Association of Uric Acid Albumin Ratio with Recurrence of Atrial Fibrillation after Cryoballoon Catheter Ablation

Impact of longitudinal changes in serum uric acid levels and weight gain on new-onset atrial fibrillation-The Nishimura Health Survey: a retrospective cohort study

OBJECTIVE

Uric acid (UA) and obesity are significant risk factors for new-onset atrial fibrillation (AF). Based on the pathogenesis mechanisms of new-onset AF involving obesity and UA, it is possible that UA and weight gain may interact with each other. We investigated the impact of UA and weight gain on new-onset AF using a simple measure of weight change over time, 'weight gain of ≥10 kg after age 20'.

DESIGN

A retrospective cohort study.

SETTING AND PARTICIPANTS

We retrospectively analysed 16 444 Japanese aged over 30 without AF from a cohort of employees undergoing annual health check-up from 2 April 2013 to 30 April 2022. We conducted a landmark survival analysis to assess the impact of longitudinal changes in UA and obesity on new-onset AF. Weight gain was defined as 'weight gain of≥10 kg after age 20' using a standardised self-administered questionnaire.

PRIMARY OUTCOME MEASURE

Subjects were diagnosed with AF when AF was present in the electrocardiogram or when indicated in a patient interview.

RESULT

During a median follow-up period of 3.91 years, 69 new-onset AF occurred (incidence; 1.12/1000 person-years). UA levels were 5.76 (±1.37) in the weight gain group and 4.87 (±1.31) in the no weight gain group, both within normal limits. A multivariable landmark survival analysis including interaction term showed that new-onset AF was significantly associated with age, sex, baseline systolic blood pressure, baseline UA and the interaction term between UA change and weight gain. The interaction term between weight gain and UA change indicates that HR for every UA 1 mg/dL increase was 1.96 (95% CI 1.38 to 2.77) in subjects with weight gain and 0.95 (95% CI 0.61 to 1.48) in those without.

CONCLUSION

Even if UA levels are within the normal range, subsequent UA change and weight gain in adulthood have an interactive effect on new-onset AF.

Lipid-lowering drugs, circulating inflammatory factors, and atrial fibrillation: a mediation Mendelian randomization study

Background

Previous studies have shown an association between lipid-lowering drugs, circulating inflammatory factors, and atrial fibrillation (AF), but the specific effects of lipid-lowering drugs on AF and whether they can be mediated by circulating inflammatory factors remain unclear.

Methods

We collected 10 genetic variants encoding lipid-lowering drug targets (LDLR, HMGCR, PCSK9, NPC1L1, APOB, APOB, ABCG5, ABCG8, LPL, APOC3, and PPARA) and AF based on genome-wide association study (GWAS) summary statistics. Drug target Mendelian randomization (MR) was used to explore the causal relationship between lipid-lowering drugs and AF. In addition, we performed a mediation analysis of 91 circulating inflammatory factors to explore potential mediators. Sensitivity analyses were performed to verify the reliability of the MR Results by MR-Egger intercept test, Cochran's Q test and leave-one-out test.

Results

The results of IVW method showed that LPL agonist had a protective effect on AF(OR = 0. 854, 95%CI: 0.816-0.894, P = 1.844E-11). However, the other nine lipid-lowering drug targets had no significant effect on AF. Notably, we found a mediator role of Fibroblast Growth Factor 5 (FGF5) in the protective effect of LPL agonist on AF with a mediator ratio of 9.22%. Sensitivity analyses supported the robustness of our findings, indicating a possible mediating pathway by which LPL agonists affect the risk of AF.

Conclusion

Our study provides new insights into the complex interactions among lipid-lowering agents, circulating inflammatory factors and AF, and also identified a potential mediating role of FGF5 in the pathogenesis of AF. Our findings highlight the potential of LPL agonists and targeting specific inflammatory factors for therapeutic intervention in AF, providing promising avenues for future research and clinical strategies for the management and prevention of AF.

Comparison of inflammatory markers for the prediction of atrial fibrillation recurrence following cryoablation

Aim: The aim of this study is to investigate the value of inflammatory markers for atrial fibrillation (AF) recurrence prediction after cryo-balloon ablation (CA).Materials & methods: The study included 399 patients divided into two groups by AF recurrence after CA. Inflammatory markers including uric acid/albumin ratio (UAR), systemic immune inflammation index (SIII) and CRP/albumin ratio (CAR) were evaluated.Results: UAR, SIII, and CAR were independently associated with the risk of recurrence in AF patients following CA. In ROC curve analysis, CAR had a greater area under curve (AUC:0.73) value than either SIII (AUC:0.68) or UAR (AUC:0.64).Conclusion: Our study results indicate that CAR compared with SIII and UAR had a greater predictive value than others inflammatory markers in predicting AF recurrence post-CA.

Myeloperoxidase and its derivative hypochlorous acid combined clinical indicators predict new-onset atrial fibrillation in sepsis: a case-control study

BACKGROUD

New-onset atrial fibrillation (NOAF) is a common complication of sepsis and linked to higher death rates in affected patients. The lack of effective predictive tools hampers early risk assessment for the development of NOAF. This study aims to develop practical and effective predictive tools for identifying the risk of NOAF.

METHODS

This case-control study retrospectively analyzed patients with sepsis admitted to the emergency department of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from September 2017 to January 2023. Based on electrocardiographic reports and electrocardiogram monitoring records, patients were categorized into NOAF and non-NOAF groups. Laboratory tests, including myeloperoxidase (MPO) and hypochlorous acid (HOCl), were collected, along with demographic data and comorbidities. Least absolute shrinkage and selection operator regression and multivariate logistic regression analyses were employed to identify predictors. The area under the curve (AUC) was used to evaluate the predictive model's performance in identifying NOAF.

RESULTS

A total of 389 patients with sepsis were included in the study, of which 63 developed NOAF. MPO and HOCl levels were significantly higher in the NOAF group compared to the non-NOAF group. Multivariate logistic regression analysis identified MPO, HOCl, tumor necrosis factor-α (TNF-α), white blood cells (WBC), and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score as independent risk factors for NOAF in sepsis. Additionally, a nomogram model developed using these independent risk factors achieved an AUC of 0.897.

CONCLUSION

The combination of MPO and its derivative HOCl with clinical indicators improves the prediction of NOAF in sepsis. The nomogram model can serve as a practical predictive tool for the early identification of NOAF in patients with sepsis.

Progress of uric acid in cardiovascular disease

Due to the global prevalence of hyperuricemia (HUA), there is growing interest in research on uric acid (UA). HUA is a common condition that has various adverse consequences, including gout and kidney disease. However, recent studies have also implicated UA in the development of cardiovascular diseases (CVD) such as atrial fibrillation (AF) and coronary heart disease (CHD). Experimental and clinical research has extensively demonstrated the detrimental effects of elevated serum UA levels on cardiovascular health. Furthermore, serum UA levels have been identified as predictors of CVD outcomes following percutaneous coronary intervention (PCI) and catheter ablation. Additionally, the use of UA-lowering therapy holds important implications for the management of CVD. This review aims to consolidate the current evidence on the relationship between serum UA and CVD.

Red cell distribution width to albumin ratio is a risk factor for atrial fibrillation in subjects hospitalized with coronary angiography

BACKGROUND

Red cell distribution width to albumin ratio (RAR) has been demonstrated to be associated with the risk of cardiovascular diseases. However, it is still unknown whether the RAR affects atrial fibrillation (AF). Therefore, this study aimed to investigate the association between RAR and AF in subjects hospitalized with coronary angiography.

METHODS

A total of 2436 participants were retrospectively included. Red cell distribution width, albumin and other data were collected. AF was confirmed using 12-lead electrocardiogram (ECG) or 24-h Holter. All participants were divided into four groups according to the RAR values by quartile (Q1, Q2, Q3, Q4). Univariate and multivariate logistic regression were performed to examine the correlation between RAR and AF.

RESULTS

Among the 2436 participants, 227 (9.3%) AF cases were observed. The RDW and RAR were significantly higher in AF group than in non-AF group (all P < 0.001). Univariate logistic regression showed an positive association between RAR and AF (P < 0.001). In multivariate logistic regression, RAR was found to be an independent risk factor of AF after adjusting for confounding factors (OR:2.015, 95%CI:1.315-3.089, P = 0.001).

CONCLUSIONS

The present study indicated that elevated RAR level was independently correlated with increased risk of AF in subjects hospitalized with coronary angiography.

Relationship between uric acid to albumin ratio and in-stent restenosis in patients with coronary artery disease undergoing drug-eluting stenting

BACKGROUND

In-stent restenosis (ISR) in patients undergoing percutaneous coronary intervention (PCI) to treat coronary artery disease (CAD) is an urgent issue in clinical practice. Recent studies have highlighted uric acid-albumin ratio (UAR) as a new marker for evaluating inflammation and oxidative stress, capable of predicting cardiovascular ailments. We aimed to examine the correlation between UAR levels and ISR in patients who underwent drug-eluting stent (DES) implantation.

METHODS

We included 503 patients with CAD who underwent initial DES implantation and angiography during the follow-up period. Based on coronary angiographic findings, the patients were categorized into ISR (n = 73) and non-ISR groups (n = 430). Before angiography, laboratory parameters were measured for all enrolled patients. To ascertain the influential factors linked to ISR, multivariate logistic regression analysis was performed. The predictive capability of UAR in determining ISR was assessed using receiver operating characteristic (ROC) curve analysis. Statistical significance was set at P  < 0.05.

RESULTS

Multivariate logistic regression analysis revealed that diabetes mellitus, stent length, UAR, albumin levels, and C-reactive protein levels independently predicted ISR. ROC curve analysis revealed that UAR had an area under the curve of 0.767 (95% CI: 0.709 - 0.826) for predicting ISR and demonstrated that UAR outperformed the individual predictive abilities of uric acid and albumin for ISR.

CONCLUSION

UAR was associated with ISR in patients with CAD undergoing PCI with DES implantation. Moreover, ROC curve analysis demonstrated that UAR exhibited superior predictive accuracy for ISR compared with evaluating uric acid and albumin levels separately.

Effects of Inflammatory Cell Death Caused by Catheter Ablation on Atrial Fibrillation

Atrial fibrillation (AF) poses a serious healthcare burden on society due to its high morbidity and the resulting serious complications such as thrombosis and heart failure. The principle of catheter ablation is to achieve electrical isolation by linear destruction of cardiac tissue, which makes AF a curable disease. Currently, catheter ablation does not have a high long-term success rate. The current academic consensus is that inflammation and fibrosis are central mechanisms in the progression of AF. However, artificially caused inflammatory cell death by catheter ablation may have a significant impact on structural and electrical remodeling, which may affect the long-term prognosis. This review first focused on the inflammatory response induced by apoptosis, necrosis, necroptosis, pyroptosis, ferroptosis and their interaction with arrhythmia. Then, we compared the differences in cell death induced by radiofrequency ablation, cryoballoon ablation and pulsed-field ablation. Finally, we discussed the structural and electrical remodeling caused by inflammation and the association between inflammation and the recurrence of AF after catheter ablation. Collectively, pulsed-field ablation will be a revolutionary innovation with faster, safer, better tissue selectivity and less inflammatory response induced by apoptosis-dominated cell death.

Clinical Outcomes and Predictors of Late Recurrence in Young Patients with Atrial Fibrillation after Catheter Ablation

Background

Catheter ablation (CA) is an established treatment for atrial fibrillation (AF), but the recurrence of AF is not neglected. Young patients with AF were generally more symptomatic and intolerant to long-term drug treatment. We aim to explore clinical outcomes and predictors of late recurrence (LR) in AF patients younger than 45 years after CA to better manage them.

Methods

We retrospectively studied 92 symptomatic AF patients who accepted CA from September 1, 2019, to August 31, 2021. Baseline clinical data (including N-terminal prohormone of brain natriuretic peptide, NT-proBNP), ablation outcomes, and follow-up outcomes were collected. Patients were followed up at 3, 6, 9, and 12 months. Follow-up data were available for 82/92 (89.1%) patients.

Results

One-year arrhythmia-free survival was 81.7% (67/82) in our study group. Major complications occurred in 3/82 (3.7%) patients with an acceptable rate. The value of ln(NT-proBNP) (P = 0.025, odds ratio [OR] = 1.977, 95% confidence interval [CI] 1.087-3.596) and a family history of AF (P = 0.041, HR = 9.269, 95% CI 1.097-78.295) could independently predict AF recurrence. The ROC analysis of ln(NT-proBNP) showed that NT-proBNP greater than 200.05 pg/ml (area under the curve: 0.772, 95% CI 0.642-0.902, P = 0.001, sensitivity 0.800, specificity 0.701) was the cut-off point for predicting late recurrence.

Conclusions

CA is a safe and effective treatment for AF patients younger than 45 years. Elevated NT-proBNP level and a family history of AF could be used as predictors for late recurrence in young patients. The result of this study may help us take more comprehensive management of those with high-recurrence risks to reduce disease burden and improve quality of life.