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Wu X, Xu Z, Yang X, Li J, Feng Y. Left atrial size modify the association between uric acid and atrial fibrillation in patients with coronary artery disease. Nutr Metab Cardiovasc Dis 2024; 34:1559-1570. [PMID: 38658225 DOI: 10.1016/j.numecd.2024.03.027] [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: 12/07/2023] [Revised: 02/25/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIMS The potential influence of left atrial size on the relationship between uric acid and atrial fibrillation has not been fully investigated. This study aims to evaluate the interaction effect of left atrial size on the association between uric acid and atrial fibrillation in patients with coronary artery disease. METHODS AND RESULTS This retrospective cohort study, conducted from January 2018 to October 2022, included 2004 patients undergoing Drug-Eluting Stent implantation for coronary artery disease. Utilizing logistic regression models with the product of left atrial enlargement (LAE) and uric acid, interaction effects were assessed. Among the participants, 383 had LAE, and 159 experienced atrial fibrillation. After adjusting for covariates, continuous uric acid levels were associated with an increased risk of atrial fibrillation in patients without LAE (OR:1.631, 95% CI: 1.284-2.072), but not in those with LAE (OR:1.069, 95% CI: 0.848-1.348). A significant interaction of uric acid levels was observed between groups with and without LAE (p = 0.046). Restricted cubic spline curves indicated a J-shaped relationship between uric acid and atrial fibrillation in the absence of LAE. However, the association between uric acid levels and atrial fibrillation in the LAE group remained unchanged with increasing uric acid levels. CONCLUSION The study suggested that left atrial size modified the association between uric acid and atrial fibrillation in patients with coronary artery disease. Uric acid serves as a potential biomarker for atrial fibrillation risk, especially in individuals without LAE.
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Affiliation(s)
- Xuefeng Wu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Cardiology, The First People's Hospital of Foshan, Foshan, China; Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhaoyan Xu
- Department of Cardiology, The First People's Hospital of Foshan, Foshan, China
| | - Xili Yang
- Department of Cardiology, The First People's Hospital of Foshan, Foshan, China
| | - Jianming Li
- Department of Cardiology, The First People's Hospital of Foshan, Foshan, China
| | - Yingqing Feng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
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Van Deutekom C, Geelhoed B, Van Munster BC, Bakker SJL, Gansevoort RT, Van Gelder IC, Rienstra M. Cardiovascular and renal multimorbidity increase risk of atrial fibrillation in the PREVEND cohort. Open Heart 2023; 10:e002315. [PMID: 37460268 DOI: 10.1136/openhrt-2023-002315] [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: 03/24/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) is a condition that occurs in the presence of comorbidities. With the accumulation of comorbidities (multimorbidity), some combinations may more often occur together than others. Information on the impact of clustering of these on incident AF is sparse. We aimed to investigate clustering of cardiovascular and renal comorbidities and study the association between comorbidity clusters and incident AF. METHODS We used the community-based Prevention of Renal and Vascular ENd-stage Disease (PREVEND) cohort in which 8592 individuals participated. Latent class analysis was performed to assess clustering of 10 cardiovascular and renal comorbidities. RESULTS We excluded individuals with prior AF or missing ECG data, leaving 8265 individuals for analysis (mean age 48.9±12.6 years, 50.2% women). During 9.2±2.1 years of follow-up, 251 individuals (3.0%) developed AF. A model with three clusters was the optimal model, with one cluster being young (44.5±10.8 years) and healthy, carrying a low (1.0%) risk of incident AF; one cluster being older (63.0±8.4 years) and multimorbid, carrying a high (16.2%) risk of incident AF and a third middle-aged (57.0±11.3 years), obese and hypertensive cluster carrying an intermediate risk (5.9%) of incident AF. While the prevalence of the comorbidities differed between classes, no clear combination(s) of comorbidities was observed within the classes. CONCLUSIONS We identified three clusters of comorbidities in individuals in the community-based PREVEND cohort. The three clusters contained different amount of comorbidities carrying different risks of incident AF. However, there were no differences between the clusters regarding specific combination(s) of comorbidities.
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Affiliation(s)
- Colinda Van Deutekom
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bastiaan Geelhoed
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara C Van Munster
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Hirose K, Nakanishi K, Daimon M, Yoshida Y, Ishiwata J, Nakao T, Morita H, Di Tullio MR, Homma S, Komuro I. Prevalence, Determinants, and Prognostic Value of Left Atrial Dysfunction in Patients With Chronic Coronary Syndrome and Normal Left Ventricular Ejection Fraction. Am J Cardiol 2023; 187:30-37. [PMID: 36459745 DOI: 10.1016/j.amjcard.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/18/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
Patients with chronic coronary syndrome (CCS), even when they have complete revascularization and normal left ventricular (LV) systolic function, experience subsequent cardiovascular disease (CVD), highlighting the importance of surrogate markers to prevent adverse consequences. Speckle-tracking echocardiography-derived left atrial (LA) reservoir strain has emerged as a sensitive marker for CVD in various clinical settings. The present study investigated the prevalence, determinants, and prognostic value of LA dysfunction in CCS. We included 278 consecutive patients with CCS with completed percutaneous coronary intervention and preserved LV ejection fraction who underwent follow-up echocardiography. Speckle-tracking analysis was performed to assess LA reservoir strain, and LA dysfunction was defined as LA reservoir strain ≤24%. The primary outcome comprised new-onset atrial fibrillation, heart failure hospitalization, acute coronary syndrome, stroke, or all-cause death. At baseline, 28 patients (10.1%) had LA dysfunction. Multivariable analysis identified age, hypertension, LV ejection fraction, and multivessel disease as independent determinants of LA reservoir strain (all p <0.05). During a median follow-up of 4.8 years, the primary outcome occurred in 60 patients (21.6%). LA dysfunction carried a significant risk for primary outcome independent of traditional risk factors, LV parameters, and LA size (adjusted hazard ratio 3.10, p = 0.003); the risk increase remained significant even after excluding atrial fibrillation from the primary outcome (adjusted hazard ratio 2.27, p = 0.043). In conclusion, approximately 10% of patients with CCS with normal LV ejection fraction had LA dysfunction associated with adverse cardiovascular outcomes. Further studies are needed to explore whether therapeutic interventions affecting LA remodeling may help prevent CVD events.
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Affiliation(s)
- Kazutoshi Hirose
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Koki Nakanishi
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masao Daimon
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Departments of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Medicine, Columbia University, New York, New York
| | - Jumpei Ishiwata
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Nakao
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Departments of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, New York
| | - Issei Komuro
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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Mitrega K, Lip GYH, Sredniawa B, Sokal A, Streb W, Przyludzki K, Zdrojewski T, Wierucki L, Rutkowski M, Bandosz P, Kazmierczak J, Grodzicki T, Opolski G, Kalarus Z. Predicting Silent Atrial Fibrillation in the Elderly: A Report from the NOMED-AF Cross-Sectional Study. J Clin Med 2021; 10:jcm10112321. [PMID: 34073411 PMCID: PMC8199269 DOI: 10.3390/jcm10112321] [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: 04/29/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Silent atrial fibrillation (SAF) is common and is associated with poor outcomes. Aims: to study the risk factors for AF and SAF in the elderly (≥65 years) general population and to develop a risk stratification model for predicting SAF. Methods: Continuous ECG monitoring was performed for up to 30 days using a vest-based system in a cohort from NOMED-AF, a cross-sectional study based on a nationwide population sample. The independent risk factors for AF and SAF were determined using multiple logistic regression. ROC analysis was applied to validate the developed risk stratification score. Results: From the total cohort of 3014 subjects, AF was diagnosed in 680 individuals (mean age, 77.5 ± 7.9; 50.1% men) with AF, and, of these, 41% had SAF. Independent associations with an increased risk of AF were age, male gender, coronary heart disease, thyroid diseases, prior ischemic stroke or transient ischemic attack (ICS/TIA), diabetes, heart failure, chronic kidney disease (CKD), obesity, and NT-proBNP >125 ng/mL. The risk factors for SAF were age, male gender, ICS/TIA, diabetes, heart failure, CKD, and NT-proBNP >125 ng/mL. We developed a clinical risk scale (MR-DASH score) that achieved a good level of prediction in the derivation cohort (AUC 0.726) and the validation cohort (AUC 0.730). Conclusions: SAF is associated with various clinical risk factors in a population sample of individuals ≥65 years. Stratifying individuals from the general population according to their risk for SAF may be possible using the MR-DASH score, facilitating targeted screening programs of individuals with a high risk of SAF.
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Affiliation(s)
- Katarzyna Mitrega
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
- Correspondence: ; Tel.: +48-322713414; Fax: +48-323733792
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool 14 3PE, UK;
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, DK-9100 Aalborg, Denmark
| | - Beata Sredniawa
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
- Department of Cardiology, Medical University of Silesia, DMS in Zabrze, 40-055 Katowice, Poland
- Silesian Park of Medical Technology Kardio-Med Silesia in Zabrze, 41-800 Zabrze, Poland
| | - Adam Sokal
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
| | - Witold Streb
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
| | - Karol Przyludzki
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdansk, 80-210 Gdansk, Poland; (T.Z.); (L.W.); (M.R.); (P.B.)
| | - Lukasz Wierucki
- Department of Preventive Medicine and Education, Medical University of Gdansk, 80-210 Gdansk, Poland; (T.Z.); (L.W.); (M.R.); (P.B.)
| | - Marcin Rutkowski
- Department of Preventive Medicine and Education, Medical University of Gdansk, 80-210 Gdansk, Poland; (T.Z.); (L.W.); (M.R.); (P.B.)
| | - Piotr Bandosz
- Department of Preventive Medicine and Education, Medical University of Gdansk, 80-210 Gdansk, Poland; (T.Z.); (L.W.); (M.R.); (P.B.)
| | - Jaroslaw Kazmierczak
- Department of Cardiology, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-007 Krakow, Poland;
| | - Grzegorz Opolski
- First Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Zbigniew Kalarus
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
- Department of Cardiology, Medical University of Silesia, DMS in Zabrze, 40-055 Katowice, Poland
- Silesian Park of Medical Technology Kardio-Med Silesia in Zabrze, 41-800 Zabrze, Poland
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New Perspective in Atrial Fibrillation. J Clin Med 2020; 9:jcm9113713. [PMID: 33228053 PMCID: PMC7699334 DOI: 10.3390/jcm9113713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 01/10/2023] Open
Abstract
Despite a large number of publications on this subject, the pathophysiological mechanisms involved in atrial fibrillation (AF) onset and recurrence are uncertain [...].
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