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1.
Artigo em Inglês | MEDLINE | ID: mdl-33799424

RESUMO

As adolescents spend the majority of their time focused on exams and assignments, they do not have sufficient time to engage in physical activity; this lack of physical activity is an important public health concern. This study aimed to investigate how school-based physical activity programs affect the health-related physical fitness of adolescents in the Republic of Korea. For this study, a total of 120 high school students participated in a school-based physical activity program that included badminton and table tennis for 15 weeks each (35 min/day, three times a week), with a total of 30 weeks for one academic year. The parameters for health-related physical fitness measured muscle strength (handgrip strength), power (standing long jump), cardiorespiratory fitness (shuttle run test), flexibility (sit and reach), body mass index (BMI), and the total score. The results revealed a statistically significant improvement in muscle strength (p < 0.001), power (p < 0.001), cardiorespiratory fitness (p < 0.001), flexibility (p = 0.005), and the overall health-related physical fitness score (p = 0.001). However, students' BMI showed no significant difference before and after participation (p = 0.825). The results of this study indicated that school-based physical activity programs can have a positive effect on the health-related physical fitness of adolescents.

2.
Heart Rhythm ; 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33482386

RESUMO

BACKGROUND: The predictors of ischemic stroke in "low-risk" patients with atrial fibrillation (AF) (CHA2DS2-VASc score 0 in men or 1 in women) are debated. OBJECTIVE: This study aimed to investigate the factors associated with ischemic stroke in low-risk patients with AF. Imaging characteristics of their ischemic strokes were also evaluated. METHODS: This was a matched case-control study conducted at a single tertiary institution. We identified 44 patients with de novo ischemic stroke and incidentally found AF with a low-risk CHA2DS2-VASc score. A 1:5 age- and sex-matched control group was selected for patients with AF and a low-risk CHA2DS2-VASc score but without ischemic stroke and oral anticoagulant therapy. Conditional multivariate logistic regression analysis was performed to identify the predictors. RESULTS: There were no significant differences in age, sex, body mass index, comorbidities, left atrial size, and left ventricular ejection fraction. Smokers were more prevalent in the stroke group than in the nonstroke group (24 of 44 [54.5%] vs 22 of 220 [10.0%]; P < .001). Additionally, the mean white blood cell count was significantly higher in the stroke group (P = .019). In conditional univariate logistic regression analysis, smoking and white blood cell count were significant predictors of stroke. In multivariate analysis, smoking was the only significantly associated factors (matched odds ratio 9.10; 95% confidence interval 2.48-33.42). In the stroke group, 14 of 44 patients (31.8%) had multiple vascular territory infarcts. CONCLUSION: Smoking was the predictor associated with ischemic stroke in patients with AF and a low-risk CHA2DS2-VASc score.

3.
Stroke ; 52(2): 511-520, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33412904

RESUMO

BACKGROUND AND PURPOSE: Limited data support the benefits of non-vitamin K oral anticoagulants (NOACs) among atrial fibrillation patients with prior gastrointestinal bleeding (GIB). We aimed to evaluate the effectiveness and safety of NOACs compared with those of warfarin among atrial fibrillation patients with prior GIB. METHODS: Oral anticoagulant-naive individuals with atrial fibrillation and prior GIB between January 2010 and April 2018 were identified from the Korean claims database. NOAC users were compared with warfarin users by balancing covariates using the inverse probability of treatment weighting method. The primary outcomes were ischemic stroke, major bleeding, and the composite outcome (combined ischemic stroke and major bleeding). Fatal events from each outcome were evaluated as secondary outcomes. RESULTS: A total of 42 048 patients were included (24 781 in the NOAC group and 17 267 in the warfarin group). The mean time from prior GIB to the initiation of oral anticoagulant was 3.1±2.6 years. After inverse probability of treatment weighting, baseline characteristics were balanced between the two groups (mean age, 72 years; men, 56.8%; and mean CHA2DS2-VASc score, 3.7). Lower risks of ischemic stroke, major bleeding, and the composite outcome were associated with NOAC use than with warfarin use (weighted hazard ratio, 0.608 [95% CI, 0.543-0.680]; hazard ratio, 0.731 [95% CI, 0.642-0.832]; and hazard ratio, 0.661 [95% CI, 0.606-0.721], respectively). For all secondary outcomes, NOACs showed greater risk reductions compared with warfarin. CONCLUSIONS: NOACs were associated with lower risks of ischemic stroke and major bleeding than warfarin among atrial fibrillation patients with prior GIB.

4.
Ann Clin Transl Neurol ; 8(1): 238-246, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33389803

RESUMO

OBJECTIVE: Parkinson's disease (PD) is the second most common neurodegenerative disorder associated with various morbidities. Although the relationship between cardiovascular disease and PD has been studied, a paucity of information on PD and atrial fibrillation (AF) association exists. Thus, we aimed to investigate whether patients with PD have an increased risk of AF. METHODS: This study included 57,585 patients with newly diagnosed PD (≥40-year-old, mean age 69.7 years, men 40.2%) and without a history of AF from the Korean National Health Insurance Service (NHIS) database between 2010 and 2015. Furthermore, an equal number of age- and sex-matched subjects without PD were selected for comparison. The primary outcome was new-onset AF. RESULTS: During the mean follow-up period of 3.4 ± 1.8 years, AF was newly diagnosed in 3,665 patients. A significantly higher incidence rate of AF was noted among patients with PD than among patients without PD (10.75 and 7.86 per 1000 person-year, respectively). Multivariate Cox-regression analysis revealed that PD was an independent risk factor for AF (hazard ratio [HR]: 1.27, 95% confidence interval [CI]: 1.18-1.36). Furthermore, subgroup analyses revealed that AF risk was higher in the younger age subgroups, and compared with the non-PD group, the youngest PD group (age: 40-49 years) had a threefold increased risk of AF (HR: 3.06, 95% CI: 1.20-7.77). INTERPRETATION: Patients with PD, especially the younger age subgroups, have an increased risk of AF. Active surveillance and management of AF should be considered to prevent further complications.

6.
Am Heart J ; 229: 81-91, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32927313

RESUMO

BACKGROUND: The evidence of effectiveness and safety of the non-vitamin K antagonist oral anticoagulants (NOACs) among elderly East Asians is limited. OBJECTIVES: We aimed to describe the effectiveness and safety outcomes associated with NOACs and warfarin among elderly Koreans aged ≥80 years. METHODS: Using the Korean Health Insurance Review and Assessment service database, patients with atrial fibrillation (AF) who were naïve to index oral anticoagulant between 2015 and 2017 were included in this study (20,573 for NOACs and 4086 for warfarin). Two treatment groups were balanced using the inverse probability of treatment weighting (IPTW) method. The clinical outcomes including ischemic stroke, major bleeding including intracranial hemorrhage (ICH) and gastrointestinal bleeding (GIB), and a composite of these outcomes were evaluated. RESULTS: Compared to warfarin, NOACs were associated with lower risks of ischemic stroke (hazard ratio 0.74 [95% confidence interval 0.62-0.89]), and composite outcome (0.78 [0.69-0.90]). NOACs showed nonsignificant trends towards to lower risks of GIB and major bleeding than warfarin. The risk of ICH of NOAC group was comparable with the warfarin group. Among NOACs, apixaban and edoxaban showed better composite outcomes than warfarin. Among the clinical outcomes, only ischemic stroke and the composite outcome had a significant interaction with age subgroups (80-89 years and ≥90 years, P-for-interaction = .097 and .040, respectively). CONCLUSION: NOACs were associated with lower risks of ischemic stroke and the composite outcome (ischemic stroke and major bleeding) compared to warfarin in elderly East Asians. Physicians should be more confident in prescribing NOACs to elderly East Asians with AF.

7.
Sci Rep ; 10(1): 15872, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32985552

RESUMO

There is a paucity of information as to whether chromosomal abnormalities, including Down Syndrome, Turner Syndrome, and Klinefelter Syndrome, have an association with atrial fibrillation (AF) and ischemic stroke development. Data from 3660 patients with Down Syndrome, 2408 with Turner Syndrome, and 851 with Klinefelter Syndrome without a history of AF and ischemic stroke were collected from the Korean National Health Insurance Service (2007-2014). These patients were followed-up for new-onset AF and ischemic stroke. Age- and sex-matched control subjects (at a ratio of 1:10) were selected and compared with the patients with chromosomal abnormalities. Down Syndrome patients showed a higher incidence of AF and ischemic stroke than controls. Turner Syndrome and Klinefelter Syndrome patients showed a higher incidence of AF than did the control group, but not of stroke. Multivariate Cox regression analysis revealed that three chromosomal abnormalities were independent risk factors for AF, and Down Syndrome was independently associated with the risk of stroke. In conclusion, Down Syndrome, Turner Syndrome, and Klinefelter Syndrome showed an increased risk of AF. Down Syndrome patients only showed an increased risk of stroke. Therefore, AF surveillance and active stroke prevention would be beneficial in patients with these chromosomal abnormalities.

8.
J Cardiovasc Electrophysiol ; 31(10): 2616-2625, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32897567

RESUMO

INTRODUCTION: Catheter ablation (CA) for atrial fibrillation (AF) is used as a treatment to restore and maintain sinus rhythm in patients with AF. However, limited data exist regarding the temporal trends of AF ablation in Asia. This study aimed to describe the temporal trends of CA for AF in Korean over 11 years. METHODS: The nationwide claims database in Korea was utilized. Patients underwent CA for AF were identified using combinations of diagnostic codes, claims history, and procedure codes. Comorbidities and complications were also identified, and their temporal trends were evaluated. RESULTS: The numbers of patients underwent CA for AF were observed to gradually increased over 11 years (452 patients in 2007 vs. 3035 patients in 2017). Mean age of the study population increased (55.4 in 2007-2010 vs. 58.9 in 2015-2017); and mean CHA2 DS2 -VASc score also increased (1.9 in 2007-2010 vs. 2.2 in 2015-2017). Risks of complications decreased during the study period but risks of all-cause deaths did not changed significantly. Older age, women, hypertension, cerebrovascular accident, chronic obstructive pulmonary disease, chronic kidney disease, general anesthesia, and small procedure volume were independent predictors of complications but, only diabetes and occurrence of any complication were associated with mortality after CA. CONCLUSION: CA for AF has become an increasingly important treatment option. Although the proportion of high-risk patients increased, risks of complications decreased over time. Performing procedure without complications and prompt managements are essential to improve the outcome of the patients with AF underwent CA.

9.
Artigo em Inglês | MEDLINE | ID: mdl-32847040

RESUMO

This study aimed to develop a physical education fitness program for adolescents to counteract the declining physical activity levels caused by the COVID-19 pandemic, as well as to investigate the program's effect. This mixed-methods study developed and implemented a five-component "Music Beeps" (MB) program to promote adolescents' physical fitness. A total of 240 students from two high schools in South Korea-divided into experimental and control groups-participated in 32 sessions over 16 weeks. The changes in students' fitness were analyzed, and the educational effects were examined via inductive analysis of the observation logs and group and in-depth interviews. The results demonstrated that, whereas the comparison group demonstrated no statistically significant changes in power, muscular strength and endurance, or cardiopulmonary endurance, the experimental group showed changes in all these variables, along with changes in flexibility. Further, the MB program had significant educational effects. First, students reported that musical cues enhanced their fitness motivation and sense of responsibility. Second, record-keeping and active participation contributed to self-led fitness management. Third, activity in a small space with few pieces of equipment led to the positive perception that the program was efficient and enabled regular exercise regardless of climate conditions.


Assuntos
Promoção da Saúde/métodos , Música , Educação Física e Treinamento/métodos , Aptidão Física , Adolescente , Infecções por Coronavirus , Exercício Físico , Humanos , Pandemias , Pneumonia Viral , República da Coreia , Instituições Acadêmicas
10.
Cardiovasc Diabetol ; 19(1): 78, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32534567

RESUMO

BACKGROUND: Bodyweight variability is a risk factor for atrial fibrillation (AF). We aimed to examine the relationship between bodyweight variability and the risk of AF in patients with type 2 diabetes mellitus (DM), and whether this relationship was affected by baseline body mass index (BMI), weight change, or advanced diabetic stage. METHODS: A nationwide population-based cohort of 670,797 patients with type 2 DM from the Korean National Health Insurance Service database without a history of AF and with ≥ 3 measurements of bodyweight over a 5-year period were followed up for AF development. Intra-individual bodyweight variability was calculated using variability independent of mean, and high bodyweight variability was defined as the quintile with the highest variability with the lower four quintiles as reference. RESULTS: During a median of 7.0 years of follow-up, 22,019 patients (3.3%) newly developed AF. After multivariate adjustment, those in the highest quintile of bodyweight variability showed a higher risk of incident AF (HR 1.16, 95% CI 1.12-1.20) compared to those in the lower 4 quintiles with reference bodyweight variability, irrespective of baseline BMI group and direction of overall weight change. This association was greater in magnitude in subjects with lower BMI, those on insulin, and those with a DM duration of greater than 5 years. In sensitivity analyses, high bodyweight variability was consistently associated with AF development using other indices of variability and adjusting for glycemic variability. CONCLUSIONS: High variability in bodyweight was associated with AF development, independently of traditional cardiovascular risk factors and baseline BMI. This association was stronger in underweight patients and with advanced diabetic stage. Weight fluctuation may interfere with the beneficial effects of weight loss and should be avoided when possible in weight control regimens for DM patients.


Assuntos
Fibrilação Atrial/epidemiologia , Trajetória do Peso do Corpo , Diabetes Mellitus Tipo 2/epidemiologia , Frequência Cardíaca , Obesidade/epidemiologia , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Índice de Massa Corporal , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/fisiopatologia , Prognóstico , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo
11.
J Clin Med ; 9(5)2020 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-32423155

RESUMO

We aimed to describe temporal trends in emergency department (ED) visits of patients with atrial fibrillation (AF) over 12 years. A repeated cross-sectional analysis of ED visits in AF patients using the Korean nationwide claims database between 2006 and 2017 were conducted. We identified AF patients who had ≥1 ED visits. The incidence of ED visits among total AF population, cause of ED visit, and clinical outcomes were evaluated. During 12 years, the annual numbers of AF patients who attended ED at least once a year continuously increased (40,425 to 99,763). However, the annual incidence of ED visits of AF patients was stationary at about 30% because the number of total AF patients also increased during the same period. The most common cause of ED visits was cerebral infarction. Although patients had a higher risk profile over time, the 30-day and 90-day mortality after ED visit decreased over time. ED visits due to ischemic stroke, intracranial hemorrhage, and myocardial infarction decreased, whereas ED visits due to AF, gastrointestinal bleeding, and other major bleeding slightly increased among total AF population over 12 years. A substantial proportion of AF patients attended ED every year, and the annual numbers of AF patients who visited the ED significantly increased over 12 years. Optimized management approaches in a holistic and integrated manner should be provided to reduce ED visits of AF patients.

12.
J Am Chem Soc ; 142(19): 8880-8889, 2020 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-32307984

RESUMO

The transition-metal-catalyzed nitrenoid transfer reaction is one of the most attractive methods for installing a new C-N bond into diverse reactive units. While numerous selective aminations are known, understanding complex structural effects of the key intermediates on the observed chemoselectivity is still elusive in most cases. Herein, we report a designing approach to enable selective nitrenoid transfer leading to sp2 spirocyclization and sp3 C-H insertion by cooperative two-point modulation of ligands in the CpXIr(III)(κ2-chelate) catalyst system. Computational analysis led us to interrogate structural motifs that can be attributed to the desired mechanistic dichotomy. Multivariate linear regression analysis on the perturbation on the η5-cyclopentadienyl ancillary (CpX) and LX coligand, wherein we prepared over than 40 new catalysts for screening, allowed for construction of an intuitive yet robust statistical model that predicts a large set of chemoselective outcomes, implying that the catalysts' structural effects play a critical role on the chemoselective nitrenoid transfer. On the basis of this quantitative analysis, a new catalytic platform is now established for the unique lactam formation, leading to the unprecedented chemoselective reactivity (up to >20:1) toward a diverse array of competing sites, such as tertiary, secondary, benzylic, allylic C-H bonds, and aromatic π system.

13.
J Med Internet Res ; 22(5): e16443, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32348254

RESUMO

BACKGROUND: Continuous photoplethysmography (PPG) monitoring with a wearable device may aid the early detection of atrial fibrillation (AF). OBJECTIVE: We aimed to evaluate the diagnostic performance of a ring-type wearable device (CardioTracker, CART), which can detect AF using deep learning analysis of PPG signals. METHODS: Patients with persistent AF who underwent cardioversion were recruited prospectively. We recorded PPG signals at the finger with CART and a conventional pulse oximeter before and after cardioversion over a period of 15 min (each instrument). Cardiologists validated the PPG rhythms with simultaneous single-lead electrocardiography. The PPG data were transmitted to a smartphone wirelessly and analyzed with a deep learning algorithm. We also validated the deep learning algorithm in 20 healthy subjects with sinus rhythm (SR). RESULTS: In 100 study participants, CART generated a total of 13,038 30-s PPG samples (5850 for SR and 7188 for AF). Using the deep learning algorithm, the diagnostic accuracy, sensitivity, specificity, positive-predictive value, and negative-predictive value were 96.9%, 99.0%, 94.3%, 95.6%, and 98.7%, respectively. Although the diagnostic accuracy decreased with shorter sample lengths, the accuracy was maintained at 94.7% with 10-s measurements. For SR, the specificity decreased with higher variability of peak-to-peak intervals. However, for AF, CART maintained consistent sensitivity regardless of variability. Pulse rates had a lower impact on sensitivity than on specificity. The performance of CART was comparable to that of the conventional device when using a proper threshold. External validation showed that 94.99% (16,529/17,400) of the PPG samples from the control group were correctly identified with SR. CONCLUSIONS: A ring-type wearable device with deep learning analysis of PPG signals could accurately diagnose AF without relying on electrocardiography. With this device, continuous monitoring for AF may be promising in high-risk populations. TRIAL REGISTRATION: ClinicalTrials.gov NCT04023188; https://clinicaltrials.gov/ct2/show/NCT04023188.


Assuntos
Fibrilação Atrial/diagnóstico , Aprendizado Profundo/normas , Fotopletismografia/métodos , Dispositivos Eletrônicos Vestíveis/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudo de Prova de Conceito , Estudos Prospectivos
14.
Hypertension ; 75(2): 309-315, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31838903

RESUMO

Blood pressure variability is a well-known risk factor for cardiovascular disease, but its association with atrial fibrillation (AF) is uncertain. We aimed to evaluate the association between visit-to-visit blood pressure variability and incident AF. This population-based cohort study used database from the Health Screening Cohort, which contained a complete set of medical claims and a biannual health checkup information of the Koran population. A total of 8 063 922 individuals who had at least 3 health checkups with blood pressure measurement between 2004 and 2010 were collected after excluding subjects with preexisting AF. Blood pressure variability was defined as variability independence of the mean and was divided into 4 quartiles. During a mean follow-up of 6.8 years, 140 086 subjects were newly diagnosed with AF. The highest blood pressure variability (fourth quartile) was associated with an increased risk of AF (hazard ratio, 95% CI; systolic blood pressure: 1.06, 1.05-1.08; diastolic blood pressure: 1.07, 1.05-1.08) compared with the lowest (first quartile). Among subjects in the fourth quartile in both systolic and diastolic blood pressure variability, the risk of AF was 7.6% higher than those in the first quartile. Moreover, this result was consistent in both patients with or without prevalent hypertension. In subgroup analysis, the impact of high blood pressure variability on AF development was stronger in high-risk subjects, who were older (≥65 years), with diabetes mellitus or chronic kidney disease. Our findings demonstrated that higher blood pressure variability was associated with a modestly increased risk of AF.


Assuntos
Fibrilação Atrial , Determinação da Pressão Arterial , Hipertensão , Medição de Risco/métodos , Assistência Ambulatorial/estatística & dados numéricos , Análise de Variância , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , República da Coreia/epidemiologia , Fatores de Risco
15.
Heart Rhythm ; 17(3): 365-371, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31585180

RESUMO

BACKGROUND: Obesity and weight gain are established risk factors for atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to investigate whether bodyweight variability is also a risk factor for AF development. METHODS: A nationwide population-based cohort of 8,091,401 adults from the Korean National Health Insurance Service database without a history of AF and with ≥3 measurements of bodyweight over a 5-year period were followed up for incident AF. Intraindividual bodyweight variability was calculated using variability independent of mean, and high bodyweight variability was defined as the quartile with the highest variability (Q4) with Q1-Q3 as reference. RESULTS: During median 8.1 years of follow-up, each increase of 1 SD in bodyweight variability was associated with a 5% increased risk of AF development, and the quartile with the highest bodyweight variability showed 14% increased risk of AF development compared to the quartile with the lowest variability (hazard ratio 1.14; 95% confidence interval 1.12-1.15), after adjustment for baseline bodyweight, height, age, sex, lifestyle factors, and comorbidities. High bodyweight variability was significantly associated with AF development in all baseline body mass index (BMI) groups except the very obese (BMI ≥30), and this association was stronger in subjects with lower bodyweight. High bodyweight variability was associated with increased risk of incident AF in all weight change groups, with a stronger association in those who lost weight. CONCLUSION: Bodyweight fluctuation was independently associated with an increased risk of AF development, especially in individuals with low bodyweight, and regardless of weight gain or loss.

16.
Sci Rep ; 9(1): 18055, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31792292

RESUMO

Although chronic kidney disease is known to increase the risk of atrial fibrillation (AF), the impact of the variability of renal function on the risk of incident AF is unknown. We aimed to evaluate the association between variability of renal function and the risk of developing AF among the general population. We evaluated a total of 3,551,249 adults who had three annual health check-ups provided by the National Health Insurance Service. The variability of renal function was defined as GFR-VIM, which is variability independent of the mean (VIM) of creatinine-based estimated glomerular filtration rate (eGFR). The study population was divided into four groups (Q1-4) based on the quartiles of GFR-VIM, and the risks of incident AF by each group were compared. During a mean of 3.2 ± 0.5 years follow-up, incident AF occurred in 15,008 (0.42%) subjects. The incidence rates of AF increased from Q1 to Q4 (0.98, 1.42, 1.27, and 1.63 per 1,000 person-years, respectively). Adjusting with multiple variables, Q4 showed an increased risk of incident AF compared to Q1 (hazard ratio (HR) 1.125, 95% confidence interval (CI) 1.071-1.181). Variability of serum creatinine or other definitions of variability showed consistent results. On subgroup analyses, Q4 in males or those with a decreasing trend of eGFR had significantly increased risks of incident AF compared to Q1 (HR 1.127, 95% CI 1.082-1.175; and HR 1.115, 95% CI 1.059-1.173, respectively). High variability of eGFR was associated with an increased risk of incident AF, particularly in males or those with decreasing trends of eGFR during follow-up.


Assuntos
Fibrilação Atrial/epidemiologia , Taxa de Filtração Glomerular/fisiologia , Insuficiência Renal Crônica/complicações , Adulto , Idoso , Fibrilação Atrial/etiologia , Creatinina/sangue , Creatinina/metabolismo , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/fisiopatologia , Medição de Risco/métodos , Fatores de Risco , Fatores Sexuais , Reino Unido/epidemiologia , Adulto Jovem
17.
Am J Cardiol ; 124(12): 1881-1888, 2019 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-31668346

RESUMO

The relation of progression of type 2 diabetes and detailed fasting glucose level with risk of atrial fibrillation (AF) is not well known. A total of 6,199,629 subjects not diagnosed with AF who underwent health check-up in 2009 were included from the Korean National Health Insurance Service database. Risk of AF was compared among subjects with normal fasting glucose (NFG), subjects with impaired fasting glucose (IFG), patients with diabetes duration <5 years (early diabetes mellitus [DM]), and patients with diabetes duration ≥5 years (late DM). Next, risk of AF stratified by fasting glucose level per 10 mg/dL was assessed. During a mean follow-up of 7.2 years, the risk of AF significantly increased across the time course of type 2 diabetes (adjusted hazard ratio (aHR) 1.04, 95% confidence interval (CI) 1.02 to 1.05 for IFG; aHR 1.06, 95% CI 1.04 to 1.08 for early DM; aHR 1.09, 95% CI 1.07 to 1.11 for late DM). The risk of AF was significantly higher in subjects who progressed to type 2 diabetes in the IFG group. Risk of AF increased with a 10 mg/dL increment of fasting blood glucose (p-for-trend <0.0001). However, there was a U-shape relationship between fasting blood glucose and risk of AF in those who received antidiabetic medication. In conclusion, the risk of AF increased with the time course of type 2 diabetes. However, low blood glucose in antidiabetic medication user was associated with an increased risk of AF.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Glicemia/análise , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Hipoglicemiantes/uso terapêutico , Adulto , Fatores Etários , Idoso , Fibrilação Atrial/terapia , Comorbidade , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/tratamento farmacológico , Progressão da Doença , Feminino , Humanos , Revisão da Utilização de Seguros , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , República da Coreia , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fatores de Tempo
18.
J Cardiovasc Electrophysiol ; 30(12): 2782-2789, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31637795

RESUMO

INTRODUCTION: The left atrium (LA), including the pulmonary vein antrum, is the main target of catheter ablation for atrial fibrillation (AF). However, there is a lack of data on the effect of extensive LA ablation on LA stiffness. This study sought to investigate the impact of extensive LA ablation on LA stiffness and dyspnea after the restoration of sinus rhythm. METHODS: In total, 97 patients with AF (80 patients who only underwent pulmonary vein isolation [PVI] and 17 patients who underwent extensive LA ablation) were investigated. Extensive LA ablation was defined as PVI plus at least two sets of LA linear-line ablation. LA stiffness was estimated using the ratio of E/e' to global longitudinal LA strain, as measured by echocardiography. The clinical outcomes we evaluated were AF recurrence and composite dyspnea, which we defined as newly prescribed diuretics or hospitalization for heart failure. RESULTS: Patients were 59.3 ± 10.0 years old on average, and 68 (70.1%) were male. There were no significant differences in baseline characteristics or echocardiographic parameters before ablation between the two groups. After ablation, LA stiffness was higher in the extensive ablation group compared with that in the PVI group (0.9 ± 0.6 vs 0.5 ± 0.3, respectively, P = .017). Multivariable linear regression analysis showed that extensive ablation increased LA stiffness (ß = 0.363, P < .001). AF recurrence was similar in both groups; however, composite dyspnea outcomes were worse in the extensive ablation group (P = .003). CONCLUSION: Extensive LA ablation was associated with a worsening of LA stiffness. This might explain dyspnea despite the successful restoration of sinus rhythm.


Assuntos
Fibrilação Atrial/cirurgia , Função do Átrio Esquerdo , Ablação por Cateter/efeitos adversos , Dispneia/etiologia , Veias Pulmonares/cirurgia , Potenciais de Ação , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Progressão da Doença , Dispneia/diagnóstico , Dispneia/fisiopatologia , Dispneia/terapia , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/fisiopatologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
J Clin Med ; 8(10)2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31590290

RESUMO

BACKGROUND: There are limited data for non-vitamin K antagonist oral anticoagulants (NOACs) impact on outcomes for patients with atrial fibrillation (AF) and valvular heart diseases (VHDs). METHODS: We identified patients with AF and associated Evaluated Heartvalves, Rheumatic or Artificial (EHRA) type 2 VHDs, and who had been naïve from the oral anticoagulants in the Korean National Health Insurance Service database between 2014 and 2016 (warfarin: n = 2671; NOAC: n = 3058). For analyzing the effect of NOAC on primary prevention, we excluded those with a previous history of ischemic stroke, intracranial hemorrhage (ICH), and gastrointestinal (GI) bleeding events. To balance covariates, we used the propensity score weighting method. Ischemic stroke, ICH, GI bleeding, major bleeding, all-cause death, and their composite outcome and fatal clinical events were evaluated. RESULTS: During a follow-up with a mean duration of 1.4 years, NOACs were associated with lower risks of ischemic stroke (hazard ratio (HR): 0.71, 95% confidence interval (CI): 0.53-0.96), GI bleeding (HR: 0.50, 95% CI: 0.35-0.72), fatal ICH (HR: 0.28, 95% CI: 0.07-0.83), and major bleeding (HR: 0.61, 95% CI: 0.45-0.80) compared with warfarin. Overall, NOACs were associated with a lower risk of the composite outcome (HR: 0.68, 95% CI: 0.58-0.80). CONCLUSIONS: In this nationwide Asian AF population with EHRA type 2 VHDs, NOAC use was associated with lower risks of ischemic stroke, major bleeding, all-cause death, and the composite outcome compared to warfarin use.

20.
Int J Cardiol ; 292: 106-111, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31256991

RESUMO

BACKGROUND: Chronic inflammation plays a role in the pathophysiology of atrial fibrillation (AF). However, there is a paucity of information about whether Behçet's disease (BD) is associated with an increased risk of AF. This population-based study aimed to determine the risk of AF in patients with BD. METHODS: A total of 6636 newly diagnosed BD patients without a history of AF were included from the Korean National Health Insurance Service database between 2010 and 2014. Newly diagnosed non-valvular AF was identified using the claims data. An age- and sex-matched non-BD subjects were extracted at a ratio of 1:5 (n = 31,040). The incidence and risk of AF were compared between groups. RESULTS: During a mean follow-up of 3.6 ±â€¯1.5 years, AF was newly diagnosed in 173 patients (51 in the BD group, 122 in the control group). The incidence was 2.3 and 1.1 per 1000 person-years, respectively. After adjustment, the BD group showed a 1.8-fold higher risk of AF compared to the control group. Patients with BD aged ≤40 years had a higher risk of AF, while patients aged ≥65 years showed a similar risk. Men with BD had a 2.5-fold increased risk of AF, whereas women with BD did not. Severe BD had a higher risk for AF compared to non-severe BD and controls. CONCLUSIONS: BD was associated with an increased risk of AF, particularly in men and young patients. Active surveillance and treatment are needed in BD patients and those with arrhythmic symptoms.


Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Síndrome de Behçet/complicações , Adulto , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Medição de Risco
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