities. Adherence to NOACs was also satisfactory. Despite such a review, there needs to be more research on vast subgroups and also on reversal antidotes like andexanet alfa and idarucizumab, as well as more head-to-head analysis between NOACs over a long duration of study, which would provide more answers and pinpoint reasons as to the differences that exist between demographics and subgroups in the usage of NOACs.
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Affiliation(s)
- Prithvi Basu Roy
- Medicine, KPC (Kali Pradip Chaudhuri) Medical College and Hospital, Kolkata, West Bengal, India, Kolkata, IND
| | - Vitrag N Tejani
- Medicine, Parul Institute of Medical Sciences and Research, Vadodara, IND
| | - Sukhmeet S Dhillon
- Internal Medicine, Baba Farid University of Health Sciences, Faridkot, IND
| | - Nanush Damarlapally
- Health Sciences, Houston Community College - Coleman College for Health Sciences, Houston, USA
| | | | | | - Binay K Panjiyar
- Global Clinical Scholars Research Training, Harvard Medical School, Boston, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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12
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Lim R, Bais N, Ali F, Monsalve R, Denney B. Right Heart and Wrong Rhythm: Atrial Flutter in Dextrocardia. Cureus 2023; 15:e42177. [PMID: 37602138 PMCID: PMC10439519 DOI: 10.7759/cureus.42177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Atrial flutter is characterized by rapid atrial activity, causing an abnormal heart rhythm. Recognition and prompt management are of utmost importance since this cardiac arrhythmia could increase the risk of thromboembolic stroke and atrial fibrillation, which may lead to disability and death. Risk factors include myocardial infarction, surgery, medication, and structural heart abnormalities. One distinctive structural abnormality is dextrocardia. Herein, we present a case of a 47-year-old male who initially complains of difficulty in ambulation. Further workup showed atrial flutter with rapid ventricular response on electrocardiogram (ECG) and dextrocardia on imaging. This case tackles the possible association between dextrocardia and arrhythmias, which was an atrial flutter, its management, and treatment outcomes.
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Affiliation(s)
- Roy Lim
- Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | - Navdeep Bais
- Medicine, Ross University School of Medicine, Miramar, USA
| | - Furkhan Ali
- Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | - Reejeen Monsalve
- Internal Medicine, Our Lady of Fatima University, Valenzeula, PHL
| | - Brian Denney
- General Medicine, Cebu Velez General Hospital, Cebu City, PHL
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13
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Sun T, Ye M, Lei F, Qin JJ, Liu YM, Chen Z, Chen MM, Yang C, Zhang P, Ji YX, Zhang XJ, She ZG, Cai J, Jin ZX, Li H. Prevalence and trend of atrial fibrillation and its associated risk factors among the population from nationwide health check-up centers in China, 2012-2017. Front Cardiovasc Med 2023; 10:1151575. [PMID: 37324618 PMCID: PMC10264614 DOI: 10.3389/fcvm.2023.1151575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, which poses huge disease burdens in China. A study was conducted to systematically analyze the recent prevalence trend of AF and age-related disparities in AF risk among the nationwide healthy check-up population. Method We conducted a nationwide cross-sectional study involving 3,049,178 individuals ≥35 years from health check-up centers to explore the prevalence and trend of AF by age, sex, and region from 2012 to 2017. Additionally, we analyzed risk factors associated with AF among the overall population and different age groups via the Boruta algorithm, the LASSO regression, and the Logistic regression. Result The age-, sex-. and regional-standardized prevalence of AF kept stable between 0.4%-0.45% among national physical examination individuals from 2012 to 2017. However, the prevalence of AF showed an undesirable upward trend in the 35-44-year age group (annual percentage changes (APC): 15.16 [95%CI: 6.42,24.62]). With increasing age, the risk of AF associated with the overweight or obesity gradually exceeds that associated with diabetes and hypertension. In addition to traditional leading risk factors such as age≥65 and coronary heart disease, elevated uric acid and impaired renal function were tightly correlated with AF in the population. Conclusion The significant rise in the prevalence of AF in the 35-44 age group reminds us that in addition to the elderly (the high-risk group), younger people seem to be in more urgent need of attention. Age-related disparities in AF risk also exist. This updated information may provide references for the national prevention and control of AF.
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Affiliation(s)
- Tao Sun
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of ModelAnimal, Wuhan University, Wuhan, China
| | - Mao Ye
- Department of Cardiology, Huanggang Central Hospital of Yangtze University, Huanggang, China
- Translation Medicine Research Center of Yangtze University, Huanggang, China
| | - Fang Lei
- Institute of ModelAnimal, Wuhan University, Wuhan, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Juan-Juan Qin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of ModelAnimal, Wuhan University, Wuhan, China
| | - Ye-Mao Liu
- Department of Cardiology, Huanggang Central Hospital of Yangtze University, Huanggang, China
- Translation Medicine Research Center of Yangtze University, Huanggang, China
| | - Ze Chen
- Institute of ModelAnimal, Wuhan University, Wuhan, China
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ming-Ming Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of ModelAnimal, Wuhan University, Wuhan, China
| | - Chengzhang Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of ModelAnimal, Wuhan University, Wuhan, China
| | - Peng Zhang
- Institute of ModelAnimal, Wuhan University, Wuhan, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Yan-Xiao Ji
- Institute of ModelAnimal, Wuhan University, Wuhan, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Xiao-Jing Zhang
- Institute of ModelAnimal, Wuhan University, Wuhan, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of ModelAnimal, Wuhan University, Wuhan, China
| | - Jingjing Cai
- Institute of ModelAnimal, Wuhan University, Wuhan, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhao-Xia Jin
- Department of Cardiology, Huanggang Central Hospital of Yangtze University, Huanggang, China
- Translation Medicine Research Center of Yangtze University, Huanggang, China
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of ModelAnimal, Wuhan University, Wuhan, China
- Translation Medicine Research Center of Yangtze University, Huanggang, China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
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14
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Pedro B, Mavropoulou A, Oyama MA, Linney C, Neves J, Dukes-McEwan J, Fontes-Sousa AP, Gelzer AR. Optimal rate control in dogs with atrial fibrillation-ORCA study-Multicenter prospective observational study: Prognostic impact and predictors of rate control. J Vet Intern Med 2023; 37:887-899. [PMID: 37128174 DOI: 10.1111/jvim.16666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/06/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The optimal heart rate (HR) in dogs with atrial fibrillation (AF) is unknown. Impact of HR on survival needs elucidation. HYPOTHESIS/OBJECTIVES Dogs with a 24 hours Holter-derived meanHR ≤125 beats per minute (bpm; rate controlled) survive longer than dogs with higher meanHR. We further aimed to determine which variables predict ability to achieving rate control. ANIMALS Sixty dogs with AF. METHODS Holter-derived meanHR, clinical, echocardiographic, and biomarker variables were analyzed prospectively. Survival was recorded from time of rate control, with all-cause mortality as primary endpoint. Cox proportional hazards analysis identified variables independently associated with survival; Kaplan-Meier survival analysis estimated the median survival time of dogs with meanHR ≤125 bpm vs >125 bpm. Logistic regression explored baseline variables associated with inability to achieve rate control. RESULTS Structural heart disease was present in 56/60 dogs, 50/60 had congestive heart failure, and 45/60 died. Median time to all-cause death was 160 days (range, 88-303 days), dogs with meanHR >125 bpm (n = 27) lived 33 days (95% confidence interval [CI], 15-141 days), dogs with meanHR ≤125 bpm (n = 33) lived 608 days (95% CI, 155-880 days; P < .0001). Congenital heart disease and N-terminal pro-B-type natriuretic peptide were independently associated with higher risk of death (P < .01 and <.0001, respectively) whereas meanHR ≤125 bpm decreased the risk of death (P < .001). Increased left atrial size, increased C-reactive protein concentration and lower blood pressure at admission were associated with failure to achieve rate control. CONCLUSIONS AND CLINICAL IMPORTANCE Rate control affects survival; an optimal target meanHR <125 bpm should be sought in dogs with AF. Baseline patient variables can help predict if rate control is achievable.
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Affiliation(s)
- Brigite Pedro
- Willows Veterinary Centre and Referral Service, West Midlands, United Kingdom
- Centro de Cardiologia Veterinária do Porto, Porto, Portugal
- Centro de Cardiologia Veterinária do Atlântico, Mafra, Portugal
- Virtual Veterinary Specialists Ltd, Middlesex, United Kingdom
- ICBAS-UP, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | | | - Mark A Oyama
- Department of Clinical Studies and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Linney
- Willows Veterinary Centre and Referral Service, West Midlands, United Kingdom
- Paragon Veterinary Referrals, Wakefield, United Kingdom
| | - João Neves
- Willows Veterinary Centre and Referral Service, West Midlands, United Kingdom
- Centro de Cardiologia Veterinária do Porto, Porto, Portugal
- Centro de Cardiologia Veterinária do Atlântico, Mafra, Portugal
- Virtual Veterinary Specialists Ltd, Middlesex, United Kingdom
| | - Joanna Dukes-McEwan
- Small Animal Teaching Hospital, Department of Small Animal Clinical Science, University of Liverpool Leahurst Campus, Neston, United Kingdom
| | - Ana P Fontes-Sousa
- ICBAS-UP, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Departamento de Imuno-Fisiologia e Farmacologia, Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), Universidade do Porto, Porto, Portugal
- UPVET, Hospital Veterinário da Universidade do Porto, Porto, Portugal
| | - Anna R Gelzer
- Department of Clinical Studies and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Hou Z, Zhao MX, Sun Y, Zhang S, Yao S, Wang C, Wang M, Yun C, Xue H, Wu S. Resting heart rate and risk of atrial fibrillation in Chinese general population: Kailuan prospective cohort study. BMJ Open 2023; 13:e070312. [PMID: 37116993 PMCID: PMC10151892 DOI: 10.1136/bmjopen-2022-070312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE Previous research has shown an association of higher heart rate with an increased risk of atrial fibrillation (AF). However, the relationship between resting heart rate (RHR) and AF is unknown. The aim of this study was to investigate the association between RHR and AF in the general population of China. DESIGN Prospective observational cohort study. SETTING Community based. PARTICIPANTS A total of 46 126 individuals from the Kailuan study who participated in the first three surveys (2006/2007, 2008/2009 and 2010/2011) and were followed up at 2-year intervals were enrolled. PRIMARY OUTCOME MEASURES The association between RHR and risk of incident AF was evaluated using Cox proportional hazards regression and restricted cubic spline models. RESULTS Two hundred and forty-one individuals (0.52%) developed AF during 7.5 years of follow-up. After adjustment for age, sex, low-density and high-density lipoprotein, physical activity, alcohol consumption, smoking status, body mass index, mean systolic blood pressure, and history of diabetes and hypertension, the HRs were 2.32 (95% CI 1.45 to 3.72) for an RHR <60 beats/min and 2.80 (1.13 to 6.94) for an RHR ≥100 beats/min in comparison with an RHR of 70-80 beats/min. Restricted cubic spline models revealed a U-shaped relationship between RHR and incident AF. CONCLUSION These findings indicate that RHR and incident AF have a U-shaped relationship in the Chinese general population. Both lower and higher RHRs were associated with an increased risk of AF.
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Affiliation(s)
- Ziwei Hou
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Mao Xiang Zhao
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yizhen Sun
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Sijing Zhang
- Clinical medicine, Nankai University, Tianjin, China
| | - Siyu Yao
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Chi Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Miao Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Cuijuan Yun
- Clinical medicine, Nankai University, Tianjin, China
| | - Hao Xue
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
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16
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Sankaranarayanan R, Bansal A, Yanamaladoddi VR, Sarvepalli SS, Vemula SL, Aramadaka S, Mannam R. Atrial Fibrillation in Obstructive Sleep Apnea Patients: Mechanisms, Risk Factors, and Management Strategies. Cureus 2023; 15:e36282. [PMID: 37073195 PMCID: PMC10105971 DOI: 10.7759/cureus.36282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/19/2023] Open
Abstract
Obstructive sleep apnea (OSA) is identified by apnea or hypopnea of the upper respiratory tract, which is associated with decreased oxygen saturation or awakening from sleep. A severe and prevalent association with OSA is atrial fibrillation (AF). This review article outlined numerous studies to understand the pathogenic pathways linked with developing OSA-associated AF and the therapeutic and preventive options available to reduce AF. The article looked for multiple risk factors common to OSA and AF. In addition, it has reviewed several therapeutic modalities such as continuous positive air pressure (CPAP), weight loss, upper airway stimulation (UAS), and other novel treatment options to find their efficiency in decreasing the outcome of AF in OSA patients. Since OSA often goes undiagnosed, this article emphasizes the importance of early screening in patients with AF and other comorbid conditions such as obesity, advanced age, diabetes, hypertension, and many more. The article focuses on the importance of preventive approaches that can be easily implemented, such as behavioral modifications.
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17
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Zhang J, Wang J, Jiang Y, Zheng X, Li W, Li H. Association of Mitral Regurgitation with Postoperative Atrial Fibrillation in Critically Ill Noncardiac Surgery Patients: A Prospective Cohort Study. Int J Gen Med 2023; 16:769-783. [PMID: 36879619 PMCID: PMC9985404 DOI: 10.2147/ijgm.s400122] [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: 12/03/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
Purpose Atrial fibrillation (AF) is common in critically ill patients and can have serious consequences. Postoperative AF (POAF) in critically ill patients following noncardiac surgery has been understudied, contrary to cardiac procedures. Mitral regurgitation (MR) is associated with left ventricular dysfunction, which might contribute to the occurrence of AF in postoperative critically ill patients. This study aimed to investigate the association between MR and POAF in critically ill noncardiac surgery patients and establish a new nomogram for the prediction of POAF in critically ill noncardiac surgery patients. Patients and Methods A prospective cohort of 2474 patients who underwent thoracic and general surgery was enrolled in this study. Data on preoperative transthoracic echocardiography (TTE), electrocardiogram (ECG), and several commonly utilized scoring systems (CHA2DS2-VASc, HATCH, COM-AF, HART, and C2HEST) and baseline clinical data were collected. Independent predictors were selected by univariate and multivariable logistic regression analysis, and a nomogram was constructed for POAF within 7 days after postoperative intensive care unit (ICU) admission. The ability of the MR-nomogram and other scoring systems to predict POAF was compared by receiver operator characteristic (ROC) curve analysis and decision curve analysis (DCA). Additional contributions were evaluated by integrated discrimination improvement (IDI) and net reclassification improvement (NRI) analysis. Results A total of 213 (8.6%) patients developed POAF within 7 days after ICU admission. Compared to CHA2DS2-VASc, HATCH, COM-AF, HART, and C2HEST scoring systems, MR-nomogram showed better predictive ability for POAF with an area under the ROC curve of 0.824 (95% confidence interval: 0.805-0.842, p < 0.001). The improvement of the MR-nomogram in predictive value was supported by NRI and IDI analysis. The net benefit of the MR nomogram was maximal in DCA. Conclusion MR is an independent risk factor of POAF in critically ill noncardiac surgery patients. The nomogram predicted POAF better than other scoring systems.
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Affiliation(s)
- Jin Zhang
- Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jingyi Wang
- Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yijia Jiang
- Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xi Zheng
- Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenxiong Li
- Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hui Li
- Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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18
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Jarab AS, Al-Qerem WA, Hamam HW, Alzoubi KH, Abu Heshmeh SR, Mukattash TL, Alefishat E. Medication Adherence and Its Associated Factors Among Outpatients with Heart Failure. Patient Prefer Adherence 2023; 17:1209-1220. [PMID: 37187575 PMCID: PMC10178996 DOI: 10.2147/ppa.s410371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023] Open
Abstract
Background Poor adherence to heart failure (HF) medications represents a major barrier to achieve the desired health outcomes in those patients. Objective To assess medication adherence and to explore the factors associated with medication non-adherence among patient with HF in Jordan. Methods The current cross-sectional study was conducted at the outpatient cardiology clinics at two main hospitals in Jordan from August 2021 through April 2022. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the 4-item Morisky Medication Adherence Scale. Multinomial logistic regression analysis was performed to identify the factors that are significantly and independently associated with medication non-adherence. Results Of the 427 participating patients, 92.5% had low to moderate medication adherence. Results of the regression analysis revealed that that patients who had higher education level (OR=3.36; 95% CI 1.08-10.43; P=0.04) and were not suffering from medication-related side effects (OR=4.7; 95% CI 1.91-11.5; P=0.001) had significantly higher odds of being in the moderate adherence group. Patients who were taking statins (OR=16.59; 95% CI 1.79-153.98; P=0.01) or ACEIs/ ARBs (OR=3.95; 95% CI 1.01-15.41; P=0.04) had significantly higher odds of being in the high adherence group. Furthermore, Patients who were not taking anticoagulants had higher odds of being in the moderate (OR=2.77; 95% CI 1.2-6.46; P=0.02) and high (OR=4.11; 95% CI 1.27-13.36; P=0.02) adherence groups when compared to patients who were taking anticoagulants. Conclusion The poor medication adherence in the present study sheds the light on the importance of implementing intervention programs which focus on improving patients' perception about the prescribed medications particularly for patients who have low educational levels, receive an anticoagulant, and do not receive a statin or an ACEI/ ARB.
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Affiliation(s)
- Anan S Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Walid A Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, 11733, Jordan
| | - Hanan Walid Hamam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shrouq R Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Eman Alefishat
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, 11942, Jordan
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
- Correspondence: Eman Alefishat, Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates, Tel +971 5 07293877, Email
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Holter ECG monitoring for the evaluation of stroke in the internal medicine department. J Stroke Cerebrovasc Dis 2022; 31:106802. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 11/21/2022] Open
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Sharma AN, McIntyre WF, Nguyen ST, Baranchuk A. Implantable loop recorders in patients with atrial fibrillation. Expert Rev Cardiovasc Ther 2022; 20:919-928. [PMID: 36444859 DOI: 10.1080/14779072.2022.2153673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Implantable loop recorders (ILRs) provide practitioners with high-quality electrocardiographic data over an extended monitoring period. These data can guide the diagnosis and management of patients with atrial fibrillation (AF). AREAS COVERED This review summarizes the available evidence and consensus statements supporting the use of ILRs in the detection of AF, as well as monitoring of patients with known AF. Future directions for research are also discussed. EXPERT OPINION ILRs are the gold standard for detecting AF, providing superior diagnostic yield compared to other modes of ambulatory electrocardiography monitoring. Both experimental evidence and consensus statements support the use of ILRs in clinical settings where the diagnosis of AF may significantly change management, or where a high degree of sensitivity is needed. ILRs may also be used to monitor patients following AF ablation. More evidence is needed to better inform how ILR-detected AF should change management.
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Affiliation(s)
- Arjun N Sharma
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | | | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, ON, Canada
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21
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Kaufmann D, Wabich E, Kapłon-Cieślicka A, Gawałko M, Budnik M, Uziębło-Życzkowska B, Krzesiński P, Starzyk K, Wożakowska-Kapłon B, Wójcik M, Błaszczyk R, Hiczkiewicz J, Budzianowski J, Mizia-Stec K, Wybraniec MT, Kosmalska K, Fijałkowski M, Szymańska A, Dłużniewski M, Haberka M, Kucio M, Michalski B, Kupczyńska K, Tomaszuk-Kazberuk A, Wilk-Śledziewska K, Wachnicka-Truty R, Koziński M, Burchardt P, Daniłowicz-Szymanowicz L. Echocardiographic predictors of thrombus in left atrial appendage—The role of novel transthoracic parameters. Front Cardiovasc Med 2022; 9:1059111. [DOI: 10.3389/fcvm.2022.1059111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
IntroductionThe left atrium appendage thrombus (LAAT) formation is a complex process. A CHA2DS2-VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation or flutter (AF/AFL). We aimed to identify whether any transthoracic echocardiography (TTE) parameters could have an additional impact on LAAT detection.MethodsThat is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3,109 consecutive patients with AF/AFL referred for transesophageal echocardiography (TEE) before cardioversion or ablation.ResultsLAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis [based on pre-specified in the receiver operating characteristic (ROC) analysis cut-off values with AUC ≥ 0.7] identified left ventricular ejection fraction (LVEF) ≤ 48% and novel TTE parameters i.e., the ratios of LVEF and left atrial diameter (LAD) ≤ 1.1 (AUC 0.75; OR 5.64; 95% CI 4.03–7.9; p < 0.001), LVEF to left atrial area (LAA) ≤ 1.7 (AUC 0.75; OR 5.64; 95% CI 4.02–7.9; p < 0.001), and LVEF to indexed left atrial volume (LAVI) ≤ 1.1 (AUC 0.75, OR 6.77; 95% CI 4.25–10.8; p < 0.001) as significant predictors of LAAT. In a multivariate logistic regression analysis, LVEF/LAVI and LVEF/LAA maintained statistical significance. Calculating the accuracy of the abovementioned ratios according to the CHA2DS2-VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk.ConclusionNovel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk.
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22
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Lin L, Li K, Tian B, Jia M, Wang Q, Xu C, Xiong L, Wang Q, Zeng Y, Wang P. Two Novel Functional Mutations in Promoter Region of SCN3B Gene Associated with Atrial Fibrillation. Life (Basel) 2022; 12:life12111794. [PMID: 36362949 PMCID: PMC9698146 DOI: 10.3390/life12111794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
The sodium voltage-gated channel beta subunit 3 (SCN3B) plays a crucial role in electrically excitable cells and conduction tissue in the heart. Some previous studies have established that genetic modification in sodium voltage-channel genes encoding for the cardiac β-subunits, such as SCN1B, SCN2B, SCN3B and SCN4B, can result in atrial fibrillation (AF). In the current study, we identified two rare variants in 5′UTR (NM_018400.4: c.-324C>A, rs976125894 and NM_018400.4: c.-303C>T, rs1284768362) of SCN3B in two unrelated lone AF patients. Our further functional studies discovered that one of them, the A allele of c.-324C>A (rs976125894), can improve transcriptional activity and may raise SCN3B expression levels. The A allele of c.-324C>A (rs976125894) has higher transcriptional activity when it interacts with GATA4, as we confirmed transcription factor GATA4 is a regulator of SCN3B. To the best of our knowledge, the current study is the first to demonstrate that the gain-of-function mutation of SCN3B can produce AF and the first to link a mutation occurring in the non-coding 5′UTR region of SCN3B to lone AF. The work also offers empirical proof that GATA4 is a critical regulator of SCN3B gene regulation. Our findings may serve as an encyclopedia for AF susceptibility variants and can also provide insight into the investigation of the functional mechanisms behind AF variants discovered by genetic methods.
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Affiliation(s)
- Liyan Lin
- Department of Clinical Laboratory, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
| | - Ke Li
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
- Human Genome Research Center, College of Life and Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Beijia Tian
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
- Human Genome Research Center, College of Life and Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Mengru Jia
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
- Human Genome Research Center, College of Life and Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Qianyan Wang
- Liyuan Cardiovascular Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
| | - Chengqi Xu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
- Human Genome Research Center, College of Life and Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Liang Xiong
- Department of Clinical Laboratory, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
| | - Qing Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
- Human Genome Research Center, College of Life and Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Yali Zeng
- Department of Clinical Laboratory, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
- Correspondence: (Y.Z.); (P.W.)
| | - Pengyun Wang
- Department of Clinical Laboratory, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
- Correspondence: (Y.Z.); (P.W.)
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23
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D'Errico MM, Piscitelli P, Mirijello A, Santoliquido M, Salvatori M, Vigna C, Vendemiale G, Lamacchia O, Fontana A, Copetti M, Pontremoli R, De Cosmo SA. CHA2DS2-VASc and R2CHA2DS2-VASc scores predict mortality in high cardiovascular risk population. Eur J Clin Invest 2022; 52:e13830. [PMID: 35778894 DOI: 10.1111/eci.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The CHA2 DS2 -VASc score, widely used to estimate cardioembolic risk in patients with atrial fibrillation (AF), appears to be useful also in predicting vascular adverse events and death in different sets of patients without AF. The R2 CHA2 DS2 -VASc score, which includes renal impairment, allows a better prediction of death and thromboembolism in patients without AF. The aims of our study were to assess, in a large sample of patients at high cardiovascular (CV) risk, (i) the correlation between CHA2 DS2 -VASc and R2 CHA2 DS2 -VASc with all-cause mortality, and (ii) to compare the performances of CHA2 DS2 -VASc and R2 CHA2 DS2 -VASc in predicting all-cause mortality. METHODS In this single-centre prospective observational study, conducted at the Research Hospital 'Casa Sollievo della Sofferenza' between June 2016 and December 2018, 1017 CV patients at high risk of undergoing coronary angiography were enrolled. RESULTS CHA₂DS₂-VASc and R2 CHA2 DS2 -VASc scores significantly associated with all-cause mortality. For each one-point increase in CHA2 DS2 -VASc or R2 CHA2 DS2 -VASc scores, mortality increased by almost 1.5-fold. The R2 CHA2 DS2 -VASc score (C-statistic = 0.71; 95% CI = 0.65-76) outperformed the CHA2 DS2 -VASc score (C-statistic = 0.66; 95% CI = 0.61-0.71) in predicting 4-year mortality (delta C-statistic = 0.05; 95% CI = 0.02-0.07). The better predictive ability of the R-CHA2 DS2 -VASc score was also demonstrated by an IDI = 0.027 (95% CI = 0.021-0.034, p < .00001) and a relative IDI = 62.8% (95% CI = 47.9%-81.3%, p < .00001). The R2 CHA2 DS2 -VASc score correctly reclassified the patients with a NRI = 0.715 (95% = 0.544-0.940, p < .00001). CONCLUSIONS The CHA₂DS₂-VASc and R2 CHA2 DS2 -VASc scores are useful predictors of all-cause mortality in subjects at high CV risk, with the R2 CHA2 DS2 -VASc score being the best performer.
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Affiliation(s)
- Maria Maddalena D'Errico
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Pamela Piscitelli
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonio Mirijello
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mariateresa Santoliquido
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.,Geriatrics Residency School, University of Foggia, Foggia, Italy
| | - Mauro Salvatori
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Carlo Vigna
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Olga Lamacchia
- Unit of Endocrinology, University of Foggia, Foggia, Italy
| | - Andrea Fontana
- Biostatistics Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Massimiliano Copetti
- Biostatistics Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Roberto Pontremoli
- University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Salvatore A De Cosmo
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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Wu J, Hou Q, Han Q, Mao R, Yue B, Yu J, Chen S, Wu S, Li K. Atrial fibrillation is an independent risk factor for new-onset myocardial infarction: a prospective study. Acta Cardiol 2022; 78:341-348. [PMID: 36251263 DOI: 10.1080/00015385.2022.2129184] [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: 11/01/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) and myocardial infarction (MI) share common cardiovascular risk factors, therefore coexistence of AF and MI is very common, in addition, both AF and MI aggravate and exacerbate each other through multiple pathological processes. The aim of this study is to investigate whether AF increases the risk of new-onset MI. METHODS In total 171,086 participants from an industrial city in North China were selected and enrolled in this prospective cohort study, participants were divided into the AF group or the non-AF group according to their medical history. 1542 participants from the AF group were propensity-matched with 4626 participants from the non-AF group. All the participants were followed up every 2 years from June 2006 to December 2020, the median follow-up was 14.25 years and the endpoint of this study was new-onset MI. The association between AF and new-onset MI was analysed by using both univariate and multivariate Cox proportional hazards regression analysis. RESULTS New-onset MI was documented in 56 cases from the AF group and 98 cases from the non-AF group, respectively, the cumulative incidence of new-onset MI in the AF group (3.73%) was significantly higher than that in the non-AF group (2.23%) (p < 0.01). In a univariate analysis, AF was associated with an increased risk of new-onset MI (hazard ratio: 1.73, 95% confidence interval: 1.24-2.40), in two multivariable-adjusted analyses, AF was still associated with an increased risk of new-onset MI (hazard ratio: 1.78, 95% confidence interval, 1.28-2.47). CONCLUSIONS AF is an independent risk factor for new-onset MI in an industrial population of North China.
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Affiliation(s)
- Jianmei Wu
- Department of Cardiovascular Surgery, Tangshan Gongren Hospital, Tangshan, China
| | - Qiqi Hou
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China.,Graduate School, Hebei Medical University, Shijiazhuang, China
| | - Quanle Han
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China.,Graduate School, Hebei Medical University, Shijiazhuang, China.,School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Ruiying Mao
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China
| | - Bocheng Yue
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China
| | - Jing Yu
- Department of Intervention, Tangshan Gongren Hospital, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China.,Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Kangbo Li
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
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25
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Mahfouz R, Douglas MF, Obeidat AE, Darweesh M, Mansour MM, Shah P, Aldiabat M, Aljabiri Y, Fishman A. Impact of Atrial Fibrillation on Patients With Inflammatory Bowel Disease Admitted for Colectomy. Cureus 2022; 14:e27849. [PMID: 36110442 PMCID: PMC9462059 DOI: 10.7759/cureus.27849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/05/2022] Open
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26
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Zhou Y, Yan M, Yuan J, Wang Y, Qiao S. Continuous Positive Airway Pressure Treatment Decreases the Risk of Atrial Fibrillation Recurrence in Patients with Obstructive Sleep Apnea after Radiofrequency Ablation. Int Heart J 2022; 63:716-721. [PMID: 35831157 DOI: 10.1536/ihj.22-129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to determine the effect of continuous positive airway pressure (CPAP) therapy on patients with atrial fibrillation (AF) and obstructive sleep apnea (OSA) after radiofrequency ablation (RFCA).OSA predicts recurrence of AF in patients with AF and OSA after RFCA. However, the effect of CPAP therapy on recurrence of AF in these patients after RFCA is poorly known.All 122 patients who underwent RFCA from 2017 to 2020 were diagnosed OSA by polysomnography. A total of 62 patients were treated by CPAP, while the remaining 60 were not treated by CPAP. The recurrence of atrial tachyarrhythmia and use of antiarrhythmic drugs were compared between the two groups during a follow-up of 12 months. The outcome of these patients with OSA was compared to a group of 60 AF patients undergoing RFCA without OSA.Patients undergoing CPAP therapy had a higher AF-free survival rate compared to non-CPAP-treated patients (70.3% versus 31.5%; P = 0.02). LAD was associated with the risk of AF recurrence in patients with OSA (HR per mm increase: 1.0; 95% CI: 1.06-1.21; P = 0.01). The CPAP nonusers had more than two-fold increased risk of AF recurrence following pulmonary vein isolation (HR: 2.37; 95% CI: 1.21-4.96; P = 0.02).CPAP treatment highly increased arrhythmia-free survival in AF patients accompanied by OSA after RFCA and reduced recurrence of AF in these patients.
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Affiliation(s)
- Ying Zhou
- Department of Cardiology, China-Japan Friendship Hospital
| | - Mengwen Yan
- Department of Cardiology, China-Japan Friendship Hospital
| | - Jiansong Yuan
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital
| | - Yong Wang
- Department of Cardiology, China-Japan Friendship Hospital
| | - Shubin Qiao
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital
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27
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Zhao M, Du W, Zhao Q, Chen Y, Li B, Xie Z, Fu Z, Zhang N, Cheng X, Li X, Yao S, Wang M, Wang C, Wu S, Xue H, Li Y. Transition of Metabolic Phenotypes and Risk of Atrial Fibrillation According to BMI: Kailuan Study. Front Cardiovasc Med 2022; 9:888062. [PMID: 35837597 PMCID: PMC9274110 DOI: 10.3389/fcvm.2022.888062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAtrial fibrillation (AF) is associated with both obesity and its metabolic consequences. However, there is a paucity of information on whether the dynamic change of metabolic health and obesity phenotypes affect the risk of AF. We aimed to prospectively examine the association between metabolic health and its change over time and AF risk across body mass index (BMI) categories.MethodsA total of 58,483 participants without history of cancer, and cardiovascular diseases from the Kailuan study were included in the present study. Transition of metabolic phenotypes was evaluated between 1st survey (2006–2007) and the 2nd survey (2008–2009). The hazard ratios (HRs) and 95% confidence intervals (CIs) for AF were assessed by Cox proportional hazards regression.ResultsDuring a median follow-up of 3 years, we documented 580 cases of AF. Compared with metabolically healthy individuals with normal weight, the multivariable-adjusted hazard ratios for metabolically healthy and unhealthy overweight/obese were 1.27 (95% CI: 1.01, 1.59) and 1.37 (95% CI: 1.09, 1.72), respectively. However, when transition was taken into account, overweight/obese people who maintained metabolically healthy status were not associated with increased long-term risk (HR, 1.11;95% CI: 0.70, 1.78), whereas participants who converted from metabolically healthy overweight/obese status to an unhealthy phenotype had higher AF risk than those who maintained metabolically healthy normal weight (HR 1.59, 95% CI: 1.11, 2.26). When BMI and metabolically healthy status were updated over the course of the study, significant short-term elevations in AF risk were associated with individuals with stable MU-OW/OB status.ConclusionIn this community-based cohort study, metabolically healthy overweight/obese individuals have increased risks of AF. Obesity remains a risk factor for AF independent of major metabolic factors. Our data further suggested that metabolic phenotype was a dynamic condition, and maintenance of metabolic health and normal weight might alleviate the risk of AF.
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Affiliation(s)
- Maoxiang Zhao
- Department of Cardiology, First Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Wenjuan Du
- Laboratory of Radiation Injury Treatment, Medical Innovation Research Division, PLA General Hospital, Beijing, China
| | - Qianqian Zhao
- Department of Cardiology, First Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Yating Chen
- Department of Cardiology, First Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Bin Li
- Department of Cardiology, First Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Zhonghui Xie
- Department of Cardiology, First Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Zihao Fu
- Department of Cardiology, First Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Nan Zhang
- Department of Cardiology, First Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Xiaowei Cheng
- Department of Cardiology, First Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Xiaoqian Li
- Department of Cardiology, Fujian Medical University, Fuzhou, China
| | - Siyu Yao
- Department of Cardiology, First Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Miao Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Chi Wang
- Department of Cardiology, First Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Tangshan, China
- *Correspondence: Shouling Wu,
| | - Hao Xue
- Department of Cardiology, Sixth Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
- Hao Xue,
| | - Yang Li
- Department of Cardiology, First Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation Army, Beijing, China
- Yang Li,
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Khatoun MA, Toufayli H, Touma MJ, Nasr SR. Persistent Atrium Standstill Post Atrial Fibrillation Ablation Therapy. Cureus 2022; 14:e25293. [PMID: 35755564 PMCID: PMC9222494 DOI: 10.7759/cureus.25293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 12/05/2022] Open
Abstract
Atrial standstill is a rare condition in which the atrium loses its mechanical contraction with or without losing the electrical conduction. In this report, we discuss a case of a 64-year-old male patient with a history of hypertrophic cardiomyopathy (HCM) and persistent refractory atrial fibrillation (AF). He underwent ablation therapy with a successful return to sinus rhythm. However, post-procedure echocardiography imaging showed the absence of left atrium mechanical activity. We aim to highlight the importance of assessing atrial mechanical activity by imaging after sinus cardioversion in order to treat any preventable complications promptly.
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Badescu MC, Badulescu OV, Butnariu LI, Floria M, Ciocoiu M, Costache II, Popescu D, Bratoiu I, Buliga-Finis ON, Rezus C. Current Therapeutic Approach to Atrial Fibrillation in Patients with Congenital Hemophilia. J Pers Med 2022; 12:519. [PMID: 35455634 PMCID: PMC9029474 DOI: 10.3390/jpm12040519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Cardiovascular disease in hemophiliacs has an increasing prevalence due to the aging of this population. Hemophiliacs are perceived as having a high bleeding risk due to the coagulation factor VIII/IX deficiency, but it is currently acknowledged that they also have an important ischemic risk. The treatment of atrial fibrillation (AF) is particularly challenging since it usually requires anticoagulant treatment. The CHA2DS2-VASc score is used to estimate the risk of stroke and peripheral embolism, and along with the severity of hemophilia, guide the therapeutic strategy. Our work provides the most complete, structured, and updated analysis of the current therapeutic approach of AF in hemophiliacs, emphasizing that there is a growing interest in therapeutic strategies that allow for short-term anticoagulant therapy. Catheter ablation and left atrial appendage occlusion have proven to be efficient and safe procedures in hemophiliacs, if appropriate replacement therapy can be provided.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.V.B.); (M.C.)
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Lacramioara Ionela Butnariu
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mariana Floria
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
- Internal Medicine Clinic, “Dr. Iacob Czihac” Emergency Military Clinical Hospital Iasi, 700483 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.V.B.); (M.C.)
| | - Irina-Iuliana Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
| | - Ioana Bratoiu
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Oana Nicoleta Buliga-Finis
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
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Hilow HJ, Whibley D, Kratz AL, Ghanbari H. A focus group study to inform design of a symptom management intervention for adults with atrial fibrillation. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 2:246-255. [PMID: 35265916 PMCID: PMC8890334 DOI: 10.1016/j.cvdhj.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Current symptom management approaches for patients with atrial fibrillation (AF) focus on addressing heart rhythm and do not include management of behavioral or emotional contributors to symptom manifestation or severity. Objective To inform content development of a digitally delivered AF symptom self-management program by exploring patients’ experiences of the impact of AF symptoms and their perspectives on behavioral approaches to symptom management. Methods This was a qualitative study of 3 focus groups composed of adults living with symptomatic AF. Group transcripts underwent thematic content analysis to identify themes and subthemes. Themes were matched to available self-management strategies that could be adapted for use in a digitally delivered AF symptom self-management program. Results Six major themes (with subthemes) were identified: symptoms (anxiety, fatigue, stress/other negative emotions, AF-specific symptoms, heart rhythm); social aspects (social impact, social support); AF treatments (medication, procedures); health behaviors (sleep, physical activity, hydration, breathing/mindfulness/relaxation); positive emotions; and AF education and information gathering. Symptom self-management strategies were identified that could be used to address these symptom-related themes. Conclusion Patients with AF reported a wide range of emotional, physical, and social impacts of the condition. They endorsed attempts to self-manage symptoms and an interest in learning more about how to effectively self-manage. Findings indicate the potential for a digital self-management program to address existing gaps in AF symptom–related care.
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Affiliation(s)
- Henry J. Hilow
- Section of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Anna L. Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Hamid Ghanbari
- Section of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Address reprint requests and correspondence: Dr Hamid Ghanbari, Department of Internal Medicine, Section of Cardiology, University of Michigan, 1425 E Ann St, Ann Arbor, MI 48109.
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Roy AT, Schwamm LH, Singhal AB. Use of Prolonged Cardiac Rhythm Monitoring to Identify Atrial Fibrillation After Cryptogenic Stroke. Curr Cardiol Rep 2022; 24:337-346. [PMID: 35171442 DOI: 10.1007/s11886-022-01652-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Prolonged cardiac monitoring (PCM) improves detection of atrial fibrillation (AF) after cryptogenic stroke. We summarize current research supporting the use of PCM as part of the cryptogenic stroke evaluation, while highlighting areas that require more investigation. RECENT FINDINGS Despite increased AF detection with longer durations of PCM, more definitive research is needed to demonstrate how PCM improves clinical outcomes. The optimal type, timing, and length of cardiac monitoring after cryptogenic stoke remains unknown. Clinical calculators will be important to risk stratify which cryptogenic stroke patients are most likely to benefit from PCM. Currently, AF detection after cryptogenic stroke should prompt consideration of anticoagulation, but it is unclear if all durations and timing of AF after stroke should be treated the same. PCM remains an important part of the cryptogenic stroke work up, and detection of AF allows for anticoagulation initiation. Additional research is needed to further refine our application of PCM to cryptogenic stroke.
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Affiliation(s)
- Alexis T Roy
- Stroke Service, Department of Neurology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Lee H Schwamm
- Stroke Service, Department of Neurology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Aneesh B Singhal
- Stroke Service, Department of Neurology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
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Sveen KA, Smith G, Björkbacka H, Orho-Melander M, Engström G, Gonçalves I, Melander O, Nilsson J, Bengtsson E. High levels of autoantibodies against apoB100 p210 are associated with lower incidence of atrial fibrillation in women. J Intern Med 2022; 291:207-217. [PMID: 34532909 DOI: 10.1111/joim.13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Atrial fibrillation (AF) is associated with inflammation, both systemically and in the atrial tissue. Oxidized low-density lipoprotein (LDL) is increased in patients with AF and is suggested to be one of the molecules that drives inflammation. Autoantibodies against oxidized LDL and apolipoprotein B100, the protein component of LDL, are linked to atherosclerotic disease. However, whether these autoantibodies are associated with occurrence of AF is not known. We investigated autoantibodies against oxidized apolipoprotein B100 peptides and incidence of AF in a large population-based cohort. METHODS IgM and IgG against native and aldehyde-modified apoB100 peptides 210 (p210) and 45 were analyzed by enzyme-linked immunosorbent assay (ELISA) in 5169 individuals from the Malmö Diet and Cancer cohort. RESULTS Seven hundred sixty-nine incident AF cases were recorded during a follow-up of 21.3 years. Individuals with high levels of IgM against native p210 at baseline had a lower risk of developing AF; however, the association did not remain after adjustment for age and sex. Women had higher levels of IgM against native p210 than men (0.70 ± 0.22 AU vs. 0.63 ± 0.21 AU, p < 0.001). The association of IgM against native p210 and AF was significantly different between sexes (p for interaction = 0.024), where females with high IgM against p210 had a lower risk for incidence of AF (hazard ratio [95% confidence interval] 4th versus 1st quartile: 0.67 [0.49-0.91]; p = 0.01) after adjusting for risk factors and comorbidities. CONCLUSION These findings support an association of humoral autoimmunity with AF.
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Affiliation(s)
- Kari Anne Sveen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.,The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Gothenburg University and the Department of Cardiology, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Harry Björkbacka
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | | | - Gunnar Engström
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Isabel Gonçalves
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Emergency and Internal Medicine, Skåne University Hospital, Lund, Sweden
| | - Jan Nilsson
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Emergency and Internal Medicine, Skåne University Hospital, Lund, Sweden
| | - Eva Bengtsson
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Liao JN, Lim SS, Chen TJ, Tuan TC, Chen SA, Chao TF. Modified Taiwan Atrial Fibrillation Score for the Prediction of Incident Atrial Fibrillation. Front Cardiovasc Med 2022; 8:805399. [PMID: 35155613 PMCID: PMC8831699 DOI: 10.3389/fcvm.2021.805399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/27/2021] [Indexed: 12/23/2022] Open
Abstract
Background We have proposed the Taiwan AF score consisting of age, male sex, hypertension, heart failure, coronary artery disease, end-stage renal disease, and alcoholism to predict incident atrial fibrillation (AF) in Asian population. We hypothesized that the modified Taiwan AF score (mTaiwan AF score) excluding alcoholism remained useful for predicting new onset AF. Methods A total of 7,220,654 subjects aged ≥ 40 years without a past history of cardiac arrhythmia were identified from a national cohort, and 438,930 incident AF occurred during a 16-year follow-up with an incidence of 0.42 per 100 person-years. The mTaiwan AF score ranging between −2 and 14 and its predictive accuracy of incident AF was analyzed. Results The areas under the receiver operating characteristic curve (AUCs) of the mTaiwan AF scores in predicting AF are 0.861 for 1-year follow-up, 0.829 for 5-year follow-up, 0.795 for 10-year follow-up, and 0.751 for 16-year follow-up. The risk of incident AF increased from 0.05%/year for patients with a score of −2 to 6.98%/year for those having a score of 14. Patients were classified into three groups based on the tertile values of the mTaiwan AF scores—group 1 (score −2-3), group 2 (score 4-9) and group 3 (score 10-14). The annual risks of incident AF were 0.20, 1.33, and 3.36% for group 1, 2, and 3, respectively. Compared to patients in group 1, the hazard ratios of incident AF were 5.79 [95% confidence interval (CI) 3.75-7.75] for group 2 and 8.93 (95% CI 6.47-10.80) for group 3. Conclusions We demonstrated that the mTaiwan AF score based on age and clinical comorbidities could be used to predict incident AF in Asian population.
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Affiliation(s)
- Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Su-Shen Lim
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Tze-Fan Chao
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A Reiffel J. The Importance of Atrial Fibrillation's Associated Comorbidities as Clinical Presentation and Outcome Contributors. J Atr Fibrillation 2021; 14:20200517. [PMID: 34950378 DOI: 10.4022/jafib.20200517] [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: 04/16/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) has a heterogeneous clinical presentation. It can occur: (a) in the presence or absence of detectable heart disease, and, (b) with or without relatedsymptoms. Its prognosis in terms of thromboembolismand mortality is most benign when applied to young individuals (aged less than 60 years) without clinical orechocardiographic evidence of cardiopulmonary disease [termed "lone AF"]. However, by virtue of aging or because of the development of concomitant cardiovascular disorders, patientsmove out of the lone AF category over time, accompanied by increased risks for thromboembolism and mortality. Thus, underlying and/or associated comorbidities must play an important role in the presentation and consequences of patients with AF. While, no doubt, most clinicians likely appreciate that the majority of the AF patients they see have associated cardiovascular, pulmonary, metabolic, endocrinologic, genetic, and/or other disorders, it is not clear how much they appreciate that these disorders directly relate to the presenting symptoms and to the risks from AF in addition to their role as risk factors (or markers) for AF. This issue is the subject of this review manuscript.
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Affiliation(s)
- James A Reiffel
- Columbia Memorial Hospital and New York Presbyterian Westchester Division
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Masè M, Cristoforetti A, Del Greco M, Ravelli F. A Divergence-Based Approach for the Identification of Atrial Fibrillation Focal Drivers From Multipolar Mapping: A Computational Study. Front Physiol 2021; 12:749430. [PMID: 35002755 PMCID: PMC8740027 DOI: 10.3389/fphys.2021.749430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
The expanding role of catheter ablation of atrial fibrillation (AF) has stimulated the development of novel mapping strategies to guide the procedure. We introduce a novel approach to characterize wave propagation and identify AF focal drivers from multipolar mapping data. The method reconstructs continuous activation patterns in the mapping area by a radial basis function (RBF) interpolation of multisite activation time series. Velocity vector fields are analytically determined, and the vector field divergence is used as a marker of focal drivers. The method was validated in a tissue patch cellular automaton model and in an anatomically realistic left atrial (LA) model with Courtemanche-Ramirez-Nattel ionic dynamics. Divergence analysis was effective in identifying focal drivers in a complex simulated AF pattern. Localization was reliable even with consistent reduction (47%) in the number of mapping points and in the presence of activation time misdetections (noise <10% of the cycle length). Proof-of-concept application of the method to human AF mapping data showed that divergence analysis consistently detected focal activation in the pulmonary veins and LA appendage area. These results suggest the potential of divergence analysis in combination with multipolar mapping to identify AF critical sites. Further studies on large clinical datasets may help to assess the clinical feasibility and benefit of divergence analysis for the optimization of ablation treatment.
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Affiliation(s)
- Michela Masè
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology – CIBIO, University of Trento, Trento, Italy
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Alessandro Cristoforetti
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology – CIBIO, University of Trento, Trento, Italy
| | - Maurizio Del Greco
- Division of Cardiology, Santa Maria del Carmine Hospital, Rovereto, Italy
| | - Flavia Ravelli
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology – CIBIO, University of Trento, Trento, Italy
- CISMed – Centre for Medical Sciences, University of Trento, Trento, Italy
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Bah A, Nuotio I, Palomäki A, Mustonen P, Kiviniemi T, Ylitalo A, Hartikainen P, Airaksinen KEJ, Hartikainen JEK. Inadequate oral anticoagulation with warfarin in women with cerebrovascular event and history of atrial fibrillation: the FibStroke study. Ann Med 2021; 53:287-294. [PMID: 33475002 PMCID: PMC7877996 DOI: 10.1080/07853890.2021.1875499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/08/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Women with atrial fibrillation (AF) may be treated less actively with oral anticoagulation (OAC) than men. PATIENTS AND METHODS We assessed sex differences in the implementation of stroke risk stratification with CHADS2 and CHA2DS2-VASc scores and reasons not to use OAC in 1747 AF patients suffering their first cerebrovascular event after the AF diagnosis. RESULTS Women were older and had more often a high stroke risk (CHADS2/CHA2DS2-VASc ≥2) than men (p < .001). On admission, 46.4% of women and 48.2% of men were on OAC with no sex difference (p = .437). However, of patients without OAC, 74.4% of women and 49.5% of men should have been on OAC based on CHADS2/CHA2DS2-VASc ≥2 (p < .001). Conversely, 34.8% of men and 17.5% of women on OAC had a low or moderate risk (CHADS2/CHA2DS2-VASc 0-1, p < .001). A valid reason to omit OAC was reported in 38.6% of patients and less often in women (p < .001). CONCLUSIONS OAC was underused in high-risk AF patients, particularly women, but prescribed often in men with low or moderate stroke risk. Reasons for omitting OAC treatment were poorly reported, particularly for women. KEY MESSAGE Women were at higher stroke risk, but were less often treated with oral anticoagulation (OAC). Men were more often on OAC at low or moderate stroke risk. Reasons for omitting guideline based OAC were poorly reported, particularly for women.
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Affiliation(s)
- Aissa Bah
- Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ilpo Nuotio
- Department of Acute Internal Medicine, Turku University Hospital, Turku, Finland
| | - Antti Palomäki
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Pirjo Mustonen
- Department of Medicine, Keski-Suomi Central Hospital, Jyväskylä, Finland
- Faculty of Information Technology, Jyväskylä University, Jyväskylä, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Ylitalo
- Heart Center, Satakunta Central Hospital, Pori, Finland
| | | | | | - Juha E. K. Hartikainen
- Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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Lee J, Kim Y, Park H, Kim C, Cho S, Kim J. Clinical Impact of Hormone Replacement Therapy on Atrial Fibrillation in Postmenopausal Women: A Nationwide Cohort Study. J Clin Med 2021; 10:jcm10235497. [PMID: 34884201 PMCID: PMC8658255 DOI: 10.3390/jcm10235497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Individuals with atrial fibrillation (AF), especially women, have an increased risk of stroke and death. Although hormone replacement therapy (HRT) is widely used in postmenopausal women, the association between HRT use and AF risk is unclear. We aimed to investigate the association between various types of HRT and AF. This was a population-based retrospective cohort study from The Korean National Health Insurance Service-National Sample Cohort (2004–2015). Participants were aged 45–60 years and were free from cardiovascular disease and AF at baseline. Overall, 13,452 (64.03%) women had never received HRT, 5671 (26.99%) had received HRT, and 1885 (8.98%) were currently receiving HRT. In multivariable analysis, the relative hazards for AF were significantly higher among current users (p < 0.001) and lower among past users (p = 0.069). Current users—except those using estradiol-only HRT—had significantly elevated AF risk. Among past users, only estradiol plus progestin HRT users had a reduced AF risk after adjusting for covariates (p = 0.027). Ongoing HRT posed an increased risk of AF. The degree of risk varied based on the specific type of estrogen and progestins co-administration. These findings indicate that, with respect to AF risk, oral estradiol-containing HRT is superior to HRT containing oral conjugated equine estrogen or tibolone.
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Affiliation(s)
- Jaehoon Lee
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Yuntae Kim
- Department of Public Health, Yonsei University, Seoul 03722, Korea; (Y.K.); (H.P.)
| | - Hyunji Park
- Department of Public Health, Yonsei University, Seoul 03722, Korea; (Y.K.); (H.P.)
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
- Institute of Human Complexity and Systems Science, Yonsei University, Incheon 21983, Korea
| | - Sihyun Cho
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
- Correspondence: (S.C.); (J.K.); Tel.: +82-2-2019-3430 (S.C.); +82-2-2019-3310 (J.K.); Fax: +82-2-3462-8209 (S.C.); +82-2-3463-3882 (J.K.)
| | - Jongyoun Kim
- Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
- Correspondence: (S.C.); (J.K.); Tel.: +82-2-2019-3430 (S.C.); +82-2-2019-3310 (J.K.); Fax: +82-2-3462-8209 (S.C.); +82-2-3463-3882 (J.K.)
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Bishop J, Akram G. Diltiazem Dosing Strategies in the Management of Atrial Fibrillation With Rapid Ventricular Rate. Cureus 2021; 13:e18829. [PMID: 34804686 PMCID: PMC8592802 DOI: 10.7759/cureus.18829] [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] [Accepted: 10/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Diltiazem is commonly used for the management of atrial fibrillation (AFIB) with rapid ventricular rate (RVR) in the emergency department (ED). Conflicting studies comparing the efficacy of diltiazem have led to various dosing strategies. The objective of this study was to investigate diltiazem administration in a community ED and determine the effect of varying doses on heart rate (HR) control, systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods This is a retrospective, single-center study of adult patients treated with diltiazem for AFIB-RVR in the ED between January 1 and December 31, 2019. Inclusion criteria included pretreatment HR > 120 beats per minute (bpm). Patients were administered diltiazem at the discretion of the ED physician. Primary endpoint was time to achieve HR < 100 bpm after diltiazem. Secondary endpoints included mean weight-based dose of diltiazem, percentage of patients achieving HR < 100 bpm within 240 minutes of diltiazem, nadir SBP and nadir DBP. Results Ninety-nine patients were included in the study. Seventy-two percent of patients received ≤ 10 mg diltiazem bolus. Mean weight-based dose of diltiazem bolus was 0.13 mg/kg. Mean time to achieve HR < 100 bpm was 270 minutes for the entire cohort. Patients treated with ≥ 0.13 mg/kg diltiazem achieved an HR < 100 bpm at a mean time of 169 minutes compared to 318 minutes for < 0.13 mg/kg (p = 0.0107). HR control was achieved in 61% of patients who received ≥ 0.13 mg/kg compared to 36% of patients who received < 0.13 mg/kg diltiazem (p = 0.0213). No patients discontinued diltiazem for hypotension or bradycardia. The lowest recorded SBP and DBP within 240 minutes of diltiazem were 90 mmHg and 47 mmHg, respectively. There was no significant difference in the lowest SBP and DBP for patients who received < 0.13 mg/kg compared to ≥ 0.13 mg/mg diltiazem. Conclusion The majority of patients with AFIB RVR received a 10 mg non-weight-based diltiazem bolus dose in the ED. Diltiazem bolus dosing ≥ 0.13 mg/kg was associated with significantly improved times to achieve HR control compared to < 0.13 mg/kg and was not associated with hypotension or bradycardia.
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Affiliation(s)
- James Bishop
- Emergency Medicine, Ascension Providence Hospital-Southfield, Southfield, USA
| | - Ghufraan Akram
- Emergency Medicine, Michigan State University College of Human Medicine, East Lansing, USA
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Wu C, Hwang M, Huang TH, Chen YMJ, Chang YJ, Ho TH, Huang J, Hwang KS, Ho WH. Application of artificial intelligence ensemble learning model in early prediction of atrial fibrillation. BMC Bioinformatics 2021; 22:93. [PMID: 34749631 PMCID: PMC8576960 DOI: 10.1186/s12859-021-04000-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Atrial fibrillation is a paroxysmal heart disease without any obvious symptoms for most people during the onset. The electrocardiogram (ECG) at the time other than the onset of this disease is not significantly different from that of normal people, which makes it difficult to detect and diagnose. However, if atrial fibrillation is not detected and treated early, it tends to worsen the condition and increase the possibility of stroke. In this paper, P-wave morphology parameters and heart rate variability feature parameters were simultaneously extracted from the ECG. A total of 31 parameters were used as input variables to perform the modeling of artificial intelligence ensemble learning model. Results This paper applied three artificial intelligence ensemble learning methods, namely Bagging ensemble learning method, AdaBoost ensemble learning method, and Stacking ensemble learning method. The prediction results of these three artificial intelligence ensemble learning methods were compared. As a result of the comparison, the Stacking ensemble learning method combined with various models finally obtained the best prediction effect with the accuracy of 92%, sensitivity of 88%, specificity of 96%, positive predictive value of 95.7%, negative predictive value of 88.9%, F1 score of 0.9231 and area under receiver operating characteristic curve value of 0.911. Conclusion In feature extraction, this paper combined P-wave morphology parameters and heart rate variability parameters as input parameters for model training, and validated the value of the proposed parameters combination for the improvement of the model’s predicting effect. In the calculation of the P-wave morphology parameters, the hybrid Taguchi-genetic algorithm was used to obtain more accurate Gaussian function fitting parameters. The prediction model was trained using the Stacking ensemble learning method, so that the model accuracy had better results, which can further improve the early prediction of atrial fibrillation.
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Affiliation(s)
- Cai Wu
- Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, No. 1, Shangcheng Road, Yiwu, Zhejiang, China
| | - Maxwell Hwang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou, Zhejiang, China
| | - Tian-Hsiang Huang
- Center for Big Data Research, Kaohsiung Medical University, No.100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan
| | - Yen-Ming J Chen
- Department of Logistics Management, National Kaohsiung University of Science and Technology, No.1, University Road, Kaohsiung, 824, Taiwan
| | - Yiu-Jen Chang
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, No.100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan
| | - Tsung-Han Ho
- Department of Engineering Science, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
| | - Jian Huang
- Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, No. 1, Shangcheng Road, Yiwu, Zhejiang, China
| | - Kao-Shing Hwang
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, No.100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan. .,Department of Electrical Engineering, National Sun Yat-Sen University, No.70, Lienhai Road, Kaohsiung, 804, Taiwan.
| | - Wen-Hsien Ho
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, No.100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, No.100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan.
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Murat F, Sadak F, Yildirim O, Talo M, Murat E, Karabatak M, Demir Y, Tan RS, Acharya UR. Review of Deep Learning-Based Atrial Fibrillation Detection Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11302. [PMID: 34769819 PMCID: PMC8583162 DOI: 10.3390/ijerph182111302] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 02/01/2023]
Abstract
Atrial fibrillation (AF) is a common arrhythmia that can lead to stroke, heart failure, and premature death. Manual screening of AF on electrocardiography (ECG) is time-consuming and prone to errors. To overcome these limitations, computer-aided diagnosis systems are developed using artificial intelligence techniques for automated detection of AF. Various machine learning and deep learning (DL) techniques have been developed for the automated detection of AF. In this review, we focused on the automated AF detection models developed using DL techniques. Twenty-four relevant articles published in international journals were reviewed. DL models based on deep neural network, convolutional neural network (CNN), recurrent neural network, long short-term memory, and hybrid structures were discussed. Our analysis showed that the majority of the studies used CNN models, which yielded the highest detection performance using ECG and heart rate variability signals. Details of the ECG databases used in the studies, performance metrics of the various models deployed, associated advantages and limitations, as well as proposed future work were summarized and discussed. This review paper serves as a useful resource for the researchers interested in developing innovative computer-assisted ECG-based DL approaches for AF detection.
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Affiliation(s)
- Fatma Murat
- Department of Electrical and Electronics Engineering, Firat University, Elazig 23000, Turkey;
| | - Ferhat Sadak
- Department of Mechanical Engineering, Bartin University, Bartin 74100, Turkey;
| | - Ozal Yildirim
- Department of Software Engineering, Firat University, Elazig 23000, Turkey; (O.Y.); (M.T.); (M.K.)
| | - Muhammed Talo
- Department of Software Engineering, Firat University, Elazig 23000, Turkey; (O.Y.); (M.T.); (M.K.)
| | - Ender Murat
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara 06000, Turkey;
| | - Murat Karabatak
- Department of Software Engineering, Firat University, Elazig 23000, Turkey; (O.Y.); (M.T.); (M.K.)
| | - Yakup Demir
- Department of Electrical and Electronics Engineering, Firat University, Elazig 23000, Turkey;
| | - Ru-San Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore;
- Department of Cardiology, Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - U. Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 138607, Singapore;
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
- Department of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Singapore 599494, Singapore
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Agudo-Fernández S, Castaño Milla C, González Blanco A, Olmos Jerez JA, Calvo Morillas I, Sancho Del Val L. RHEDAR study: Determination of the risk of gastrointestinal hemorrhage in treatment with dabigatran, acenocoumarol and rivaroxaban. J Gastroenterol Hepatol 2021; 36:2794-2802. [PMID: 33978991 DOI: 10.1111/jgh.15547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/18/2021] [Accepted: 05/08/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Atrial fibrillation is a major cause of death and disability due to stroke. Vitamin K antagonist drugs are effective for prevention, but they have a narrow therapeutic range and multiple pharmacological interactions. In recent years, new therapeutic alternatives have been searched to minimize complications. The main objective is to evaluate the risk of gastrointestinal bleeding in anticoagulated patients and compare the classic treatment with new anticoagulants. METHODS We conducted a retrospective cohort study to determine the risk of gastrointestinal bleeding in patients treated with acenocoumarol/dabigatran/rivaroxaban, between 2012 and 2016. We compared the classic with the new anticoagulant group, and a multivariate logistic regression analysis was used to determinate the risk factors of gastrointestinal bleeding. RESULTS A total of 1213 patients were selected, 52.7% male patients, a mean age of 72.6 years old (± 14.563). 73.6% had atrial fibrilation. 14.5% of patients used acetylsalicylic acid, and 4% clopidogrel. 67.2% had a high-risk CHADS-2 Score, and 36.9% a high-risk HAS-BLED Score. We determined a 5.6% (68) of gastrointestinal bleeding, without differences according to anticoagulant used. The multivariate model showed a greater risk for digestive hemorrhage in patients with a previous hemorrhagic event (odds ratio [OR] = 2.422 95% confidence interval [CI]: 1.101-5.327) and the concomitant therapy with clopidogrel (OR = 2.373 95% CI: 0.996-5.652). CONCLUSIONS No differences were found in the risk of gastrointestinal bleeding between the different anticoagulants. A previous gastrointestinal bleeding were considered independent risk factor. The HAS-BLED score should be taken into account to make clinical decisions about to prescribe anticoagulant treatment.
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Affiliation(s)
| | - Carlos Castaño Milla
- Department of Gastroenterology, Rey Juan Carlos Hospital, Móstoles, Madrid, Spain
| | - Ana González Blanco
- Department of Gastroenterology, Rey Juan Carlos Hospital, Móstoles, Madrid, Spain
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Immunothrombosis and new-onset atrial fibrillation in the general population: the Rotterdam Study. Clin Res Cardiol 2021; 111:96-104. [PMID: 34559294 PMCID: PMC8766396 DOI: 10.1007/s00392-021-01938-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/03/2021] [Indexed: 12/30/2022]
Abstract
Background Atrial fibrillation (AF) is the most common age-related cardiac arrhythmia. The etiology underlying AF is still largely unknown. At the intersection of the innate immune system and hemostasis, immunothrombosis may be a possible cause of atrial remodeling, and therefore be an underlying cause of AF. Methods From 1990 to 2014, we followed participants aged 55 and over, free from AF at inclusion. Immunothrombosis factors fibrinogen, von Willebrand factor, ADAMTS13, and neutrophil extracellular traps (NETs) levels were measured at baseline. Participants were followed until either onset of AF, loss-to-follow-up, or reaching the end-date of 01-01-2014. Cox proportional hazard modelling was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for cardiovascular risk factors. Results We followed 6174 participants (mean age 69.1 years, 57% women) for a median follow-up time of 12.8 years. 364 men (13.7%, incidence rate 13.0/1000 person-years) and 365 women (10.4%, incidence rate 8.9/1000 person-years) developed AF. We found no significant association between markers of immunothrombosis and new-onset AF after adjusting for cardiovascular risk factors [HR 1.00 (95% CI 0.93–1.08) for fibrinogen, 1.04 (0.97–1.12) for von Willebrand factor, 1.00 (1.00–1.01) for ADAMTS13, and 1.01 (0.94–1.09) for NETs]. In addition, we found no differences in associations between men and women. Conclusion We found no associations between markers of immunothrombosis and new-onset AF in the general population. Inflammation and immunothrombosis may be associated with AF through other cardiovascular risk factors or predisposing conditions of AF. Our findings challenge the added value of biomarkers in AF risk prediction. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01938-4.
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Ikemura N, Spertus JA, Kimura T, Katsumata Y, Fujisawa T, Ueda I, Fukuda K, Takatsuki S, Kohsaka S. Baseline and Postprocedural Health Status Outcomes in Contemporary Patients With Atrial Fibrillation Who Underwent Catheter Ablation: A Report from the Japanese Outpatient Registry. J Am Heart Assoc 2021; 10:e019983. [PMID: 34514817 PMCID: PMC8649523 DOI: 10.1161/jaha.120.019983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Randomized clinical trials have demonstrated that catheter ablation (CA) for atrial fibrillation improves health‐related quality of life (HRQoL). In daily practice, however, CA is performed on a wide range of patients, and outcomes may vary. We aimed to examine baseline and 1‐year HRQoL outcomes of patients with atrial fibrillation after CA in daily practice. Methods and Results Using a registry‐based cohort study designed to recruit patients with atrial fibrillation newly referred to 11 hospitals, we extracted data from 1097 consecutive patients with atrial fibrillation who underwent CA between 2012 and 2019. The Atrial Fibrillation Effects on Quality of Life Overall Summary (AFEQT‐OS) was assessed at registration and 1 year after, and a 5‐point increase in AFEQT‐OS score was considered a meaningful improvement. Overall, the median age was 64 (interquartile range, 56–70) years, 836 (76.2%) were men, and 93.0% (n=1021) of the patients answered the AFEQT questionnaire. The mean AFEQT‐OS score was 74.9 (SD, 18.0) at registration and 88.8 (SD, 12.6) at 1 year after. Notably, the incidence of meaningful improvement in HRQoL after CA was 88.6% for the patients with impaired HRQoL (AFEQT‐OS score <80), which was only 40.1% in those with preserved HRQoL (AFEQT‐OS score ≥80). Female sex, left atrium diameter, and high baseline HRQoL were independently associated with nonimprovement after CA. Conclusions The improvement in HRQoL after CA was similar to that seen in clinical trials; however, one‐third of patients did not show improvement. These results underscore the importance of quantitative evaluation of patients’ HRQoL to maximize the effect of CA before its performance.
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Affiliation(s)
- Nobuhiro Ikemura
- Department of Cardiology Keio University School of Medicine Tokyo Japan.,Division of Molecular Epidemiology Jikei University School of Medicine Tokyo Japan
| | - John A Spertus
- Cardiovascular Research Department of Biomedical and Health Informatics Saint Luke's Mid America Heart Institute/UMKC Kansas City MO
| | - Takehiro Kimura
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | | | - Taishi Fujisawa
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Ikuko Ueda
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Keiichi Fukuda
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Seiji Takatsuki
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Shun Kohsaka
- Department of Cardiology Keio University School of Medicine Tokyo Japan
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Arslan Ş, Batıt S, Kılıçarslan O, Doğan Ö, Yumuk MT, Arslan Ş, Haberal İ, Koçaş C, Doğan SM, Abacı O. Incidence of atrial fibrillation and its effects on long-term follow-up outcomes in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Anatol J Cardiol 2021; 25:609-616. [PMID: 34498591 DOI: 10.5152/anatoljcardiol.2021.26020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The incidence of atrial fibrillation (AF) in patients with ST segment elevation myocardial infarction (STEMI) varies between 7% and 21%, and most of these studies were in the thrombolytic era. However, the frequency of new-onset AF during the primary percutaneous coronary intervention (PCI) period is still unclear. We aimed to investigate the frequency of new-onset AF and its effects on long-term clinical events in patients undergoing primary PCI. METHODS A total of 1,603 patients who were diagnosed with STEMI and underwent primary PCI were included in the study. All the patients were monitored for at least 48 hours after the procedure. The primary endpoint of the study was defined as new-onset AF during hospitalization. RESULTS The median follow-up period of our study was 44 months. New-onset AF developed in 85 (6.1%) patients. CHADs-VASc > 2, KILLIP > 2, and left atrial diameter were found to be independent predictors for the development of new-onset AF. In the AF (+) group, the all-cause and in-hospital mortality rates were found to be significantly higher. New-onset AF development in patients with STEMI was detected as an independent predictor of in-hospital mortality. CONCLUSION In the era of primary percutaneous transluminal coronary angioplasty, new-onset AF rates were found to be lower than the literature data. In addition, new-onset AF was found to be a predictor of in-hospital mortality, and deaths occurred mostly in the early period. Therefore, close follow-up of these patients in the early period and re-evaluation in terms of AF burden when the patient becomes stable are important.
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Affiliation(s)
- Şükrü Arslan
- Department of Cardiology, İstanbul University-Cerrahpaşa Institude of Cardiology; İstanbul-Turkey
| | - Servet Batıt
- Department of Cardiology, İstanbul University-Cerrahpaşa Institude of Cardiology; İstanbul-Turkey
| | - Onur Kılıçarslan
- Department of Cardiology, İstanbul University-Cerrahpaşa Institude of Cardiology; İstanbul-Turkey
| | - Ömer Doğan
- Department of Cardiology, İstanbul University-Cerrahpaşa Institude of Cardiology; İstanbul-Turkey
| | - Mehmet Tugay Yumuk
- Department of Cardiology, İstanbul University-Cerrahpaşa Institude of Cardiology; İstanbul-Turkey
| | | | - İsmail Haberal
- Department of Cardiology, İstanbul University-Cerrahpaşa Institude of Cardiology; İstanbul-Turkey
| | - Cüneyt Koçaş
- Department of Cardiology, İstanbul University-Cerrahpaşa Institude of Cardiology; İstanbul-Turkey
| | - Sait Mesut Doğan
- Department of Cardiology, İstanbul University-Cerrahpaşa Institude of Cardiology; İstanbul-Turkey
| | - Okay Abacı
- Department of Cardiology, İstanbul University-Cerrahpaşa Institude of Cardiology; İstanbul-Turkey
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Liu M, Mei K, Xie L, Ma J, Yu P, Niu S, Xu Y, Zhao Y, Liu X. Dose-response relationship among body mass index, abdominal adiposity and atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of 35 cohorts. PeerJ 2021; 9:e11855. [PMID: 34327066 PMCID: PMC8308618 DOI: 10.7717/peerj.11855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background Whether overweight increases the risk of postoperative atrial fibrillation (POAF) is unclear, and whether adiposity independently contributes to POAF has not been comprehensively studied. Thus, we conducted a meta-analysis to clarify the strength and shape of the exposure-effect relationship between adiposity and POAF. Methods The PubMed, Cochrane Library, and EMBASE databases were searched for revelant studies (randomized controlled trials (RCTs), cohort studies, and nest-case control studies) reporting data regarding the relationship between adiposity and the risk of POAF. Results Thirty-five publications involving 33,271 cases/141,442 patients were included. Analysis of categorical variables showed that obesity (RR: 1.39, 95% CI [1.21–1.61]; P < 0.001), but not being underweight (RR: 1.44, 95% CI [0.90–2.30]; P = 0.13) or being overweight (RR: 1.03, 95% CI [0.95–1.11]; P = 0.48) was associated with an increased risk of POAF. In the exposure-effect analysis (BMI) was 1.09 (95% CI [1.05–1.12]; P < 0.001) for the risk of POAF. There was a significant linear relationship between BMI and POAF (Pnonlinearity = 0.44); the curve was flat and began to rise steeply at a BMI of approximately 30. Notably, BMI levels below 30 (overweight) were not associated with a higher risk of POAF. Additionally, waist obesity or visceral adiposity index was associated with the risk of POAF. Conclusion Based on the current evidence, our findings showed that high body mass index or abdominal adiposity was independently associated with an increased risk of POAF, while underweight or overweight might not significantly increase the POAF risk.
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Affiliation(s)
- Menglu Liu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Kaibo Mei
- Anesthesiology Department,, the People's Hospital of Shanggrao, Shangrao, Jiangxi, China
| | - Lixia Xie
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, Oh, China
| | - Peng Yu
- Department of Endocrine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Siquan Niu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Ya Xu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Yujie Zhao
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou, China
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Farwati M, Wazni OM, Tarakji KG, Diab M, Scandinaro A, Amin M, Zmaili M, Bazarbashi N, Dikilitas O, Nakagawa H, Kuroda S, Kanj M, Dresing TJ, Callahan TD, Bhargava M, Baranowski B, Rickard J, Cantillon DJ, Tchou PJ, Saliba WI, Hussein AA. Super and Nonresponders to Catheter Ablation for Atrial Fibrillation: A Quality-of-Life Assessment Using Patient Reported Outcomes. Circ Arrhythm Electrophysiol 2021; 14:e009938. [PMID: 34279998 DOI: 10.1161/circep.121.009938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Medhat Farwati
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Oussama M Wazni
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Khaldoun G Tarakji
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Mohamed Diab
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Anna Scandinaro
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Mustapha Amin
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Mohammad Zmaili
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Najdat Bazarbashi
- Department of Internal Medicine, University of Maryland, Baltimore (N.B.)
| | - Ozan Dikilitas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (O.D.)
| | - Hiroshi Nakagawa
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Shunsuke Kuroda
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | | | - Thomas J Dresing
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Thomas D Callahan
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Mandeep Bhargava
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Bryan Baranowski
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - John Rickard
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Daniel J Cantillon
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Patrick J Tchou
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Walid I Saliba
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Ayman A Hussein
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
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Michalowski M, Wilk S, Michalowski W, O’Sullivan D, Bonaccio S, Parimbelli E, Carrier M, Le Gal G, Kingwell S, Peleg M. A Health eLearning Ontology and Procedural Reasoning Approach for Developing Personalized Courses to Teach Patients about Their Medical Condition and Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7355. [PMID: 34299806 PMCID: PMC8307382 DOI: 10.3390/ijerph18147355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 11/16/2022]
Abstract
We propose a methodological framework to support the development of personalized courses that improve patients' understanding of their condition and prescribed treatment. Inspired by Intelligent Tutoring Systems (ITSs), the framework uses an eLearning ontology to express domain and learner models and to create a course. We combine the ontology with a procedural reasoning approach and precompiled plans to operationalize a design across disease conditions. The resulting courses generated by the framework are personalized across four patient axes-condition and treatment, comprehension level, learning style based on the VARK (Visual, Aural, Read/write, Kinesthetic) presentation model, and the level of understanding of specific course content according to Bloom's taxonomy. Customizing educational materials along these learning axes stimulates and sustains patients' attention when learning about their conditions or treatment options. Our proposed framework creates a personalized course that prepares patients for their meetings with specialists and educates them about their prescribed treatment. We posit that the improvement in patients' understanding of prescribed care will result in better outcomes and we validate that the constructs of our framework are appropriate for representing content and deriving personalized courses for two use cases: anticoagulation treatment of an atrial fibrillation patient and lower back pain management to treat a lumbar degenerative disc condition. We conduct a mostly qualitative study supported by a quantitative questionnaire to investigate the acceptability of the framework among the target patient population and medical practitioners.
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Affiliation(s)
- Martin Michalowski
- Nursing Informatics, School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
| | - Szymon Wilk
- Institute of Computing Science, Poznan University of Technology, 60-965 Poznań, Poland;
| | - Wojtek Michalowski
- Telfer School of Management, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (W.M.); (S.B.)
| | - Dympna O’Sullivan
- School of Computer Science, Technological University Dublin, D02 HW71 Dublin, Ireland;
| | - Silvia Bonaccio
- Telfer School of Management, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (W.M.); (S.B.)
| | - Enea Parimbelli
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy;
| | - Marc Carrier
- Division of Hematology, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada;
| | - Grégoire Le Gal
- Department of Medicine, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada;
| | - Stephen Kingwell
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada;
| | - Mor Peleg
- Department of Information Systems, University of Haifa, Haifa 3498838, Israel;
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Predictive Value of Cardiac CTA, Cardiac MRI, and Transthoracic Echocardiography for Cardioembolic Stroke Recurrence. AJR Am J Roentgenol 2021; 217:336-346. [PMID: 32936016 DOI: 10.2214/ajr.20.23903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Transthoracic echocardiography (TTE) is the standard of care for initial evaluation of patients with suspected cardioembolic stroke. Although TTE is useful for assessing certain sources of cardiac emboli, its diagnostic capability is limited in the detection of other sources, including left atrial thrombus and aortic plaques. OBJECTIVE. The purpose of this article was to investigate sensitivity, specificity, and predictive value of cardiac CTA (CCTA), cardiac MRI (CMRI), and TTE for recurrence in patients with suspected cardioembolic stroke. METHODS. We retrospectively included 151 patients with suspected cardioembolic stroke who underwent TTE and either CMRI (n = 75) or CCTA (n = 76) between January 2013 and May 2017. We evaluated for the presence of left atrial thrombus, left ventricular thrombus, vulnerable aortic plaque, cardiac tumors, and valvular vegetation as causes of cardioembolic stroke. The end point was stroke recurrence. Sensitivity, specificity, PPV, and NPV for recurrent stroke were calculated; the diagnostic accuracy of CMRI, CCTA, and TTE was compared between and within groups using AUC. RESULTS. Twelve and 14 recurrent strokes occurred in the CCTA and CMRI groups, respectively. Sensitivity, specificity, PPV, and NPV were 33.3%, 93.7%, 50.0%, and 88.2% for CCTA; 14.3%, 80.3%, 14.3%, and 80.3% for CMRI; 14.3%, 83.6%, 16.7%, and 80.9% for TTE in the CMRI group; and 8.3%, 93.7%, 20.0%, and 84.5% for TTE in the CCTA group. Accuracy was not different (p > .05) between CCTA (AUC = 0.63; 95% CI, 0.49-0.77), CMRI (0.53; 95% CI, 0.42-0.63), TTE in the CMRI group (0.51; 95% CI, 0.40-0.61), and TTE in the CCTA group (0.51; 95% CI, 0.42-0.59). In the CCTA group, atrial and ventricular thrombus were detected by CCTA in three patients and TTE in one patient; in the CMRI group, thrombus was detected by CMRI in one patient and TTE in two patients. CONCLUSION. CCTA, CMRI, and TTE showed comparably high specificity and NPV for cardioembolic stroke recurrence. CCTA and CMRI may be valid alternatives to TTE. CCTA may be preferred given potentially better detection of atrial and ventricular thrombus. CLINICAL IMPACT. CCTA and CMRI have similar clinical performance as TTE for predicting cardioembolic stroke recurrence. This observation may be especially important when TTE provides equivocal findings.
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Roh SY, Ahn J, Lee KN, Baek YS, Kim DH, Lee DI, Shim J, Choi JI, Kim YH. The Impact of Personal Thoracic Impedance on Electrical Cardioversion in Patients with Atrial Arrhythmias. ACTA ACUST UNITED AC 2021; 57:medicina57060618. [PMID: 34199329 PMCID: PMC8231855 DOI: 10.3390/medicina57060618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/31/2021] [Accepted: 06/11/2021] [Indexed: 11/30/2022]
Abstract
Background and Objectives: Direct current cardioversion (DCCV) is a safe and useful treatment for atrial tachyarrhythmias. In the past, the energy delivered in DCCV was decided upon empirically, based only on the type of tachyarrhythmia. This conventional method does not consider individual factors and may lead to unnecessary electrical damage. Materials and Methods: We performed DCCV in patients with atrial tachyarrhythmias. The impedance and electrical current at the moment of shock were measured. The human thoracic impedance between both defibrillator patches and the electric current that was used were measured. Results: A total of 683 DCCVs were performed on 466 atrial tachyarrhythmia patients. The average impedance was 64 ± 11 Ω and the average successful current was 23 ± 6 mA. The magnitude of the electrical current that was successful depended upon the human impedance (linear regression, B = −0.266, p < 0.001) and the left atrial diameter (B = 0.092, p < 0.001). Impedance was directly proportional to body mass index (BMI) (B = 1.598, p < 0.001) and was higher in females than in males (77 ± 15 Ω vs. 63 ± 11 Ω, p < 0.001). Notably, the high-impedance (>70 Ω) group had a higher BMI (27 ± 4 kg/m2 vs. 25 ± 3 kg/m2, p < 0.001) and a higher proportion of females (37% vs. 9%, p < 0.001) than the low-impedance group (<70 Ω). However, thoracic impedance was not an independent predictor for successful DCCV. Conclusions: Human thoracic impedance was one of the factors that impacted the level of electrical current required for successful DCCV in patients with atrial arrhythmias. In the future, it will be helpful to consider individual predictors, such as BMI and gender, to minimize electrical damage during DCCV.
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Affiliation(s)
- Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (S.-Y.R.); (J.S.); (J.-I.C.)
| | - Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hsopital, Busan 49241, Korea;
| | - Kwang-No Lee
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Suwon 16499, Korea;
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University hospital, Incheon 22332, Korea;
| | - Dong-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Ewha University Hospital, Seoul 07804, Korea;
| | - Dae-In Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungju-si 28644, Korea;
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (S.-Y.R.); (J.S.); (J.-I.C.)
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (S.-Y.R.); (J.S.); (J.-I.C.)
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (S.-Y.R.); (J.S.); (J.-I.C.)
- Correspondence:
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Ikeda T, Ogawa S, Kitazono T, Nakagawara J, Minematsu K, Miyamoto S, Murakawa Y, Iwashiro S, Okayama Y, Sunaya T, Hirano K, Hayasaki T. Real-world safety and effectiveness of rivaroxaban using Japan-specific dosage during long-term follow-up in patients with atrial fibrillation: XAPASS. PLoS One 2021; 16:e0251325. [PMID: 34115769 PMCID: PMC8195353 DOI: 10.1371/journal.pone.0251325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background The Xarelto Post-Authorization Safety and Effectiveness Study in Japanese Patients with Atrial Fibrillation (XAPASS) was designed to investigate safety and effectiveness during long-term follow-up of rivaroxaban treatment, using reduced doses compared with other global regions, in Japanese patients with non-valvular atrial fibrillation in real-world clinical practice. Methods In this prospective, open-label, single-arm, observational study, 11,308 patients with non-valvular atrial fibrillation newly prescribed rivaroxaban (15/10 mg once daily) at 1416 sites across Japan were enrolled and followed for a mean of 2.5 years. Results In total, 10,664 and 10,628 patients were included in the safety and effectiveness analyses, respectively. In the safety population, mean (standard deviation) age was 73.1 (9.8) years and Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke/TIA (2 points) (CHADS2) score was 2.2 (1.3). Incidences (95% confidence intervals) of any and major bleeding were 3.77 (3.53–4.01) and 1.16 (1.03–1.29) events per 100 patient-years, respectively. Age ≥75 years, creatinine clearance <50 mL/min, diabetes mellitus, and vascular disease were independently associated with incidence of major bleeding. The primary composite effectiveness outcome of stroke, non-central nervous system systemic embolism, and myocardial infarction occurred at an incidence (95% confidence interval) of 1.32 (1.18–1.46) events per 100 patient-years. Age ≥75 years, hypertension, prior ischemic stroke/transient ischemic attack, and concomitant use of antiplatelets were independently associated with incidence of the composite outcome of stroke, non-central nervous system systemic embolism, and myocardial infarction. Conclusion In the XAPASS, a large-scale study involving a broad range of patients with non-valvular atrial fibrillation newly prescribed rivaroxaban using Japan-specific dosage in real-world clinical practice, no unexpected safety or effectiveness concerns were detected during up to 5 years of follow-up.
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Affiliation(s)
- Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
- * E-mail:
| | - Satoshi Ogawa
- International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jyoji Nakagawara
- Osaka Namba Clinic, Osaka, Japan
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuo Minematsu
- National Cerebral and Cardiovascular Center, Suita, Japan
- Iseikai Medical Corporation, Osaka, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital, Kawasaki, Japan
| | - Sanghun Iwashiro
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., Osaka, Japan
| | - Yutaka Okayama
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., Osaka, Japan
| | | | - Kazufumi Hirano
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., Osaka, Japan
| | - Takanori Hayasaki
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., Osaka, Japan
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