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Payami B, Akiash N, Kiarsi M, Moradi A, Kheradmandpour M, Abbaspour S. Evaluation of the Effect of Conversion of Nonvalvular Atrial Fibrillation to Sinus Rhythm on Cardiac Remodeling. Cureus 2024; 16:e60504. [PMID: 38883085 PMCID: PMC11180483 DOI: 10.7759/cureus.60504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) represents the most prevalent cardiac arrhythmia globally, with a significant burden on mortality and morbidity. While rhythm control strategies, particularly electrical cardioversion (EC), have gained traction in recent years, the precise impact of sinus rhythm (SR) restoration on cardiac reverse remodeling remains a subject of debate. METHODS In this study, 23 AF patients underwent elective EC. AF diagnosis was made via ECG by a cardiologist, and candidates for cardioversion were selected by an electrophysiologist. Transthoracic echocardiography (TTE) by utilizing two-dimensional, three-dimensional, and tissue Doppler imaging modalities was performed before cardioversion. Patients who maintained SR after six months underwent a second TTE evaluation. RESULTS SR was restored successfully in all 23 patients and 15 patients (65.2%) maintained SR after six months. SR group had significantly lower baseline cardiac output (CO) and indexed left ventricular end-systolic volume (LVESVi), and better European Heart Rhythm Association (EHRA) scores after six months. Within the SR group, patients exhibited significant changes in mitral regurgitation, tricuspid regurgitation, EHRA score, LVESVi, stroke volume, left ventricle ejection fraction, left ventricle global longitudinal strain, indexed minimum left atrial volume, left atrial emptying fraction, and left and right atrial diameters. Reduced CO was associated with AF recurrence. Receiver operating curve analysis revealed that CO value can predict six-month AF recurrence with a cut-off point of 2.3. CONCLUSION Our study underscores the beneficial effects of SR restoration on cardiac parameters in AF patients post EC. Notably, CO value emerged as a predictor of AF recurrence, emphasizing the importance of comprehensive assessments for predicting long-term outcomes.
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Affiliation(s)
- Babak Payami
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Nehzat Akiash
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Mohammadreza Kiarsi
- Department of Cardiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Amir Moradi
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Mohammad Kheradmandpour
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Somayeh Abbaspour
- Department of Cardiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
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Raniga D, Goda M, Hattingh L, Thorning S, Rowe M, Howes L. Left atrial volume index: A predictor of atrial fibrillation recurrence following direct current cardioversion - A systematic review and meta-analysis. IJC HEART & VASCULATURE 2024; 51:101364. [PMID: 38426114 PMCID: PMC10902144 DOI: 10.1016/j.ijcha.2024.101364] [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: 11/26/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
This systematic review and meta-analysis was conducted to determine the clinical relevance of echocardiographically measured left atrial (LA) size to predict the recurrence of atrial fibrillation (AF) after direct current cardioversion (DCCV). A search was performed on Medline (Ovid), Embase (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL) in Cochrane Library, Wiley and Web of Science (Clarivate) to identify relevant studies. Amongst the initial 4066 citations identified, 31 fulfilled the criteria for inclusion in the data analysis incorporating 2725 patients with a mean follow-up period of 6.5 months. The weighted mean left atrial volume index (LAVI) was 40.56 ml/m2 (95 %CI:37.24-43.88) in the sinus rhythm (SR) maintenance group versus 48.69 ml/m2 (95 % CI: 44.42-52.97) in the AF recurrence group with P value of < 0.001, left atrial diameter (LAD) was 42.06 mm (95 %CI: 41.08-43.05) in the SR maintenance group versus 45.13 mm (95 %CI: 44.09-46.16) in the AF recurrence group, P value < 0.001. Effect size analysis of LAVI showed that each unit increase in LAVI resulted in an increase in the risk of AF recurrence by 6 % (95 % CI: 3 %-10 %). Age and AF duration were also statistically significant between the two groups however comorbidities, use of beta blockers or amiodarone were not significantly different. This meta-analysis shows that AF duration, LAVI, LAD and age predict the risk of recurrence of atrial fibrillation post electrical cardioversion with LAVI being the most clinically relevant echocardiographic feature.
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Affiliation(s)
- Dipesh Raniga
- Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
| | - Mina Goda
- Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
| | - Laetitia Hattingh
- Allied Health Research, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
- School of Pharmacy, The University of Queensland, QLD 4102, Australia
- School of Pharmacy and Medical Sciences, Griffith University, QLD 4222, Australia
| | - Sarah Thorning
- Office of Research, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
| | - Matthew Rowe
- Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
| | - Laurie Howes
- Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
- School of Medicine, Griffith University, QLD 4222, Australia
- School of Medicine, Bond University, QLD 4226, Australia
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Dons M, Olsen FJ, de Knegt MC, Fritz-Hansen T, Mogelvang R, Alhakak AS, Jespersen T, Gislason G, Biering-Sørensen T. Myocardial performance index by tissue Doppler echocardiography predicts adverse events in patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 2020; 21:560-566. [PMID: 31257445 DOI: 10.1093/ehjci/jez173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS The prognostic value of myocardial performance index (MPI) has not yet been assessed in patients with atrial fibrillation (AF). The aim of this study was to evaluate the prognostic value of MPI by tissue Doppler imaging (TDI) M-mode in AF patients. METHODS AND RESULTS Echocardiograms from 210 patients with AF during examination were analysed offline. Patients with known heart failure (HF) were excluded. Time intervals were measured using an M-mode line through the mitral valve leaflets to provide a colour diagram of the mitral leaflet movement so all time intervals could be measured from one cardiac cycle. MPI was calculated as the sum of isovolumic relaxation time and isovolumic contraction time divided by the ejection time [(IVRT+IVCT)/ET]. During a median follow-up of 2.4 years, 84 patients (40%) reached the combined endpoint of major adverse cardiovascular events (MACE), being all-cause mortality, HF, myocardial infarction, or stroke. Increasing MPI was significantly associated with an increased risk of MACE, and the risk increased with 20% per 0.1 increase in MPI [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.10-1.32; P < 0.001]. Increasing MPI was also significantly associated with a lower left ventricular ejection fraction (LVEF) (P < 0.001). Nevertheless, MPI remained an independent predictor even after adjustment for age, sex, diabetes mellitus, left atrial volume, and LVEF (HR 1.12, 95% CI 1.01-1.25; P = 0.038). CONCLUSION Increasing MPI was significantly associated with increased risk of MACE and remained an independent predictor after multivariable adjustment. This demonstrates that the MPI obtained by TDI M-mode might be useful in assessing cardiac function in AF patients with ongoing arrhythmia during examination.
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Affiliation(s)
- Maria Dons
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, Post 835, Hellerup, Copenhagen DK-2900, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, Post 835, Hellerup, Copenhagen DK-2900, Denmark
| | - Martina Chantal de Knegt
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, Post 835, Hellerup, Copenhagen DK-2900, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, Post 835, Hellerup, Copenhagen DK-2900, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, Post 835, Hellerup, Copenhagen DK-2900, Denmark
| | - Alia Saed Alhakak
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, Post 835, Hellerup, Copenhagen DK-2900, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen DK-2200, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, Post 835, Hellerup, Copenhagen DK-2900, Denmark.,Institution of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen DK-2200, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, Post 835, Hellerup, Copenhagen DK-2900, Denmark.,Institution of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen DK-2200, Denmark
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Packer M. Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment. Eur J Heart Fail 2019; 22:214-227. [PMID: 31849132 DOI: 10.1002/ejhf.1646] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/14/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023] Open
Abstract
Obesity and diabetes can lead to heart failure with preserved ejection fraction (HFpEF), potentially because they both cause expansion and inflammation of epicardial adipose tissue and thus lead to microvascular dysfunction and fibrosis of the underlying left ventricle. The same process also causes an atrial myopathy, which is clinically evident as atrial fibrillation (AF); thus, AF may be the first manifestation of HFpEF. Many patients with apparently isolated AF have latent HFpEF or subsequently develop HFpEF. Most patients with obesity or diabetes who have AF and exercise intolerance have increased left atrial pressures at rest or during exercise, even in the absence of diagnosed HFpEF. Among patients with AF, those who also have latent HFpEF have increased risk for systemic thromboembolism and death. The identification of HFpEF in patients with obesity or diabetes alters the risk-to-benefit relationship of commonly prescribed treatments. Bariatric surgery and statins can ameliorate AF and reduce the risk for HFpEF. Conversely, antihyperglycaemic drugs that promote adipogenesis or cause sodium retention (insulin and thiazolidinediones) may increase the risk for heart failure in patients with an underlying ventricular myopathy. Patients with obesity and diabetes who undergo catheter ablation for AF are at increased risk for AF recurrence and for post-ablation increases in pulmonary venous pressures and worsening heart failure, especially if HFpEF coexists. Therefore, AF may be the earliest indicator of HFpEF in patients with obesity or type 2 diabetes, and recognition of HFpEF alters the management of these patients.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA.,Imperial College London, London, UK
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Turker Y, Ekinozu I, Aytekin S, Turker Y, Basar C, Baltaci D, Kaya E. Comparison of Changes in Anxiety and Depression Level Between Dabigatran and Warfarin Use in Patients With Atrial Fibrillation. Clin Appl Thromb Hemost 2016; 23:164-167. [PMID: 26276685 DOI: 10.1177/1076029615600792] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We hypothesized that patients taking warfarin require frequent hospital follow-up and they are at higher risk for complications, so the incidence of depression and anxiety is higher in patients with atrial fibrillation (AF) in the period of taking warfarin compared to the period of taking dabigatran. Fifty patients having AF without valvular diseases under treatment of warfarin in whom a transition to dabigatran was planned were consecutively enrolled in this study and followed up prospectively between July 2013 and July 2014. All patients completed Beck Depression Inventory and Hamilton Anxiety Scale (HAS) at the initiation of study and 6 months after initiation of study. Of the patients enrolled in the study, age, gender, smoking status, and comorbidities were questioned. A total of 50 patients (28 women; mean age 74.6 ± 8.7 years) treated with warfarin in whom a transition to dabigatran was planned were included. Basal mean value of BDS (15.6 ± 7.8 vs 11.5 ± 4.8, P < .001) and HAS (16.8 ± 10.4 vs 12.6 ± 8.1, P < 0.001) was significantly higher in patients when they used warfarin than when they switched to dabigatran. In categorical analysis, frequency of patients with depression (mild, moderate, and severe) was significantly higher in period of warfarin use than after dabigatran transition (n = 24, 48% vs n = 14, 28%, P = .039). Our study demonstrates that patients with nonvalvular AF under treatment of dabigatran had lower BDS and HAS scores compared to warfarin. These findings suggest that dabigatran may increase quality of life and decrease morbidity and mortality due to reduction in anxiety and depression.
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Affiliation(s)
- Yasin Turker
- 1 Department of Cardiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Ismail Ekinozu
- 2 Department of Cardiology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Seda Aytekin
- 2 Department of Cardiology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | | | - Cengiz Basar
- 4 Department of Cardiology, Düzce Atatürk State Hospital, Düzce Turkey
| | - Davut Baltaci
- 5 Department of Family Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Ertugrul Kaya
- 6 Department of Pharmacology, Duzce University, Medical School, Duzce, Turkey
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Besli F, Basar C, Ekinozu I, Turker Y. Relationship Between Tei Index and PEP-Derived Myocardial Performance Index in Sinus Rhythm. Medicine (Baltimore) 2015; 94:e1112. [PMID: 26200613 PMCID: PMC4602998 DOI: 10.1097/md.0000000000001112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The goal of this study was to evaluate the preejection time (PEP)-derived myocardial performance index (MPI) in hypertensive (HT) patients with sinus rhythm and its relationship to the classic Tei index. One hundred five patients were enrolled in the study (65 HT and 40 control subjects). The mean age of all patients was 50.5 ± 15 years and 60% were female. Echocardiography was performed on all patients. MPI was measured with the classic Tei method (MPI-Tei index) and the PEP-derived MPI method by using tissue Doppler echocardiography. Although the MPI-Tei index is defined as the ratio of isovolumetric contraction time (IVCT) along with isovolumetric relaxation time (IVRT) to ejection time (ET), PEP-derived MPI is defined as the ratio of PEP and IVRT to ET. We compared echocardiographic data between the HT group and the control group. MPI-Tei index and the PEP-derived MPI values were higher in the HT group compared with controls (0.52 ± 0.10 vs 0.39 ± 0.07, P < 0.001, and 0.51 ± 0.09 vs 0.39 ± 0.07). PEP-derived MPI was strongly correlated with the MPI-Tei index (r = 0.945, P < 0.001). Our study determined that the PEP-derived MPI might be used in the evaluation of left ventricular function in patients with HT, similar to the classic MPI-Tei index.
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Affiliation(s)
- Feyzullah Besli
- From the Department of Cardiology (FB), Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa; Department of Cardiology (CB), Duzce Ataturk State Hospital; and Department of Cardiology (IE, YT), Duzce University Faculty of Medicine Hospital, Duzce, Turkey
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