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Batko J, Rusinek J, Słomka A, Litwinowicz R, Burysz M, Bartuś M, Lakkireddy DR, Lee RJ, Natorska J, Ząbczyk M, Kapelak B, Bartuś K. Postoperative Coagulation Changes in Patients after Epicardial Left Atrial Appendage Occlusion Varies Based on the Left Atrial Appendage Size. Diseases 2023; 12:8. [PMID: 38248359 PMCID: PMC10814509 DOI: 10.3390/diseases12010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Left atrial appendage occlusion affects systemic coagulation parameters, leading to additional patient-related benefits. The aim of this study was to investigate the differences in coagulation factor changes 6 months after epicardial left atrial appendage occlusion in patients with different LAA morphometries. This is the first study to analyze these relationships in detail. A prospective study of 22 consecutive patients was performed. Plasminogen, fibrinogen, tPA concentration, PAI-1, TAFI and computed tomography angiograms were performed. Patients were divided into subgroups based on left atrial appendage body and orifice diameter enlargement. The results of blood tests at baseline and six-month follow-up were compared. In a population with normal LAA body size and normal orifice diameter size, a significant decrease in analyzed clotting factors was observed between baseline and follow-up for all parameters except plasminogen. A significant decrease between baseline and follow-up was observed with enlarged LAA body size in all parameters except TAFI, in which it was insignificant and plasminogen, in which a significant increase was observed. Occlusion of the left atrial appendage is beneficial for systemic coagulation. Patients with a small LAA may benefit more from LAA closure in terms of stabilizing their coagulation factors associated with potential thromboembolic events in the future.
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Affiliation(s)
- Jakub Batko
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, 85-094 Bydgoszcz, Poland;
| | - Jakub Rusinek
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Artur Słomka
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, 85-094 Bydgoszcz, Poland;
- Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Radosław Litwinowicz
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Cardiac Surgery, Regional Specialist Hospital, 86-300 Grudziądz, Poland
| | - Marian Burysz
- Department of Cardiac Surgery, Regional Specialist Hospital, 86-300 Grudziądz, Poland
| | - Magdalena Bartuś
- Department of Pharmacology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Dhanunjaya R. Lakkireddy
- The Kansas City Heart Rhythm Institution and Research Foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA
| | - Randall J. Lee
- Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, CA 94158, USA
| | - Joanna Natorska
- Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (J.N.); (M.Z.)
| | - Michał Ząbczyk
- Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (J.N.); (M.Z.)
| | - Bogusław Kapelak
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland
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Illési Á, Fejes Z, Pócsi M, Debreceni IB, Hodosi K, Nagy Jr. B, Kappelmayer J, Kőszegi Z, Csanádi Z, Szük T. Technically Challenging Percutaneous Interventions of Chronic Total Occlusions Are Associated with Enhanced Platelet Activation. J Clin Med 2023; 12:6829. [PMID: 37959293 PMCID: PMC10648871 DOI: 10.3390/jcm12216829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Percutaneous coronary intervention (PCI) is a frequently performed treatment option for recanalization in patients with chronic total occlusion (CTO). As CTO-PCIs are often complicated and challenging for interventionalists, the stressful and damaging nature of the procedure can be remarkable, thus platelets can be easily activated. Our aim was to investigate the effect of CTO-PCI on platelet activation and the expression of selected circulating microRNAs (miR) of platelet and endothelium origin after CTO-PCI. In this study, 50 subjects after CTO-PCI were enrolled. Blood samples were obtained before PCI, at 2 days and 3-6 months after the procedure to measure the degree of platelet activation and the level of plasma miR-223, miR-181b, and miR-126. Patients were divided based on the characteristics of the intervention. Patients with higher Japanese CTO scores and longer duration of PCI showed significantly elevated platelet P-selectin positivity (p = 0.004 and p = 0.013, respectively) 2 days after the procedure compared to pre-PCI and increased concentration of soluble P-selectin 3-6 months after the intervention (higher Japanese CTO score: p = 0.028 and longer duration of PCI: p = 0.023) compared to baseline values. Shorter total stent length caused a significantly lower miR-181b expression at 3-6 months after the intervention (p = 0.031), while no difference was observed in miR-223 and miR-126. One stent thrombosis occurred during the follow-up period. Although these technically challenging CTO-PCIs may cause enhanced platelet activation right after the intervention and long-term endothelial cell dysfunction, these interventions are not associated with more adverse clinical events.
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Affiliation(s)
- Ádám Illési
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (Á.I.); (Z.K.); (Z.C.)
- Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Zsolt Fejes
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (Z.F.); (M.P.); (I.B.D.); (B.N.J.); (J.K.)
| | - Marianna Pócsi
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (Z.F.); (M.P.); (I.B.D.); (B.N.J.); (J.K.)
| | - Ildikó Beke Debreceni
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (Z.F.); (M.P.); (I.B.D.); (B.N.J.); (J.K.)
| | - Katalin Hodosi
- Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Béla Nagy Jr.
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (Z.F.); (M.P.); (I.B.D.); (B.N.J.); (J.K.)
| | - János Kappelmayer
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (Z.F.); (M.P.); (I.B.D.); (B.N.J.); (J.K.)
| | - Zsolt Kőszegi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (Á.I.); (Z.K.); (Z.C.)
- Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- András Jósa University Teaching Hospital, 4400 Nyiregyhaza, Hungary
| | - Zoltán Csanádi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (Á.I.); (Z.K.); (Z.C.)
- Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Tibor Szük
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (Á.I.); (Z.K.); (Z.C.)
- Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
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Du M, Wang X, Zhang A, Li F, Yi M. Prognostic effect of atrial fibrillation on survival in patients with hypertrophic cardiomyopathy: a meta-analysis. J Cardiothorac Surg 2023; 18:196. [PMID: 37340493 DOI: 10.1186/s13019-023-02299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 05/29/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE To systematically evaluate the prognostic impact of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). METHODS The Chinese and English databases (PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, and Wanfang database were systematically searched to include observational studies on the prognosis of AF in cardiovascular events or death in patients with HCM; these were evaluated using Revman 5.3. RESULTS After systematic search and screening, a total of 11 studies with a high study quality were included in this study. Meta-analysis showed that patients with HCM accompanied by AF had a higher risk of all-cause death (odds ratio [OR] = 2.75; 95% confidence interval [CI]: 2.18-3.47; P < 0.001), heart-related death (OR = 2.62; 95%CI: 2.02-3.40; P < 0.001), sudden cardiac death (OR = 7.09; 95%CI: 5.77-8.70; P < 0.001), heart-failure-related death (OR = 2.04; 95%CI: 1.24-3.36; P = 0.005), and stroke death (OR = 17.05; 95%CI: 6.99-41.58; P < 0.001) compared with patients with HCM without AF. CONCLUSION Atrial fibrillation is a risk factor for adverse survival outcomes in patients with HCM, and aggressive interventions are needed in this population to avoid the occurrence of adverse outcomes.
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Affiliation(s)
- Meiling Du
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, No. 12 of Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China.
| | - Xiaoyuan Wang
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, No. 12 of Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China
| | - Aiai Zhang
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, No. 12 of Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China
| | - Feixing Li
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, No. 12 of Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China
| | - Mengyang Yi
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, No. 12 of Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China
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Li Z, Pan L, Deng Y, Liu Q, Hidru TH, Liu F, Li C, Cong T, Yang X, Xia Y. Development and Validation of a Nomogram for Estimation of Left Atrial Thrombus or Spontaneous Echo Contrast Risk in Non-Valvular Atrial Fibrillation Patients with Low to Borderline CHA2DS2-VASc Score. Int J Gen Med 2022; 15:7329-7339. [PMID: 36157292 PMCID: PMC9499731 DOI: 10.2147/ijgm.s384519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Left atrial thrombus (LAT)/left atrial spontaneous echo contrast (LASEC) still exists in CHA2DS2-VASc score-defined low/borderline risk population. The purpose of this study is to explore the risk factors that associate with LAT/SEC and to create a nomogram to predict LAT/SEC risk in NVAF patients with low/borderline CHA2DS2-VASc scores. Patients and Methods A total of 834 NVAF patients with complete data on transesophageal echocardiography (TEE) were included in this study. Univariate and multivariate logistic regression analyses were performed to identify the risk factors that associate with LAT/SEC, and a nomogram was established based on the results. Receiver operating characteristic curve (ROC), calibration curve and decision curve analysis were performed to verify the predictive power of nomogram. Results The rates for LAT/SEC for the training and validation cohorts were 84 (14.7%) and 30 (11.4%), respectively. Independent factors including age, left ventricular ejection fraction (LVEF), left atrial diameter (LAD), smoke, non-paroxysmal AF (NPAF), and E/e’ were considered to construct the nomogram for LAT/SEC. The AUC for nomogram was 0.839 and 0.811 in the training and validation cohorts, respectively. The calibration and decision curve analysis showed that the nomogram had a good prediction capacity and would be clinically useful. Conclusion Age, LVEF, LAD, smoke, NPAF, and E/e’ are independently associated with LAT/SEC in NVAF patients with low/borderline CHA2DS2-VASc scores. The nomogram that incorporates these six variables effectively predict LAT/SEC risk in NVAF patients with low/borderline CHA2DS2-VASc scores.
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Affiliation(s)
- Zhitong Li
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Lifei Pan
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Yawen Deng
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Quanbo Liu
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Tesfaldet H Hidru
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Fei Liu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Chenglin Li
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Tao Cong
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Xiaolei Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Correspondence: Xiaolei Yang; Yunlong Xia, Email ;
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
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Feng Y, Wang Y, Li X, Mao H. Anticoagulation therapy for pulmonary embolism involving a myxoma mimicking, giant type C thrombus: a case report. J Biomed Res 2022; 37:148-152. [PMID: 36058837 PMCID: PMC10018411 DOI: 10.7555/jbr.36.20220118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Right heart thrombus (RHTh) with concurrent acute pulmonary embolism (PE) is rare and can seriously destabilize hemodynamics, leading to an emergency situation with high mortality. Diagnosis and treatment of RHTh with acute PE are not yet standardized. There are few reports of acute PE concurrent with RHTh and even less is known about patients with a right heart mural thrombus. For physicians, the diagnostic choice and treatment of these patients are particularly difficult due to the lack of knowledge. Here, we report a rare case of partial mural RHTh (type C RHTh) with acute PE. The mural mass in the right heart was initially diagnosed as atrial myxoma according to transthoracic echocardiography (TTE), and both pulmonary embolus and the mural mass were completely absorbed after administering Rivaroxiban. This case suggests that TTE alone is insufficient to identify and diagnoses a right heart mural mass such as this. However, novel oral anticoagulants may be effective at alleviating PE with type C RHTh.
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Affiliation(s)
- Yinhe Feng
- Department of Respiratory and Critical Care Medicine, People's Hospital of Deyang City, Affiliated Hospital of Chengdu College of Medicine, Deyang, Sichuan 618000, China.,Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yubin Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaolong Li
- Department of Respiratory and Critical Care Medicine, People's Hospital of Deyang City, Affiliated Hospital of Chengdu College of Medicine, Deyang, Sichuan 618000, China
| | - Hui Mao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Nguyen HT, Nguyen HVB, Nguyen HQ, Le HQ. Prevalence of left atrial appendage thrombus in patients with acute ischaemic stroke and sinus rhythm: a cross-sectional study. BMJ Open 2021; 11:e051563. [PMID: 34921077 PMCID: PMC8685935 DOI: 10.1136/bmjopen-2021-051563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Thrombi originating in the left atrial appendage (LAA) mainly form because of atrial fibrillation (AF) and are a known cause of cardioembolic stroke. We aimed to investigate the prevalence of LAA thrombus in patients with acute ischaemic stroke (AIS) and sinus rhythm on 12-lead ECG. METHODS From June 2019 to February 2021, we conducted a cross-sectional study wherein we performed transoesophageal echocardiography (TEE) in patients with AIS and sinus rhythm on 12-lead ECG who were referred for detection of LAA thrombus. After TEE, all patients underwent 24-hour ECG monitoring to screen for paroxysmal AF. Predictors of LAA thrombus were determined using logistic regression analysis. RESULTS Overall, 223 patients (age: 66.2±11.3 years, men: 61.4%) were included in the study. LAA thrombus was detected in 15 patients (6.7%). Paroxysmal AF was detected in 14 of the 15 patients during 24-hour ECG monitoring. Compared with the non-thrombus group, the thrombus group had a statistically significant higher rate of spontaneous echo contrast (SEC), longer LAA, lower peak LAA emptying velocity and predominantly bilateral stroke. In the adjusted model, the presence of SEC increased the probability of LAA thrombus (OR 9.04; 95% CI 2.12 to 38.54; p=0.003). CONCLUSIONS In patients with AIS and sinus rhythm on 12-lead ECG, our study revealed that the prevalence of LAA thrombus was 6.7% with the most prevalent aetiology being paroxysmal AF. The presence of SEC can be a predictor of LAA thrombus in these patients.
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Affiliation(s)
- Huan Thanh Nguyen
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh city, Ho Chi Minh City, Vietnam
- Department of Cardiology, Thong Nhat Hospital, Ho Chi Minh, Vietnam
| | | | - Huy Quang Nguyen
- Department of Cardiology, Thong Nhat Hospital, Ho Chi Minh, Vietnam
| | - Hung Quoc Le
- Department of Cardiology, Thong Nhat Hospital, Ho Chi Minh, Vietnam
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Zhao W, He L. Comment on "Predictors of left atrial thrombus in acute ischemic stroke patients without atrial fibrillation: a single-center cross-sectional study". REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 67:1068. [PMID: 34817527 DOI: 10.1590/1806-9282.20210463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/23/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Wenying Zhao
- Taizhou University, School of Medicine - Zhejiang, China
| | - Lianping He
- Taizhou University, School of Medicine - Zhejiang, China
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