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Walker M, Patel P, Kwon O, Koene RJ, Duprez DA, Kwon Y. Atrial Fibrillation and Hypertension: "Quo Vadis". Curr Hypertens Rev 2022; 18:39-53. [PMID: 35023459 DOI: 10.2174/1573402118666220112122403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/29/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022]
Abstract
Hypertension is one of the most well-established risk factors for atrial fibrillation. Long-standing untreated hypertension leads to structural remodeling and electrophysiologic alterations causing an atrial myopathy that forms a vulnerable substrate for the development and maintenance of atrial fibrillation. Hypertension-induced hemodynamic, inflammatory, hormonal, and autonomic changes all appear to be important contributing factors. Furthermore, hypertension is also associated with several atrial fibrillation-related comorbidities. As such, hypertension may represent an important target for therapy in atrial fibrillation. Clinicians should be aware of pitfalls of the blood pressure measurement in atrial fibrillation. While the auscultatory method is preferred, the use of automated devices appears to be an acceptable method in the ambulatory setting. There are pathophysiologic bases and emerging clinical evidence suggesting the benefit of renin-angiotensin system inhibition in risk reduction of atrial fibrillation development particularly in patients with left ventricular hypertrophy or left ventricular dysfunction. A better understanding of hypertension's pathophysiologic link to atrial fibrillation may lead to the development of novel therapies for the primary prevention of atrial fibrillation. Finally, future studies are needed to address optimal blood pressure goal to minimize the risk of atrial fibrillation-related complications.
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Affiliation(s)
- McCall Walker
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, USA
| | - Paras Patel
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, USA
| | - Osung Kwon
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Uslan College of Medicine, Seoul, Korea
| | - Ryan J Koene
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Daniel A Duprez
- Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Younghoon Kwon
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, USA
- Department of Medicine, University of Minnesota, Minneapolis, USA
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Norby FL, Alonso A, Rooney MR, Maheshwari A, Koene RJ, Zhang M, Soliman EZ, Loehr LR, Mosley T, Gottesman RF, Coresh J, Chen LY. Association of Ventricular Arrhythmias With Dementia: The Atherosclerosis Risk in Communities (ARIC) Study. Neurology 2020; 96:e926-e936. [PMID: 33106393 DOI: 10.1212/wnl.0000000000011122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE We performed a cross-sectional analysis to determine whether nonsustained ventricular tachycardia (NSVT) and premature ventricular contractions (PVCs) were associated with dementia in a population-based study. METHODS We included 2,517 (mean age 79 years, 26% Black) participants who wore a 2-week ambulatory continuous ECG recording device in 2016 to 2017. NSVT was defined as a wide-complex tachycardia ≥4 beats with a rate >100 bpm. We calculated NSVT and PVC burden as the number of episodes per day. Dementia was adjudicated by experts. We used logistic regression to assess the associations of NSVT and PVCs with dementia. RESULTS The mean recording time of the Zio XT Patch was 12.6 ± 2.6 days. There were 768 (31%) participants with NSVT; prevalence was similar in White and Black participants. There were 134 (6.5%) dementia cases (5% in White, 10% in Black participants). After multivariable adjustment, there was no overall association between NSVT and dementia; however, there was a significant race interaction (p < 0.001). In Black participants, NSVT was associated with a 3.67 times higher adjusted odds of dementia (95% confidence interval [CI] 1.92-7.02) compared to those without NSVT, whereas in White participants NSVT was not associated with dementia (odds ratio [95% CI] 0.64 [0.37-1.10]). In Black participants only, a higher burden of PVCs was associated with dementia. CONCLUSIONS Presence of NSVT and a higher burden of NSVT and PVCs are associated with dementia in elderly Black people. Further research to confirm this novel finding and to elucidate the underlying mechanisms is warranted.
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Affiliation(s)
- Faye L Norby
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Alvaro Alonso
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Mary R Rooney
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Ankit Maheshwari
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Ryan J Koene
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Michael Zhang
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Elsayed Z Soliman
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Laura R Loehr
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Thomas Mosley
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Rebecca F Gottesman
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Josef Coresh
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Lin Y Chen
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
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Koene RJ, Menon V, Cantillon DJ, Dresing TJ, Martin DO, Kanj M, Saliba WI, Tarakji KG, Baranowski B, Hussein AA, Tchou PJ, Bhargava M, Callahan TD, Rickard JW, Niebauer MJ, Chung MK, Varma N, Wilkoff BL, Lindsay BD, Wazni OM. Clinical Outcomes and Characteristics With Dofetilide in Atrial Fibrillation Patients Considered for Implantable Cardioverter-Defibrillator. Circ Arrhythm Electrophysiol 2020; 13:e008168. [PMID: 32538135 DOI: 10.1161/circep.119.008168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dofetilide is one of the only anti-arrhythmic agents approved for atrial fibrillation (AF) in patients with reduced left ventricular ejection fraction (LVEF). However, postapproval data and safety outcomes are limited. In this study, we assessed the incidence and predictors of LVEF improvement, safety, and outcomes in patients with AF with LVEF ≤35% without prior implantable cardioverter defibrillator, cardiac resynchronization therapy, or AF ablation. METHODS An analysis of 168 consecutive patients from 2007 to 2016 was performed. Incidences of adverse events, drug continuation, implantable cardioverter defibrillator and cardiac resynchronization therapy implantation, LVEF improvement (>35%) and recovery (≥50%), AF recurrence, and AF ablation were determined. Multivariable regression analysis to identify predictors of LVEF improvement/recovery was performed. RESULTS The mean age was 64±12 years. Dofetilide was discontinued before hospital discharge in 46 (27%) because of QT prolongation (14%), torsades de pointe or polymorphic ventricular tachycardia/fibrillation (6% [sustained 3%, nonsustained 3%]), ineffectiveness (5%), or other causes (3%). At 1 year, 43% remained on dofetilide. Freedom from AF was 42% at 1 year, and 40% underwent future AF ablation. LVEF recovered (≥50%) in 45% and improved to >35% in 73%. Predictors of LVEF improvement included presence of AF during echocardiogram (odds ratio, 4.22 [95% CI, 1.71-10.4], P=0.002), coronary artery disease (odds ratio, 0.35 [95% CI, 0.16-0.79], P=0.01), left atrial diameter (odds ratio, 0.52 per 1 cm increase [95% CI, 0.30-0.90], P=0.01), and LVEF (odds ratio, per 1% increase, 1.09 [95% CI, 1.02-1.16], P=0.006). The C statistic was 0.78. CONCLUSIONS In patients with LVEF ≤35%, who are potential implantable cardioverter defibrillator candidates, treated with dofetilide as an initial anti-arrhythmic strategy for AF, drug discontinuation rates were high, and many underwent future AF ablation. However, most patients had improvement in LVEF, obviating the need for primary prevention implantable cardioverter defibrillator.
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Affiliation(s)
- Ryan J Koene
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Vivek Menon
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Daniel J Cantillon
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Thomas J Dresing
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - David O Martin
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Patrick J Tchou
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Mandeep Bhargava
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Thomas D Callahan
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - John W Rickard
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Mark J Niebauer
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Mina K Chung
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Niraj Varma
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Bruce D Lindsay
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
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Koene RJ, Buch E, Seo YJ, Li JM, Mbai M, Chandrashekhar Y, Shivkumar K, Tholakanahalli VN. Increased baseline ECG R-R dispersion predicts improvement in systolic function after atrial fibrillation ablation. Open Heart 2019; 6:e000958. [PMID: 31328002 PMCID: PMC6609144 DOI: 10.1136/openhrt-2018-000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/14/2019] [Accepted: 05/30/2019] [Indexed: 11/12/2022] Open
Abstract
Background Atrial fibrillation (AF) is associated with left ventricular (LV) systolic dysfunction which may improve after AF ablation. We hypothesised that increased ventricular irregularity, as measured by R-R dispersion on the baseline ECG, would predict improvement in the left ventricular ejection fraction (LVEF) after AF ablation. Methods Patients with LVEF <50% at two US centres (2007–2016), having both a preablation and postablation echocardiogram or cardiac MRI, were included. LVEF improvement was defined as absolute increase in LVEF by >7.5%. Multivariable logistic regression (restricted to echocardiographic/ECG variables) was performed to evaluate predictors of LVEF improvement. Results Fifty-two patients were included in this study. LVEF improved in 30 patients (58%) and was unchanged/worsened in 22 patients (42%). Those with versus without LVEF improvement had an increased baseline R-R dispersion (645±155 ms vs 537±154 ms, p=0.02, respectively). The average baseline heart rate in all patients was 93 beats per minute. After multivariable logistic regression, increased R-R dispersion (OR 1.59, 95% CI 1.00 to 2.55, p=0.03) predicted LVEF improvement. Conclusions Increased R-R dispersion on ECG was independently associated with improved systolic function after AF ablation. This broadens the existing knowledge of arrhythmia-induced cardiomyopathy, demonstrating that irregular electrical activation (as measured by increased R-R dispersion on ECG) is associated with a cardiomyopathy capable of improving after AF ablation.
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Affiliation(s)
- Ryan J Koene
- Department of Cardiovascular Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Eric Buch
- UCLA Medical Center, UCLA Health System, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Young-Ji Seo
- Cardiovascular Division, University of California, Los Angeles, Los Angeles, California, USA
| | - Jian-Ming Li
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Mackenzi Mbai
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Y Chandrashekhar
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Kalyanam Shivkumar
- UCLA Medical Center, UCLA Health System, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Walker M, Patel P, Kwon O, Koene RJ, Duprez DA, Kwon Y. Withdrawal Notice: Atrial Fibrillation and Hypertension: “Quo Vadis”. Curr Hypertens Rev 2019; 15:CHYR-EPUB-98332. [PMID: 31057122 DOI: 10.2174/1573402115666190502142824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022]
Abstract
The article has been withdrawn at the request of the editor of the journal Current Hypertension Reviews: Bentham Science apologizes to the readers of the journal for any inconvenience this may have caused. The Bentham Editorial Policy on Article Withdrawal can be found at https://benthamscience.com/editorial-policies-main.php . BENTHAM SCIENCE DISCLAIMER It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submitting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript, the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.
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Affiliation(s)
- McCall Walker
- Department of Medicine, University of Virginia, Charlottesville, VA. United States
| | - Paras Patel
- Department of Medicine, University of Virginia, Charlottesville, VA. United States
| | - Osung Kwon
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Uslan, Seoul. Korea
| | - Ryan J Koene
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio OH. United States
| | - Daniel A Duprez
- Department of Medicine, University of Minnesota, Minneapolis MN. United States
| | - Younghoon Kwon
- Department of Medicine, University of Virginia, Charlottesville, VA. United States
- Department of Medicine, University of Minnesota, Minneapolis MN. United States
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Koene RJ, Alraies MC, Norby FL, Soliman EZ, Maheshwari A, Lip GY, Alonso A, Chen LY. Relation of the CHA 2DS 2-VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without Atrial Fibrillation (From The Atherosclerosis Risk in Communities [ARIC] Study). Am J Cardiol 2019; 123:402-408. [PMID: 30527796 DOI: 10.1016/j.amjcard.2018.10.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/27/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
Recent hospital-based cohort studies found the CHA2DS2-VASc score to be associated with ischemic stroke in individuals without atrial fibrillation (AF). Our aim was to determine the distribution of embolic and thrombotic strokes and association with the CHA2DS2-VASc score, among community-dwelling individuals without AF. We included participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 4 (1996 to 1998) and had no previous AF, stroke, or anticoagulant use (n = 10,671). During follow-up through 2008, incident AF cases (n = 760) and participants who started warfarin were censored. Incident AF was ascertained from study electrocardiograms and hospital discharge diagnosis codes, and stroke was physician-adjudicated. After 10 years of follow-up, 280 ischemic strokes were identified, of which 146 were thrombotic and 57 embolic. The hazard ratios (95% confidence intervals [CI]) for thrombotic stroke were 1 (reference), 1.71 (1.13 to 2.59), 2.92 (1.91 to 4.45), 3.22 (1.70 to 6.11), and 1.25 (0.17 to 9.09), with CHA2DS2-VASc scores of 0 to 1, 2, 3, 4, and ≥5, respectively. The hazard ratios (95% CI) for embolic stroke were 1 (ref), 4.91 (2.10 to 11.5), 7.07 (2.93 to 17.0), 14.8 (5.50 to 39.6), and 15.2 (3.16 to 73.3), with CHA2DS2-VASc scores of 0 to 1, 2, 3, 4, and ≥5, respectively. A receiver-operating characteristic model had a C-statistic of 0.65 for ischemic stroke, 0.61 for thrombotic stroke, and 0.71 for embolic stroke. In conclusion, in community-dwelling individuals without AF, the CHA2DS2-VASc score can assess ischemic stroke risk and has good discriminatory capacity for embolic stroke.
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Maheshwari A, Norby FL, Roetker NS, Soliman EZ, Koene RJ, Rooney MR, O’Neal WT, Shah AM, Claggett BL, Solomon SD, Alonso A, Gottesman RF, Heckbert SR, Chen LY. Refining Prediction of Atrial Fibrillation-Related Stroke Using the P 2-CHA 2DS 2-VASc Score. Circulation 2019; 139:180-191. [PMID: 30586710 PMCID: PMC6481672 DOI: 10.1161/circulationaha.118.035411] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND In people with atrial fibrillation (AF), periods of sinus rhythm present an opportunity to detect prothrombotic atrial remodeling through measurement of P-wave indices (PWIs)-prolonged P-wave duration, abnormal P-wave axis, advanced interatrial block, and abnormal P-wave terminal force in lead V1. We hypothesized that the addition of PWIs to the CHA2DS2-VASc score would improve its ability to predict AF-related ischemic stroke. METHODS We included 2229 participants from the ARIC study (Atherosclerosis Risk in Communities) and 700 participants from MESA (Multi-Ethnic Study of Atherosclerosis) with incident AF who were not on anticoagulants within 1 year of AF diagnosis. PWIs were obtained from study visit ECGs before development of AF. AF was ascertained using study visit ECGs and hospital records. Ischemic stroke cases were based on physician adjudication of hospital records. We used Cox proportional hazards models to estimate hazard ratios and 95% CIs of PWIs for ischemic stroke. Improvement in 1-year stroke prediction was assessed by C-statistic, categorical net reclassification improvement, and relative integrated discrimination improvement. RESULTS Abnormal P-wave axis was the only PWI associated with increased ischemic stroke risk (hazard ratio, 1.84; 95% CI, 1.33-2.55) independent of CHA2DS2-VASc variables, and that resulted in meaningful improvement in stroke prediction. The β estimate was approximately twice that of the CHA2DS2-VASc variables, and thus abnormal P-wave axis was assigned 2 points to create the P2-CHA2DS2-VASc score. This improved the C-statistic (95% CI) from 0.60 (0.51-0.69) to 0.67 (0.60-0.75) in ARIC and 0.68 (0.52-0.84) to 0.75 (0.60-0.91) in MESA (validation cohort). In ARIC and MESA, the categorical net reclassification improvements (95% CI) were 0.25 (0.13-0.39) and 0.51 (0.18-0.86), respectively, and the relative integrated discrimination improvement (95% CI) were 1.19 (0.96-1.44) and 0.82 (0.36-1.39), respectively. CONCLUSIONS Abnormal P-wave axis-an ECG correlate of left atrial abnormality- improves ischemic stroke prediction in AF. Compared with CHA2DS2-VASc, the P2-CHA2DS2-VASc is a better prediction tool for AF-related ischemic stroke.
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Kwon Y, Gadi S, Shah NR, Stout C, Blackwell JN, Cho Y, Koene RJ, Mehta N, Mazimba S, Darby AE, Ferguson JD, Bilchick KC. Atrial Fibrillation and Objective Sleep Quality by Slow Wave Sleep. J Atr Fibrillation 2018; 11:2031. [PMID: 30505377 PMCID: PMC6244306 DOI: 10.4022/jafib.2031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/16/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Self-reported poor sleep quality has been suggested in patients with AF. Slow wave sleep (SWS) is considered the most restorative sleep stage and represents an important objective measure of sleep quality. The aim of this study was to compare quantity of SWS between patients with and without AF. METHODS AND RESULTS We included patients with and without a documented history of AF by reviewing clinically indicated polysomnography data from a single sleep center. Patients on medications with potential influence on sleep architecture were excluded. Logistic regression was performed to determine the association between AF and SWS time (low vs. high) adjusting for age, gender, body mass index, and sleep apnea. In a 2:1 case-control set-up, a total of 205 subjects (139 with AF, 66 without AF) were included. Mean age was 62 (SD: 14.3) years and 59% were men. Patients with AF had lower SWS time (11.1 vs. 16.6 min, p=0.02). In multivariable analysis, prevalent AF was associated with low SWS independent of sleep apnea and other potential confounders (OR 2.5 [1.3, 5.0], p=0.006). Limiting the analysis to patients whose total sleep time was greater than 4 hours (by excluding N=31) resulted in more robust results (OR 3.9 [1.7, 9.7]. p=0.002). CONCLUSION AF is associated with more impaired sleep quality as indicated by lower quantity of SWS. More studies are needed to explore the mechanistic interactions between AF and sleep.
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Affiliation(s)
- Younghoon Kwon
- Cardiovascular Division, Department of Medicine, University of Virginia
| | - Sneha Gadi
- Cardiovascular Division, Department of Medicine, University of Virginia
| | - Neil R Shah
- Cardiovascular Division, Department of Medicine, University of Virginia
| | - Christopher Stout
- Cardiovascular Division, Department of Medicine, University of Virginia
| | - Jacob N Blackwell
- Cardiovascular Division, Department of Medicine, University of Virginia
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic Foundation
| | - Yeilim Cho
- Cardiovascular Division, Department of Medicine, University of Virginia
| | - Ryan J Koene
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic Foundation
| | - Nishaki Mehta
- Cardiovascular Division, Department of Medicine, University of Virginia
| | - Sula Mazimba
- Cardiovascular Division, Department of Medicine, University of Virginia
| | - Andrew E Darby
- Cardiovascular Division, Department of Medicine, University of Virginia
| | - John D Ferguson
- Cardiovascular Division, Department of Medicine, University of Virginia
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Koene RJ, Adkisson WO, Benditt DG. Syncope and the risk of sudden cardiac death: Evaluation, management, and prevention. J Arrhythm 2017; 33:533-544. [PMID: 29255498 PMCID: PMC5728985 DOI: 10.1016/j.joa.2017.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/04/2017] [Accepted: 07/04/2017] [Indexed: 12/17/2022] Open
Abstract
Syncope is a clinical syndrome defined as a relatively brief self-limited transient loss of consciousness (TLOC) caused by a period of inadequate cerebral nutrient flow. Most often the trigger is an abrupt drop of systemic blood pressure. True syncope must be distinguished from other common non-syncope conditions in which real or apparent TLOC may occur such as seizures, concussions, or accidental falls. The causes of syncope are diverse, but in most instances, are relatively benign (e.g., reflex and orthostatic faints) with the main risks being accidents and/or injury. However, in some instances, syncope may be due to more worrisome conditions (particularly those associated with cardiac structural disease or channelopathies); in such circumstances, syncope may be an indicator of increased morbidity and mortality risk, including sudden cardiac death (SCD). Establishing an accurate basis for the etiology of syncope is crucial in order to initiate effective therapy. In this review, we focus primarily on the causes of syncope that are associated with increased SCD risk (i.e., sudden arrhythmic cardiac death), and the management of these patients. In addition, we discuss the limitations of our understanding of SCD in relation to syncope, and propose future studies that may ultimately address how to improve outcomes of syncope patients and reduce SCD risk.
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Affiliation(s)
| | | | - David G. Benditt
- From the Cardiac Arrhythmia Center, Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Koene RJ, Norby FL, Maheshwari A, Rooney MR, Soliman EZ, Alonso A, Chen LY. Predictors of sudden cardiac death in atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) study. PLoS One 2017; 12:e0187659. [PMID: 29117224 PMCID: PMC5678684 DOI: 10.1371/journal.pone.0187659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/24/2017] [Indexed: 11/18/2022] Open
Abstract
We previously reported that incident atrial fibrillation (AF) is associated with an increased risk of sudden cardiac death (SCD) in the general population. We now aimed to identify predictors of SCD in persons with AF from the Atherosclerosis Risk in Communities (ARIC) study, a community-based cohort study. We included all participants who attended visit 1 (1987–89) and had no prior AF (n = 14,836). Incident AF was identified from study electrocardiograms and hospitalization discharge codes through 2012. SCD was physician-adjudicated. We used cause-specific Cox proportional hazards models, followed by stepwise selection (backwards elimination, removing all variables with p>0.10) to identify predictors of SCD in participants with AF. AF occurred in 2321 (15.6%) participants (age 45–64 years, 58% male, 18% black). Over a median of 3.3 years, SCD occurred in 110 of those with AF (4.7%). Predictors of SCD in AF included higher age, body mass index (BMI), coronary heart disease, hypertension, diabetes, current smoker, left ventricular hypertrophy, increased heart rate, and decreased albumin. Predictors associated only with SCD and not other cardiovascular (CV) death included increased BMI (HR per 5-unit increase, 1.15, 95% CI, 0.97–1.36, p = 0.10), increased heart rate (HR per SD increase, 1.18, 95% CI 0.99–1.41, p = 0.07), and low albumin (HR per SD decrease 1.23, 95% CI 1.02–1.48, p = 0.03). In the ARIC study, predictors of SCD in AF that are not associated with non-sudden CV death included increased BMI, increased heart rate, and low albumin. Further research to confirm these findings in larger community-based cohorts and to elucidate the underlying mechanisms to facilitate prevention is warranted.
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Affiliation(s)
- Ryan J. Koene
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Faye L. Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Ankit Maheshwari
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Mary R. Rooney
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Lin Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
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Kwon Y, Koene RJ, Johnson AR, Lin GM, Ferguson JD. Sleep, sleep apnea and atrial fibrillation: Questions and answers. Sleep Med Rev 2017; 39:134-142. [PMID: 29029984 DOI: 10.1016/j.smrv.2017.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 08/20/2017] [Accepted: 08/30/2017] [Indexed: 11/16/2022]
Abstract
Sleep apnea (SA) is a common sleep disorder increasingly recognized as a risk for cardiovascular disease. Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with significant morbidity and mortality. An increasing number of investigations in recent years have linked SA to AF. In this review, we aim to provide a critical overview of the existing evidence in a question and answer format by addressing the following: What is the prevalent association between the two conditions (separating nocturnally detected AF episodes from AF as a prevalent condition)? Is SA a risk factor for incident AF? Is SA a risk factor for recurrence of AF following cardioversion/catheter-based ablation? What is the association between SA and AF in patients with heart failure? Are there signature electrocardiographic markers of AF found in patients with SA? Are there electrophysiology-based studies supporting the link between SA and AF? What other sleep characteristics (beyond SA) are found in patients with AF? What is the impact of SA treatment on AF? What is the effect of AF treatment on sleep? Finally, we address unsolved questions and suggest future directions to enhance our understanding of the AF-SA relationship.
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Affiliation(s)
- Younghoon Kwon
- Division of Cardiovascular Medicine, Department of Medicine and Department of Sleep Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Ryan J Koene
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alan R Johnson
- Division of Cardiovascular Medicine, Department of Medicine and Department of Sleep Medicine, University of Virginia, Charlottesville, VA, USA
| | - Gen-Min Lin
- Department of Medicine, Hualien-Armed Forces General Hospital, Hualien 970, Taiwan; Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; College of Science and Engineering, National Dong Hwa University, Hualien 974, Taiwan
| | - John D Ferguson
- Division of Cardiovascular Medicine, Department of Medicine and Department of Sleep Medicine, University of Virginia, Charlottesville, VA, USA
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Abstract
There is a growing body of evidence that suggests cancer and cardiovascular disease have a shared biological mechanism. Although there are several shared risk factors for both diseases, including advancing age, gender, obesity, diabetes, physical activity, tobacco use, and diet, inflammation and biomarkers, such as insulinlike growth factor 1, leptin, estrogen, and adiponectin, may also play a role in the biology of these diseases. This article provides an overview of the shared biological mechanism between cancer and cardiovascular disease.
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Affiliation(s)
- Anne Blaes
- Division of Hematology and Oncology, University of Minnesota, 420 Delaware Street, Southeast, MMC 480, Minneapolis, MN 55455, USA.
| | - Anna Prizment
- School of Public Health, University of Minnesota, 1300 South 2nd Street, 7525A, Minneapolis, MN 55454, USA
| | - Ryan J Koene
- Division of Cardiology, University of Minnesota, 420 Delaware Street, Southeast, MMC 480, Minneapolis, MN 55455, USA
| | - Suma Konety
- Division of Cardiology, University of Minnesota, 420 Delaware Street, Southeast, MMC 508, Minneapolis, MN 55455, USA
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13
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Maheshwari A, Norby FL, Soliman EZ, Koene RJ, Rooney MR, O'Neal WT, Alonso A, Chen LY. Abnormal P-Wave Axis and Ischemic Stroke: The ARIC Study (Atherosclerosis Risk In Communities). Stroke 2017; 48:2060-2065. [PMID: 28626057 PMCID: PMC5534350 DOI: 10.1161/strokeaha.117.017226] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/12/2017] [Accepted: 05/22/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Abnormal P-wave axis (aPWA) has been linked to incident atrial fibrillation and mortality; however, the relationship between aPWA and stroke has not been reported. We hypothesized that aPWA is associated with ischemic stroke independent of atrial fibrillation and other stroke risk factors and tested our hypothesis in the ARIC study (Atherosclerosis Risk In Communities), a community-based prospective cohort study. METHODS We included 15 102 participants (aged 54.2±5.7 years; 55.2% women; 26.5% blacks) who attended the baseline examination (1987-1989) and without prevalent stroke. We defined aPWA as any value outside 0 to 75° using 12-lead ECGs obtained during study visits. Each case of incident ischemic stroke was classified in accordance with criteria from the National Survey of Stroke by a computer algorithm and adjudicated by physician review. Multivariable Cox regression was used to estimate hazard ratios and 95% confidence intervals for the association of aPWA with stroke. RESULTS During a mean follow-up of 20.2 years, there were 657 incident ischemic stroke cases. aPWA was independently associated with a 1.50-fold (95% confidence interval, 1.22-1.85) increased risk of ischemic stroke in the multivariable model that included atrial fibrillation. When subtyped, aPWA was associated with a 2.04-fold (95% confidence interval, 1.42-2.95) increased risk of cardioembolic stroke and a 1.32-fold (95% confidence interval, 1.03-1.71) increased risk of thrombotic stroke. CONCLUSIONS aPWA is independently associated with ischemic stroke. This association seems to be stronger for cardioembolic strokes. Collectively, our findings suggest that alterations in atrial electric activation may predispose to cardiac thromboembolism independent of atrial fibrillation.
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Affiliation(s)
- Ankit Maheshwari
- Cardiovascular Division, Department of Medicine (A.M., R.K., L.Y.C.) and Division of Epidemiology and Community Health, School of Public Health (F.L.N., M.R.R.), University of Minnesota, Minneapolis; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (W.T.O.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.).
| | - Faye L Norby
- Cardiovascular Division, Department of Medicine (A.M., R.K., L.Y.C.) and Division of Epidemiology and Community Health, School of Public Health (F.L.N., M.R.R.), University of Minnesota, Minneapolis; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (W.T.O.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Elsayed Z Soliman
- Cardiovascular Division, Department of Medicine (A.M., R.K., L.Y.C.) and Division of Epidemiology and Community Health, School of Public Health (F.L.N., M.R.R.), University of Minnesota, Minneapolis; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (W.T.O.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Ryan J Koene
- Cardiovascular Division, Department of Medicine (A.M., R.K., L.Y.C.) and Division of Epidemiology and Community Health, School of Public Health (F.L.N., M.R.R.), University of Minnesota, Minneapolis; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (W.T.O.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Mary R Rooney
- Cardiovascular Division, Department of Medicine (A.M., R.K., L.Y.C.) and Division of Epidemiology and Community Health, School of Public Health (F.L.N., M.R.R.), University of Minnesota, Minneapolis; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (W.T.O.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Wesley T O'Neal
- Cardiovascular Division, Department of Medicine (A.M., R.K., L.Y.C.) and Division of Epidemiology and Community Health, School of Public Health (F.L.N., M.R.R.), University of Minnesota, Minneapolis; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (W.T.O.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Alvaro Alonso
- Cardiovascular Division, Department of Medicine (A.M., R.K., L.Y.C.) and Division of Epidemiology and Community Health, School of Public Health (F.L.N., M.R.R.), University of Minnesota, Minneapolis; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (W.T.O.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine (A.M., R.K., L.Y.C.) and Division of Epidemiology and Community Health, School of Public Health (F.L.N., M.R.R.), University of Minnesota, Minneapolis; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (W.T.O.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
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Kwon Y, Koene RJ, Kwon O, Kealhofer JV, Adabag S, Duval S. Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Heart Failure: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol 2017; 10:e004609. [PMID: 28213507 DOI: 10.1161/circep.116.004609] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 01/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with heart failure and reduced ejection fraction are at increased risk of malignant ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) is recommended to prevent sudden cardiac death in some of these patients. Sleep-disordered breathing (SDB) is highly prevalent in this population and may impact arrhythmogenicity. We performed a systematic review and meta-analysis of prospective studies that assessed the impact of SDB on ICD therapy. METHODS AND RESULTS Relevant prospective studies were identified in the Ovid MEDLINE, EMBASE, and Google Scholar databases. Weighted risk ratios of the association between SDB and appropriate ICD therapies were estimated using random effects meta-analysis. Nine prospective cohort studies (n=1274) were included in this analysis. SDB was present in 52% of the participants. SDB was associated with a 55% higher risk of appropriate ICD therapies (45% versus 28%; risk ratio, 1.55; 95% confidence interval, 1.32-1.83). In a subgroup analysis based on the subtypes of SDB, the risk was higher in both central (risk ratio, 1.50; 95% confidence interval, 1.11-2.02) and obstructive (risk ratio, 1.43; 95% confidence interval, 1.01-2.03) sleep apnea. CONCLUSIONS SDB is associated with an increased risk of appropriate ICD therapy in patients with heart failure and reduced ejection fraction.
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Affiliation(s)
- Younghoon Kwon
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
| | - Ryan J Koene
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Osung Kwon
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Jessica V Kealhofer
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Selcuk Adabag
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Sue Duval
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
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Taimeh Z, Koene RJ, Furne J, Singal A, Eckman PM, Levitt MD, Pritzker MR. Erythrocyte aging as a mechanism of anemia and a biomarker of device thrombosis in continuous-flow left ventricular assist devices. J Heart Lung Transplant 2017; 36:625-632. [DOI: 10.1016/j.healun.2017.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 01/14/2023] Open
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16
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Konety SH, Koene RJ, Norby FL, Wilsdon T, Alonso A, Siscovick D, Sotoodehnia N, Gottdiener J, Fox ER, Chen LY, Adabag S, Folsom AR. Echocardiographic Predictors of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004431. [PMID: 27496550 DOI: 10.1161/circimaging.115.004431] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/23/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study assessed the echocardiographic predictors of sudden cardiac death (SCD) within 2 population-based cohorts. METHODS AND RESULTS Echocardiograms were obtained on 2383 participants (1993-1995) from the ARIC study (Atherosclerosis Risk in Communities; 100% black) and 5366 participants (1987-1989 and 1994-1995) from the CHS (Cardiovascular Health Study). The main outcome was physician-adjudicated SCD. We used Cox proportional-hazards models with incident coronary heart disease and heart failure as time-dependent covariates to assess the association between echocardiographic variables and SCD, adjusting for Framingham risk score variables, coronary heart disease, and renal function. Cohort-specific results were meta-analyzed. During a median follow-up of 7.3 and 13.1 years, 44 ARIC study participants and 275 CHS participants had SCD, respectively. In the meta-analyzed results, the adjusted hazard ratios (95% confidence intervals) for predictors of SCD were 3.07 (2.29-4.11) for reduced left ventricular ejection fraction; 1.85 (1.36-2.52) for mitral annular calcification; 1.64 (1.07-2.51) for mitral E/A >1.5, and 1.52 (1.14-2.02) for mitral E/A <0.7 (versus mitral E/A 0.7-1.5); 1.30 (1.15-1.48) per 1 SD increase in left ventricular mass; and 1.15 (1.02-1.30) per 1 SD increase in left atrial diameter. A receiver-operating characteristic model for prediction of SCD using Framingham risk score variables had a C statistic of 0.61 for ARIC study and 0.67 for CHS; the full multivariable model including all echocardiographic variables had a C statistic of 0.76 for ARIC study and 0.74 for CHS. CONCLUSIONS In addition to reduced left ventricular ejection fraction, we identified other echocardiographic-derived variables predictive for SCD that provided incremental value compared with clinical risk factors.
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Affiliation(s)
- Suma H Konety
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
| | - Ryan J Koene
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Faye L Norby
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Tony Wilsdon
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Alvaro Alonso
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - David Siscovick
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Nona Sotoodehnia
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - John Gottdiener
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Ervin R Fox
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Lin Y Chen
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Selcuk Adabag
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Aaron R Folsom
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
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17
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Abstract
BACKGROUND Changes in left ventricular (LV) systolic function in response to coronary artery bypass grafting (CABG) have not been fully assessed. METHODS Between January 2001 and December 2014, 2,838 consecutive patients underwent isolated CABG at the Minneapolis Veterans Affairs Health Care System. Of these, 375 had echocardiographic assessment of LV function before (within 6 months) and after (3 to 24 months) CABG and were included in this analysis. RESULTS While the mean LV ejection fraction (LVEF) did not change following CABG [(49±13)% vs. (49±12)%, P=0.51], LVEF decreased in the subgroup with normal (≥50%) pre-operative LVEF [from (59±5)% to (56±9)%, P<0.001] and improved in those with decreased (<50%) pre-operative LVEF [from (36±9)% to (41±12)%, P<0.001]. There was a significant reduction in LV internal diameter during end-diastole (LVIDd) (5.4±0.8 vs. 5.3±0.9, P=0.002) and an increase in left atrial diameter (LAD) (4.4±0.7 vs. 4.6±0.7, P<0.001). There were no perioperative changes in LV internal diameter during end-systole, LV mass, posterior wall thickness, or septal wall thickness. LVEF improved by >5% in 24% of the study population, did not change (+/- 5%) in 55%, and worsened by >5% in 21%. Patients with improved EF were less often diabetic and had lower pre-operative LVEF, and greater LV dimensions at baseline. CONCLUSIONS After CABG, there was a decrease in LVIDd and an increase in LAD. Also, a decrease in LV systolic function with CABG was observed in patients with normal pre-operative LVEF and an improvement in LV systolic function was observed in patients with decreased pre-operative LVEF.
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Affiliation(s)
- Ryan J Koene
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jessica V Kealhofer
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Selcuk Adabag
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA;; Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Kairav Vakil
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Viorel G Florea
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA;; Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
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18
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Abstract
Cardiovascular disease (CVD) and cancer are the 2 leading causes of death worldwide. Although commonly thought of as 2 separate disease entities, CVD and cancer possess various similarities and possible interactions, including a number of similar risk factors (eg, obesity, diabetes mellitus), suggesting a shared biology for which there is emerging evidence. Although chronic inflammation is an indispensable feature of the pathogenesis and progression of both CVD and cancer, additional mechanisms can be found at their intersection. Therapeutic advances, despite improving longevity, have increased the overlap between these diseases, with millions of cancer survivors now at risk of developing CVD. Cardiac risk factors have a major impact on subsequent treatment-related cardiotoxicity. In this review, we explore the risk factors common to both CVD and cancer, highlighting the major epidemiological studies and potential biological mechanisms that account for them.
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Affiliation(s)
- Ryan J Koene
- From Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis (R.J.K., S.H.K.); Department of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.E.P.); Department of Medicine, Division of Oncology, University of Minnesota, Minneapolis (A.B.); and Masonic Cancer Center, University of Minnesota, Minneapolis (A.E.P.).
| | - Anna E Prizment
- From Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis (R.J.K., S.H.K.); Department of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.E.P.); Department of Medicine, Division of Oncology, University of Minnesota, Minneapolis (A.B.); and Masonic Cancer Center, University of Minnesota, Minneapolis (A.E.P.)
| | - Anne Blaes
- From Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis (R.J.K., S.H.K.); Department of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.E.P.); Department of Medicine, Division of Oncology, University of Minnesota, Minneapolis (A.B.); and Masonic Cancer Center, University of Minnesota, Minneapolis (A.E.P.)
| | - Suma H Konety
- From Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis (R.J.K., S.H.K.); Department of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.E.P.); Department of Medicine, Division of Oncology, University of Minnesota, Minneapolis (A.B.); and Masonic Cancer Center, University of Minnesota, Minneapolis (A.E.P.)
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19
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Kwon Y, Koene RJ, Cross C, McEntee J, Green JS. Fatal non-thrombotic pulmonary embolization in a patient with undiagnosed factitious disorder. BMC Res Notes 2015; 8:302. [PMID: 26164684 PMCID: PMC4499184 DOI: 10.1186/s13104-015-1265-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 06/30/2015] [Indexed: 11/22/2022] Open
Abstract
Background Factitious fever is extremely challenging to diagnose in patients with complicated chronic medical problems, and represents as much as 10% of fevers of unknown origin. Factitious fever caused by self-injecting oral medications through indwelling central catheters is a diagnostic challenge. Case presentation We present a 32-year-old Caucasian female with history of short gut syndrome, malnutrition requiring total parental nutrition, and pancreatic auto-islet transplant with fever of unknown origin. Multiple episodes of bacteremia occurred with atypical pathogens, including α-hemolytic Streptococcus, Achromobacter xylosoxidans, and Mycobacterium mucogenicum. Chest computed tomography was notable for extensive tree-in-bud infiltrates. Sudden cardiac arrest with right-sided heart failure following acute hypoxemia led to her death. Diffuse microcrystalline cellulose emboli with foreign body granulomatosis was found on autopsy. Circumstantial evidence indicated that this patient suffered from factitious disorder, and was self-injecting oral medications through her central catheter. Conclusion A high index of suspicion, early recognition, and multifaceted team support is essential to detect and manage patients with factitious disorders before fatal events occur.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
| | - Ryan J Koene
- Department of Medicine, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
| | - Caroline Cross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
| | - Jennifer McEntee
- Department of Medicine, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA. .,Department of Medicine, Duke University, Durham, NC, USA.
| | - Jaime S Green
- Department of Medicine, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
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20
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Koene RJ, Liao KK, Eckman PM, John R. Anastomosis of the outflow cannula to the descending aorta in a HeartWare left ventricular assist device. J Cardiol Cases 2014; 11:66-68. [PMID: 30546533 DOI: 10.1016/j.jccase.2014.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/12/2014] [Accepted: 10/22/2014] [Indexed: 11/16/2022] Open
Abstract
We report a case in which a recipient of a HeartWare® HVAD left ventricular assist device (HeartWare, Framingham, MA, USA) was unable to undergo standard outflow graft anastomosis to the ascending aorta due to severe aortic calcification. The outflow graft of the device was instead anastomosed to the descending aorta. <Learning objective: Not all left ventricular assist device (LVAD) patients are candidates for outflow graft anastomosis to the ascending aorta. We report a case in which a HeartWare LVAD outflow graft was anastomosed to the descending aorta. We review this approach described in other contemporary devices and animal models. We include reports on device explant and exchange.>.
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Affiliation(s)
- Ryan J Koene
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth K Liao
- Department of Surgery, Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Peter M Eckman
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Ranjit John
- Department of Surgery, Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, USA
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21
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Kwon Y, Koene RJ, Cho Y. A case of cerebral venous sinus thrombosis associated with Crohn's disease: dilemma in management. Gastroenterol Rep (Oxf) 2014; 4:154-7. [PMID: 25389155 PMCID: PMC4863183 DOI: 10.1093/gastro/gou079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/30/2014] [Indexed: 11/14/2022] Open
Abstract
Inflammatory bowel disease (IBD) is known to increase the risk of venous thromboembolism. Cerebral venous sinus thrombosis (CVST) is a rare but important complication of IBD. Timely diagnosis, particularly in younger patients, requires a high level of suspicion in order to prevent potentially devastating complications such as hemorrhage or venous infarction. The paper presents a 44-year-old Caucasian woman with a previous history of Crohn's disease and deep venous thrombosis. Magnetic resonance imaging confirmed the diagnosis of CVST. Achieving therapeutic anticoagulation with warfarin was difficult, due to presumed pharmacological interaction between warfarin and 6-mercaptopurine. Clinicians should have a high index of suspicion for CVST when a patient with Crohn's disease presents with acute headache, and be aware of challenges related to medical management.
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Affiliation(s)
- Younghoon Kwon
- St. Joseph's Hospital, HealthEast Care System, Saint Paul, Minnesota, USA and Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ryan J Koene
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yeilim Cho
- St. Joseph's Hospital, HealthEast Care System, Saint Paul, Minnesota, USA and
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22
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Koene RJ, Win S, Naksuk N, Adatya SN, Rosenbaum AN, John R, Eckman PM. HAS-BLED and CHA2DS2-VASc Scores as Predictors of Bleeding and Thrombotic Risk After Continuous-Flow Ventricular Assist Device Implantation. J Card Fail 2014; 20:800-7. [DOI: 10.1016/j.cardfail.2014.08.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/16/2014] [Accepted: 08/19/2014] [Indexed: 01/12/2023]
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