Cardiac variables associated with atrial fibrillation occurrence and mortality in octogenarians implanted with dual chamber permanent pacemakers

Heart rate variability in patients with atrial fibrillation of sinus rhythm or atrial fibrillation: chaos or merit?

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia characterized by consistently irregular atrial and ventricular contractions. Heart rate variability (HRV) refers to the changes in the intervals between consecutive ventricular heartbeats. In sinus rhythm, HRV may be subtle and is quantitatively reflecting the dynamic interplay of the cardiac autonomic nervous system, which plays a crucial role in the onset, development, and maintenance of AF. HRV metrics, consisting of time-domain, frequency-domain, and nonlinear parameters, have been verified to vary significantly before and after AF episodes, and AF treatment-related procedures such as electrical cardioversion, ablation, and surgery of AF. Therefore, HRV may serve as a digital biomarker in predicting AF risk in long-term and acute risk period, identification of patients with AF risk in sinus rhythm and recurrence risk stratification after procedures. HRV in AF rhythm, predominantly influenced by dynamic atrioventricular node conduction under the onslaught of irregular atrial impulses, shows a huge disparity compared to that in sinus rhythm. Despite this, HRV in AF rhythm still provides valuable prognostic information, as reduced HRV may indicate a poor heart function and outcomes in patients with AF. Despite being influenced by lots of variables, HRV can still serve as an independent digital biomarker in the clinical management of AF throughout its entire lifecycle.

Troponin is associated with mortality and significant coronary artery disease in patients treated for atrial fibrillation in the emergency department

Troponin is a crucial biomarker in the emergency department (ED). Current evidence does not support differentiation between an uncomplicated tachyarrhythmia and significant coronary artery disease (CAD). The aim of the present study was to assess the use of troponins to predict CAD and mortality in patients with acute atrial fibrillation/flutter (AF/AFL). This cohort study included 3,425 consecutive episodes with AF/AFL treated at the ED of the Medical University of Vienna between 2012 and 2024. Coronary angiography was performed in 251 cases. Patients were grouped according to the troponin levels (ng/L): 0-4; 5-14; 15-28; 29-51 and ≥ 52. Outcomes were significant CAD and mortality. Of all cases (n = 3,425), coronary angiography was performed within 30 days in 251 (7%); 115 (46%) had significant CAD. The rate increased with rising troponin levels: baseline troponin, ng/L, %: 5-14: 32, 15-28: 38, 29-51: 47, ≥ 52: 57; p = 0.028; serial troponin, ng/L, %: 5-14: 15, 15-28: 19; 29-51: 54; ≥ 52: 66; p < 0.001. Sensitivity for significant CAD at 5 ng/L was 99%; specificity at ≥ 52 ng/L was 77% and increased to > 92% at ≥ 92 ng/L. 713 patients (21%) died in an observation time of 13,771 years. A troponin value ≥ 15 ng/L was significantly associated with all-cause mortality. Prevalence of significant CAD increases with rising and dynamic troponin levels. Troponin thresholds for further diagnostics or interventions may be different in AF/AFL than in the general population. Elevated troponin levels at baseline and in subsequent measurements as well as significant changes are associated with an increased all-cause mortality.

Prognostic values of atrial high-rate episodes on mortality risks in CIED patients

BACKGROUND

Recent data showed that patients with cardiac implantable electronic devices (CIEDs) who have atrial high-rate episodes (AHRE) have an increased risk of systemic thromboembolism even without a history of atrial fibrillation. However, data regarding the impact of AHRE on mortality outcomes remain conflicting. This study aims to elucidate this relationship by summarizing all available data via systematic review and meta-analysis.

METHODS

We systematically reviewed MEDLINE and EMBASE from inception to May 2024 to evaluate the association between AHRE and mortality risk in patients with CIED who did not have a history of atrial fibrillation at implantation. We compared all-cause and cardiovascular mortality in patients with AHRE to those without AHRE. Relative risk (RR) or hazard ratio and their 95 % confidence intervals (CIs) were extracted from each study and combined using the generic inverse variance method.

RESULTS

A total of 15 cohort studies were included in the meta-analysis. The pooled analysis showed that patients with AHRE had a higher risk of all-cause mortality compared to those without AHRE, with a pooled RR of 1.57 (95 % CI 1.21-2.03; I2 = 67 %; p < 0.001). Similarly, AHRE was associated with higher cardiovascular mortality, with a pooled RR of 1.80 (95 % CI 1.06-3.05; I2 = 49 %; p = 0.03).

CONCLUSIONS

Our study found that patients with CIEDs who developed AHRE were at a higher risk of all-cause and cardiovascular mortality compared to those without AHRE.

Associations of Systemic Immune-Inflammation Index With Mortality Risk Among Adults in Diabetic Kidney Disease, NHANES 1999 to 2018

OBJECTIVES

Immune-inflammation plays a crucial role in the pathogenesis of diabetic kidney disease (DKD), but an exact assessment of indicators remains undefined. In this study we address the link between systemic immune-inflammation index (SII) and mortality risk in DKD, and we explore the effect of sex disparities.

METHODS

Data from patients with DKD from the National Health and Nutritional Examination Surveys (NHANES, 1999 to 2018) were studied and their causes of death were identified from NHANES-related files. A weighted Cox model was used to evaluate hazard ratios for all-cause, cardiovascular, and cardiocerebrovascular mortality, and these associations were visualized by smoothing curves.

RESULTS

The average SII was 634.20 (103/μL). There were 1,283 deaths recorded during 273,422 person months (396 were cardiovascular related and 461 were cardiocerebrovascular related). Higher SIIs in the fifth quintile were significantly associated with increased mortality (p<0.01). SII trends showed an increased risk of all-cause mortality of >697.0 (103/μL), cardiovascular risk of >717.8 (103/μL), and cardiocerebrovascular risk of >650.0 (103/μL). In men, mortality increased when SII reached 500 to 660 (103/μL) and 700 to 760 (103/μL) for women.

CONCLUSIONS

There was a significant association between higher SII and increased risk of all-cause, cardiovascular, and cardiocerebrovascular mortality in DKD patients. In addition, although men had lower SII, their mortality was higher than that of women.

Correlation of epicardial adipose tissue with microvascular obstruction and its effect on new-onset atrial arrhythmias after PCI in STEMI patients

Epicardial adipose tissue (EAT) is associated with microvascular obstruction (MVO). However, its association with new-onset atrial arrhythmias after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is unclear. We investigated the correlation of cardiac magnetic resonance (CMR)-measured EAT with MVO and its effect on new-onset atrial arrhythmias after PCI in patients with STEMI. This study employed a single-centre retrospective design. Patients diagnosed with STEMI who underwent CMR after PCI between January 2019 and January 2023 were consecutively included and followed-up regularly. Participants were categorised based on whether they developed new-onset atrial arrhythmia after PCI. In comparison to the non-arrhythmia group, the atrial arrhythmia group exhibited higher values for age, heart rate, peak hs-TnT, peak NT-proBNP, EATV, LAES, LAED, and MVO, alongside reduced LVEF. A positive association was identified between EATV and MVO. Univariate analysis using logistic regression revealed that age, heart rate, hs-TnT level, NT-proBNP level, LVEF, EATV, LAES, LAED, and MVO were significant risk factors for atrial arrhythmia. Multivariate logistic regression analysis further identified age, LAES, EATV, and MVO as independent predictors of atrial arrhythmia. ROC curve analysis produced AUC values of 0.690 for age, 0.584 for LAES, 0.607 for MVO, and 0.769 for EATV. The EATV demonstrated a strong positive relationship with MVO after PCI in patients with STEMI. Age, LAES, EATV, and MVO were independent predictors of new-onset atrial arrhythmias and exhibited substantial prognostic significance.

Prognostic nutritional index as a predictor of mortality in acute ischemic stroke

OBJECTIVE

Nutritional and immune status have been recognized as important factors influencing the prognosis of acute ischemic stroke. This study aims to evaluate the prognostic value of the Prognostic Nutritional Index (PNI) in predicting 30-day mortality in patients with acute ischemic stroke.

METHODS

A retrospective cohort study was conducted in a tertiary care hospital emergency department. Patients diagnosed with acute ischemic stroke between January 1, 2019, and January 1, 2024, were included. PNI was calculated using serum albumin levels and total lymphocyte count. Data on demographics, clinical parameters, laboratory results, and 30-day mortality were collected from electronic medical records and patient follow-up via phone calls. Appropriate statistical tests were applied based on the data distribution, and p-values < 0.05 were considered statistically significant.

RESULTS

A total of 169 patients were included in the study, with a mean age of 74.2 ± 10.5 years, and 55 % were male. Of these patients, 25 (14.8 %) did not survive within the 30-day follow-up period. PNI was significantly lower in deceased patients compared to survivors (p < 0.001). The area under the receiver operating characteristic (AUROC) curve was 0.831, indicating good predictive accuracy for 30-day mortality. The optimal PNI cut-off of 37.21 demonstrated a sensitivity of 72.0 % and a specificity of 81.2 %.

CONCLUSION

The PNI is a reliable predictor of 30-day mortality in acute ischemic stroke patients. Lower PNI values were associated with higher mortality, highlighting the importance of nutritional and immune status in stroke outcomes. PNI could be used in clinical practice to help identify high-risk patients and inform more appropriate treatment decisions.

Impact of Dipeptidyl Peptidase-4 Inhibitors on Aminotransferases Levels in Patients with Type 2 Diabetes Mellitus With Nonalcoholic Fatty Liver Disease: A Meta-Analysis of Randomized Controlled Trial

Background

Type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) are highly prevalent diseases that constitute enormous public health problems. The efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitors in blood glucose control in T2DM patients with NAFLD has been established, but little is known about its effect on liver enzyme levels.

Objective

This meta-analysis aimed to evaluate the influences of DPP-4 inhibitors on alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in patients with T2DM and NAFLD.

Methods

To identify the relevant studies, we searched PubMed, Embase, the Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure. Means differences in liver enzymes and metabolic outcomes were meta-analyzed using a random-effects model, with subgroup analyses by gender, age, area, follow-up duration, and type of DPP-4 inhibitor. Quality assessment of the included studies was conducted using the revised Cochrane risk of bias tool.

Results

A total of 1323 patients from 16 studies were included in this meta-analysis. The results of analysis of DPP-4 inhibitors showed that the mean difference was -6.19 (95% confidence interval [CI]: -9.45 to -2.92) for ALT and -5.17 (95% CI: -8.10 to -2.23) for AST; this effect was statistically significant from the placebo group which indicates the beneficial effect on liver enzymes. Subgroup analysis revealed that while there were no significant gender differences in enzyme reductions, individuals over 55 years old experienced more pronounced decreases in ALT. Notably, Asian studies showed significant reductions in liver enzymes, contrasting with the minor variations observed in Euramerican regions, and the effectiveness of DPP-4 inhibitors was particularly pronounced during shorter follow-up periods, with effects diminishing over time. Regarding secondary outcomes, there was a notable improvement in gamma-glutamyl transpeptidase, with a mean reduction, and in HbA1c levels, indicating improved glycemic control. Homeostatic model assessment for insulin resistance levels also improved, reflecting better insulin sensitivity. Additionally, adverse event analysis confirmed that DPP-4 inhibitors were well-tolerated with a favorable safety profile.

Conclusions

DPP-4 inhibitors appear to enhance glycemic control and improve liver enzyme levels, suggesting a potentially effective therapeutic approach for managing T2DM/NAFLD and highlighting their broader metabolic benefits.

Relationship between serum albumin level and hospitalization duration following percutaneous coronary intervention for acute coronary syndrome

Low serum albumin levels increase coronary morbidity, mortality, and postoperative cardiovascular risk. Therefore, this study investigated the relationship between these levels and the length of hospital stay in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome. A total of 350 patients were divided into quartiles according to serum albumin levels. Univariate and multivariate analyses were performed to identify factors associated with the length of hospital stay. A non-linear regression analysis of serum albumin and length of hospital stay was also performed. The results of the multifactorial analysis revealed low serum albumin levels as an independent predictor of longer hospital stay, even in the fully adjusted model. In the segmented linear regression model, serum albumin level showed a U-shaped relationship with the length of hospital stay. In conclusion, low serum albumin level was an independent predictor of longer hospital stay in patients undergoing PCI for acute coronary syndrome, with shorter stays observed for increasing serum albumin levels. Low serum albumin can be used to identify patients who require longer hospitalization and may need additional nutritional support or interventions to improve their prognosis.

Red cell distribution width to albumin ratio is a risk factor for atrial fibrillation in subjects hospitalized with coronary angiography

BACKGROUND

Red cell distribution width to albumin ratio (RAR) has been demonstrated to be associated with the risk of cardiovascular diseases. However, it is still unknown whether the RAR affects atrial fibrillation (AF). Therefore, this study aimed to investigate the association between RAR and AF in subjects hospitalized with coronary angiography.

METHODS

A total of 2436 participants were retrospectively included. Red cell distribution width, albumin and other data were collected. AF was confirmed using 12-lead electrocardiogram (ECG) or 24-h Holter. All participants were divided into four groups according to the RAR values by quartile (Q1, Q2, Q3, Q4). Univariate and multivariate logistic regression were performed to examine the correlation between RAR and AF.

RESULTS

Among the 2436 participants, 227 (9.3%) AF cases were observed. The RDW and RAR were significantly higher in AF group than in non-AF group (all P < 0.001). Univariate logistic regression showed an positive association between RAR and AF (P < 0.001). In multivariate logistic regression, RAR was found to be an independent risk factor of AF after adjusting for confounding factors (OR:2.015, 95%CI:1.315-3.089, P = 0.001).

CONCLUSIONS

The present study indicated that elevated RAR level was independently correlated with increased risk of AF in subjects hospitalized with coronary angiography.

Systematic Review of the Association of the Hospital Frailty Risk Score with Mortality in Patients with Cerebrovascular and Cardiovascular Disease

BACKGROUND

There is limited systematic data on the association between the Hospital Frailty Risk Score (HFRS) and characteristics and mortality in patients with cerebrovascular and cardiovascular disease (CVD). This systematic review aimed to summarise the use of the HFRS in describing the prevalence of frailty in patients with CVD, the clinical characteristics of patients with CVD, and the association between frailty on the likelihood of mortality in patients with CVD.

METHODS

A systematic literature search for observational studies using terms related to CVD, cerebrovascular disease, and the HFRS was conducted using 6 databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were appraised using the Newcastle-Ottawa Scale (NOS).

RESULTS

Seventeen observational studies were included, all rated 'good' quality according to the NOS. One study investigated 5 different CVD cohorts (atrial fibrillation (AF), heart failure (HF), hypotension, hypertension, and chronic ischemic heart disease), 1 study investigated 2 different CVD cohorts (AF and acute myocardial infarction (AMI)), 6 studies investigated HF, 3 studies investigated AMI, 4 studies investigated stroke, 1 study investigated AF, and 1 study investigated cardiac arrest. Increasing frailty risk category was associated with increased age, female sex, and non-white racial group across all CVD. Increasing frailty risk category is also associated with increased length of hospital stay, total costs, and increased odds of 30-day all-cause mortality across all CVD.

CONCLUSIONS

The HFRS is an efficient and effective tool for stratifying frailty in patients with CVD and predicting adverse health outcomes.

A Complex Interplay between Nutrition and Alcohol use Disorder: Implications for Breaking the Vicious Cycle

Approximately 16.5% of the United States population met the diagnostic criteria for substance use disorder (SUD) in 2021, including 29.5 million individuals with alcohol use disorder (AUD). Individuals with AUD are at increased risk for malnutrition, and impairments in nutritional status in chronic alcohol users can be detrimental to physical and emotional well-being. Furthermore, these nutritional deficiencies could contribute to the never-ending cycle of alcoholism and related pathologies, thereby jeopardizing the prospects of recovery and treatment outcomes. Improving nutritional status in AUD patients may not only compensate for general malnutrition but could also reduce adverse symptoms during recovery, thereby promoting abstinence and successful treatment of AUD. In this review, we briefly summarize alterations in the nutritional status of people with addictive disorders, in addition to the underlying neurobiological mechanisms and clinical implications regarding the role of nutritional intervention in recovery from alcohol use disorder.

A synergistic impact of body mass index and gamma gap on heart failure and mortality rate among older patients with coronary artery disease: a prospective study with 10-year follow-up

PURPOSE

This prospective study with 10-year follow-up aimed to analyze potential impact of body mass index (BMI) and gamma gap on heart failure and mortality rate in older patients with coronary artery disease (CAD).

METHODS

There were 987 consecutive older patients with CAD included and divided into four groups according to BMI and gamma gap levels.

RESULTS

Median age was 86 years. The highest proportion of heart failure (46.2%) and the highest mortality rate (84.4%) was observed in patients with low BMI and high gamma gap, whereas the lowest proportion of heart failure (18.9%) and the lowest mortality rate (62.9%) was observed in those with high BMI and low gamma gap. After full adjustment in multivariate Logistic regression analysis, heart failure was most common in patients with low BMI and high gamma gap compared with those with high BMI and low gamma gap (hazard ratio [HR]: 2.82, 95% confidence interval [CI]: 1.79-4.48, P < 0.05). Meanwhile, multivariate Cox regression analysis showed that mortality rate was the highest in those with low BMI and high gamma gap compared with patients with high BMI and low gamma gap (HR: 1.65, 95% CI: 1.32-2.07, P < 0.05).

CONCLUSION

The combination of low BMI and high gamma gap could further promote heart failure and increase mortality rate in older patients with CAD. Future studies should explore the underlying mechanisms linking low BMI, high gamma gap, and mortality rate, as well as the potential benefits of nutritional and immunological interventions to improve health prognosis in older patients with CAD.

Identification of functional lncRNAs in atrial fibrillation based on RNA sequencing

BACKGROUND

Atrial fibrillation (AF) is one of the most common arrhythmia contributing to serious conditions such as stroke and heart failure. Recent studies demonstrated that long noncoding RNAs (lncRNAs) were related to cardiovascular disease. However, the molecular mechanisms of AF are not fully clear. This study intended to discover lncRNAs that are differentially expressed in AF compared with controls and evaluate the potential functions of these lncRNAs.

METHODS

Ninety-seven patients (49 patients with AF and 48 patients without AF) were included in this study. Among these patients, leucocyte suspensions of 3 AF patients and 3 controls were sent for RNA-seq analysis to select differentially expressed lncRNA and mRNA. Different lncRNA expressions were validated in another samples (46 AF patients and 45 controls). Gene ontology (GO) enrichment analysis was conducted to annotate the function of selected mRNAs. Alternative splicing (AS) analysis was performed and a lncRNA-mRNA network was also constructed. The receiver operating characteristics (ROC) curve was used to evaluate diagnostic values. Logistic regression analysis was utilized to assess the risk or protective factor of AF.

RESULTS

A total of 223 mRNAs and 105 lncRNAs were detected in AF patients compared with controls. Total 4 lncRNAs (LINC01781, AC009509.2, AL662844.3, AL662844.4) associated with AF were picked out for validation in another samples by quantitative real-time PCR (qRT-PCR), detecting that upregulated AC009509.2 and downregulated LINC01781 in AF patients. Multivariate logistic regression analysis illustrated that left atrial diameter (OR 1.201; 95% CI 1.093-1.320; P=0.000) and AC009509.2 (OR 1.732; 95% CI 1.092-2.747; P=0.020) were related to AF respectively. ROC curve showed that AC009509.2, LINC01781 and left atrial diameter (LAD) were predictors of AF. For LINC01781, the area under the curve (AUC) was 0.654 (95% CI 0.541-0.767, P=0.0113). For AC009509.2, the AUC was 0.710 (95% CI 0.599-0.822, P=0.0005). Bioinformatic methods (GO enrichment, AS analysis and lncRNA-mRNA network construction) were performed to reveal the role of lncRNAs.

CONCLUSIONS

This study discussed differentially expressed lncRNA and their potential interaction with mRNA in AF. LncRNA AC009509.2 could be a new potential biomarker for AF prediction.

Serum fibrinogen-to-albumin ratio predicts new-onset atrial fibrillation risk during hospitalization in patients with acute myocardial infarction after percutaneous coronary intervention: a retrospective study

BACKGROUND

New-onset atrial fibrillation (NOAF) is a common adverse outcome of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) and is closely correlated with hospital stay and prognosis. In recent years, serum fibrinogen-to-albumin ratio (FAR), a novel biomarker for inflammation and thrombosis, has been used to predict the severity and prognosis of coronary artery disease. Our study aimed to investigate the relationship between FAR and NOAF during hospitalization after PCI in patients with AMI.

METHODS

We retrospectively analyzed the incidence of NOAF during hospitalization and follow-up in 670 patients with AMI after PCI. Data were collected on patient age, sex, body mass index, medical history, current medication, heart failure, laboratory tests, culprit blood vessels, echocardiographic characteristics, and AMI type. The enrolled patients were divided into NOAF and non-NOAF groups. The baseline characteristics of patients in the two groups were compared, and the predictive correlation between FAR and NOAF was evaluated using logistic regression analysis and the receiver operating characteristic curve.

RESULTS

Fifty-three (7.9%) patients developed NOAF during hospitalization. The occurrence of NOAF was found to be independently associated with higher FAR besides older age, higher neutrophil count, greater left atrial size, worse Killip class upon admission, lower body mass index, lower platelet count, lower left ventricle ejection fraction, and target left circumflex artery disease. FAR exhibited a better predictive value for the occurrence of NOAF during hospitalization (area under the curve, 0.732; 95% confidence interval, 0.659-0.808).

CONCLUSIONS

FAR is a robust tool for predicting NOAF risk during hospitalization in patients with AMI after PCI and has a better predictive value than serum fibrin and serum albumin levels alone.

Nutritional Status as a Risk Factor for New-Onset Atrial Fibrillation in Acute Myocardial Infarction

Purpose

Our study aimed to identify new-onset atrial fibrillation (NOAF) risk factors in acute myocardial infarction (AMI) patients after treatment with percutaneous coronary intervention (PCI) and investigate whether their nutritional status can be a predicting factor of NOAF.

Patients and Methods

We analyzed 662 AMI patients after PCI for NOAF occurrence during follow-up hospitalization and divided them into an NOAF and non-NOAF group. The patients' nutritional status was assessed using the controlling nutritional status (CONUT) score and geriatric nutritional risk index (GNRI). The Kaplan‒Meier analysis was used to assess NOAF-free survival in varying degrees of malnutrition. Cox proportional hazards models were used to identify the risk factors for NOAF.

Results

Eighty-four (12.7%) patients developed NOAF during hospitalization. There was a statistically significant difference in the occurrence of NOAF among different categories of nutritional status. The CONUT score and GNRI classifications were independent predictors of NOAF. NOAF occurrence was associated with older age, higher uric acid levels, higher N-terminal pro-B-type natriuretic peptide levels, greater left atrial size, and worse Killip class upon admission.

Conclusion

The nutritional status can affect NOAF occurrence in AMI patients after PCI. The CONUT score and GNRI are ideal tools for evaluating the nutritional status of AMI patients, with an excellent predictive effect on NOAF.