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Li Z, Wang X, Liu Q, Li C, Gao J, Yang Y, Wang B, Hidru TH, Liu F, Yang X, Xia Y. Atrial cardiomyopathy markers predict ischemic cerebrovascular events independent of atrial fibrillation in patients with acute myocardial infarction. Front Cardiovasc Med 2022; 9:1025842. [DOI: 10.3389/fcvm.2022.1025842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022] Open
Abstract
BackgroundContemporary data on atrial cardiomyopathy (ACM) markers and ischemic cerebrovascular events (ICVE) in patients with acute myocardial infarction (AMI) is lacking. We aimed to examine whether ACM markers predict ICVE among AMI patients.Materials and methodsA total of 4,206 AMI cases diagnosed in clinical examinations between January 2016 and June 2021 were assessed for markers of ACM including B-type natriuretic peptide (BNP), P-wave terminal force in ECG lead V1 (PTFV1), and left atrium diameter (LAD). Left atrial enlargement (LAE) and abnormal PTFV1 were defined by previously published cut-off points. The primary outcome was incident ICVE composed of ischemic stroke (IS) and transient ischemic attack (TIA). Receiver operating curve analyses were used to compare the predictive performance of the CHA2DS2-VASc score combined with ACM markers to the CHA2DS2-VASc score alone.ResultsDuring a median follow-up of 44.0 months, 229 (5.44%) ICVE occurred. Of these, 156 individuals developed IS and the remaining 73 cases were diagnosed with TIAs. The ICVE group showed larger PTFV1 and increased LAD as well as elevated BNP levels at baseline. In the multivariate analysis, we found significant associations with ICVE for PTFV1 (HR per 1,000 μV*ms, 1.143; 95% CI, 1.093–1.196), LAD (HR per millimeter, 1.148; 95% CI, 1.107–1.190), but not BNP after adjusting for known ICVE risk factors and interim atrial fibrillation (AF). The addition of abnormal PTFV1 and LAE improved the predictive accuracy of the CHA2DS2-VASc score with C-statistic increasing from 0.708 to 0.761 (p < 0.001).ConclusionAtrial cardiomyopathy markers including PTFV1 and LAD were associated with incident ICVE independent of well-established risk factors and AF occurrence. The addition of ACM markers with CHA2DS2-VASc score may well discriminate individuals at high risk of ICVE in AMI patients.
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2
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MR-proANP measured at admission is associated with incident atrial fibrillation in STEMI patients. Heart Vessels 2022; 37:1906-1913. [PMID: 35648185 DOI: 10.1007/s00380-022-02099-8] [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: 09/06/2021] [Accepted: 05/11/2022] [Indexed: 11/04/2022]
Abstract
Atrial fibrillation (AF) is common following ST-segment elevation myocardial infarction (STEMI). Increased blood levels of mid regional pro atrial natriuretic peptide (MR-proANP) have been associated with a greater risk of incident AF. However, knowledge of the value of MR-proANP in predicting incident AF after STEMI is sparse. To assess whether MR-proANP measured at admission is associated with development of incident AF in patients with STEMI. 673 STEMI patients with no history of AF treated with primary percutaneous coronary intervention (pPCI) were prospectively enrolled from September 2006 to December 2008. Blood samples were drawn before the procedure. MR-proANP was measured by an automated processing assay. End point was incident AF. Median follow-up time was 5.5 years (interquartile-range 4.7-6.0), during which 63 patients developed AF. In a multivariable Cox regression model adjusted for relevant clinical and biochemical variables, MR-proANP was significantly associated with the development of AF (HR 1.18 per 100 pmol, 95% CI 1.11-1.28, p < 0.001). In a subgroup of patients who underwent echocardiography (N = 360), MR-proANP remained significantly associated with the development of AF (HR 1.39 per 100 pmol, 95% CI 1.13-1.71, p = 0.002) after adjusting for clinical and biochemical variables and left ventricular ejection fraction. When stratifying patients according to tertiles of MR-proANP, patients in the upper tertile displayed an 11 times greater risk of developing AF during follow-up as compared to patients in the lower tertile (HR 11.1, 95% CI 4.4-28.2, p < 0.001). Plasma MR-proANP measured at admission is an independent predictor of incident AF after STEMI.
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3
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Piccini JP, Harrington J. Midregional Pro-Atrial Natriuretic Peptide and Atrial Fibrillation: Interesting Association or Practice Changing? J Am Coll Cardiol 2022; 79:1382-1384. [PMID: 35393019 DOI: 10.1016/j.jacc.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jonathan P Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - Josephine Harrington
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA. https://twitter.com/JLHarrington_MD
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4
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Measurement of Midregional Pro-Atrial Natriuretic Peptide to Discover Atrial Fibrillation in Patients With Ischemic Stroke. J Am Coll Cardiol 2022; 79:1369-1381. [PMID: 35393018 DOI: 10.1016/j.jacc.2022.01.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Midregional pro-atrial natriuretic peptide (MR-proANP) is a promising biomarker to differentiate the underlying etiology of acute ischemic stroke (AIS). OBJECTIVES This study aimed to determine the role of MR-proANP for classification as cardioembolic (CE) stroke, identification of newly diagnosed atrial fibrillation (NDAF), and risk assessment for major adverse cardiovascular events (MACE). METHODS This study measured MR-proANP prospectively collected within 24 hours after symptom-onset in patients with AIS from the multicenter BIOSIGNAL (Biomarker Signature of Stroke Aetiology) cohort study. Primary outcomes were CE stroke etiology and NDAF after prolonged cardiac monitoring, as well as a composite outcome of MACE (recurrent cerebrovascular events, myocardial infarction, or cardiovascular death) within 1 year. Logistic/Poisson and subproportional hazard regression were applied to evaluate the association between MR-proANP levels and outcomes. Additionally, a model for prediction of NDAF was derived and validated as a decision tool for immediate clinical application. RESULTS Between October 1, 2014, and October 31, 2017, this study recruited 1,759 patients. Log10MR-proANP levels were associated with CE stroke (OR: 7.96; 95% CI: 4.82-13.14; risk ratio: 3.12; 95% CI: 2.23-4.37), as well as NDAF (OR: 35.3; 95% CI: 17.58-71.03; risk ratio: 11.47; 95% CI: 6.74-19.53), and MACE (subdistributional HR: 2.02; 95% CI: 1.32-3.08) during follow-up. The model to predict NDAF including only age and MR-proANP levels had a good discriminatory capacity with an area under the curve of 0.81 (95% CI: 0.76-0.86), was well calibrated (calibration in the large: -0.086; calibration slope 1.053), and yielded higher net-benefit compared with validated scores to predict NDAF (AS5F score, CHA2DS2-VASc [Congestive Heart Failure, Hypertension, Age ≥65 or ≥75, Diabetes, Prior Cardioembolic Event, (female) Sex, or Vascular Disease] score). CONCLUSIONS MR-proANP is a valid biomarker to determine risk of NDAF and MACE in patients with AIS and can be used as a decision tool to identify patients for prolonged cardiac monitoring. (Biomarker Signature of Stroke Aetiology Study: The BIOSIGNAL study [BIOSIGNAL]; NCT02274727).
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5
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Serum Atrial Natriuretic Peptide, NPPA Promoter Methylation, and Cardiovascular Disease: A 10-year Follow-Up Study in Chinese Adults. Glob Heart 2022; 17:27. [PMID: 35586748 PMCID: PMC8992767 DOI: 10.5334/gh.1116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
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6
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Bohm A, Snopek P, Tothova L, Bezak B, Jajcay N, Vachalcova M, Uher T, Kurecko M, Kissova V, Danova K, Olejnik P, Michalek P, Hlavata T, Petrikova K, Mojto V, Kyselovic J, Farsky S. Association Between Apelin and Atrial Fibrillation in Patients With High Risk of Ischemic Stroke. Front Cardiovasc Med 2021; 8:742601. [PMID: 34712712 PMCID: PMC8545982 DOI: 10.3389/fcvm.2021.742601] [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: 07/16/2021] [Accepted: 09/13/2021] [Indexed: 01/29/2023] Open
Abstract
Background: Atrial fibrillation (AF) is associated with high risk of stroke preventable by timely initiation of anticoagulation. Currently available screening tools based on ECG are not optimal due to inconvenience and high costs. Aim of this study was to study the diagnostic value of apelin for AF in patients with high risk of stroke. Methods: We designed a multicenter, matched-cohort study. The population consisted of three study groups: a healthy control group (34 patients) and two matched groups of 60 patients with high risk of stroke (AF and non-AF group). Apelin levels were examined from peripheral blood. Results: Apelin was significantly lower in AF group compared to non-AF group (0.694 ± 0.148 vs. 0.975 ± 0.458 ng/ml, p = 0.001) and control group (0.982 ± 0.060 ng/ml, p < 0.001), respectively. Receiver operating characteristic (ROC) analysis of apelin as a predictor of AF scored area under the curve (AUC) of 0.658. Apelin's concentration of 0.969 [ng/ml] had sensitivity = 0.966 and specificity = 0.467. Logistic regression based on manual feature selection showed that only apelin and NT-proBNP were independent predictors of AF. Logistic regression based on selection from bivariate analysis showed that only apelin was an independent predictor of AF. A logistic regression model using repeated stratified K-Fold cross-validation strategy scored an AUC of 0.725 ± 0.131. Conclusions: Our results suggest that apelin might be used to rule out AF in patients with high risk of stroke.
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Affiliation(s)
- Allan Bohm
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia.,3rd Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Bratislava, Slovakia.,Premedix Academy, Bratislava, Slovakia
| | - Peter Snopek
- Department of Cardiology, Faculty Hospital Nitra, Nitra, Slovakia.,St. Elizabeth University of Health and Social Work in Bratislava, Bratislava, Slovakia
| | - Lubomira Tothova
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Branislav Bezak
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia.,Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Nikola Jajcay
- Premedix Academy, Bratislava, Slovakia.,Department of Complex Systems, Institute of Computer Science, Czech Academy of Sciences, Prague, Czechia
| | - Marianna Vachalcova
- 1st Department of Cardiology, East Slovak Institute of Cardiovascular Diseases, Košice, Slovakia.,Faculty of Medicine, Pavol Jozef Safarik University, Košice, Slovakia
| | | | - Marian Kurecko
- 1st Department of Cardiology, East Slovak Institute of Cardiovascular Diseases, Košice, Slovakia
| | - Viera Kissova
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Katarina Danova
- Department of Laboratory Medicine, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Peter Olejnik
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia.,Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Tereza Hlavata
- 3rd Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Bratislava, Slovakia.,Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Viliam Mojto
- 3rd Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Bratislava, Slovakia
| | - Jan Kyselovic
- Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Stefan Farsky
- House of the Heart (Dom Srdca), Slovak League Against Hypertension, Martin, Slovakia
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7
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Himmelreich JCL, Veelers L, Lucassen WAM, Schnabel RB, Rienstra M, van Weert HCPM, Harskamp RE. Prediction models for atrial fibrillation applicable in the community: a systematic review and meta-analysis. Europace 2021; 22:684-694. [PMID: 32011689 PMCID: PMC7526764 DOI: 10.1093/europace/euaa005] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/06/2020] [Indexed: 01/06/2023] Open
Abstract
Aims Atrial fibrillation (AF) is a common arrhythmia associated with an increased stroke risk. The use of multivariable prediction models could result in more efficient primary AF screening by selecting at-risk individuals. We aimed to determine which model may be best suitable for increasing efficiency of future primary AF screening efforts. Methods and results We performed a systematic review on multivariable models derived, validated, and/or augmented for AF prediction in community cohorts using Pubmed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) through 1 August 2019. We performed meta-analysis of model discrimination with the summary C-statistic as the primary expression of associations using a random effects model. In case of high heterogeneity, we calculated a 95% prediction interval. We used the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) checklist for risk of bias assessment. We included 27 studies with a total of 2 978 659 unique participants among 20 cohorts with mean age ranging from 42 to 76 years. We identified 21 risk models used for incident AF risk in community cohorts. Three models showed significant summary discrimination despite high heterogeneity: CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology) [summary C-statistic 0.71; 95% confidence interval (95% CI) 0.66–0.76], FHS-AF (Framingham Heart Study risk score for AF) (summary C-statistic 0.70; 95% CI 0.64–0.76), and CHA2DS2-VASc (summary C-statistic 0.69; 95% CI 0.64–0.74). Of these, CHARGE-AF and FHS-AF had originally been derived for AF incidence prediction. Only CHARGE-AF, which comprises easily obtainable measurements and medical history elements, showed significant summary discrimination among cohorts that had applied a uniform (5-year) risk prediction window. Conclusion CHARGE-AF appeared most suitable for primary screening purposes in terms of performance and applicability in older community cohorts of predominantly European descent.
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Affiliation(s)
- Jelle C L Himmelreich
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Lieke Veelers
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Wim A M Lucassen
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg/German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck, Martinistrasse 52, 20246 Hamburg, Germany
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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8
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Hofer F, Hammer A, Steininger M, Kazem N, Koller L, Steinlechner B, Laufer G, Andreas M, Marculescu R, Hengstenberg C, Wojta J, Niessner A, Sulzgruber P. The Prognostic Potential of Atrial Natriuretic Peptide on the Development of Postoperative Atrial Fibrillation after Cardiac Surgery. Thromb Haemost 2021; 121:1523-1529. [DOI: 10.1055/a-1400-6096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Background Postoperative atrial fibrillation (POAF) represents a common complication after cardiac surgery associated with major adverse events and poor patient outcome. Tools for risk stratification of this arrhythmia remain scarce. Atrial natriuretic peptide (ANP) represents an easily assessable biomarker picturing atrial function and strain; however, its prognostic potential on the development of POAF has not been investigated so far.
Methods Within the present investigation, 314 patients undergoing elective cardiac surgery were prospectively enrolled. Preoperative mid-region proANP (MR-proANP) values were assessed before the surgical intervention. Patients were followed prospectively and continuously screened for the development of arrhythmic events.
Results A total of 138 individuals (43.9%) developed POAF. Median concentrations of MR-proANP were significantly higher within the POAF group (p < 0.001). MR-proANP showed a strong association with the development of POAF with a crude odds ratio (OR) of 1.68 per 1 standard deviation (1-SD; 95% confidence interval [CI]: 1.31–2.15; p < 0.001), which remained stable after comprehensive adjustment for confounders with an adjusted OR of 1.74 per 1-SD (95% CI: 1.17–2.58; p = 0.006). The discriminatory power of MR-proANP for the development of POAF was validated by the category-free net reclassification improvement (0.23 [95% CI: 0.0349–0.4193]; p = 0.022) and integrated discrimination increment (0.02 [95% CI: 0.0046–0.0397], p = 0.013).
Conclusion MR-proANP proved to be a strong and independent predictor of the development of POAF. Considering a personalized diagnostic and prognostic preoperative work-up, a standardized preoperative evaluation of MR-proANP levels might help to identify patients at risk for development of POAF after cardiac surgery.
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Affiliation(s)
- Felix Hofer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas Hammer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Matthias Steininger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Niema Kazem
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Lorenz Koller
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Günther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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9
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Himmelreich JCL, Lucassen WAM, Harskamp RE, Aussems C, van Weert HCPM, Nielen MMJ. CHARGE-AF in a national routine primary care electronic health records database in the Netherlands: validation for 5-year risk of atrial fibrillation and implications for patient selection in atrial fibrillation screening. Open Heart 2021; 8:openhrt-2020-001459. [PMID: 33462107 PMCID: PMC7816907 DOI: 10.1136/openhrt-2020-001459] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/21/2020] [Accepted: 12/18/2020] [Indexed: 01/24/2023] Open
Abstract
Aims To validate a multivariable risk prediction model (Cohorts for Heart and Aging Research in Genomic Epidemiology model for atrial fibrillation (CHARGE-AF)) for 5-year risk of atrial fibrillation (AF) in routinely collected primary care data and to assess CHARGE-AF’s potential for automated, low-cost selection of patients at high risk for AF based on routine primary care data. Methods We included patients aged ≥40 years, free of AF and with complete CHARGE-AF variables at baseline, 1 January 2014, in a representative, nationwide routine primary care database in the Netherlands (Nivel-PCD). We validated CHARGE-AF for 5-year observed AF incidence using the C-statistic for discrimination, and calibration plot and stratified Kaplan-Meier plot for calibration. We compared CHARGE-AF with other predictors and assessed implications of using different CHARGE-AF cut-offs to select high-risk patients. Results Among 111 475 patients free of AF and with complete CHARGE-AF variables at baseline (17.2% of all patients aged ≥40 years and free of AF), mean age was 65.5 years, and 53% were female. Complete CHARGE-AF cases were older and had higher AF incidence and cardiovascular comorbidity rate than incomplete cases. There were 5264 (4.7%) new AF cases during 5-year follow-up among complete cases. CHARGE-AF’s C-statistic for new AF was 0.74 (95% CI 0.73 to 0.74). The calibration plot showed slight risk underestimation in low-risk deciles and overestimation of absolute AF risk in those with highest predicted risk. The Kaplan-Meier plot with categories <2.5%, 2.5%–5% and >5% predicted 5-year risk was highly accurate. CHARGE-AF outperformed CHA2DS2-VASc (Cardiac failure or dysfunction, Hypertension, Age >=75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [Female]) and age alone as predictors for AF. Dichotomisation at cut-offs of 2.5%, 5% and 10% baseline CHARGE-AF risk all showed merits for patient selection in AF screening efforts. Conclusion In patients with complete baseline CHARGE-AF data through routine Dutch primary care, CHARGE-AF accurately assessed AF risk among older primary care patients, outperformed both CHA2DS2-VASc and age alone as predictors for AF and showed potential for automated, low-cost patient selection in AF screening.
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Affiliation(s)
- Jelle C L Himmelreich
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Wim A M Lucassen
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Ralf E Harskamp
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Claire Aussems
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Henk C P M van Weert
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Mark M J Nielen
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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10
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Arnold M, Nakas C, Luft A, Christ-Crain M, Leichtle A, Katan M. Independent Prognostic Value of MRproANP (Midregional Proatrial Natriuretic Peptide) Levels in Patients With Stroke Is Unaltered Over Time. Stroke 2020; 51:1873-1875. [DOI: 10.1161/strokeaha.120.029333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background and Purpose—
MRproANP (midregional proatrial natriuretic peptide) is known to be independently associated with cardioembolic stroke cause and to improve risk stratification for 90-day mortality when measured within 24 to 72 hours after symptom onset in patients with acute ischemic stroke. However, the optimal time point for assessment remains unclear. This study aimed to evaluate prognostic utility of MRproANP at different time points during the first 5 days of hospitalization in patients with acute ischemic stroke.
Methods—
Samples of MRproANP were collected on admission (<72 hours after onset) and at multiple time points during the first 5 days of hospitalization in 348 consecutively enrolled patients with acute ischemic stroke. The prognostic value for 90-day mortality, 90-day functional outcome, and the association with cardioembolic stroke cause was assessed regarding the time of measurement, and change over time was modeled using generalized estimating equations.
Results—
MRproANP levels modestly decease over the initial 5 days but remain highly predictive for cardioembolic stroke cause (odds ratio, 9.75 [95% CI, 3.2–29]; 10.62 [95% CI, 3.4–33.3]; 10.8 [95% CI, 3.1–37.1]; 19.4 [95% CI, 5.49–68.7] on admission, day 1, 3 and 5) and 90-day mortality (odds ratio, 59.4 [95% CI, 7.4–480.7]; 78.3 [95% CI, 7.9–772.6]; 14.5 [95% CI, 1.4–145]; 19.81 [95% CI, 2.7–143.4] on admission, day 1, 3, and 5). Change over time does not significantly modify the prognostic value of MRproANP (
P
=0.65 and
P
=0.56 for the interaction term in the multivariate model).
Conclusions—
Independent prognostic value of MRproANP remains unaltered in the acute phase of stroke at least up to 5 days; repeated measurements do not improve the prognostic value.
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Affiliation(s)
- Markus Arnold
- From the Department of Neurology, University Hospital of Zurich, Switzerland (M.A., A.L., M.K.)
| | - Christos Nakas
- Laboratory of Biometry, University of Thessaly, Nea Ionia/Volos, Magnesia, Greece (C.N.)
- University Institute of Clinical Chemistry, Bern University Hospital, Switzerland (C.N., A.L.)
| | - Andreas Luft
- From the Department of Neurology, University Hospital of Zurich, Switzerland (M.A., A.L., M.K.)
| | - Mirjam Christ-Crain
- Department of Endocrinology, University Hospital of Basel, Switzerland (M.C.-C.)
| | - Alexander Leichtle
- University Institute of Clinical Chemistry, Bern University Hospital, Switzerland (C.N., A.L.)
| | - Mira Katan
- From the Department of Neurology, University Hospital of Zurich, Switzerland (M.A., A.L., M.K.)
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11
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Doehner W, Mazighi M, Hofmann BM, Lautsch D, Hindricks G, Bohula EA, Byrne RA, Camm AJ, Casadei B, Caso V, Cognard C, Diener HC, Endres M, Goldstein P, Halliday A, Hopewell JC, Jovanovic DR, Kobayashi A, Kostrubiec M, Krajina A, Landmesser U, Markus HS, Ntaios G, Pezzella FR, Ribo M, Rosano GMC, Rubiera M, Sharma M, Touyz RM, Widimsky P. Cardiovascular care of patients with stroke and high risk of stroke: The need for interdisciplinary action: A consensus report from the European Society of Cardiology Cardiovascular Round Table. Eur J Prev Cardiol 2020; 27:682-692. [PMID: 31569966 PMCID: PMC7227126 DOI: 10.1177/2047487319873460] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Comprehensive stroke care is an interdisciplinary challenge. Close collaboration of cardiologists and stroke physicians is critical to ensure optimum utilisation of short- and long-term care and preventive measures in patients with stroke. Risk factor management is an important strategy that requires cardiologic involvement for primary and secondary stroke prevention. Treatment of stroke generally is led by stroke physicians, yet cardiologists need to be integrated care providers in stroke units to address all cardiovascular aspects of acute stroke care, including arrhythmia management, blood pressure control, elevated levels of cardiac troponins, valvular disease/endocarditis, and the general management of cardiovascular comorbidities. Despite substantial progress in stroke research and clinical care has been achieved, relevant gaps in clinical evidence remain and cause uncertainties in best practice for treatment and prevention of stroke. The Cardiovascular Round Table of the European Society of Cardiology together with the European Society of Cardiology Council on Stroke in cooperation with the European Stroke Organisation and partners from related scientific societies, regulatory authorities and industry conveyed a two-day workshop to discuss current and emerging concepts and apparent gaps in stroke care, including risk factor management, acute diagnostics, treatments and complications, and operational/logistic issues for health care systems and integrated networks. Joint initiatives of cardiologists and stroke physicians are needed in research and clinical care to target unresolved interdisciplinary problems and to promote the best possible outcomes for patients with stroke.
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Affiliation(s)
- Wolfram Doehner
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), partner site Berlin, Universitätsmedizin Berlin, Germany
- BCRT – Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
- Wolfram Doehner, Department of Cardiology (Virchow Klinikum), BCRT – Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Föhrerstr. 15, 13353 Berlin, Germany.
| | - Mikael Mazighi
- Department of Neurology, Lariboisière Hospital, University of Paris, France
| | | | | | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, University of Leipzig, Germany
| | - Erin A Bohula
- Cardiovascular Division, Harvard Medical School, USA
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich, Germany
| | - A John Camm
- Molecular and Clinical Sciences Research Institute, St George's University of London, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, University of Oxford, UK
- British Heart Foundation Centre of Research Excellence, Oxford
| | - Valeria Caso
- Santa Maria della Misericordia Hospital, University of Perugia, Italy
| | | | | | - Matthias Endres
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
| | | | - Alison Halliday
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, UK
| | - Jemma C Hopewell
- CTSU Nuffield Department of Population Health, University of Oxford, UK
| | | | - Adam Kobayashi
- Kazimierz Pulaski University of Technology and Humanities, Poland
| | - Maciej Kostrubiec
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - Antonin Krajina
- Department of Radiology, Charles University and University Hospital, Hradec Kralove Czech Republic
| | - Ulf Landmesser
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Germany
- Berlin Institute of Health (BIH), Germany
| | | | - George Ntaios
- Department of Medicine, University of Thessaly, Greece
| | | | - Marc Ribo
- Stroke Unit, Vall d'Hebron University Hospital, Spain
| | - Giuseppe MC Rosano
- IRCCS San Raffaele Hospital Roma, Italy
- Cardiovascular and Cell Sciences Institute, St George's University of London, UK
| | - Marta Rubiera
- Stroke Unit, Vall d'Hebron University Hospital, Spain
| | - Mike Sharma
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Canada
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Petr Widimsky
- Cardicenter, Charles University, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Prague, Czech Republic
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12
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Persson AP, Fedorowski A, Hedblad B, Persson M, Juul-Möller S, Engström G, Johnson LSB. Heart rate and premature atrial contractions at 24hECG independently predict atrial fibrillation in a population-based study. Heart 2019; 106:287-291. [PMID: 31405897 DOI: 10.1136/heartjnl-2019-315119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/29/2019] [Accepted: 07/11/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Low resting heart rate and premature atrial contractions (PACs) predict incident atrial fibrillation (AF) and could be interdependent, since PACs occur in the gaps between normal beats. OBJECTIVE To study the association between low heart rate at 24hECG, PACs and incident AF in a prospective population-based cohort. METHODS In the Malmö Diet and Cancer study, 24hECGs were performed in 377 AF-free subjects. The endpoint was clinical AF retrieved from national hospital (mean follow-up 17 years). The interaction between increased supraventricular activity (SVA) top quartile of either PACs/hour or supraventricular tachycardias/hour) and mean heart rate (mHR) as regards AF risk was assessed in multivariable Cox regression analyses adjusted for age, sex, height, BMI, systolic blood pressure, antihypertensive medication, smoking and homeostasis model assessment of insulin resistance. RESULTS There were 80 (21%) incident cases of AF. Below median mHR (80 bpm/75 bpm for women/men) was associated with increased AF incidence (HR: 1.89, 95% CI 1.18 to 3.02, p=0.008). There was no correlation between mHR and SVA (p=0.6) or evidence of a multiplicative interaction between these factors for AF risk (p for interaction=0.6) In the group with both increased SVA and below median mHR (17% of the population) the relative risk of AF was very high (HR 4.5, 95% CI 2.2 to 9.1, p=0.001). CONCLUSION Low mHR at 24hECG independently predicts AF, but there is no association between mHR and SVA, and these factors are independent as regards AF risk. Subjects with both low mHR and increased SVA have high AF risk.
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Affiliation(s)
- Anders Paul Persson
- Department of Clinical Sciences, Lund University, Malmö, Sweden .,Department of Clinical Physiology, Skånes universitetssjukhus Malmö, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skånes universitetssjukhus Malmö, Malmö, Sweden
| | - Bo Hedblad
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Medicine, Skånes universitetssjukhus Malmö, Malmö, Sweden
| | | | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Linda S B Johnson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Clinical Physiology, Skånes universitetssjukhus Malmö, Malmö, Sweden
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13
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Berntsson J, Smith JG, Johnson LSB, Söderholm M, Borné Y, Melander O, Orho-Melander M, Nilsson J, Engström G. Increased vascular endothelial growth factor D is associated with atrial fibrillation and ischaemic stroke. Heart 2018; 105:553-558. [PMID: 30327392 DOI: 10.1136/heartjnl-2018-313684] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Vascular endothelial growth factor D (VEGF-D) has important functions in lymphangiogenesis and angiogenesis. High plasma levels of VEGF-D have been associated with incidence of heart failure. The association of VEGF-D with atrial fibrillation (AF) and stroke is unclear and we hypothesised that VEGF-D could also be associated with incidence of AF and ischaemic stroke. METHODS VEGF-D was measured in fasting blood samples of 4689 subjects (40% men) without a history of AF from the Malmö Diet and Cancer Study, a prospective, population-based study in Sweden. Median age was 58 years (range 46-68). Cox regression analyses, adjusted for multiple risk factors, was used to assess AF and ischaemic stroke risk in relation to VEGF-D levels. RESULTS During a median follow-up time of 20.6 years, there were 637 cases of incident AF and 322 cases of first ischaemic stroke. After adjustment, VEGF-D was significantly associated with AF (HR 1.13(95% CI 1.04 to 1.23) per 1 SD increase) and ischaemic stroke (HR 1.14(95% CI 1.02 to 1.28) per 1 SD). The association with ischaemic stroke was explained by an increased incidence of AF-related stroke. HRs per 1 SD were 1.34 (95% CI 1.04 to 1.71) for AF-related ischaemic stroke and 1.04 (95% CI 0.90 to 1.19) for ischaemic stroke without AF. CONCLUSIONS Increased VEGF-D concentrations were associated with AF and ischaemic stroke. The relationship with ischaemic stroke was more pronounced in subjects with a diagnosis of AF.
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Affiliation(s)
- John Berntsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.,Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Linda S B Johnson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Martin Söderholm
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Malmö, Sweden
| | - Yan Borné
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Marju Orho-Melander
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jan Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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14
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Ricci C, Gervasi F, Gaeta M, Smuts CM, Schutte AE, Leitzmann MF. Physical activity volume in relation to risk of atrial fibrillation. A non-linear meta-regression analysis. Eur J Prev Cardiol 2018; 25:857-866. [DOI: 10.1177/2047487318768026] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Light physical activity is known to reduce atrial fibrillation risk, whereas moderate to vigorous physical activity may result in an increased risk. However, the question of what volume of physical activity can be considered beneficial remains poorly understood. The scope of the present work was to examine the relation between physical activity volume and atrial fibrillation risk. Design A comprehensive systematic review was performed following the PRISMA guidelines. Methods A non-linear meta-regression considering the amount of energy spent in physical activity was carried out. The first derivative of the non-linear relation between physical activity and atrial fibrillation risk was evaluated to determine the volume of physical activity that carried the minimum atrial fibrillation risk. Results The dose–response analysis of the relation between physical activity and atrial fibrillation risk showed that physical activity at volumes of 5–20 metabolic equivalents per week (MET-h/week) was associated with significant reduction in atrial fibrillation risk (relative risk for 19 MET-h/week = 0.92 (0.87, 0.98). By comparison, physical activity volumes exceeding 20 MET-h/week were unrelated to atrial fibrillation risk (relative risk for 21 MET-h/week = 0.95 (0.88, 1.02). Conclusion These data show a J-shaped relation between physical activity volume and atrial fibrillation risk. Physical activity at volumes of up to 20 MET-h/week is associated with reduced atrial fibrillation risk, whereas volumes exceeding 20 MET-h/week show no relation with risk.
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Affiliation(s)
- Cristian Ricci
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
| | - Federico Gervasi
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Maddalena Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
| | - Aletta E Schutte
- MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
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