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Kreimer F, Backhaus JF, Krogias C, Pflaumbaum A, Mügge A, Gotzmann M. P-wave parameters and their association with thrombi and spontaneous echo contrast in the left atrial appendage. Clin Cardiol 2023; 46:397-406. [PMID: 36808747 PMCID: PMC10106666 DOI: 10.1002/clc.23980] [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: 07/06/2022] [Revised: 01/07/2023] [Accepted: 01/12/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND The aim of this study was to examine the prevalence of abnormal P-wave parameters in patients with thrombus and/or spontaneous echo contrast (SEC) in the left atrial appendage (LAA), and to identify P-wave parameters particularly associated with thrombus and SEC formation. HYPOTHESIS We presume a significant relationship of P-wave parameters with thrombi and SEC. METHODS All patients in whom a thrombus or SEC was detected in the LAA on transoesophageal echocardiography were included in this study. Patients at risk (CHA2DS2-VASc Score ≥3) and routine transoesophageal echocardiography to exclude thrombi served as the control group. A detailed ECG analysis was performed. RESULTS Of a total of 4062 transoesophageal echocardiographies, thrombi and SEC were detected in 302 patients (7.4%). Of these patients, 27 (8.9%) presented with sinus rhythm. The control group included 79 patients. There was no difference in mean CHA2DS2-VASc score in the two groups (p = .182). A high prevalence of abnormal P-wave parameters was detected in patients with thrombus/SEC. Indicators for the presence of thrombi or SEC in the LAA were P-wave duration >118 ms (Odds ratio (OR) 3.418, Confidence interval (CI) 1.522-7.674, p < .001), P-wave dispersion >40 ms (OR 2.521, CI 1.390-4.571, p < .001) and advanced interatrial block (OR 1.431, CI 1.033-1.984, p = .005). CONCLUSION Our study revealed that several P-wave parameters are associated with thrombi and SEC in the LAA. The results may help identify patients who are at particularly high risk for thromboembolic events (e.g., in patients with embolic stroke of undetermined source).
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Affiliation(s)
- Fabienne Kreimer
- Cardiology and Rhythmology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Julian Felix Backhaus
- Cardiology and Rhythmology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christos Krogias
- Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Andreas Pflaumbaum
- Cardiology and Rhythmology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Andreas Mügge
- Cardiology and Rhythmology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Michael Gotzmann
- Cardiology and Rhythmology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
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Wu Y, Yang X, Jing J, Meng X, Li Z, Pan Y, Jiang Y, Yan H, Huang X, Liu L, Zhao X, Wang Y, Li H, Wang Y. Prognostic significance of atrial cardiopathy in patients with acute ischemic stroke. Eur Stroke J 2022; 8:183-190. [PMID: 37021197 PMCID: PMC10069199 DOI: 10.1177/23969873221126000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Whether atrial cardiopathy is associated with stroke prognosis remains unclear. We evaluated the association between atrial cardiopathy markers and outcomes in patients with ischemic stroke using a nationwide prospective registry. Patients and methods: Based on the Third China National Stroke Registry, we evaluated different atrial cardiopathy markers including increased P-wave terminal force in V1 (PTFV1), advanced interatrial block (aIAB), prolonged P-wave duration, prolonged P-wave dispersion, paroxysmal supraventricular tachycardia, premature atrial contractions, prolonged PR interval, and severe left atrial enlargement in ischemic stroke patients. The outcomes were death and ischemic stroke recurrence at 1 year. The association between atrial cardiopathy markers and outcomes was analyzed using Cox regression models. Results: At 1-year follow-up, 486 (3.4%) patients had died and 1317 (9.3%) patients had experienced ischemic stroke recurrence. After adjustment for clinical risk factors including atrial fibrillation, PTFV1 > 5000 μV·ms (adjusted hazard ratio [HR] 1.70, 95% confidence interval [CI]: 1.18–2.45, p = 0.004) and aIAB (adjusted HR 1.47, 95% CI: 1.14–1.91, p = 0.003) were significantly associated with mortality. PTFV1 > 5000 μV·ms was significantly associated with ischemic stroke recurrence (adjusted HR 1.54, 95% CI: 1.22–1.96, p = 0.0004). This association was observed although we excluded patients diagnosed with atrial fibrillation. Discussion and Conclusion: Atrial cardiopathy markers, especially PTFV1 and aIAB, are significantly associated with a higher risk of poor prognosis in patients with ischemic stroke.
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Affiliation(s)
- Yueyang Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Xiaomeng Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Hongyi Yan
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Xinying Huang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
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Wang H, Cai L, Guo Y, Shuai L, Shi Y, Si Q. Advanced Interatrial Block Predicts Recurrence of Atrial Fibrillation and Ischemic Stroke in Elderly Patients With Hypertension. Front Physiol 2022; 13:913454. [PMID: 35784875 PMCID: PMC9243526 DOI: 10.3389/fphys.2022.913454] [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] [Received: 04/05/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to investigate whether advanced interatrial block (IAB) is a predictor of recurrent atrial fibrillation (AF) and/or ischemic stroke in elderly patients with AF and hypertension.Methods and objectives: Five hundred and sixteen elderly inpatients (mean age 85.53 ± 9.08 years; 5.43% women) with concurrent paroxysmal AF and hypertension were enrolled in this retrospective observational study. Data on comorbidity, medication, digital electrocardiograms (ECG), and outcomes were obtained from the medical records and follow-up examinations. IAB was classified as partial IAB or advanced IAB according to 12-lead surface ECG analysis on admission. Advanced IAB was defined as a maximum P wave duration of >120 ms with biphasic (±) morphology in leads II, Ⅲ, and aVF by two blinded investigators. The endpoints were recurrent AF and ischemic stroke.Results: We enrolled 120 patients (23.26%) with partial IAB and 187 (36.24%) with advanced IAB. The mean follow-up duration was 19 months. A total of 320 patients (62.02%) developed AF recurrence, and 31 (6.01%) experienced ischemic stroke. Significant predictors of advanced IAB in multivariate analysis were older age (>80 years), increased left atrial diameter (>40 mm), and being overweight (body mass index >25 kg/m2). In the multivariable comprehensive Cox regression analyses, partial IAB was associated with AF recurrence. Advanced IAB was an independent predictor of increased risk of AF recurrence and ischemic stroke.Conclusion: Both partial and advanced IAB are associated with AF recurrence in elderly patients with hypertension. Furthermore, advanced IAB is an independent predictor of ischemic stroke.
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Affiliation(s)
- Haijun Wang
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Lili Cai
- Department of Laboratory Medicine, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yan Guo
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Li Shuai
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yang Shi
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yang Shi, ; Quanjin Si,
| | - Quanjin Si
- Department of the Third Health Care, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yang Shi, ; Quanjin Si,
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P-wave indices in Japanese patients with ischemic stroke: Implication of atrial myopathy in subtype of ischemic stroke. J Electrocardiol 2021; 66:18-22. [PMID: 33706220 DOI: 10.1016/j.jelectrocard.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND P-wave indices have been not fully studied in subtypes of ischemic stroke. We compared P-wave indices among embolic stroke, lacunar stroke and the control. METHODS P-wave duration, advanced interatrial block (aIAB) defined as P-wave duration ≥120 ms and biphasic (positive negative) morphology in inferior leads, and P-terminal force in lead V1 (PTFV1) were measured at the time of the first episode of cardioembolic stroke in 81 patients with paroxysmal atrial fibrillation (PAF), and in 64 patients with lacunar stroke, and compared with 100 control subjects. The latter two groups had no episode of PAF. RESULTS The age of participants was 76 ± 11 years. Age, sex distribution, body mass index and CHADS2 score were comparable among three groups. Maximum P-wave duration, the longest across 12 leads, was significantly prolonged in cardioembolic and lacuna stroke compared to the control; 118 ± 12 ms and 118 ± 11 ms vs. 110 ± 11 ms, respectively (P < 0.0001). P-wave duration ≥120 ms and aIAB were more prevalent in ischemic stroke groups than the control, and associated with a higher Odds ratio for stroke, more so in cardioembolic stroke. However, PTFV1 value and the prevalence of PTFV1 ≥ 4.0 ms·mV were significantly not different among the three groups. Abnormal P-wave duration and aIAB indicating the presence of atrial myopathy were present in cardioembolic and lacuna stroke. CONCLUSION Atrial myopathy was present in cardioembolic and lacunar stroke, but it can't be the direct cause of small vessel occlusion in lacunar stroke. Roles of atrial myopathy in each subtype of ischemic stroke should be studied.
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Iomini PA, Martínez-Sellés M, Elosua R, Bayés-de-Luna A, Baranchuk A. [Bayés Syndrome, Stroke and Dementia]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:27-39. [PMID: 37727263 PMCID: PMC10506554 DOI: 10.47487/apcyccv.v2i1.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/03/2021] [Indexed: 09/21/2023]
Abstract
Bayés's syndrome is a clinical entity based on the association between advanced interatrial block and the development of supraventricular tachyarrhythmia, being atrial fibrillation (AF) the most frequent. This association was discovered by Prof. Antoni Bayés de Luna in the '80s. Further studies by other groups found a strong relationship between Bayés's syndrome and thromboembolic phenomena, being stroke the most serious. Moreover, patients with this syndrome have an increased incidence of cognitive impairment and dementia. This observation triggered the question about whether the use of anticoagulation therapy prior to the documentation of AF could prevent A-IAB associated thromboembolic events. There are ongoing studies in different phases of development aiming to compare the efficacy of anticoagulation in patients with A-IAB with no prior documentation of AF. The outcomes of these studies will allow determining the efficacy of this early therapeutic intervention, and help deciding the role of anticoagulation in patients with A-IAB and no demonstrated AF.
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Affiliation(s)
- Pablo A. Iomini
- *Correspondencia: Balcarce 434, Morón (CP 1708), Buenos Aires, Argentina. Correo
| | - Manuel Martínez-Sellés
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV). EspañaCentro de InvestigaciónRed de Enfermedades Cardiovasculares (CIBERCV)España
- Hospital General Universitario Gregorio Marañón. Madrid, EspañaHospital General Universitario Gregorio MarañónMadridEspaña
- Universidad Europea de Madrid y Universidad Complutense de Madrid, EspañaUniversidad Europea de MadridUniversidad Europea de Madrid y Universidad Complutense de MadridSpain
| | - Roberto Elosua
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV). EspañaCentro de InvestigaciónRed de Enfermedades Cardiovasculares (CIBERCV)España
- Facultad de Medicina, Universidad de Vic-Universidad Central de Catalunya. Barcelona, EspañaFacultad de MedicinaUniversidad Central de CatalunyaBarcelonaEspaña
- Fundación Investigación Cardiovascular, Programa Cardiovascular-ICCC, Institut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant Pau. Barcelona, EspañaFundación Investigación CardiovascularPrograma Cardiovascular-ICCCInstitut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant PauBarcelonaEspaña
| | - Antoni Bayés-de-Luna
- Fundación Investigación Cardiovascular, Programa Cardiovascular-ICCC, Institut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant Pau. Barcelona, EspañaFundación Investigación CardiovascularPrograma Cardiovascular-ICCCInstitut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant PauBarcelonaEspaña
| | - Adrián Baranchuk
- Division of cardiology, Kingston Health Science Center, Kingston.Ontario, CanadaDivision of cardiologyKingston Health Science CenterOntarioCanada
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Vicent L, Fernández‐Cordón C, Nombela‐Franco L, Escobar‐Robledo LA, Ayesta A, Ariza Solé A, Gómez‐Doblas JJ, Bernal E, Tirado‐Conte G, Cobiella J, González‐Saldivar H, López‐Otero D, Díez‐Villanueva P, Sarnago F, Armario X, Bayés‐de-Luna A, Martínez‐Sellés M. Baseline ECG and Prognosis After Transcatheter Aortic Valve Implantation: The Role of Interatrial Block. J Am Heart Assoc 2020; 9:e017624. [PMID: 33140688 PMCID: PMC7763710 DOI: 10.1161/jaha.120.017624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/25/2020] [Indexed: 01/03/2023]
Abstract
Background The clinical significance of conduction disturbances after transcatheter aortic valve implantation has been described; however, little is known about the influence of baseline ECGs in the prognosis of these patients. Our aim was to study the influence of baseline ECG parameters, including interatrial block (IAB), in the prognosis of patients treated with transcatheter aortic valve implantation. Methods and Results The BIT (Baseline Interatrial Block and Transcatheter Aortic Valve Implantation) registry included 2527 patients with aortic stenosis treated with transcatheter aortic valve implantation. A centralized analysis of baseline ECGs was performed. Patients were divided into 4 groups: normal P wave duration (<120 ms); partial IAB (P wave duration ≥120 ms, positive in the inferior leads); advanced IAB (P wave duration ≥120 ms, biphasic [+/-] morphology in the inferior leads); and nonsinus rhythm (atrial fibrillation/flutter and paced rhythm). The mean age of patients was 82.6±9.8 years and 1397 (55.3%) were women. A total of 960 patients (38.0%) had a normal P wave, 582 (23.0%) had partial IAB, 300 (11.9%) had advanced IAB, and 685 (27.1%) presented with nonsinus rhythm. Mean follow-up duration was 465±171 days. Advanced IAB was the only independent predictor of all-cause mortality (hazard ratio [HR], 1.48; 95% CI, 1.10-1.98 [P=0.010]) and of the composite end point (death/stroke/new atrial fibrillation) (HR, 1.51; 95% CI, 1.17-1.94 [P=0.001]). Conclusions Baseline ECG characteristics influence the prognosis of patients with aortic stenosis treated with transcatheter aortic valve implantation. Advanced IAB is present in about an eighth of patients and is associated with all-cause death and the composite end point of death, stroke, and new atrial fibrillation during follow-up.
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Affiliation(s)
- Lourdes Vicent
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
- Department of CardiologyHospital General Universitario 12 de OctubreCIBERCVMadridSpain
| | - Clara Fernández‐Cordón
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
| | | | - Luis Alberto Escobar‐Robledo
- Department of CardiologyHospital de la Santa Creu i Sant Pau. Fundación Investigación Cardiovascular. Programa‐ICCC CardiovascularInstitut de Recerca del Hospital de la Santa Creu I Sant PauIIB‐Sant Pau Barcelona, SpainBarcelonaSpain
| | - Ana Ayesta
- Department of CardiologyHospital Universitario Central de AsturiasOviedoAsturiasSpain
| | - Albert Ariza Solé
- Department of CardiologyBellvitge University Hospital. L’Hospitalet de LlobregatBarcelonaSpain
| | | | - Eva Bernal
- Department of CardiologyHospital Universitari Germans Trias i Pujol BadalonaBarcelonaSpain
| | | | - Javier Cobiella
- Cardiovascular InstituteHospital Clinico San Carlos, IdISSCMadridSpain
| | - Hugo González‐Saldivar
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
| | - Diego López‐Otero
- Department of CardiologyHospital Cínico UniversitarioSantiago de CompostelaSpain
| | | | - Fernando Sarnago
- Department of CardiologyHospital General Universitario 12 de OctubreCIBERCVMadridSpain
| | - Xavier Armario
- Department of CardiologyHospital de la Santa Creu i Sant Pau. Fundación Investigación Cardiovascular. Programa‐ICCC CardiovascularInstitut de Recerca del Hospital de la Santa Creu I Sant PauIIB‐Sant Pau Barcelona, SpainBarcelonaSpain
| | - Antonio Bayés‐de-Luna
- Department of CardiologyHospital de la Santa Creu i Sant Pau. Fundación Investigación Cardiovascular. Programa‐ICCC CardiovascularInstitut de Recerca del Hospital de la Santa Creu I Sant PauIIB‐Sant Pau Barcelona, SpainBarcelonaSpain
| | - Manuel Martínez‐Sellés
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
- Universidad EuropeaUniversidad ComplutenseMadridSpain
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YALIM Z, ERSOY İ. Evaluation of the relationship between diastolic dysfunction and interatrial block. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.770238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Jacobsson J, Carlson J, Reitan C, Borgquist R, Platonov PG. Interatrial Block Predicts Atrial Fibrillation and Total Mortality in Patients with Cardiac Resynchronization Therapy. Cardiology 2020; 145:720-729. [PMID: 33022672 DOI: 10.1159/000509916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Interatrial block (IAB) and abnormal P-wave terminal force in lead V1 (PTFV1) are electrocardiographic (ECG) abnormalities that have been shown to be associated with new-onset atrial fibrillation (AF) and death. However, their prognostic importance has not been proven in cardiac resynchronization therapy (CRT) recipients. OBJECTIVE To assess if IAB and abnormal PTFV1 are associated with new-onset AF or death in CRT recipients. METHODS CRT recipients with sinus rhythm ECG at CRT implantation and no AF history were included (n = 210). Automated analysis of P-wave duration (PWD) and morphology classified patients as having either no IAB (PWD <120 ms), partial IAB (pIAB: PWD ≥120 ms, positive P waves in leads II and aVF), or advanced IAB (aIAB: PWD ≥120 ms and biphasic or negative P wave in leads II or aVF). PTFV1 >0.04 mm•s was considered abnormal. Adjusted Cox regression analyses were performed to assess the impact of IAB and abnormal PTFV1 on the primary endpoint new-onset AF, death, or heart transplant (HTx) and the secondary endpoint death or HTx at 5 years of follow-up. RESULTS IAB was found in 45% of all patients and independently predicted the primary endpoint with HR 1.9 (95% CI 1.2-2.9, p = 0.004) and the secondary endpoint with HR 2.1 (95% CI 1.2-3.4, p = 0.006). Abnormal PTFV1 was not associated with the endpoints. CONCLUSIONS IAB is associated with new-onset AF and death in CRT recipients and may be helpful in the risk stratification in the context of heart failure management. Abnormal PTFV1 did not demonstrate any prognostic value.
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Affiliation(s)
- Jonatan Jacobsson
- Lund University, Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund, Sweden, .,Department of Medicine, Sahlgrenska University Hospital, Mölndal, Sweden,
| | - Jonas Carlson
- Lund University, Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund, Sweden
| | - Christian Reitan
- Lund University, Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden
| | - Rasmus Borgquist
- Lund University, Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund, Sweden.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Pyotr G Platonov
- Lund University, Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund, Sweden
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Bayés de Luna A, Martínez-Sellés M, Bayés-Genís A, Elosua R, Baranchuk A. Síndrome de Bayés. Lo que todo clínico debe conocer. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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10
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Bayés de Luna A, Martínez-Sellés M, Bayés-Genís A, Elosua R, Baranchuk A. What every clinician should know about Bayés syndrome. ACTA ACUST UNITED AC 2020; 73:758-762. [PMID: 32684442 DOI: 10.1016/j.rec.2020.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 10/23/2022]
Abstract
Bayés syndrome is a new clinical entity, characterized by the association of advanced interatrial block (IAB) on surface electrocardiogram with atrial fibrillation (AF) and other atrial arrhythmias. This syndrome is associated with an increased risk of stroke, dementia, and mortality. Advanced IAB is diagnosed by the presence of a P-wave ≥ 120ms with biphasic morphology (±) in inferior leads. The cause of IAB is complete Bachmann bundle blockade, leading to retrograde depolarization of the left atrium from areas near the atrioventricular junction. The anatomic substrate of advanced IAB is fibrotic atrial cardiomyopathy. Dyssynchrony induced by advanced IAB is a trigger and maintenance mechanism of AF. This alteration of the atrial architecture produces atrial remodeling, blood stasis and hypercoagulability, triggering the thrombogenic cascade. The presence of advanced IAB, even in patients without documented atrial arrhythmias, has also been associated with AF, stroke, dementia, and mortality. However, in these patients, there is no evidence to support the use of anticoagulation. Therefore, in patients with advanced IAB, a proactive search for AF is recommended.
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Affiliation(s)
- Antoni Bayés de Luna
- Fundación de Investigación Cardiovascular ICCC, Instituto de Investigación Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain.
| | - Antoni Bayés-Genís
- Instituto del Corazón, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
| | - Roberto Elosua
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), CIBERCV, Facultad de Medicina, Universidad de Vic-Universidad Central de Cataluña, Vic, Barcelona, Spain
| | - Adrián Baranchuk
- Department of Medicine, Queens University, Kingston, Ontario, Canada
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Wang Z, Qin H, Chen G, Mok VCT, Dai Y, Cai Y, Cheng X, Qian Y, Chu M, Lu X. Association between advanced interatrial block and small vessel diseases in the brain. Quant Imaging Med Surg 2020; 10:585-591. [PMID: 32269919 DOI: 10.21037/qims.2020.02.02] [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: 01/09/2023]
Abstract
Background The latest evidence shows the association of atrial cardiopathy with embolic strokes of undetermined source. Advanced interatrial block (aIAB) is an electrophysiological mark of atrial cardiopathy. This study investigated the relationship between aIAB and the burden of silent cerebral small vessel diseases (SVD) on magnetic resonance imaging in the absence of atrial fibrillation (AF) and atrial flutter. Methods This cross-sectional study included 499 patients with normal left ventricular ejection fraction (LVEF), who were free of AF, atrial flutter, stroke, and acute coronary syndrome in our hospital. aIAB was ascertained by digital electrocardiograms. Left atrial diameter, LVEF, and left ventricular posterior wall thickness (LVPWT) were measured on echocardiograms. Based on the presence of 4 manifestations of SVD, including white matter hyperintensity (WMH), lacunes, microbleeds, and enlarged perivascular spaces (EPVS) on magnetic resonance imaging, an ordinal SVD score (range, 0-4) was devised to reflect the total burden of cerebral SVD. The ordinal regression model was used to explore the association of aIAB with SVD burden after adjusting for confounding factors. Results The mean age was 67.7 years, and 327 (65.5%) were male. A total of 23 (4.6%) patients had aIAB. The number of patients with cerebral SVD scores of 0, 1, 2, 3, and 4 was 92 (18.4%), 122 (24.4%), 190 (38.1%), 83 (16.6%), and 12 (2.4%), respectively. After adjusting for age, sex, hypertension, diabetes, hyperlipidemia, left atrial diameter, LVEF, and LVPWT, the regression model showed a significant association of aIAB with cerebral SVD score (OR =2.408, 95% CI, 1.082-5.366). Conclusions Atrial cardiopathy indexed by aIAB was independently associated with a high burden of SVD in the brain.
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Affiliation(s)
- Zhaolu Wang
- Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Huiyuan Qin
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Guilin Chen
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Yan Dai
- The First School of Clinical Medicine, Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yingyuan Cai
- Division of Neurology, Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xi Cheng
- Division of Neurology, Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yun Qian
- Division of Neurology, Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ming Chu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.,Department of Cardiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
| | - Xiaowei Lu
- Division of Neurology, Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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