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Mohanty S, La Fazia VM, Natale A. The Antwerp score: is this the 'new hope on the horizon'? Eur Heart J 2023; 44:3336-3338. [PMID: 37387669 DOI: 10.1093/eurheartj/ehad420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Affiliation(s)
- Sanghamitra Mohanty
- St. David's Medical Center, Texas Cardiac Arruthmia Institute, 1015 E. 32nd St., Suite 516, Austin, TX 78705, USA
| | - Vincenzo Mirco La Fazia
- St. David's Medical Center, Texas Cardiac Arruthmia Institute, 1015 E. 32nd St., Suite 516, Austin, TX 78705, USA
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arruthmia Institute, 1015 E. 32nd St., Suite 516, Austin, TX 78705, USA
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Aoyama D, Miyazaki S, Tsuji T, Nomura R, Kakehashi S, Mukai M, Ikeda H, Ishida K, Uzui H, Tada H. Low troponin I levels predict the presence of arrhythmia-induced cardiomyopathy in patients with atrial fibrillation and left ventricular systolic dysfunction. Heart Vessels 2023; 38:929-937. [PMID: 36823474 DOI: 10.1007/s00380-023-02242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/18/2023] [Indexed: 02/25/2023]
Abstract
Successful atrial fibrillation (AF) ablation can improve reduced left ventricular ejection fraction (LVEF) with AF, which is defined as arrhythmia-induced cardiomyopathy (AIC). However, it is difficult to pre-procedurally predict the presence of AIC. We aimed to explore the pre-procedural predictors of AIC in patients with AF and reduced LVEF. This study included 60 patients with a reduced LVEF (LVEF < 50%; 69.1 ± 8.8 years; 45 men) who underwent successful AF ablation. Responders were defined as patients whose LVEF post-procedurally improved to the normal range (≥ 50%). Multivariate analysis revealed that the log-transformed pre-procedural troponin I (TnI) levels (odds ratio [OR] = 0.059; 95% confidence interval [CI] = 0.0052-0.42, p = 0.003) and age (OR = 0.91; 95% CI = 0.82-1.00, p = 0.044) were independent predictors of post-procedural LVEF recovery; further, low TnI levels (< 11.1 pg/ml) predicted LVEF recovery (sensitivity, 79.1%; specificity, 76.5%; positive predictive value, 89.5%; and negative predictive value, 59.1%). There were no significant differences in TnI levels between the baseline and 1 month after the procedure. However, four patients with high baseline TnI levels showed a > 50% reduction in the TnI levels post-procedurally, with three of these patients showing LVEF recovery. Low pre-procedural TnI levels can predict LVEF recovery after successful AF ablation in patients with reduced LVEF.
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Affiliation(s)
- Daisetsu Aoyama
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan.
| | - Shinsuke Miyazaki
- The Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshihiko Tsuji
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Ryohei Nomura
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Shota Kakehashi
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Moe Mukai
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Hiroyuki Ikeda
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Kentaro Ishida
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Hiroyasu Uzui
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Hiroshi Tada
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
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Nomura Y, Harada M, Motoike Y, Nishimura A, Koshikawa M, Ito T, Sobue Y, Kitagawa F, Watanabe E, Ozaki Y, Izawa H. Selvester QRS Score Predicts Improvement of LVEF in Atrial Fibrillation Patients with Systolic Heart Failure. Pacing Clin Electrophysiol 2022; 45:619-628. [PMID: 35383970 DOI: 10.1111/pace.14498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 03/17/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left-ventricular systolic dysfunction (LVSD) comorbid with atrial fibrillation is reversible, but recovery is limited in a subset of patients. The Selvester QRS (S-QRS) score is an electrocardiogram-based assessment that reportedly reflects myocardial scar/damage. We evaluated the predictability of S-QRS score for the recovery of left-ventricular ejection fraction (LVEF) in persistent AF (PeAF) patients with LVSD undergoing catheter ablation (CA). METHOD CA was performed in 51 PeAF patients with reduced LVEF (<40%); S-QRS scores were measured after restoration of sinus rhythm. LVEF was re-evaluated at one year after CA; LVEF recovery was related to the S-QRS score. RESULTS The median [interquartile range] S-QRS score was 1 points [0-2]. LVEF increased from 32% [28-37] at baseline to 56% [49-57] at one year after CA. Thirty-seven patients achieved normalization of LVEF (≥50%, Group A); 14 patients did not (Group B). Group A had significantly lower S-QRS scores than Group B (0 point [0-2] vs. 2 points [2-3], p<0.05). In univariate/multivariate analyses, S-QRS score was an independent predictor of LVEF normalization. In the receiver operating characteristic curve, the cut-off value of S-QRS score was 2 points for prediction of the LVEF normalization (AUC = 0.75). Patients with low S-QRS score (<2 points) had greater LVEF improvement than those with high S-QRS score (≥2 points, ΔLVEF: 23% [17-28] vs. 17% [12-24], p<0.05). CONCLUSION S-QRS scoring non-invasively assesses the improvement of LVEF in PeAF patients with LVSD after CA. A high S-QRS score may indicate underlying myocardial scar/damage associated with unknown etiologies for LVSD other than PeAF. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yoshihiro Nomura
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masahide Harada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yuji Motoike
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Asuka Nishimura
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masayuki Koshikawa
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takehiro Ito
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yoshihiro Sobue
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Fumihiko Kitagawa
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University Hospital, Toyoake, Japan, Toyoake, Aichi, Japan
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Diamant MJ, Andrade JG, Virani SA, Jhund PS, Petrie MC, Hawkins NM. Heart failure and atrial flutter: a systematic review of current knowledge and practices. ESC Heart Fail 2021; 8:4484-4496. [PMID: 34505352 PMCID: PMC8712920 DOI: 10.1002/ehf2.13526] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 01/14/2023] Open
Abstract
While the interplay between heart failure (HF) and atrial fibrillation (AF) has been extensively studied, little is known regarding HF and atrial flutter (AFL), which may be managed differently. We reviewed the incidence, prevalence, and predictors of HF in AFL and vice versa, and the outcomes of treatment of AFL in HF. A systematic literature review of PubMed/Medline and EMBASE yielded 65 studies for inclusion and qualitative synthesis. No study described the incidence or prevalence of AFL in unselected patients with HF. Most cohorts enrolled patients with AF/AFL as interchangeable diagnoses, or highly selected patients with tachycardia‐induced cardiomyopathy. The prevalence of HF in AFL ranged from 6% to 56%. However, the phenotype of HF was never defined by left ventricular ejection fraction (LVEF). No studies reported the predictors, phenotype, and prognostic implications of AFL in HF. There was significant variation in treatments studied, including the proportion that underwent ablation. When systolic dysfunction was tachycardia‐mediated, catheter ablation demonstrated LVEF normalization in up to 88%, as well as reduced cardiovascular mortality. In summary, AFL and HF often coexist but are understudied, with no randomized trial data to inform care. Further research is warranted to define the epidemiology and establish optimal management.
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Affiliation(s)
- Michael J Diamant
- Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada.,Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason G Andrade
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean A Virani
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Uncovering the Molecular Mechanism of the Qiang-Xin 1 Formula on Sepsis-Induced Cardiac Dysfunction Based on Systems Pharmacology. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:3815185. [PMID: 32908632 PMCID: PMC7474398 DOI: 10.1155/2020/3815185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/29/2022]
Abstract
Cardiac dysfunction is a critical manifestation of sepsis-induced multiorgan failure and results in the high mortality of sepsis. Our previous study demonstrated that a traditional Chinese medicine formula, Qiang-Xin 1 (QX1), ameliorates cardiac tissue damage in septic mice; however, the underlying pharmacology mechanism remains to be elucidated. The present study was aimed at clarifying the protective mechanism of the QX1 formula on sepsis-induced cardiac dysfunction. The moderate sepsis model of mice was established by cecal ligation and puncture surgery. Treatment with the QX1 formula improved the 7-day survival outcome, attenuated cardiac dysfunction, and ameliorated the disruption of myocardial structure in septic mice. Subsequent systems pharmacology analysis found that 63 bioactive compounds and the related 79 candidate target proteins were screened from the QX1 formula. The network analysis showed that the QX1 active components quercetin, formononetin, kaempferol, taxifolin, cryptotanshinone, and tanshinone IIA had a good binding activity with screened targets. The integrating pathway analysis indicated the calcium, PI3K/AKT, MAPK, and Toll-like receptor signaling pathways may be involved in the protective effect of the QX1 formula on sepsis-induced cardiac dysfunction. Further, experimental validation showed that the QX1 formula inhibited the activity of calcium/calmodulin-dependent protein kinase II (CaMKII), MAPK (P38, ERK1/2, and JNK), and TLR4/NF-κB signaling pathways but promoted the activation of the PI3K/AKT pathway. A cytokine array found that the QX1 formula attenuated sepsis-induced upregulated levels of serum IFN-γ, IL-1β, IL-3, IL-6, IL-17, IL-4, IL-10, and TNF-α. Our data suggested that QX1 may represent a novel therapeutic strategy for sepsis by suppressing the activity of calcium, MAPK, and TLR4/NF-κB pathways, but promoting the activation of AKT, thus controlling cytokine storm and regulating immune balance. The present study demonstrated the multicomponent, multitarget, and multipathway characteristics of the QX1 formula and provided a novel understanding of the QX1 formula in the clinical application on cardiac dysfunction-related diseases.
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Aoyama D, Miyazaki S, Hasegawa K, Kaseno K, Ishikawa E, Mukai M, Nodera M, Miyahara K, Matsui A, Shiomi Y, Tama N, Ikeda H, Fukuoka Y, Morishita T, Ishida K, Uzui H, Tada H. Preprocedural Troponin T Levels Predict the Improvement in the Left Ventricular Ejection Fraction After Catheter Ablation of Atrial Fibrillation/Flutter. J Am Heart Assoc 2020; 9:e015126. [PMID: 32200728 PMCID: PMC7428643 DOI: 10.1161/jaha.119.015126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Left ventricular (LV) systolic dysfunction is reversible in some patients once the arrhythmia is controlled. However, identifying this arrhythmia‐induced cardiomyopathy among patients with LV systolic dysfunction is challenging. We explored the factors predicting the reversibility of the LV ejection fraction (LVEF) after catheter ablation of atrial fibrillation and/or atrial flutter in patients with LV systolic dysfunction. Methods and Results Forty patients with a reduced LVEF (LVEF <50%; 66.2±10.7 years; 32 men) who underwent atrial fibrillation/atrial flutter ablation were included. Transthoracic echocardiography was performed before and during the early (<4 days) and late phases (>3 months) after the ablation. Responders were defined as having a normalized LVEF (≥50%) during the late phase after the ablation. The LVEF improved from 39.8±8.8 to 50.9±10.9% at 1.2±0.6 days after the procedure, and to 56.2±12.2% at 9.6±8.0 months after the procedure (both for P<0.001). Thirty (75.0%) patients were responders. The preprocedural echocardiographic parameters were comparable between the responders and nonresponders. In the multivariate analysis, the preprocedural high‐sensitivity troponin T was the only independent predictor of the recovery of the LV dysfunction during the late phase after ablation (odds ratio, 1.17; 95% CI, 1.06–1.33; P=0.001), and a level of ≤12 pg/mL predicted recovery of the LV dysfunction with a high accuracy (sensitivity, 90.0%; specificity, 76.7%; positive predictive value, 56.3%; and negative predictive value, 95.8%). Conclusions Preprocedural high‐sensitivity troponin T levels might be a simple and useful parameter for predicting the reversibility of the LV systolic dysfunction after atrial fibrillation/atrial flutter ablation in patients with a reduced LVEF.
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Affiliation(s)
- Daisetsu Aoyama
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Kenichi Kaseno
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Eri Ishikawa
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Kosuke Miyahara
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Akira Matsui
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Yuichiro Shiomi
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Naoto Tama
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Hiroyuki Ikeda
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Yoshitomo Fukuoka
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Tetsuji Morishita
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Kentaro Ishida
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine Faculty of Medical Sciences University of Fukui Japan
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