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Rivera-Toquica A, Saldarriaga C, Buelvas-Herazo J, Rolong B, Manzur-Jatin F, Mosquera-Jimenez JI, Pacheco-Jimenez OA, Rodriguez-Ceron AH, Rodriguez-Gomez P, Rivera-Toquica F, Trout-Guardiola G G, De Leon-Espitia MA, Castro-Osorio EE, Echeverria LE, Gomez-Mesa JE. Characteristics and Outcomes of Atrial Fibrillation in Chronic Heart Failure Patients: A Comprehensive Analysis of the Colombian Heart Failure Registry. Cardiol Res 2024; 15:37-46. [PMID: 38464710 PMCID: PMC10923258 DOI: 10.14740/cr1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/02/2023] [Indexed: 03/12/2024] Open
Abstract
Background Heart failure (HF) and atrial fibrillation (AF) represent conditions that commonly coexist. The impact of AF in HF has yet to be well studied in Latin America. This study aimed to characterize the sociodemographic and clinical features, along with patients' outcomes with AF and HF from the Colombian Heart Failure Registry (RECOLFACA). Methods Patients with ambulatory HF and AF were included in RECOLFACA, mainly with persistent or permanent AF. A 6-month follow-up was performed. Primary outcome was all-cause mortality. To assess the impact of AF on mortality, we used a logistic regression model. A P value of < 0.05 was considered significant. All statistical tests were two-tailed. Results Of 2,528 patients with HF in the registry, 2,514 records included information regarding AF diagnosis. Five hundred sixty (22.3%) were in AF (mean age 73 ± 11, 56% men), while 1,954 had no AF (mean age 66 ± 14 years, 58% men). Patients with AF were significantly older and had a different profile of comorbidities and implanted devices compared to non-AF patients. Moreover, AF diagnosis was associated with lower quality of life score (EuroQol-5D), mainly in mobility, personal care, and daily activity. AF was prevalent in patients with preserved ejection fraction (EF), while no significant differences in N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels were observed. Although higher mortality was observed in the AF group compared to individuals without AF (8.9% vs. 6.1%, respectively; P = 0.016), this association lost statistical significance after adjusting by age in a multivariate regression model (odds ratio (OR): 1.35; 95% confidence interval (CI): 0.95 - 1.92). Conclusions AF is more prevalent in HF patients with higher EF, lower quality of life and different clinical profiles. Similar HF severity and non-independent association with mortality were observed in our cohort. These results emphasize the need for an improved understanding of the AF and HF coexistence phenomenon.
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Affiliation(s)
- Alex Rivera-Toquica
- Department of Cardiology, Centro Medico para el Corazon, Pereira, Colombia
- Department of Cardiology, Clinica Los Rosales S.A., Pereira, Colombia
- Department of Cardiology, Universidad Tecnologica de Pereira, Pereira, Colombia
| | | | | | - Balkis Rolong
- Department of Cardiology, Cardiologia Integral, Barranquilla, Colombia
| | | | | | | | | | | | - Fernando Rivera-Toquica
- Department of Internal Medicine, Clinica Los Rosales S.A., Pereira, Colombia
- Department of Internal Medicine, IPS Virrey Solis, Pereira, Colombia
| | | | | | | | | | - Juan Esteban Gomez-Mesa
- Department of Cardiology, Fundacion Valle del Lili, Cali, Colombia
- Department of Health Sciences, Universidad Icesi, Cali, Colombia
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Yan Q. The Yin-Yang Dynamics in Cardiovascular Pharmacogenomics and Personalized Medicine. Methods Mol Biol 2022; 2547:255-266. [PMID: 36068468 DOI: 10.1007/978-1-0716-2573-6_11] [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] [Indexed: 06/15/2023]
Abstract
Studies of genetic variants and systems biology have indicated that Yin-Yang dynamics are especially meaningful for cardiovascular pharmacogenomics and personalized therapeutic strategies. The comprehensive concepts of Yin-Yang can be used to characterize the dynamical factors in the adaptive microenvironments of the complex cardiovascular systems. The Yin-Yang imbalances in the complex adaptive systems (CAS) at different levels and stages are essential for cardiovascular diseases (CVDs), including atherosclerosis, hypertension, and heart failure (HF). At the molecular and cellular levels, Yin-Yang interconnections have been considered critical for genetic variants and various pathways, mitophagy, cell death, and cholesterol homeostasis. The significance of the adaptive and spatiotemporal factors in the nonlinear Yin-Yang interactions has been identified in different pathophysiological processes such as fibrosis. The Yin-Yang dynamical balances between proinflammatory and anti-inflammatory cytokines have vital roles in the complex reactions to stress and impairments to the heart. Procoagulant and anticoagulant lipids and lipoproteins in plasma have the Yin-Yang roles that increase or decrease thrombin productions and thrombosis. At the systems level, the Yin-Yang type of relationships has been suggested between atrial fibrillation (AF), diastolic dysfunction (DD), and HF. Based on such perceptions, systemic and personalized cardiovascular profiles can be constructed by embracing the features of CAS, especially the microenvironments and the adaptative pathophysiological stages. These features can be integrated into the comprehensive Yin-Yang dynamics framework to identify more accurate biomarkers for better prevention and treatments. The goal of reestablishing ubiquitous Yin-Yang dynamical balances may become the central theme for personalized and systems medicine for cardiovascular diseases.
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Huang WH, Sung KT, Kuo JY, Chen YJ, Huang CT, Chien SC, Tsai JP, Lo CI, Hsiao CC, Lin JL, Tsai IH, Yun CH, Su CH, Hung TC, Yeh HI, Hung CL. Atrioventricular Longitudinal Mechanics Using Novel Speckle-Tracking Improved Risk Stratification Beyond Baseline Thyroid Hormone in Asymptomatic Subclinical Hypothyroidism. Circ Cardiovasc Imaging 2021; 14:e012433. [PMID: 34784240 DOI: 10.1161/circimaging.121.012433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypothyroidism is reportedly associated with increased cardiovascular risk and heart failure. We aimed to elucidate the mechanistic influence of atrio-ventricular deformations and their prognostic utilizations in asymptomatic subclinical hypothyroidism (SCH). METHODS We assessed speckle-tracking of deformations among 4173 population-based asymptomatic individuals classified as euthyroid (0.25< thyroid-stimulating hormone [TSH] ≤4.0 μIU/mL, n=3799) or having mild (4< TSH ≤10.0 μIU/mL, n=349) or marked (TSH >10 μIU/mL, n=25) SCH. We further related deformational indices to outcomes of atrial fibrillation and heart failure. RESULTS Despite borderline differences in indexed left ventricular mass and left atrial volume (P=0.054 and 0.051), those classified as mild and marked SCH presented with modest but significant reductions of global longitudinal strain, and showed elevated E/tissue Doppler imaging (TDI)-e', markedly diminished peak atrial longitudinal strain and higher left atrial stiffness (all P<0.05) when compared with euthyroid subjects. A higher TSH level was independently associated with reduced TDI-s'/TDI-e', worse global atrio-ventricular strains (global longitudinal strain/peak atrial longitudinal strain), elevated E/TDI-e', and worsened left atrial strain rate components (all P<0.05). Over a median 5.6 years (interquartile range, 4.7-6.5 years) follow-up, myocardial deformations yielded independent risk prediction using Cox regression in models adjusted for baseline covariates, N-terminal pro-brain natriuretic peptide, E/e', and treatment effect. Incorporation of global atrio-ventricular strain (global longitudinal strain/peak atrial longitudinal strain) and strain rates further showed improved risk reclassification when added to the baseline TSH strata (classified as euthyroid and mild and marked SCH; all P<0.05). Cox regression models remained significant with improved risk reclassification beyond TSH-based strata by using slightly different deformational cutoffs after excluding marked SCH group. CONCLUSIONS Hypothyroidism, even when asymptomatic, may widely influence subclinical atrio-ventricular mechanical functions that may lead to higher heart failure and atrial fibrillation risk. We proposed the potential usefulness and prognostic utilization of myocardial strains in such population.
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Affiliation(s)
- Wen-Hung Huang
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan
| | - Kuo-Tzu Sung
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
| | - Jen-Yuan Kuo
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
| | - Ying-Ju Chen
- Telemedicine Center (Y.-J.C., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan
| | - Chun-Ta Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine (C.-T.H., J.-L.L.), MacKay Memorial Hospital, Taipei, Taiwan
| | | | - Jui-Peng Tsai
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan (J.-P.T., T.-C.H.)
| | - Chi-In Lo
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Chung Hsiao
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan
| | - Jiun-Lu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine (C.-T.H., J.-L.L.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
| | | | - Chun-Ho Yun
- Department of Radiology (C.-H.Y.), MacKay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Huang Su
- Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
| | - Ta-Chuan Hung
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan (J.-P.T., T.-C.H.)
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Telemedicine Center (Y.-J.C., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Telemedicine Center (Y.-J.C., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan.,Institute of Biomedical Sciences (C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
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Hosseini Farahabadi M, Milani-Nejad S, Liu S, Yu W, Shafie M. Left Atrial Dilatation and Reduced Left Ventricular Ejection Fraction Are Associated With Cardioembolic Stroke. Front Neurol 2021; 12:680651. [PMID: 34589043 PMCID: PMC8475948 DOI: 10.3389/fneur.2021.680651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Left atrial (LA) dilatation and heart failure are independent risk factors for ischemic stroke. The goal of this study is to evaluate the association between LA dilatation and reduced left ventricular ejection fraction (EF) with cardioembolic stroke. Methods: Four hundred fifty-three patients with ischemic stroke admitted to the University of California, Irvine between 2016 and 2017 were included based on the following criteria: age >18 and availability of echocardiogram. Stroke was categorized into cardioembolic and non-cardioembolic. EF was categorized into normal: 52-72% (male), 54-74% (female), mildly abnormal: 41-51% (male), 41-53% (female), moderately abnormal: 30-40%, and severely abnormal: <30%. LA volume was categorized into normal (≤34 ml/m2) vs. enlarged (≥35 ml/m2). Other variables included gender, hypertension [systolic blood pressure (SBP) ≥ 140 or diastolic blood pressure (DBP) ≥ 90], and known history of atrial fibrillation (Afib). Results: Two hundred eighteen patients had cardioembolic, and 235 had non-cardioembolic stroke. Among patients with cardioembolic stroke, 49 (22.4%) and 142 (65%) had reduced EF and enlarged LA, respectively, as compared with 19 (8.1%) and 65 (27.7%) patients with non-cardioembolic stroke (p < 0.0001). The odds of cardioembolic stroke were 2.0 (95% CI: 0.1-6.0) and 8.8 times (95% CI: 1.9-42.3) higher in patients with moderately and severely reduced EF, respectively, than in patients with normal EF. The odds of cardioembolic stroke was 2.4 times (95% CI: 1.5-3.9) higher in patients with enlarged LA than in patients with normal LA size. Compared with patients with normal LA and EF, patients with combined enlarged LA and reduced EF had significantly higher rates of Afib (43.4 vs. 9.0%, p < 0.0001) and cardioembolic stroke (78.3 vs. 43.4%, p < 0.0001). Conclusions: LA dilatation along with reduced EF is a reliable predictor of Afib and cardioembolic stroke. Further studies are warranted to determine the benefit of anticoagulation for secondary stroke prevention in such patient population.
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Affiliation(s)
| | - Shadi Milani-Nejad
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Shimeng Liu
- Department of Neurology, University of California, Irvine, Irvine, CA, United States.,Department of Neurology, Beijing Tiatan Hospital, Capital Medical University, Beijing, China
| | - Wengui Yu
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Mohammad Shafie
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
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Yang E, Spragg D, Schulman S, Gilotra NA, Kilic A, Salenger R, Whitman G, Metkus TS. Rate Versus Rhythm Control in Heart Failure Patients with Post-Operative Atrial Fibrillation After Cardiac Surgery. J Card Fail 2021; 27:915-919. [PMID: 34364670 DOI: 10.1016/j.cardfail.2021.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Whether rhythm control for post-operative atrial fibrillation after cardiac surgery (POAF) is superior to rate control in patients with heart failure or systolic dysfunction (HF) is not known. METHODS We performed a post-hoc analysis of a trial by the Cardiothoracic Surgical Trials Network, which randomized patients with POAF after cardiac surgery to rate control or rhythm control with amiodarone/cardioversion. We assessed subgroups of trial participants defined by heart failure/cardiomyopathy history or left ventricular ejection fraction (LVEF) < 50%. We conducted a stratified analysis in patients with and without HF to explore outcomes of rhythm versus rate control strategy. RESULTS Of 523 subjects with POAF after cardiac surgery, 131 (25%) had HF. 49% of HF patients were randomized to rhythm control. In HF patients, rhythm control was associated with less atrial fibrillation within the first 7 days. There were no differences in rhythm at 30- and 60-day follow-up. In the HF group, there were significantly more subjects with AF < 48 hours in the rhythm control group compared to rate control group- 68.8% compared to 46.3%, P=0.009. By comparison, in the non-HF stratum, 54.4% of the rate control group had AF < 48 hours compared to 63.5% of the rhythm control group (P=0.067).), though there was no significant interaction of heart failure with cardiac rhythm at 7 days (Pinteraction 0.16). CONCLUSION Rhythm control for HF patients with POAF after cardiac surgery increases early restoration of sinus rhythm. Rate and rhythm control are both reasonable for HF patients with AF after cardiac surgery.
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Affiliation(s)
- Eunice Yang
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine, Baltimore MD
| | - David Spragg
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine, Baltimore MD
| | - Steven Schulman
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine, Baltimore MD
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine, Baltimore MD
| | - Ahmet Kilic
- Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore MD
| | - Rawn Salenger
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Glenn Whitman
- Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore MD
| | - Thomas S Metkus
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine, Baltimore MD; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore MD.
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Farag M, Kiberu Y, Ashwin Reddy S, Shoaib A, Egred M, Krishnan U, Fares M, Peverelli M, Gorog DA, Elmahdy W, Berman M, Osman M. Preoperative Atrial Fibrillation is associated with long-term morTality in patients undergoing suRgical AortiC valvE Replacement. J Card Surg 2021; 36:3561-3566. [PMID: 34309884 DOI: 10.1111/jocs.15844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is frequent after any cardiac surgery, but evidence suggests it may have no significant impact on survival if sinus rhythm (SR) is effectively restored early after the onset of the arrhythmia. In contrast, management of preoperative AF is often overlooked during or after cardiac surgery despite several proposed protocols. This study sought to evaluate the impact of preoperative AF on mortality in patients undergoing isolated surgical aortic valve replacement (AVR). METHODS We performed a retrospective, single-center study involving 2628 consecutive patients undergoing elective, primary isolated surgical AVR from 2008 to 2018. A total of 268/2628 patients (10.1%) exhibited AF before surgery. The effect of preoperative AF on mortality was evaluated with univariate and multivariate analyses. RESULTS Short-term mortality was 0.8% and was not different between preoperative AF and SR cohorts. Preoperative AF was highly predictive of long-term mortality (median follow-up of 4 years [Q1-Q3 2-7]; hazard ratio [HR]: 2.24, 95% confidence interval [CI]: 1.79-2.79, p < .001), and remained strongly and independently predictive after adjustment for other risk factors (HR: 1.54, 95% CI: 1.21-1.96, p < .001) compared with preoperative SR. In propensity score-matched analysis, the adjusted mortality risk was higher in the AF cohort (OR: 1.47, 95% CI: 1.04-1.99, p = .03) compared with the SR cohort. CONCLUSIONS Preoperative AF was independently predictive of long-term mortality in patients undergoing isolated surgical AVR. It remains to be seen whether concomitant surgery or other preoperative measures to correct AF may impact long-term survival.
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Affiliation(s)
- Mohamed Farag
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - Yusuf Kiberu
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - S Ashwin Reddy
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Mohaned Egred
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Unni Krishnan
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Mina Fares
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Diana A Gorog
- Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - Walid Elmahdy
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Marius Berman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Mohamed Osman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,National Heart Institute, Giza, Egypt
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Anthony C, Griffin BP. Vicious Cycle of Concurrent Low-Flow, Low-Gradient Aortic Stenosis and Atrial Fibrillation. Circ Cardiovasc Imaging 2021; 14:e013061. [PMID: 34247517 DOI: 10.1161/circimaging.121.013061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chris Anthony
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH
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Assessment of the Left Ventricular Diastolic Function and Its Association with the Left Atrial Pressure in Patients with Atrial Fibrillation. ACTA ACUST UNITED AC 2020; 2:55-65. [PMID: 36263078 PMCID: PMC9536730 DOI: 10.36628/ijhf.2020.0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/30/2023]
Abstract
Background and Objectives The evaluation of left ventricular (LV) diastolic function in patients with atrial fibrillation (AF) is challenging. This study aimed to investigate the efficacy of the diagnostic algorithm for LV diastolic dysfunction (LVDD) in the current guidelines and to evaluate the association between increased left atrial pressure (LAP) and LV diastolic parameters. Methods One hundred and twenty-four patients with non-valvular AF and a preserved LV ejection fraction who had the same rhythm status on echocardiography and LAP measurements during catheter ablation were included. LV diastolic function was classified as normal, indeterminate, or LVDD according to the recent guidelines. Increased LAP was defined as mean LAP (mLAP) ≥15 mmHg. Results The mLAP was not different among the normal, indeterminate, and LVDD groups. However, the prevalence of increased LAP was higher in the LVDD group. Among the LV diastolic parameters, only medial E/e′ was independently associated with mLAP in the whole study population. In patients with persistent AF (PeAF), E/e′ and e′ were significantly associated with mLAP, whereas in paroxysmal AF (PAF), mLAP was not associated with the LV diastolic parameters but with left atrial conduit function. Conclusions In general, increased LAP is known to be closely related with LVDD. However, the algorithm for LVDD from recent guidelines does not reflect well the increased LAP in AF patients. The diastolic parameters may aid in estimating the increased LAP in PeAF but may only have limited value for assessing increased LAP in PAF.
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Mortalidad y fibrilación auricular en el estudio FIACA: evidencia de un efecto diferencial según el diagnóstico al ingreso hospitalario. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Clavel-Ruipérez FG, Consuegra-Sánchez L, Félix Redondo FJ, Lozano Mera L, Mellado-Delgado P, Martínez-Díaz JJ, López Mínguez JR, Fernández-Bergés D. Mortality and Atrial Fibrillation in the FIACA Study: Evidence of a Differential Effect According to Admission Diagnosis. ACTA ACUST UNITED AC 2017; 71:155-161. [PMID: 28528882 DOI: 10.1016/j.rec.2017.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/09/2017] [Indexed: 01/30/2023]
Abstract
INTRODUCTION AND OBJECTIVES Atrial fibrillation (AF) is an independent risk factor for mortality in several diseases. However, data published in acute decompensated heart failure (DHF) are contradictory. Our objective was to investigate the impact of AF on mortality in patients admitted to hospital for DHF compared with those admitted for other reasons. METHODS This retrospective cohort study included all patients admitted to hospital within a 10-year period due to DHF, acute myocardial infarction (AMI), or ischemic stroke (IS), with a median follow-up of 6.2 years. RESULTS We included 6613 patients (74 ± 11 years; 54.6% male); 2177 with AMI, 2208 with DHF, and 2228 with IS. Crude postdischarge mortality was higher in patients with AF hospitalized for AMI (incident rate ratio, 2.48; P < .001) and IS (incident rate ratio, 1.84; P < .001) than in those without AF. No differences were found in patients with DHF (incident rate ratio, 0.90; P = .12). In adjusted models, AF was not an independent predictor of in-hospital mortality by clinical diagnosis. However, AF emerged as an independent predictor of postdischarge mortality in patients with AMI (HR, 1.494; P = .001) and IS (HR, 1.426; P < .001), but not in patients admitted for DHF (HR, 0.964; P = .603). CONCLUSIONS AF was as an independent risk factor for postdischarge mortality in patients admitted to hospital for AMI and IS but not in those admitted for DHF.
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Affiliation(s)
| | | | - Francisco Javier Félix Redondo
- Unidad de Investigación, Programa de Investigación en Enfermedades Cardiovasculares PERICLES, Servicio Extremeño de Salud, Área de Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain
| | - Luis Lozano Mera
- Unidad de Investigación, Programa de Investigación en Enfermedades Cardiovasculares PERICLES, Servicio Extremeño de Salud, Área de Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain; Centro de Salud Urbano I, Servicio Extremeño de Salud, Mérida, Badajoz, Spain
| | - Pedro Mellado-Delgado
- Unidad de Investigación, Programa de Investigación en Enfermedades Cardiovasculares PERICLES, Servicio Extremeño de Salud, Área de Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain
| | - Juan José Martínez-Díaz
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - José Ramón López Mínguez
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - Daniel Fernández-Bergés
- Unidad de Investigación, Programa de Investigación en Enfermedades Cardiovasculares PERICLES, Servicio Extremeño de Salud, Área de Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain.
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Longitudinal relationships of periodic limb movements during sleep and incident atrial fibrillation. Sleep Med 2016; 25:78-86. [PMID: 27823721 DOI: 10.1016/j.sleep.2016.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/17/2016] [Accepted: 08/27/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to examine relationship between periodic limb movements during sleep (PLMS) and incident atrial fibrillation/flutter (AF). METHODS Prospective multicenter cohort (n = 2273: adjudicated AF group; n = 843: self-reported AF group) of community-dwelling men without prevalent AF were followed for an average of 8.3 years (adjudicated) and 6.5 years (self-reported). PLMS index (PLMI, <5 (ref), ≥5 to <30, ≥30) and PLM arousal index (PLMAI, <1 (ref), ≥1 to <5, ≥5) were measured by polysomnography. Incident adjudicated and self-reported AF were analyzed by Cox proportional hazards and logistic regression, respectively, and adjusted for age, clinic, race, body mass index (BMI), alcohol use, cholesterol level, cardiac medications, pacemaker, apnea-hypopnea index, renal function, and cardiac risk. The interaction of age and PLMS was examined. RESULTS In this primarily Caucasian (89.8%) cohort of older men (mean age 76.1 ± 5.5 years) with BMI of 27.2 ± 3.7, there were 261 cases (11.5%) of adjudicated and 85 cases (10.1%) of self-reported incident AF. In the overall cohort, PLMI and PLMAI were not associated with adjudicated or self-reported AF. There was some evidence of an interaction of age and PLMI (p = 0.08, adjudicated AF) and PLMAI (p ≤ 0.06, both outcomes). Among men aged ≥76 years, the highest PLMI tertile was at increased risk of adjudicated AF (≥30 vs. <5; hazard ratio (HR) = 1.63, 1.01-2.63) and the middle PLMAI tertile predicted increased risk of both outcomes (1 to <5 vs. <1; adjudicated, HR = 1.65, 1.05-2.58; self-reported HR = 5.76, 1.76-18.84). No such associations were found in men aged <76 years. CONCLUSIONS Although PLMS do not predict AF incidence in the overall cohort, the findings suggest PLMS increases incident AF risk in the older subgroup.
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Yoon JH, Kim MH, Chung H, Choi EY, Min PK, Yoon YW, Lee BK, Hong BK, Rim SJ, Kwon HM, Kim JY. Echo-Doppler-derived indexes of ventricular stiffness and ventriculo-arterial interaction as predictors of new-onset atrial fibrillation in patients with heart failure. Cardiovasc Ultrasound 2016; 14:7. [PMID: 26846527 PMCID: PMC4743395 DOI: 10.1186/s12947-016-0050-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is common in patients with heart failure (HF) and worsens their prognosis. Vulnerability to changes in loading is an important factor in the development of AF and is strongly influenced by ventricular stiffness and ventriculo-arterial interaction. The aim of this study was to investigate predictors of AF development in patients with HF. METHODS We studied 349 patients with stable HF. The following parameters of ventricular stiffness and ventriculo-arterial interaction were derived from echo-Doppler measurements: left ventricular (LV) diastolic elastance (Ed), effective arterial elastance (Ea), LV end-systolic elastance (Ees) and ventricular-vascular coupling index (VVI). RESULTS AF occurred in 57 (16.3%) patients over a median follow up of 30.3 months. Echo-Doppler-derived parameters of ventricular stiffness and ventriculo-arterial interaction were closely associated with HF severity. Ed was independently associated with AF after adjustment for age, hypertension, diabetes mellitus, and left atrial volume index (hazard ratio [HR] 5.49, p = 0.018). Ea and VVI were also associated with new-onset AF (HR 1.66, p = 0.027, and HR 1.06, p = 0.001, respectively). CONCLUSIONS Echo-Doppler indexes of ventricular stiffness are closely associated with HF severity. LV diastolic elastance (Ed) is the strongest predictor of new-onset AF in HF patients.
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Affiliation(s)
- Ji Hyun Yoon
- Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea
| | - Myung-Hyun Kim
- Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea
| | - Hyemoon Chung
- Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea
| | - Eui-Young Choi
- Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea
| | - Pil-Ki Min
- Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea
| | - Young Won Yoon
- Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea
| | - Byoung Kwon Lee
- Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea
| | - Bum-Kee Hong
- Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea
| | - Se-Joong Rim
- Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea
| | - Hyuck Moon Kwon
- Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea
| | - Jong-Youn Kim
- Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
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13
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Kato TS, Di Tullio MR, Qian M, Wu M, Thompson JLP, Mann DL, Sacco RL, Pullicino PM, Freudenberger RS, Teerlink JR, Graham S, Lip GYH, Levin B, Mohr JP, Labovitz AJ, Estol CJ, Lok DJ, Ponikowski P, Anker SD, Homma S. Clinical and Echocardiographic Factors Associated With New-Onset Atrial Fibrillation in Heart Failure - Subanalysis of the WARCEF Trial. Circ J 2016; 80:619-26. [PMID: 26804607 DOI: 10.1253/circj.cj-15-1054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Heart failure (HF) patients have a high incidence of new-onset AF. Given the adverse prognostic influence of AF in HF, identifying patients at high risk of developing AF is important. METHODS AND RESULTS The incidence and factors associated with new-onset AF were investigated in patients in sinus rhythm with reduced LVEF enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. Analyses involved clinical factors alone (n=2,219), and clinical plus echocardiographic findings (n=1,125). During 3.5±1.8 years of follow-up, 212 patients (9.6% of total cohort) developed AF. In both samples, new-onset AF was associated with age, male sex, White race, and IHD. Among echocardiographic variables, only LAD predicted AF. On multivariate Cox modeling, age (HR, 1.02; 95% CI: 1.00-1.03, P=0.008), IHD (HR, 1.37; 95% CI: 1.02-1.84, P=0.036) and LAD (HR, 1.48; 95% CI: 1.15-1.91, P=0.003) remained associated with AF onset. Patients with IHD, LAD>4.5 cm and age>50 years had a 2.5-fold higher risk of AF than patients without any of these characteristics (HR, 2.52; 95% CI: 1.72-3.69, P<0.0001). CONCLUSIONS Age, IHD and LAD independently predict new-onset AF in HF patients in sinus rhythm, at younger age and smaller LAD than generally believed. This information may be useful to risk-stratify HF patients for AF development, allowing close monitoring and possibly early detection. (Circ J 2016; 80: 619-626).
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Affiliation(s)
- Tomoko S Kato
- Department of Medicine, Division of Cardiology, Columbia University Medical Center
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14
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Campbell RT, McMurray JJV. Comorbidities and differential diagnosis in heart failure with preserved ejection fraction. Heart Fail Clin 2015; 10:481-501. [PMID: 24975911 DOI: 10.1016/j.hfc.2014.04.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Careful consideration must be given when diagnosing heart failure with preserved ejection fraction (HF-PEF). HF-PEF diagnosis is challenging and essentially a diagnosis of exclusion, with comorbidities potentially making the diagnosis more difficult. This article describes the comorbidities commonly associated with HF-PEF, the potential influence of these comorbidities on morbidity and mortality, and the differential diagnosis.
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Affiliation(s)
- Ross T Campbell
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK.
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15
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Khan MA, Ahmed F, Neyses L, Mamas MA. Atrial fibrillation in heart failure: The sword of Damocles revisited. World J Cardiol 2013; 5:215-227. [PMID: 23888191 PMCID: PMC3722419 DOI: 10.4330/wjc.v5.i7.215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 06/06/2013] [Accepted: 06/20/2013] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) and atrial fibrillation (AF) frequently coexist and have emerged as major cardiovascular epidemics. There is growing evidence that AF is an independent prognostic marker in HF and affects patients with both reduced as well as preserved LV systolic function. There has been a general move in clinical practice from a rhythm control to a rate control strategy in HF patients with AF, although recent data suggests that rhythm control strategies may provide better outcomes in selected subgroups of HF patients. Furthermore, various therapeutic modalities including pace and ablate strategies with cardiac resynchronisation or radiofrequency ablation have become increasingly adopted, although their role in the management of AF in patients with HF remains uncertain. This article presents an overview of the multidimensional impact of AF in patients with HF. Relevant literature is highlighted and the effect of various therapeutic modalities on prognosis is discussed. Finally, while novel anticoagulants usher in a new era in thromboprophylaxis, research continues in a variety of new pathways including selective atrial anti-arrhythmic agents and genomic polymorphisms in AF with HF.
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16
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Erdem A, Tekelioğlu ÜY, Yazıcı M. The relationship between cardiac autonomic functions and left ventricular diastolic dysfunctions in metabolic syndrome. Int J Cardiol 2013; 166:542. [DOI: 10.1016/j.ijcard.2012.09.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/25/2012] [Indexed: 11/16/2022]
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Khan MA, Neyses L, Mamas MA. Atrial fibrillation in heart failure: an innocent bystander? Curr Cardiol Rev 2013; 8:273-80. [PMID: 22920477 PMCID: PMC3492811 DOI: 10.2174/157340312803760839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 05/01/2012] [Accepted: 06/20/2012] [Indexed: 12/21/2022] Open
Abstract
Heart failure (HF) and atrial fibrillation (AF) frequently coexist and each complicates the course of the other. The purpose of this review is to analyse the prognostic impact of AF in patients with HF and assess whether there is an advantage in targeting therapies towards the maintenance of sinus rhythm (SR) in this cohort of patients. The presence of AF in patients with HF has been reported to be independently associated with an increase in mortality in many studies and this increased risk is observed in those with both preserved and impaired LV systolic function. The optimal strategy for targeting AF in patients with HF is unclear but recent randomised controlled studies indicate no significant prognostic advantage associated with a rhythm control strategy as compared to a rate control strategy. A number of small studies have investigated the role of both cardiac resynchronization therapy (CRT) and AF catheter ablation for the maintenance of / conversion to SR in patients with HF with initial promising results although larger randomised controlled studies will need to be performed to define the role of these modalities in the treatment of this cohort and whether preliminary benefits observed in these studies translate to improvements in longer term prognosis. Finally, there has been a focus on modifying the arrhythmogenic atrial substrate and neurohormonal milieu by pharmacological means in order to prevent AF although it remains to be seen whether this approach proves to be efficacious with improvements in clinically relevant outcomes.
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Affiliation(s)
- M A Khan
- Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9PT, UK
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Abstract
This article provides an evidence-based overview of heart failure (HF), including its pathogenesis, staging, assessment, prognosis, and treatment with intravenous inotropic medications in the home. Inotropic infusions in the home setting require advanced care planning, symptom management, and knowledge about ambulatory pumps and devices. These medications can be safely used throughout the continuum of care as pediatric/adult bridges from transplant to hospice care. Nurses who recognize advanced HF symptomatology and use prognostic/risk-stratification models will be better prepared to facilitate this advanced care planning, thus supporting optimal treatment outcomes. The ultimate goal of care for heart failure therapy in the home is to integrate pharmacotherapeutic knowledge of treatment advances with comfort measures and to provide them to patients concurrently and in a seamless process.
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19
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Burup Kristensen C, Jensen JS, Sogaard P, Carstensen HG, Mogelvang R. Atrial fibrillation in aortic stenosis--echocardiographic assessment and prognostic importance. Cardiovasc Ultrasound 2012; 10:38. [PMID: 23006976 PMCID: PMC3517318 DOI: 10.1186/1476-7120-10-38] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 09/18/2012] [Indexed: 01/20/2023] Open
Abstract
Background Atrial fibrillation (AFib) exists more frequently in patients with aortic stenosis (AS) than in patients without, and AFib may be a sign of progressive deterioration of AS. Echocardiographic assessment of AS in sinus rhythm is well documented, however, little is known about AFib in AS since such patients often are excluded from clinical echocardiographic trials. Aim The purpose of this study was to assess the prognostic importance of AFib in AS. Methods The study was designed as a single-center case-control study. Patients with AS and AFib were enrolled as cases (n = 103) and subsequently matched to controls (103 patients with AS but sinus rhythm). Cases and controls were matched according to age, gender and severity of AS. Primary outcome was all cause mortality and follow-up was 100% complete. Results Compared to controls the group with AFib had lower mean ejection fraction (42% vs. 49%; p < 0.001) and stroke volume (47 mL vs. 55 mL; p = 0.004), but higher heart rate (81 bpm vs. 68 bpm; p < 0.001) and no significant difference with regard to cardiac output (3.8 L vs. 4.0 L; p = 0.29). Accordingly, aortic jet velocity and gradients were significantly lower in AFib compared to controls but there were no differences (p = 0.38) in aortic valve area calculated by the continuity equation. During a median follow-up of 2.3 years (IQR: 1.2-3.6), 70 (34%) patients with AS died: 42 patients with AFib and 28 patients with sinus rhythm (p < 0.02). After adjusting for echocardiographic significant differences, AFib remained an independent predictor of mortality (HR 2.72 (95% CI: 1.12–6.61), p < 0.03). There was no significant interaction (p = 0.62) between AFib and AS on the risk of mortality, indicating that AFib predicted bad outcome regardless of the severity of AS. Conclusions AFib is an independent risk factor in patients with AS and the prognostic impact of AFib seems to be the same despite the severity of AS.
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Affiliation(s)
- Charlotte Burup Kristensen
- Copenhagen University Hospital Gentofte, Department of Cardiology P835, Niels Andersens vej 65, DK-2900, Hellerup, Denmark.
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