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Wang K, Zeng D, Chen Z, Yu W. Impact of left atrial diameter on all-cause mortality of patients with STEMI undergoing primary percutaneous coronary intervention. Saudi Med J 2023; 44:1260-1268. [PMID: 38016743 PMCID: PMC10712788 DOI: 10.15537/smj.2023.44.12.20230235] [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: 08/14/2023] [Accepted: 10/17/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES To evaluating the predictive significance of the left atrial diameter in acute ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). METHODS The STEMI population came from 2 retrospective cohorts with 1097 patients, cohorts A (YongChuan Hospital) and cohorts B (Taizhou First People's Hospital). Within 3 days (cohort A) or 5 days (cohort B) post-PCI, patients underwent ultrasound evaluations. Cohort A was segmented into quartile categories based on eft atrial diameter (LAd) (Q1 to Q4). The odds ratios (ORs) for overall mortality were assessed using logistic regression. Cohort B was used for sensitivity analysis. RESULTS During follow-up period, 226 (20.6%) patients experienced endpoint. In cohort A, univariable odds ratios were 2.68 (95%CI 1.11~6.89), 5.32 (95%CI 2.46~12.83) and 11.92 (95%CI 5.78~27.92), while multivariate ORs were 2.25 (95%CI 0.82~6.55), 5.09 (95%CI 2.12~13.56), and 15.05 (95%CI 6.58~39.09) in Q2 to Q4 group, respectively, compared with Q1 group (p for trend <0.001). Upon subgroup evaluation, the correlation between LAd and the likelihood of overall mortality was more pronounced in patients having a left ventricular ejection fraction (LVEF) between 40% and 50%, and those with LVEF ≥50%, in contrast to those with LVEF <40% (p for interaction <0.001). CONCLUSION Left atrial diameter is indicative of the long-term overall mortality risk in STEMI patients post-PCI, particularly in those with an LVEF ≥ 40%.
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Affiliation(s)
- Kai Wang
- From the Department of Cardiology (Wang, Zeng, Chen), Yongchuan Hospital of Chongqing Medical University; and form the Department of Cardiology (Chen, Yu), The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Deli Zeng
- From the Department of Cardiology (Wang, Zeng, Chen), Yongchuan Hospital of Chongqing Medical University; and form the Department of Cardiology (Chen, Yu), The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Zijun Chen
- From the Department of Cardiology (Wang, Zeng, Chen), Yongchuan Hospital of Chongqing Medical University; and form the Department of Cardiology (Chen, Yu), The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Wei Yu
- From the Department of Cardiology (Wang, Zeng, Chen), Yongchuan Hospital of Chongqing Medical University; and form the Department of Cardiology (Chen, Yu), The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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López-Galvez R, Rivera-Caravaca JM, Roldán V, Orenes-Piñero E, Esteve-Pastor MA, López-García C, Saura D, González J, Lip GYH, Marín F. Imaging in atrial fibrillation: A way to assess atrial fibrosis and remodeling to assist decision-making. Am Heart J 2023; 258:1-16. [PMID: 36526006 DOI: 10.1016/j.ahj.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/22/2022] [Accepted: 12/10/2022] [Indexed: 05/11/2023]
Abstract
The 2020 ESC atrial fibrillation (AF) guidelines suggest the novel 4S-AF scheme for the characterization of AF. Imaging techniques could be helpful for this objective in everyday clinical practice, and information derived from these techniques reflects basic aspects of the pathophysiology of AF, which may facilitate treatment decision-making, and optimal management of AF patients. The aim of this review is to provide an overview of the mechanisms associated with atrial fibrosis and to describe imaging techniques that may help the management of AF patients in clinical practice. Transthoracic echocardiography is the most common procedure given its versatility, safety, and simplicity. Transesophageal echocardiography provides higher resolution exploration, and speckle tracking echocardiography can provide incremental functional and prognostic information over conventional echocardiographic parameters. In addition, LA deformation imaging, including LA strain and strain rate, are related to the extent of fibrosis. On the other hand, multidetector-row computed tomography and cardiac magnetic resonance provide higher resolution data and more accurate assessment of the dimensions, structure, and spatial relationships of the LA. Imaging is central when deciding on catheter ablation or cardioversion, and helps in selecting those patients who will really benefit from these procedures. Moreover, imaging enhances the understanding of the underlying mechanisms of atrial remodeling and might assists in refining the risk of stroke, which help to select the best medical therapies/interventions. In summary, evaluation of LA enlargement, LA remodeling and fibrosis with imaging techniques adds clinical and prognostic information and should be assessed as a part of routine comprehensive AF evaluation.
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Affiliation(s)
- Raquel López-Galvez
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain; School of Nursing, University of Murcia, Murcia, Spain; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
| | - Vanessa Roldán
- Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Esteban Orenes-Piñero
- Department of Biochemistry and Molecular Biology, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Cecilia López-García
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Daniel Saura
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Josefa González
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
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Fan Y, Ma Y, Zhang Y, Sun C. A Retrospective Analysis of Internet-Based Sharing Nursing Service Appointment Data. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8735099. [PMID: 36035277 PMCID: PMC9410863 DOI: 10.1155/2022/8735099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022]
Abstract
Aims To investigate the historical data of the "Internet+ Nursing" service platform and provide a theoretical basis to optimize the "Internet+ Nursing" service model by analyzing a population in need of nursing care services, service prices, services in demand, willingness to place orders, and feedback on use. Methods A retrospective analysis of data related to home care services on the "Jiuzhou Nursing Care" platform from April 2020 to August 2021, a total of 279 person-times, relevant information about the research subjects, and the status of home care services was conducted. SPSS 24.0 software was used for data analyses, such as calculating frequencies and percentages and conducting chi-square tests. Results The "Jiuzhou Online Nurse" primarily serves elderly patients, and the majority of these patients have lost their ability to care for themselves. The average cost of nursing services was ¥183.45, and the unit cost of services had no effect on the number of service items. This particular internet-based home nursing service has a high level of satisfaction. Patients aged 60 to 74 have the highest number of Internet-based home care service orders (χ 2 = 11.791, P < 0.05). Patients who reuse the platform are more willing to assign people to provide services (χ 2 = 238.078, P < 0.05). Patients who were unable to care for themselves had a higher rate of repeat order (χ 2 = 10.877, P < 0.05). Conclusion The "Internet+ Nursing" service platform specifically meets the individual needs of elderly patients, provides them with home nursing services, and improves local medical treatment and door-to-door services. This platform also provides convenience for elderly individuals who cannot care for themselves so that they can receive prompt treatment and assistance to improve their quality of life.
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Affiliation(s)
- Yuchen Fan
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Jinan 250000, China
| | - Yuezhen Ma
- Intensive Care Unit, Shandong Provincial Third Hospital, Jinan 250000, China
| | - Yong Zhang
- Intensive Care Unit, Shandong Provincial Third Hospital, Jinan 250000, China
| | - Changjian Sun
- College of Electronic Science and Engineering, Jilin University, Changchun 130012, China
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Dmour BA, Miftode RS, Iliescu Halitchi D, Anton-Paduraru DT, Iliescu Halitchi CO, Miftode IL, Mitu O, Costache AD, Stafie CS, Costache II. Latest Insights into Mechanisms behind Atrial Cardiomyopathy: It Is Not always about Ventricular Function. Diagnostics (Basel) 2021; 11:diagnostics11030449. [PMID: 33807827 PMCID: PMC8001077 DOI: 10.3390/diagnostics11030449] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/27/2021] [Accepted: 02/27/2021] [Indexed: 12/19/2022] Open
Abstract
Atrial cardiomyopathy (ACM) represents a constantly evolving concept, with increasing importance in contemporary research and clinical practice. A better understanding of the mechanisms involved in atrial remodeling and its clinical correlations especially with atrial fibrillation (AF) and other cardiometabolic comorbidities may induce a significant impact on the diagnosis, prognosis, and therapeutic approach of ACM-related comorbidities. Although initially described several decades ago, investigators have only recently highlighted that several renal, metabolic, and cardiovascular diseases are determining factors for atrial remodeling and subsequent ACM. Based on data from multiple recent studies, our research emphasizes the correlations between ACM and other coexisting pathologies including cardiovascular, respiratory, or metabolic diseases, with fibrosis being the most incriminated pathophysiological mechanism. In addition to the usual tests, the paraclinical assessment of ACM is increasingly based on the use of various cardiac biomarkers, while the cardiac magnetic resonance (CMR) has become an increasingly tempting diagnostic too for describing morphofunctional aspects of the heart chambers, with the gadolinium contrast enhanced CMR (LGE-CMR) emerging as a commonly used technique aiming to identify and quantify the precise extent of atrial fibrosis. Further research should be conducted in order to clarify our knowledge regarding atrial remodeling and, therefore, to develop new and improved therapeutic approaches in these patients.
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Affiliation(s)
- Bianca-Ana Dmour
- Department of Internal Medicine I (Internal Medicine), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Radu-Stefan Miftode
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (D.I.H.); (O.M.); (A.-D.C.); (I.I.C.)
- Correspondence:
| | - Dan Iliescu Halitchi
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (D.I.H.); (O.M.); (A.-D.C.); (I.I.C.)
| | - Dana Teodora Anton-Paduraru
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (D.T.A.-P.); (C.-O.I.H.)
| | - Codruta-Olimpiada Iliescu Halitchi
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (D.T.A.-P.); (C.-O.I.H.)
| | - Ionela-Larisa Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Ovidiu Mitu
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (D.I.H.); (O.M.); (A.-D.C.); (I.I.C.)
| | - Alexandru-Dan Costache
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (D.I.H.); (O.M.); (A.-D.C.); (I.I.C.)
| | - Celina-Silvia Stafie
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Irina Iuliana Costache
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (D.I.H.); (O.M.); (A.-D.C.); (I.I.C.)
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Gawałko M, Budnik M, Uziębło-Życzkowska B, Krzesiński P, Scisło P, Kochanowski J, Jurek A, Kiliszek M, Gielerak G, Filipiak KJ, Opolski G, Kapłon-Cieślicka A. Decreased left atrial appendage emptying velocity as a link between atrial fibrillation type, heart failure and older age and the risk of left atrial thrombus in atrial fibrillation. Int J Clin Pract 2020; 74:e13609. [PMID: 32654352 DOI: 10.1111/ijcp.13609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Decreased left atrial appendage emptying velocity (LAAV) is a known predictor of LAA thrombus in atrial fibrillation (AF). The aim of our study was to identify which of the clinical risk factors for LAA thrombus are associated with decreased LAAV. METHODS The study included 1476 consecutive AF patients who underwent transesophageal echocardiography (TEE) before AF direct current cardioversion or ablation in two high-reference cardiology departments. Patients were divided into two groups: 71 (4.8%) patients with LAAV < 20 cm/s and 1405 patients (95%) with LAAV ≥ 20 cm/s. RESULTS Compared with patients with LAAV ≥ 20 cm/s, those with decreased LAAV were older, more often had non-paroxysmal AF, were burdened with more concomitant diseases (including hypertension, diabetes, vascular disease, and heart failure [HF]) with higher median CHA2 DS2 -VASc score (3 [2-4] vs 2 [1-3], P < .0001), and had lower glomerular filtration rate (GFR). Prevalence of LAA thrombus was higher in patients with decreased LAAV compared with those with LAAV ≥ 20cm/s (20% vs 4.6%, P < .0001). In patients with decreased LAAV, there was no difference in the frequency of LAA thrombus between those treated with VKA and those receiving NOAC, while in patients with LAAV ≥ 20 cm/s a trend was observed towards a benefit with NOAC. In multivariate logistic regression, non-paroxysmal AF, HF and age ≥ 65 years predicted both LAAV < 20 cm/s and LAA thrombus, while GFR < 60 mL/min/1.73 m2 predicted only the presence of LAA thrombus. CONCLUSION One in five AF patients with decreased LAAV had LAA thrombus, regardless of the type of OAC. Non-paroxysmal AF, HF and age ≥ 65 years might increase LAA thrombus risk via reduced LAAV.
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Affiliation(s)
- Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Budnik
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Scisło
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochanowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Jurek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Marek Kiliszek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | | | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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