Left atrial size modify the association between uric acid and atrial fibrillation in patients with coronary artery disease.

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.

Left ventricular hypertrophy and left atrial diameter are associated with mortality risk in haemodialysis patients: a retrospective cohort study.

BACKGROUND: Cardiovascular death is the main cause of death in patients with end-stage kidney disease (ESKD). Left ventricular hypertrophy (LVH) and left atrial diameter (LAD) enlargement are frequent cardiac alterations in patients with ESKD and are major risk factors for cardiovascular events. However, it remains unclear whether there is an association between combined LAD or LVH and all-cause or cardiovascular mortality in this population. METHODS: A single-centre, retrospective cohort study including 576 haemodialysis (HD) patients was conducted. Patients were evaluated by cardiac ultrasound, and the study cohort was divided into four groups according to LAD and LVH status: low LAD and non-LVH; low LAD and LVH; high LAD and non-LVH; and high LAD and LVH. We used Kaplan-Meier analysis and Cox proportional hazard regression to analyse all-cause and cardiovascular mortality after multivariate adjustment. RESULTS: LAD was associated with an increased risk of all-cause mortality (HR 2.371, 1.602-3.509; p < 0.001). No significant differences were found between LVH and the risk of all-cause mortality. Patients with high LAD and LVH had significantly greater all-cause and cardiovascular mortality than did those with low LAD and non-LVH after adjustments for numerous potential confounders (HR 3.080, 1.608-5.899; p = 0.001) (HR 4.059, 1.753-9.397; p = 0.001). CONCLUSION: Among maintenance haemodialysis (MHD) patients, LAD was more strongly associated with mortality than was LVH. A high LAD and LVH are associated with a greater risk of mortality. Our results emphasize that the occurrence of LAD and LVH in combination provides information that may be helpful in stratifying the risk of MHD patients.

The role of miR1 and miR133a in new-onset atrial fibrillation after acute myocardial infarction.

BACKGROUND: The development of new-onset atrial fibrillation (NOAF) after acute myocardial infarction (AMI) is a clinical complication that requires a better understanding of the causative risk factors. This study aimed to explore the risk factors and the expression and function of miR-1 and miR-133a in new atrial fibrillation after AMI. METHODS: We collected clinical data from 172 patients with AMI treated with emergency percutaneous coronary intervention (PCI) between October 2021 and October 2022. Independent predictors of NOAF were determined using binary logistic univariate and multivariate regression analyses. The predictive value of NOAF was assessed using the area under the receiver operating characteristic (ROC) curve for related risk factors. In total, 172 venous blood samples were collected preoperatively and on the first day postoperatively; the expression levels of miR-1 and miR-133a were determined using the polymerase chain reaction. The clinical significance of miR-1 and miR-133a expression levels was determined by Spearman correlation analysis. RESULTS: The Glasgow prognostic score, left atrial diameter, and infarct area were significant independent risk factors for NOAF after AMI. We observed that the expression levels of miR-1 and miR-133a were significantly higher in the NOAF group than in the non-NOAF group. On postoperative day 1, strong associations were found between miR-133a expression levels and the neutrophil ratio and between miR-1 expression levels and an increased left atrial diameter. CONCLUSIONS: Our findings indicate that the mechanism of NOAF after AMI may include an inflammatory response associated with an increased miR-1-related mechanism. Conversely, miR-133a could play a protective role in this clinical condition.

Predicting a decrease in left atrial appendage flow velocity using left atrial diameter and CHA2DS2-VASc score in patients with non-valvular atrial fibrillation.

BACKGROUND: Left atrial (LA) appendage flow velocity (LAAFV) is a classic but invasive predictor of thromboembolic events in patients with atrial fibrillation (AF). We aimed to explore the usefulness of LA diameter (LAD) combined with CHA2DS2-VASc score, which is easily available and non-invasive, as a novel score for predicting a decrease in LAAFV in non-valvular AF (NVAF). METHODS: In total, 716 consecutive NVAF patients who underwent transesophageal echocardiography were divided into the decreased LAAFV (< 0.4 m/s) and preserved LAAFV (≥ 0.4 m/s) groups. RESULTS: The decreased LAAFV group had a larger LAD and a higher CHA2DS2-VASc score than the preserved LAAFV group (P < 0.001). Multivariate linear regression indicated that brain natriuretic peptide (BNP) concentration, persistent AF, LAD, and CHA2DS2-VASc score were remained inversely associated with LAAFV. Moreover, multivariate logistic regression revealed that BNP concentration (odds ratio [OR] 1.003, 95% confidence interval [CI] 1.001-1.005, P = 0.003), persistent AF (OR 0.159, 95% CI 0.102-0.247, P < 0.001), and LAD (OR 1.098, 95% CI 1.049-1.149, P < 0.001) were independent factors for a decrease in LAAFV. A novel score, LAD combined with CHA2DS2-VASc score, was more accurate for predicting a decrease in LAAFV among NVAF patients (area under the curve was 0.733). CONCLUSION: Enlarged LAD was independent risk factor for a decrease in LAAFV among NVAF patients. LAD combined with CHA2DS2-VASc score enhanced the predictive ability for a decrease in LAAFV among NVAF patients.

Evaluation of changes in atrial fibrillation predictors(P wave parameters and left atrial diameter) in morbidly obese patients undergoing bariatric surgery.

BACKGROUND: Bariatric surgery has been associated with reduced cardiovascular event in obese patients.In this study, we aimed to investigate the changes between pre-operation and post-operation atrial fibrillation predictors(p-wave parameters and left atrial diameter)in morbidly obese patients who underwent bariatric surgery. METHODS: 176 obese patients undergoing bariatric surgery were enrolled. Heart rate, PR, P-wave max, P-wave min,P-wave dispersion (PWdis), average P-axis, P-wave peak time (PWPT) of lead II and lead V1, terminal force of lead V1 (PWTF V1), partial interatrial block (p-IAB), advanced interatrial block(a-IAB), and left atrial diamete were measured both before operation and 8 months post-operation. RESULTS: Heart rate, PR, PW max, PW min, PWdis, mean P-axis, PWPT II, PWPT V1, and PWTF V1 were near their upper limits before operation. Left atrial diameter was larger than the upper limit before operation. All parameters showed statistically significant decrease at 8 months post-operation. The most significant changes were observed in PWPT II (55.69 ± 6.87 ms vs 50.43 ± 7.48 ms, p < 0.001), PWPT V1(54.21 ± 7.01 ms vs 48.02 ± 7.13 ms, p < 0.001), PWTF V1(74 [42.0%] vs 41 [23.3%], p < 0.001),p-IAB(41[23.2%]vs11[6.2%],p < 0.001),a-IAB(6[3.4%]vs2[1.1%], p < 0.001), and left atrial diameter(43.25 ± 9.23 mm vs 34.27 ± 6.21 mm,p < 0.001). CONCLUSIONS: The results of our study showed that bariatric surgery had a positive effect on the regression of P wave parameters and left atrial diameter which are predictors of atrial fibrillation.

Correlation between Serum Myosin Light Chain 4 Levels and Recurrence after Radiofrequency Ablation in Patients with Atrial Fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia that is harmful to human health. This study aims to explore the relationship between myosin light chain 4 (MYL4) and AF recurrence after radiofrequency ablation (RFA). Patients with AF (n = 85) were enrolled, and healthy subjects (n = 90) with normal sinus rhythm and no previous history of AF were selected as controls. The serum levels of MYL4, transforming growth factor (TGF) -ß1, and procollagen type-I C-terminal propeptide (PICP) were determined. The correlation between MYL4 and atrial fibrosis remodeling indicators (TGF-ß1/PICP) and left atrial diameter (LAD) was analyzed. The influence of MYL4 on AF recurrence after RFA was evaluated, and the independent correlation between them was assessed. Patients with AF and the controls showed no significant differences in age, gender, body mass index, systolic blood pressure, diastolic blood pressure, left ventricular ejection fraction, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, white blood cell count, neutrophil/lymphocyte ratio, brain natriuretic peptide, and history of smoking, drinking, hypertension, and diabetes (P > 0.05), but with increased LAD in patients with AF (P < 0.01). Serum MYL4 level was reduced in patients with AF (0.6 ± 0.2) compared with that of controls (0.1 ± 0.6) (P < 0.01), and it was negatively correlated with TGF-ß1, PICP, and LAD (r = -0.2389, P < 0.05; r = -0.5174, P < 0.01; r = -0.3191; P < 0.01). Low levels of MYL4 increased the risk of AF recurrence after RFA (χ2 = 16.64; P < 0.0001). A low MYL4 level in patients with AF showed a poorer prognosis. Serum MYL4 level and AF type were independent risk factors affecting AF recurrence after RFA.

Risk factors for late recurrence in patients with nonvalvular atrial fibrillation after radiofrequency catheter ablation.

OBJECTIVE: To identify the risk factors for postoperative atrial fibrillation (AF) recurrence in nonvalvular AF patients undergoing radiofrequency catheter ablation (CA). METHODS: We retrospectively reviewed the data from 426 of 450 AF patients who underwent CA. Patients were divided into two groups according to recurrence after the operation; the risk factors for AF recurrence were analyzed. A stratification system for lesions was created based on the cutoff of the risk factors; the associations among the subgroups and the AF recurrence rate were analyzed. RESULTS: AF recurrence occurred in 98 (23.0%) patients. Univariate analysis demonstrated that AF type, hypertrophic cardiomyopathy, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), serum albumin, and D-dimer concentrations were associated with AF recurrence. AF type (OR =2.907, p < .001), serum albumin concentration (OR =1.112, p < .05), and LAD (OR =1.115, p < .001) were independent risk factors for AF recurrence. The area under the ROC curve of LAD for the prediction of AF recurrence was 0.722 (95% CI: 0.664~0.779) and that of serum albumin for the prediction of AF recurrence was 0.608 (95% CI: 0.545~0.672). Further stratification revealed that patients with persistent or paroxysmal AF with LAD ≥43.5 mm and serum albumin concentration ≥42.2 g/L had a higher rate of AF recurrence than the reference group. CONCLUSION: Atrial fibrillation type, LAD, and serum albumin concentration are risk factors for AF recurrence after CA in patients with nonvalvular AF. Patients with persistent AF with LAD ≥43.5 mm and serum albumin concentration ≥42.2 g/L have a higher risk of late AF recurrence after surgery.

Thyrotropin-secreting pituitary adenomas induce left atrial enlargement with subclinical atrial fibrillation: an echocardiographic study.

PURPOSE: Thyrotropin-secreting pituitary adenoma (TSHoma) is rare but occasionally causes cardiovascular complications such as atrial fibrillation (AF) due to hyperthyroidism. Graves' disease (GD) is a common hyperthyroid condition often associated with subclinical AF. Some reports have shown echocardiographic changes in patients with GD. We aimed to evaluate the preoperative cardiac function in patients with TSHomas and compared the results among patients with TSHomas and GD and control subjects. METHODS: Patients with TSHomas (n = 6) and GD (n = 20) were compared with control subjects with normal cardiac function (n = 20) based on echocardiographic findings. The average age, sex, and proportions of patients with a history of diabetes mellitus and hypertension were equal in each group, and the AF prevalence was matched in patients with TSHomas and GD. The values of left ventricular end-diastolic diameter (LVEDd), left ventricular end-systolic diameter (LVEDs), left ventricular ejection fraction (LVEF), and left atrial diameter (LAD) were used to assess cardiac function. RESULTS: In echocardiography, LAD showed a significant difference between patients with TSHomas and control subjects (p = 0.026). The mean LAD values were 36.9 ± 7.1, 38.2 ± 8.9, and 28.7 ± 3.9 mm for patients with TSHomas and GD and control subjects, respectively. There were no significant differences in other echocardiographic parameters among the groups. Before treatment, serum thyroid hormone levels (free triiodothyronine and thyroxin) were not significantly different among patients with TSHomas and GD. CONCLUSION: We found that patients with TSHomas or GD had enlarged LADs. This finding suggests that AF may be more hidden in patients with TSHomas than previously reported.

Conversion of left atrial volume to diameter for automated estimation of sudden cardiac death risk in hypertrophic cardiomyopathy.

BACKGROUND: A subset of patients with hypertrophic cardiomyopathy (HCM) is at high risk of sudden cardiac death (SCD). Practice guidelines endorse use of a risk calculator, which requires entry of left atrial (LA) diameter. However, American Society of Echocardiography (ASE) guidelines recommend the use of LA volume index (LAVI) for routine quantification of LA size. The aims of this study were to (a) develop a model to estimate LA diameter from LAVI and (b) evaluate whether substitution of measured LA diameter by estimated LA diameter derived from LAVI reclassifies HCM-SCD risk. METHODS: The study cohort was comprised of 500 randomly selected HCM patients who underwent transthoracic echocardiography (TTE). LA diameter and LAVI were measured offline using digital clips from TTE. Linear regression models were developed to estimate LA diameter from LAVI. A European Society of Cardiology endorsed equation estimated SCD risk, which was measured using LA diameter and estimated LA diameter derived from LAVI. RESULTS: The mean LAVI was 48.5 ± 18.8 mL/m2 . The derived LA diameter was 45.1 mm (SD: 5.5 mm), similar to the measured LA diameter (45.1 mm, SD: 7.1 mm). Median SCD risk at 5 years estimated by measured LA diameter was 2.22% (interquartile range (IQR): 1.39, 3.56), while median risk calculated by estimated LA diameter was 2.18% (IQR: 1.44, 3.52). 476/500 (95%) patients maintained the same risk classification regardless of whether the measured or estimated LA diameter was used. CONCLUSIONS: Substitution of measured LA diameter by estimated LA diameter in the HCM-SCD calculator did not reclassify risk.

The preablation monocyte/ high density lipoprotein ratio predicts the late recurrence of paroxysmal atrial fibrillation after radiofrequency ablation.

BACKGROUND: The monocyte/high-density lipoprotein ratio (MHR) has emerged as a promising alternative biomarker in the fields of cardiovascular disease and atrial fibrillation (AF). This retrospective study was aimed to explore the predictive value of the MHR for the late recurrence of AF after radiofrequency ablation. METHODS: From April 2015 to October 2018, patients with paroxysmal AF who had undergone radiofrequency catheter ablation at Subei People's Hospital of Jiangsu Province were enrolled in our study. All the participants were observed until November 2019 after the procedure. During the postoperative follow up, the patients were categorized into the recurrence group and maintenance of sinus rhythm group based on who had experienced AF recurrence. RESULTS: One hundred twenty-five patients were diagnosed with paroxysmal AF, with an average age of 61.2 ± 9.3 years. Forty-seven patients had developed late recurrence during a mean follow up of 25.1 ± 12.0 months. The AF recurrence event rates were significantly increased in the highest MHR tertile compared with those in the lowest MHR tertile (22.0% vs. 57.1%; P < 0.05). On multivariate logistic regression analysis, the preablation MHR (OR = 1.34; 95% CI = 1.12 ~ 1.60; P = 0.001) and left atrial diameter (LAD) (OR = 1.21, 95% CI = 1.08 ~ 1.35; P = 0.001) were independent risk factors predicting the recurrence of AF after radiofrequency ablation. Furthermore, receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of the MHR was 0.712 (95% CI = 0.618 ~ 0.806; P = 0.000) and that of LAD was 0.739 (95% CI = 0.653 ~ 0.814; P = 0.000). Z-test found no significant difference between the MHR and LAD regarding the AUC (Z = 0.451; P = 0.652). CONCLUSION: An elevated preablation MHR was associated with an increased risk of the postoperative recurrence of AF. Additionally, the MHR independently predicted the late recurrence of paroxysmal AF after radiofrequency ablation, with the same predictive value as LAD.

Optimal diameter of the pulmonary vein ostium for second-generation 28-mm cryoballoon ablation of atrial fibrillation.

BACKGROUND: Large pulmonary veins (PVs) have the risk of excessive cooling when the cryoballoon is moved into them, whereas smaller PVs may not be isolated because of insufficient balloon-tissue contact. We previously reported that the effective nadir balloon temperature (NBT) was <- 44°C for predicting early PV reconnections. However, the ideal PV and left atrial (LA) diameters for cooling temperatures during cryoballoon ablation (CBA) are unknown. METHODS: We measured the PV ostium (PVos) and LA diameters on computed tomography images in 71 atrial fibrillation patients who underwent a 28-mm CBA. We defined -60°C ≤ NBT <- 44°C as the optimal NBT. The optimal PVos diameters and elliptical area were determined using the receiver operating characteristic curve cutoff values for the optimal NBT. RESULTS: The maximum PVos diameter (PVmax), minimum PVos diameter (PVmin), and PV elliptical area correlated negatively with the NBT (PVmax: r = -.34, P < .0001; PVmin: r = -.41, P < .0001; PV elliptical area: r = -.41, P < .0001). Based on the NBT-derived definition, the optimal PVmax, PVmin, and PV elliptical area were 19 < PVmax ≤ 21 mm, 14 < PVmin ≤ 16 mm, and 186.83 < PV elliptical area ≤ 254.34 mm2 , respectively. In addition, a positive correlation between the LA longitudinal diameter and NBT was observed in the right superior PV (r = .34, P = .004), and the LA transverse diameter correlated inversely with the NBT in the left inferior PV (r = -.34, P = .004). CONCLUSIONS: We identified the optimal PV diameters and elliptical area to establish the optimal NBT during the second-generation 28-mm CBA. These data will help for the preclinical judgment for a successful CBA.

Left atrial volume index is superior to left atrial diameter index in relation to coronary heart disease in hypertension patients with preserved left ventricular ejection fraction.

Objective: Research hypothesis is that left atrial (LA) volume index is superior to LA diameter index for coronary heart disease and LA volume index is important to refine risk stratification.Methods: We retrospectively enrolled 222 asymptomatic non-ischemic patients with hypertension who had stored digital images in 2012. Patients were followed up for coronary heart disease over a median of 3.2 years. The Area under receiver operating characteristic curve for LA parameters with coronary heart disease was evaluated. Cox regression was used to assess the association between left atrial parameters and coronary heart disease.Results: The mean age of patients was 62 years, 45% were men, and mean left atrial diameter, mean left atrial volume, mean LA diameter index, mean LA volume index was 32 mm, 43 ml, 21 mm/m2, 27 ml/m2, respectively. After 3.2 years follow up, 10 patients experienced coronary heart disease. Compared with patients without coronary heart disease, LA diameter index and LA volume index increased in coronary heart disease group (P < 0.05). Multivariate cox regression analysis showed, adjusted for age, sex, smoking, cholesterol, fasting plasma glucose, diabetes, systolic blood pressure, left ventricular mass index, and E/e' ratio, a unit rise in LA volume index was associated with a 15% increase in the risk of coronary heart disease. (HR:1.155; 95% CI 1.002-1.332). Compared with LA diameter index, the area under receiver operating characteristic curve values for predicting coronary heart disease were higher for LA volume index (0.797).Conclusions: Our study showed that LA volume index was superior to LA diameter index. LA volume index had independent prognostic implications in terms of coronary heart disease prediction in hypertension patients with preserved left ventricular ejection fraction.

Effects of body mass index and gender on left atrial size in Chinese hypertensive patients.

BACKGROUND: Left atrial enlargement (LAE) is a common cardiac structural change in patients with hypertension, and obesity could further promote LAE. However, little is known about the effect of overweight on left atrial size, and if there is a gender difference of the effect. The aim of this study was to analyze the effects of different body mass index (BMI) grades (normal weight, overweight, and obesity) on left atrial size in both male and female patients with hypertension. METHODS: A total of 710 patients with hypertension were divided into 3 study groups: normal weight group (BMI < 24 g/m2, n = 302), overweight group (24 kg/m2 ≤ BMI < 28 kg2, n = 318), and obesity group (BMI ≥28 kg/m2, n = 90). The clinical data, echocardiographic indexes and left atrial size were obtained from all the subjects. Pearson correlation analysis was used to analyze the correlation between clinical variables and left atrial diameter (LAD)/left atrial diameter index (LADI), and stepwise regression evaluation was used to study the relevant factors affecting LAD/LADI among all patients, male and female patients for possible gender difference. RESULTS: The significant difference in LADI was noted in the three study groups with obesity group of 23.96 ± 2.90 mm/m, overweight group of 22.50 ± 3.02 mm/m and normal weight group of 21.08 ± 2.80 mm/m, respectively (P < . 05). After adjusting for age and gender, there was still significant difference in LADI among the three groups (P < . 05). The correlation between BMI and LADI was higher than that between systolic blood pressure (SBP) and diastolic blood pressure (DBP) (r = 0.348 vs 0.092 and -0.068, respectively, P < .05). After adjusting for other influencing factors, there was still a significant correlation between BMI and LADI (ß = 0.326, P < .001), but no correlation was found between SBP and DBP (P > .05). For each additional unit of BMI, LAD increased by 0.034 mm and LADI increased by 0.305 mm/m. Multiple linear regression analysis showed that BMI, left ventricular mass index (LVMI), age and female gender were independently correlated with LADI (P < .05). And BMI was the most significant influencing factor of LADI in male patients (ß = 0.350, P < .001), followed by LVMI (ß = 0.343, P < .001). While in female patients, LVMI was the most significant (ß = 0.353, P < .001), followed by BMI (ß = 0.302, P < .001). CONCLUSION: Overweight and obesity were significantly associated with LAE in hypertensive patients, with obesity more significant than overweight. While BMI had the greatest correlation with LAE in male, LVMI was the most important determinant of LAE in female. Therefore, in addition to weight loss, more attention should be paid to early inhibition of left ventricular remodeling in female with hypertension.

Factors Associated with a Large Decline in Renal Function or Progression to Renal Insufficiency in Hospitalized Atrial Fibrillation Patients with Early-Stage CKD.

Clinicians must consider renal function when administering anticoagulants for atrial fibrillation (AF). Determination of risk factors for renal function decline may enable identification of patients who require closer monitoring. We investigated the characteristics associated with renal function decline in patients with AF. The study cohort consisted of 631 AF patients who had at least one readmission during the follow-up period and stages 1-3 chronic kidney disease (CKD). The primary outcome measure was large renal function decline (≥30% decrease from baseline estimated glomerular filtration rate [eGFR]). The secondary outcome measure was a final eGFR < 60 mL/minute/1.73 m2 for those with a baseline eGFR above this level. The mean eGFR was 74.4 ± 18.5 mL/minute/1.73 m2, and the mean follow-up time was 30.2 ± 13.2 months. The primary outcome occurred in 155 patients (24.6%) and was associated with congestive heart failure (CHF), proteinuria, type of AF, and left atrial diameter (LAD) ≥ 45 mm. Among 478 patients with a baseline eGFR ≥ 60 mL/minute/1.73 m2, 137 (28.7%) progressed to renal failure (eGFR < 60 mL/minute/1.73 m2). A decreasing eGFR was associated with age ≥ 75 years, CHF, lower baseline eGFR, and LAD ≥ 45 mm. CHF, proteinuria, type of AF, and LAD ≥ 45 mm were associated with eGFR decline ≥ 30% in AF patients with CKD stages 1-3. Advanced age, CHF, lower baseline eGFR, and LAD ≥ 45 mm were associated with progression to renal insufficiency. These results should be considered when identifying patients who require more frequent monitoring of eGFR.

Clinical significance of the timing of early recurrence of atrial arrhythmia after pulmonary vein isolation: a two-institution clinical study.

Early recurrence of atrial arrhythmia (ERAA) after ablation frequently occurs, but there is limited evidence about ERAA-timing. This study aimed to investigate the association between ERAA-timing and late recurrence. We retrospectively investigated 332 patients who underwent PVI for paroxysmal atrial fibrillation at Nagoya University Hospital and Komaki City Hospital. Seventy-six patients (23%) had ERAA. The cutoff value of the first ERAA for late recurrence was set as 3 days, with a specificity of 77% and sensitivity of 43%. On multivariate analysis, first ERAA beyond 3 days (hazard ratio, 2.477; 95% confidence interval, 1.168-5.25; p = 0.018) and large left atrial diameter (LAD) (hazard ratio, 1.101; 95% confidence interval, 1.024-1.184; p = 0.009) were independent predictors for late recurrence. Patients who had first ERAA within 3 days and no ERAA beyond 3 days showed a significantly higher recurrence-free rate than those who had first ERAA beyond 3 days and those who had ERAA both within 3 days and beyond 3 days (89% versus 39%, 44%; p < 0.001). Moreover, the patients with ERAA within 3 days and LAD ≤ 37.7 mm showed a significantly higher recurrence-free rate than those with ERAA beyond 3 days and LAD > 37.7 mm, and as compared with the other patients (100% versus 26% and 60%, respectively; p < 0.001). ERAA beyond 3 days after ablation was a predictor for late recurrence. Among patients with ERAA, those with ERAA within 3 days and smaller LAD showed favorable prognosis after ablation.

Association of serum adropin with the presence of atrial fibrillation and atrial remodeling.

OBJECTIVE: Adropin, a newly identified regulatory protein encoded by Enho gene, suppressed tumor necrosis factor α-induced THP1 monocyte adhesion to human umbilical vein endothelial cells. In addition, inflammation is demonstrated to be involved in the mechanism of atrial fibrillation (AF). Atrial remodeling is correlated with the persistence and progression of AF. Adropin is hypothesized to correlated with AF and atrial remodeling. This study aims to determine the correlation of serum adropin and the presence of AF and remodeling. METHODS: This study consisted of 344 AF patients and 210 healthy controls. AF patients were then divided into three subgroups of paroxysmal AF, persistent AF, and permanent AF. Serum adropin concentrations were examined using enzyme-linked immunosorbent assay method. Left atrial diameter (LAD) was measured to evaluate atrial remodeling. RESULTS: Decreased serum adropin concentrations were found in AF patients compared with healthy controls. Logistic regression analysis confirmed that serum adropin was inversely associated with the presence of AF (OR 0.218, 95% CI 0.15-0.316; P < 0.001). Permanent AF patients had significantly reduced serum adropin concentrations compared with persistent and paroxysmal AF patients. There were decreased serum adropin concentrations in persistent AF group than those in paroxysmal AF group. Simple linear regression analyses showed that serum adropin in AF patients were negatively correlated with BMI, SBP, and LAD. Multiple stepwise regression analysis showed that LAD remained to be inversely associated with serum adropin (ß = 0.2, P = 0.010). CONCLUSION: Serum adropin concentrations are inversely correlated with the presence of AF and atrial remodeling.

Left atrial diameter, left ventricle filling indices, and association with all-cause mortality: Results from the population-based Tromsø Study.

AIMS: To examine the associations between diastolic dysfunction indices and long-term risk of all-cause mortality in adults over 23-year follow-up. METHODS AND RESULTS: Participants (n = 2734) of the population-based Tromsø Study of Norway had echocardiography in 1994-1995. Of these 67% were repeated in 2001 and/or 2007-2008. Mortality between 1994 and 2016 was determined by linkage to the national death registry. Cox regression was used to model the hazard of all-cause mortality in relation to left atrial parameters (treated as time-dependent using repeated measurements) adjusted for traditional risk factors and cardiovascular disease. During the follow-up, 1399 participants died. Indexed left atrial diameter, mitral peak E deceleration time, and mitral peak E to peak A ratio showed an U-shaped association with all-cause mortality. Combining left atrial diameter with mitral peak E deceleration time increased the prognostic accuracy for all-cause mortality whereas adding mitral peak E to peak A ratio did not increase prognostic value. We estimated new optimal cutoff values of left atrial diameter, mitral peak E deceleration time, and mitral peak E to peak A ratio for all-cause mortality outcome. E/e' had a cubic relation to mortality. CONCLUSION: Both enlarged and small left atrial diameters were associated with increased all-cause mortality risk. A combination of Doppler-based left ventricle filling parameters had an incremental effect on all-cause mortality risk. The cutoff values of diastolic dysfunction indices we determined had similar all-cause mortality prediction ability as those recommended by American Association of Echocardiography and European Association of Cardiovascular Imaging.

Resistant hypertension in elderly: a clinical manifestation of heart failure with preserved ejection fraction? retrospective single-center analysis.

Background: Resistant hypertension (RHT) is defined as high blood pressure despite three antihypertensive medications one being a diuretic. RHT is a common clinical problem and as a subgroup has not been studied widely. The present study has investigated patient demographics and if the RHT might be a clinical presentation of heart failure with preserved ejection fraction (HFPEF) in elderly. Method: The outpatient data between January and June 2015 of Izmir Kemalpasa State hospital's hypertension specialty clinic has been reviewed retrospectively. The patients with pseudo-RHT are excluded. Among 957 patients, 68 patients have been identified as true RHT with a left ventricle ejection fraction ≥50%. HFPEF is defined according to the latest guideline. Instead of a common cut-off level for NT-proBNP, age and gender-related cut-off levels have been used. Results: The mean age was 63.24 ± 12.05 years. Among 68 patients, 49 were female. While only 3 patients in younger group (8.8%) had elevated levels of NT-proBNP, 22 of older RHT patients (64.7%) had high levels. NT-proBNP levels were disproportionally high in elderly (p < 0.001) and high levels in RHT patients were related to a larger left atrial diameter (p < 0.001). Conclusion: The underlying mechanism might be different in RHT according to age. Hypervolemia might be the key factor in older RHT patients but not in younger patients. The current study suggests RHT in elderly can be a clinical presentation of HFPEF, and they should be investigated and treated accordingly. Because of single-center results and limited patients, further studies are needed.

The role of pro-fibrotic biomarkers in paroxysmal and persistent atrial fibrillation.

PURPOSE: Signaling pathways involved in electrical, structural and contractile remodeling processes behind development and progression of atrial fibrillation (AF) have not been completely elucidated, but it seems to be related to complex interactions among neurohormonal and cellular mediators. We aimed to investigate interleukin-6 (IL-6), transforming growth factor-beta1 (TGF-ß1), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), as biomarkers of atrial remodeling, in patients with paroxysmal and persistent AF, and their correlation with N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and left atrial (LA) diameter. METHODS: Thirty-seven patients (22M/15F) with paroxysmal AF, 32 patients (22M/10F) with persistent AF and 30 healthy control subjects (18M/12F) were enrolled in the study. Serum levels of biomarkers were measured by ELISA. Cardiac function was assessed echocardiographically. RESULTS: IL-6 levels and MMP-9/TIMP-1 ratio were significantly higher in AF patients than in non-AF controls (P < .001), and in persistent than in paroxysmal AF (P < .001), in line with NT-proBNP and LA diameter. In contrast, TGF-ß1levels declined with increasing AF duration (from 51.2 pg/mL, IQR: 38.9-87.9 pg/mL in paroxysmal to 23.9 pg/mL, IQR: 16.9-43.6 pg/mL in persistent AF). TGF-ß1 was negatively correlated with NT-proBNP (r = -0.53, P = .001 in paroxysmal AF and r = -0.71, P < .001 in persistent AF) and LA diameter (r = -0.44, P = .006 in paroxysmal AF and r = -0.51, P = .003 in persistent AF). CONCLUSIONS: Our results demonstrate that AF development and progression (from paroxysmal to persistent) is associated with a gradual increase in serum levels of NT-proBNP, IL-6 and MMP-9/TIMP-1 ratio. Moreover, this study suggests that the relationship between TGF-ß1, NT-proBNP and LA diameter allows for the progression of atrial remodeling during AF, despite compensatory changes in the TGF-ß1 signaling pathway.

Clinical, Electrocardiographic, and Echocardiographic Parameter Combination Predicts the Onset of Atrial Fibrillation.

BACKGROUND: The ability to identify risk markers for new-onset atrial fibrillation (AF) is critical to the development of preventive strategies, but it remains unknown whether a combination of clinical, electrocardiographic, and echocardiographic parameters predicts the onset of AF. In the present study, we evaluated the predictive value of a combined score that includes these parameters. Methods and Results: We retrospectively studied 1,040 patients without AF who underwent both echocardiography and 24-h Holter electrocardiography between May 2005 and December 2010. During a median follow-up period of 68.4 months (IQR, 49.9-93.3 months), we investigated the incidence of new-onset AF. Of the 1,040 patients, 103 (9.9%) developed AF. Patients who developed AF were older than patients who did not. Total heart beats, premature atrial contraction (PAC) count, maximum RR interval, and frequency of sinus pause quantified on 24-h electrocardiography were associated with new-onset AF. LA diameter (LAD) on echocardiography was also associated with the development of AF. On multivariate Cox analysis, age ≥58 years, PAC count ≥80 beats/day, maximum RR interval ≥1.64 s, and LAD ≥4.5 cm were independently associated with the development of AF. The incidence rate of new-onset AF significantly increased as the combined score (i.e., the sum of the risk score determined using hazard ratios) increased. CONCLUSIONS: A combined score that includes age, PAC count, maximum RR interval, and LAD could help characterize the risk of new-onset AF.