1
|
Zhao J, Deng G, Wang W, Wang P, Shen X, Yuan X, Jiang H, Ruan ZB. Effect of atrial fibrosis on clot burden score and physicochemical properties of thrombus in patients with ischaemic stroke occurring in non-valvular atrial fibrillation. PeerJ 2025; 13:e19173. [PMID: 40151456 PMCID: PMC11949112 DOI: 10.7717/peerj.19173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 02/24/2025] [Indexed: 03/29/2025] Open
Abstract
Background To investigate the effect of the degree of atrial fibrosis on the clot burden score (CBS) and physicochemical properties in patients with acute ischaemic stroke (AIS) due to non-valvular atrial fibrillation (NVAF). Methods A total of 117 patients with AIS in NVAF attending the Department of Cardiovascular Medicine and the Cerebrovascular Diagnostic and Treatment Centre between August 2021 and May 2024 were included in the study. Baseline clinical data, biochemical indexes, and imaging data of the patients were collected, and the patients were divided into 93 cases of the CBS (score of 0-6) group and 24 cases of the CBS (score of 7-10) group according to the CBS. CBS (score of 0-6) signifies higher clot burden. The enzyme-linked immunosorbent assay was used to measure the concentration of galactaglutinin-3 (gal-3) and transforming growth factor (TGF-β1) in the serum of the patients, and the PTFV1 were collected by 12-lead electrocardiogram, and the differences in the degree of atrial fibrosis between different groups and the risk factors of CBS (score of 0-6) were analysed. To analyse the effect of atrial fibrosis on the collateral circulation of stroke, the patients were divided into 31 cases with good collateral circulation (grade 3-4) and 86 cases with poor collateral circulation (grade 0-2) according to the digital subtraction angiography (DSA) images. The cerebral thrombus was collected from 60 AIS patients who underwent mechanical thrombectomy. The content of erythrocyte, fibrin/platelets and leukocytes in the thrombus was analysed by Mathew's scarlet blue staining, and the density of thrombus was measured by computed tomography (CT). Results A total of 117 patients were included in this study, and the proportion of hypertensive patients, proportion of chronic atrial fibrillation (CAF), B-type natriuretic peptide (BNP), neutrophil/lymphocyte ratio (NLR), D-dimer, uric acid concentration, proportion of patients with PTFV1 < -0.03 mm s, gal-3, and TGF-β1 were higher in the CBS (score of 0-6) group as compared to the CBS (score of 7-10) group (P-value < 0.05). Hypertension, proportion of CAF, homocysteine, NLR, D-dimer, uric acid, PTFV1 < -0.03 mm s, gal-3, and TGF-β1, were risk factors for the development of high CBS in atrial fibrillation (AF), and hypertension and CAF were the most important factors for the occurrence of AF in the independent risk factors for stroke combined with high clot burden. gal-3 and TGF-β1 were risk factors for poor collateral circulation, atrial fibrosis indexes were not associated with thrombus pathological composition and thrombus density. Conclusions Atrial fibrosis increases clot burden in patients with AIS due to NVAF but does not significantly correlate with the physicochemical properties and density of the thrombus.
Collapse
Affiliation(s)
- Juan Zhao
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
- Department of Cardiology, Tongzhou People’s Hospital, Nantong, Jiangsu, China
| | - Guangjun Deng
- Department of Medical Imaging, Tongzhou People’s Hospital, Nantong, Jiangsu, China
| | - Weijing Wang
- Department of Cardiology, Tongzhou People’s Hospital, Nantong, Jiangsu, China
| | - Peng Wang
- Department of Cardiology, Tongzhou People’s Hospital, Nantong, Jiangsu, China
| | - Xinyu Shen
- Department of Cardiology, Tongzhou People’s Hospital, Nantong, Jiangsu, China
| | - Xiaoxiao Yuan
- Department of Cardiology, Tongzhou People’s Hospital, Nantong, Jiangsu, China
| | - Haifei Jiang
- Department of Cerebrovascular Interventional Diagnosis and Treatment Center, Tongzhou People’s Hospital, Nantong, Jiangsu, China
| | - Zhong-bao Ruan
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
- Department of Cardiology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
| |
Collapse
|
2
|
Johnson LS, Platonov PG, Conen D, Kennbäck C, Jujic A, Healey JS, Holm H, Sundström J, Engström G. Markers of Atrial Myopathy in the General Population: Prevalence, Predictors, and Inter-Relations. JACC Clin Electrophysiol 2023; 9:2240-2249. [PMID: 37676201 DOI: 10.1016/j.jacep.2023.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Atrial myopathy refers to structural and functional cardiac abnormalities associated with atrial fibrillation and stroke, but appropriate diagnostic criteria are lacking. OBJECTIVES This study aimed to assess prevalence, clinical correlates, and overlap between potential atrial myopathy markers. METHODS The population-based SCAPIS (Swedish CArdioPulmonary bioImage Study) prospectively included 6,013 subjects without atrial fibrillation with 24-hour electrocardiograms. Resting electrocardiograms measuring P-wave indices were collected at 1 screening site (n = 1,201), and a random sample (n = 385) had echocardiographic left atrial volume index (LAVi). Atrial myopathy markers were defined as ≥500 premature atrial complexes/24 h, LAVi ≥34 mL/m2, P-wave duration >120 milliseconds, or P-wave terminal force in V1 >4,000 ms·s. Clinical correlates included age, sex, body mass index, height, smoking, physical activity, coronary artery disease, diabetes, systolic blood pressure, antihypertensive medication, and low education. RESULTS Atrial myopathy was common; 42% of the sample with all diagnostic modalities available had ≥1 atrial myopathy marker, but only 9% had 2 and 0.3% had ≥3. Only P-wave duration and LAVi were correlated (ρ = 0.10; P = 0.04). Clinical correlates of premature atrial complexes, P-wave indices, and LAVi differed; current smoking (34% increase; P < 0.001), systolic blood pressure (4%/mm Hg increase; P = 0.01), diabetes (35% increase; P = 0.001), and coronary artery disease (71% increase; P = 0.003) were associated with premature atrial complexes, physical activity ≥2 h/wk was associated with increased LAVi (β-coefficient = 3.1; P < 0.0001) and body mass index was associated with P-wave duration (β-coefficient = 0.4/kg/m2; P < 0.0001). CONCLUSIONS In the general population, indirect markers of atrial myopathy are common but only weakly correlated, and their risk factor patterns are different. More studies are needed to accurately identify individuals with atrial myopathy with diagnostic methods.
Collapse
Affiliation(s)
- Linda S Johnson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
| | - Pyotr G Platonov
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Cecilia Kennbäck
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Amra Jujic
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Malmö University Hospital, Malmö, Sweden
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Hannes Holm
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Johan Sundström
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| |
Collapse
|
3
|
Yang M, Kondo T, Butt JH, Abraham WT, Anand IS, Desai AS, Køber L, Packer M, Pfeffer MA, Rouleau JL, Sabatine MS, Solomon SD, Swedberg K, Zile MR, Jhund PS, McMurray JJV. Stroke in patients with heart failure and reduced or preserved ejection fraction. Eur Heart J 2023; 44:2998-3013. [PMID: 37358785 PMCID: PMC10424882 DOI: 10.1093/eurheartj/ehad338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/17/2023] [Accepted: 05/16/2023] [Indexed: 06/27/2023] Open
Abstract
AIMS Stroke is an important problem in patients with heart failure (HF), but the intersection between the two conditions is poorly studied across the range of ejection fraction. The prevalence of history of stroke and related outcomes were investigated in patients with HF. METHODS AND RESULTS Individual patient meta-analysis of seven clinical trials enrolling patients with HF with reduced (HFrEF) and preserved ejection fraction (HFpEF). Of the 20 159 patients with HFrEF, 1683 (8.3%) had a history of stroke, and of the 13 252 patients with HFpEF, 1287 (9.7%) had a history of stroke. Regardless of ejection fraction, patients with a history of stroke had more vascular comorbidity and worse HF. Among those with HFrEF, the incidence of the composite of cardiovascular death, HF hospitalization, stroke, or myocardial infarction was 18.23 (16.81-19.77) per 100 person-years in those with prior stroke vs. 13.12 (12.77-13.48) in those without [hazard ratio 1.37 (1.26-1.49), P < 0.001]. The corresponding rates in patients with HFpEF were 14.16 (12.96-15.48) and 9.37 (9.06-9.70) [hazard ratio 1.49 (1.36-1.64), P < 0.001]. Each component of the composite was more frequent in patients with stroke history, and the risk of future stroke was doubled in patients with prior stroke. Among patients with prior stroke, 30% with concomitant atrial fibrillation were not anticoagulated, and 29% with arterial disease were not taking statins; 17% with HFrEF and 38% with HFpEF had uncontrolled systolic blood pressure (≥140 mmHg). CONCLUSION Heart failure patients with a history of stroke are at high risk of subsequent cardiovascular events, and targeting underutilization of guideline-recommended treatments might be a way to improve outcomes in this high-risk population.
Collapse
Affiliation(s)
- Mingming Yang
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Toru Kondo
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jawad H Butt
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, OH, USA
| | - Inder S Anand
- VA Medical Center, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jean L Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael R Zile
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| |
Collapse
|
4
|
Orlova EV, Berdalin AB, Lelyuk VG. Correlation of microembolism risk factors with age in the ischemic stroke recovery period. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2022. [DOI: 10.24075/brsmu.2022.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Identification of the age-related features of interaction between the risk factors of microembolism can improve understanding of the mechanisms underlying the development of ischemic stroke (IS). The study was aimed to assess the effects of age and other risk factors of stroke on the biophysical characteristics of microembolic signals (MES) recorded during the ischemic stroke recovery period. Transcranial Doppler ultrasound (TCD) involving microembolus detection (MED) was performed in 515 people, the data of 28 patients having a history of ischemic stroke, among them 9 women (32%) and 19 men (68%) aged 33–78 (average age 58 ± 13 years), were included in the study. Using the mixed-effects linear model it was found that age and interaction between age and atrial fibrillation affected the power of MES. The increase in the power of the recorded MES with age is observed, that is especially evident in patients with atrial fibrillation (р < 0.0005). As for cardioembolic IS variant, the power and duration of MES turn out to be significantly higher in elderly patients (p < 0.0005). The power of MES gradually increases with age in patients with no atherosclerosis and gradually decreases in patients with atherosclerosis, while MES power in patients with atherosclerosis in general (all age groups) is significantly higher (р < 0.0005) than that observed in patients with no atherosclerosis.
Collapse
Affiliation(s)
- EV Orlova
- Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency, Moscow, Russia
| | - AB Berdalin
- Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency, Moscow, Russia
| | - VG Lelyuk
- Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency, Moscow, Russia
| |
Collapse
|
5
|
Rivner H, Goldberger JJ. Optimal therapy for stroke prevention in atrial fibrillation: Is it left atrial appendage closure? J Card Surg 2022; 37:1142-1144. [PMID: 35194833 DOI: 10.1111/jocs.16344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Harold Rivner
- Cardiovascular Division, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|