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Lembo M, Strisciuglio T, Fonderico C, Mancusi C, Izzo R, Trimarco V, Bellis A, Barbato E, Esposito G, Morisco C, Rubattu S. Obesity: the perfect storm for heart failure. ESC Heart Fail 2024. [PMID: 38491741 DOI: 10.1002/ehf2.14641] [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: 07/14/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 03/18/2024] Open
Abstract
Obesity condition causes morphological and functional alterations involving the cardiovascular system. These can represent the substrates for different cardiovascular diseases, such as atrial fibrillation, coronary artery disease, sudden cardiac death, and heart failure (HF) with both preserved ejection fraction (EF) and reduced EF. Different pathogenetic mechanisms may help to explain the association between obesity and HF including left ventricular remodelling and epicardial fat accumulation, endothelial dysfunction, and coronary microvascular dysfunction. Multi-imaging modalities are required for appropriate recognition of subclinical systolic dysfunction typically associated with obesity, with echocardiography being the most cost-effective technique. Therapeutic approach in patients with obesity and HF is challenging, particularly regarding patients with preserved EF in which few strategies with high level of evidence are available. Weight loss is of extreme importance in patients with obesity and HF, being a primary therapeutic intervention. Sodium-glucose co-transporter-2 inhibitors have been recently introduced as a novel tool in the management of HF patients. The present review aims at analysing the most recent studies supporting pathogenesis, diagnosis, and management in patients with obesity and HF.
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Affiliation(s)
- Maria Lembo
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Teresa Strisciuglio
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Celeste Fonderico
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Valentina Trimarco
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Alessandro Bellis
- Emergenza Accettazione Department, Azienda Ospedaliera 'Antonio Cardarelli', Naples, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanni Esposito
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Speranza Rubattu
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
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Ge WL, Lu YF, Li T, Wang Y, Yin J, Li XR, Jiang JJ, Mi YF, Tung TH, Yan SH. Clinical effect of vein of Marshall ethanol infusion on mitral isthmus ablation. Front Cardiovasc Med 2024; 11:1253554. [PMID: 38374993 PMCID: PMC10875083 DOI: 10.3389/fcvm.2024.1253554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose This study aimed to investigate the effect of Marshall ethanol infusion (VOM-Et) in the vein on mitral isthmus (MI) ablation. Methods Patients with persistent atrial fibrillation (AF) were grouped into vein of VOM-Et combined with radiofrequency (RF) ablation (VOM-Et-RF) and RF groups. The primary outcome was MI block immediate block rate after surgery. Stratified analysis was also performed for factors affecting the outcome measures. Results A total of 118 consecutive patients underwent AF ablation at Taizhou Hospital of Zhejiang Province from January 2018 to December 2021. Successful bidirectional perimitral block was achieved in 96% of patients in VOM-Et-RF (69 of 72) and in 76% of patients in the RF group (35 of 46) (P < 0.01). In the subgroup analysis, male sex, elder than 60 years, Left atrial diameter <55 mm, and AF duration <3 years were associated with the benefits of VOM-Et in AF Patients. Conclusion The vein of Marshall ethanol infusion for catheter ablation can improve the MI block rate. Male sex, elder age, smaller Left atrial diameter and shorter AF duration may have significant benefits for VOM-Et.
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Affiliation(s)
- Wei-Li Ge
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
- Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yi-Fei Lu
- Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Tao Li
- Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Ye Wang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jie Yin
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xin-Ran Li
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jian-Jun Jiang
- Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Ya-Fei Mi
- Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
- Key Laboratory of Evidence-Based Radiology of Taizhou, Linhai, Zhejiang, China
| | - Su-Hua Yan
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan, China
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Akşit E, Taylan G, Küçük U. The importance of statin therapy in atrial fibrillation patients independent of CHADS-VASc score. Europace 2023; 25:euad281. [PMID: 37725939 PMCID: PMC10552378 DOI: 10.1093/europace/euad281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Ercan Akşit
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz Mart University, Barbaros Street Terzioglu Campus B Block No: 4, Canakkale 17000, Turkey
| | - Gökay Taylan
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Uğur Küçük
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz Mart University, Barbaros Street Terzioglu Campus B Block No: 4, Canakkale 17000, Turkey
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Bodagh N, Williams MC, Vickneson K, Gharaviri A, Niederer S, Williams SE. State of the art paper: Cardiac computed tomography of the left atrium in atrial fibrillation. J Cardiovasc Comput Tomogr 2023; 17:166-176. [PMID: 36966040 PMCID: PMC10689253 DOI: 10.1016/j.jcct.2023.03.002] [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: 10/17/2022] [Revised: 02/06/2023] [Accepted: 03/11/2023] [Indexed: 03/27/2023]
Abstract
The clinical spectrum of atrial fibrillation means that a patient-individualized approach is required to ensure optimal treatment. Cardiac computed tomography can accurately delineate atrial structure and function and could contribute to a personalized care pathway for atrial fibrillation patients. The imaging modality offers excellent spatial resolution and has been utilised in pre-, peri- and post-procedural care for patients with atrial fibrillation. Advances in temporal resolution, acquisition times and analysis techniques suggest potential expanding roles for cardiac computed tomography in the future management of patients with atrial fibrillation. The aim of the current review is to discuss the use of cardiac computed tomography in atrial fibrillation in pre-, peri- and post-procedural settings. Potential future applications of cardiac computed tomography including atrial wall thickness assessment and epicardial fat volume quantification are discussed together with emerging analysis techniques including computational modelling and machine learning with attention paid to how these developments may contribute to a personalized approach to atrial fibrillation management.
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Affiliation(s)
- Neil Bodagh
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | | | - Keeran Vickneson
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ali Gharaviri
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Liu Z, Deng Y, Wang X, Liu X, Zheng X, Sun G, Zhen Y, Liu M, Ye Z, Wen J, Liu P. Radiomics signature of epicardial adipose tissue for predicting postoperative atrial fibrillation after pulmonary endarterectomy. Front Cardiovasc Med 2023; 9:1046931. [PMID: 36698949 PMCID: PMC9869069 DOI: 10.3389/fcvm.2022.1046931] [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] [Received: 09/17/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose This study aimed to construct a radiomics signature of epicardial adipose tissue for predicting postoperative atrial fibrillation (POAF) after pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods We reviewed the preoperative computed tomography pulmonary angiography images of CTEPH patients who underwent PEA at our institution between December 2016 and May 2022. Patients were divided into training/validation and testing cohorts by stratified random sampling in a ratio of 7:3. Radiomics features were selected by using intra- and inter-class correlation coefficient, redundancy analysis, and Least Absolute Shrinkage and Selection Operator algorithm to construct the radiomics signature. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the discrimination, calibration, and clinical practicability of the radiomics signature. Two hundred-times stratified five-fold cross-validation was applied to assess the reliability and robustness of the radiomics signature. Results A total of 93 patients with CTEPH were included in this study, including 23 patients with POAF and 70 patients without POAF. Five of the 1,218 radiomics features were finally selected to construct the radiomics signature. The radiomics signature showed good discrimination with an AUC of 0.804 (95%CI: 0.664-0.943) in the training/validation cohort and 0.728 (95% CI: 0.503-0.953) in the testing cohorts. The average AUC of 200 times stratified five-fold cross-validation was 0.804 (95%CI: 0.801-0.806) and 0.807 (95%CI: 0.798-0.816) in the training and validation cohorts, respectively. The calibration curve showed good agreement between the predicted and actual observations. Based on the DCA, the radiomics signature was found to be clinically significant and useful. Conclusion The radiomics signature achieved good discrimination, calibration, and clinical practicability. As a potential imaging biomarker, the radiomics signature of epicardial adipose tissue (EAT) may provide a reference for the risk assessment and individualized treatment of CTEPH patients at high risk of developing POAF after PEA.
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Affiliation(s)
- Zhan Liu
- Department of Cardiovascular Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China,Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yisen Deng
- Department of Cardiovascular Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China,Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xuming Wang
- Department of Cardiovascular Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China,Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaopeng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xia Zheng
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Guang Sun
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yanan Zhen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jianyan Wen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China,*Correspondence: Jianyan Wen,
| | - Peng Liu
- Department of Cardiovascular Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China,Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China,Peng Liu,
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Nowak B, Schmidt B, Chen S, Urbanek L, Bordignon S, Schaack D, Tohoku S, Chun J. [Metabolic syndrome and atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2022; 33:367-372. [PMID: 36131155 DOI: 10.1007/s00399-022-00898-0] [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: 07/21/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
Metabolic syndrome is defined by the simultaneous occurrence of the cardiovascular risk factors obesity, hypertension, diabetes and dyslipidemia. Overweight, in particular, is continuously increasing in many countries. In this respect, metabolic syndrome is a strong risk factor for atrial fibrillation. Only few data are available on the influence of obesity on antiarrhythmic drugs. Sodium channel blockers, in particular, appear to show a reduced effectiveness. Direct oral anticoagulants can be used for anticoagulation in obese patients. With a body weight > 140 kg, a plasma level measurement is recommended. Severe overweight reduces the chances of successful ablation treatment and leads to more complications. Consistent treatment of the metabolic syndrome, and in particular weight reduction, can significantly improve the risk and the frequency of atrial fibrillation, the associated symptoms and the success of treatment for maintaining cardiac rhythm.
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Affiliation(s)
- Bernd Nowak
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland.
| | - Boris Schmidt
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - Shaojie Chen
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - Lukas Urbanek
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - Stefano Bordignon
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - David Schaack
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - Shota Tohoku
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
| | - Julian Chun
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland
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Ilyushenkova J, Sazonova S, Popov E, Zavadovsky K, Batalov R, Archakov E, Moskovskih T, Popov S, Minin S, Romanov A. Radiomic phenotype of epicardial adipose tissue in the prognosis of atrial fibrillation recurrence after catheter ablation in patients with lone atrial fibrillation. J Arrhythm 2022; 38:682-693. [PMID: 36237852 PMCID: PMC9535779 DOI: 10.1002/joa3.12760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Epicardial adipose tissue (EAT) has been considered as one of the probable triggers of atrial fibrillation (AF). CT‐rediomics is a perspective noninvasive method of assessment of EAT. We evaluate the radiomic phenotype of EAT in patients with lone AF in the prognosis of AF recurrence after catheter ablation. Methods A total of 43 patients with lone AF referred for CA and 20 out‐hospital patients without arrhythmia underwent multidetector computed tomography coronary angiography. Segmentation of EAT and extraction radiomic features were performed on calcium scoring series using by 3D‐Slicer. Clinical follow‐up was performed for 12 months period after the CA. Results EAT in patients with lone AF had a distinct radiomic phenotype. Thus, 45 of 93 calculated radiomic features, volume and attenuation of EAT were significantly different between patients with lone AF and persons without any arrhythmia. In addition, 17 radiomic features were significantly different in subgroups with and without AF recurrence. Multivariate regression analysis demonstrated that only gray level nonuniformity normalized (GLSZM) was an independent predictor of AF recurrence (OR 1.0027, 95%CI 1.0009–1.0044, p = 0.002). ROC analysis data showed that GLSZM >1227.4 indicates high probability of AF recurrence during 12 months (sensitivity 89.4%, specificity 70.8%, AUC: 0.809; p = 0.001). Conclusion The radiomic parameter GLSZM is associated with late AF recurrence after CA in patients with lone AF. In current study GLSZM was a stronger predictor of lone AF recurrence in multivariate analysis comparing with other established risk factors and EAT volume and attenuation.
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Affiliation(s)
- Julia Ilyushenkova
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Svetlana Sazonova
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Evgeny Popov
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Konstantin Zavadovsky
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Roman Batalov
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Evgeny Archakov
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Tatyana Moskovskih
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Sergey Popov
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Stanislav Minin
- E. Meshalkin National Medical Research Ministry of Health of the Russian Federation Novosibirsk Russian Federation
| | - Alexander Romanov
- E. Meshalkin National Medical Research Ministry of Health of the Russian Federation Novosibirsk Russian Federation
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Epicardial adipose tissue (EAT): A prognostic factor in patients with non-ischemic cardiomyopathy. Int J Cardiol 2022; 366:67. [PMID: 35810919 DOI: 10.1016/j.ijcard.2022.07.009] [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] [Received: 03/30/2022] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022]
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