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Evbayekha E, Antia A, Dixon B, Reiss C, LaRue S. Predictors of mortality and burden of arrhythmias in endstage heart failure. Curr Probl Cardiol 2024; 49:102541. [PMID: 38521289 DOI: 10.1016/j.cpcardiol.2024.102541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Heart failure (HF) is a significant cause of morbidity and mortality in the United States, contributing to approximately 1 in 8 deaths. Individuals with end-stage HF (eHF) experience debilitating symptoms leading to poor quality of life (QoL). METHODS We used the ICD-10 code for eHF (I5084) from the National Inpatient Sample (NIS) (2016-2020) to identify all patients with eHF. We used a multivariable logistic regression model to adjust for confounders and estimate the mortality probability in each arrhythmia cohort. Our primary outcome was in-hospital mortality risk in each group. A p-value of 0.05 was deemed significant. RESULTS There were 22,703 hospitalizations with eHF (mean age 67 years ±16). Men represented 66.5 % (15,091) of the population. In this cohort, 59 % (13,018) were Caucasians, 27.2 % (6,017) were Blacks, 8.7 % (1,924) were Hispanics, and 2.9 % (505) were Asians. Of these individuals, 50.4 % (11,434) had atrial fibrillation (AFIB). The majority of the arrhythmia subgroups had independent associations with mortality, with adjusted odds ratio (aOR) for VFIB 5.8 (4.6-7.1), AFIB 4.3 (3.9-4.5), SVT 1.9 (1.6-2.4), and VT 1.2 (1.1-1.4), p < 0.0001, each. CONCLUSION This analysis revealed that approximately half of the hospitalized population with end-stage heart failure are burdened with atrial fibrillation. Ventricular and atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia each carried an independent mortality risk, with ventricular fibrillation having the highest risk.
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Chetran A, Bădescu MC, Şerban IL, Duca ŞT, Afrăsânie I, Cepoi MR, Dmour BA, Matei IT, Haba MŞC, Costache AD, Mitu O, Cianga CM, Tuchiluş C, Constantinescu D, Costache-Enache II. Insights into the Novel Cardiac Biomarker in Acute Heart Failure: Mybp-C. Life (Basel) 2024; 14:513. [PMID: 38672783 PMCID: PMC11051483 DOI: 10.3390/life14040513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Given its high cardiac specificity and its capacity to directly assess the cardiac function, cardiac myosin-binding protein (MyBP-C) is a promising biomarker in patients with acute heart failure (AHF). The aim of our study was to investigate the clinical utility of this novel marker for diagnosis and short-term prognosis in subjects with AHF. (2) Methods: We measured plasma levels of MyBP-C at admission in 49 subjects (27 patients admitted with AHF and 22 controls). (3) Results: The plasma concentration of MyBP-C was significantly higher in patients with AHF compared to controls (54.88 vs. 0.01 ng/L, p < 0.001). For 30-day prognosis, MyBP-C showed significantly greater AUC (0.972, p < 0.001) than NT-proBNP (0.849, p = 0.001) and hs-TnI (0.714, p = 0.047). In a multivariate logistic regression analysis, an elevated level of MyBP-C was the best independent predictor of 30-day mortality (OR = 1.08, p = 0.039) or combined death/recurrent 30-days rehospitalization (OR = 1.12, p = 0.014). (4) Conclusions: Our data show that circulating MyBP-C is a sensitive and cardiac-specific biomarker with potential utility for the accurate diagnosis and prognosis of AHF.
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Affiliation(s)
- Adriana Chetran
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Minerva Codruţa Bădescu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Ionela Lăcrămioara Şerban
- Department of Morpho-Functional Science II-Physiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Ştefania Teodora Duca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Irina Afrăsânie
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Maria-Ruxandra Cepoi
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Bianca Ana Dmour
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Iulian Theodor Matei
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Mihai Ştefan Cristian Haba
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Corina Maria Cianga
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (C.M.C.); (D.C.)
- Immunology Laboratory, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Cristina Tuchiluş
- Department of Microbiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Microbiology Laboratory, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Daniela Constantinescu
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (C.M.C.); (D.C.)
- Immunology Laboratory, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Irina Iuliana Costache-Enache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
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Oraii A, Healey JS, Kowalik K, Pandey AK, Benz AP, Wong JA, Conen D, McIntyre WF. Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis of clinical trials. Eur Heart J 2024; 45:756-774. [PMID: 38195054 DOI: 10.1093/eurheartj/ehad811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/05/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND AND AIMS Mineralocorticoid receptor antagonists (MRAs) improve cardiovascular outcomes in a variety of settings. This study aimed to assess whether cardioprotective effects of MRAs are modified by heart failure (HF) and atrial fibrillation (AF) status and to study their impact on AF events. METHODS MEDLINE, Embase, and Cochrane Central databases were searched to 24 March 2023 for randomized controlled trials evaluating the efficacy of MRAs as compared with placebo or usual care in reducing cardiovascular outcomes and AF events in patients with or at risk for cardiovascular diseases. Random-effects models and interaction analyses were used to test for effect modification. RESULTS Meta-analysis of seven trials (20 741 participants, mean age: 65.6 years, 32% women) showed that the efficacy of MRAs, as compared with placebo, in reducing a composite of cardiovascular death or HF hospitalization remains consistent across patients with HF [risk ratio = 0.81; 95% confidence interval (CI): 0.67-0.98] and without HF (risk ratio = 0.84; 95% CI: 0.75-0.93; interaction P = .77). Among patients with HF, MRAs reduced cardiovascular death or HF hospitalization in patients with AF (hazard ratio = 0.95; 95% CI: 0.54-1.66) to a similar extent as in those without AF (hazard ratio = 0.82; 95% CI: 0.63-1.07; interaction P = .65). Pooled data from 20 trials (21 791 participants, mean age: 65.2 years, 31.3% women) showed that MRAs reduce AF events (risk ratio = 0.76; 95% CI: 0.67-0.87) in both patients with and without prior AF. CONCLUSIONS Mineralocorticoid receptor antagonists are similarly effective in preventing cardiovascular events in patients with and without HF and most likely retain their efficacy regardless of AF status. Mineralocorticoid receptor antagonists may also be moderately effective in preventing incident or recurrent AF events.
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Affiliation(s)
- Alireza Oraii
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
- Division of Cardiology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - Krzysztof Kowalik
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Avinash K Pandey
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexander P Benz
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
| | - Jorge A Wong
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
- Division of Cardiology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - David Conen
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
- Division of Cardiology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - William F McIntyre
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
- Division of Cardiology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
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Li N, Zhu Y, Cheng F, Chen Y, Peng X, Wu M, Huang H, Zhang L, Liao M, Xiao S, Zhang H, Zhou Y, Chen S, Liu Z, Yi L, Peng Y, Fan J, Zeng J. Impact of atrial fibrillation on cerebro-cardiovascular outcome of heart failure with mildly-reduced ejection fraction. ESC Heart Fail 2023; 10:2882-2894. [PMID: 37421168 PMCID: PMC10567636 DOI: 10.1002/ehf2.14458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/23/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023] Open
Abstract
AIMS Atrial fibrillation (AF) and heart failure (HF) often co-exist and are closely intertwined. The impact of AF on the outcome of patients with heart failure with mildly-reduced ejection fraction (HFmrEF) is not fully clear. This study aimed to investigate the impact of AF on the outcomes of hospitalized HFmrEF patients. METHODS AND RESULTS The study included 1691 consecutive patients with HFmrEF (mean 68.2 years, 64.8% male) including 296 AF patients. Patients completed 1 year and mean of 33 month clinical follow-up after discharge by telephone interview, clinical visit, or community visit. The primary endpoint was cerebro-cardiovascular events (CCE, composite of HF rehospitalization, stroke, or cardiovascular death). After propensity score matching, 296 patients were included into the AF group (mean 71.5 years) and 592 patients into the non-AF group (mean 70.6 years). After propensity score matching, CCE at 1 year (59.1% vs. 48.5%, P = 0.003) and at a mean of 33 month (77.0% vs. 70.6%, P = 0.043). AF was independently associated with increased CCE within 1 year (HR = 1.31, 95% CI 1.07 to 1.61, P = 0.010) and at 33 months (HR = 1.20, 95% CI 1.00 to 1.43, P = 0.050) post-discharge after adjusted for other clinical confounders including discharge heart rate, NT-proBNP, haemoglobin, and uric acid. CONCLUSIONS AF is independently associated with an increased risk of CCE in HFmrEF patients within 1 year and at a mean of 33 months after discharge.
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Affiliation(s)
- Na Li
- Department of CardiologyXiangtan Central HospitalXiangtanChina
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Yunlong Zhu
- Department of CardiologyXiangtan Central HospitalXiangtanChina
- Department of Cardiovascular MedicineThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Fangqun Cheng
- Department of CardiologyXiangtan Central HospitalXiangtanChina
| | - Yongliang Chen
- Department of CardiologyXiangtan Central HospitalXiangtanChina
| | - Xin Peng
- Department of CardiologyXiangtan Central HospitalXiangtanChina
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Mingxin Wu
- Department of CardiologyXiangtan Central HospitalXiangtanChina
| | - Haobo Huang
- Department of CardiologyXiangtan Central HospitalXiangtanChina
| | - Lingling Zhang
- Department of CardiologyXiangtan Central HospitalXiangtanChina
| | - Min Liao
- Department of CardiologyXiangtan Central HospitalXiangtanChina
| | - Sha Xiao
- Department of CardiologyXiangtan Central HospitalXiangtanChina
| | - Hui Zhang
- Department of CardiologyXiangtan Central HospitalXiangtanChina
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Yuying Zhou
- Department of CardiologyXiangtan Central HospitalXiangtanChina
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Sihao Chen
- Department of CardiologyXiangtan Central HospitalXiangtanChina
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Zhican Liu
- Department of CardiologyXiangtan Central HospitalXiangtanChina
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Liqing Yi
- Department of CardiologyXiangtan Central HospitalXiangtanChina
| | - Yiqun Peng
- Department of CardiologyXiangtan Central HospitalXiangtanChina
| | - Jie Fan
- Department of CardiologyXiangtan Central HospitalXiangtanChina
| | - Jianping Zeng
- Department of CardiologyXiangtan Central HospitalXiangtanChina
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
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Dalgaard F, Fudim M, Al-Khatib SM, Friedman DJ, Abraham WT, Cleland JGF, Curtis AB, Gold MR, Kutyifa V, Linde C, Young J, Ali-Ahmed F, Tang A, Olivas-Martinez A, Inoue LY, Sanders GD. Cardiac resynchronization therapy in patients with a prior history of atrial fibrillation: Insights from four major clinical trials. J Cardiovasc Electrophysiol 2023; 34:1914-1924. [PMID: 37522254 PMCID: PMC10529427 DOI: 10.1111/jce.16022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
AIMS To investigate the association of cardiac resynchronization therapy (CRT) on outcomes among participants with and without a history of atrial fibrillation (AF). METHODS Individual-patient-data from four randomized trials investigating CRT-Defibrillators (COMPANION, MADIT-CRT, REVERSE) or CRT-Pacemakers (COMPANION, MIRACLE) were analyzed. Outcomes were time to a composite of heart failure hospitalization or all-cause mortality or to all-cause mortality alone. The association of CRT on outcomes for patients with and without a history of AF was assessed using a Bayesian-Weibull survival regression model adjusting for baseline characteristics. RESULTS Of 3964 patients included, 586 (14.8%) had a history of AF; 2245 (66%) were randomized to CRT. Overall, CRT reduced the risk of the primary composite endpoint (hazard ratio [HR]: 0.69, 95% credible interval [CI]: 0.56-0.81). The effect was similar (posterior probability of no interaction = 0.26) in patients with (HR: 0.78, 95% CI: 0.55-1.10) and without a history of AF (HR: 0.67, 95% CI: 0.55-0.80). In these four trials, CRT did not reduce mortality overall (HR: 0.82, 95% CI: 0.66-1.01) without evidence of interaction (posterior probability of no interaction = 0.14) for patients with (HR: 1.09, 95% CI: 0.70-1.74) or without a history of AF (HR: 0.70, 95% CI: 0.60-0.97). CONCLUSION The association of CRT on the composite endpoint or mortality was not statistically different for patients with or without a history of AF, but this could reflect inadequate power. Our results call for trials to confirm the benefit of CRT recipients with a history of AF.
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Affiliation(s)
- Frederik Dalgaard
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Cardiology, Herlev and Gentofte hospital, Copenhagen, Denmark
- Department of Medicine, Nykøbing Falster Sygehus, Nykøbing, Denmark
| | - Marat Fudim
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Sana M. Al-Khatib
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Daniel J. Friedman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - William T. Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH
| | - John G. F. Cleland
- National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK
| | | | | | - Valentina Kutyifa
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center Rochester, NY
| | - Cecilia Linde
- Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - James Young
- Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Fatima Ali-Ahmed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Anthony Tang
- Department of Medicine, Western University, Ontario, Canada
| | | | | | - Gillian D. Sanders
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC
- Evidence Synthesis Group, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
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6
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Mundisugih J, Franke KB, Tully PJ, Munawar DA, Kumar S, Mahajan R. Prevalence and Prognostic Implication of Atrial Fibrillation in Heart Failure Subtypes: Systematic Review and Meta-Analysis. Heart Lung Circ 2023:S1443-9506(23)00113-0. [PMID: 37003940 DOI: 10.1016/j.hlc.2023.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/26/2022] [Accepted: 02/25/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) and heart failure (HF) portends a poor outcome. The HF universal definition has incorporated Heart Failure with mildly reduced Ejection Fraction (HFmrEF). We sought to evaluate the relationship between AF and different HF subtypes, with emphasis on HFmrEF. METHODS PubMed and Embase databases were searched up to July 2022. Studies that classified HF with EF≥50% as Heart Failure with Preserved Ejection Fraction (HFpEF); EF 40%-49% as HFmrEF; and EF <40% as Heart Failure with Reduced Ejection Fraction (HFrEF) were included. RESULTS Fifty (50) eligible studies, with 126,720 acute HF and 109,683 chronic HF patients, were included. Ten percent (10%) and 12% of patients constituted HFmrEF subtype in patients with acute and chronic HF, respectively. The AF prevalence was 38% (95%CI [33, 44], I2=96.9%) in HFmrEF, as compared to 43% (95%CI [39, 47], I2=97.9%) in HFpEF, and 32% (95%CI [29, 35], I2 =98.6%) in HFrEF in acute HF patients. Meta-regression showed HFmrEF shared age as a determinant for AF prevalence with HFrEF and HFpEF. Similar AF prevalence also was observed in chronic HF. Compared to sinus rhythm, AF was associated with an increased risk of all-cause mortality in all HF subtypes: HFmrEF (n=6; HR 1.28, 95%CI [1.08, 1.51], I2=71%), HFpEF (n=10; HR 1.14, 95%CI [1.06, 1.23], I2=55%) and HFrEF (n=9; HR 1.11, 95%CI [1.02, 1.21], I2=78%). CONCLUSION The prevalence of AF was intermediate for HFmrEF in between HFpEF and HFrEF, with determinants shared with either HF subtype. The co-existence of AF and HF predicts an increased all-cause mortality across all categories of HF. (PROSPERO registry: CRD42021189411).
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Affiliation(s)
- Juan Mundisugih
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Kyle B Franke
- School of Psychology, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | | | - Dian A Munawar
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia; School of Psychology, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Westmead, Sydney, NSW, Australia
| | - Rajiv Mahajan
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia; School of Psychology, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
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Zhuang J, Xie L, Chen H, Yan X, Lu J, Ye J, Zhang Y, Qiang W, Zhang Q, Zhou L. Correlation of Serum Laminin Levels with Cardiac Function and In-Hospital Prognosis in Patients with Atrial Fibrillation. Int Heart J 2023; 64:172-177. [PMID: 37005313 DOI: 10.1536/ihj.22-393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
We aimed to investigate the correlation between serum laminin (LN) levels and cardiac function in patients with atrial fibrillation (AF) and its predictive value for in-hospital prognosis. This study included 295 patients with AF who were admitted to the Second Affiliated Hospital of Nantong University from January 2019 to January 2021. The patients were divided into three groups according to the New York Heart Association (NYHA) functional classification (I-II, III, and IV); the LN levels increased with increasing NYHA class (P < 0.05). Spearman's correlation analysis revealed a positive correlation between LN and NT-proBNP (r = 0.527, P < 0.001). Of the patients, 36 had in-hospital major adverse cardiac events (MACEs), of whom 30 had acute heart failure, 5 had malignant arrhythmias, and one had stroke. The area under the ROC curve for predicting the in-hospital MACEs by LN was 0.815 (95% CI: 0.740-0.890, P < 0.001). Multivariate logistic regression analysis revealed that LN could be an independent predictor of in-hospital MACEs (odds ratio: 1.009, 95% confidence interval: 1.004-1.015, P = 0.001). In conclusion, LN may serve as a potential biomarker to evaluate the severity of cardiac function and predict in-hospital prognosis in AF patients.
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Affiliation(s)
- Jianfen Zhuang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University
- Department of Cardiology, The Second Affiliated Hospital of Nantong University
| | - Ling Xie
- Department of Cardiology, The Second Affiliated Hospital of Nantong University
| | - Haixiao Chen
- Department of General Practice, Affiliated Hospital 2 of Nantong University
| | - Xiaoyun Yan
- Department of General Practice, Affiliated Hospital 2 of Nantong University
| | - Jinya Lu
- Department of General Practice, Affiliated Hospital 2 of Nantong University
| | - Jiaqi Ye
- Department of General Practice, Affiliated Hospital 2 of Nantong University
| | - Yin Zhang
- Department of General Practice, Affiliated Hospital 2 of Nantong University
| | - Wenhui Qiang
- Department of General Practice, Affiliated Hospital 2 of Nantong University
| | - Qing Zhang
- Department of Cardiology, The Second Affiliated Hospital of Nantong University
| | - Lei Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University
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