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Hypertension and cardiomyopathy associated with chronic kidney disease: epidemiology, pathogenesis and treatment considerations. J Hum Hypertens 2023; 37:1-19. [PMID: 36138105 PMCID: PMC9831930 DOI: 10.1038/s41371-022-00751-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/09/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
Chronic kidney disease (CKD) is a complex condition with a prevalence of 10-15% worldwide. An inverse-graded relationship exists between cardiovascular events and mortality with kidney function which is independent of age, sex, and other risk factors. The proportion of deaths due to heart failure and sudden cardiac death increase with progression of chronic kidney disease with relatively fewer deaths from atheromatous, vasculo-occlusive processes. This phenomenon can largely be explained by the increased prevalence of CKD-associated cardiomyopathy with worsening kidney function. The key features of CKD-associated cardiomyopathy are increased left ventricular mass and left ventricular hypertrophy, diastolic and systolic left ventricular dysfunction, and profound cardiac fibrosis on histology. While these features have predominantly been described in patients with advanced kidney disease on dialysis treatment, patients with only mild to moderate renal impairment already exhibit structural and functional changes consistent with CKD-associated cardiomyopathy. In this review we discuss the key drivers of CKD-associated cardiomyopathy and the key role of hypertension in its pathogenesis. We also evaluate existing, as well as developing therapies in the treatment of CKD-associated cardiomyopathy.
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Is hypertensive left ventricular hypertrophy a cause of sustained ventricular arrhythmias in humans? J Hum Hypertens 2021; 35:492-498. [PMID: 33674703 PMCID: PMC8208890 DOI: 10.1038/s41371-021-00503-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 01/19/2023]
Abstract
Sudden cardiac death (SCD) is most commonly secondary to sustained ventricular arrhythmias (VAs). This review aimed to evaluate if left ventricular hypertrophy (LVH) secondary to systemic hypertension in humans is an isolated risk factor for ventricular arrhythmogenesis. Animal models of hypertensive LVH have shown changes in ion channel function and distribution, gap junction re-distribution and fibrotic deposition. Clinical data has consistently exhibited an increase in prevalence and complexity of non-sustained VAs on electrocardiographic monitoring. However, there is a dearth of trials suggesting progression to sustained VAs and SCD, with extrapolations being confounded by presence of co-existent asymptomatic coronary artery disease (CAD). Putatively, this lack of data may be due to the presence of more homogenous distribution of pathophysiological changes seen in those with hypertensive LVH versus known pro-arrhythmic conditions such as HCM and myocardial infarction. The overall impression is that sustained VAs in the context of hypertensive LVH are most likely to be precipitated by other causes such as CAD or electrolyte disturbance.
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Ledwoch J, Fröhlich C, Olbrich I, Poch F, Thalmann R, Fellner C, Bradaric C, Laugwitz KL, Kupatt C, Hoppmann P. Impact of sinus rhythm versus atrial fibrillation on left ventricular remodeling after transcatheter aortic valve replacement. Clin Res Cardiol 2021; 110:689-698. [PMID: 33566184 PMCID: PMC8099831 DOI: 10.1007/s00392-021-01810-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
AIMS Atrial fibrillation (AF) is associated with increased mortality after transcatheter aortic valve replacement (TAVR). Cerebrovascular complications and bleeding events associated with anticoagulation therapy are discussed to be possible causes for this increased mortality. The present study sought to assess whether AF is associated with impaired left ventricular (LV) reverse remodeling representing another possible mechanism for poor outcome. METHODS All patients who underwent TAVR in our institution and had 1-year echocardiography follow-up were included. LV mass index (LVMI) at baseline and follow-up as well as LVMI change at 1 year were assessed with respect to the presence of AF (either at baseline or during hospitalization after TAVR) and sinus rhythm (SR). RESULTS A total of 213 patients (n = 95 in AF; n = 118 in SR) were enrolled in the present study. Patients with AF had higher LVMI at 1 year compared to those with SR (173 ± 61 g/m2 vs. 154 ± 55 g/m2; p = 0.02) and they showed lower relative LVMI change at 1 year (- 2 ± 28% vs. - 9 ± 29%; p = 0.04). In linear regression analysis, AF was independently associated with relative LVMI change (regression coefficient ß 0.076 [95% CI 0.001-0.150]; p = 0.04). With respect to clinical outcome depending on AF and LVMI regression, the Kaplan-Meier estimated event-free of death or cardiac rehospitalization at 3 years was lowest among patients with AF and no LVMI regression. CONCLUSIONS The present study identified a significant association of AF with changes in LVMI after TAVR, which was also shown to be associated with clinical outcome.
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Affiliation(s)
- Jakob Ledwoch
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der isar, Technical University of Munich, Munich, Germany.
- Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, München Klinik Neuperlach, Munich, Germany.
| | - Carolin Fröhlich
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ida Olbrich
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Felix Poch
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ruth Thalmann
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Carmen Fellner
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Bradaric
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Kupatt
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Petra Hoppmann
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Abstract
Hypertension (HTN) is a major modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality. The left ventricle (LV) is a primary target for HTN end-organ damage. In addition to being a marker of HTN, LV geometrical changes: concentric remodeling, concentric or eccentric LV hypertrophy (LVH) are major independent risk factors for not only CVD morbidity and mortality but also for all-cause mortality and neurological pathologies. Blood pressure control with lifestyle changes and antihypertensive agents has been demonstrated to prevent and regress LVH. Herein, we provide a comprehensive review of literature on the relationship between HTN and LV geometry abnormalities with a focus on diagnosis, prognosis, pathophysiological mechanisms, and treatment approaches.
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Dudink EA, Weijs B, Tull S, Luermans JG, Fabritz L, Chua W, Rienstra M, Gelder ICV, Schotten U, Kirchhof P, Crijns HJ. The Biomarkers NT-proBNP and CA-125 are Elevated in Patients with Idiopathic Atrial Fibrillation. J Atr Fibrillation 2018; 11:2058. [PMID: 31139280 PMCID: PMC6533832 DOI: 10.4022/jafib.2058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/19/2017] [Accepted: 08/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Blood biomarkers related to AF could be useful to detect silent AF and to develop stratified strategies for AF prevention. Previous studies identified markers that predict incident AF. However, it is difficult to differentiate whether biomarkers relate to underlying cardiovascular diseases, are generated by the atria in response to an AF episode, or both. We therefore measured a panel of blood biomarkers in patients without overt CVD with and without AF to investigate the association between biomarkers and atrial fibrillation (AF) in patients without overt cardiovascular disease (CVD). METHODS Blood samples - drawn remote from an AF episode - of 60 patients with AF but without overt forms of CVD (idiopathic AF; iAF) were compared to 120 matched patients with sinus rhythm only. A novel antibody-based method for quantification of blood biomarkers (OlinkProseek Multiplex Cardiovascular) was used to compare 92 biomarkers between the two groups. RESULTS N-terminal pro-B-type natriuretic peptide (NT-proBNP), Cathepsin L1, Endothelial cell-specific molecule 1, Cancer Antigen-125 (CA-125), Heat shock 27kDa protein, Galanin peptides, Proteinase-activated receptor 1, Stem cell factor, and CD40-ligand were all higher in iAF patients than in SR controls. Both NT-proBNP (OR1.55(1.07-2.25);p=0.022) and CA-125 (OR1.68(1.07-2.64);p=0.026) were independently associated with iAF. CONCLUSIONS This exploratory study, investigating over 90 cardiovascular blood biomarkers in patients without known CVD, identified one established biomarker for paroxysmal AF, NT-proBNP, and a novel marker, CA-125. CA-125 - previously unrelated to paroxysmal AF in an otherwise healthy population - may thus be a potential indicator of remote paroxysms of AF.
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Affiliation(s)
- Elton Amp Dudink
- Maastricht University Medical Center+ and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, Maastricht, the Netherlands
| | - Bob Weijs
- Maastricht University Medical Center+ and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, Maastricht, the Netherlands
| | - Samantha Tull
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - Justin Glm Luermans
- Maastricht University Medical Center+ and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, Maastricht, the Netherlands
| | - Larissa Fabritz
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - Winnie Chua
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - Michiel Rienstra
- University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Isabelle C Van Gelder
- University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Ulrich Schotten
- Maastricht University and Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Maastricht, the Netherlands
| | - Paulus Kirchhof
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
- Sandwell and West Birmingham Hospitals and University Hospitals Birmingham NHS trusts, Birmingham, United Kingdom
- AFNET, Münster, Germany
| | - Harry Jgm Crijns
- Maastricht University Medical Center+ and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, Maastricht, the Netherlands
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Erküner Ö, Dudink EA, Nieuwlaat R, Rienstra M, Van Gelder IC, Camm AJ, Capucci A, Breithardt G, LeHeuzey JY, Lip GY, Crijns HJ, Luermans JG. Effect of Systemic Hypertension With Versus Without Left Ventricular Hypertrophy on the Progression of Atrial Fibrillation (from the Euro Heart Survey). Am J Cardiol 2018; 122:578-583. [PMID: 29958714 DOI: 10.1016/j.amjcard.2018.04.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 11/26/2022]
Abstract
Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, that is major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these end points. We aimed to assess this in low-risk AF patients, also assessing gender-related differences. We included 799 patients from the Euro Heart Survey with nonvalvular AF and a baseline echocardiogram. Patients with and without hypertension were included. End points after 1 year were occurrence of AF progression, that is paroxysmal AF becoming persistent and/or permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared with hypertensive patients without LVH (23.3% vs 8.8%, p = 0.011). In hypertensive AF patients, LVH was the most important multivariably adjusted determinant of AF progression on multivariable logistic regression (odds ratio 4.84, 95% confidence interval 1.70 to 13.78, p = 0.003). This effect was only seen in male patients (27.5% vs 5.8%, p = 0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs 15.0%, p = 0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women.
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Menezes Falcão L. Early detection by non-invasive methods of predisposition to atrial remodeling in hypertension. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Menezes Falcão L. Predisposição para remodelagem auricular na hipertensão arterial - deteção precoce por meios não invasivos. Rev Port Cardiol 2017; 36:461-463. [DOI: 10.1016/j.repc.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Avci BK, Gulmez O, Donmez G, Pehlivanoglu S. Early Changes in Atrial Electromechanical Coupling in Patients with Hypertension: Assessment by Tissue Doppler Imaging. Chin Med J (Engl) 2017; 129:1311-5. [PMID: 27231168 PMCID: PMC4894041 DOI: 10.4103/0366-6999.182846] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hypertension (HT) is associated with atrial electrophysiological abnormalities. Echocardiographic pulsed wave tissue Doppler imaging (TDI) is one of the noninvasive methods for evaluation of atrial electromechanical properties. The aims of our study were to investigate the early changes in atrial electromechanical conduction in patients with HT and to assess the parameters that affect atrial electromechanical conduction. METHODS Seventy-six patients with HT (41 males, mean age 52.6 ± 9.0 years) and 41 controls (22 males, mean age 49.8 ± 7.9 years) were included in the study. Atrial electromechanical coupling at the right (PRA), left (PLA), interatrial septum (PIS) were measured with TDI. Intra- (right: PIS-PRA, left: PLA-PIS) and inter-atrial (PLA-PRA) electromechanical delays were calculated. Maximum P-wave duration (Pmax) was calculated from 12-lead electrocardiogram. RESULTS Atrial electromechanical coupling at PLA (76.6 ± 14.1 ms vs. 82.9 ± 15.8 ms, P = 0.036), left intra-atrial (10.9 ± 5.0 ms vs. 14.0 ± 9.7 ms, P = 0.023), right intra-atrial (10.6 ± 7.8 ms vs. 14.5 ± 10.1 ms, P = 0.035), and interatrial electromechanical (21.4 ± 9.8 ms vs. 28.3 ± 12.7 ms, P = 0.003) delays were significantly longer in patients with HT. The linear regression analysis showed that left ventricular (LV) mass index and Pmax were significantly associated with PLA (P = 0.001 and P = 0.002, respectively), and the LV mass index was the only related factor for interatrial delay (P = 0.001). CONCLUSIONS Intra- and interatrial electromechanical delay, PLA were significantly prolonged in hypertensive patients. LV mass index and Pmax were significantly associated with PLA, and the LV mass index was the only related factor for interatrial delay. The atrial TDI can be a valuable method to assess the early changes of atrial electromechanical conduction properties in those patients.
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Affiliation(s)
- Burcak Kilickiran Avci
- Department of Cardiology, Baskent University, Istanbul Medical and Research Center, Oymacı Sok, 34662 Altunizade, Istanbul, Turkey
| | - Oyku Gulmez
- Department of Cardiology, Baskent University, Istanbul Medical and Research Center, Oymacı Sok, 34662 Altunizade, Istanbul, Turkey
| | - Guclu Donmez
- Department of Cardiology, Baskent University, Istanbul Medical and Research Center, Oymacı Sok, 34662 Altunizade, Istanbul, Turkey
| | - Seckin Pehlivanoglu
- Department of Cardiology, Baskent University, Istanbul Medical and Research Center, Oymacı Sok, 34662 Altunizade, Istanbul, Turkey
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Santoro F, Di Biase L, Trivedi C, Burkhardt JD, Paoletti Perini A, Sanchez J, Horton R, Mohanty P, Mohanty S, Bai R, Santangeli P, Lakkireddy D, Reddy M, Elayi CS, Hongo R, Beheiry S, Hao S, Schweikert RA, Viles-Gonzalez J, Fassini G, Casella M, Dello Russo A, Tondo C, Natale A. Impact of Uncontrolled Hypertension on Atrial Fibrillation Ablation Outcome. JACC Clin Electrophysiol 2015; 1:164-173. [DOI: 10.1016/j.jacep.2015.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/07/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
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Miyamura M, Fujita SI, Morita H, Sakane K, Okamoto Y, Sohmiya K, Hoshiga M, Ishizaka N. Circulating Fibroblast Growth Factor 23 Has a U-Shaped Association With Atrial Fibrillation Prevalence. Circ J 2015; 79:1742-8. [PMID: 26016926 DOI: 10.1253/circj.cj-15-0413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) occurs more frequently among patients with renal dysfunction. We investigated the possible association between prevalence of AF and serum fibroblast growth factor 23 (FGF23), which has been shown to be increased in subjects with renal dysfunction. METHODS AND RESULTS Among the total enrollment of 851 cardiac patients, 188 patients had AF (paroxysmal AF, 95; non-paroxysmal AF, 93). Prevalence of AF for FGF23 octile had a U-shaped relationship with the lowest prevalence at the fifth octile. On logistic regression analysis, when the third FGF23 quartile was used as the reference, the first and fourth FGF23 quartiles were associated with prevalence of AF with an odds ratio (OR) of 3.34 (95% confidence interval [CI]: 1.89-5.88) and 2.58 (95% CI: 1.45-4.58), respectively, after adjusting for confounding factors including estimated glomerular filtration rate (eGFR). Among the subgroup of 416 patients for whom serum parathyroid hormone and 25-hydroxy vitamin D data were available, OR of the first and the fourth FGF23 quartile were calculated to be 3.52 and 2.97, respectively, when further adjusted for these two variables in the statistical model. CONCLUSIONS Serum FGF23 had a U-shaped relationship with prevalence of AF among Japanese cardiac patients, which was independent of other calcium/phosphate metabolism-related parameters and eGFR. Pathophysiology underlying the observed link, if at all, awaits further investigation.
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Laser KT, Houben BA, Körperich H, Haas NA, Kelter-Klöpping A, Barth P, Burchert W, DallaPozza R, Kececioglu D, Herberg U. Calculation of Pediatric Left Ventricular Mass: Validation and Reference Values Using Real-Time Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2015; 28:275-83. [DOI: 10.1016/j.echo.2014.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Indexed: 02/08/2023]
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Effects of septal myectomy on left ventricular diastolic function and left atrial volume in patients with hypertrophic cardiomyopathy. Am J Cardiol 2014; 114:1568-72. [PMID: 25260948 DOI: 10.1016/j.amjcard.2014.08.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 11/24/2022]
Abstract
Ventricular septal myectomy in patients with obstructive hypertrophic cardiomyopathy (HC) has been shown to reduce left ventricular (LV) outflow tract (LVOT) gradient and improve symptoms, although little data exist regarding changes in left atrial (LA) volume and LV diastolic function after myectomy. We investigated changes in LA size and LV diastolic function in patients with HC after septal myectomy from 2004 to 2011. We studied 25 patients (age 49.2 ± 13.1 years, 48% women) followed for a mean of 527 days after surgery who had serial echocardiography at baseline and at most recent follow-up, at least 6 months after myectomy. In addition to myectomy, 3 patients (12%) underwent Maze surgery and 13 (52%) underwent mitral valve surgery, of whom 5 had a mitral valve replacement or mitral annuloplasty. Patients with mitral valve replacement or mitral annuloplasty were excluded from LV diastolic function analysis. LA volume index decreased (from 47.2 ± 17.6 to 35.9 ± 17.0 ml/m(2), p = 0.001) and LV diastolic function improved with an increase in lateral e' velocity (from 7.3 ± 2.9 to 9.8 ± 3.1 cm/sec, p = 0.01) and a decrease in E/e' (from 14.8 ± 6.3 to 11.7 ± 5.5, p = 0.051). Ventricular septal thickness and LVOT gradient decreased, and symptoms of dyspnea and heart failure improved, with reduction in the New York Heart Association functional class III/IV symptoms from 21 (84%) to 1 (4%). In conclusion, relief of LVOT obstruction in HC by septal myectomy results in improved LV diastolic function and reduction in LA volume with improved symptoms.
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Chatterjee S, Bavishi C, Sardar P, Agarwal V, Krishnamoorthy P, Grodzicki T, Messerli FH. Meta-analysis of left ventricular hypertrophy and sustained arrhythmias. Am J Cardiol 2014; 114:1049-52. [PMID: 25118122 DOI: 10.1016/j.amjcard.2014.07.015] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/05/2014] [Accepted: 07/05/2014] [Indexed: 01/19/2023]
Abstract
Presence of left ventricular hypertrophy (LVH) has been reported to be associated with supraventricular and ventricular arrhythmias, but the association has not been systematically quantified and evaluated. A systematic search of studies in MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was undertaken through April 2014. Studies reporting on LVH and sustained arrhythmias such as atrial fibrillation and supraventricular tachycardias (SVTs) and ventricular arrhythmias (tachycardia and fibrillation) were identified. Pooled effect estimates were calculated with random-effects models (DerSimonian and Laird). A total of 10 eligible studies with 27,141 patients were included in the analysis. The incidence of SVT in patients with LVH was 11.1% compared with 1.1% among patients without LVH (p<0.001). Patients with LVH had 3.4-fold greater odds of developing SVT (odds ratio 3.39, 95% confidence interval 1.57 to 7.31) than those without LVH, although significant heterogeneity was present (I2=98%). Meta-regression analyses revealed the heterogeneity to have originated from differences in the baseline covariates such as age, male gender, hypertension, and diabetes of the individual studies. The incidence of ventricular arrhythmias was 5.5% compared with 1.2% in patients without LVH (p<0.001). The occurrence of ventricular tachycardia or fibrillation was 2.8-fold greater, in the presence of LVH (odds ratio 2.83, 95% confidence interval 1.78 to 4.51), and there was no significant heterogeneity (I2=9%). Presence of LVH in hypertensive patients is associated with a greater risk of sustained supraventricular/atrial and ventricular arrhythmias, and there is an unmet need for identifying and refining risk stratification for this group.
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Affiliation(s)
- Saurav Chatterjee
- Division of Cardiology, Department of Internal Medicine, Mount Sinai St. Luke's-Roosevelt Hospital, New York, New York.
| | - Chirag Bavishi
- Division of Cardiology, Department of Internal Medicine, Mount Sinai St. Luke's-Roosevelt Hospital, New York, New York
| | - Partha Sardar
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Vikram Agarwal
- Division of Cardiology, Department of Internal Medicine, Mount Sinai St. Luke's-Roosevelt Hospital, New York, New York
| | - Parasuram Krishnamoorthy
- Division of Cardiology, Department of Internal Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey
| | - Tomasz Grodzicki
- Division of Cardiology, Department of Internal Medicine, Collegium Medicum, Jagiellonian University, Krakow, Poland
| | - Franz H Messerli
- Division of Cardiology, Department of Internal Medicine, Mount Sinai St. Luke's-Roosevelt Hospital, New York, New York
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Jong GP, Chen HY, Li SY, Liou YS. Long-term effect of antihypertensive drugs on the risk of new-onset atrial fibrillation: a longitudinal cohort study. Hypertens Res 2014; 37:950-3. [PMID: 24965171 DOI: 10.1038/hr.2014.104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 04/14/2014] [Accepted: 04/16/2014] [Indexed: 11/09/2022]
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16
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Apostolakis S, Sullivan RM, Olshansky B, Lip GYH. Left ventricular geometry and outcomes in patients with atrial fibrillation: the AFFIRM Trial. Int J Cardiol 2013; 170:303-8. [PMID: 24315343 DOI: 10.1016/j.ijcard.2013.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/01/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Echocardiographically determined left ventricular hypertrophy (LVH) is a marker of cardiovascular disease related to prognosis and clinical outcomes. We sought to determine if LVH is a measure of outcomes in atrial fibrillation (AF) patients. METHODS We performed a post-hoc analysis of patients with echocardiographic data enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Trial. Patients were stratified based on gender-adjusted echocardiography derived interventricular septal (IVS) thickness, relative wall thickness (RWT), gender-adjusted LV mass, and type of LV remodeling (normal LV geometry, concentric hypertrophy, eccentric hypertrophy, and concentric remodeling). RESULTS Of 4060 patients in AFFIRM, echocardiographic data were available in 2433 patients (60%). Multivariate analysis revealed that LVH defined as moderately or severely abnormal IVS thickness was an independent predictor of both all cause mortality (HR 1.46, 95%CI 1.14-1.86, p=0.003) and stroke (HR 1.89, 95%CI 1.17-3.08, p=0.01). This association was confirmed when IVS thickness was assessed as continuous or categorical variable. Concentric LV hypertrophy was associated with the highest rates of all cause mortality (HR 1.53; 95%CI 1.11-2.12; p=0.009). CONCLUSION An easily obtained echocardiographic index of LVH (IVS thickness) may enhance risk stratification of patients with AF, and raise the possibility that LVH regression should be a therapeutic target in this population.
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Affiliation(s)
- Stavros Apostolakis
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Renee M Sullivan
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Brian Olshansky
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
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Du H, Fan J, Ling Z, Woo K, Su L, Chen S, Liu Z, Lan X, Zhou B, Xu Y, Chen W, Xiao P, Yin Y. Effect of nifedipine versus telmisartan on prevention of atrial fibrillation recurrence in hypertensive patients. Hypertension 2013; 61:786-92. [PMID: 23438932 DOI: 10.1161/hypertensionaha.111.202309] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It is controversial whether angiotensin II receptor blockers provide better protection than calcium antagonists against atrial fibrillation (AF) recurrence in hypertensive patients. This study was designed to compare the effect of nifedipine- and telmisartan-based antihypertensive treatments for preventing AF recurrence in hypertensive patients with paroxysmal AF. A total of 149 hypertensive patients with paroxysmal AF were randomized to nifedipine- or telmisartan-based antihypertensive treatment groups. The target blood pressure (BP) was <130/80 mm Hg. Clinic BP, ECG, Holter monitoring, and echocardiography were followed up for 2 years. The primary end point was the incidence of overall and persistent AF recurrence. During follow-up, there was no statistical difference in the rate of patients lowering to target BP between both groups, whereas nifedipine group had slightly better BP control but similar heart rate control at 24 months. The incidence of AF recurrence was similar in both groups (nifedipine versus telmisartan: 58.7% versus 55.4%; P=0.742), and Kaplan-Meier analysis showed no significant difference in the freedom from AF recurrence (log-rank test; P=0.48). However, the rate of developing persistent AF in telmisartan group was lower than that in nifedipine group (5.4% versus 16.0%; P=0.035). Patients in telmisartan group had lower values of left atrial diameter, left atrial volume index, and left ventricular mass index at the end of follow-up. The effects of telmisartan in preventing AF recurrences in hypertensive patients with paroxysmal AF after intensive lowering BP is similar to that of nifedipine, but telmisartan has more potent effects on preventing progression to persistent AF.
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Affiliation(s)
- Huaan Du
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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SANDERS NATALIEA, BERTOLONE CRISTINA, JETTER TAWNIL, WASMUND STEPHENL, CROCI FRANCESCO, SOLANO ALBERTO, BRIGNOLE MICHELE, HAMDAN MOHAMEDH. Restoring Sinus Rhythm Results in Blood Pressure Reduction in Patients with Persistent Atrial Fibrillation and a History of Hypertension. J Cardiovasc Electrophysiol 2012; 23:722-6. [DOI: 10.1111/j.1540-8167.2011.02280.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Hypertension and atrial fibrillation: epidemiology, pathophysiology and therapeutic implications. J Hum Hypertens 2011; 26:563-9. [PMID: 22129612 DOI: 10.1038/jhh.2011.105] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Hypertension is one of the most important risk factors associated with atrial fibrillation (AF) and increased the risk of cardiovascular events in patients with AF. However, the pathophysiological link between hypertension and AF is unclear. Nevertheless, this can be explained by the hemodynamic changes of the left atrium secondary to long standing hypertension, resulting in elevated left atrium pressure and subsequently left atrial enlargement. Moreover, the activation of renin-angiotensin-aldosterone system (RAAS) activation in patients with hypertension induces left atrial fibrosis and conduction block in the left atrium, resulting in the development of AF. Accordingly, recent studies have shown that effective blockage of RAAS by angiotensin converting enzyme inhibitors or angiotensin receptor antagonist may be effective in both primary and secondary prevention of AF in patients with hypertension, although with controversies. In addition, optimal antithrombotic therapy, blood pressure control as well as rate control for AF are key to the management of patients with AF.
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20
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Hennersdorf M, Schannwell C, Motz W. Hochdruck und Herz. Internist (Berl) 2010; 51:815-25. [DOI: 10.1007/s00108-009-2556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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McLeod CJ, Gersh BJ. A practical approach to the management of patients with atrial fibrillation. HEART ASIA 2010; 2:95-103. [PMID: 27325953 DOI: 10.1136/ha.2009.000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 10/20/2009] [Indexed: 11/03/2022]
Abstract
Atrial fibrillation is the most commonly encountered clinical arrhythmia and continues to grow in incidence. Current management involves highly individualised therapies based on underlying concomitant disease processes and symptoms. Moreover, there are numerous therapeutic permutations involving anticoagulation, rate-limitation and antiarrhythmic strategies. This review serves to update the clinician with a practical approach to each patient population and on current advances in management.
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Affiliation(s)
| | - Bernard J Gersh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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22
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Tsai WC, Lee CH, Lin CC, Liu YW, Huang YY, Li WT, Chen JY, Lin LJ. Association of Left Atrial Strain and Strain Rate Assessed by Speckle Tracking Echocardiography with Paroxysmal Atrial Fibrillation. Echocardiography 2009; 26:1188-94. [DOI: 10.1111/j.1540-8175.2009.00954.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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23
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Crandall MA, Bradley DJ, Packer DL, Asirvatham SJ. Contemporary management of atrial fibrillation: update on anticoagulation and invasive management strategies. Mayo Clin Proc 2009; 84:643-62. [PMID: 19567719 PMCID: PMC2704137 DOI: 10.1016/s0025-6196(11)60754-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Its increasing prevalence, particularly among the elderly, renders it one of the most serious current medical epidemics. Several management questions confront the clinician treating a patient with AF: Should the condition be treated? Is the patient at risk of death or serious morbidity as a result of this diagnosis? If treatment is necessary, is rate control or rhythm control superior? Which patients need anticoagulation therapy, and for how long? This review of articles obtained by a search of the PubMed and MEDLINE databases presents the available evidence that can guide the clinician in answering these questions. After discussing the merits of available therapy, including medications aimed at controlling rate, rhythm, or both, we focus on the present status of ablative therapy for AF. Catheter ablation, particularly targeting the pulmonary veins, is being increasingly performed, although the precise indications for this approach and its effectiveness and safety are being actively investigated. We briefly discuss other invasive options that are less frequently used, such as pacemakers, defibrillators, left atrial appendage closure devices, and the surgical maze procedure.
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Affiliation(s)
| | | | | | - Samuel J. Asirvatham
- Address correspondence to Samuel J. Asirvatham, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (). Individual reprints of this article and a bound reprint of the entire Symposium on Cardiovascular Diseases will be available for purchase from our Web site www.mayoclinicproceedings.com.
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24
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CRANDALL MARKA, HORNE BENJAMIND, DAY JOHND, ANDERSON JEFFREYL, MUHLESTEIN JOSEPHB, CRANDALL BRIANG, WEISS JPETER, LAPPÉ DONALDL, BUNCH TJARED. Atrial Fibrillation and CHADS2 Risk Factors are Associated with Highly Sensitive C-Reactive Protein Incrementally and Independently. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:648-52. [DOI: 10.1111/j.1540-8159.2009.02339.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Wachtell K, Devereux RB, Lyle PA, Okin PM, Gerdts E. The left atrium, atrial fibrillation, and the risk of stroke in hypertensive patients with left ventricular hypertrophy. Ther Adv Cardiovasc Dis 2008; 2:507-13. [DOI: 10.1177/1753944708093846] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study provided extensive data on predisposing factors, consequences, and prevention of atrial fibrillation (AF) in patients with hypertension and left ventricular (LV) hypertrophy. Randomized losartan-based treatment was superior to atenolol-based treatment for reducing new-onset AF and complications, especially stroke, associated with new-onset or pre-existing AF. Potential mechanisms of AF prevention by angiotensin receptor blockade supported by LIFE results include greater reduction in left atrial size and LV hypertrophy. Differential effects of antihypertensive treatment on the left atrium and left ventricle may help prevent AF and reduce risk of stroke associated with hypertensive heart disease.
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Affiliation(s)
- Kristian Wachtell
- Department of Cardiology B2142, The Heart Center, Rigshospitalet, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark,
| | | | | | | | - Eva Gerdts
- Institute of Medicine, University of Bergen and Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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