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Tirandi A, Carbone F, Liberale L, Montecucco F. Evaluating inflammatory status to predict atrial fibrillation recurrence following ablation: The role of systemic immune-inflammation index. World J Cardiol 2025; 17:103074. [DOI: 10.4330/wjc.v17.i3.103074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Revised: 03/06/2025] [Accepted: 03/12/2025] [Indexed: 03/21/2025] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in humans, affecting more than 40 million people worldwide. Radiofrequency catheter ablation (RFCA) was first introduced as a treatment for AF by Haïssaguerre M in the late 1990s. This procedure quickly became the treatment of choice, especially for symptomatic patients with AF refractory to medication. However, up to 45% of patients may experience AF recurrence within 12 months after RFCA. In this setting, AF recurrence is likely multifactorial, including atrial remodeling, local fibrosis or incomplete ablation due to failure in locating the trigger. Additionally, patients with obesity, sleep apnea, hypertension, or diabetes are at an increased risk of AF recurrence after RFCA. Inflammation is increasingly recognized as a potential key factor in AF recurrence and may arise both from the healing response of heart tissue post-ablation or from chronic low-grade inflammation, as observed in many risk factors. Here, we present an original study by Wang et al, which investigated the combination of the systemic immune-inflammation index—a marker developed to assess overall inflammatory status—and the APPLE score, designed to predict AF recurrence following RFCA. The study found that using both indicators together improved the accuracy of AF recurrence prediction. These findings underscore the significant role of inflammation in cardiovascular disease and demonstrated its impact on AF recurrence after RFCA. Further research is warranted to validate the combined use of these two scores in clinical settings for predicting AF recurrence following catheter ablation.
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Affiliation(s)
- Amedeo Tirandi
- Center for Molecular Cardiology, University of Zurich, Schlieren 8952, Zürich, Switzerland
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa 16132, Liguria, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa 16132, Liguria, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa–Italian Cardiovascular Network, Genoa 16132, Liguria, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa 16132, Liguria, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa–Italian Cardiovascular Network, Genoa 16132, Liguria, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa 16132, Liguria, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa–Italian Cardiovascular Network, Genoa 16132, Liguria, Italy
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Pokorney SD, Nemeth H, Chiswell K, Albert C, Allyn N, Blanco R, Butler J, Calkins H, Elkind MSV, Fonarow GC, Fontaine JM, Frankel DS, Fermann GJ, Gale R, Kalscheur M, Kirchhof P, Koren A, Miller JB, Rashkin J, Russo AM, Rutan C, Steinberg BA, Piccini JP. Design and rationale of a pragmatic randomized clinical trial of early dronedarone versus usual care to change and improve outcomes in persons with first-detected atrial fibrillation - the CHANGE AFIB study. Am Heart J 2025; 279:66-75. [PMID: 39423993 DOI: 10.1016/j.ahj.2024.10.001] [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] [Received: 08/26/2023] [Revised: 09/27/2024] [Accepted: 10/01/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND While there are several completed clinical trials that address treatment strategies in patients with symptomatic and recurrent atrial fibrillation (AF), there are no randomized clinical trials that address first-line rhythm control of new-onset AF. Recent data suggest that early initiation of rhythm control within 1 year can improve outcomes. METHODS In this open-label pragmatic clinical trial nested within the Get with The Guidelines Atrial Fibrillation registry, approximately 3,000 patients with first-detected AF will be enrolled at approximately 200 sites. Participants will be randomized (1:1) to treatment with dronedarone in addition to usual care versus usual care alone. The primary endpoint will be time to first cardiovascular (CV) hospitalization or death from any cause through 12 months from randomization. Secondary endpoints will include a WIN ratio (all-cause death, ischemic stroke or systemic embolism, heart failure hospitalization, acute coronary hospitalization), CV hospitalization, and all-cause mortality. Patient reported outcomes will be analyzed based on change in Atrial Fibrillation Effect on Quality of Life (AFEQT) and change in Mayo AF-Specific Symptom Inventory (MAFSI) from baseline to 12 months. CONCLUSION CHANGE AFIB will determine if treatment with dronedarone in addition to usual care is superior to usual care alone for the prevention of CV hospitalization or death from any cause in patients with first-detected AF. The trial will also determine whether initiation of rhythm control at the time of first-detected AF affects CV events or improves patient reported outcomes. TRIAL REGISTRATION - NCT05130268.
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Affiliation(s)
- Sean D Pokorney
- Duke Clinical Research Institute, Durham, NC; Duke Heart Center, Duke University Medical Center, Durham, NC
| | - Hayley Nemeth
- Duke Clinical Research Institute, Durham, NC; Duke Heart Center, Duke University Medical Center, Durham, NC
| | | | - Christine Albert
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX; Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | | | | | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | | | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rex Gale
- Hilton Head Island Leadership Institute, Hilton Head, SC
| | | | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center UKE Hamburg, Germany; German Center of Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Germany; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Joseph B Miller
- Department of Emergency Medicine, Wayne State University & Henry Ford Hospital, Detroit, MI
| | | | - Andrea M Russo
- Division of Cardiovascular Disease, Cooper Medical School of Rowan University, Camden, NJ
| | | | | | - Jonathan P Piccini
- Duke Clinical Research Institute, Durham, NC; Duke Heart Center, Duke University Medical Center, Durham, NC.
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Choi SH, Lee YC, Baek YS. The Efficacy and Safety of NOAC in Very Elderly Atrial Fibrillation Patients: Data From the Korean National Health Insurance Cohort Registry. Korean Circ J 2024; 54:811-821. [PMID: 39434362 DOI: 10.4070/kcj.2024.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/26/2024] [Accepted: 07/08/2024] [Indexed: 10/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We investigated the clinical benefit of anticoagulation with non-vitamin K antagonist oral anticoagulant (NOAC) in very elderly atrial fibrillation (AF) patients through national healthcare insurance registry. METHODS Clinical data was acquired from the National Health Insurance Service of south Korea. Medical records of 862,935 patients who were diagnosed with AF from 2015 to 2020 were collected for analysis. Patients under the age of 85, prior history of intracranial hemorrhage, gastrointestinal bleeding and prior prescription days of aspirin, warfarin or NOAC exceeding 90 along with follow up period less than 90 days were excluded. RESULTS A total of 10,625 patients were eligible for analysis. Patients with oral anticoagulant (hazard ratio [HR], 0.60, 95% confidence interval [CI], 0.53-0.69, p<0.001) showed higher efficacy regarding cerebrovascular accident (CVA) compared to aspirin (HR, 0.84, 95% CI, 0.74-0.95, p=0.008) and no treatment group. Individual comparison of NOAC and aspirin via propensity score matching showed that patients with NOAC (HR, 0.71, 95% CI, 0.61-0.85, p<0.001) showed higher event free survival regarding CVA compared to aspirin. Bleeding risk was also higher for NOAC (HR, 1.28, 95% CI, 1.07-1.56, p=0.006) group but did not result in commensurate increase in mortality (HR, 0.60, 95% CI, 0.45-0.81, p<0.001). CONCLUSIONS Anticoagulation with NOAC in very elderly patient showed higher event free survival regarding CVA. Despite having higher event rate of bleeding, eventual death was lower for NOAC.
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Affiliation(s)
- Seong Huan Choi
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon, Korea
| | - Yeong Chan Lee
- Department of Physiology, Ajou University School of Medicine, Suwon, Korea
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon, Korea.
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Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Sanders P, Schnabel RB, Suwalski P, Svennberg E, Tamargo J, Tica O, Traykov V, Tzeis S, Kotecha D. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024; 45:3314-3414. [PMID: 39210723 DOI: 10.1093/eurheartj/ehae176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Toghroli F, Noorbakhsh MF, Sajedianfard J. The Effects of Silymarin on Calcium Chloride-Induced Arrhythmia in Male Rat. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2024; 2024:6720138. [PMID: 39247668 PMCID: PMC11380717 DOI: 10.1155/2024/6720138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 07/14/2024] [Accepted: 08/07/2024] [Indexed: 09/10/2024]
Abstract
Antioxidants play an important role in protecting cardiac arrhythmias. Silymarin, strong antioxidant, is effective in reducing the complications caused by arrhythmias. This study was conducted to determine the effect of silymarin on the prevention and treatment of calcium chloride-induced arrhythmia. In total, 48 male rats were randomly divided into six groups: the first control group for acute administration received intravenous injection of 0.2 mL of dimethylsulfoxide, a cosolvent, immediately after induction of arrhythmia; the second control group for chronic administration, daily gavage of dimethylsulfoxide for 2 weeks before induction of arrhythmia; acute silymarin group, 100 mg/kg intravenous, immediately after the occurrence of arrhythmia; chronic silymarin group, daily gavage of 50 mg/kg for 2 weeks before induction of arrhythmia; amiodarone standard treatment, 5 mg/kg intravenous, immediately after induction of arrhythmia; and quinidine standard treatment, 10 mg/kg intravenous, immediately after induction of arrhythmia. Calcium chloride (140 mg/kg, i.v.) was used to induce arrhythmia. Electrocardiogram was recorded and monitored by PowerLab™ system. The incidence rates of premature ventricular beat (PVB), ventricular tachycardia (VT), and ventricular fibrillation (VF) were calculated. The antiarrhythmic effect of silymarin was observed with a significant decrease in the incidence of premature ventricular beat (22.56 ± 1.04%, P < 0.001), ventricular tachycardia (34.150 ± 1.59%, P < 0.001), and ventricular fibrillation (24.31 ± 1.02%, P < 0.001) compared with the control group (100%). These effects were comparable to antiarrhythmic drugs such as quinidine (29.23% ± 1.24%, 52.23% ± 1.13%, 66.31% ± 1.81%) and amiodarone (22.91% ± .72%, 41.09% ± 1.66%, 61.59% ± 1.11%). Silymarin exerts a potent antioxidant effect, thereby mitigating the risk of VT, VF, and PVC.
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Affiliation(s)
- Fereshteh Toghroli
- Department of Basic Sciences School of Veterinary Medicine Shiraz University, Shiraz, Iran
| | | | - Javad Sajedianfard
- Department of Basic Sciences School of Veterinary Medicine Shiraz University, Shiraz, Iran
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Jameie M, Rezaee M, Pashang M, Jalali A, Khalaji A, Behnoush AH, Fallahzadeh A, Sheikhy A, Masoudkabir F, Tafti HA, Momtahen S, Mansourian S, Hosseini K. Factors Affecting Late Atrial Fibrillation and Its Association With Coronary Artery Bypass Outcomes. Ann Thorac Surg 2024; 117:1145-1152. [PMID: 38360338 DOI: 10.1016/j.athoracsur.2024.02.007] [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] [Received: 09/12/2023] [Revised: 01/07/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Although predictors and outcomes of postoperative atrial fibrillation (POAF) are well studied, evidence is lacking concerning postdischarge late/recurrent atrial fibrillation (AF). This study evaluated factors affecting late/recurrent AF and its association with coronary artery bypass grafting (CABG) outcomes in a real-world setting. METHODS From 2012 through 2016, 5175 patients were included. Independent factors associated with late/recurrent AF were identified in a competing risk setting. Cox proportional hazard regression was used to evaluate the association between late/recurrent AF and study outcomes, consisting of all-cause mortality, major adverse cardio-cerebrovascular events, acute coronary syndrome, cerebrovascular events, and heart failure admissions. RESULTS During a median follow-up of 60 months (quartile 1-quartile 3, 59.3-60.7 months), late/recurrent AF developed in 85 patients (1.64%). Independent factors associated with late/recurrent AF were age (subdistribution hazard ratio [sHR], 1.04; 95% CI, 1.02-1.07), left-ventricular ejection fraction (sHR, 0.97; 95% CI, 0.95-0.99), length of stay (sHR, 1.02; 95% CI, 1.01-1.04), and POAF (sHR, 4.02; 95% CI, 2.50-6.45). Late/recurrent AF was not significantly associated with all-cause mortality and major adverse cardio-cerebrovascular events at unadjusted or adjusted levels (adjusted hazard ratio, 0.80 [95% CI, 0.50-1.28] and 0.74 [95% CI, 0.48-1.13], respectively). Nevertheless, it significantly increased the unadjusted risk of cerebrovascular events (hazard ratio, 2.28; 95% CI, 01.07-4.87), which disappeared after adjustments. CONCLUSIONS Patients with advanced age, a lower left-ventricular ejection fraction, and POAF are more likely to have late/recurrent clinical AF. Albeit counterintuitive, late/recurrent AF was not independently associated with worse midterm post-CABG outcomes. These observations need to be further elucidated in larger-scale studies and interpreted in the context of a developing country with limited resources for late AF surveillance.
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Affiliation(s)
- Mana Jameie
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Rezaee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Khalaji
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Behnoush
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Fallahzadeh
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheikhy
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ahmadi Tafti
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Momtahen
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Mansourian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Ali ZS, Bhuiyan A, Vyas P, Miranda-Arboleda AF, Tse G, Bazoukis G, Burak C, Abuzeid W, Lee S, Gupta S, Meghdadi A, Baranchuk A. PR prolongation as a predictor of atrial fibrillation onset: A state-of-the-art review. Curr Probl Cardiol 2024; 49:102469. [PMID: 38369207 DOI: 10.1016/j.cpcardiol.2024.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
First-degree atrioventricular block (1-AVB), characterized by a PR interval exceeding 200 milliseconds, has traditionally been perceived as a benign cardiac condition. Recently, this perception has been challenged by investigations that indicate a potential association between PR prolongation and an elevated risk of atrial fibrillation (AF). To consolidate these findings, we performed a comprehensive review to assess the available evidence indicating a relationship between these two conditions. We searched MEDLINE and EMBASE databases as well as manually searched references of retrieved articles. We selected 18 cohort studies/meta-analyses involving general and special populations. Consistent findings across expansive cohort studies reveal that incremental increases in the PR interval may serve as an independent risk factor for AF. However, our analyses underscore the need for further research into the association between 1-AVB, defined by a specified PR interval cutoff, and the risk of AF.
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Affiliation(s)
- Zain S Ali
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Abdullah Bhuiyan
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Purav Vyas
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region
| | - George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus; School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Cengiz Burak
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Wael Abuzeid
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Sharen Lee
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region
| | - Shyla Gupta
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amin Meghdadi
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada.
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Ng Y, Liao MT, Chen TL, Lee CK, Chou CY, Wang W. Few-shot transfer learning for personalized atrial fibrillation detection using patient-based siamese network with single-lead ECG records. Artif Intell Med 2023; 144:102644. [PMID: 37783539 DOI: 10.1016/j.artmed.2023.102644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 06/15/2023] [Accepted: 08/28/2023] [Indexed: 10/04/2023]
Abstract
The proliferation of wearable devices has allowed the collection of electrocardiogram (ECG) recordings daily to monitor heart rhythm and rate. For example, 24-hour Holter monitors, cardiac patches, and smartwatches are widely used for ECG gathering and application. An automatic atrial fibrillation (AF) detector is required for timely ECG interpretation. Deep learning models can accurately identify AFs if large amounts of annotated data are available for model training. However, it is impractical to request sufficient labels for ECG recordings for an individual patient to train a personalized model. We propose a Siamese-network-based approach for transfer learning to address this issue. A pre-trained Siamese convolutional neural network is created by comparing two labeled ECG segments from the same patient. We sampled 30-second ECG segments with a 50% overlapping window from the ECG recordings of patients in the MIT-BIH Atrial Fibrillation Database. Subsequently, we independently detected the occurrence of AF in each patient in the Long-Term AF Database. By fine-tuning the model with the 1, 3, 5, 7, 9, or 11 ECG segments ranging from 30 to 180 s, our method achieved macro-F1 scores of 96.84%, 96.91%, 96.97%, 97.02%, 97.05%, and 97.07%, respectively.
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Affiliation(s)
- Yiuwai Ng
- Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan.
| | - Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Ting-Li Chen
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
| | - Chih-Kuo Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
| | - Cheng-Ying Chou
- Department of Biomechatronics Engineering, National Taiwan University, Taipei, Taiwan.
| | - Weichung Wang
- Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan.
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Alhotye M, Evans R, Ng A, Singh SJ. Cardiac rehabilitation for heart failure and atrial fibrillation: a propensity- matched study. Open Heart 2023; 10:e002372. [PMID: 37567605 PMCID: PMC10423825 DOI: 10.1136/openhrt-2023-002372] [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: 05/28/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is common in individuals with heart failure (HF). Individuals with HF and AF may have a reduced functional capacity and quality of life (QoL) which leads to hospital admission and burden on clinical services. Evidence supported the effect of exercise training in individuals with HF. However, there is no existing data on the effectiveness of comprehensive cardiac rehabilitation (CR) in individuals with coexisting HF and AF. AIM To explore the effect of CR in individuals with HF and AF compared with those with HF and no-coexisting AF. METHODS Using CR database, individuals with HF and AF were identified and propensity matched to those with no coexisting AF. The change in incremental shuttle walking test, Heart Disease Quality of Life questionnaire, Hospital Anxiety and Depression Scores were compared between groups pre-CR and post-CR. RESULTS 149 individuals were propensity matched from each group. The mean±SD age of the matched sample was 73.4±8 years, body mass index 29±5.5 kg/m2, left ventricular ejection fraction 35.2±9.8% and 56% were male.A statistically significant improvements in exercise capacity, heart disease QoL, anxiety and depression scores were observed within each group. There were no significant differences between groups for any of these outcome measures. CONCLUSIONS Individuals with HF and AF gain a similar improvement in exercise capacity and health related QoL outcomes as individuals with no coexisting AF following CR. The presence of AF did not compromise the effectiveness of CR.
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Affiliation(s)
- Munyra Alhotye
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Respiratory Therapy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rachael Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
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Verma LA, Penson PE, Akpan A, Lip GYH, Lane DA. Managing older people with atrial fibrillation and preventing stroke: a review of anticoagulation approaches. Expert Rev Cardiovasc Ther 2023; 21:963-983. [PMID: 38088256 DOI: 10.1080/14779072.2023.2276892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Oral anticoagulants (OACs) are the cornerstone of stroke prevention in atrial fibrillation (AF), but prescribing decisions in older people are complicated. Clinicians must assess the net clinical benefit of OAC in the context of multiple chronic conditions, polypharmacy, frailty and life expectancy. The under-representation of high-risk, older adult sub-populations in clinical trials presents the challenge of choosing the right OAC, where a 'one-size-fits-all' approach cannot be taken. AREAS COVERED This review discusses OAC approaches for stroke prevention in older people with AF and presents a prescribing aid to support clinicians' decision-making. High-risk older adults with multiple chronic conditions, specifically chronic kidney disease, dementia/cognitive impairment, previous stroke/transient ischemic attack or intracranial hemorrhage, polypharmacy, frailty, low body weight, high falls risk, and those aged ≥75 years are considered. EXPERT OPINION Non-vitamin K antagonist OACs are the preferred first-line OAC in older adults with AF, including high-risk subpopulations, after individual assessment of stroke and bleeding risk, except those with mechanical heart valves and moderate-to-severe mitral stenosis. Head-to-head comparisons of NOACs are not available, therefore the choice of drug (and dose) should be based on an individual's risk (stroke and bleeding) and incorporate their treatment preferences. Treatment decisions must be person-centered and principles of shared decision-making applied.
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Affiliation(s)
- Leona A Verma
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Peter E Penson
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Asangaedem Akpan
- Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Medicine for Older People, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Parent S, Vaka R, Risha Y, Ngo C, Kanda P, Nattel S, Khan S, Courtman D, Stewart DJ, Davis DR. Prevention of atrial fibrillation after open-chest surgery with extracellular vesicle therapy. JCI Insight 2023; 8:e163297. [PMID: 37384420 PMCID: PMC10481795 DOI: 10.1172/jci.insight.163297] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 06/28/2023] [Indexed: 07/01/2023] Open
Abstract
Almost half of patients recovering from open-chest surgery experience atrial fibrillation (AF) that results principally from inflammation in the pericardial space surrounding the heart. Given that postoperative AF is associated with increased mortality, effective measures to prevent AF after open-chest surgery are highly desirable. In this study, we tested the concept that extracellular vesicles (EVs) isolated from human atrial explant-derived cells can prevent postoperative AF. Middle-aged female and male rats were randomized to undergo sham operation or induction of sterile pericarditis followed by trans-epicardial injection of human EVs or vehicle into the atrial tissue. Pericarditis increased the probability of inducing AF while EV treatment abrogated this effect in a sex-independent manner. EV treatment reduced infiltration of inflammatory cells and production of pro-inflammatory cytokines. Atrial fibrosis and hypertrophy seen after pericarditis were markedly attenuated by EV pretreatment, an effect attributable to suppression of fibroblast proliferation by EVs. Our study demonstrates that injection of EVs at the time of open-chest surgery shows prominent antiinflammatory effects and prevents AF due to sterile pericarditis. Translation of this finding to patients might provide an effective new strategy to prevent postoperative AF by reducing atrial inflammation and fibrosis.
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Affiliation(s)
- Sandrine Parent
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramana Vaka
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
| | - Yousef Risha
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
| | - Clarissa Ngo
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
| | - Pushpinder Kanda
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stanley Nattel
- Research Center and Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Saad Khan
- Ottawa Hospital Research Institute, Division of Regenerative Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Courtman
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Division of Regenerative Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Duncan J. Stewart
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Division of Regenerative Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Darryl R. Davis
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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12
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Yang Y, Lu J, Xiong C, Shen Z, Shen C, Tong J, Jiang J, Fu G, Xu F. Establishment and Verification of a Nomogram for Predicting the Probability of New-Onset Atrial Fibrillation After Dual-Chamber Pacemaker Implantation. Tex Heart Inst J 2023; 50:492746. [PMID: 37130328 DOI: 10.14503/thij-21-7796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND This study aims to establish and validate a nomogram as a predictive model in patients with new-onset atrial fibrillation (AF) after dual-chamber cardiac implantable electronic device (pacemaker) implantation. METHODS A total of 1120 Chinese patients with new-onset AF after pacemaker implantation were included in this retrospective study. Patients had AF of at least 180/minute lasting 5 minutes or longer, detected by atrial lead and recorded at least 3 months after implantation. Patients with previous atrial tachyarrhythmias before device implantation were excluded. A total of 276 patients were ultimately enrolled, with 51 patients in the AF group and 225 patients in the non-AF group. Least absolute shrinkage and selection operator (LASSO) method was used to determine the best predictors. Through multivariate logistic regression analysis, a nomogram was drawn as a predictive model. Concordance index, calibration plot, and decision curve analyses were applied to evaluate model discrimination, calibration, and clinical applicability. Internal verification was performed using a bootstrap method. RESULTS The LASSO method regression analysis found that variables including peripheral arterial disease, atrial pacing-ventricular pacing of at least 50%, atrial sense-ventricular sense of at least 50%, increased left atrium diameter, and age were important predictors of developing AF. In multivariate logistic regression, peripheral arterial disease, atrial pacing-ventricular pacing of at least 50%, and age were found to be independent predictors of new-onset AF. CONCLUSION This nomogram may help physicians identify patients at high risk of new-onset AF after pacemaker implantation at an early stage in a Chinese population.
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Affiliation(s)
- Ying Yang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Jiangting Lu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Cui Xiong
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Zhida Shen
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Chao Shen
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Jinshan Tong
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Jiangfen Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Fen Xu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
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13
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AbuElkhair A, Boidin M, Buckley BJR, Lane DA, Williams NH, Thijssen D, Lip GYH, Barraclough DL. Effects of different exercise types on quality of life for patients with atrial fibrillation: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2023; 24:87-95. [PMID: 36583977 DOI: 10.2459/jcm.0000000000001386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM To investigate the effectiveness of exercise and the most effective types of exercise for patients with atrial fibrillation (AF) to improve health-related quality of life (HRQoL) and exercise capacity, and reduce AF burden, AF recurrence and adverse events. METHODS AND RESULTS Systematic search in PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL Plus, and SPORTDiscus for randomized controlled trials (RCTs) and nonrandomized pre-post intervention studies investigating the effect of different types of exercise on AF patients. After exclusion, 12 studies (11 RCTs, 1 prepost) with a total of 670 participants were included. Exercise interventions consisted of aerobic exercise, aerobic interval training (AIT), Qigong, yoga, and exercise-based cardiac rehabilitation (CR). There were significant positive effects of exercise on general health {mean difference [MD] = 6.42 [95% confidence interval (CI): 2.90, 9.93]; P = 0.0003; I2 = 17%} and vitality [MD = 6.18 (95% CI: 1.94, 10.41); P = 0.004; I2 = 19%)] sub-scales of the Short Form 36-item questionnaire (SF-36). Qigong resulted in a significant improvement in the 6-min walk test [MD = 105.00m (95% CI: 19.53, 190.47)]. Exercise-based CR and AIT were associated with a significant increment in V̇O2peak, and AIT significantly reduced AF burden. Adverse events were few and one intervention-related serious adverse event was reported for exercise-based CR. CONCLUSION Exercise led to improvements in HRQoL, exercise capacity, and reduced AF burden. The available exercise interventions for AF patients are few and heterogeneous. Future studies are needed for all types of exercise intervention in this patient group to (co-)develop an optimized exercise training intervention for AF patients.
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Affiliation(s)
- Ahlam AbuElkhair
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Department of Physiotherapy, Faculty of Medical Technology, University of Tripoli, Libya
| | - Maxime Boidin
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University and Liverpool Centre for Cardiovascular Sciences, Liverpool, U.K.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
| | - Benjamin J R Buckley
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University and Liverpool Centre for Cardiovascular Sciences, Liverpool, U.K.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Deirdre A Lane
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Nefyn H Williams
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, U.K
| | - Dick Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University and Liverpool Centre for Cardiovascular Sciences, Liverpool, U.K
| | - Gregory Y H Lip
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dong L Barraclough
- Department of Musculoskeletal & Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, U.K
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14
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He J, Liu S, Yang C, Wei Y. Value of baseline characteristics in the risk prediction of atrial fibrillation. Front Cardiovasc Med 2023; 10:1068562. [PMID: 36818333 PMCID: PMC9928725 DOI: 10.3389/fcvm.2023.1068562] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction Atrial fibrillation (AF) is prone to heart failure and stroke. Early management can effectively reduce the stroke rate and mortality. Current clinical guidelines screen high-risk individuals based solely on age, while this study aims to explore the possibility of other AF risk predictors. Methods A total of 18,738 elderly people (aged over 60 years old) in Chinese communities were enrolled in this study. The baseline characteristics were mainly based on the diagnosis results of electrocardiogram (ECG) machine during follow up, accompanied by some auxiliary physical examination basic data. After the analysis of both independent and combined baseline characteristics, AF risk predictors were obtained and prioritized according to the results. Independent characteristics were studied from three aspects: Chi-square test, Mann-Whitney U test and Cox univariate regression analysis. Combined characteristics were studied from two aspects: machine learning models and Cox multivariate regression analysis, and the former was combined with recursive feature elimination method and voting decision. Results The resulted optimal combination of risk predictors included age, atrial premature beats, atrial flutter, left ventricular hypertrophy, hypertension and heart disease. Conclusion Patients diagnosed by short-time ECG machines with the occurrence of the above events had a higher probability of AF episodes, who are suggested to be included in the focus of long-term ECG monitoring or increased screening density. The incidence of risk predictors in different age ranges of AF patients suggests differences in age-specific patient management. This can help improve the detection rate of AF, standardize the management of patients, and slow down the progression of AF.
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Affiliation(s)
- Jiacheng He
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Sen Liu
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Cuiwei Yang
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China,Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai, China,*Correspondence: Cuiwei Yang,
| | - Yong Wei
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Yong Wei,
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15
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Liu L, Liu X, Ding X, Chen H, Li W, Li H. Lipid Levels and New-Onset Atrial Fibrillation in Patients with Acute Myocardial Infarction. J Atheroscler Thromb 2022; 30:515-530. [PMID: 35871559 PMCID: PMC10164594 DOI: 10.5551/jat.63574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM In acute myocardial fraction (AMI) patients, the association between lipid parameters and new-onset atrial fibrillation (NOAF) remains unclear due to limited evidence. METHODS A total of 4282 participants free from atrial fibrillation (AF) at baseline were identified in Beijing Friendship Hospital. Fasting levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured at baseline. The study population was stratified based on tertiles of lipid profile and lipid ratios. Incidence of NOAF was observed at the follow-up visits. The associations between different lipid parameters and the incidence of NOAF were assessed by multivariate Cox regression analysis. RESULTS Over a median follow-up period of 42.0 months (IQR: 18.7, 67.3 months), 3.1% (N=132) AMI patients developed NOAF. After multivariable adjustment, higher TC (hazard ratios (HR): 0.205, 95% confidence intervals (CI): 0.061-0.696) levels were inversely associated with NOAF development. However, higher HDL-C (HR: 1.892, 95% CI: 1.133-3.159) levels were positively associated with NOAF development. LDL-C levels, TG levels, non-HDL-C levels, and lipid ratios showed no association with NOAF development. CONCLUSION TC levels were inversely associated with incidence of NOAF; this was mainly reflected in the subgroups of male gender and older patients (65 years or older). HDL-C levels were positively associated with incidence of NOAF; this was mainly reflected in the subgroups of male gender and younger patients (age ＜65 years). There was no significant association of NOAF with LDL-C, TG, or non-HDL-C levels.
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Affiliation(s)
- Lei Liu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Xiaoyan Liu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Weiping Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University.,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University.,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease.,Department of Geriatrics, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
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16
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Verberk WJ. Atrial fibrillation and 24-h ambulatory blood pressure pattern. J Clin Hypertens (Greenwich) 2022; 24:848-850. [PMID: 35702949 PMCID: PMC9278569 DOI: 10.1111/jch.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Willem J. Verberk
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtthe Netherlands
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17
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Tanaka N, Inoue K, Okada M, Sakata Y, Akao M, Yamashita T, Suzuki S, Okumura K. Impact of anemia on the clinical outcomes in elderly patients with atrial fibrillation receiving apixaban: J-ELD AF registry subanalysis. IJC HEART & VASCULATURE 2022; 40:100994. [PMID: 35342786 PMCID: PMC8943397 DOI: 10.1016/j.ijcha.2022.100994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/19/2022] [Accepted: 03/05/2022] [Indexed: 10/27/2022]
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18
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Toma MM, Bungau SG, Tit DM, Moisi MI, Bustea C, Vesa CM, Behl T, Stoicescu M, Brisc CM, Purza LA, Gitea D, Diaconu CC. Use of anticoagulant drugs in patients with atrial fibrillation. Does adherence to therapy have a prognostic impact? Biomed Pharmacother 2022; 150:113002. [PMID: 35462339 DOI: 10.1016/j.biopha.2022.113002] [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: 02/23/2022] [Revised: 04/10/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022] Open
Abstract
Anticoagulant therapy represents a pivotal element that strongly influences the thromboembolic risk of non-valvular atrial fibrillation (NVAF) subjects. The main purpose of this review was to identify issues and suggest strategies to improve the oral anticoagulants (OACs) treatment adherence, which is the most important predictor of NVAF outcome. Advantages, efficacy, and impact of these drugs on patients' prognosis were revealed in important clinical trials on large cohorts of patients and are often prescribed nowadays. A real-life data registry, the Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF) analyzed the profile and outcome of patients diagnosed with NVAF receiving oral antithrombotic treatment. The observations gathered in the registry were crucial for identifying relevant elements that clinicians must improve, such as adherence strategies and predisposing factors that correlated with stroke. Adherence to OACs in AF patients is essential from the viewpoint of clinical efficacy and safety. Major adverse events and negative outcome are correlated with a weak anticoagulation control caused by an ineffective treatment adherence strategy. Solving the issue of oral anticoagulation adherence is possible using new technologies, but future directions should be explored. Mobile phone applications centered on patients' needs, telemedicine programs that evaluate patients' evolution and detect adverse reactions or events, encouraging an adequate management of the event without interruption of OACs, represent perspectives with a major impact on treatment adherence.
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Affiliation(s)
- Mirela Marioara Toma
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea 410087, Romania.
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea 410087, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Delia Mirela Tit
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea 410087, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Madalina Ioana Moisi
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania.
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania.
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania.
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, 140401 Punjab, India.
| | - Manuela Stoicescu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
| | - Cristina Mihaela Brisc
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
| | - Lavinia Anamaria Purza
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Daniela Gitea
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Camelia Cristina Diaconu
- Department 5, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania; Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania.
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19
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Koniari I, Artopoulou E, Velissaris D, Mplani V, Anastasopoulou M, Kounis N, de Gregorio C, Tsigkas G, Karunakaran A, Plotas P, Ikonomidis I. Pharmacologic Rate versus Rhythm Control for Atrial Fibrillation in Heart Failure Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:743. [PMID: 35744006 PMCID: PMC9228123 DOI: 10.3390/medicina58060743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022]
Abstract
Atrial fibrillation (AF) and Heart failure (HF) constitute two frequently coexisting cardiovascular diseases, with a great volume of the scientific research referring to strategies and guidelines associated with the best management of patients suffering from either of the two or both of these entities. The common pathophysiological paths, the adverse outcomes, the hospitalization rates, and the mortality rates that occur from various reports and trials indicate that a targeted therapy to the common background of these cardiovascular conditions may reverse the progression of their interrelating development. Among other optimal treatments concerning the prevalence of both AF and HF, the introduction of rhythm and rate control strategies in the guidelines has underlined the importance of sinus rhythm and heart rate control in the prevention of deleterious complications. The use of these strategies in the clinical practice has led to a debate about the superiority of rhythm versus rate control. The current guidelines as well as the published randomized trials and studies have not proved that rhythm control is more beneficial than the rate control treatments in the terms of survival, all-cause mortality, hospitalization rates, and quality of life. Therefore, the current therapeutic strategy is based on the therapy guidelines and the clinical judgment and experience. The aim of this review was to elucidate the endpoints of pharmacologic randomized clinical trials and the clinical data of each antiarrhythmic or rate-limiting medication, so as to promote their effective, individualized, evidence-based clinical use.
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Affiliation(s)
- Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK; (I.K.); (A.K.)
| | - Eleni Artopoulou
- Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece; (E.A.); (D.V.)
| | - Dimitrios Velissaris
- Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece; (E.A.); (D.V.)
| | - Virginia Mplani
- Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece; (V.M.); (M.A.); (N.K.); (G.T.)
| | - Maria Anastasopoulou
- Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece; (V.M.); (M.A.); (N.K.); (G.T.)
| | - Nicholas Kounis
- Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece; (V.M.); (M.A.); (N.K.); (G.T.)
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine Cardiology Unit, University Hospital of Messina, 98125 Messina, Italy;
| | - Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece; (V.M.); (M.A.); (N.K.); (G.T.)
| | - Arun Karunakaran
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK; (I.K.); (A.K.)
| | - Panagiotis Plotas
- Laboratory Primary Health Care, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece;
| | - Ignatios Ikonomidis
- Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
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20
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Kumar D, Maharjan R, Maxhuni A, Dominguez H, Frølich A, Bardram JE. mCardia: A Context-Aware ECG Collection System for Ambulatory Arrhythmia Screening. ACM TRANSACTIONS ON COMPUTING FOR HEALTHCARE 2022; 3:1-28. [DOI: 10.1145/3494581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/01/2021] [Indexed: 07/25/2023]
Abstract
This article presents the design, technical implementation, and feasibility evaluation of
mCardia
—a context-aware, mobile
electrocardiogram
(ECG) collection system for longitudinal arrhythmia screening under free-living conditions. Along with ECG,
mCardia
also records active and passive contextual data, including patient-reported symptoms and physical activity. This contextual data can provide a more accurate understanding of what happens before, during, and after an arrhythmia event, thereby providing additional information in the diagnosis of arrhythmia. By using a plugin-based architecture for ECG and contextual sensing,
mCardia
is device-agnostic and can integrate with various wireless ECG devices and supports cross-platform deployment. We deployed the
mCardia
system in a feasibility study involving 24 patients who used the system over a two-week period. During the study, we observed high patient acceptance and compliance with a satisfactory yield of collected ECG and contextual data. The results demonstrate the high usability and feasibility of
mCardia
for longitudinal ambulatory monitoring under free-living conditions. The article also reports from two clinical cases, which demonstrate how a cardiologist can utilize the collected contextual data to improve the accuracy of arrhythmia analysis. Finally, the article discusses the lessons learned and the challenges found in the
mCardia
design and the feasibility study.
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Affiliation(s)
- Devender Kumar
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
| | - Raju Maharjan
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
| | - Alban Maxhuni
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
| | - Helena Dominguez
- Bispebjerg-Frederiksberg Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jakob E. Bardram
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
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21
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Schnabel RB, Witt H, Walker J, Ludwig M, Geelhoed B, Kossack N, Schild M, Miller R, Kirchhof P. Machine learning-based identification of risk-factor signatures for undiagnosed atrial fibrillation in primary prevention and post-stroke in clinical practice. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 9:16-23. [PMID: 35436783 PMCID: PMC9745664 DOI: 10.1093/ehjqcco/qcac013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/24/2022] [Accepted: 03/08/2022] [Indexed: 12/15/2022]
Abstract
AIMS Atrial fibrillation (AF) carries a substantial risk of ischemic stroke and other complications, and estimates suggest that over a third of cases remain undiagnosed. AF detection is particularly pressing in stroke survivors. To tailor AF screening efforts, we explored German health claims data for routinely available predictors of incident AF in primary care and post-stroke using machine learning methods. METHODS AND RESULTS We combined AF predictors in patients over 45 years of age using claims data in the InGef database (n = 1 476 391) for (i) incident AF and (ii) AF post-stroke, using machine learning techniques. Between 2013-2016, new-onset AF was diagnosed in 98 958 patients (6.7%). Published risk factors for AF including male sex, hypertension, heart failure, valvular heart disease, and chronic kidney disease were confirmed. Component-wise gradient boosting identified additional predictors for AF from ICD-codes available in ambulatory care. The area under the curve (AUC) of the final, condensed model consisting of 13 predictors, was 0.829 (95% confidence interval (CI) 0.826-0.833) in the internal validation, and 0.755 (95% CI 0.603-0.890) in a prospective validation cohort (n = 661). The AUC for post-stroke AF was of 0.67 (95% CI 0.651-0.689) in the internal validation data set, and 0.766 (95% CI 0.731-0.800) in the prospective clinical cohort. CONCLUSION ICD-coded clinical variables selected by machine learning can improve the identification of patients at risk of newly diagnosed AF. Using this readily available, automatically coded information can target AF screening efforts to identify high-risk populations in primary care and stroke survivors.
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Affiliation(s)
- Renate B Schnabel
- Corresponding author. Tel: +49-1522-2816064, Fax: +49 (0)40 7410-55310,
| | - Henning Witt
- Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
| | - Jochen Walker
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117 Berlin, Germany
| | - Marion Ludwig
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117 Berlin, Germany
| | - Bastian Geelhoed
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251 Hamburg, Germany,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany
| | | | - Marie Schild
- Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
| | - Robert Miller
- Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany,Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251 Hamburg, Germany,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany,Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of Birmingham, Edgbaston, Birmingham UK
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22
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INCIDENCE OF NEW ONSET ATRIAL FIBRILLATION AFTER TRANSCATHETER PFO CLOSURE USING 15 YEARS OF ONTARIO ADMINISTRATIVE HEALTH DATA. Heart Rhythm 2022; 19:1414-1420. [DOI: 10.1016/j.hrthm.2022.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 03/17/2022] [Accepted: 04/05/2022] [Indexed: 12/19/2022]
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23
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Wundersitz DWT, Wright BJ, Gordon BA, Pompei S, Lavie CJ, Nadurata V, Nolan K, Kingsley MIC. Sympathovagal Balance Is a Strong Predictor of Post High-Volume Endurance Exercise Cardiac Arrhythmia. Front Physiol 2022; 13:848174. [PMID: 35388290 PMCID: PMC8978599 DOI: 10.3389/fphys.2022.848174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Regular physical activity is important for cardiovascular health. However, high-volume endurance exercise has been associated with increased number of electrocardiogram (ECG) abnormalities, including disturbances in cardiac rhythm (arrhythmias) and abnormalities in ECG pattern. The aim of this study was to assess if heart rate variability (HRV) is associated with ECG abnormalities. Fifteen participants with previous cycling experience completed a 21-day high-volume endurance exercise cycle over 3,515 km. Participants wore a 5-lead Holter monitor for 24 h pre- and post-exercise, which was used to quantify ECG abnormalities and export sinus R-to-R intervals (NN) used to calculate HRV characteristics. As noise is prevalent in 24-h HRV recordings, both 24-h and heart rate collected during stable periods of time (i.e., deep sleep) were examined. Participants experienced significantly more arrhythmias post high-volume endurance exercise (median = 35) compared to pre (median = 12; p = 0.041). All 24-h and deep sleep HRV outcomes were not different pre-to-post high-volume endurance exercise (p > 0.05). Strong and significant associations with arrhythmia number post-exercise were found for total arrhythmia (total arrhythmia number pre-exercise, ρ = 0.79; age, ρ = 0.73), supraventricular arrhythmia (supraventricular arrhythmia number pre-exercise: ρ = 0.74; age: ρ = 0.66), and ventricular arrhythmia (age: ρ = 0.54). As a result, age and arrhythmia number pre-exercise were controlled for in hierarchical regression, which revealed that only deep sleep derived low frequency to high frequency (LF/HF) ratio post high-volume endurance exercise predicted post total arrhythmia number (B = 0.63, R2Δ = 34%, p = 0.013) and supraventricular arrhythmia number (B = 0.77, R2Δ = 69%, p < 0.001). In this study of recreationally active people, only deep sleep derived LF/HF ratio was associated with more total and supraventricular arrhythmias after high-volume endurance exercise. This finding suggests that measurement of sympathovagal balance during deep sleep might be useful to monitor arrhythmia risk after prolonged high-volume endurance exercise performance.
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Affiliation(s)
- Daniel W. T. Wundersitz
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
- *Correspondence: Daniel W. T. Wundersitz,
| | - Bradley J. Wright
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Brett A. Gordon
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Stephanie Pompei
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, United States
| | | | - Kimberly Nolan
- Cardiology Department, Bendigo Health, Bendigo, VIC, Australia
| | - Michael I. C. Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
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24
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Seki A, Fishbein MC. Age-related cardiovascular changes and diseases. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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25
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Pokorney SD, Berchuck SI, Chiswell K, Sun JL, Thomas L, Jones WS, Patel MR, Piccini JP. Atrial Branch Coronary Artery Stenosis as a Mechanism for Atrial Fibrillation. Heart Rhythm 2021; 19:1237-1244. [PMID: 34958941 DOI: 10.1016/j.hrthm.2021.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The etiology of atrial fibrillation (AF) is multifactorial and incompletely understood. OBJECTIVE Evaluate the association between coronary artery disease (CAD) affecting atrial tissue and AF. METHODS Patients from a single center with obstructive CAD during cardiac catheterization (1/12007-12/1/2013) were included in a matched case-control analysis, based on the presence or absence of new-onset AF within 12 months post-catheterization. Quantitative measurements of stenosis severity were performed for sinoatrial (SA) nodal artery, atrioventricular (AV) nodal artery, and right intermediate atrial artery (RIAA), as well as the right coronary, left circumflex, and left anterior descending proximal to the take-off for each atrial-level artery. A multivariable logistic regression model identified factors associated with AF. RESULTS Among 1,794 patients, 115 (6%) developed AF within 1-year post-catheterization. The matched cohort included 110 patients with and 110 patients without AF within 12 months post-catheterization. Higher odds of AF at 1 year were associated with increasing lesion stenosis severity in the RIAA (OR 1.41 per 10% increase >50%, 95% CI 1.01-1.97, p=0.047) and AV nodal artery (OR 1.58 per 10% increase >50%, 95% CI 1.00-2.49, p=0.050). Odds of AF diagnosis during the year post-catheterization increased with the number of atrial arteries with >50% lesion (OR 1.53 for each additional artery, 95% CI 1.08-2.15, p=0.015). CONCLUSIONS Among patients with obstructive CAD, disease of the AV nodal artery and RIAA, as well as higher burden of CAD within all arteries supplying blood flow to the atrial myocardium were associated with higher odds of new-onset AF at 1 year.
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Affiliation(s)
- Sean D Pokorney
- Division of Cardiology, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC.
| | | | | | | | | | - W Schuyler Jones
- Division of Cardiology, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Manesh R Patel
- Division of Cardiology, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Jonathan P Piccini
- Division of Cardiology, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
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26
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Shah K, Pandya A, Kotwani P, Saha S, Desai C, Tyagi K, Saxena D, Puwar T, Gaidhane S. Cost-Effectiveness of Portable Electrocardiogram for Screening Cardiovascular Diseases at a Primary Health Center in Ahmedabad District, India. Front Public Health 2021; 9:753443. [PMID: 34926378 PMCID: PMC8678108 DOI: 10.3389/fpubh.2021.753443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: District Health Authority in Ahmedabad, Gujarat has introduced Project Lifeline, 12-lead portable ECG devices across all primary health centers (PHC) in the district to screen cardiac abnormalities among high-risk and symptomatic adults for providing primary management and proper timely referral. The prime purpose of the study was to assess the cost-effectiveness of portable ECG for the screening of cardiovascular diseases (CVD) among high-risk and symptomatic adults at the PHC in Ahmedabad, Gujarat. Methods: Cost-effective analysis was conducted using a societal perspective. An incremental costing approach was adapted, and cost-effectiveness analysis was done using a decision-analytic model. We surveyed 73 patients who screened positive for cardiac abnormality, documented the type of ECG abnormalities, and diagnosed CVD. The program cost was obtained from the implementers. Transition probabilities were derived from primary data supported by expert opinion for the intervention arm, while a systematic search of the literature was undertaken to derive transition probabilities for the control arm. Results: The ECG screening at PHC saves 2.90 life years at an incremental cost of 89.97 USD (6657.47 INR), yielding a cost-effectiveness ratio of 31.07 USD (2,299.06 INR) per life-year saved, which is below the willingness to pay threshold. The budget impact analysis was also performed. Results are sensitive to the relative risk reduction associated with the non-participation and the cost of initial screening. Conclusion: Cost-effectiveness analysis clearly shows that the facility to screen cardiac abnormality at the PHC level is highly recommended for high-risk adults and symptomatic cases.
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Affiliation(s)
- Komal Shah
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Apurvakumar Pandya
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Priya Kotwani
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Somen Saha
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Chintan Desai
- District Panchayat, Department of Health, Ahmedabad, India
| | - Kirti Tyagi
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Deepak Saxena
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Tapasvi Puwar
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Shilpa Gaidhane
- Department of Medicine, J. N. Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
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27
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Mulder MJ, Kemme MJB, Hopman LHGA, Kuşgözoğlu E, Gülçiçek H, van de Ven PM, Hauer HA, Tahapary GJM, Götte MJW, van Rossum AC, Allaart CP. Comparison of the predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation. Int J Cardiol 2021; 344:103-110. [PMID: 34555444 DOI: 10.1016/j.ijcard.2021.09.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND A significant number of patients experience recurrent atrial fibrillation (AF) after ablation. Various risk scores have been described that may predict outcomes after AF ablation. In this study, we aimed to compare ten previously described risk scores with regard to their predictive value for post-ablation AF recurrence and procedural complications. METHODS A total of 482 AF patients (63% paroxysmal AF, 66% male, mean age 62 ± 9 years) undergoing initial radiofrequency pulmonary vein isolation (PVI) were included in the present analysis. Prior to ablation, all patients underwent both transthoracic echocardiography (TTE) and either cardiac CT imaging or CMR imaging. The following risk scores were calculated for each patient: APPLE, ATLAS, BASE-AF2, CAAP-AF, CHADS2, CHA2DS2-VASc, DR-FLASH, HATCH, LAGO and MB-LATER. RESULTS Median follow-up was 16 (12-31) months. AF recurrence after a 90-day blanking period was observed in 199 patients (41%), occurring after a median of 183 (124-360) days. AF recurrence was less frequent in paroxysmal AF patients compared to non-paroxysmal AF patients (34% vs. 54%, p < 0.001). Overall periprocedural complication rate was 6%. All scores, except the HATCH score, demonstrated statistically significant but poor predictive value for recurrent AF after ablation (area under curve [AUC] 0.553-0.669). CHA2DS2-VASc and CAAP-AF were the only risk scores with predictive value for procedural complications (AUC 0.616, p = 0.043; AUC 0.615, p = 0.044; respectively). CONCLUSIONS Currently available risk scores perform poorly in predicting outcomes after AF ablation. These data suggest that the utility of these scores for clinical decision-making is limited.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Elif Kuşgözoğlu
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Hatice Gülçiçek
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Cardiology Centers of the Netherlands, Amsterdam, the Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Cardiology, North West Clinics, Alkmaar, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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Murat F, Sadak F, Yildirim O, Talo M, Murat E, Karabatak M, Demir Y, Tan RS, Acharya UR. Review of Deep Learning-Based Atrial Fibrillation Detection Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11302. [PMID: 34769819 PMCID: PMC8583162 DOI: 10.3390/ijerph182111302] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 02/01/2023]
Abstract
Atrial fibrillation (AF) is a common arrhythmia that can lead to stroke, heart failure, and premature death. Manual screening of AF on electrocardiography (ECG) is time-consuming and prone to errors. To overcome these limitations, computer-aided diagnosis systems are developed using artificial intelligence techniques for automated detection of AF. Various machine learning and deep learning (DL) techniques have been developed for the automated detection of AF. In this review, we focused on the automated AF detection models developed using DL techniques. Twenty-four relevant articles published in international journals were reviewed. DL models based on deep neural network, convolutional neural network (CNN), recurrent neural network, long short-term memory, and hybrid structures were discussed. Our analysis showed that the majority of the studies used CNN models, which yielded the highest detection performance using ECG and heart rate variability signals. Details of the ECG databases used in the studies, performance metrics of the various models deployed, associated advantages and limitations, as well as proposed future work were summarized and discussed. This review paper serves as a useful resource for the researchers interested in developing innovative computer-assisted ECG-based DL approaches for AF detection.
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Affiliation(s)
- Fatma Murat
- Department of Electrical and Electronics Engineering, Firat University, Elazig 23000, Turkey;
| | - Ferhat Sadak
- Department of Mechanical Engineering, Bartin University, Bartin 74100, Turkey;
| | - Ozal Yildirim
- Department of Software Engineering, Firat University, Elazig 23000, Turkey; (O.Y.); (M.T.); (M.K.)
| | - Muhammed Talo
- Department of Software Engineering, Firat University, Elazig 23000, Turkey; (O.Y.); (M.T.); (M.K.)
| | - Ender Murat
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara 06000, Turkey;
| | - Murat Karabatak
- Department of Software Engineering, Firat University, Elazig 23000, Turkey; (O.Y.); (M.T.); (M.K.)
| | - Yakup Demir
- Department of Electrical and Electronics Engineering, Firat University, Elazig 23000, Turkey;
| | - Ru-San Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore;
- Department of Cardiology, Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - U. Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 138607, Singapore;
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
- Department of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Singapore 599494, Singapore
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Zhang K, Lovasi GS, Odden MC, Michael YL, Newman AB, Arnold AM, Kim DH, Wu C. Association of Retail Environment and Neighborhood Socioeconomic Status with Mortality among Community-dwelling Older Adults in the US: Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2021; 77:2240-2247. [PMID: 34669918 DOI: 10.1093/gerona/glab319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Few studies have examined the association of neighborhood environment and mortality among community-dwelling older populations. Geographic Information Systems (GIS)-based measures of neighborhood physical environment may provide new insights on the health effects of the social and built environment. METHODS We studied 4,379 community-dwelling older adults in the US aged ≥65 years from the Cardiovascular Health Study. Principal component analysis was used to identify neighborhood components from 48 variables assessing facilities and establishments, demographic composition, socio-economic status, and economic prosperity. We used a Cox model to evaluate the association of neighborhood components with five-year mortality. Age, sex, race, education, income, marital status, body mass index, smoking status, disability, coronary heart disease, and diabetes were included as covariates. We also examined the interactions between neighborhood components and sex and race (Black vs. white or other). RESULTS We identified five neighborhood components, representing facilities and resources, immigrant communities, community-level economic deprivation, resident-level socio-economic status and residents' age. Communities' economic deprivation and residents' socio-economic status were significantly associated with five-year mortality. We did not find interactions between sex or race and any of the five neighborhood components. The results were similar in a sensitivity analysis where we used ten-year mortality as the outcome. CONCLUSIONS We found that communities' economic status but not facilities in communities was associated with mortality among older adults. These findings revealed the importance and benefits living in a socio-economically advantaged neighborhood could have on health among older residents with different demographic backgrounds.
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Affiliation(s)
- Kehan Zhang
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Gina S Lovasi
- Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA
| | - Yvonne L Michael
- Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Anne B Newman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Alice M Arnold
- School of Public Health, University of Washington, Seattle, WA
| | - Dae Hyun Kim
- Hebrew Rehabilitation Center, Harvard University, Cambridge, MA
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
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30
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Patient-Reported Atrial Fibrillation Following Septal Myectomy for Hypertrophic Cardiomyopathy. Ann Thorac Surg 2021; 113:1918-1924. [PMID: 34655566 DOI: 10.1016/j.athoracsur.2021.08.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patient-reported outcomes are important metrics of medical and surgical care. In this study, we investigated the prevalence and risk factors of patient-reported postdischarge atrial fibrillation (AF) following septal myectomy for obstructive hypertrophic cardiomyopathy. METHODS Patients undergoing transaortic septal myectomy from August 2001 to January 2017 were contacted regarding postdischarge AF through questionnaire-based surveys sent at 3, 5, and 10 years post procedure. For each patient, the most recent survey response was analyzed. RESULTS Among 949 patients, 248 (26.1%) last responded at 3 years post procedure, 353 (37.2%) at 5 years, and 348 (36.7%) at 10 years. The overall incidence of patient-reported postdischarge AF was 34.4% (n=326), and at 3, 5, and 10 years, the incidences were 22.2%, 34.8%, and 42.5% (P<0.001). After multivariable adjustment, history of preoperative AF (OR 5.566, P<0.001), early postoperative AF within the first 30 days (OR 2.211, P<0.001), preoperative left atrial volume index (OR 1.014, P=0.005), postoperative right ventricular systolic pressure (OR 1.021, P=0.013), postoperative moderate or greater mitral valve regurgitation (OR 1.893, P=0.022), and preoperative septal thickness (OR 1.043, P=0.036) were independently associated with patient-reported postdischarge AF. CONCLUSIONS The incidence of patient-reported postdischarge AF increases with increasing length of follow-up after septal myectomy. We identified several risk factors for late postdischarge AF that were associated with chronicity of left ventricular outflow tract obstruction, and earlier intervention may mitigate late atrial arrhythmias.
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31
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Lee DU, Fan GH, Hastie DJ, Addonizio EA, Karagozian R. The clinical impact of paroxysmal arrhythmias on the hospital outcomes of patients admitted with cirrhosis: propensity score matched analysis of 2011-2017 US hospitals. Expert Rev Cardiovasc Ther 2021; 19:947-956. [PMID: 34493127 DOI: 10.1080/14779072.2021.1978841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND We evaluate the effects of paroxysmal arrhythmia on the hospital outcomes of patients admitted with cirrhosis. RESEARCH DESIGN AND METHODS 2011-2017 National Inpatient Sample was used to isolate patients with decompensated/compensated cirrhosis, stratified by paroxysmal arrhythmia (supraventricular: PSVT and ventricular: PVT). The cohorts were matched using propensity-score matching and compared to mortality, length of stay, cost, and cardiac complications (cardioversion, cardiogenic shock, cardiac arrest, and ventricular fibrillation). RESULTS In compensated cirrhosis, 2,453 had PSVT with matched controls; 5,274 had PVT with matched controls. Those with PSVT had higher mortality (aOR 1.55 95%CI 1.23-1.95) and higher rates of cardioversion and cardiogenic shock; likewise, those with PVT had higher mortality (aOR 2.41 95%CI 2.09-2.78) and higher rates of all complications. In decompensated cirrhosis, 1,598 had PSVT with matched controls; 4,178 had PVT with matched controls. Those with PSVT had higher mortality (aOR 1.57 95%CI 1.28-1.93) and higher rates of cardioversion, cardiogenic shock, cardiac arrest; those with PVT had higher mortality (aOR 2.25 95%CI 1.98-2.56) and higher rates of all complications. CONCLUSION The findings from this study show that in either decompensated or compensated cohort, those with paroxysmal arrhythmias are at a higher risk of in-hospital mortality and adverse cardiac outcomes.
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Affiliation(s)
- David Uihwan Lee
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Gregory Hongyuan Fan
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - David Jeffrey Hastie
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Elyse Ann Addonizio
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Raffi Karagozian
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
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Heidarali M, Bakhshandeh H, Golpira R, Fazelifar A, Alizadeh-Diz A, Emkanjoo Z, Madadi S, Kamali F, Maleki M, Lip GYH, Haghjoo M. A prospective survey of atrial fibrillation management in Iran: Baseline results of the Iranian Registry of Atrial Fibrillation (IRAF). Int J Clin Pract 2021; 75:e14313. [PMID: 33950579 DOI: 10.1111/ijcp.14313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/28/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Atrial fibrillation. (AF) is the most common sustained arrhythmia globally and its prevalence is likely to increase in the next decades as a result of increasing age and co-morbidities. There are no data on demographic features, clinical characteristics, associated comorbidities, and practice patterns of AF in Iran. METHODS The Iranian Registry of Atrial Fibrillation (IRAF) is a hospital-based prospective survey of AF patients with a 12-month follow-up. Data were collected on a standardized case report form and entered into a web-based electronic database. This paper reports the baseline characteristics of the IRAF cohort. RESULTS Between February 2018 and March 2020, a total of 1300 patients (57% Male, mean age, 60 ± 14 years) were enrolled. Palpitations were the most common presenting symptom (66%). The most common cardiac comorbidities were hypertension (52%), heart failure (23.7%), and valvular heart disease (21.8%). AF mainly presented as a paroxysmal pattern (44.6%). Seventy-eight percent of the patients with non-valvular AF had CHA2 DS2 -VASc score ≥1 and most (97%) were at low risk for bleeding (HAS-BLED score <3). Rhythm control was given to 55.1% of the patients. Anticoagulation for stroke prevention was provided to 69.5% of the eligible patients, while aspirin was used in 35%. CONCLUSION The IRAF Registry has provided a systematic collection of contemporary data regarding the management and treatment of AF in Iran. Oral anticoagulant was used in 69.5%, but aspirin use was still common.
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Affiliation(s)
- Mona Heidarali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Golpira
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amirfarjam Fazelifar
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfath Alizadeh-Diz
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Emkanjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Madadi
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Kamali
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Majid Haghjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Gouissem I, Midani F, Soualmia H, Bouchemi M, Ouali S, Kallele A, Romdhane NB, Mourali MS, Feki M. Contribution of the ACE (rs1799752) and CYP11B2 (rs1799998) Gene Polymorphisms to Atrial Fibrillation in the Tunisian Population. Biol Res Nurs 2021; 24:31-39. [PMID: 34227426 DOI: 10.1177/10998004211029376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study investigated the association of angiotensin-converting enzyme (ACE I/D) and aldosterone synthase (CYP11B2-344C/T) gene polymorphisms in the renin-angiotensin-aldosterone system (RAAS) with atrial fibrillation (AF) in the Tunisian population. MATERIALS AND METHODS The study population included 120 patients with AF and 123 age-matched controls. Genotyping of the I/D polymorphism in the ACE gene and the -344C/T polymorphism in the CYP11B2 gene was performed by polymerase chain reaction (PCR) and PCR-RFLP methods, respectively. RESULTS The genotype distribution of the ACE I/D and CYP11B2-344C/T polymorphisms was significantly different between AF patients and control participants (p < 0.01 and p < 0.006 respectively). In addition, ACE I/D increased the risk of AF significantly by 3.41-fold for the DD genotype (OR = 3.41; 95% CI [1.39-8.34]; p < 0.007), and after adjusting for confounding factors (age, diabetes, hypertension, and dyslipidemia), the risk was higher (OR = 5.71; 95% CI [1.48-21.98]; p < 0.01). Likewise, the CYP11B2-344C/T polymorphism increased the incidence of AF for the TT genotype (OR = 3.66; 95% CI [1.62-8.27]; p < 0.002) and the CT genotype (OR = 2.68; 95% CI [1.22-5.86]; p < 0.01). After adjusting for confounding factors (age, diabetes, hypertension and dyslipidemia), the risk remained higher for the TT genotype (OR = 3.58; 95% CI [1.08-11.77]; p < 0.03). Furthermore, the haplotype-based association of the ACE I/D and CYP11B2-344C/T polymorphisms showed that the D-T haplotype increased the risk for AF. CONCLUSION Our study suggests a significant association of the ACE (I/D) and CYP11B2-344C/T polymorphisms with AF in the Tunisian population.
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Affiliation(s)
- Ilhem Gouissem
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia.,University of Carthage, Faculty of Sciences of Bizerte, Tunisia.,University of Tunis El Manar, High Institute of Medical Technologies of Tunis, Jebbari, Tunis, Tunisia
| | - Fatma Midani
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia.,University of Tunis El Manar, High Institute of Medical Technologies of Tunis, Jebbari, Tunis, Tunisia
| | - Hayet Soualmia
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia.,University of Tunis El Manar, High Institute of Medical Technologies of Tunis, Jebbari, Tunis, Tunisia
| | - Meryem Bouchemi
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia.,University of Tunis El Manar, High Institute of Medical Technologies of Tunis, Jebbari, Tunis, Tunisia
| | - Sana Ouali
- University of Tunis El Manar, Faculty of Medicine of Tunis, Rabta Hospital, Department of Cardiology, Jebbari, Tunis, Tunisia
| | - Ameni Kallele
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia
| | - Neila Ben Romdhane
- University of Tunis El Manar, Faculty of Medicine of Tunis, Rabta Hospital, Department of Hematology, Jebbari, Tunis, Tunisia
| | - Mohamed Sami Mourali
- University of Tunis El Manar, Faculty of Medicine of Tunis, Rabta Hospital, Department of Cardiology, Jebbari, Tunis, Tunisia
| | - Moncef Feki
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia
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Hämmerle P, Aeschbacher S, Springer A, Eken C, Coslovsky M, Dutilh G, Moschovitis G, Rodondi N, Chocano P, Conen D, Osswald S, Kühne M, Zuern CS. Cardiac autonomic function and cognitive performance in patients with atrial fibrillation. Clin Res Cardiol 2021; 111:60-69. [PMID: 34156525 PMCID: PMC8766386 DOI: 10.1007/s00392-021-01900-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022]
Abstract
Background Atrial fibrillation (AF) is associated with loss of cognition and dementia. Cardiac autonomic dysfunction has been linked to cognitive decline. We aimed to investigate if reduced cardiac autonomic function (CAF) is associated with cognitive impairment in AF patients. Methods Patients with paroxysmal, persistent and permanent AF were enrolled from a multicenter cohort study if they had AF (“AF group”) or sinus rhythm (“SR group”) on a baseline 5 min ECG recording. Parameters quantifying CAF (heart rate variability triangular index (HRVI), mean heart rate (MHR), RMSSD, SDNN, total power and power in the VLF, LF, HF ranges) were calculated. We used the Montreal Cognitive Assessment (MoCA) to assess global cognitive function. Results 1685 AF patients with a mean age of 73 ± 8 years, 29% females, were included. MoCA score was 24.5 ± 3.2 in the AF group (N = 710 patients) and 25.4 ± 3.2 in the SR group (N = 975 patients). After adjusting for multiple confounders, lower HRVI was associated with lower MoCA scores, both in the SR group [β = 0.049; 95% confidence interval (CI) 0.016–0.081; p = 0.003] and in the AF group (β = 0.068; 95% CI 0.020–0.116; p = 0.006). In the AF group, higher MHR was associated with a poorer performance in the MoCA (β = − 0.008; 95% CI − 0.014 to − 0.002; p = 0.014). We found no convincing evidence of association for other CAF parameters with cognition. Conclusion Our data suggest that impaired CAF is associated with worse cognitive performance in patients with AF. Among standard HRV parameters, HRVI might be the most promising ECG index. Trial registration ClinicalTrials.gov Identifier: NCT02105844. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01900-4.
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Affiliation(s)
- Peter Hämmerle
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Anne Springer
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Ceylan Eken
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Coslovsky
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
- Department Clinical Research, University of Basel, Basel, Switzerland
| | - Gilles Dutilh
- Department Clinical Research, University of Basel, Basel, Switzerland
| | - Giorgio Moschovitis
- Department of Cardiology, Hospedale Regionale Di Lugano, Lugano, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Patricia Chocano
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Stefan Osswald
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Christine S Zuern
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.
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Wang M, Liu M, Huang J, Fan D, Liu S, Yu T, Huang K, Wei X, Lei Q. Long-Term High-Altitude Exposure Does Not Increase the Incidence of Atrial Fibrillation Associated with Organic Heart Diseases. High Alt Med Biol 2021; 22:285-292. [PMID: 34143663 DOI: 10.1089/ham.2020.0228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Wang, Man, Mengxue Liu, Jia Huang, Dan Fan, Shengzhong Liu, Tao Yu, Keli Huang, Xinchuan Wei, and Qian Lei. Long-term high-altitude exposure does not increase the incidence of atrial fibrillation associated with organic heart diseases. High Alt Med Biol. 00:000-000, 2021.- Background: Atrial fibrillation (AF) is one of the most common arrhythmias and is associated with several complications following cardiac surgery. However, the differences in the incidence of AF associated with organic heart diseases between highland and lowland populations have not been comprehensively studied. Methods: In this retrospective study, a total of 2,316 highland and lowland patients who underwent cardiac surgery between January 2013 and December 2018 in a single center were enrolled. According to the altitude of residence, patients were divided into high-altitude (>1,500 m) and low-altitude (<1,500 m) groups. A propensity score matching analysis was performed to estimate the association of lifetime high-altitude exposure with AF. Results: Among the enrolled patients, 239 (10.9%) were from a high-altitude plateau, while 1,946 (89.1%) were from a low-altitude area. There were statistical differences in age, gender, European System for Cardiac Operative Risk Evaluation, and other factors, between the two groups (p < 0.05). According to the propensity score, 237 patients in the high-altitude group were successfully matched to 237 patients in the low-altitude group without significant difference in baseline data (p > 0.05). Among the matched patients, 125 patients (26.4%) suffered from AF, with 66 (27.8%) in the high-altitude group and 59 (24.9%) in the low-altitude group. The incidence of AF was statistically similar between the two groups and not significantly influenced by long-term high-altitude exposure (odds ratio 1.07; 95% confidence interval 0.71-1.60, p > 0.05). Conclusion: Long-term high-altitude exposure did not significantly increase the occurrence of AF in patients with organic heart diseases. Clinical Trial No. ChiCTR1900028612.
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Affiliation(s)
- Man Wang
- Anesthesia and Operation Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mengxue Liu
- Anesthesia and Operation Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jia Huang
- Anesthesia and Operation Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Dan Fan
- Anesthesia and Operation Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Shengzhong Liu
- Department of Cardiac Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Tao Yu
- Department of Cardiac Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Keli Huang
- Department of Cardiac Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinchuan Wei
- Anesthesia and Operation Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qian Lei
- Anesthesia and Operation Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Freedman B, Hindricks G, Banerjee A, Baranchuk A, Ching CK, Du X, Fitzsimons D, Healey JS, Ikeda T, Lobban TCA, Mbakwem A, Narasimhan C, Neubeck L, Noseworthy P, Philbin DM, Pinto FJ, Rwebembera J, Schnabel RB, Svendsen JH, Aguinaga L, Arbelo E, Böhm M, Farhan HA, Hobbs FDR, Martínez-Rubio A, Militello C, Naik N, Noubiap JJ, Perel P, Piñeiro DJ, Ribeiro AL, Stepinska J. World Heart Federation Roadmap on Atrial Fibrillation - A 2020 Update. Glob Heart 2021; 16:41. [PMID: 34211827 PMCID: PMC8162289 DOI: 10.5334/gh.1023] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.
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Affiliation(s)
- Ben Freedman
- Heart Research Institute, University of Sydney, Sydney, AU
| | | | | | | | | | - Xin Du
- Beijing Anzhen Hospital, Capital Medical University, CN
| | | | | | | | - Trudie C. A. Lobban
- Arrhythmia Alliance & Atrial Fibrillation Association, Stratford Upon Avon, UK
| | - Amam Mbakwem
- Lagos University Teaching Hospital, Idi Araba, Lagos, NG
| | | | | | | | | | - Fausto J. Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisboa, PT
| | | | | | | | | | - Elena Arbelo
- Hospital Clinic de Barcelona, Universitat de Barcelona, ES
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Hornburg/Saar, DE
| | | | | | | | | | - Nitish Naik
- All India Institute of Medical Sciences, New Delhi, IN
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Small hiatal hernia as a risk factor of atrial fibrillation. Pol J Radiol 2021; 86:e1-e3. [PMID: 33708268 PMCID: PMC7934566 DOI: 10.5114/pjr.2021.102602] [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] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Hiatal hernia (HH) is considered a risk factor of atrial fibrillation (AF). The aim of this study was to evaluate HH in computed tomography (CT) images in patients awaiting ablation due to atrial fibrillation, and to look for a correlation between HH in patients without AF and with AF. Material and methods This study included 441 patients divided in two groups: 207 patients subjected to computed tomography before ablation procedure due to atrial fibrillation and 234 patients as the control group, who underwent CT scans to rule out coronary disease (no AF in history). Results Small HH, e.g. under or equal to 2 cm, are associated with a higher risk of AF compared to the control group, which was not observed for bigger HH. Conclusions The presence of small HH may be a risk factor of AF.
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Abstract
The Wnt signaling pathway regulates physiological processes such as cell proliferation and differentiation, cell fate decisions, and stem cell maintenance and, thus, plays essential roles in embryonic development, but also in adult tissue homeostasis and repair. The Wnt signaling pathway has been associated with heart development and repair and has been shown to be crucially involved in proliferation and differentiation of progenitor cells into cardiomyocytes. The investigation of the role of the Wnt signaling pathway and the regulation of its expression/activity in atrial fibrillation has only just begun. The present minireview (I) provides original data regarding the expression of Wnt signaling components in atrial tissue of patients with atrial fibrillation or sinus rhythm and (II) summarizes the current state of knowledge of the regulation of Wnt signaling components' expression/activity and the contribution of the various levels of the Wnt signal transduction pathway to the processes of the development, maintenance, and progression of atrial fibrillation.
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Affiliation(s)
- Carmen Wolke
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald D-17475, Germany
| | - Elmer Antileo
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald D-17475, Germany
| | - Uwe Lendeckel
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald D-17475, Germany
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Nashimoto S, Morishita S, Iida S, Hotta K, Tsubaki A. Relationship between the face scale for rating of perceived exertion and physiological parameters in older adults and patients with atrial fibrillation. Physiol Rep 2021; 9:e14759. [PMID: 33650814 PMCID: PMC7923560 DOI: 10.14814/phy2.14759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Borg scale is used to determine exercise intensity in rehabilitation but can be difficult for older adults to understand. By contrast, face scale that are used to evaluate pain are much easier to understand thanks to the inclusion of illustrations. On the other hand, the prevalence of atrial fibrillation (AF) increases with age. This study aimed to determine the validity of the face scale for rating perceived exertion (RPE-face scale) in older adults and patients with AF during cardiopulmonary exercise test. Furthermore, the relationship between face scale and anaerobic threshold (AT) was also investigated. METHODS A total of 90 patients with sinus rhythm (SR) (74 men, 16 women) and 22 with AF were enrolled. Participants' responses were recorded using the RPE-face scale and compared with exercise intensity, heart rate, oxygen uptake, and minute ventilation during the exercise test. We determined the AT by the V-slope method. RESULTS Correlations between RPE-face scale and physiological parameters were significantly positive for men with SR and women with SR and AF. However, differences in the correlation coefficient between age and SR or AF were not statistically significant. The cutoff value for AT of the RPE-face scale was "4," showing high sensitivity and specificity. CONCLUSIONS The RPE-face scale can be used to determine the intensity of physical exercise, unaffected by age, gender, SR, or AF.
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Affiliation(s)
- Satoshi Nashimoto
- Department of RehabilitationNiigata Medical CenterNiigata‐city, NiigataJapan
| | - Shinichiro Morishita
- Institute for Human Movement and Medical SciencesNiigata University of Health and WelfareNiigata‐city, NiigataJapan
| | - Susumu Iida
- Department of RehabilitationNiigata Medical CenterNiigata‐city, NiigataJapan
| | - Kazuki Hotta
- Institute for Human Movement and Medical SciencesNiigata University of Health and WelfareNiigata‐city, NiigataJapan
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical SciencesNiigata University of Health and WelfareNiigata‐city, NiigataJapan
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Romero G, Salama G. Relaxin abrogates genomic remodeling of the aged heart. VITAMINS AND HORMONES 2021; 115:419-448. [PMID: 33706957 DOI: 10.1016/bs.vh.2020.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
"Healthy" aging drives structural and functional changes in the heart including maladaptive electrical remodeling, fibrosis and inflammation, which lower the threshold for cardiovascular diseases such as heart failure (HF) and atrial fibrillation (AF). Despite mixed results in clinical trials, Relaxin-therapy for 2-days reduced mortality by 37% at 180-days post-treatment, in patients with acute decompensated HF. Relaxin's short lifespan (2-3h) but long-lasting protective actions suggested that relaxin acts at a genomic level to reverse maladaptive remodeling in AF, HF and aging. Our recent studies showed that a 2-week treatment with Relaxin (0.4mg/kg/day) of aged (24months old F-344 rats) increases the expression of voltage-gated Na+ channels (mRNA, Nav1.5 and INa), connexin-43, abrogates inflammatory and immune responses and reverses myocardial fibrosis and cellular hypertrophy of the aged hearts. Relaxin acts directly at a wide range of cell types in the cardiovascular system that express its cognate GPCR receptor, RXFP1. RNA-seq analysis of young and aged hearts with and without Relaxin treatment revealed that "normal" aging altered the expression of ~10% of genes expressed in the ventricles, including: ion channels, components of fibrosis, hemodynamic biomarkers, immune and inflammatory responses which were reversed by Relaxin. The extensive cardiovascular remodeling caused by Relaxin was mediated through the activation of the Wnt/β-catenin signaling pathway which was otherwise suppressed by in adult cardiomyocytes intracellular by cytosolic Dickkopf1 (Dkk1). Wnt/β-catenin signaling is a mechanism that can explain the pleiotropic actions of Relaxin and the marked reversal of genomic changes that occur in aged hearts.
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Affiliation(s)
- Guillermo Romero
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Guy Salama
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 6081] [Impact Index Per Article: 1520.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Wańkowicz P, Nowacki P, Gołąb-Janowska M. Atrial fibrillation risk factors in patients with ischemic stroke. Arch Med Sci 2021; 17:19-24. [PMID: 33488851 PMCID: PMC7811312 DOI: 10.5114/aoms.2019.84212] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 02/27/2019] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common heart arrhythmia. The condition is known to increase the risk of ischemic stroke (IS). Classical risk factors for the development of AF include advanced age, hypertension, diabetes mellitus, coronary heart disease and lipid metabolism disorders. Importantly, these are also recognized risk factors for ischemic stroke. Therefore, the purpose of this study was to investigate AF risk factors in patients with IS. MATERIAL AND METHODS This is single-centre retrospective study which included 696 patients with acute ischemic stroke and nonvalvular atrial fibrillation and 1678 patients with acute ischemic stroke without atrial fibrillation. RESULTS In this study we found - based on a univariable and multivariable logistic regression model - that compared to the patients with IS without AF, the group of patients which suffered from IS with nonvalvular atrial fibrillation (NVAF) had a higher proportion of patients who smoked cigarettes (OR = 15.742, p < 0.01; OR = 41.1, p < 0.01), had hypertension (OR = 5.161, p < 0.01; OR = 5.666, p < 0.01), history of previous stroke (OR = 3.951, p < 0.01; OR = 4.792, p < 0.01), dyslipidemia (OR = 2.312, p < 0.01; OR = 1.592, p < 0.01), coronary heart disease (OR = 2.306, p < 0.01; OR = 1.988, p < 0.01), a greater proportion of female patients (OR = 1.717, p < 0.01; OR = 2.095, p < 0.01), higher incidence of diabetes mellitus (OR = 1.341, p < 0.01; OR = 1.261, p = 0.106) and more patients in old age (OR = 1.084, p < 0.01; OR = 1.101, p < 0.01). CONCLUSIONS Our study demonstrates a need for thorough and systematic monitoring of post-ischemic stroke patients in whom AF has not been detected and who display other important risk factors. Regardless of the stroke, these factors may be responsible for development of AF.
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Affiliation(s)
- Paweł Wańkowicz
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
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Ismail AS, Baghdady Y, Salem MA, Wahab AA. The use of MRI in quantification of the atrial fibrosis in patients with rheumatic mitral disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a common type of arrhythmia with higher incidence in countries with increased prevalence of rheumatic heart disease (RHD), where AF contributes to significant morbidity and mortality in young population. Atrial fibrosis is a common feature of AF. Delayed enhancement MRI (DE-MRI) is a well-established method for characterizing fibrosis in ventricles. The use of DE-MRI to detect left atrial fibrosis helps to evaluate the extent of atrial structural remodeling non-invasively. The aim of this study is to evaluate the atrial fibrosis in patients with mitral valve disease, using the DE MRI, regarding its amount, distribution, and relation to AF.
Results
Patients with AF were older and have longer duration of symptoms, smaller valve area, larger LA size, and more fibrosis at the left atrium (with the posterior wall most frequently involved) in comparison to those with sinus rhythm. Patients with atrial fibrosis were older and have longer duration of symptoms, smaller valve area, and larger LA, and most of them had AF compared to those without fibrosis. The comparison between types of AF showed a significant difference in the amount of atrial fibrosis that increases across the spectrum of AF.
Conclusion
In patients with rheumatic mitral valve diseases, AF is associated with more atrial fibrosis as assessed by DE-MRI. Atrial fibrosis is the best independent predictor of AF.
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Differences in Clinical and Echocardiographic Profiles and Outcomes of Patients With Atrial Fibrillation Versus Sinus Rhythm in Medically Managed Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. Heart Lung Circ 2020; 29:1773-1781. [DOI: 10.1016/j.hlc.2020.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 10/01/2019] [Accepted: 02/26/2020] [Indexed: 11/19/2022]
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Abstract
Atrial high rate episodes (AHREs) are defined as asymptomatic atrial tachyarrhythmias detected by cardiac implantable electronic devices with atrial sensing, providing automated continuous monitoring and tracings storage, occurring in subjects with no previous clinical atrial fibrillation (AF) and with no AF detected at conventional electrocardiogram recordings. AHREs are associated with an increased thrombo-embolic risk, which is not negligible, although lower than that of clinical AF. The thrombo-embolic risk increases with increasing burden of AHREs, and moreover, AHREs burden shows a dynamic pattern, with tendency to progression along with time, with potential transition to clinical AF. The clinical management of AHREs, in particular with regard to prophylactic treatment with oral anticoagulants (OACs), remains uncertain and heterogeneous. At present, in patients with confirmed AHREs, as a result of device tracing analysis, an integrated, individual and clinically-guided assessment should be applied, taking into account the patients' risk of stroke (to be reassessed regularly) and the AHREs burden. The use of OACs, preferentially non-vitamin K antagonists OACs, may be justified in selected patients, such as those with longer AHREs durations (in the range of several hours or ≥24 h), with no doubts on AF diagnosis after device tracing analysis and with an estimated high/very high individual risk of stroke, accounting for the anticipated net clinical benefit, and informed patient's preferences. Two randomized clinical trials on this topic are currently ongoing and are likely to better define the role of anticoagulant therapy in patients with AHREs.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, dr Subotica 8, 11000 Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Visegradska 26, 11000 Belgrade, Serbia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
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Kodani E, Akao M. Atrial fibrillation and stroke prevention: state of the art-epidemiology and pathophysiology: new risk factors, concepts and controversies. Eur Heart J Suppl 2020; 22:O1-O13. [PMID: 33380940 PMCID: PMC7753870 DOI: 10.1093/eurheartj/suaa176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Atrial fibrillation (AF) increases the risk of thromboembolism, and risk assessment for thromboembolism is necessary for the management of AF patients. CHADS2 and CHA2DS2-VASc scores have been adopted in international guidelines for AF management, but the significance of each risk factor included in these risk scores are sometimes controversial, and the performance of these scores is only modest. There are several other risk factors not included in the scores such as renal dysfunction, low body weight, type of AF (paroxysmal or non-paroxysmal) as well as echocardiographic parameters and blood biomarkers, and physicians should assess patients risk in an integrated manner.
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Affiliation(s)
- Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama-Nagayama Hospital, 1-7-1, Nagayama, Tama-shi, Tokyo 206-8512, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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Andrade JG, Aguilar M, Atzema C, Bell A, Cairns JA, Cheung CC, Cox JL, Dorian P, Gladstone DJ, Healey JS, Khairy P, Leblanc K, McMurtry MS, Mitchell LB, Nair GM, Nattel S, Parkash R, Pilote L, Sandhu RK, Sarrazin JF, Sharma M, Skanes AC, Talajic M, Tsang TSM, Verma A, Verma S, Whitlock R, Wyse DG, Macle L. The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation. Can J Cardiol 2020; 36:1847-1948. [PMID: 33191198 DOI: 10.1016/j.cjca.2020.09.001] [Citation(s) in RCA: 368] [Impact Index Per Article: 73.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/05/2020] [Accepted: 09/05/2020] [Indexed: 12/20/2022] Open
Abstract
The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published in 2010. Since then, periodic updates were published dealing with rapidly changing areas. However, since 2010 a large number of developments had accumulated in a wide range of areas, motivating the committee to complete a thorough guideline review. The 2020 iteration of the CCS AF guidelines represents a comprehensive renewal that integrates, updates, and replaces the past decade of guidelines, recommendations, and practical tips. It is intended to be used by practicing clinicians across all disciplines who care for patients with AF. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate recommendation strength and the quality of evidence. Areas of focus include: AF classification and definitions, epidemiology, pathophysiology, clinical evaluation, screening and opportunistic AF detection, detection and management of modifiable risk factors, integrated approach to AF management, stroke prevention, arrhythmia management, sex differences, and AF in special populations. Extensive use is made of tables and figures to synthesize important material and present key concepts. This document should be an important aid for knowledge translation and a tool to help improve clinical management of this important and challenging arrhythmia.
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Affiliation(s)
- Jason G Andrade
- University of British Columbia, Vancouver, British Columbia, Canada; Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada.
| | - Martin Aguilar
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | - Alan Bell
- University of Toronto, Toronto, Ontario, Canada
| | - John A Cairns
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jafna L Cox
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Dorian
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Paul Khairy
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Girish M Nair
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Stanley Nattel
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Jean-François Sarrazin
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Mukul Sharma
- McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - Mario Talajic
- Montreal Heart Institute, University of Montreal, Montréal, Quebec, Canada
| | - Teresa S M Tsang
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Laurent Macle
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
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HAN-ECG: An interpretable atrial fibrillation detection model using hierarchical attention networks. Comput Biol Med 2020; 127:104057. [PMID: 33126126 DOI: 10.1016/j.compbiomed.2020.104057] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 11/22/2022]
Abstract
Atrial fibrillation (AF) is one of the most prevalent cardiac arrhythmias that affects the lives of many people around the world and is associated with a five-fold increased risk of stroke and mortality. Like other problems in the healthcare domain, artificial intelligence (AI)-based models have been used to detect AF from patients' ECG signals. The cardiologist level performance in detecting this arrhythmia is often achieved by deep learning-based methods, however, they suffer from the lack of interpretability. In other words, these approaches are unable to explain the reasons behind their decisions. The lack of interpretability is a common challenge toward a wide application of machine learning (ML)-based approaches in the healthcare which limits the trust of clinicians in such methods. To address this challenge, we propose HAN-ECG, an interpretable bidirectional-recurrent-neural-network-based approach for the AF detection task. The HAN-ECG employs three attention mechanism levels to provide a multi-resolution analysis of the patterns in ECG leading to AF. The detected patterns by this hierarchical attention model facilitate the interpretation of the neural network decision process in identifying the patterns in the signal which contributed the most to the final detection. Experimental results on two AF databases demonstrate that our proposed model performs better than the existing algorithms. Visualization of these attention layers illustrates that our proposed model decides upon the important waves and heartbeats which are clinically meaningful in the detection task (e.g., absence of P-waves, and irregular R-R intervals for the AF detection task).
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Yan S, Gu K, Wu X, Wang W. Computer simulation study on the effect of electrode-tissue contact force on thermal lesion size in cardiac radiofrequency ablation. Int J Hyperthermia 2020; 37:37-48. [PMID: 31918588 DOI: 10.1080/02656736.2019.1708482] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Purpose: In cardiac radiofrequency (RF) ablation, RF energy is often used to create a series of transmural lesions for blocking accessory conduction pathways. Electrode-tissue contact force (CF) is one of the key determinants of lesion formation during RF ablation. Low electrode-tissue CF is associated with ineffective RF lesion formation, whereas excessive CF may increase the risk of steam pop and perforation. By using finite element analysis, we studied lesion size and features at different values of electrode-tissue CF in cardiac RF ablation.Materials and methods: A computer-model-coupled electrode-tissue CF field, RF electric field, and thermal field were developed to study temperature distribution and lesion dimensions in cardiac tissue subjected to CF of 2, 5, 10, 20, 30, and 40 g with identical RF voltage and duration.Results: Increasing CF was associated with an increase in lesion depth, width, and cross-section area. The lesion cross-section area exhibited a linear increase, and the lesion width was significantly greater than lesion depth under the identical ablation condition. The relationship between CF value and lesion size is a power function: Lesion Size = a × CFb (Lesion Depth = 3.17 × CF0.14 and Lesion Width = 5.17 × CF0.14).Conclusions: This study confirmed that CF is a major determinant of RF lesion size and that electrode-tissue CF affects the amount of power dissipated in tissue. At a constant RF voltage and application time, RF lesion size increases as CF increases.
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Affiliation(s)
- Shengjie Yan
- Electronic Engineering Department, Fudan University, Shanghai, China
| | - Kaihao Gu
- Electronic Engineering Department, Fudan University, Shanghai, China
| | - Xiaomei Wu
- Electronic Engineering Department, Fudan University, Shanghai, China.,Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Weiqi Wang
- Electronic Engineering Department, Fudan University, Shanghai, China
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