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Xu C, Song Z, Hu LT, Tong YH, Hu JY, Shen H. Abnormal platelet parameters in inflammatory bowel disease: a systematic review and meta-analysis. BMC Gastroenterol 2024; 24:214. [PMID: 38961334 PMCID: PMC11221001 DOI: 10.1186/s12876-024-03305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Platelet dysfunction plays a critical role in the pathogenesis of inflammatory bowel disease (IBD). Despite clinical observations indicating abnormalities in platelet parameters among IBD patients, inconsistencies persist, and these parameters lack standardization for diagnosis or clinical assessment. METHODS A comprehensive search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases for relevant articles published up to December 16th, 2023. A random-effects model was employed to pool the weighted mean difference (WMD) and 95% confidence interval (95% CI) of platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) between IBD patients and healthy controls, and subgroup analyses were performed. RESULTS The meta-analysis included 79 articles with 8,350 IBD patients and 13,181 healthy individuals. The results revealed significantly increased PLT and PCT levels (WMD: 69.910, 95% CI: 62.177, 77.643 109/L; WMD: 0.046%, 95% CI: 0.031%, 0.061%), and decreased MPV levels (WMD: -0.912, 95% CI: -1.086, -0.739 fL) in IBD patients compared to healthy individuals. No significant difference was found in PDW between the IBD and control groups (WMD: -0.207%, 95% CI: -0.655%, 0.241%). Subgroup analysis by disease type and disease activity showed no change in the differences for PLT, PCT, and MPV in the ulcerative colitis and Crohn's disease groups, as well as the active and inactive groups. Notably, the active group exhibited significantly lower PDW levels than the control group (WMD: -1.138%, 95% CI: -1.535%, -0.741%). CONCLUSIONS Compared with healthy individuals, IBD patients display significantly higher PLT and PCT and significantly lower MPV. Monitoring the clinical manifestations of platelet abnormalities serves as a valuable means to obtain diagnostic and prognostic information. Conversely, proactive measures should be taken to prevent the consequences of platelet abnormalities in individuals with IBD. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023493848.
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Affiliation(s)
- Cheng Xu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhen Song
- Nanjing University of Chinese Medicine, Nanjing, China
- Yancheng Binhai Hospital of Traditional Chinese Medicine, Yancheng, China
| | - Li-Ting Hu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yi-Heng Tong
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Jing-Yi Hu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hong Shen
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
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2
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Sinh P, Cross RK. Cardiovascular Comorbidities and Inflammatory Bowel Disease: Causes and Consequences. Gastroenterol Hepatol (N Y) 2024; 20:204-215. [PMID: 38682122 PMCID: PMC11047149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Patients with inflammatory bowel disease (IBD) have an increased risk of cardiovascular disease (CVD) such as myocardial infarction and stroke. CVD in patients with IBD might occur in those with younger age and active disease, which are not traditional risk factors of CVD. Atherosclerotic CVD (ASCVD) and IBD are both proinflammatory conditions, and the underlying chronic inflammation might drive ASCVD risk. Decreasing inflammation might reduce this risk; however, data are limited. IBD medications can increase or decrease ASCVD risk. There are no specific guidelines or modalities to assess ASCVD in IBD. Early detection and risk stratification strategies have been established in other chronic inflammatory disorders. This article discusses causes of CVD in IBD and strategies to modify the consequences.
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Affiliation(s)
- Preetika Sinh
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Raymond K. Cross
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
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3
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Xiao Y, Powell DW, Liu X, Li Q. Cardiovascular manifestations of inflammatory bowel diseases and the underlying pathogenic mechanisms. Am J Physiol Regul Integr Comp Physiol 2023; 325:R193-R211. [PMID: 37335014 PMCID: PMC10979804 DOI: 10.1152/ajpregu.00300.2022] [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: 11/22/2022] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
Inflammatory bowel disease (IBD), consisting of ulcerative colitis and Crohn's disease, mainly affects the gastrointestinal tract but is also known to have extraintestinal manifestations because of long-standing systemic inflammation. Several national cohort studies have found that IBD is an independent risk factor for the development of cardiovascular disorders. However, the molecular mechanisms by which IBD impairs the cardiovascular system are not fully understood. Although the gut-heart axis is attracting more attention in recent years, our knowledge of the organ-to-organ communication between the gut and the heart remains limited. In patients with IBD, upregulated inflammatory factors, altered microRNAs and lipid profiles, as well as dysbiotic gut microbiota, may induce adverse cardiac remodeling. In addition, patients with IBD have a three- to four times higher risk of developing thrombosis than people without IBD, and it is believed that the increased risk of thrombosis is largely due to increased procoagulant factors, platelet count/activity, and fibrinogen concentration, in addition to decreased anticoagulant factors. The predisposing factors for atherosclerosis are present in IBD and the possible mechanisms may involve oxidative stress system, overexpression of matrix metalloproteinases, and changes in vascular smooth muscle phenotype. This review focuses mainly on 1) the prevalence of cardiovascular diseases associated with IBD, 2) the potential pathogenic mechanisms of cardiovascular diseases in patients with IBD, and 3) adverse effects of IBD drugs on the cardiovascular system. Also, we introduce here a new paradigm for the gut-heart axis that includes exosomal microRNA and the gut microbiota as a cause for cardiac remodeling and fibrosis.
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Affiliation(s)
- Ying Xiao
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
- Division of Gastroenterology, Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas, United States
| | - Don W Powell
- Division of Gastroenterology, Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas, United States
| | - Xiaowei Liu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Qingjie Li
- Division of Gastroenterology, Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas, United States
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Konstantinou CS, Korantzopoulos P, Fousekis FS, Katsanos KH. Inflammatory bowel disease and atrial fibrillation: a contemporary overview. Eur J Gastroenterol Hepatol 2023; 35:695-701. [PMID: 37161981 DOI: 10.1097/meg.0000000000002562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Atrial fibrillation is the most common arrhythmia in clinical practice and it is associated with increased morbidity and mortality. Atrial fibrillation is linked with inflammatory signaling while inflammation and oxidative stress promote atrial remodeling promoting the development and perpetuation of the arrhythmia. On the other hand, inflammatory bowel disease (IBD) is considered a chronic inflammatory condition with flares and remissions. IBD has been associated with an increased risk of atherosclerotic cardiovascular disease but its relationship with atrial fibrillation has not been studied well. Recent epidemiological evidence indicates an association between IBD and atrial fibrillation, especially during flares/hospitalizations. This brief review provides a concise overview of all available data regarding the association between IBD and atrial fibrillation including the predictive role of electrocardiographic and echocardiographic markers. Several unresolved issues including the thromboembolic risk in this setting and the potential role of antiinflammatory interventions are also discussed.
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Affiliation(s)
| | | | - Fotios S Fousekis
- Department of Gastroenterology, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Konstantinos H Katsanos
- Department of Gastroenterology, University of Ioannina Faculty of Medicine, Ioannina, Greece
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5
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Rebecchi M, Fanisio F, Rizzi F, Politano A, De Ruvo E, Crescenzi C, Panattoni G, Squeglia M, Martino A, Sasso S, Golia P, Pugliese G, Del Gigante S, Giamundo D, Desimone P, Grieco D, De Luca L, Giordano I, Barillà F, Perrone MA, Calò L, Iellamo F. The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System. Life (Basel) 2023; 13:life13051139. [PMID: 37240784 DOI: 10.3390/life13051139] [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: 04/10/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Arrhythmogenic substrate, modulating factors, and triggering factors (the so-called Coumel's triangle concept) play a primary role in atrial fibrillation (AF) pathophysiology. Several years have elapsed since Coumel and co-workers advanced the concept of the relevance of autonomic nervous system (ANS) influences on atrial cells' electrophysiological characteristics. The ANS is not only associated with cardiac rhythm regulation but also exerts an important role in the triggering and maintenance of atrial fibrillation. This review aims to describe in detail the autonomic mechanisms involved in the pathophysiology of atrial fibrillation (AF), starting from the hypothesis of an "Autonomic Coumel Triangle" that stems from the condition of the fundamental role played by the ANS in all phases of the pathophysiology of AF. In this article, we provide updated information on the biomolecular mechanisms of the ANS role in Coumel's triangle, with the molecular pathways of cardiac autonomic neurotransmission, both adrenergic and cholinergic, and the interplay between the ANS and cardiomyocytes' action potential. The heterogeneity of the clinical spectrum of the ANS and AF, with the ANS playing a relevant role in situations that may promote the initiation and maintenance of AF, is highlighted. We also report on drug, biological, and gene therapy as well as interventional therapy. On the basis of the evidence reviewed, we propose that one should speak of an "Autonomic Coumel's Triangle" instead of simply "Coumel's Triangle".
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Affiliation(s)
- Marco Rebecchi
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | | | - Fabio Rizzi
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | | | | | | | | | | | | | - Stefano Sasso
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Paolo Golia
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Giulia Pugliese
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Sofia Del Gigante
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Domenico Giamundo
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Pietro Desimone
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Domenico Grieco
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Lucia De Luca
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Ignazio Giordano
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Francesco Barillà
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Marco Alfonso Perrone
- Department of Clinical Science and Translational Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Leonardo Calò
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Ferdinando Iellamo
- Department of Clinical Science and Translational Medicine, University Tor Vergata, 00133 Rome, Italy
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Olivera PA, Lasa JS, Peretto G, Zuily S, Danese S, Peyrin-Biroulet L. Review article: Risk of cardiovascular events in patients with inflammatory bowel disease receiving small molecule drugs. Aliment Pharmacol Ther 2023; 57:1231-1248. [PMID: 37038269 DOI: 10.1111/apt.17509] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/18/2023] [Accepted: 03/26/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND In the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel small molecule drugs (SMDs) for the treatment of moderate-to-severe IBD have been recently approved, including Janus kinase (JAK) inhibitors and sphingosine-1-phosphate receptor (S1P) modulators. Data from rheumatoid arthritis population have raised concerns about the risk of cardiovascular events with the use of tofacitinib, which was extrapolated to other immune-mediated diseases and other JAK inhibitors. S1P receptor modulation has been associated with potential cardiovascular events, especially bradycardia and cardiac conduction abnormalities. AIM To review the incidence of cardiovascular events with the use of SMDs in patients with IBD and to provide practical recommendations on mitigation strategies. METHODS Published literature was reviewed; recommendations were synthesised by experts in both cardiovascular diseases and IBD. RESULTS Evidence from the IBD population does not indicate a higher risk of cardiovascular events with tofacitinib and other JAK inhibitors. The risk is higher in patients with intermediate to high cardiovascular risk. S1P modulators may be associated with a dose-dependent, first-dose effect, transient risk of conduction abnormalities (bradycardia and AV block). Screening and monitoring of cardiovascular risk factors should be done in all patients with IBD. Risk stratification for cardiovascular disease should be performed before starting treatment with SMDs. CONCLUSIONS Available evidence of both JAK inhibitors and S1P modulators indicates a reassuring safety profile of SMDs from the cardiovascular perspective in the overall IBD population. Efforts should be made to identify patients with IBD at a higher risk of cardiovascular events.
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Affiliation(s)
- Pablo A Olivera
- IBD Unit, Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigación Clínica (CEMIC), Buenos Aires, Argentina
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Juan S Lasa
- IBD Unit, Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigación Clínica (CEMIC), Buenos Aires, Argentina
- Gastroenterology Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Giovanni Peretto
- Myocarditis Disease Unit, Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Stephane Zuily
- Vascular Medicine Division and Regional Competence Center for Rare Auto-Immune Diseases, Université de Lorraine, INSERM, DCAC and CHRU-Nancy, Nancy, France
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- INSERM NGERE and Department of Hepatogastroenterology, Nancy University Hospital, Lorraine University, Vandoeuvre-lés-Nancy, France
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Hatamnejad MR, Karvandi M, Jodatfar F, Ebrahimi N, Shojaeian F, Baradaran Ghavami S, Balaii H, Moeeni M, Rajabnia M, Shahrokh S, Asadzadeh Aghdaei H. Evaluation of adalimumab effects on left ventricle performance by echocardiography indexes among patients with immunosuppressant refractory ulcerative colitis. Front Med (Lausanne) 2023; 9:1008711. [PMID: 36687438 PMCID: PMC9853977 DOI: 10.3389/fmed.2022.1008711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background and aims Inflammatory bases lead to a simultaneous flourishing of cardiovascular complications with inflammatory bowel disease (IBD). As a released cytokine, tumor necrosis factor-α (TNF-α) can either disrupt or preserve cardiovascular performance. Due to this controversy, this study aimed to appraise the short-term anti-TNF (adalimumab [ADA]) relics on cardiac function by gauging the echocardiography indexes in patients with immunosuppressant refractory ulcerative colitis (UC). Methods All cases with a definite diagnosis of UC were included based on providing written informed consent and owning the severe form of active disease (Mayo score ≥7), which did not dampen with immunosuppressant. Patients were excluded in the case of previous cardiac ailments/risk factors and prior related surgical or pharmaceutical intervention. Transthoracic echocardiography (TTE) was carried out before and 3 months after biological regimen allocation and changes in indexes [ejection fraction (EF), left ventricular end-diastolic volume (LVEDV)/left ventricular end-systolic volume (LVESV), and global longitudinal strain (GLS) in standard parasternal short axis from mid-ventricular level, two-, three-, and four-chamber apical long axes] were compared via statistical analyses. Results The study consisted of 13 (65%) men and 7 (35%) women, with a mean age of 36.54 ± 11.3 years. Participants mainly possessed Montreal class I (45%) and an average of 3.25 years of disease duration. The intervention significantly controlled inflammation [endoscopic Mayo score (P = 0.001), partial Mayo score (P = 0.001), and C-reactive protein (P = 0.001)]. Endoscopic and clinical remission was obtained in 7 (35%) and 9 (45%) patients, respectively; however, no significant discrepancy related to the LVEDV (P = 0.86), LVESV (P-value = 0.25), EF (P-value = 0.06), and GLS in standard parasternal short axis (P = 0.73), long axis [apical 2-chamber (P-value = 0.61), apical 3-chamber (P-value = 0.15), and apical 4-chamber (P-value = 0.19) views] was observed before and after the intervention. Furthermore, no statistically significant correlation between disease activity and cardiac function was found, neither before nor after ADA administration. Conclusion The present perusal found no deterioration in left ventricular function indexes with ADA intervention among patients with IBD without cardiac ailment. Thus, prescribing the anti-TNF to alleviate the inflammation can be carried out with less concern about cardiac consequences and considering other adverse traces in the target group.
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Affiliation(s)
- Mohammad Reza Hatamnejad
- Department of Basic and Molecular Epidemiology of Gastrointestinal Disorders, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mersedeh Karvandi
- Department of Cardiovascular Imaging Research, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fateme Jodatfar
- Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Fateme Jodatfar ✉
| | - Nastaran Ebrahimi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Shojaeian
- Department of Surgical Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shaghayegh Baradaran Ghavami
- Department of Basic and Molecular Epidemiology of Gastrointestinal Disorders, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hedieh Balaii
- Department of Basic and Molecular Epidemiology of Gastrointestinal Disorders, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Moeeni
- Department of Cardiology, Seyed-ol Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohsen Rajabnia
- Non-Communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Shabnam Shahrokh
- Department of Basic and Molecular Epidemiology of Gastrointestinal Disorders, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Shabnam Shahrokh ✉
| | - Hamid Asadzadeh Aghdaei
- Department of Basic and Molecular Epidemiology of Gastrointestinal Disorders, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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Namazi N, Ariaeenejad S, Azad ME, Pishgahi M. Risk of Atrial Fibrillation in Pemphigus Vulgaris. Indian J Dermatol 2022; 67:639-644. [PMID: 36998858 PMCID: PMC10043688 DOI: 10.4103/ijd.ijd_69_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Background Pemphigus vulgaris (PV) is a rare immunobullous disease with a higher mortality rate than the general population. The aim of this study was to investigate P-wave duration and P-wave dispersion (PWD) in patients with PV as predictors of atrial fibrillation (AF). Materials and Methods In this case-control study, the risk of AF development was determined by measuring maximum and minimum P-wave duration (P-max and P-min) and PWD in 45 PV patients and 45 healthy individuals. The incidence of metabolic syndrome was evaluated. Results PWD and P-max values of the study group were significantly higher than those of the control group. No difference was observed between PWD with regards to disease duration and disease phenotype (p > 0.05). There was no significant difference regarding the prevalence of metabolic syndrome in PV patients compared with the control group. Conclusion PWD and P-max, which are accepted as risk factors for AF development, were found to be higher in PV patients. Some components of metabolic syndrome were more prevalent in PV patients. It seems that there is an increased risk of CVD and AF in PV patients.
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Affiliation(s)
- Nastaran Namazi
- From the Department of Dermatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Ariaeenejad
- From the Department of Dermatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Esmailii Azad
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Pishgahi
- Department of Cardiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bambo GM, Shiferaw E, Melku M. A mean platelet volume in inflammatory bowel disease: A systematic review and meta-analysis. PLoS One 2022; 17:e0273417. [PMID: 36040881 PMCID: PMC9426900 DOI: 10.1371/journal.pone.0273417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) is a chronic gastrointestinal tract inflammatory state, which is affecting millions of individuals in the world. It can affect alimentary canals such as colon, rectum, ileum and other parts. In IBD, platelet parameters underwent several changes. Therefore, the aim of this review was determining the estimated pooled mean platelet volume and mean difference in inflammatory bowel disease to elucidate its potential diagnostic value. Methods Articles were extensively searched in bibliographic databases using Medical Subject Heading and entry phrases or terms. In addition, articles were directly searched in Google Scholar to account for the studies omission in searching bibliographic databases. Observational (cohort, cross-sectional and case-control) studies, published in English language and conducted on IBD were included. For studies meeting the eligibility criteria, the first author’s name, publication year, population, study design, study area, sample size, mean platelet volume and standard deviation were extracted and entered in to Microsoft-excel. The analysis was done by Stata version 11. In order to estimate the pooled mean platelet volume and mean difference, random effect model was done. The heterogeneity was quantified using Higgin’s I2 statistics. Publication bias was determined using Egger’s test statistics and funnel plot. Sub-group analysis based on population carried to reduce heterogeneity. Results A total of 17 relevant articles with 2957 participants (1823 IBD cases and 1134 healthy controls) were included to this study. The pooled estimated MPV was 9.29fl; 95% CI: 9.01–9.57 and 9.50fl; 95% CI: 8.81–10.20 in IBD and control groups, respectively. The standardized pooled estimate of mean difference in mean platelet volume was -0.83fl; 95% CI: -1.15, -0.51; I2: 93.1%; P-value < 0.001. In subgroup analysis based on population, the highest estimated mean difference in MPV was observed among patients of CD; -2.30; 95% CI: -3.46, -1.14; I2: 97.8%; P-value < 0.001. Conclusion According to the current systematic review and meta-analysis, mean platelet volume was lower in IBD compared to control. The decreased mean platelet volume could be attributed to platelet consumption or sequestration associated with the progression of IBD. As a result, in IBD, mean platelet volume can provide diagnostic and prognostic information.
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Affiliation(s)
- Getachew Mesfin Bambo
- Department of Medical Laboratory Science, College of Health Sciences, Mizan Tepi University, Mizan, Ethiopia
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Elias Shiferaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
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10
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What Links an Increased Cardiovascular Risk and Inflammatory Bowel Disease? A Narrative Review. Nutrients 2021; 13:nu13082661. [PMID: 34444821 PMCID: PMC8398182 DOI: 10.3390/nu13082661] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Several studies have shown increased rates of cardiovascular disease (CVD) in patients suffering from inflammatory bowel disease (IBD), particularly in cases of early atherosclerosis and myocardial infarction. IBD most frequently begins at an early age, patients usually present normal weight and remain under constant care of a physician, as well as of a nutritionist. Therefore, the classical risk factors of CVD are not reflected in the higher prevalence of CVD in the IBD population. Still, both groups are characterised by chronic inflammation and display similar physiopathological mechanisms. In the course of IBD, increased concentrations of pro-inflammatory cytokines, such as C-reactive protein (CRP) and homocysteine, may lead to endothelial dysfunctions and the development of CVD. Furthermore, gut microbiota dysbiosis in patients with IBD also constitutes a risk factor for an increased susceptibility to cardiovascular disease and atherosclerosis. Additionally, diet is an essential factor affecting both positively and negatively the course of the aforementioned diseases, whereas several dietary patterns may also influence the association between IBD and CVD. Thus, it is essential to investigate the factors responsible for the increased cardiovascular (CV) risk in this group of patients. Our paper attempts to review the role of potential inflammatory and nutritional factors, as well as intestinal dysbiosis and pharmacotherapy, in the increased risk of CVD in IBD patients.
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Chen L, Fu G, Jiang C. Mendelian randomization as an approach to assess causal effects of inflammatory bowel disease on atrial fibrillation. Aging (Albany NY) 2021; 13:12016-12030. [PMID: 33824227 PMCID: PMC8109086 DOI: 10.18632/aging.202906] [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: 01/13/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
Background: Despite growing evidence indicating that patients with inflammatory bowel disease (IBD) have an increased risk of atrial fibrillation (AF), owing to the potential biases of confounding effects and reverse causation, the specific relationship between IBD and AF remains controversial. The aim of this study is to determine whether there is a causal effect of IBD on AF. Methods: A two-sample Mendelian randomization (MR) study was performed to evaluate the causal effect of IBD on AF. Statistical summaries for the associations between single nucleotide polymorphisms (SNPs) and traits of interest were obtained from independent consortia with European populations. The dataset of IBD was acquired from genome-wide association studies (GWAS), including more than 75,000 cases and controls. A GWAS with 60,620 AF cases and 970,216 controls was used to identify genetic variation underlying AF. The causal effect was estimated using the multiplicative random effects inverse-variance weighted method (IVW), followed by sensitivity analysis. Results: Using 81 SNPs, there was no evidence to suggest an association between genetically predicted IBD and risk of AF with multiplicative random-effects IVW MR analysis (odds ratio = 1.0000, 95% confidence interval: 0.9994 1.0005, p = 0.88). Conclusion: As opposed to current assumptions, no substantial evidence was found to support a causal role of IBD in the development of AF.
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Affiliation(s)
- LaiTe Chen
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
| | - GuoSheng Fu
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
| | - ChenYang Jiang
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
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12
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Kamperidis V, Kamperidis N. Response to the Letter Regarding: Atherosclerosis and Other Cardiac Manifestations in Inflammatory Bowel Disease. Angiology 2021; 72:594-595. [PMID: 33813909 DOI: 10.1177/00033197211003438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vasileios Kamperidis
- 1st Cardiology Department, 37788AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
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13
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Viscido A, Capannolo A, Petroni R, Stefanelli G, Zerboni G, De Martinis M, Necozione S, Penco M, Frieri G, Latella G, Romano S. Association between Corrected QT Interval and C-Reactive Protein in Patients with Inflammatory Bowel Diseases. ACTA ACUST UNITED AC 2020; 56:medicina56080382. [PMID: 32751480 PMCID: PMC7466199 DOI: 10.3390/medicina56080382] [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: 07/04/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/21/2022]
Abstract
Background and objectives: Electrocardiograph abnormalities (i.e., QT interval prolongation) have been described in inflammatory bowel diseases (IBD). We aimed to measure the QT interval in a cohort of patients with IBD and to analyze its relationship with clinical and inflammatory activity. Materials and Methods: We performed a cross-sectional study that included 38 IBD outpatients and 38 “age- and sex-matched” healthy controls. Nine patients had active IBD, and 29 were in clinical remission. Among the latter, 10 patients had sustained (lasting >1 year) and 19 had short-term remission (≤1 year). Corrected QT (QTc) interval was measured on standard 12-lead electrocardiograph. A systematic review of the literature on studies investigating the QT interval in patients with IBD was also performed. Results: QTc interval values were similar between IBD patients and healthy controls (417.58 ± 22.05 ms vs. 409.13 ± 19.61 ms, respectively; p: 0.479). Patients with active IBD had significantly higher QTc values (435.11 ± 27.31 ms) than both controls (409.13 ± 19.61 ms) and patients in remission (412.14 ± 17.33 ms) (p: 0.031). Post hoc analysis showed that the difference in QTc values between active IBD and remission was attributable to the group of patients with sustained remission (p < 0.05). Lastly, a significant correlation between QTc interval and C-reactive protein (CRP) values was observed (Spearman test: r = 0.563; p: 0.0005). Conclusions: Our study demonstrates an association between QTc duration and both clinical and inflammatory activity in patients with IBD. The higher the CRP value, the longer is the QTc duration. For practical purposes, all patients with active IBD should undergo a standard ECG. Prescription of drugs able to modify the QT interval should be avoided in patients with active IBD. The systematic review of the literature indicated that this is the first published study demonstrating an association between the QTc duration and CRP values in patients with IBD.
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Affiliation(s)
- Angelo Viscido
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.C.); (G.S.); (G.F.); (G.L.)
- Correspondence: ; Tel.: +39-086-243-4746
| | - Annalisa Capannolo
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.C.); (G.S.); (G.F.); (G.L.)
| | - Renata Petroni
- Cardiology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (R.P.); (M.P.); (S.R.)
- Di Lorenzo Clinic, Avezzano, 67100 L’Aquila, Italy
| | - Gianpiero Stefanelli
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.C.); (G.S.); (G.F.); (G.L.)
| | | | - Massimo De Martinis
- Clinical Immunology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Stefano Necozione
- Statistics Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Maria Penco
- Cardiology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (R.P.); (M.P.); (S.R.)
| | - Giuseppe Frieri
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.C.); (G.S.); (G.F.); (G.L.)
| | - Giovanni Latella
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.C.); (G.S.); (G.F.); (G.L.)
| | - Silvio Romano
- Cardiology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (R.P.); (M.P.); (S.R.)
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Ghoneim S, Shah A, Dhorepatil A, Butt MU, Waghray N. The Risk of Cerebrovascular Accidents in Inflammatory Bowel Disease in the United States: A Population-Based National Study. Clin Exp Gastroenterol 2020; 13:123-129. [PMID: 32440189 PMCID: PMC7210027 DOI: 10.2147/ceg.s250182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) has been associated with an increased risk of cardiovascular events, but the risk of cerebrovascular accidents (CVA) remains unknown. Hypercoagulability and systemic inflammation are two proposed mechanisms by which the presence of IBD might lead to the development of CVA. Objective To assess the risk of CVA in patients with IBD compared to those without IBD with known traditional risk factors for CVA. Methods We reviewed data from a large commercial database (Explorys, IBM) that aggregated records from 26 health-care systems nationwide. Using systemized nomenclature of medicine – clinical terms, we identified adult patients diagnosed with IBD (ulcerative colitis or Crohn’s disease) between September 1994 and September 2019. We then examined the risk of CVA in these patients. Known risk factors such as age ≥65-years old, diabetes mellitus (DM), hypertension (HTN), female gender, atrial fibrillation (Afib) were collected. A univariate binary logistic model was constructed using CVA as the dependent variable and other variables as independent variables. To adjust for possible confounding, a multivariable model adjusting for all covariates was created to test for CVA. Results A total of 52,176,550 patients were included in this analysis, and 261,890 had IBD. The prevalence of CVA was higher in IBD patients compared to non-IBD patients (6.24% versus 0.48%, p <0.0001). The univariate binary logistic regression showed 13.7 times higher odds of having CVA in IBD patients than without IBD (odds ratio (OR) 13.74, p <0.0001). In multivariate binary logistic regression, after adjusting for traditional risk factors for CVA (Afib, HTN, female gender, DM, age ≥65 years), odds ratio of CVA in IBD patients remained significantly higher (OR 8.07, 95% CI: 7.9–8.2, p<0.0001). Conclusion In our large cohort of patients, IBD appears to be an independent risk factor for CVA. Further prospective studies are needed to understand the underlying mechanisms by which IBD increases the risk of CVA. This may lead to early identification and intervention to reduce the risk of CVA in this highly heterogeneous group of patients.
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Affiliation(s)
- Sara Ghoneim
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA
| | - Aun Shah
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA
| | - Aneesh Dhorepatil
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA
| | - Muhammad Umer Butt
- Division of Cardiology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA
| | - Nisheet Waghray
- Division of Gastroenterology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA
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Zhou X, Dudley SC. Evidence for Inflammation as a Driver of Atrial Fibrillation. Front Cardiovasc Med 2020; 7:62. [PMID: 32411723 PMCID: PMC7201086 DOI: 10.3389/fcvm.2020.00062] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/26/2020] [Indexed: 12/31/2022] Open
Abstract
Atrial fibrillation (AF) is one of the most common types of arrhythmias and increases cardiovascular morbidity and mortality. Current therapeutic approaches to AF that focus on rhythm control have high recurrence rates and no life prolongation value. While possible explanations include toxicity of current therapies, another likely explanation may be that current therapies do not address fundamental mechanisms of AF initiation and maintenance. Inflammation has been shown to affect signaling pathways that lead to the development of AF. This paper reviews the roles of inflammation in the occurrence, development, and mechanisms of AF and reviews the therapeutic implications of the correlation of inflammation and AF.
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Affiliation(s)
- Xiaoxu Zhou
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota at Twin Cities, Minneapolis, MN, United States
| | - Samuel C Dudley
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota at Twin Cities, Minneapolis, MN, United States
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16
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Gawałko M, Balsam P, Lodziński P, Grabowski M, Krzowski B, Opolski G, Kosiuk J. Cardiac Arrhythmias in Autoimmune Diseases. Circ J 2020; 84:685-694. [PMID: 32101812 DOI: 10.1253/circj.cj-19-0705] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Autoimmune diseases (ADs) affect approximately 10% of the world's population. Because ADs are frequently systemic disorders, cardiac involvement is common. In this review we focus on typical arrhythmias and their pathogenesis, arrhythmia-associated mortality, and possible treatment options among selected ADs (sarcoidosis, systemic lupus erythematosus, scleroderma, type 1 diabetes, Graves' disease, rheumatoid arthritis, ankylosing spondylitis [AS], psoriasis, celiac disease [CD], and inflammatory bowel disease [IBD]). Rhythm disorders have different underlying pathophysiologies; myocardial inflammation and fibrosis seem to be the most important factors. Inflammatory processes and oxidative stress lead to cardiomyocyte necrosis, with subsequent electrical and structural remodeling. Furthermore, chronic inflammation is the pathophysiological basis linking AD to autonomic dysfunction, including sympathetic overactivation and a decline in parasympathetic function. Autoantibody-mediated inhibitory effects of cellular events (i.e., potassium or L-type calcium currents, M2muscarinic cholinergic or β1-adrenergic receptor signaling) can also lead to cardiac arrhythmia. Drug-induced arrhythmias, caused, for example, by corticosteroids, methotrexate, chloroquine, are also observed among AD patients. The most common arrhythmia in most AD presentations is atrial arrhythmia (primarily atrial fibrillation), expect for sarcoidosis and scleroderma, which are characterized by a higher burden of ventricular arrhythmia. Arrhythmia-associated mortality is highest among patients with sarcoidosis and lowest among those with AS; there are scant data related to mortality in patients with psoriasis, CD, and IBD.
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Affiliation(s)
- Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Paweł Balsam
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Piotr Lodziński
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Bartosz Krzowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Jędrzej Kosiuk
- 1st Chair and Department of Cardiology, Medical University of Warsaw.,Department of Electrophysiology, Helios Klinikum Koethen
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17
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Kahyaoglu M, Gunay N, Bayam E, Yilmaz Y, Gecmen C, Ozdil K, Uyan C. Atrial peak longitudinal strain may be predictive of pancolitis in patients with ulcerative colitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:102-107. [PMID: 31273822 DOI: 10.1002/jcu.22752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/31/2019] [Accepted: 06/16/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Ulcerative colitis is a chronic idiopathic inflammatory bowel disease of the colon that is characterized by a relapsing and remitting course. Previous studies have shown that arterial stiffness, carotid intima media thickness, atrial electromechanical delay, and global longitudinal strain suggested subclinical cardiovascular disorders in ulcerative colitis patients. The aims of our study was to evaluate the left atrial function of patients with ulcerative colitis by using speckle tracking echocardiography, and to assess the relationship between echocardiographic variables and the extent of the disease. METHODS We recruited 51 outpatients with ulcerative colitis in remission phase and 52 healthy volunteers. The ulcerative colitis patients were evaluated by for the extent of the disease by endoscopy at the initial diagnosis. RESULTS E/Em , left atrial volume, and left atrial stiffness index were higher, and peak atrial longitudinal strain was lower in pancolitis than in non-pancolitis patients. In the multivariate logistic regression test, peak atrial longitudinal strain and E/Em were found to be independent predictors for pancolitis. CONCLUSION Early detection of myocardial abnormalities by conventional echocardiography and speckle tracking echocardiography, which is a simple and non-invasive technique, may be useful for giving insights to the extent of the disease in ulcerative colitis patients.
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Affiliation(s)
- Muzaffer Kahyaoglu
- Department of Cardiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Nuran Gunay
- Department of Cardiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Emrah Bayam
- Department of Cardiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Yilmaz
- Department of Cardiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Cetin Gecmen
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Turkey
| | - Kamil Ozdil
- Department of Gastroenterology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Cihangir Uyan
- Department of Cardiology, Umraniye Training and Research Hospital, Istanbul, Turkey
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18
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Yüzbaşıoğlu B, Ustaoğlu M, Yüzbaşıoğlu Ş, Akbulut UE, Özdil K. Levels of TAFI, TFPI and ADAMTS-13 in inflammatory bowel disease. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:1025-1029. [PMID: 31854307 DOI: 10.5152/tjg.2019.19346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS There is an increased tendency for thrombosis and thromboembolic complications in patients with inflammatory bowel disease (IBD). The aim of the present study was to determine the serum concentrations of thrombin-activatable fibrinolysis inhibitor (TAFI), tissue factor pathway inhibitor (TFPI) and a disintegrin and metalloproteinase with thrombospondin motif-13 (ADAMTS-13) in patients with IBD and to assess their possible role in the etiopathogenesis of the disease. MATERIALS AND METHODS Thirty-four patients with IBD (23 ulcerative colitis and 11 Crohn's disease) and 20 healthy controls were included in the present study. TAFI, TFPI, and ADAMTS-13 concentrations were determined by enzyme-linked immunosorbent assay. RESULTS Mean TAFI, TFPI, and ADAMTS-13 concentrations in the patient group were 17.75 ng/ml, 72.10 ng/ml, and 14.90 U/l, respectively. In the control group, these values were 117.10 ng/ml, 300 ng/ml, and 191.55 U/l, respectively. TAFI, TFPI, and ADAMTS-13 values were significantly lower in the patient group than in the control group (all p<0.01). CONCLUSION TAFI, TFPI, and ADAMTS-13 levels were significantly lower in the patient group. These findings indicate the presence of a clear, multifactorial imbalance in the coagulation-fibrinolytic system in the patient group. It is also possible that this imbalance in the coagulation and fibrinolytic system may play a role in the still unclear etiopathogenesis of the disease.
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Affiliation(s)
| | - Müge Ustaoğlu
- Department of Gastroenterology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Şule Yüzbaşıoğlu
- Department of Hematology, Bursa Higher Specialization Training and Research Hospital, Bursa, Turkey
| | - Ulaş Emre Akbulut
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Health Sciences University, Antalya Trainig and Research Hospital, Antalya, Turkey
| | - Kamil Özdil
- Department of Gastroenterology, Health Sciences University, Ümraniye Training and Research Hospital, İstanbul, Turkey
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19
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P-wave dispersion and atrial electromechanical delay in patients with inflammatory bowel disease. COR ET VASA 2019. [DOI: 10.33678/cor.2019.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Inflammatory bowel disease and the risk for cardiovascular disease: Does all inflammation lead to heart disease? Trends Cardiovasc Med 2019; 30:463-469. [PMID: 31653485 DOI: 10.1016/j.tcm.2019.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 02/07/2023]
Abstract
Inflammation has a strong role in the development of atherosclerotic cardiovascular disease (ASCVD). Several systemic inflammatory conditions have been linked to an increased risk of ASCVD; however, this has not been well established in Inflammatory Bowel Disease (IBD). IBD is comprised of Ulcerative Colitis and Crohn's disease, both of which involve chronic inflammation of the intestinal tract, often with evidence of systemic involvement. Several ASCVD risk factors such as smoking, diabetes, poor diet and the presence of obesity may increase the risk of ASCVD in patients suffering from IBD, despite a lower prevalence of hypertension and hypercholesterolemia. Medications used to treat IBD and target inflammation, such as steroids, may also accelerate the risk of the risk for ASCVD heart failure while exacerbating ASCVD risk factors. Several studies have demonstrated an elevated risk of acute myocardial infarction and stroke in these patients, most notably in women and in younger patients. Some cohort studies have also suggested a link between IBD and both atrial fibrillation and heart failure, particularly during periods of active flares. All IBD patients, particularly younger individuals, should be screened for ASCVD risk factors with aggressive risk factor modification to reduce the risk of cardiovascular events. Further research is needed to identify how to prevent and treat cardiovascular events that occur in patients with IBD, particularly during active flares.
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21
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Lazzerini PE, Laghi‐Pasini F, Acampa M, Srivastava U, Bertolozzi I, Giabbani B, Finizola F, Vanni F, Dokollari A, Natale M, Cevenini G, Selvi E, Migliacci N, Maccherini M, Boutjdir M, Capecchi PL. Systemic Inflammation Rapidly Induces Reversible Atrial Electrical Remodeling: The Role of Interleukin-6-Mediated Changes in Connexin Expression. J Am Heart Assoc 2019; 8:e011006. [PMID: 31423933 PMCID: PMC6759884 DOI: 10.1161/jaha.118.011006] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 06/11/2019] [Indexed: 12/17/2022]
Abstract
Background Systemic inflammation is a strong predictor of atrial fibrillation. A key role for electrical remodeling is increasingly recognized, and experimental data suggest that inflammatory cytokines can directly affect connexins resulting in gap-junction dysfunction. We hypothesized that systemic inflammation, regardless of its origin, promotes atrial electric remodeling in vivo, as a result of cytokine-mediated changes in connexin expression. Methods and Results Fifty-four patients with different inflammatory diseases and elevated C-reactive protein were prospectively enrolled, and electrocardiographic P-wave dispersion indices, cytokine levels (interleukin-6, tumor necrosis factor-α, interleukin-1, interleukin-10), and connexin expression (connexin 40, connexin 43) were measured during active disease and after reducing C-reactive protein by >75%. Moreover, peripheral blood mononuclear cells and atrial tissue specimens from an additional sample of 12 patients undergoing cardiac surgery were evaluated for atrial and circulating mRNA levels of connexins. Finally, in vitro effects of interleukin-6 on connexin expression were studied in HL-1 mouse atrial myocytes. In patients with active inflammatory diseases, P-wave dispersion indices were increased but rapidly decreased within days when C-reactive protein normalizes and interleukin-6 levels decline. In inflammatory disease patients, both P-wave dispersion indices and interleukin-6 changes were inversely associated with circulating connexin levels, and a positive correlation between connexin expression in peripheral blood mononuclear cells and atrial tissue was demonstrated. Moreover, interleukin-6 significantly reduced connexin expression in HL-1 cells. Conclusions Our data suggest that regardless of specific etiology and organ localization, systemic inflammation, via interleukin-6 elevation, rapidly induces atrial electrical remodeling by down-regulating cardiac connexins. Although transient, these changes may significantly increase the risk for atrial fibrillation and related complications during active inflammatory processes.
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Affiliation(s)
| | - Franco Laghi‐Pasini
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | | | - Ujala Srivastava
- Cardiovascular Research ProgramVA New York Harbor Healthcare SystemBrooklyn, New YorkNY
- Department of Medicine, Cell Biology and PharmacologyState University of New York Downstate Medical CenterBrooklyn, New YorkNY
| | - Iacopo Bertolozzi
- Cardiology Intensive Therapy UnitDepartment of Internal MedicineHospital of CarraraItaly
| | - Beatrice Giabbani
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Francesco Finizola
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Francesca Vanni
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Aleksander Dokollari
- Department of Cardiac SurgeryUniversity Hospital of SienaItaly
- Department of Cardiovascular SurgerySaint Michael HospitalUniversity of TorontoOntarioCanada
| | - Mariarita Natale
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | | | - Enrico Selvi
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Nicola Migliacci
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | | | - Mohamed Boutjdir
- Cardiovascular Research ProgramVA New York Harbor Healthcare SystemBrooklyn, New YorkNY
- Department of Medicine, Cell Biology and PharmacologyState University of New York Downstate Medical CenterBrooklyn, New YorkNY
- Department of MedicineNYU School of MedicineNew YorkNY
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Xu XJ, Li LN, Wu WY. Importance of stabilization of the neonatal transport network in critically ill neonates. J Int Med Res 2019; 47:3737-3744. [PMID: 31307258 PMCID: PMC6726806 DOI: 10.1177/0300060519853948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study aimed to investigate how to stabilize the condition of critically ill neonates within the neonatal transport network. Methods A total of 243 critically ill newborns in four hospitals involved in the transport network were enrolled. The newborns were divided into the research and control groups. In the research group, medical staff underwent theoretical training, and neonatal intensive care unit (NICU) professionals participated and provided on-site guidance on delivery of high-risk infants. Delivery of high-risk neonates in the control group was conventionally managed in local hospitals, and neonates were transferred after a phone call to the NICU. Results Gestational age and body weight were lower, and dexamethasone use was higher in the research group than in the control group. The proportions of neonates who underwent mask pressure, endotracheal intubation, pulmonary surfactant application, and chest compressions were higher, and those with dyspnea and nervous system abnormalities were lower in the research group than in the control group. Blood gas and sugar levels were better in the research group than in the control group. Conclusion Strengthening professional training and participation of professional NICU staff in childbirth can improve the conditions of high-risk neonates and increase safety of their transportation.
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Affiliation(s)
- Xiao-Jing Xu
- Department of Pediatrics, The First Hospital of Tsinghua University, Beijing, China
| | - Li-Na Li
- Department of Pediatrics, The First Hospital of Tsinghua University, Beijing, China
| | - Wen-Yan Wu
- Department of Pediatrics, The First Hospital of Tsinghua University, Beijing, China
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23
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Mehain SO, Haines JM, Lee PM. Platelet indices as biomarkers for characterization and determination of severity in canine chronic enteropathy. Vet J 2019; 248:37-41. [PMID: 31113560 DOI: 10.1016/j.tvjl.2019.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 01/14/2023]
Abstract
Human studies have shown an association between certain platelet indices and active inflammatory bowel disease when compared to healthy controls. The objectives of this retrospective study were to determine if any platelet indices differ between dogs with chronic enteropathies and healthy age- and sex-matched control dogs and are predictive of the severity of chronic enteropathy based on canine chronic enteropathy clinical activity index (CCECAI) scores. Medical records for 22 chronic enteropathy-positive dogs and 22 healthy control dogs were reviewed for historical and physical examination findings, platelet indices, and histologic diagnoses of chronic enteropathy. Platelet indices were compared between the groups, and an association between platelet indices and CCECAI scores in dogs with chronic enteropathy was investigated. Chronic diarrhea and weight loss were common clinical signs associated with chronic enteropathy. Lymphoplasmacytic enteritis was the most common histologic diagnosis. Only one platelet index, platelet component distribution width (P = 0.045), was found to be significantly different between the groups. For predicting severity of disease, determined by CCECAI score, statistically significant differences in indices associated with higher scores were platelet count (P = 0.024) and platelet dry mass distribution width (P = 0.036). Only platelet component distribution width showed potential in characterizing dogs with chronic enteropathy compared to normal dogs. Elevated platelet count and decreased platelet dry mass distribution width had a significant effect on total CCECAI scores. These findings suggest further investigation into the utility of platelet indices as predictors of disease presence and severity in dogs with chronic enteropathy is warranted.
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Affiliation(s)
- S O Mehain
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, PO Box 647060, Pullman, WA 99164-7060, USA
| | - J M Haines
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, PO Box 647060, Pullman, WA 99164-7060, USA.
| | - P M Lee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, PO Box 647060, Pullman, WA 99164-7060, USA
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24
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Long MT, Ko D, Arnold LM, Trinquart L, Sherer JA, Keppel SS, Benjamin EJ, Helm RH. Gastrointestinal and liver diseases and atrial fibrillation: a review of the literature. Therap Adv Gastroenterol 2019; 12:1756284819832237. [PMID: 30984290 PMCID: PMC6448121 DOI: 10.1177/1756284819832237] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/10/2018] [Indexed: 02/04/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with significant morbidity and mortality. A number of risk factors have been associated with AF, though few studies have explored the association between gastrointestinal and liver diseases and AF. Additionally, AF and treatment for AF may predispose to gastrointestinal and liver diseases. We review the current literature on the bidirectional associations between gastrointestinal and liver diseases and AF. We highlight the gaps in knowledge and areas requiring future investigation.
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Affiliation(s)
| | - Darae Ko
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jason A. Sherer
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Sunny-Skye Keppel
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Emelia J. Benjamin
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA, USA Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA The Framingham Heart Study, Framingham, MA, USA
| | - Robert H. Helm
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Bunu DM, Timofte CE, Ciocoiu M, Floria M, Tarniceriu CC, Barboi OB, Tanase DM. Cardiovascular Manifestations of Inflammatory Bowel Disease: Pathogenesis, Diagnosis, and Preventive Strategies. Gastroenterol Res Pract 2019; 2019:3012509. [PMID: 30733802 PMCID: PMC6348818 DOI: 10.1155/2019/3012509] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/18/2018] [Accepted: 12/06/2018] [Indexed: 12/16/2022] Open
Abstract
Inflammatory bowel disease (IBD) refers to a group of chronic inflammatory diseases that targets mainly the gastrointestinal tract. The clinical presentation of IBD includes both gastrointestinal manifestations and extraintestinal manifestations (EIM). The reported cardiovascular manifestations in IBD patients include pericarditis, myocarditis, venous and arterial thromboembolism, arrhythmias, atrioventricular block, heart failure, endocarditis, valvulopathies, and Takayasu arteritis. The aim of this article is to review the available literature about the possible pathogenic mechanisms and determine preventive measures capable of reducing the incidence and severity of the cardiovascular manifestations. In IBD patients, the incidence of cardiovascular manifestations is low, but higher than that in the general population. Therefore, clinicians should pay attention to any new modification that might indicate cardiovascular involvement in IBD patients, and they should consider chronic inflammatory diseases in patients with cardiac conditions without an evident cause. Considering the role of inflammation in the development of cardiovascular manifestations, the management should include prevention of flares and maintenance of remission for as long as possible. Preventive measures should also include active screening and strict control of the cardiovascular risk factors in all IBD patients.
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Affiliation(s)
- Diana-Maria Bunu
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara 300310, Romania
| | | | - Manuela Ciocoiu
- Department of Pathophysiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Mariana Floria
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
- 3rd Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital Iasi, Iasi, Romania
| | - Claudia-Cristina Tarniceriu
- Department of Morpho-Functional Sciences I, Discipline of Anatomy, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Oana-Bogdana Barboi
- Institute of Gastroenterology and Hepatology-“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Iasi, Romania
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Daniela-Maria Tanase
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
- 3rd Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital Iasi, Iasi, Romania
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Mitchell NE, Harrison N, Junga Z, Singla M. Heart Under Attack: Cardiac Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:2322-2326. [PMID: 29788235 DOI: 10.1093/ibd/izy157] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Indexed: 12/12/2022]
Abstract
There is a well-established association between chronic inflammation and an elevated risk of heart disease among patients with systemic autoimmune conditions. This review aims to summarize existing literature on the relationship between inflammatory bowel disease and ischemic heart disease, heart failure, arrhythmia, and pericarditis, with particular attention to approaches to management and treatment.
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Affiliation(s)
- Natalie E Mitchell
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nicole Harrison
- Gastroenterology Service , Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Zachary Junga
- Gastroenterology Service , Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Manish Singla
- Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
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Namazi N, Ariaeenejad S, Azad ME, Pishgahi M. Risk of Atrial Fibrillation in Pemphigus Vulgaris. Indian Dermatol Online J 2018; 9:275-277. [PMID: 30050823 PMCID: PMC6042181 DOI: 10.4103/idoj.idoj_205_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nastaran Namazi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Ariaeenejad
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra E Azad
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Pishgahi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lazzerini PE, Capecchi PL, Laghi-Pasini F. Systemic inflammation and arrhythmic risk: lessons from rheumatoid arthritis. Eur Heart J 2018; 38:1717-1727. [PMID: 27252448 DOI: 10.1093/eurheartj/ehw208] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic immuno-mediated disease primarily affecting the joints, characterized by persistent high-grade systemic inflammation. Cardiovascular morbidity and mortality are significantly increased in RA, with >50% of premature deaths attributable to cardiovascular disease. In particular, RA patients were twice as likely to experience sudden cardiac death compared with non-RA subjects, pointing to an increased propensity to develop malignant ventricular arrhythmias. Indeed, ventricular repolarization (QT interval) abnormalities and cardiovascular autonomic nervous system dysfunction, representing two well-recognized risk factors for life-threatening ventricular arrhythmias in the general population, are commonly observed in RA. Moreover, large population-based studies seem to indicate that also the prevalence of atrial fibrillation is significantly higher in RA subjects than in the general population, thus suggesting that these patients are characterized by an abnormal diffuse myocardial electrical instability. Although the underlying mechanisms accounting for the pro-arrhythmogenic substrate in RA are probably intricate, the leading role seems to be played by chronic systemic inflammatory activation, able to promote arrhythmias both indirectly, by accelerating the development of ischaemic heart disease and congestive heart failure, and directly, by affecting cardiac electrophysiology. In this integrated mechanistic view, lowering the inflammatory burden through an increasingly tight control of disease activity may represent the most effective intervention to reduce arrhythmic risk in these patients. Intriguingly, these considerations could be more generally applicable to all the diseases characterized by chronic systemic inflammation, and could help elucidate the link between low-grade chronic inflammation and arrhythmic risk in the general population.
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Prolonged P-Wave and QT Dispersion in Children with Inflammatory Bowel Disease in Remission. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6960810. [PMID: 28316985 PMCID: PMC5339525 DOI: 10.1155/2017/6960810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/28/2016] [Accepted: 01/17/2017] [Indexed: 02/07/2023]
Abstract
Objectives. Ulcerative colitis (UC) and Crohn's disease (CD) are chronic inflammatory bowel diseases (IBD) with unclear underlying aetiologies. Severe cardiac arrhythmias have been emphasised in a few studies on adult IBD patients. This study aimed to investigate the alteration of the P-wave and QT interval dispersion parameters to assess the risk of atrial conduction and ventricular repolarisation abnormalities in pediatric IBD patients. Patients and Methods. Thirty-six IBD patients in remission (UC: 20, CD: 16) aged 3–18 years and 36 age- and sex-matched control patients were enrolled in the study. Twelve-lead electrocardiograms were used to determine durations of P-wave, QT, and corrected QT (QTc) interval dispersion. Transthoracic echocardiograms and 24-hour rhythm Holter recordings were obtained for both groups. Results. The P-wave dispersion, QT dispersion, and QTc interval dispersion (Pdisp, QTdisp, and QTcdisp) were significantly longer in the patient group. The mean values of Pminimum, Pmaximum, and QTcminimum were significantly different between the two groups. The echocardiography and Holter monitoring results were not significantly different between the groups. Furthermore, no differences in these parameters were detected between the CD and UC groups. Conclusion. Results suggest that paediatric IBD patients may carry potential risks for serious atrial and ventricular arrhythmias over time even during remission.
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Efe TH, Cimen T, Ertem AG, Coskun Y, Bilgin M, Sahan HF, Pamukcu HE, Yayla C, Sunman H, Yuksel I, Yeter E. Atrial Electromechanical Properties in Inflammatory Bowel Disease. Echocardiography 2016; 33:1309-16. [PMID: 27158773 DOI: 10.1111/echo.13261] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is much evidence linking inflammation to the initiation and continuation of atrial fibrillation (AF). Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic systemic inflammatory disorders. Atrial electromechanical delay (EMD) has been known as an early marker of AF. The objectives of this study were to evaluate the atrial electromechanical properties in patients with IBD. METHODS Fifty-two patients with IBD and 26 healthy controls were recruited in the study. Twenty-five of patients with IBD were on active period, and the remaining 27 were on remission period. Atrial electromechanical properties were measured by using transthoracic echocardiography and tissue Doppler imaging and simultaneous surface ECG recording. Interatrial EMD, left intraatrial EMD, and right intraatrial EMD were calculated. RESULTS Patients on activation with IBD had significantly prolonged left and right intraatrial EMDs and interatrial EMD compared to patients on remission (P = 0.048, P = 0.036, P < 0.001, respectively) and healthy controls (P < 0.001, for all comparisons). Left and right intraatrial EMDs and interatrial EMD were also found to be higher when patients on remission with IBD compared with healthy controls. No statistical difference was observed between UC and CD in terms of inter- and intraatrial EMDs. CONCLUSIONS Atrial electromechanical conduction is prolonged in IBD, and exposure to chronic inflammation may lead to structural and electrophysiological changes in the atrial tissue that causes slow conduction. Measurement of atrial EMD parameters might be used to predict the risk for the development of AF in patients with IBD.
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Affiliation(s)
- Tolga Han Efe
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey.
| | - Tolga Cimen
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Ahmet Goktug Ertem
- Department of Cardiology, Turkiye Yuksek Ihtisas Education and Training Hospital, Ankara, Turkey
| | - Yusuf Coskun
- Department of Gastroenterology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Murat Bilgin
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Haluk Furkan Sahan
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Hilal Erken Pamukcu
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Cagri Yayla
- Department of Cardiology, Turkiye Yuksek Ihtisas Education and Training Hospital, Ankara, Turkey
| | - Hamza Sunman
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Ilhami Yuksel
- Department of Gastroenterology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Ekrem Yeter
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
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Yayla C, Yayla KG, Acar B, Unal S, Ertem AG, Akboga MK. Atherosclerosis in Inflammatory Bowel Disease. Angiology 2016; 68:462. [PMID: 27448828 DOI: 10.1177/0003319716661068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cagri Yayla
- 1 Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Kadriye Gayretli Yayla
- 2 Diskapi Yildirim Beyazit Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Burak Acar
- 1 Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Sefa Unal
- 1 Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Ahmet Goktug Ertem
- 1 Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mehmet Kadri Akboga
- 1 Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
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Linz D, Hohl M, Vollmar J, Ukena C, Mahfoud F, Böhm M. Atrial fibrillation and gastroesophageal reflux disease: the cardiogastric interaction. Europace 2016; 19:16-20. [PMID: 27247004 DOI: 10.1093/europace/euw092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/14/2016] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and mortality. Multiple conditions like hypertension, heart failure, diabetes, sleep apnoea, and obesity play a role for the initiation and perpetuation of AF. Recently, a potential association between gastroesophageal reflux disease (GERD) and AF development has been proposed due to the close anatomic vicinity of the oesophagus and the left atrium. As an understanding of the association between acid reflux disease and AF may be important in the global multimodal treatment strategy to further improve outcomes in a subset of patients with AF, we discuss potential atrial arrhythmogenic mechanisms in patients with GERD, such as gastric and subsequent systemic inflammation, impaired autonomic stimulation, mechanical irritation due to anatomical proximity of the left atrium and the oesophagus, as well as common comorbidities like obesity and sleep-disordered breathing. Data on GERD and oesophageal lesions after AF-ablation procedures will be reviewed. Treatment of GERD to avoid AF or to reduce AF burden might represent a future treatment perspective but needs to be scrutinized in prospective trials.
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Affiliation(s)
- Dominik Linz
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, Homburg, Saar D-66421, Germany
| | - Mathias Hohl
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, Homburg, Saar D-66421, Germany
| | - Johanna Vollmar
- Gastroenterologie, Hepatologie, Nephrologie, Rheumatologie, Infektiologie, Endokrinologie und Stoffwechselerkrankungen, Universitätsklinikum Mainz, Mainz, Germany
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, Homburg, Saar D-66421, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, Homburg, Saar D-66421, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, Homburg, Saar D-66421, Germany
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Nar G, Ergul B, Aksan G, Inci S. Assessment of Atrial Electromechanical Delay and Left Atrial Mechanical Functions in Patients with Ulcerative Colitis. Echocardiography 2016; 33:970-6. [PMID: 27009549 DOI: 10.1111/echo.13213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Ulcerative colitis (UC) is a common inflammatory bowel disease causing systemic inflammation, which may also affect the cardiovascular system, as well as other organ systems. The aim of the current study was to evaluate left atrial (LA) mechanical functions and duration of atrial electromechanical delay (AEMD) with echocardiography in patients with UC. METHOD A total of 91 patients, 45 with UC (Group 1) and 46 healthy individuals as control (Group 2) were included in the study. The demographic and laboratory data were recorded, and echocardiographic measurements were taken for all patients. RESULTS In the evaluation of basal clinical and laboratory findings, no difference was detected between the two groups, except for white blood cell count (WBC) (8.26 ± 2.71 vs. 7.06 ± 1.70, P = 0.013) and high-sensitivity C-reactive protein (Hs-CRP; 3.4 ± 1.7 vs. 1.0 ± 0.8, P < 0.001). The echocardiographic assessment revealed that the diastolic parameters such as E-, E/A-, and E- waves decreased in the UC group when compared to the control group. LA mechanical functions were different between groups, except for left atrial (LA) maximal volume: LA minimum volume (22.2 ± 12.9 vs. 15.3 ± 4.7, P = 0.001), LA volume before atrial systole (29.9 ± 14.2 vs. 24.2 ± 4.9, P = 0.021), LA ejection fraction (27.4 ± 16.5 vs. 38.6 ± 10.1, P < 0.001), LA total emptying volume (17.9 ± 6.9 vs. 21.9 ± 5.9, P = 0.004), LA active emptying fraction (27.4 ± 16.5 vs. 38.6 ± 10.1, P < 0.001), LA active emptying volume (7.7 ± 3.6 vs. 9.4 ± 2.9, P = 0.013), LA passive emptying fraction (26.8 ± 10.2 vs. 33.2 ± 9.2, P = 0.002), and LA passive emptying volume (10.3 ± 4.9 vs. 12.5 ± 4.5, P = 0.029). There was a significant difference between the groups in terms of AEMD durations, except time interval from the onset of the P-wave on the surface ECG to the peak of the late diastolic wave (PA) of the tricuspid valve. The correlation analysis revealed that age and duration of disease were correlated with AEMD. CONCLUSION The current study reported that LA volume and mechanical functions degenerated and AEMD increased in patients with UC when compared to the control group. These findings demonstrate that UC may have effects on LA electromechanical functions related to duration of disease.
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Affiliation(s)
- Gokay Nar
- Department of Cardiology, Faculty of Medicine, Ahi Evran University, Kirsehir, Turkey
| | - Bilal Ergul
- Department of Gastroenterology, Ahi Evran University Education and Research Hospital, Kirsehir, Turkey
| | - Gokhan Aksan
- Department of Cardiology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Sinan Inci
- Department of Cardiology, Aksaray State hospital, Aksaray, Turkey
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Koksal AR, Boga S, Alkim H, Ergun M, Bayram M, Sakiz D, Ozdogan O, Altinkaya E, Alkim C. How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy? Libyan J Med 2014; 9:23441. [PMID: 24560378 PMCID: PMC3930941 DOI: 10.3402/ljm.v9.23441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/10/2014] [Accepted: 01/11/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Terminal ileum endoscopy and biopsy are the diagnostic tools of diseases attacking the ileum. However, abnormal histological findings can be found in endoscopically normal terminal ileum. OBJECTIVE This study was performed to evaluate the histopathological results of biopsies from endoscopically normal terminal ileum in order to determine pre-procedure clinical and laboratory factors predicting abnormal histopathological results, if any. METHODS A total of 297 patients who underwent colonoscopy and terminal ileum biopsy and had normal terminal ileum or a few aphthous ulcers in the terminal ileum together with completely normal colon mucosa were included in the study. The patients were grouped into two arms as normal cases and cases with aphthous ulcers. Histopathological and pre-procedural laboratory results of patients were analyzed according to their indications. RESULTS The terminal ileum was endoscopically normal in 200 patients, and 97 patients had aphthous ulcers. Chronic ileitis rate was present in 5.5% of those with endoscopically normal terminal ileum and in 39.2% of the patients with aphthous ulcers. In both groups, the highest rate of chronic ileitis was detected in the patients with known inflammatory bowel disease (IBD) (15.4 and 50%, respectively), anemia (9.5 and 43.5%, respectively), and in the patients having chronic diarrhea together with abdominal pain (7.7 and 44.8%, respectively). We found that the sensitivity of mean platelet volume for predicting chronic ileitis was 87% and the specificity was 45% at a cut-off value lower than 9.35 fl. CONCLUSION In anemia indication or chronic diarrhea together with abdominal pain, the frequency of aphthous ulcers detected by ileoscopy and the frequency of chronic ileitis detected histopathologically despite a normal-appearing ileum were elevated.
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Affiliation(s)
- Ali Riza Koksal
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey;
| | - Salih Boga
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Huseyin Alkim
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Meltem Ergun
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Bayram
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Damlanur Sakiz
- Department of Pathology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Osman Ozdogan
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Engin Altinkaya
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Canan Alkim
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
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Kristensen SL, Lindhardsen J, Ahlehoff O, Erichsen R, Lamberts M, Khalid U, Torp-Pedersen C, Nielsen OH, Gislason GH, Hansen PR. Increased risk of atrial fibrillation and stroke during active stages of inflammatory bowel disease: a nationwide study. Europace 2013; 16:477-84. [PMID: 24108228 DOI: 10.1093/europace/eut312] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS Inflammation is considered to play a role in the development of atrial fibrillation (AF). Hence inflammatory bowel disease (IBD) may be associated with AF. We therefore examined the incidence of AF and stroke in patients with IBD. METHODS AND RESULTS From Danish nationwide registries 1996-2011, we identified 24 499 patients with new-onset IBD and 236 275 age- and sex-matched controls. Poisson regression analyses with continuously updated covariates were used to estimate incidence rate ratios (IRRs) of AF and stroke. Disease activity stages of flare (new disease activity), persistent activity, and remission were defined by corticosteroid prescriptions, IBD hospital admissions, and biological treatment. Inflammatory bowel disease patients had a mean age of 43.9 years, 53.9% were women, and mean follow-up was 6.8 years. Among IBD patients, 685 had AF and 549 had a stroke, corresponding to incidence rates per 1000 person-years of 4.16 vs. 2.70 for AF and 3.33 vs. 2.44 for stroke, compared with matched controls. Overall IBD-associated risk of AF corresponded to IRR 1.26 (1.16-1.36), but was driven by increased AF incidence during IBD flares [IRR 2.63 (2.26-3.06)] and persistent activity [IRR 2.06 (1.67-2.55)], whereas no increased AF risk was observed in remission periods [IRR 0.97 (0.88-1.08)]. Likewise increased stroke risk was exclusively found during active IBD [IRRs: 1.57 (1.27-1.93), 1.71 (1.32-2.21), and 1.04 (0.93-1.15) for flares, persistent activity, and remission, respectively]. CONCLUSION Active IBD is associated with increased risk of AF and stroke. These findings may be relevant to clinical practice.
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Affiliation(s)
- Søren Lund Kristensen
- Department of Cardiology-Post 635, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark
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