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Kirchhof P, Haas S, Amarenco P, Turpie AGG, Bach M, Lambelet M, Hess S, Camm AJ. Causes of death in patients with atrial fibrillation anticoagulated with rivaroxaban: a pooled analysis of XANTUS. Europace 2024; 26:euae183. [PMID: 38941511 PMCID: PMC11257075 DOI: 10.1093/europace/euae183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/07/2024] [Indexed: 06/30/2024] Open
Abstract
AIMS Anticoagulation can prevent stroke and prolong lives in patients with atrial fibrillation (AF). However, anticoagulated patients with AF remain at risk of death. The aim of this study was to investigate the causes of death and factors associated with all-cause and cardiovascular death in the XANTUS population. METHODS AND RESULTS Causes of death occurring within a year after rivaroxaban initiation in patients in the XANTUS programme studies were adjudicated by a central adjudication committee and classified following international guidance. Baseline characteristics associated with all-cause or cardiovascular death were identified. Of 11 040 patients, 187 (1.7%) died. Almost half of these deaths were due to cardiovascular causes other than bleeding (n = 82, 43.9%), particularly heart failure (n = 38, 20.3%) and sudden or unwitnessed death (n = 24, 12.8%). Fatal stroke (n = 8, 4.3%), which was classified as a type of cardiovascular death, and fatal bleeding (n = 17, 9.1%) were less common causes of death. Independent factors associated with all-cause or cardiovascular death included age, AF type, body mass index, left ventricular ejection fraction, hospitalization at baseline, rivaroxaban dose, and anaemia. CONCLUSION The overall risk of death due to stroke or bleeding was low in XANTUS. Anticoagulated patients with AF remain at risk of death due to heart failure and sudden death. Potential interventions to reduce cardiovascular deaths in anticoagulated patients with AF require further investigation, e.g. early rhythm control therapy and AF ablation. TRIAL REGISTRATION NUMBERS NCT01606995, NCT01750788, NCT01800006.
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Affiliation(s)
- Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center UKE Hamburg, Martinistraße 52, Gebäude Ost 70, 20246 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sylvia Haas
- Formerly Technical University Munich, Munich, Germany
| | - Pierre Amarenco
- Department of Neurology and Stroke Centre, Paris-Diderot-Sorbonne University, Paris, France
| | | | | | | | | | - A John Camm
- Cardiovascular and Cell Sciences Research Institute, St George’s University of London, London, UK
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Hegland NØ, Rezahosseini O, Pedersen CR, Møller DL, Bugge TB, Wareham NE, Arentoft NS, Hillingsø J, Lund TK, Rasmussen A, Nielsen SD. Anemia in liver transplant recipients: prevalence, severity, risk factors, and survival. APMIS 2024; 132:152-160. [PMID: 38084017 DOI: 10.1111/apm.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/11/2023] [Indexed: 02/17/2024]
Abstract
Information about anemia in liver transplant (LTx) recipients is scarce. We investigated the prevalence and severity of anemia before and within the first-year post-LTx, risk factors for having anemia before LTx, and 1-year survival according to anemia status before LTx. This retrospective cohort study received data from The Knowledge Center for Transplantation database at Rigshospitalet, Copenhagen, Denmark. Uni- and multivariate logistic regression were used to investigate factors associated with anemia and a Kaplan-Meier plot to illustrate the probability of survival. We included 346 first-time adult LTx recipients. The median age was 50 years (IQR: 42-57), and 203 (59%) were male. The prevalence of anemia before and 1-year post-LTx were 69 and 45%, respectively. Male sex (aOR 4.0 [95% CI: 2.2-7.2]; p < 0.001) and each unit increase in MELD score (aOR 1.2 [95% CI: 1.1-1.2]; p < 0.001) were positively associated with anemia before LTx. Compared to autoimmune liver diseases, LTx recipients with fulminant hepatic failure (aOR 0.03 [0.00-0.17]; p = 0.001) had lower odds for anemia. The 1-year survival in LTx recipients who had and did not have anemia before transplantation were 93 and 91% (p = 0.47). Anemia was frequent among LTx recipients, and anemia before LTx did not affect 1-year survival.
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Affiliation(s)
- Nina Øksnes Hegland
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Omid Rezahosseini
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christian Ross Pedersen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dina Leth Møller
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Terese Brun Bugge
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Nicoline Stender Arentoft
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jens Hillingsø
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Kromann Lund
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Alabdullah B, Ferreira D, Bourke E, Kamalanathan H, Elashri I, Porwal K, Tiller MJ, Gadre PH, Jones S, McGee M. The Prevalence of Iron Deficiency in Atrial Fibrillation: Low Hanging Fruit? Medicina (B Aires) 2022; 58:medicina58101492. [PMID: 36295652 PMCID: PMC9610053 DOI: 10.3390/medicina58101492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. The relationship between AF and iron deficiency is poorly understood. Materials and Methods: We conducted an observational study investigating the prevalence of iron deficiency in those with AF. Iron deficiency was defined by the American College of Cardiology (ACC) criteria for iron deficiency in heart failure. Results: Of 134 eligible subjects, 81 (60.4%) met the ACC definition of iron deficiency in heart failure. Those who were iron deficient were more likely to be female (OR 1.876, p = 0.005), have a history of diabetes mellitus (OR 3.085, p = 0.001) a history of stroke (OR 3.147, p = 0.016), and have higher CHA2DS2-VASc (p ≤ 0.0001) and Charlson Comorbidity Index scores (CCI) (p = 0.007). Conclusions: The prevalence of iron deficiency in those with AF appears high and warrants evaluation in a prospective study.
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Affiliation(s)
- Bachar Alabdullah
- Cardiology Department, Tamworth Rural Referral Hospital, Dean Street, North Tamworth, NSW 2340, Australia
| | - David Ferreira
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia
- Correspondence:
| | - Erin Bourke
- Cardiology Department, Tamworth Rural Referral Hospital, Dean Street, North Tamworth, NSW 2340, Australia
| | - Harish Kamalanathan
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Ibrahim Elashri
- Cardiology Department, Tamworth Rural Referral Hospital, Dean Street, North Tamworth, NSW 2340, Australia
| | - Kushal Porwal
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Michael J. Tiller
- Cardiology Department, Tamworth Rural Referral Hospital, Dean Street, North Tamworth, NSW 2340, Australia
| | - Payal H. Gadre
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Sarah Jones
- Cardiology Department, Tamworth Rural Referral Hospital, Dean Street, North Tamworth, NSW 2340, Australia
| | - Michael McGee
- Cardiology Department, Tamworth Rural Referral Hospital, Dean Street, North Tamworth, NSW 2340, Australia
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4
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Arkew M, Gemechu K, Haile K, Asmerom H. Red Blood Cell Distribution Width as Novel Biomarker in Cardiovascular Diseases: A Literature Review. J Blood Med 2022; 13:413-424. [PMID: 35942475 PMCID: PMC9356613 DOI: 10.2147/jbm.s367660] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
Red blood cell distribution width (RDW) is a measure of the change in size of red blood cells and it is used in combination with other hematological parameters for the differential diagnosis of anemias. Recent evidence suggested that the change in RDW level may be a predictive biomarker of morbidity and mortality in cardiovascular diseases (CVDs). Cardiovascular diseases are the most common cause of death globally as compared to cancer and communicable diseases. Early diagnosis and prompt intervention of these diseases are very important to minimize their complications. Nowadays, the diagnosis of most cardiovascular diseases majorly depends on clinical judgment, electrocardiography and biochemical parameters. Red blood cell distribution width as a new predictive biomarker may play a pivotal role in assessing the severity and progression of CVDs. However, the underlying mechanisms for the association between RDW and CVDs are not clear. A deeper understanding of their association could help the physicians in more careful identification, early prevention, intervention, and treatment to prevent adverse cardiovascular events. This review aims to elaborate on the recent knowledge on the association between RDW and cardiovascular diseases and some possible pathophysiological mechanisms.
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Affiliation(s)
- Mesay Arkew
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Correspondence: Mesay Arkew, School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O. Box: 235, Harar, Ethiopia, Email
| | - Kabtamu Gemechu
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kassahun Haile
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Haftu Asmerom
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Hanna-Rivero N, Tu SJ, Elliott AD, Pitman BM, Gallagher C, Lau DH, Sanders P, Wong CX. Anemia and iron deficiency in patients with atrial fibrillation. BMC Cardiovasc Disord 2022; 22:204. [PMID: 35508964 PMCID: PMC9066804 DOI: 10.1186/s12872-022-02633-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/13/2022] [Indexed: 12/11/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac tachyarrhythmia and has a rising global prevalence. Given the increasing burden of AF-related symptoms and complications, new approaches to management are required. Anemia and iron deficiency are common conditions in patients with AF. Furthermore, emerging evidence suggests that the presence of anemia may be associated with worse outcome in these patients. The role of anemia and iron deficiency has been extensively explored in other cardiovascular states, such as heart failure and ischemic heart disease. In particular, the role of iron repletion amongst patients with heart failure is now an established treatment modality. However, despite the strong bidirectional inter-relationship between AF and heart failure, the implications of anemia and iron-deficiency in AF have been scarcely studied. This area is of mechanistic and clinical relevance given the potential that treatment of these conditions may improve symptoms and prognosis in the increasing number of individuals with AF. In this review, we summarise the current published literature on anemia and iron deficiency in patients with AF. We discuss AF complications such as stroke, bleeding, and heart failure, in addition to AF-related symptoms such as exercise intolerance, and the potential impact of anemia and iron deficiency on these. Finally, we summarize current research gaps on anemia, iron deficiency, and AF, and underscore potential research directions.
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Affiliation(s)
- Nicole Hanna-Rivero
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Samuel J Tu
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Bradley M Pitman
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia.
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Dong M, Xu C, Zhou J, Yuan Z. Influence of hemoglobin concentration on the in-hospital outcomes in newly diagnosed heart failure patients with atrial fibrillation: Finding from CCC-AF (improving care for cardiovascular disease in China-atrial fibrillation) project. Medicine (Baltimore) 2022; 101:e28978. [PMID: 35244067 PMCID: PMC8896450 DOI: 10.1097/md.0000000000028978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
Atrial fibrillation (AF) and heart failure (HF) coexistence is common of clinical significance. Although anemia is a well-recognized risk factor for adverse outcomes, the prognostic value of hemoglobin is controversial in AF and HF. We aimed to determine whether hemoglobin is associated with in-hospital outcomes in such patients.On the basis of the data from the CCC-AF (Improving Care for Cardiovascular Diseases in China-Atrial Fibrillation) project, 2367 inpatients with a definitive diagnosis of AF and HF and record of admission hemoglobin concentration were included. Logistic regression analysis was performed to investigate the relationship between hemoglobin and in-hospital outcomes.All patients were divided into 4 groups according to quartiles of hemoglobin values. Compared with patients with higher hemoglobin, patients with lower hemoglobin had higher proportion of males, heart rate (HR), and diastolic blood pressure (DBP). On the contrary, they had lower age, medical history, left ventricular ejection fraction (LVEF), and brain natriuretic peptide (P < .05). Spearman correlation showed that hemoglobin was negatively correlated with age, LVEF, international normalized ratio, and serum creatinine but positively correlated with HR, DBP, and blood urea nitrogen (P < .05). Multivariable logistic regression analysis revealed that increasing hemoglobin was an independent protective factor for in-hospital outcomes (odds ratio = 0.989; 95% confidence interval: 0.979-1.000; P = .046).Admission hemoglobin concentration was an independent protective factor for in-hospital outcomes in HF patients with AF. Our study indicated that increasing hemoglobin level and improving anemia degree might improve the prognosis of patients with AF and HF.
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Affiliation(s)
- Mengya Dong
- Department of Cardiology, Shaanxi Provincial People's Hospital, Shaanxi, China
| | - Chenbo Xu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi’an Jiao tong University, Xi’an, Shaanxi, China
| | - Juan Zhou
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi’an Jiao tong University, Xi’an, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi’an Jiao tong University, Xi’an, Shaanxi, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi’an Jiao tong University, Ministry of Education, Xi’an, Shaanxi, China
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7
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Kany S, Brachmann J, Lewalter T, Akin I, Sievert H, Zeymer U, Hochadel M, Senges J, Kirchhof P, Lubos E. Influence of severe anemia on procedural safety and one-year outcome after left atrial appendage closure: Insights from a very high-risk cohort. IJC HEART & VASCULATURE 2022; 38:100946. [PMID: 35028410 PMCID: PMC8739449 DOI: 10.1016/j.ijcha.2021.100946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/05/2021] [Accepted: 12/24/2021] [Indexed: 01/28/2023]
Abstract
Introduction Patients undergoing left atrial appendage closure (LAAC) are often severly anemic and close to the transfusion threshold. The aim was to investigate the prevalence of severe anemia in this cohort and if procedural safety is compromised compared with non-anemic patients. Methods and results Comparison of severly anemic patients (Hb < 80 g/l) vs. non-severly anemic patients in the prospective, multicentre observational LAARGE registry of patients undergoing LAAC. A total of 638 patients (anemia 22.3% vs non-anemic 77.7%) were included. Anemic patients were older (77.1 years ± 7.9 vs 75.6 years ± 7.9, p = 0.014), had more comorbidities, higher CHA2DS2-VASc (4.8 vs 4.4, p = 0.017) and higher HAS-BLED (4.3 vs 3.8, p < 0.001) scores. Implant success was not influenced by anemia (99.3% vs 97.2%). Severe in-hospital (0.7% vs 5.6%, p = 0.01) and overall complications (8.5% vs 13.7%, p = 0.11) were less common in patients with anemia, driven by fewer pericardial effusions. Mortality was higher in anemic patients and associated with an increased hazard ratio, albeit not significantly (16.0% vs 10.3%, HR 1.61 (95%-CI: 0.97–2.67), p = 0.06). In the one-year follow-up, composite outcome of death, stroke or systemic embolism occurred in 22/142 anemic and in 54/496 non-anemic patients with an adjusted HR of 1.04 (95%-CI 0.62–1.73, p = 0.89). Conclusion Severe anemia close to the transfusion threshold is common in patients undergoing LAAC. However, this does not influence in-hospital complications or implant success. One-year mortality is higher in anemic patients, mainly driven by co-morbidities.
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Affiliation(s)
- Shinwan Kany
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Brachmann
- Department of Cardiology, Angiology and Pneumology, Coburg Hospital, Coburg, Germany
| | - Thorsten Lewalter
- Department of Medicine-Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | - Ibrahim Akin
- Department of Cardiology, University Hospital Mannheim, Mannheim, Germany
| | - Horst Sievert
- Cardio Vascular Centre Frankfurt, Frankfurt/Main, Germany
| | - Uwe Zeymer
- Department of Cardiology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | | | - Jochen Senges
- Stiftung für Herzinfarktforschung (IHF), Ludwigshafen, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
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Seong JM, Park CE, Gi MY, Cha JA, Moon AE, Lee JH, Sung HH, Lim JH, Oh SH, Chung CH, Seo EK, Yoon H. Gender difference in the relationship between anemia and vitamin D in Korean adults: the fifth Korea National Health and Nutrition Examination Survey. J Clin Biochem Nutr 2021; 69:299-304. [PMID: 34857993 PMCID: PMC8611370 DOI: 10.3164/jcbn.21-26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/30/2021] [Indexed: 11/22/2022] Open
Abstract
This study was conducted to assess the relationship between vitamin D deficiency and anemia, by gender, in Korean adults. The data of 16,060 adults were analyzed (men, 6,840; premenopausal women, 4,916; postmenopausal women, 4,340) from the fifth Korean National Health and Nutrition Examination Survey (KNHANES V) (2010–2012). There were several key findings. First, after adjusting for related variables, the odds ratio (OR) of anemia [hemoglobin (Hb) <13 g/dl in men or Hb <12 g/dl in women] using the vitamin D normal group {25-hydroxyvitamin [25(OH)D] ≥15.0 ng/ml} as reference, was significant for the vitamin D deficient group [25(OH)D <15.0 ng/ml] in the overall population [OR, 1.310; 95% confidence interval (CI), 1.168–1.470]. Second, the OR of anemia, using the vitamin D normal group as reference, was significant for the vitamin D deficient group in premenopausal women (OR, 1.293; 95% CI, 1.105–1.513). However, vitamin D deficiency in the vitamin D normal group in men (OR, 1.093; 95% CI, 0.806–1.484) and postmenopausal women (OR, 1.130; 95% CI, 0.906–1.409) was not significant. In conclusion, Vitamin D deficiency is positively associated with anemia in premenopausal women, but not in men and postmenopausal women.
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Affiliation(s)
- Jeong Min Seong
- Department of Dental Hygiene, College of Health Science, Kangwon National University, Samcheok-si, Gangwon-do, 25949, South Korea
| | - Chang Eun Park
- Department of Biomedical Laboratory Science, Namseoul University, Cheonan-si, Chungcheongnam-do, 31020, South Korea
| | - Mi Young Gi
- Department of Nursing, Christian College of Nursing, Gwangju, 61662, South Korea
| | - Ju Ae Cha
- Department of Nursing, Chunnam Technouniversity, Gokseong-gun, Jeollanam-do, 57500, South Korea
| | - Ae Eun Moon
- Department of Dental Hygiene, Honam University, Gwangju, 62399, South Korea
| | - Jun Ho Lee
- Department of Clinical Laboratory Science, Wonkwang Health Science University, 514, Iksan-daero, Iksan-si, Jeollabuk-do, 54538, South Korea
| | - Hyun Ho Sung
- Department of Clinical Laboratory Science, Dongnam Health University, Suwonsi, Gyeonggi-do, 16328, South Korea
| | - Jae Heon Lim
- Department of Physiotherapy, Wonkwang Health Science University, 514, Iksan-daero, Iksan-si, Jeollabuk-do, 54538, South Korea
| | - Suk Hee Oh
- Department of Nursing, Jeonbuk Science College, 509, Jeongeupsa-ro, Jeongeup-si, Jeollabuk-do, 56204, South Korea
| | - Chong Hee Chung
- Department of Nursing, Jeonbuk Science College, 509, Jeongeupsa-ro, Jeongeup-si, Jeollabuk-do, 56204, South Korea
| | - Eun Kyung Seo
- Department of Nursing, Jeonbuk Science College, 509, Jeongeupsa-ro, Jeongeup-si, Jeollabuk-do, 56204, South Korea
| | - Hyun Yoon
- Department of Clinical Laboratory Science, Wonkwang Health Science University, 514, Iksan-daero, Iksan-si, Jeollabuk-do, 54538, South Korea
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Krittayaphong R, Pumprueg S, Thongsri T, Wiwatworapan W, Choochunklin T, Kaewkumdee P, Yindeengam A. Impact of anemia on clinical outcomes of patients with atrial fibrillation: The COOL-AF registry. Clin Cardiol 2021; 44:415-423. [PMID: 33538035 PMCID: PMC7943899 DOI: 10.1002/clc.23559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/16/2021] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine whether anemia is an independent risk factor for ischemic stroke and major bleeding in patients with non-valvular atrial fibrillation (NVAF). HYPOTHESIS Anemia in patients with NVAF increase risk of clinical complications related to atrial fibrillation. METHODS We conducted a prospective multicenter registry of patients with NVAF in Thailand. Demographic data, medical history, comorbid conditions, laboratory data, and medications were collected and recorded, and patients were followed-up every 6 months. The outcome measurements were ischemic stroke or transient ischemic attack (TIA), major bleeding, heart failure (HF), and death. All events were adjudicated by the study team. We analyzed whether anemia is a risk factor for clinical outcomes with and without adjusting for confounders. RESULTS There were a total of 1562 patients. The average age of subjects was 68.3 ± 11.5 years, and 57.7% were male. The mean hemoglobin level was 13.2 ± 1.8 g/dL. Anemia was demonstrated in 518 (33.16%) patients. The average follow-up duration was 25.8 ± 10.5 months. The rate of ischemic stroke/TIA, major bleeding, HF, and death was 2.9%, 4.9%, 1.8%, 8.6%, and 9.2%, respectively. Anemia significantly increased the risk of these outcomes with a hazard ratio of 2.2, 3.2, 2.9, 1.9, and 2.8, respectively. Oral anticoagulants (OAC) was prescribed in 74.8%; warfarin accounts for 89.9% of OAC. After adjusting for potential confounders, anemia remained a significant predictor of major bleeding, heart failure, and death, but not for ischemic stroke/TIA. CONCLUSION Anemia was found to be an independent risk factor for major bleeding, heart failure, and death in patients with NVAF.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Satchana Pumprueg
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tomon Thongsri
- Department of Cardiology, Buddhachinaraj Hospital, Phitsanulok, Thailand
| | - Weerapan Wiwatworapan
- Department of Cardiology, Maharat Nakorn Ratchasima Hospital, Nakorn Ratchasima, Thailand
| | | | - Pontawee Kaewkumdee
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ahthit Yindeengam
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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10
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Wang S, Song C, Cui H, Zhu C, Wu R, Huang X, Lai Y, Wang S. Red blood cell distribution width is associated with adverse cardiovascular events after septal myectomy. J Thorac Dis 2021; 13:582-591. [PMID: 33717531 PMCID: PMC7947493 DOI: 10.21037/jtd-20-2528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Red blood cell distribution width (RDW) is associated with increased morbidity and mortality in several cardiovascular diseases. However, the prognostic significance of RDW in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal myectomy remains unclear as no studies have been conducted on this topic. This study aimed to assess the prognostic significance of RDW in these patients. Methods A total of 867 adults with HOCM who underwent septal myectomy at Fuwai Hospital from 2011 to 2017 were retrospectively studied. All patients were assessed comprehensively, including their medical history, echocardiograms, and blood test results. Results The median age of patients was 47.9 [interquartile range (IQR), 37.0–56.0] years and 61.5% of patients were men. During a median follow-up period of 32 (IQR, 17–53) months, 26 patients died and 23 had a cardiovascular death during follow-up. Compared to patients in the lowest RDW quartile, those in the highest quartile had a significantly lower 5-year survival free from all-cause and cardiovascular death (95.9% vs. 87.6%, P<0.001; 95.9% vs. 89.9%, P<0.001). Compared with lower RDW, higher RDW was significantly associated with all-cause and cardiovascular death after adjustment for age, sex, body mass index, and relevant clinical risk factors [per RDW standard deviation (SD) hazard ratio (HR) increase =1.76, 95% confidence interval (CI): 1.54–2.05, P<0.001; per RDW SD HR =1.91, 95% CI: 1.63–2.22, P for trend <0.001]. Conclusions Higher RDW is independently associated with all-cause and cardiovascular death in patients with HOCM after septal myectomy. Therefore, this readily available biomarker could be considered as an additive biomarker for risk stratification in these patients.
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Affiliation(s)
- Shengwei Wang
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Changpeng Song
- Department of Special Medical Treatment Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Cui
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Changsheng Zhu
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rong Wu
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohong Huang
- Department of Special Medical Treatment Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongqiang Lai
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Shuiyun Wang
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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11
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An Y, Ogawa H, Esato M, Ishii M, Iguchi M, Masunaga N, Fujino A, Ide Y, Hamatani Y, Doi K, Ikeda S, Ishigami K, Tsuji H, Wada H, Hasegawa K, Abe M, Lip GYH, Akao M. Cardiovascular Events and Mortality in Patients With Atrial Fibrillation and Anemia (from the Fushimi AF Registry). Am J Cardiol 2020; 134:74-82. [PMID: 32900468 DOI: 10.1016/j.amjcard.2020.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
Data regarding the associations of anemia (hemoglobin level <13.0 g/dl in men and <12.0 g/dl in women) with clinical outcomes in patients with atrial fibrillation (AF) remains scarce. This study sought to investigate the associations of anemia with the incidences of stroke or systemic embolism, major bleeding, heart failure (HF) hospitalization, and all-cause mortality including its causes, using the data from a Japanese community-based survey, the Fushimi AF Registry. A total of 4,169 AF patients were divided into the 3 groups, based on the baseline hemoglobin level: no (n = 2,622), mild (11.0 to <13.0 g/dl for men and <12.0 g/dl for women; n = 880), and moderate/severe anemia (<11.0 g/dl; n = 667). During a median follow-up of 1,464 days, the incidences of major bleeding, HF hospitalization, and mortality increased with higher rates of cardiac death, in accordance with anemic severity. On multivariate analyses, the higher risk of moderate/severe anemia, relative to no anemia, for major bleeding remained statistically significant (hazard ratio [HR]: 2.00, 95% confidential interval [CI]: 1.48 to 2.72). The risks of those with anemia, relative to no anemia, for HF hospitalization (mild; HR: 1.87, 95% CI: 1.51 to 2.31, and moderate/severe; HR: 2.02, 95% CI: 1.59 to 2.57) as well as for mortality (mild; HR: 1.80, 95% CI: 1.50 to 2.16, and moderate/severe; HR: 2.95, 95% CI: 2.45 to 3.55) were also higher, but not for stroke/systemic embolism. These relations were consistent, regardless of the use of oral anticoagulants. In conclusion, anemia was associated with higher risks of HF hospitalization, mortality, and major bleeding in AF patients.
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Affiliation(s)
- Yoshimori An
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masahiro Esato
- Department of Cardiology, Heart Rhythm Section, Ogaki Tokushukai Hospital, Gifu, Japan
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Nobutoyo Masunaga
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akiko Fujino
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yuya Ide
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kosuke Doi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Syuhei Ikeda
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kenjiro Ishigami
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - Hiromichi Wada
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
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12
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Seeking predictors for paroxysmal atrial fibrillation in stroke with an online clinical database. North Clin Istanb 2020; 7:378-385. [PMID: 33043264 PMCID: PMC7521092 DOI: 10.14744/nci.2019.91668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/01/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: A considerable fraction of ischemic stroke cases remain cryptogenic and there is increasing data suggesting the role of missed paroxysmal atrial fibrillations (pAF) in at least a number of these cases. Since electrophysiological identification of pAFs can be challenging, there has been an accumulation of proposed predictors and biomarkers for pAFs. The predictive values of these is varying and sometimes conflicting among studies. Therefore, we aimed to verify a fraction of previously reported parameters for pAF detection by investigating an independent clinical sample. METHODS: Using a publicly available data downloaded from the MIMIC-3 intensive care unit database, we tested the predictive role of particular risk factors and biomarkers for pAF detection after ischemic stroke in 124 patients with ischemic stroke admitted within 24 hours of stroke onset. RESULTS: Our evaluation revealed a strong association of older age in women, as well as admission National Institutes of Health Stroke Scale (NIHSS) and discharge modified Rankin Scores (mRS) in both sexes for pAFs, in patients that were in sinus rhythm on admission. We also detected a trend for lower gender-adjusted hemoglobin in patients with pAF, although the difference was insignificant. On the other hand, we did not find any significant association of pAF detection with some other previously reported biomarkers: serum magnesium level, leukocyte count, neutrophil/lymphocyte ratio or left atrial dilatation. CONCLUSION: Even though our analysis did not reveal a strong and specific biomarker to predict pAFs after stroke, it identified key risk factors. It may be necessary to consider the possibility of pAFs and perform rigorous evaluation to prevent further events of embolic stroke in female patients older than 75 years, with more severe neurological deficits on admission, higher disability on discharge and also with relatively lower hemoglobin level. This first study from Turkey using clinical data from the MIMIC-3 database also demonstrates the value of publicized clinical data for confirmatory studies on various medical fields across the World.
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13
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Higher blood pressure during light exercise is associated with increased left ventricular mass index in normotensive subjects. Hypertens Res 2018. [DOI: 10.1038/s41440-018-0028-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Yoon H, Lee JH, Kim GS, Kim YJ, Hwang EY, Park CE, Park J. The relationship between anemia and pulse pressure and hypertension: The Korea National Health and Nutrition Examination Survey 2010–2012. Clin Exp Hypertens 2018; 40:650-655. [DOI: 10.1080/10641963.2017.1416123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hyun Yoon
- Department of Biomedical Laboratory Science, Hanlyo University, Gwangyang-si, South Korea
| | - Jun Ho Lee
- Department of Biomedical Laboratory Science, Wonkwang Health Science University, Iksan-si, South Korea
| | - Gwang Seok Kim
- Department of Emergency Medical Technology, Chungbuk Health and Science University, Cheongju-si, South Korea
| | - Yu Jeong Kim
- Department of Nursing, Chosun Nursing College, Gwangju, South Korea
| | - Eun Young Hwang
- Department of Nursing Graduate School, Chosun University, Gwangju, South Korea
| | - Chang Eun Park
- Department of Biomedical Laboratory Science, Namseoul University, Cheonan-si, South Korea
| | - Jong Park
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, South Korea
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15
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Li N, Zhou H, Tang Q. Red Blood Cell Distribution Width: A Novel Predictive Indicator for Cardiovascular and Cerebrovascular Diseases. DISEASE MARKERS 2017; 2017:7089493. [PMID: 29038615 PMCID: PMC5606102 DOI: 10.1155/2017/7089493] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
The red blood cell distribution width (RDW) obtained from a standard complete blood count (CBC) is a convenient and inexpensive biochemical parameter representing the variability in size of circulating erythrocytes. Over the past few decades, RDW with mean corpuscular volume (MCV) has been used to identify quite a few hematological system diseases including iron-deficiency anemia and bone marrow dysfunction. In recent years, many clinical studies have proved that the alterations of RDW levels may be associated with the incidence and prognosis in many cardiovascular and cerebrovascular diseases (CVDs). Therefore, early detection and intervention in time of these vascular diseases is critical for delaying their progression. RDW as a new predictive marker and an independent risk factor plays a significant role in assessing the severity and progression of CVDs. However, the mechanisms of the association between RDW and the prognosis of CVDs remain unclear. In this review, we will provide an overview of the representative literatures concerning hypothetical and potential epidemiological associations between RDW and CVDs and discuss the underlying mechanisms.
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Affiliation(s)
- Ning Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Heng Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Qizhu Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
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16
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Zhu W, Wan R, Liu F, Hu J, Huang L, Li J, Hong K. Relation of Body Mass Index With Adverse Outcomes Among Patients With Atrial Fibrillation: A Meta-Analysis and Systematic Review. J Am Heart Assoc 2016; 5:e004006. [PMID: 27613773 PMCID: PMC5079045 DOI: 10.1161/jaha.116.004006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/16/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Several studies have investigated the impact of body mass index (BMI) on the prognosis of atrial fibrillation, but the results remain controversial. We sought to estimate the association of BMI with atrial fibrillation-related outcomes. METHODS AND RESULTS We systematically searched the Cochrane Library, PubMed, and Elsevier databases for all studies reporting associations between BMI and atrial fibrillation-related outcomes. Relative risks (RRs) and 95% CIs were extracted and pooled. Nine studies with 49 364 participants were included. Underweight BMI was associated with an increased risk of stroke or systemic embolism (RR 1.67, 95% CI 1.12-2.49), all-cause mortaliity (RR 2.61, 95% CI 2.21-3.09), and cardiovascular death (RR 2.49, 95% CI 1.38-4.50). Nevertheless, the pooled RRs of overweight and obese patients were lower than those of normal-weight patients for stroke or systemic embolism (overweight: RR 0.91, 95% CI 0.80-1.04; obese: RR 0.84, 95% CI 0.72-0.98; grade 1 obesity: RR 0.89, 95% CI 0.71-1.11; grade 2 obesity: RR 0.64, 95% CI 0.45-0.91; grade 3 obesity: RR 0.82, 95% CI 0.54-1.25), all-cause death (overweight: RR 0.78, 95% CI 0.62-0.96; obese: RR 0.84, 95% CI 0.64-1.10; grade 1 obesity: RR 0.64, 95% CI 0.57-0.73; grade 2 obesity: RR 0.70, 95% CI 0.47-1.03; grade 3 obesity: RR 0.72, 95% CI 0.59-0.88), and cardiovascular death (overweight: RR 0.79, 95% CI 0.58-1.08; obese: RR 0.99, 95% CI 0.79-1.24). CONCLUSIONS Underweight BMI is associated with an increased risk of stroke or systemic embolism, cardiovascular death, and all-cause death in Asian patients with atrial fibrillation, whereas in all atrial fibrillation patients, overweight and obese BMI was not associated with increased risks of these outcomes.
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Affiliation(s)
- Wengen Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Rong Wan
- Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, China
| | - Fuwei Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Jinzhu Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Lin Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Juxiang Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Kui Hong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, China
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17
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Wang Y, Kang W, Wang X, Chen M, Qin Q, Guo M, Ge Z. Functional Role and Mechanism of microRNA-28b in Atrial Myocyte in a Persistent Atrial Fibrillation Rat Model. Med Sci Monit 2016; 22:3073-8. [PMID: 27574952 PMCID: PMC5008747 DOI: 10.12659/msm.896780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Persistent atrial fibrillation has been indicated to be related with microRNA-28b. However, the exact role of microRNA-28b in persistent atrial fibrillation needs to be further elucidated. Therefore, this study aimed to establish a rat model of persistent atrial fibrillation to investigate the level of microRNA-28b in atrial myocytes and to explore the molecular mechanism involved. Material/Methods A persistent atrial fibrillation model was established in rats by using chronic rapid atrial pacing induction. The size of the heart was measured by ultrasonic method. The expression of microRNA-28b in left atrial myocytes was quantified by RT-PCR. Cardiomyocytes were isolated and cultured to detect cell proliferation and apoptosis by MTT and flow cytometry, respectively. The specific inhibitor of ERK signaling pathway, PD98059, was used to further illustrate the role of ERK signaling pathway in the modulation of cardiomyocytes in persistent atrial fibrillation. Results MicroRNA-28b was up-regulated in the experimental rat model with persistent atrial fibrillation. The proliferation of cardiomyocytes was significantly inhibited with potentiated apoptosis. Blockage of the ERK pathway suppressed the microRNA-28b expression and inhibited cell apoptosis. Conclusions microRNA-28b-induced growth inhibition and cell apoptosis of atrial myocytes was observed in the rat model with persistent atrial fibrillation, via activation of the ERK signaling pathway.
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Affiliation(s)
- Yongbin Wang
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Weiqiang Kang
- Department of Cardiology, Qingdao Municipal hospital, Qingdao, Shandong, China (mainland)
| | - Xu Wang
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Meina Chen
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Qiaoji Qin
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Minglei Guo
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Zhiming Ge
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
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18
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Lee HH, Lee MK, Lee WH, Hsu PC, Chu CY, Lee CS, Lin TH, Voon WC, Lai WT, Sheu SH, Su HM. Atrial fibrillation per se was a major determinant of global left ventricular longitudinal systolic strain. Medicine (Baltimore) 2016; 95:e4038. [PMID: 27368031 PMCID: PMC4937945 DOI: 10.1097/md.0000000000004038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Atrial fibrillation (AF) may cause systolic abnormality via inadequate diastolic filling and tachycardia-induced cardiomyopathy. Global longitudinal strain (GLS) is a very sensitive method for detecting subtle left ventricular systolic dysfunction. Hence, this study aimed to evaluate whether AF patients had a more impaired GLS, AF was a major determinant of GLS, and determine the major correlates of GLS in AF patients.The study included 137 patients with persistent AF and left ventricular ejection fraction (LVEF) above 50% and 137 non-AF patients matched according to age, gender, and LVEF. Comprehensive echocardiography with GLS assessment was performed for all cases.Compared with non-AF patients, AF patients had a more impaired GLS, a larger left atrial volume index, higher transmitral E wave velocity (E), and early diastolic mitral velocity (Ea) (all P < 0.001) but comparable E/Ea. After adjustment for baseline and echocardiographic characteristics, the presence of AF remained significantly associated with impaired GLS (β = 0.533, P < 0.001). In addition, multivariate analysis of AF patients indicated that faster heart rates and decreased E, Ea, and LVEF were associated with more impaired GLS.This study demonstrated that AF patients had a more impaired GLS than non-AF patients, although LVEF was comparable between the 2 groups. AF was a major determinant of GLS even after adjustment for relevant clinical and echocardiographic parameters.
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Affiliation(s)
- Hung-Hao Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
| | - Meng-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital
| | - Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Hsiung Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Correspondence: Ho-Ming Su, Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, 482, Shan-Ming Rd., Hsiao-Kang Dist., 812 Kaohsiung, Taiwan, R.O.C (e-mail: )
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19
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Ali AN, Athavale NV, Abdelhafiz AH. Anemia: An Independent Predictor Of Adverse Outcomes In Older Patients With Atrial Fibrillation. J Atr Fibrillation 2016; 8:1366. [PMID: 27909494 DOI: 10.4022/jafib.1366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 01/02/2023]
Abstract
Both anemia and atrial fibrillation are common in older people and their prevalence is age dependent which increases as population ages. Anemia, especially acute onset, predisposes to new onset atrial fibrillation which is likely to be mediated through inducing heart failure first and this predisposition seems to be potentiated by the presence of renal impairment. Anemia adds to the comorbidity burden of patients with atrial fibrillation and independently increases the risks of adverse outcomes such as increased hospitalization, mortality, bleeding and thromboembolic events. Early detection and correction of anemia in patients with atrial fibrillation may have a positive impact on reducing these adverse events.
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Affiliation(s)
- Ali N Ali
- Stroke Unit, Sheffield Teaching Hospitals, Sheffield
| | | | - Ahmed H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
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20
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Chu CY, Lee WH, Hsu PC, Lee MK, Lee HH, Chiu CA, Lin TH, Lee CS, Yen HW, Voon WC, Lai WT, Sheu SH, Su HM. Association of Increased Epicardial Adipose Tissue Thickness With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation. Medicine (Baltimore) 2016; 95:e2874. [PMID: 26986099 PMCID: PMC4839880 DOI: 10.1097/md.0000000000002874] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The thickness of epicardial adipose tissue (EAT) was reported to be highly associated with the incidence and severity of atrial fibrillation (AF). This study was conducted to analyze the ability of EAT thickness in predicting adverse cardiovascular (CV) events in AF. In 190 persistent AF patients, we performed a comprehensive transthoracic echocardiographic examination with assessment of EAT thickness. The definition of CV events included CV mortality, hospitalization for heart failure, myocardial infarction, and stroke. There were 69 CV events including 19 CV deaths, 32 hospitalizations for heart failure, 3 myocardial infarctions, and 15 strokes during a mean follow-up of 29 (25th-75th percentile: 17-36) months. The multivariable analysis demonstrates that chronic heart failure, increased left ventricular (LV) mass index and the ratio of transmitral E-wave velocity to early diastolic mitral annulus velocity, decreased body mass index, and increased EAT thickness (per 1-mm increase, odds ratio 1.224, 95% confidence interval [CI] 1.096-1.368, P < 0.001) were associated with adverse CV events. Additionally, the addition of EAT thickness to a model containing CHA2DS2-VASc score, left atrial volume index, and LV systolic and diastolic function significantly improved the values in predicting CV events (global χ increase 14.65, P < 0.001 and integrated discrimination improvement 0.10, 95% CI 0.04-0.16, P < 0.001). In AF, EAT thickness was useful in predicting adverse CV events. Additionally, EAT thickness could provide incremental value for CV outcome prediction over traditional clinical and echocardiographic parameters in AF.
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Affiliation(s)
- Chun-Yuan Chu
- From the Faculty of Medicine, College of Medicine (C-YC, W-HL, P-CH, T-HL, C-SL, H-WY, W-CV, W-TL, S-HS, H-MS); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital (C-YC, W-HL, P-CH, M-KL, H-HL, C-AC, T-HL, C-SL, H-WY, W-CV, W-TL, S-HS, H-MS); and Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (W-HL, M-KL, H-MS), Kaohsiung, Taiwan
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21
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Chen SC, Lee WH, Hsu PC, Lee CS, Lee MK, Yen HW, Lin TH, Voon WC, Lai WT, Sheu SH, Su HM. Association of the Ratio of Early Mitral Inflow Velocity to the Global Diastolic Strain Rate with a Rapid Renal Function Decline in Atrial Fibrillation. PLoS One 2016; 11:e0147446. [PMID: 26820304 PMCID: PMC4731152 DOI: 10.1371/journal.pone.0147446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 12/27/2015] [Indexed: 01/20/2023] Open
Abstract
The ratio of early mitral inflow velocity (E) to the global diastolic strain rate (E'sr) has been correlated with left ventricular filling pressure and predicts adverse cardiac outcomes in atrial fibrillation (AF). The relationship between the E/E'sr ratio and renal outcomes in AF has not been evaluated. This study examined the ability of the E/E'sr ratio in predicting progression to the renal endpoint, which is defined as a ≥ 25% decline in the estimated glomerular filtration rate in patients with AF. Comprehensive echocardiography was performed on 149 patients with persistent AF, and E'sr was assessed from three standard apical views using the index beat method. During a median follow-up period of 2.3 years, 63 patients (42.3%) were reaching the renal endpoint. Multivariate analysis showed that an increased E/E'sr ratio (per 10 cm) (hazard ratio, 1.230; 95% confidence interval, 1.088 to 1.391; p = 0.001) was associated with an increased renal endpoint. In a direct comparison, the E/E'sr ratio outperformed the ratio of E to early diastolic mitral annular velocity (E') in predicting progression to the renal endpoint in both univariate and multivariate models (p ≤ 0.039). Moreover, adding the E/E'sr ratio to a clinical model and echocardiographic parameters provided an additional benefit in the prediction of progression to the renal endpoint (p = 0.006). The E/E'sr ratio is a useful parameter and is stronger than the E/E' ratio in predicting the progression to the renal endpoint, and it may offer an additional prognostic benefit over conventional clinical and echocardiographic parameters in patients with AF.
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Affiliation(s)
- Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsueh-Wei Yen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Hsiung Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
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