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1.
Hypertension ; 75(2): 309-315, 2020 Feb.
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.

2.
Sci Rep ; 9(1): 18055, 2019 Dec 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.

3.
Am J Cardiol ; 124(12): 1881-1888, 2019 Dec 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.

4.
J Cardiovasc Electrophysiol ; 30(12): 2782-2789, 2019 Dec.
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.

5.
Heart Rhythm ; 2019 Oct 01.
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.

6.
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.

7.
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.

8.
World J Gastroenterol ; 25(22): 2788-2798, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31236001

RESUMO

BACKGROUND: Inflammatory bowel disease (IBD), a chronic inflammatory disease of the gastrointestinal tract, could play a role in the pathophysiology of atrial fibrillation (AF). AIM: To investigate the association between IBD and AF development. METHODS: We performed a population-based cohort study using records in the Korean National Health Insurance Services database between 2010 and 2014. A total of 37696 patients with IBD (12349 with Crohn's disease and 25397 with ulcerative colitis) were identified. The incidence rate of newly diagnosed AF in patients with IBD was compared with that in a 3 times larger cohort of 113088 age- and sex-matched controls without IBD. RESULTS: During 4.9 ± 1.3 years of follow-up, 1120 patients newly diagnosed with AF (348 in the IBD group and 772 in controls) were identified. After adjustments using multivariable Cox proportional hazards, patients with IBD were at a 36% [95% confidence interval (CI) 20%-54%] higher risk of AF than controls. The association between IBD and the development of AF was stronger in younger than in older patients. Patients without cardiovascular risk factors showed a higher risk of AF primarily. Additionally, patients receiving immun-omodulators [Hazard ration (HR) 1.46, 95%CI 1.31-1.89], systemic corticosteroids (HR 1.37, 95%CI 1.10-1.71), or biologics agents (HR 2.38, 95%CI 1.51-3.75) were at higher risk of AF than patients without them. CONCLUSION: IBD significantly increased the risk of AF, and the impact of IBD on developing AF was in patients with moderate to severe disease.


Assuntos
Fibrilação Atrial/epidemiologia , Colite Ulcerativa/complicações , Doença de Crohn/complicações , Adulto , Fibrilação Atrial/etiologia , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/diagnóstico , Doença de Crohn/tratamento farmacológico , Feminino , Seguimentos , Humanos , Fatores Imunológicos/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
9.
Int J Cardiol ; 293: 153-158, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31253527

RESUMO

BACKGROUND: This study examined the effects of variability of four metabolic parameters, namely systolic blood pressure (BP), body mass index (BMI), fasting blood glucose (FBG), and total cholesterol level (TC) on the risk of HF. The effects of metabolic parameter variability on the risk of heart failure (HF) remain unclear. METHODS: We studied individuals aged ≥40 years who had undergone ≥3 health check-ups under the Korean National Health Insurance Corporation during 2009 and 2012, and those who did not have hypertension, diabetes, or dyslipidemia. BP, BMI, FBG, and TC were measured at every visit. We defined the variability of each parameter using the variability independent of the mean (VIM) method. VIMs were categorized into four groups according to quartiles. The metabolic variability (MV) score for each subject was defined as the number of VIMs in the highest quartile. RESULTS: Among the 3,820,191 subjects, 17,253 (0.45%) had incident HF during a mean 5.3 ±â€¯1.1 years of follow-up. High variability of each parameter was associated with increased HF risk, which increased according to the MV score. After multivariable adjustment, compared to subjects with MV score = 0, subjects with MV score = 1-4 had an increased risk of HF (adjusted HR [95% CI], 1.15 [1.10-1.19] for MV score = 1, 1.33 [1.28-1.39] for MV score = 2, 1.48 [1.40-1.57] for MV score = 3, 1.74 [1.55-1.96] for MV score = 4 [p-for-trend ≪0.0001]). CONCLUSIONS: High variability of BP, BMI, FBG, and TC was synergistically associated with a higher incidence of new-onset HF.

10.
JMIR Mhealth Uhealth ; 7(6): e12770, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31199302

RESUMO

BACKGROUND: Wearable devices have evolved as screening tools for atrial fibrillation (AF). A photoplethysmographic (PPG) AF detection algorithm was developed and applied to a convenient smartphone-based device with good accuracy. However, patients with paroxysmal AF frequently exhibit premature atrial complexes (PACs), which result in poor unmanned AF detection, mainly because of rule-based or handcrafted machine learning techniques that are limited in terms of diagnostic accuracy and reliability. OBJECTIVE: This study aimed to develop deep learning (DL) classifiers using PPG data to detect AF from the sinus rhythm (SR) in the presence of PACs after successful cardioversion. METHODS: We examined 75 patients with AF who underwent successful elective direct-current cardioversion (DCC). Electrocardiogram and pulse oximetry data over a 15-min period were obtained before and after DCC and labeled as AF or SR. A 1-dimensional convolutional neural network (1D-CNN) and recurrent neural network (RNN) were chosen as the 2 DL architectures. The PAC indicator estimated the burden of PACs on the PPG dataset. We defined a metric called the confidence level (CL) of AF or SR diagnosis and compared the CLs of true and false diagnoses. We also compared the diagnostic performance of 1D-CNN and RNN with previously developed AF detectors (support vector machine with root-mean-square of successive difference of RR intervals and Shannon entropy, autocorrelation, and ensemble by combining 2 previous methods) using 10 5-fold cross-validation processes. RESULTS: Among the 14,298 training samples containing PPG data, 7157 samples were obtained during the post-DCC period. The PAC indicator estimated 29.79% (2132/7157) of post-DCC samples had PACs. The diagnostic accuracy of AF versus SR was 99.32% (70,925/71,410) versus 95.85% (68,602/71,570) in 1D-CNN and 98.27% (70,176/71,410) versus 96.04% (68,736/71,570) in RNN methods. The area under receiver operating characteristic curves of the 2 DL classifiers was 0.998 (95% CI 0.995-1.000) for 1D-CNN and 0.996 (95% CI 0.993-0.998) for RNN, which were significantly higher than other AF detectors (P<.001). If we assumed that the dataset could emulate a sufficient number of patients in training, both DL classifiers improved their diagnostic performances even further especially for the samples with a high burden of PACs. The average CLs for true versus false classification were 98.56% versus 78.75% for 1D-CNN and 98.37% versus 82.57% for RNN (P<.001 for all cases). CONCLUSIONS: New DL classifiers could detect AF using PPG monitoring signals with high diagnostic accuracy even with frequent PACs and could outperform previously developed AF detectors. Although diagnostic performance decreased as the burden of PACs increased, performance improved when samples from more patients were trained. Moreover, the reliability of the diagnosis could be indicated by the CL. Wearable devices sensing PPG signals with DL classifiers should be validated as tools to screen for AF.


Assuntos
Algoritmos , Fibrilação Atrial/diagnóstico , Aprendizado Profundo/tendências , Fotopletismografia/normas , Idoso , Fibrilação Atrial/fisiopatologia , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotopletismografia/instrumentação , Fotopletismografia/métodos , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Seul
11.
J Interv Card Electrophysiol ; 55(2): 171-181, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31102113

RESUMO

PURPOSE: The ablation index (AI) is a recently developed marker for ablation lesion quality that incorporates contact force (CF), time, and power in a weighted formula. There is a paucity of information on whether AI-guided pulmonary vein isolation (PVI) could improve the outcome in patients with atrial fibrillation (AF). We evaluated the optimal AI threshold for avoiding acute pulmonary vein reconnection (PVR), and to compare the efficacy of optimal AI-targeted PVI with that of conventional CF-guided PVI. METHODS: Seventy patients with AF (paroxysmal, 67%) were enrolled. In a phase 1 study, the patients underwent conventional CF-guided PVI (CON group), and the optimal AI threshold for avoiding acute PVR was identified. In phase 2, the patients underwent AI-guided PVI (OAI group). We compared the acute PVR rate between the CON group and the OAI group to demonstrate the efficacy of AI-guided PVI. RESULTS: In phase 1 (n = 38), acute PVR was observed in 57 of 532 (10.7%) segments. AI values of ≥ 450 at the anterior/roof segments and of ≥ 350 at the posterior/inferior/carina segments were identified as the optimal AI thresholds for avoiding acute PVR. In the phase 2 study targeting those AI values, the OAI group (n = 32) showed a significantly lower acute PVR rate than the CON group (4.2% vs. 10.7%, p < 0.001). The OAI group showed a higher minimum AI and smaller variations in AI values than the CON group. CONCLUSIONS: Optimal AI-targeted PVI is feasible and could improve the acute outcome in patients with AF. TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03389074.


Assuntos
Fibrilação Atrial/cirurgia , Veias Pulmonares/cirurgia , Ablação por Radiofrequência/métodos , Animais , Cães , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros
12.
PLoS One ; 14(1): e0209593, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30645601

RESUMO

BACKGROUND: We investigated the recent 10-year trends in the number of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) in relation to prescription patterns of antithrombotic therapy. METHODS: We analyzed the annual prevalence of PCI and patterns of antithrombotic therapy after PCI, including antiplatelets and oral anticoagulants (vitamin K antagonists and non-vitamin K antagonist oral anticoagulants [NOACs]), in patients with AF between 2006 and 2015 by using the Korean National Health Insurance Service database. Independent factors associated with triple therapy (oral anticoagulant plus dual antiplatelet) prescription were assessed using multivariable logistic regression analysis. RESULTS: The number of patients with AF undergoing PCI increased gradually from 2006 (n = 2,140) to 2015 (n = 3,631) (ptrend<0.001). In 2006, only 22.7% of patients received triple therapy after PCI although 96.2% of them were indicated for anticoagulation (CHA2DS2-VASc score ≥2). The prescription rate of triple therapy increased to 38.3% in 2015 (ptrend<0.001), which was mainly attributed to a recent increment of NOAC-based triple therapy from 2013 (17.5% in 2015). Previous ischemic stroke or systemic embolism, old age, hypertension, and congestive heart failure were significantly associated with a higher triple therapy prescription rate, whereas previous myocardial infarction, PCI, and peripheral arterial disease were associated with triple therapy underuse. CONCLUSIONS: From 2006 to 2015, the number of patients with AF undergoing PCI and the prescription rate of triple therapy increased gradually with a recent increment of NOAC-based antithrombotic therapy from 2013. Previous myocardial infarction, peripheral artery disease, and PCI were associated with underuse of triple therapy.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação de Plaquetas/farmacologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Coagulação Sanguínea , Planejamento em Saúde Comunitária/métodos , Quimioterapia Combinada , Feminino , Fibrinolíticos/farmacologia , Humanos , Masculino , Infarto do Miocárdio/complicações , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Prevalência , República da Coreia/epidemiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
13.
Heart Rhythm ; 16(2): 197-203, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30170225

RESUMO

BACKGROUND: The prognostic efficacy of quantitative platelet activity in atrial fibrillation (AF) remains unclear. OBJECTIVE: The purpose of this study was to evaluate the platelet count (PLT) as a prognostic indicator in patients with nonvalvular AF. METHODS: Data on 10,978 patients with nonvalvular AF were retrieved from a prospective registry of a single medical center in Korea. Cumulative risk for stroke and bleeding events were compared between patients with normal PLT (n = 8322), mild thrombocytopenia (n = 1791), and moderate to severe thrombocytopenia (n = 865) after propensity score matching. Prediction models for stroke were derived by conventional risk factors (model 1) and by combining PLT with model 1 (model 2), and model performance was assessed by area under the receiver operator characteristics curve (AUC). RESULTS: During the follow-up period, 7.3%, 7.0%, and 4.5% had stroke and 7.6%, 10.8%, and 17.2% had bleeding events in the normal PLT, mild, and moderate to severe thrombocytopenia groups, respectively. Compared to the normal PLT group, the moderate to severe thrombocytopenia group showed a lower risk of stroke (hazard ratio [HR] 0.57; 95% confidence interval [CI] 0.40-0.80; P = .002). A reverse relationship was found between PLT and bleeding risk (moderate to severe thrombocytopenia: HR 2.19; 95% CI 1.77-2.70; P <.001; mild thrombocytopenia: HR 1.43; 95% CI 1.18-1.73; P <.001). Compared to model 1, model 2 showed significant improvement in risk prediction (AUC 0.628 vs 0.644; P <.001). CONCLUSION: A lower PLT was associated with a lower risk of stroke and a higher risk of bleeding events. PLT combined with conventional risk factors showed significant improvement in prediction for stroke.

14.
Int J Cardiol ; 275: 77-82, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30360993

RESUMO

BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease, associated with a number of cardiovascular diseases. We sought to investigate whether AS increases the risk of atrial fibrillation (AF) in a nationwide population-based study. METHODS: A total of 14,129 patients newly diagnosed with AS (mean age 41.8 ±â€¯15.3 years, 72% male) were recruited from the Korean National Health Insurance Service database between 2010 and 2014 and followed up for new onset AF. Age- and sex-matched non-AS subjects (1:5, n = 70,645) were selected and compared with the AS patients. RESULTS: During a mean follow-up of 3.5 years, AF was newly diagnosed in 486 patients (114 patients of the AS group). The AS patients developed AF more frequently than the non-AS subjects (2.32 vs. 1.51 per 1000 person-years). In multivariate Cox regression analysis, AS was an independent risk factor for AF (Hazard ratio [HR] 1.28, 95% confidence interval [1.03-1.58]). The AS with tumor necrosis factor inhibitor (TNFi) therapy group showed higher risk for AF (HR 1.60 [1.02-2.39]). In younger patients of the AS group (patients <40 years old), the risk for AF was three times higher than patients at same age in the non-AS group. AS was an independent risk factor for AF in men, but not in women (HR 1.53 [1.18-1.95]; HR 1.42 [0.94-2.08], respectively). CONCLUSIONS: AS was an independent risk factor for AF, especially in those under 40 years of age and those administered TNFi. It would be reasonable to screen for AF and stroke prevention in these high-risk patients.


Assuntos
Fibrilação Atrial/epidemiologia , Vigilância da População , Medição de Risco/métodos , Espondilite Anquilosante/complicações , Adulto , Idoso , Fibrilação Atrial/etiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Espondilite Anquilosante/epidemiologia , Adulto Jovem
15.
Diabetes Res Clin Pract ; 148: 14-22, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30578822

RESUMO

AIMS: Metabolic syndrome (MetS) and chronic kidney disease (CKD) are significant risk factors for incident atrial fibrillation (AF). Few studies have reported the synergistic effect of MetS and CKD on development of AF. We investigated the individual and synergistic effects of MetS and CKD on the risk of incident AF. METHODS: We studied a retrospective cohort comprising 22,886,663 Koreans whose data was obtained from the national health claims database established by the Korean National Health Insurance Service between 2008 and 2013. Patients were classified into a MetS and a CKD group and followed-up until 2016 for new-onset AF. A Cox proportional hazards model assessed the independent and synergistic effect of MetS and CKD on the risk of incident AF. RESULTS: The prevalence of MetS and CKD in these patients was 27.4% and 5.4%, respectively. During a mean follow-up of 5.4 years, AF developed in 225,529 patients (1% of the total cohort). The adjusted hazard ratio (HR) for incident AF was 1.38 (95% confidence interval [CI] 1.36-1.39) for MetS, and 1.35 (95% CI 1.34-1.37) for CKD. Patients with MetS and CKD showed a higher risk of AF (HR 1.75, 95% CI 1.73-1.78) than that observed in those without MetS and CKD. CONCLUSIONS: The combination of MetS and CKD showed a high risk of development of AF in a large-scale nationwide cohort. Further studies are warranted to determine whether pharmacological and/or lifestyle interventions can control/manage these modifiable risk factors to reduce the risk of development of AF.


Assuntos
Fibrilação Atrial/epidemiologia , Síndrome Metabólica/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Idoso , Fibrilação Atrial/complicações , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/complicações , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
16.
PLoS One ; 13(12): e0209687, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30586468

RESUMO

BACKGROUND: Patients with atrial fibrillation are known to have a high risk of mortality. There is a paucity of population-based studies about the impact of atrial fibrillation on the mortality risk stratified by age, sex, and detailed causes of death. METHODS: A total of 15,411 patients with atrial fibrillation from the Korean National Health Insurance Service-National Sample Cohort were enrolled, and causes of death were identified according to codes of the 10th revision of the International Classification of Diseases. RESULTS: From 2002 to 2013, a total of 4,479 (29%) deaths were confirmed, and the crude mortality rate for all-cause death was 63.3 per 1,000 patient-years. Patients with atrial fibrillation had a 3.7-fold increased risk of all-cause death compared with the general population. The standardized mortality ratio for all-cause death was the highest in young patients and decreased with increasing age (standardized mortality ratio 21.93, 95% confidence interval 7.60-26.26 in patients aged <20 years; standardized mortality ratio 2.77, 95% confidence interval 2.63-2.91 in patients aged ≥80 years). Women with atrial fibrillation exhibited a greater excess mortality risk than men (standardized mortality ratio 3.81, 95% confidence interval 3.65-3.98 in women; standardized mortality ratio 3.35, 95% confidence interval 3.21-3.48 in men). Cardiovascular disease was the leading cause of death (38.5%), and cerebral infarction was the most common specific disease. Patients with atrial fibrillation had an about 5 times increased risk of death due to cardiovascular disease compared with the general population. CONCLUSIONS: Patients with atrial fibrillation had a 4 times increased risk of mortality compared with the general population. However, the impact of atrial fibrillation on mortality decreased with age and in men. Cerebral infarction was the most common cause of death, and more attention should be paid to reducing the risk of stroke.


Assuntos
Fibrilação Atrial/mortalidade , Doenças Cardiovasculares/mortalidade , Causas de Morte , Acidente Vascular Cerebral/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Infarto Cerebral/mortalidade , Infarto Cerebral/fisiopatologia , Feminino , Humanos , Coreia (Geográfico) , Masculino , Pessoa de Meia-Idade , Mortalidade , Neoplasias/mortalidade , Neoplasias/fisiopatologia , Sistema de Registros , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/fisiopatologia , Adulto Jovem
17.
Int J Cardiol ; 273: 130-135, 2018 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-30150122

RESUMO

BACKGROUND: Atrial fibrillation (AF) and stroke are common in hypertrophic cardiomyopathy (HCM). We aimed to determine the prevalence and incidence of AF and stroke in patients with HCM during a 10-year period. METHODS: Using the Korean National Health Insurance Services database, we identified patients diagnosed with HCM from the entire Korean population between 2005 and 2015. The annual prevalence and incidence of AF and stroke in HCM patients were estimated. RESULTS: The prevalence of AF in HCM patients has gradually increased to 1.6-fold from 13.4% in 2005 to 20.9% in 2015. The incidence of AF ranged from 4.1 to 5.5%, a similar trend was observed for each year in HCM patients. The prevalence of stroke in HCM patients was approximately 10%, while that in HCM patients with AF was about 20%. During 8741 person-years, AF-related stroke occurred in 257 subjects among 2309 HCM patients with new-onset AF. The overall incidence rate of AF-associated stroke was 2.94 per 100 person-years. In subgroup analysis, the incidence rate of AF-associated stroke was 1.49 per 100 person-years in the under 45 year-old group and 1.48 per 100 person-years in the group with CHA2DS2-VASc score of 0 or 1 point in HCM patients. CONCLUSIONS: The prevalence of AF in HCM patients gradually increased over 10 years. The annual risk of AF-associated stroke in HCM was over 1% even in younger patients and those with CHA2DS2-VASc score of 0 or 1 point, which provide evidence to support the prevention of stroke in HCM patients with AF.


Assuntos
Grupo com Ancestrais do Continente Asiático , Fibrilação Atrial/epidemiologia , Cardiomiopatia Hipertrófica/epidemiologia , Vigilância da População , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico por imagem , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Prevalência , República da Coreia/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Fatores de Tempo
19.
JACC Cardiovasc Interv ; 9(20): 2097-2109, 2016 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-27692820

RESUMO

OBJECTIVES: The purpose of this study was to evaluate the clinical impact of chronic kidney disease (CKD) on clinical outcomes in contemporary practice of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES). BACKGROUND: Although second-generation DES have improved the safety and efficacy issues in PCI, data regarding the performance of second-generation DES in patients with CKD are still limited. METHODS: We performed a patient-level pooled analysis on 12,426 patients undergoing PCI using second-generation DES from the Korean Multicenter Drug-Eluting Stent Registry. Endpoints were stent-oriented outcomes (target lesion failure [TLF]) and patient-oriented composite outcomes (POCO) during a median follow-up of 35 months. CKD patients were stratified by the estimated glomerular filtration rate (eGFR) from mild CKD to end-stage renal disease patients, and by the coexistence of diabetes mellitus (DM). RESULTS: A total of 2,927 patients had CKD (23.6%), who showed a significantly higher risk of TLF (adjusted hazard ratio [HRadjust]: 1.50; 95% confidence interval [CI]: 1.21 to 1.86) and POCO (HRadjust 1.34; 95% CI: 1.17 to 1.55) compared to patients with preserved renal function. Stratified analysis by eGFR showed that TLF was not increased in the mild to moderate CKD, whereas severe CKD and dialysis-dependent patients showed significantly higher risk of TLF (HRadjust 2.44; 95% CI: 1.54 to 3.86; HRadjust 3.58; 95% CI: 2.52 to 5.08, respectively). The eGFR threshold of increased clinical events was 40 to 45 ml/min/1.73 m2. Among CKD patients, DM CKD patients showed a higher incidence of TLF compared to non-DM CKD patients (HRadjust: 1.82; 95% CI: 1.32 to 2.52), driven by the increase in target vessel-related events. CONCLUSIONS: In the era of second-generation DES, CKD patients were at a significantly higher risk of clinical outcomes only in severe CKD and end-stage renal disease patients.


Assuntos
Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Rim/fisiopatologia , Intervenção Coronária Percutânea/instrumentação , Insuficiência Renal Crônica/fisiopatologia , Idoso , Comorbidade , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Diabetes Mellitus/epidemiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/mortalidade , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Modelos de Riscos Proporcionais , Desenho de Prótese , Sistema de Registros , Diálise Renal , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
20.
Acta Crystallogr E Crystallogr Commun ; 71(Pt 11): o813, 2015 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-26594540

RESUMO

In the title compound, C6H4BrN3O4, the dihedral angles between the nitro groups and the aniline ring are 2.04 (3) and 1.18 (4)°, respectively. In the crystal, N-H⋯O and C-H⋯O hydrogen bonds and weak side-on C-Br⋯π inter-actions [3.5024 (12) Å] link adjacent mol-ecules, forming a three-dimensional network. A close O⋯Br contact [3.259 (2) Å] may also add additional stability.

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