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Latif F, Nasir MM, Meer KK, Farhan SH, Cheema HA, Khan AB, Umer M, Rehman WU, Ahmad A, Khan MA, Almas T, Mactaggart S, Nashwan AJ, Ahmed R, Dani SS. The effect of oral anticoagulants on the incidence of dementia in patients with atrial fibrillation: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200282. [PMID: 38766665 PMCID: PMC11101875 DOI: 10.1016/j.ijcrp.2024.200282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/20/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
Background Dementia is a recognized complication of atrial fibrillation (AF). Oral anticoagulant (OAC) therapy can potentially be protective against this complication. Methods A comprehensive search of MEDLINE and Embase for comparative observational studies reporting the efficacy of OAC therapy for the incidence of dementia in patients with AF was conducted from its inception until March 2023. Studies that had patients with prior use of OAC or with a previous history of dementia were excluded. Results A total of 22 studies were included in this review involving 617,204 participants. The pooled analysis revealed that OAC therapy, including direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), was associated with a reduced incidence of dementia in AF patients. Specifically, compared to non-OAC treatment, OACs demonstrated a significant reduction in dementia incidence (HR 0.68, 95 % CI [0.58, 0.80], p < 0.00001), with similar findings observed for DOACs (HR 0.69, 95 % CI [0.51, 0.94], p = 0.02) and VKAs (HR 0.73, 95 % CI [0.56, 0.95], p = 0.02). The comparison of DOAC vs VKA revealed that DOACs are associated with reduced risk of dementia (HR 0.87, 95 % CI [0.79, 0.96], p = 0.004). Conclusion Our SR and meta-analysis showed that the use of OAC therapy is associated with a reduced risk of dementia in individuals with AF. However, our results are limited by the potential influence of confounding bias and significant heterogeneity in the analyses.
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Affiliation(s)
- Fakhar Latif
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Moiz Nasir
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Komail K. Meer
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Husain Farhan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Adam Bilal Khan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammad Umer
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan
| | - Wajeeh Ur Rehman
- Department of Internal Medicine, United Health Services Hospital, Johnson City, NY, USA
| | - Adeel Ahmad
- Department of Internal Medicine, Mass General Brigham - Salem Hospital, Salem, MA, USA
| | - Muhammad Aslam Khan
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Talal Almas
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sebastian Mactaggart
- Department of Medicine, Northumbria Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Raheel Ahmed
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Sourbha S. Dani
- Department of Cardiology, Lahey Hospital and Medical Center, Burlington, MA, USA
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2
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Kogelschatz B, Zenger B, Steinberg BA, Ranjan R, Jared Bunch T. Atrial fibrillation and the risk of early-onset dementia and cognitive decline: An updated review. Trends Cardiovasc Med 2024; 34:236-241. [PMID: 36702389 DOI: 10.1016/j.tcm.2023.01.005] [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: 12/02/2022] [Revised: 01/02/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
The relationship between atrial fibrillation (AF) and dementia has been well described; however, recent data suggest that AF confers a greater risk for the development of early-onset dementia irrespective of clinical stroke. Numerous mechanisms have been hypothesized to explain cognitive decline in the setting of AF, including silent cerebral ischemia, cerebral hypoperfusion, and cerebral microvascular disease. Despite the emergence of data supporting the increased risk of early-onset dementia in patients with AF, the underlying mechanism remains unclear. Furthermore, the mechanism may be influenced by survival bias, genetic susceptibility, or early dysfunction of brain adaptation. Investigation into why this relationship exists could change how prevention and treatment are evaluated.
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Affiliation(s)
- Benjamin Kogelschatz
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Brian Zenger
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA.
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3
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Feldman DR, Zeitler EP. Neurologic impact of atrial fibrillation. Curr Opin Cardiol 2024; 39:33-38. [PMID: 37678332 DOI: 10.1097/hco.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW Cognitive dysfunction is a complex condition that is becoming increasingly more prevalent. There has been growing acknowledgement that individuals with atrial fibrillation are at an increased risk of cognitive dysfunction beyond the association of age with both disorders. The purpose of this review is to explore the potential underlying mechanisms connecting atrial fibrillation and cognitive dysfunction and to examine the existing evidence for potential treatment options. RECENT FINDINGS Many mechanisms have been proposed for the association between cognitive dysfunction and atrial fibrillation. These include cerebral infarction (both micro and macro embolic events), cerebral microbleeds including those secondary to therapeutic anticoagulation, an increased inflammatory state, cerebral hypoperfusion, and a genetic predisposition to both diseases. Treatments designed to target each of these mechanisms have led to mixed results and there are no specific interventions that have definitively led to a reduction in the incidence of cognitive dysfunction. SUMMARY The relationship between cognitive dysfunction and atrial fibrillation remains poorly understood. Standard of care currently focuses on reducing risk factors, managing stroke risk, and maintaining sinus rhythm in appropriately selected patients. Further work needs to be conducted in this area to limit the progression of cognitive dysfunction in patients with atrial fibrillation.
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Affiliation(s)
| | - Emily P Zeitler
- Dartmouth Health and Dartmouth-Hitchcock Medical Center
- The Dartmouth Institute, Lebanon, New Hampshire, USA
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4
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Tian Y, Liu S, Zhang Y, Yang J, Guo P, Zhang H, Yu X, Zou T. Immune infiltration and immunophenotyping in atrial fibrillation. Aging (Albany NY) 2023; 15:213-229. [PMID: 36602538 PMCID: PMC9876632 DOI: 10.18632/aging.204470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023]
Abstract
Atrial fibrillation (AF) is a relatively common arrhythmia in clinical practice. Although significant progress has been achieved in the treatment of AF and its associated complications, research on AF prevention lags behind, mainly due to the lack of a deep understanding of AF pathogenesis. In recent years, as our knowledge has grown, the role of the inflammatory/immune response in the occurrence and progression of AF has gradually gained attention. In this paper, based on existing gene expression data in the Gene Expression Omnibus database, a detailed description of immune infiltration status in AF is presented using a series of analytical methods, including differential analysis, Gene Ontology categorization, Kyoto Encyclopedia of Genes and Genomes enrichment analysis, and weighted gene coexpression network analysis, and analysis tools such as CIBERSORTx and Cytoscape. Several new AF/immune infiltrations-related signature genes were identified, and the AF/immune infiltration pathology was classified based on these immune signature genes, thus providing novel insights into the pathogenesis of AF based on the inflammatory response.
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Affiliation(s)
- Yuqing Tian
- Department of Cardiology, Affiliated Hospital of Panzhihua University, Panzhihua 617000, Sichuan, P.R. China
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Shiying Liu
- Department of Plastic Surgery, Affiliated Hospital of Panzhihua University, Panzhihua 617000, Sichuan, P.R. China
| | - Yanan Zhang
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, P.R. China
| | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, P.R. China
| | - Peiyao Guo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, P.R. China
- Peking University Fifth School of Clinical Medicine, Beijing Hospital, Beijing 100730, P.R. China
| | - Hongchao Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, P.R. China
| | - Xue Yu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, P.R. China
| | - Tong Zou
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, P.R. China
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5
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Akushevich I, Yashkin A, Ukraintseva S, Yashin AI, Kravchenko J. The Construction of a Multidomain Risk Model of Alzheimer's Disease and Related Dementias. J Alzheimers Dis 2023; 96:535-550. [PMID: 37840484 PMCID: PMC10657690 DOI: 10.3233/jad-221292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) and related dementia (ADRD) risk is affected by multiple dependent risk factors; however, there is no consensus about their relative impact in the development of these disorders. OBJECTIVE To rank the effects of potentially dependent risk factors and identify an optimal parsimonious set of measures for predicting AD/ADRD risk from a larger pool of potentially correlated predictors. METHODS We used diagnosis record, survey, and genetic data from the Health and Retirement Study to assess the relative predictive strength of AD/ADRD risk factors spanning several domains: comorbidities, demographics/socioeconomics, health-related behavior, genetics, and environmental exposure. A modified stepwise-AIC-best-subset blanket algorithm was then used to select an optimal set of predictors. RESULTS The final predictive model was reduced to 10 features for AD and 19 for ADRD; concordance statistics were about 0.85 for one-year and 0.70 for ten-year follow-up. Depression, arterial hypertension, traumatic brain injury, cerebrovascular diseases, and the APOE4 proxy SNP rs769449 had the strongest individual associations with AD/ADRD risk. AD/ADRD risk-related co-morbidities provide predictive power on par with key genetic vulnerabilities. CONCLUSION Results confirm the consensus that circulatory diseases are the main comorbidities associated with AD/ADRD risk and show that clinical diagnosis records outperform comparable self-reported measures in predicting AD/ADRD risk. Model construction algorithms combined with modern data allows researchers to conserve power (especially in the study of disparities where disadvantaged groups are often grossly underrepresented) while accounting for a high proportion of AD/ADRD-risk-related population heterogeneity stemming from multiple domains.
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Affiliation(s)
- Igor Akushevich
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Arseniy Yashkin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Svetlana Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Anatoliy I. Yashin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Julia Kravchenko
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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6
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Niu Q, Liu W, Wang F, Dong Y. Prevalence and factors associated with cognitive impairment in Chinese heart failure patients: A pilot study. Front Cardiovasc Med 2022; 9:978432. [PMID: 36211559 PMCID: PMC9537606 DOI: 10.3389/fcvm.2022.978432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe prevalence of Cognitive impairment (CI) is high in patients with heart failure (HF). It leads to poor prognosis, such as self-care, hospital readmission and increased mortality. However, such information among Chinese population is unclear.ObjectiveThe purpose of this study was to examine the prevalence of CI in Chinese patients with HF, and explore its correlation with biomarkers and clinical factors to better manage HF patients with CI.MethodsThis study is a cross-sectional study of 200 hospitalized HF patients in China. The cognitive function of HF patients was assessed by the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE).ResultsThe majority are male (62.5%, n = 125), have primary school and below level of education (57.5%, n = 115), NYHA III and above (62%, n = 124). They have an average MoCA score of 15.10 ± 8.18, MMSE score of 19.55 ± 8.23. Age, NYHA class, and atrial fibrillation were independently associated with CI (p < 0.05). There was a significant association between CI and the 4th quartile of TNT (p = 0.013), and the 3rd and 4th quartile of NT-proBNP (p = 0.015, p = 0.038).ConclusionsThe prevalence of undiagnosed CI in Chinese HF patients is high (81%). HF patients with high levels of TNT or NT-proBNP or both values may be at risk of developing CI. Therefore, we suggest that HF patients with older age, atrial fibrillation, NYHA class II and III, as well as elevated TNT or NT-proBNP or both values to be followed up with a formal evaluation for CI. Nurses need to provide targeted health education program for cognitively impaired HF population to improve their self-care ability and nursing outcome.
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Affiliation(s)
- Qi Niu
- School of Nursing, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - WeiHua Liu
- School of Nursing, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
- *Correspondence: WeiHua Liu
| | | | - YanHong Dong
- School of Nursing, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- YanHong Dong
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7
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Giannone ME, Filippini T, Whelton PK, Chiari A, Vitolo M, Boriani G, Vinceti M. Atrial Fibrillation and the Risk of Early‐Onset Dementia: A Systematic Review and Meta‐Analysis. J Am Heart Assoc 2022; 11:e025653. [PMID: 35861843 PMCID: PMC9707836 DOI: 10.1161/jaha.122.025653] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Recent studies have identified an increased risk of dementia in patients with atrial fibrillation (AF). However, both AF and dementia usually manifest late in life. Few studies have investigated this association in adults with early‐onset dementia. The aim of this study was to investigate the relationship between AF and early‐onset dementia.
Methods and Results
We searched the PubMed/MEDLINE, Embase, and Scopus databases through April 15, 2022, for studies reporting on the association between AF and dementia in adults aged <70 years, without language restrictions. Two reviewers independently performed the study selection, assessed the risk of bias, and extracted the study data. We performed a meta‐analysis of early‐onset dementia risk according to occurrence of AF using a random‐effects model. We retrieved and screened 1006 potentially eligible studies. We examined the full text of 33 studies and selected the 6 studies that met our inclusion criteria. The pooled analysis of their results showed an increased risk of developing dementia in individuals with AF, with a summary relative risk of 1.50 (95% CI, 1.00–2.26) in patients aged <70 years, and 1.06 (95% CI, 0.55–2.06) in those aged <65 years.
Conclusions
In this systematic review and meta‐analysis, AF was a risk factor for dementia in adults aged <70 years, with an indication of a slight and statistically imprecise excess risk already at ages <65 years. Further research is needed to assess which characteristics of the arrhythmia and which mechanisms play a role in this relationship.
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Affiliation(s)
- Maria Edvige Giannone
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center University of Modena and Reggio Emilia Modena Italy
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center University of Modena and Reggio Emilia Modena Italy
- School of Public Health University of California Berkeley Berkeley CA
| | - Paul K. Whelton
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
| | - Annalisa Chiari
- Neurology Unit, Department of Neurosciences Azienda Ospedaliero Universitaria di Modena Modena Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
- Clinical and Experimental Medicine PhD Program University of Modena and Reggio Emilia Modena Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center University of Modena and Reggio Emilia Modena Italy
- Department of Epidemiology Boston University School of Public Health Boston MA
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8
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Huang M, Lai H, Yu Y, Chen X, Wang T, Feng Q. Deep-gated recurrent unit and diet network-based genome-wide association analysis for detecting the biomarkers of Alzheimer's disease. Med Image Anal 2021; 73:102189. [PMID: 34343841 DOI: 10.1016/j.media.2021.102189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/30/2021] [Accepted: 07/16/2021] [Indexed: 01/01/2023]
Abstract
Genome-wide association analysis (GWAS) is a commonly used method to detect the potential biomarkers of Alzheimer's disease (AD). Most existing GWAS methods entail a high computational cost, disregard correlations among imaging data and correlations among genetic data, and ignore various associations between longitudinal imaging and genetic data. A novel GWAS method was proposed to identify potential AD biomarkers and address these problems. A network based on a gated recurrent unit was applied without imputing incomplete longitudinal imaging data to integrate the longitudinal data of variable lengths and extract an image representation. In this study, a modified diet network that can considerably reduce the number of parameters in the genetic network was proposed to perform GWAS between image representation and genetic data. Genetic representation can be extracted in this way. A link between genetic representation and AD was established to detect potential AD biomarkers. The proposed method was tested on a set of simulated data and a real AD dataset. Results of the simulated data showed that the proposed method can accurately detect relevant biomarkers. Moreover, the results of real AD dataset showed that the proposed method can detect some new risk-related genes of AD. Based on previous reports, no research has incorporated a deep-learning model into a GWAS framework to investigate the potential information on super-high-dimensional genetic data and longitudinal imaging data and create a link between imaging genetics and AD for detecting potential AD biomarkers. Therefore, the proposed method may provide new insights into the underlying pathological mechanism of AD.
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Affiliation(s)
- Meiyan Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China; Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China.
| | - Haoran Lai
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China.
| | - Yuwei Yu
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China.
| | - Xiumei Chen
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China.
| | - Tao Wang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China.
| | - Qianjin Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China; Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China.
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9
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Biomarkers and Risk Prediction Tools for Stroke and Dementia in Patients with Atrial Fibrillation. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Ladwig KH, Goette A, Atasoy S, Johar H. Psychological aspects of atrial fibrillation: A systematic narrative review : Impact on incidence, cognition, prognosis, and symptom perception. Curr Cardiol Rep 2020; 22:137. [PMID: 32910300 PMCID: PMC7496063 DOI: 10.1007/s11886-020-01396-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF THE REVIEW Atrial fibrillation (AF) is the most frequent arrhythmia in the general population. This review aims to provide a comprehensive overview of the psychological aspects of AF, compiling evidence from epidemiological, clinical, and basic research sources. RECENT FINDINGS Findings from large-scale population-based and clinical longitudinal studies reveal an association between negative affectivity (e.g. depression) and the incidence and clinical prognosis of AF. Studies investigating the impact of work stress parameters on AF onset show conflicting results. Researchers have reported the impact of AF on cognitive decline and on health-related quality of life, and have highlighted the role of interoceptive cues in the development of AF symptom burden and gender differences in psychological covariates of AF. Among biological pathways linking psychosocial factors to AF, research on autonomic regulation has yielded the most evidence so far, showing that the onset of AF is associated with simultaneous sympatho-vagal activation rather than an increase in vagal or sympathetic drive alone. Thus, modulation of the autonomic nervous system is likely to be a promising strategy for protecting the myocardium from pro-arrhythmic autonomic influences. In total, the findings show that AF is embedded as a disease condition in a psycho-societal context and is not an isolated medical problem per se. A broader perspective than a focus on the electrophysiology alone is urgently needed.
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Affiliation(s)
- Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM), Langerstr. 3, 81675 Munich, Germany
- Institute of Epidemiology, Mental Health Research Unit, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
| | - Andreas Goette
- St. Vincenz-Krankenhaus GmbH, Medizinischen Klinik II, Paderborn, Germany
- Working Group on Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Seryan Atasoy
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM), Langerstr. 3, 81675 Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Marburg, Germany
| | - Hamimatunnisa Johar
- Institute of Epidemiology, Mental Health Research Unit, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Marburg, Germany
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Puccio D, Vizzini MC, Baiamonte V, Lunetta M, Evola S, Galassi AR, Novo G. Atrial fibrillation and cognitive disorders: An overview on possible correlation. Mech Ageing Dev 2020; 191:111326. [PMID: 32768444 DOI: 10.1016/j.mad.2020.111326] [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: 04/21/2020] [Revised: 07/21/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
Atrial Fibrillation is the most common cardiac arrhythmia affecting people of all ages, principally the elderly. Cognitive decline and dementia are also prevalent diseases in elderly. The scientific community always showed interest in the possible association between these two pathological entities, both implicating social and economic burden. This has been confirmed by several longitudinal population-based studies. Some studies also revealed that the association between atrial fibrillation and dementia may be not related to history of stroke. Therefore, other pathophysiological mechanisms are likely implicated, so far unclear or undefined. The aim of the present review is to analyse the possible mechanisms underlying the frequent association between atrial fibrillation and cognitive impairment.
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Affiliation(s)
- Danilo Puccio
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy.
| | - M Chiara Vizzini
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | | | - Monica Lunetta
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy
| | - Salvatore Evola
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy
| | - Alfredo Ruggero Galassi
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Giuseppina Novo
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
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12
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Manolis TA, Manolis AA, Apostolopoulos EJ, Melita H, Manolis AS. Atrial Fibrillation and Cognitive Impairment: An Associated Burden or Burden by Association? Angiology 2020; 71:498-519. [DOI: 10.1177/0003319720910669] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Growing evidence suggests that atrial fibrillation (AF), in addition to its thromboembolic risk, is a risk factor for cognitive impairment (CI) via several pathways and mechanisms, further contributing to morbidity/mortality. Prior stroke is a contributor to CI, but AF is also associated with CI independently from prior stroke. Silent brain infarctions, microemboli and microbleeds, brain atrophy, cerebral hypoperfusion from widely fluctuating ventricular rates, altered hemostatic function, vascular oxidative stress, and inflammation may all exacerbate CI, particularly in patients with persistent/permanent rather than paroxysmal AF and with increased duration/burden of the arrhythmia. Brain magnetic resonance imaging is an important screening tool in eliciting and monitoring vascular and nonvascular lesions contributing to CI. Evidence is also emerging about the role of genetics in CI development. Anticoagulation and rhythm/rate control strategies may protect against CI preventing or slowing its progression or conversion to dementia, particularly at the early stages when CI may still be a treatable condition. Importantly, AF and CI share many common risk factors. Thus, screening for these 2 conditions and searching for and managing modifiable risk factors and potentially reversible causes for both AF and CI remains an important step toward prevention or amelioration of the impact incurred by these 2 conditions.
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Affiliation(s)
| | | | | | | | - Antonis S. Manolis
- First and Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
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13
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Sepehri Shamloo A, Dagres N, Müssigbrodt A, Stauber A, Kircher S, Richter S, Dinov B, Bertagnolli L, Husser-Bollmann D, Bollmann A, Hindricks G, Arya A. Atrial Fibrillation and Cognitive Impairment: New Insights and Future Directions. Heart Lung Circ 2020; 29:69-85. [DOI: 10.1016/j.hlc.2019.05.185] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/13/2019] [Accepted: 05/30/2019] [Indexed: 12/18/2022]
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14
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Ostroumova OD, Kochetkov AI, Korchagina SP, Ostroumova TM, Chernyaeva MS, Kirichenko AA. Anticoagulant Therapy as a Tool for the Prevention of Cognitive Impairment Associated with Atrial Fibrillation. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-5-713-724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in clinical practice and important additional risk factor for the development of cognitive impairment (CI) and dementia as it has been shown in recent studies. According to the Diagnostic and statistical manual of mental disorders latest revision CI refers to a decrease of one or more higher cortical functions that provide the processes of perception, storage, transformation and transmission of information compared to the premorbid level. The main hypothesis that explains the relationship between AF and dementia is the assumption that in the presence of this arrhythmia a brain substance is damaged due to microembolism and cerebral microbleeding. The high clinical significance of AF as well as CI served as a background for the development by European experts several consensus documents concerning the problem of the relationships between these conditions. In addition, they emphasize the role of anticoagulant therapy as a preventing tool for the development of stroke, which can be a factor in the CI progression in patients with AF, with particular priority to direct oral anticoagulants (DOACs). In randomized clinical trials, meta-analyses and systematic reviews have been shown that the use of DOACs, as compared to vitamin K antagonists, is a more rational strategy for preventing stroke associated with AF. Among the DOAC class, rivaroxaban is worth noticing as a drug that has a favorable efficacy profile for primary and secondary stroke prevention. Rivaroxaban distinguishing characteristics are a once daily administration as well as a calendar package which is practically important for patients with CI.
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Affiliation(s)
- O. D. Ostroumova
- Pirogov Russian National Research Medical University, Russian Clinical and Research Center of Gerontology;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. I. Kochetkov
- Pirogov Russian National Research Medical University, Russian Clinical and Research Center of Gerontology
| | | | - T. M. Ostroumova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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15
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Kobalava ZD, Lazarev PV, Fedorova DN. [Cognitive Dysfunction at the Background of Atrial Fibrillation: Clinical-Pathological Aspects, Diagnostics and Prevention, Issues of the Use of the Application of Anticoagulant Therapy]. KARDIOLOGIIA 2019; 59:66-77. [PMID: 31615389 DOI: 10.18087/cardio.2019.10.n612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
Atrial fibrillation (AF) and cognitive dysfunction - common states with similar risk factors. Recently significant scientific epidemiological data has been received in favor of independence of effect of AF on possibility of development of cognitive dysfunction. In this review we present problems of prevalence, pathogenesis, and diagnostics of various variants of cognitive disorders at the background of AF, as well as methods of their prevention and tactics of anticoagulant therapy in the presence of cognitive disturbances.
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Affiliation(s)
- Zh D Kobalava
- Peoples Friendship University of Russia (RUDN University)
| | - P V Lazarev
- Peoples Friendship University of Russia (RUDN University)
| | - D N Fedorova
- Peoples Friendship University of Russia (RUDN University)
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16
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Abstract
PURPOSE OF REVIEW Atrial fibrillation is one of the most common clinically encountered arrhythmias exhibiting a strong association with a spectrum of cerebral injuries from the occurrence of clinical stroke, subclinical stroke, dementia, and cognitive decline. Dynamic noninvasive specific and sensitive diagnostic tests may allow a personalized approach to the atrial fibrillation patient's treatment based upon quantitative parameters, aiming to prevent or delay stroke, dementia, progressive cognitive decline, or to assess responses to these therapies. This review will explore molecular markers that have been shown to have an association with atrial fibrillation, and have a potential to be predictive for the risk for stroke, cognitive dysfunction, and dementia in these patients. RECENT FINDINGS Circulating biomarkers of vascular disease, fibrosis, thrombosis, and inflammation are associated with risk of stroke in patients with atrial fibrillation. These biomarkers are additive to the predictive utility of the CHADS2 and CHA2DS2-VASc scores, and in some cases allow for additional risk prognostication of the broad categories allocated by CHADS2 and CHA2DS2-VASc scores of low, medium, and high. SUMMARY Across the spectrum of cerebral injuries in patients with atrial fibrillation, biomarkers hold the promise of personalized risk stratification and management to minimize risks of disease.
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17
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Gallinoro E, D'Elia S, Prozzo D, Lioncino M, Natale F, Golino P, Cimmino G. Cognitive Function and Atrial Fibrillation: From the Strength of Relationship to the Dark Side of Prevention. Is There a Contribution from Sinus Rhythm Restoration and Maintenance? ACTA ACUST UNITED AC 2019; 55:medicina55090587. [PMID: 31540311 PMCID: PMC6780629 DOI: 10.3390/medicina55090587] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/07/2019] [Accepted: 09/10/2019] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia with an increasing prevalence over time mainly because of population aging. It is well established that the presence of AF increases the risk of stroke, heart failure, sudden death, and cardiovascular morbidity. In the last two decades several reports have shown an association between AF and cognitive function, ranging from impairment to dementia. Ischemic stroke linked to AF is a well-known risk factor and predictor of cognitive decline. In this clinical scenario, the risk of stroke might be reduced by oral anticoagulation. However, recent data suggest that AF may be a predictor of cognitive impairment and dementia also in the absence of stroke. Cerebral hypoperfusion, reduced brain volume, microbleeds, white matter hyperintensity, neuroinflammation, and genetic factors have been considered as potential mechanisms involved in the pathogenesis of AF-related cognitive dysfunction. However, a cause-effect relationship remains still controversial. Consequently, no therapeutic strategies are available to prevent AF-related cognitive decline in stroke-free patients. This review will analyze the potential mechanisms leading to cognitive dysfunction in AF patients and examine the available data on the impact of a sinus rhythm restoration and maintenance strategy in reducing the risk of cognitive decline.
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Affiliation(s)
- Emanuele Gallinoro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Saverio D'Elia
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Dario Prozzo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Michele Lioncino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Francesco Natale
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Paolo Golino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Giovanni Cimmino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
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18
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Cruz D, Pinto R, Freitas-Silva M, Nunes JP, Medeiros R. GWAS contribution to atrial fibrillation and atrial fibrillation-related stroke: pathophysiological implications. Pharmacogenomics 2019; 20:765-780. [PMID: 31368859 DOI: 10.2217/pgs-2019-0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Atrial fibrillation (AF) and stroke are included in a group of complex traits that have been approached regarding of their study by susceptibility genetic determinants. Since 2007, several genome-wide association studies (GWAS) aiming to identify genetic variants modulating AF risk have been conducted. Thus, 11 GWAS have identified 26 SNPs (p < 5 × 10-2), of which 19 reached genome-wide significance (p < 5 × 10-8). From those variants, seven were also associated with cardioembolic stroke and three reached genome-wide significance in stroke GWAS. These associations may shed a light on putative shared etiologic mechanisms between AF and cardioembolic stroke. Additionally, some of these identified variants have been incorporated in genetic risk scores in order to elucidate new approaches of stroke prediction, prevention and treatment.
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Affiliation(s)
- Diana Cruz
- Molecular Oncology & Viral Pathology Group-Research Center, Portuguese Institute of Oncology, Edifício Laboratórios. 4° piso, Rua Dr António Bernardino de Almeida, 4200-4072 Porto, Portugal.,FMUP, Faculty of Medicine, Porto University, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ricardo Pinto
- Molecular Oncology & Viral Pathology Group-Research Center, Portuguese Institute of Oncology, Edifício Laboratórios. 4° piso, Rua Dr António Bernardino de Almeida, 4200-4072 Porto, Portugal
| | - Margarida Freitas-Silva
- FMUP, Faculty of Medicine, Porto University, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal.,Department of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - José Pedro Nunes
- FMUP, Faculty of Medicine, Porto University, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal.,Department of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology & Viral Pathology Group-Research Center, Portuguese Institute of Oncology, Edifício Laboratórios. 4° piso, Rua Dr António Bernardino de Almeida, 4200-4072 Porto, Portugal.,FMUP, Faculty of Medicine, Porto University, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal.,Research Department, Portuguese League Against Cancer (NRNorte), Estrada Interior da Circunvalação, 6657, 4200-172 Porto, Portugal.,CEBIMED, Faculty of Health Sciences, Fernando Pessoa University, Praça 9 de Abril, 349, 4249-004 Porto, Portugal
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19
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Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Europace 2019; 20:1399-1421. [PMID: 29562326 DOI: 10.1093/europace/euy046] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 01/24/2023] Open
Abstract
Abstract
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Affiliation(s)
- Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, Strümpellstr. 39, Leipzig, Germany
| | - Tze-Fan Chao
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | - Daniel Benhayon
- Cardiac and Vascular Institute, Memorial Health, Hollywood, FL, USA
| | - Emelia J Benjamin
- Boston University Schools of Medicine and Public Health, Framingham Heart Study, Boston, MA, USA
| | | | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Angelo de Paola
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Université François Rabelais, Tours, France
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | - Deirdre A Lane
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Manlio F Márquez
- Departmen of Electrocardiography, Instituto Nacional De Cardiologia, Mexico City, Mexico
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | - Irina Savelieva
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK
| | | | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Atul Verma
- Southlake Regional Health Centre, Ontario, Canada
| | - Shu Zhang
- Beijing Fuwai Hospital, Beijing, People's Republic of China
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20
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Bunch TJ, Galenko O, Graves KG, Jacobs V, May HT. Atrial Fibrillation and Dementia: Exploring the Association, Defining Risks and Improving Outcomes. Arrhythm Electrophysiol Rev 2019; 8:8-12. [PMID: 30918661 PMCID: PMC6434510 DOI: 10.15420/aer.2018.75.2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AF is strongly associated with a spectrum of cranial injuries including stroke and dementia. Dementia risk is seen in patients with and without a prior stroke and includes idiopathic forms of dementia, such as Alzheimer’s disease. The initiation, use and efficacy of anticoagulation have been shown in multiple observational trials to have an impact on dementia risk. Cerebral hypoperfusion during AF can result in cognitive decline and patients with cranial atherosclerosis may have unique susceptibility. Therapies to carefully control the ventricular rate and catheter ablation have been shown in observational trials to lower dementia risk. There is a need for further research in multiple areas and the observational trials will require prospective trials confirmation. Recent guidelines for AF have advocated the initiation of effective anticoagulation, the treatment of associated disease conditions that may influence the progression of AF and catheter ablation, with long-term management of risk factors to lower risk of dementia.
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Affiliation(s)
- T Jared Bunch
- Intermountain Medical Center Heart Institute Murray, UT, US.,Department of Internal Medicine Stanford University, Palo Alto, CA, US
| | - Oxana Galenko
- Intermountain Medical Center Heart Institute Murray, UT, US
| | | | | | - Heidi T May
- Intermountain Medical Center Heart Institute Murray, UT, US
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21
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Xiang S, Huang Z, Wang T, Han Z, Yu CY, Ni D, Huang K, Zhang J. Condition-specific gene co-expression network mining identifies key pathways and regulators in the brain tissue of Alzheimer's disease patients. BMC Med Genomics 2018; 11:115. [PMID: 30598117 PMCID: PMC6311927 DOI: 10.1186/s12920-018-0431-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Gene co-expression network (GCN) mining is a systematic approach to efficiently identify novel disease pathways, predict novel gene functions and search for potential disease biomarkers. However, few studies have systematically identified GCNs in multiple brain transcriptomic data of Alzheimer’s disease (AD) patients and looked for their specific functions. Methods In this study, we first mined GCN modules from AD and normal brain samples in multiple datasets respectively; then identified gene modules that are specific to AD or normal samples; lastly, condition-specific modules with similar functional enrichments were merged and enriched differentially expressed upstream transcription factors were further examined for the AD/normal-specific modules. Results We obtained 30 AD-specific modules which showed gain of correlation in AD samples and 31 normal-specific modules with loss of correlation in AD samples compared to normal ones, using the network mining tool lmQCM. Functional and pathway enrichment analysis not only confirmed known gene functional categories related to AD, but also identified novel regulatory factors and pathways. Remarkably, pathway analysis suggested that a variety of viral, bacteria, and parasitic infection pathways are activated in AD samples. Furthermore, upstream transcription factor analysis identified differentially expressed upstream regulators such as ZFHX3 for several modules, which can be potential driver genes for AD etiology and pathology. Conclusions Through our state-of-the-art network-based approach, AD/normal-specific GCN modules were identified using multiple transcriptomic datasets from multiple regions of the brain. Bacterial and viral infectious disease related pathways are the most frequently enriched in modules across datasets. Transcription factor ZFHX3 was identified as a potential driver regulator targeting the infectious diseases pathways in AD-specific modules. Our results provided new direction to the mechanism of AD as well as new candidates for drug targets. Electronic supplementary material The online version of this article (10.1186/s12920-018-0431-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shunian Xiang
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University, Shenzhen, 518060, China.,Department of Medical & Molecular Genetics, Indiana University, Indianapolis, IN, 46202, USA
| | - Zhi Huang
- Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Tianfu Wang
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University, Shenzhen, 518060, China
| | - Zhi Han
- Department of Medicine, Indiana University, Indianapolis, IN, 46202, USA
| | - Christina Y Yu
- Department of Medicine, Indiana University, Indianapolis, IN, 46202, USA.,Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - Dong Ni
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University, Shenzhen, 518060, China.
| | - Kun Huang
- Department of Medicine, Indiana University, Indianapolis, IN, 46202, USA.
| | - Jie Zhang
- Department of Medical & Molecular Genetics, Indiana University, Indianapolis, IN, 46202, USA.
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22
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Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications. Am J Med 2018; 131:1408-1417. [PMID: 30076825 DOI: 10.1016/j.amjmed.2018.06.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 11/23/2022]
Abstract
Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors such as age or hypertension. Critical appraisal of studies evaluating the association between atrial fibrillation and dementia in stroke-free patients reveals that several suffer from methodological issues, such as not including silent stroke or anticoagulation therapy in multivariate analyses. Some studies show a close relationship between atrial fibrillation and dementia due to silent stroke, in the absence of overt stroke. Evidence is accumulating that anticoagulation may be effective to decrease the risk of dementia in atrial fibrillation patients. Overall, the pathogenesis linking atrial fibrillation to dementia is likely multifactorial. Cerebral infarctions, including silent stroke, play a central role. These findings underscore the importance of stroke prevention measures in atrial fibrillation patients.
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23
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Akushevich I, Kravchenko J, Yashkin AP, Yashin AI. Time trends in the prevalence of cancer and non-cancer diseases among older U.S. adults: Medicare-based analysis. Exp Gerontol 2018; 110:267-276. [PMID: 29932968 DOI: 10.1016/j.exger.2018.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 04/30/2018] [Accepted: 06/17/2018] [Indexed: 12/15/2022]
Abstract
Longer lifespan is accompanied by a larger number of chronic diseases among older adults. Because of a growing proportion of older adults in the U.S., this brings the problem of age-related morbidity to the forefront as a major contributor to rising medical expenditures. We evaluated 15-year time trends (from 1998 to 2013) in the prevalence of 48 acute and chronic non-cancer diseases and cancers in older U.S. adults aged 65+ and estimated the annual percentage changes of these prevalence trends using SEER-Medicare and HRS-Medicare data. We found that age-adjusted prevalence of cancers of kidney, pancreas, and melanoma, as well as diabetes, renal disease, limb fracture, depression, anemia, weight deficiency, dementia/Alzheimer's disease, drug/medications abuse and several other diseases/conditions increased over time. Conversely, prevalence of myocardial infarction, heart failure, cardiomyopathy, pneumonia/influenza, peptic ulcer, and gastrointestinal bleeding, among others, decreased over time. There are also diseases whose prevalence did not change substantially over time, e.g., a group of fast progressing cancers and rheumatoid arthritis. Analysis of trends of multiple diseases performed simultaneously within one study design with focus on the same time interval and the same population for all diseases allowed us to provide insight into the epidemiology of these conditions and identify the most alarming and/or unexpected trends and trade-offs. The obtained results can be used for health expenditures planning for growing sector of older adults in the U.S.
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Affiliation(s)
- Igor Akushevich
- Biodemography of Aging Research Unit, Center for Population Health and Aging, Duke University, Durham, NC, United States of America.
| | - Julia Kravchenko
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, Duke University, Durham, NC, United States of America
| | - Arseniy P Yashkin
- Biodemography of Aging Research Unit, Center for Population Health and Aging, Duke University, Durham, NC, United States of America
| | - Anatoliy I Yashin
- Biodemography of Aging Research Unit, Center for Population Health and Aging, Duke University, Durham, NC, United States of America
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24
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Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK, Bautista-Vargas WF, Chiang CE, Cuesta A, Dan GA, Frankel DS, Guo Y, Hatala R, Lee YS, Murakawa Y, Pellegrini CN, Pinho C, Milan DJ, Morin DP, Nadalin E, Ntaios G, Prabhu MA, Proietti M, Rivard L, Valentino M, Shantsila A. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: What is the best practice? J Arrhythm 2018; 34:99-123. [PMID: 29657586 PMCID: PMC5891416 DOI: 10.1002/joa3.12050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Nikolaos Dagres
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany
| | | | | | | | - Daniel Benhayon
- Cardiac and Vascular Institute Memorial Health Hollywood FL USA
| | - Emelia J Benjamin
- Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA
| | | | - Lin Yee Chen
- Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA
| | | | | | - Angelo de Paola
- Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
| | - Laurent Fauchier
- Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany
| | - Jonathan Kalman
- Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia
| | | | | | - Deirdre A Lane
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | | | - Manlio F Márquez
- Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico
| | - Tatjana Potpara
- School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia
| | | | | | - Irina Savelieva
- Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK
| | | | - Hung-Fat Tse
- Department of Medicine The University of Hong Kong Hong Kong China
| | - Atul Verma
- Southlake Regional Health Centre Newmarket ON Canada
| | - Shu Zhang
- Beijing Fuwai Hospital Beijing China
| | | | - William-Fernando Bautista-Vargas
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Chern-En Chiang
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Alejandro Cuesta
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Gheorghe-Andrei Dan
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - David S Frankel
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Yutao Guo
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Robert Hatala
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Young Soo Lee
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Yuji Murakawa
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Cara N Pellegrini
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Claudio Pinho
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - David J Milan
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Daniel P Morin
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Elenir Nadalin
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - George Ntaios
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Mukund A Prabhu
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Marco Proietti
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Lena Rivard
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Mariana Valentino
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Alena Shantsila
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
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European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Heart Rhythm 2018; 15:e37-e60. [PMID: 29563045 DOI: 10.1016/j.hrthm.2018.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Indexed: 12/18/2022]
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Mechanisms, Clinical Significance, and Prevention of Cognitive Impairment in Patients With Atrial Fibrillation. Can J Cardiol 2017; 33:1556-1564. [DOI: 10.1016/j.cjca.2017.09.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/21/2017] [Accepted: 09/24/2017] [Indexed: 11/18/2022] Open
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Bunch TJ, May HT, Bair TL, Crandall BG, Cutler MJ, Day JD, Jacobs V, Mallender C, Osborn JS, Stevens SM, Weiss JP, Woller SC. Atrial Fibrillation Patients Treated With Long-Term Warfarin Anticoagulation Have Higher Rates of All Dementia Types Compared With Patients Receiving Long-Term Warfarin for Other Indications. J Am Heart Assoc 2016; 5:JAHA.116.003932. [PMID: 27402230 PMCID: PMC5015414 DOI: 10.1161/jaha.116.003932] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The mechanisms behind the association of atrial fibrillation (AF) and dementia are unknown. We previously found a significantly increased risk of dementia in AF patients taking warfarin with a low percentage of time in therapeutic range. The purpose of this study was to determine the extent to which AF itself increases dementia risk, in addition to long-term anticoagulation exposure. METHODS AND RESULTS A total of 10 537 patients anticoagulated with warfarin (target INR 2-3), managed by the Clinical Pharmacist Anticoagulation Service with no history of dementia were included. Warfarin indication was for AF (n=4460), thromboembolism (n=5868), and mechanical heart valve(s) (n=209). Patients in the latter 2 categories were included only if they had no prior history of AF. The primary outcome was dementia. Patients with AF were older and had higher rates of hypertension, diabetes, heart failure, and stroke. AF patients experienced higher rates of total dementia (5.8% versus 1.6%, P<0.0001), Alzheimer disease (2.8% versus 0.9%, P<0.0001), and vascular dementia (1.0% versus 0.2%, P<0.0001). A propensity analysis of 6030 patients was performed to account for baseline demographics differences. Long-term risk of dementia remained significant in AF patients compared with matched non-AF patients (total dementia: hazard ratio [HR]=2.42 [1.85-3.18], P<0.0001; Alzheimer: HR=2.04 [1.40-2.98], P<0.0001; senile: HR=2.46 [1.58-3.86], P<0.0001). Low percent therapeutic range compared with a higher percent therapeutic range was associated with dementia risk in both AF (26-50% versus >75%: HR=2.51, P=0.005) and non-AF groups (≤25% versus >75%: HR=3.92, P<0.0001). CONCLUSIONS The presence of AF significantly increases risk of dementia, including Alzheimer's disease, compared with matched patients receiving warfarin anticoagulation for other reasons. Quality of anticoagulation management remains an important risk factor for dementia in all patients.
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Affiliation(s)
- T Jared Bunch
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT Department of Internal Medicine, Stanford University, Palo Alto, CA
| | - Heidi T May
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - Tami L Bair
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - Brian G Crandall
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - Michael J Cutler
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - John D Day
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - Victoria Jacobs
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - Charles Mallender
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - Jeffrey S Osborn
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - Scott M Stevens
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - J Peter Weiss
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - Scott C Woller
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
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