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Karaliūtė R, Leleika A, Apanavičiūtė I, Kazakevičius T, Mizarienė V, Zabiela V, Kavoliūnienė A, Ragaišytė N, Urbonienė D, Šakalytė G. Risk Factors of Early Atrial Fibrillation Recurrence Following Electrical Cardioversion When Left Ventricular Ejection Fraction Is Preserved. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081053. [PMID: 36013520 PMCID: PMC9416115 DOI: 10.3390/medicina58081053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/22/2022] [Accepted: 07/30/2022] [Indexed: 11/24/2022]
Abstract
Background and objectives: To identify clinical, echocardiographic, and laboratory parameters that affect the early recurrence of atrial fibrillation (AF) after restoring sinus rhythm (SR) by electrical cardioversion (ECV), and to determine whether left atrial (LA) strain, as a noninvasive indicator reflecting fibrosis, is associated with laboratory indicators affecting the development of fibrosis, interleukin 6 (IL-6) or tumor necrosis factor α (TNF-α). Materials and Methods: The study included 92 persistent AF patients who underwent elective ECV. The effective maintenance of SR was evaluated after 40 ± 10 days of ECV. Echocardiography, inflammatory markers (high-sensitivity c-reactive protein (hs-CRP), IL-6, and TNF-α), and natriuretic peptides (N-terminal pro b-type natriuretic peptide (NT-proBNP) and N-terminal pro a-type natriuretic peptide (NT-proANP)) were assessed. Results: After a 40 ± 10 days observation period, 51 patients (55.4%) were in SR. Patients with AF recurrence had a significantly longer duration of AF (p = 0.008) and of arterial hypertension (p = 0.035), lower LA ejection fraction (p = 0.009), lower LA strain (p < 0.0001), higher left ventricular global longitudinal strain (p = 0.001), and a higher E/e‘ ratio (p < 0.0001). LA strain was an independent predictor of early AF recurrence (OR: 0.65; 95% Cl 0.5−0.9, p = 0.004). LA strain < 11.85% predicted AF recurrence with 70% sensitivity and 88% specificity (AUC 0.855, 95% CI 0.77−0.94, p < 0.0001). LA strain demonstrated the association with NT-proBNP (r = −0.489, p < 0.0001) and NT-proANP (r = −0.378, p = 0.002), as well as with hs-CRP (r = −0.243, p = 0.04). Conclusions: LA strain appeared to be the most accurate predictor of early AF recurrence after ECV in patients with persistent AF. LA strain inversely correlated with NT-proBNP and NT-proANP, but no significant association with any of the inflammatory markers was identified.
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Affiliation(s)
- Rasa Karaliūtė
- Laboratory of Behavioural Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
- Correspondence: (R.K.); (A.L.)
| | - Arnoldas Leleika
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
- Medicine Faculty, Medicine Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Correspondence: (R.K.); (A.L.)
| | - Ieva Apanavičiūtė
- Medicine Faculty, Medicine Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
| | - Tomas Kazakevičius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Vaida Mizarienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Vytautas Zabiela
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
| | - Aušra Kavoliūnienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Nijolė Ragaišytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Daiva Urbonienė
- Department of Laboratory Medicine, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
| | - Gintarė Šakalytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
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Vinter N, Frederiksen AS, Albertsen AE, Lip GYH, Fenger-Grøn M, Trinquart L, Frost L, Møller DS. Role for machine learning in sex-specific prediction of successful electrical cardioversion in atrial fibrillation? Open Heart 2020; 7:openhrt-2020-001297. [PMID: 32565431 PMCID: PMC7307540 DOI: 10.1136/openhrt-2020-001297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023] Open
Abstract
Objective Electrical cardioversion is frequently performed to restore sinus rhythm in patients with persistent atrial fibrillation (AF). However, AF recurs in many patients and identifying the patients who benefit from electrical cardioversion is difficult. The objective was to develop sex-specific prediction models for successful electrical cardioversion and assess the potential of machine learning methods in comparison with traditional logistic regression. Methods In a retrospective cohort study, we examined several candidate predictors, including comorbidities, biochemistry, echocardiographic data, and medication. The outcome was successful cardioversion, defined as normal sinus rhythm immediately after the electrical cardioversion and no documented recurrence of AF within 3 months after. We used random forest and logistic regression models for sex-specific prediction. Results The cohort comprised 332 female and 790 male patients with persistent AF who underwent electrical cardioversion. Cardioversion was successful in 44.9% of the women and 49.9% of the men. The prediction errors of the models were high for both women (41.0% for machine learning and 48.8% for logistic regression) and men (46.0% for machine learning and 44.8% for logistic regression). Discrimination was modest for both machine learning (0.59 for women and 0.56 for men) and logistic regression models (0.60 for women and 0.59 for men), although the models were well calibrated. Conclusions Sex-specific machine learning and logistic regression models showed modest predictive performance for successful electrical cardioversion. Identifying patients who will benefit from cardioversion remains challenging in clinical practice. The high recurrence rate calls for thoroughly informed shared decision-making for electrical cardioversion.
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Affiliation(s)
- Nicklas Vinter
- Diagnostic Centre, Regionshospitalet Silkeborg, Silkeborg, Denmark .,Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | | | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Morten Fenger-Grøn
- Research Unit for General Practice and Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University, Boston, Massachusetts, USA
| | - Lars Frost
- Diagnostic Centre, Regionshospitalet Silkeborg, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
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Vitali F, Serenelli M, Airaksinen J, Pavasini R, Tomaszuk‐Kazberuk A, Mlodawska E, Jaakkola S, Balla C, Falsetti L, Tarquinio N, Ferrari R, Squeri A, Campo G, Bertini M. CHA2DS2-VASc score predicts atrial fibrillation recurrence after cardioversion: Systematic review and individual patient pooled meta-analysis. Clin Cardiol 2019; 42:358-364. [PMID: 30597581 PMCID: PMC6712331 DOI: 10.1002/clc.23147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/12/2018] [Accepted: 12/27/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite progresses in the treatment of the thromboembolic risk related to atrial fibrillation (AF), the management of recurrences remains a challenge. HYPOTHESIS To assess if congestive heart failure or left ventricular systolic dysfunction (CHA2 DS2 -VASc) score is predictive of early arrhythmia recurrence after AF cardioversion. METHODS Systematic review and individual patient pooled meta-analysis following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. INCLUSION CRITERIA observational trials in patients with AF undergoing cardioversion, available data on recurrence of AF and available data on CHA2 DS2 -VASc score. Clinical studies of interest were retrieved by PubMed, Cochrane Library, and Biomed Central. Seven authors were contacted for joining the patient level meta-analysis, and three shared data regarding anthropometric measurements, risk factors, major comorbidities, and CHA2 DS2 -VASc score. The primary outcome was the recurrence of AF after cardioversion in patients free from antiarrhythmic prophylaxis. Univariate and multivariate logistic regression was performed. RESULTS Overall, we collect data of 2889 patients: 61% were male, 50% with hypertension, 12% with diabetes, and 23% with history of ischemic heart disease. The median CHA2DS2-VASc score was 2.. At the multivariate analysis, chronic kidney disease (odds ratio [OR] 1.94; 95% confidence interval [CI] 1.12-3.27; P = 0.01), peripheral artery disease (OR 1.65; 95% CI 1.23-2.19; P < 0,0001), previous use of beta blockers (OR 1.5; 95% CI 1.19-1.88; P < 0.0001), and CHA2DS2-VASc score > 2 (OR 1.37; 95% CI 1.1-1.68; P = 0.002) were independent predictors of early recurrence of AF. CONCLUSIONS CHA2DS2-VASc score predicts early recurrence of AF in the first 30 days after electrical or pharmacological cardioversion. Protocol registration PROSPERO (CRD42017075107).
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Affiliation(s)
- Francesco Vitali
- Cardiovascular CenterAzienda Ospedaliero‐Universitaria di FerraraFerraraItaly
| | - Matteo Serenelli
- Cardiovascular CenterAzienda Ospedaliero‐Universitaria di FerraraFerraraItaly
| | - Juhani Airaksinen
- Heart CentreTurku University Hospital and University of TurkuTurkuFinland
| | - Rita Pavasini
- Cardiovascular CenterAzienda Ospedaliero‐Universitaria di FerraraFerraraItaly
| | | | | | - Samuli Jaakkola
- Heart CentreTurku University Hospital and University of TurkuTurkuFinland
| | - Cristina Balla
- Cardiovascular CenterAzienda Ospedaliero‐Universitaria di FerraraFerraraItaly
| | - Lorenzo Falsetti
- Internal and Sub‐intensive Medicine DepartmentA.O.U. “Ospedali Riuniti”AnconaItaly
| | - Nicola Tarquinio
- Department of Internal MedicineOspedale 'S.S. Benvenuti e Rocco'AnconaItaly
| | - Roberto Ferrari
- Cardiovascular CenterAzienda Ospedaliero‐Universitaria di FerraraFerraraItaly
- Maria Cecilia HospitalGVM Care and ResearchCotignolaItaly
| | - Angelo Squeri
- Maria Cecilia HospitalGVM Care and ResearchCotignolaItaly
| | - Gianluca Campo
- Cardiovascular CenterAzienda Ospedaliero‐Universitaria di FerraraFerraraItaly
- Maria Cecilia HospitalGVM Care and ResearchCotignolaItaly
| | - Matteo Bertini
- Cardiovascular CenterAzienda Ospedaliero‐Universitaria di FerraraFerraraItaly
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Vijayarajan V, Ekmejian A, Zaky F, Shetty P. The Use of CHA2DS2VASc Score in Predicting the Outcome of Electrical Cardioversion in Patients with Persistent atrial Fibrillation Immediately Post–Cardioversion and at 4 Weeks. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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