Atrial Fibrillation In Men Research Articles

Sex-specific genetic risks for adverse outcomes after coronary revascularization procedures.

Men and women have differing risks of adverse events after revascularization procedures and these differences could be partially driven by genetics. We studied the sex-specific differences in associations of polygenic risk scores (PRSs) with atrial fibrillation (AF), ischaemic stroke (STR), intracranial haemorrhage (ICH), myocardial infarction (MI) and gastrointestinal haemorrhage (GIH) in coronary revascularization patients. The study cohort comprised 5561 and 17578 revascularized women and men. All participants underwent genotyping and register-based follow-up from 1961 to 2021. We calculated PRSs for all individuals and used Cox models with interaction term to examine the sex-specific associations between the PRSs and adverse outcomes after revascularization. The AF-PRS was more strongly associated with AF in men [hazard ratio (HR) per 1 standard deviation increase, 1.16; 95% confidence interval (CI), 1.12-1.19; P = 7.6 × 10-22) than in women (P for interaction 0.006). Conversely, ICH-PRS was more strongly associated with ICH after revascularization in women (HR, 1.32; 95% CI, 1.08-1.62; P = 0.008) than in men (P for interaction 0.008). We observed no sex-specific differences for the associations of PRSs with STR, MI or GIH. The genetic risk of AF after revascularization is greater in men than in women, and vice versa for ICH. Sex-specific PRSs could be used to identify individuals in high genetic risk for these complications.

Differences of women and men in smartphone-based screening for atrial fibrillation: a pre-specified subgroup analysis of the eBRAVE-AF trial

Abstract Background eBRAVE-AF, a siteless, randomized, controlled trial, showed that digital smart-device based screening for atrial fibrillation (AF) significantly increased the detection rate of treatment-relevant AF when compared to usual care. Purpose In this pre-specified subgroup analysis, we aimed to investigate the effect of sex on compliance, efficacy of digital screening, as well as the interaction between sex and AF-triggered major adverse cardiovascular complications (MACCE). Methods 5.551 individuals, free of AF at baseline were randomized to digital screening (n=2.860) or usual care (n=2.691). For digital screening, participants used a certified app to screen for irregularities in their pulse waves by means of photoplethysmography (PPG). Abnormal findings were confirmed by a 14-day Holter-ECG. The primary endpoint was newly diagnosed AF treated with oral anticoagulation (OAC) within 6 months. After 6 months, participants were invited to cross-over for a second study phase with reverse assignment. For this analysis we combined the two phases of the study using multilevel clustered Cox-regression analysis. Results The median age was 65 ± 11 years, the median CHA2DS2-VASc score was 3 ± 1 and 1.725 participants (31%) were females. Female sex was associated with better compliance in terms of more frequent PPG-measurements (57 ± 57) compared to male sex (50 ± 62; p<0.001). During a median follow-up time of 12 months 102 subjects reached the primary endpoint (including 2 endpoints in the cross-over window). Male sex (81 events) compared to female sex (21 events) was a significant predictor for reaching the primary endpoint (HR 1.74; 95% CI 1.08-2.82, p=0.023). While digital screening significantly increased the detection rate of AF requiring OAC in men (HR 2.48; 95% CI 1.52-4.05, p <0.001; Fig 1A), this effect did not reach the level of statistical significance in women (HR 1.83; 95% CI 0.74-4.54, p=0.193; Fig 1B), most probably due to the lower event-rate. The interaction between sex and the efficacy of digital screening was not statistically significant (p=0.563). Next to a higher incidence of AF in men (3.0% per year; 95% CI 2.4-4.5%) compared to women (1.8% per year; 95% CI 1.1%-2.4%; p=0.013), male participants were also at a higher risk for developing MACCE (106 vs. 20 events) (HR 2.57; 95% CI 1.57-4.20, p <0.001). AF was a significant predictor for developing MACCE in men (HR 6.52; 95% CI 3.42-12.43, p<0.001). Only one female participant with AF developed MACCE. Therefore, this analysis cannot be applied in females. Conclusion In a large-scale clinical trial, comparing digital screening to usual care for detecting AF requiring OAC, female sex was associated with better compliance to the study protocol and lower risk for developing AF requiring OAC. There was no significant interaction between sex and the efficacy of digital screening for detecting AF requiring OAC. In men, newly-diagnosed AF was associated with increased risk for MACCE.

Height Explains Sex Difference in Atrial Fibrillation Risk: Copenhagen General Population Study

ObjectiveTo test the hypothesis that the increased risk of atrial fibrillation (AF) in men compared with women is explained by height. MethodsFrom the Copenhagen General Population Study, we included 106,207 individuals (47,153 men and 59,054 women) from 20 to 100 years of age, without a prior diagnosis of AF, examined between November 25, 2003, and April 28, 2015. The main outcome was AF incidence from national hospital registers until April 2018. The association of risk factors with AF incidence was assessed by cause-specific Cox proportional hazards regression and Fine-Gray subdistribution hazards regression analysis. ResultsDuring a maximum of 14.4 years of follow-up (median, 8.9 years), incident AF was observed in 3449 men and 2772 women with 845 (95% CI, 815 to 875) and 514 (95% CI, 494 to 535) events per 100,000 person-years, respectively. The age-adjusted hazard of incident AF was 63% (95% CI, 55% to 72%) higher in men compared with women. Risk factors for AF were generally similar in men and women, except men were taller than women (179 cm vs 166 cm, respectively; P<.001). When controlling for height, the difference in hazard of incident AF between sexes disappeared. For population attributable risk of AF, height was the most important risk factor investigated and explained 21% and 19% of the risk of incident AF in men and women, respectively. ConclusionA 63% higher risk of incident AF in men compared with women is explained by differences in height.

Clinical outcomes after pulmonary vein isolation for atrial fibrillation in men versus women; insights from a contemporary large-scale population study

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is associated with an increased risk of stroke and mortality. Pulmonary vein isolation (PVI) is the most effective treatment to reduce AF burden and is associated with a reduced risk of stroke and death. Differences in long-term clinical outcomes following PVI between sexes are debatable. Purpose We aimed to explore the sex differences in outcomes following PVI in a contemporary population of AF patients. Methods This is a historical population-based study including all adult patients of the largest health maintenance organization in Israel who were first diagnosed with AF between January 1st, 2010, and January 1st, 2020. Patients with congenital heart disease, significant mitral stenosis, or who underwent valvular surgery were excluded. The primary outcomes were stroke and all-cause death after PVI. Early (30-day) outcomes were compared using logistic regression, and late (3-year) outcomes were assessed using multivariable survival analyses with Cox regression. Results Of 94,612 patients diagnosed with incident AF during the study period, 4593 (4.85%) underwent PVI, of whom 1892 (38.2%) were women. Women were older (65±12 vs. 63±13) and less likely to be smokers (15.0% vs. 33.0%). Women had higher body-mass-index (30.26±6.58 vs. 29.14±4.86) and higher rates of hypertension (66.4% vs. 63.2%) but had lower rates of known coronary or peripheral vascular disease and congestive heart failure (p&amp;lt;0.05 for all). The CHA2DS2-VASc score was higher among women compared to men [median 3 (IQR 2-4) vs. median 2 IQR (1-3), p&amp;lt;0.001). Compared to men, women were treated more often with beta-blockers (74.5% vs. 69.4%), non-dihydropyridine calcium channel blockers (6.5% vs. 3.0%), and class 1c antiarrhythmic drugs (19.4% vs. 12.8%; p&amp;lt;0.001 for all), but were treated less with amiodarone (14.2% vs. 18.1%, p&amp;lt;0.001). In the 30 days following CA, stroke occurred in 8 (0.2%) patients, and 26 (0.6%) patients died (p&amp;gt;0.1 for both). Three-year mortality was lower in women than in men (6.2%% vs. 8.6%, p=0.003), while stroke rates were similar in women (1.0%) and men (1.5%, p&amp;gt;0.1). In multivariable survival models, adjusting for potential confounders, women had a lower risk of mortality [aHR 0.72 95%CI (0.56-0.92), p=0.009]. Conversely, the risk of stroke was similar in women and men [aHR 0.62 95%CI (0.33-1.12), p=0.114]. The results were similar in propensity-adjusted models accounting for all differences between men and women. Conclusions In this contemporary AF population, short-term stroke and mortality rates after PVI were very low and similar in men and women. The risk of long-term stroke following PVI was relatively low and similar across sex criteria. Women had a lower risk of long-term mortality than men following PVI despite undergoing the procedure at an older age and after adjusting for comorbidities and background medical therapy, suggesting possible sex differences in long-term mortality after PVI.

Sex Differences in the Association Between Hypertension and Incident Atrial Fibrillation.

Background Limited evidence is available on sex differences about the association between hypertension and incident atrial fibrillation (AF). Methods and Results We used a nationwide health checkup and claims database to analyze 3 383 738 adults (median age, 43 (36-51) years, 57.4% men). We investigated the relationship between hypertension and incident AF in men and women using a Cox regression model. We used restricted cubic spline functions to identify the association of blood pressure (BP) as a continuous parameter with incident AF. We categorized the men and women into 4 groups according to the 2017 American College of Cardiology/American Heart Association BP guidelines. During a mean follow-up of 1199±950 days, 13 263 AF diagnoses were recorded. The incidence (95% CI) of AF was 15.8 (15.5-16.1) per 10 000 person-years in men and 6.1 (5.9-6.3) per 10 000 person-years in women. Compared with normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension were associated with an increased risk AF in both men and women. However, the hazard ratios were greater in women than in men, and the P value for interactions in the multivariable model was 0.0076. The models using restricted cubic spline showed that the risk of AF associated with elevated systolic BP increased steeply above an approximate threshold of systolic BP of 130 mm Hg in men and 100 mm Hg in women. Although our primary findings were consistent across subgroup analyses, this association was most significant in younger individuals. Conclusions Although the incidence of AF was higher in men, the association between hypertension and incident AF was more pronounced in women than in men, suggesting a potential sex difference in the relationship between hypertension and incident AF.

Noise annoyance and risk of prevalent and incident atrial fibrillation-A sex-specific analysis.

While chronic exposure to high levels of noise was demonstrated to increase the risk of various cardiovascular diseases, the association between noise annoyance and risk of cardiovascular disease remains still inconsistent. Recently, we showed that noise annoyance is associated with prevalent atrial fibrillation in the general population. However, the association between noise annoyance and risk of incident atrial fibrillation as well as potential sex-differences remain still elusive. 15,010 subjects from a German population-based cohort were examined at baseline (2007 to 2012) and follow-up five years later (2012 to 2017) to investigative the association between noise annoyance due to multiple sources and prevalent and incident atrial fibrillation. After multivariable adjustment, the results from logistic regression analyses revealed overall consistent and positive associations between noise annoyance and prevalent and incident atrial fibrillation in men, whereas this association was weaker in women, in particular with respect to incident atrial fibrillation. For instance, industrial noise annoyance was associated with 21% (95% confidence interval (CI) 9-34%) and 18% (8-29%) higher odds of prevalent atrial fibrillation in men and women, respectively. In prospective analysis, this association remained stable in men (odds ratio (OR) 1.25, 1.07-1.44), while in women no association was observed (OR 1.03, 0.89-1.18). The findings suggest that noise annoyance can increase the risk of incident atrial fibrillation in a large population-based cohort and that men may be more sensitive to the adverse effects of noise annoyance with regard to the risk of atrial fibrillation.

Association between serum apolipoprotein B and atrial fibrillation: a case–control study

The relationship between apolipoprotein B (APOB) and atrial fibrillation (AF) is less well-known. We aimed to investigate the association between APOB and AF by gender. We conducted a case–control study including 1913 consecutive hospitalized patients to analyze the association between APOB and AF. 950 AF patients and 963 age-, sex-matched non-AF patients with sinus rhythm were evaluated. T-test, Mann–Whitney test, ANOVA, and Chi-square analysis were performed to analyze baseline data and intergroup comparisons. Pearson's correlation tests or Spearman correlation tests were performed to determine the interrelationships. Multiple regression analysis was performed to adjust for covariables. The receiver operator characteristic (ROC) curve was constructed to examine the performance of APOB. AF patients had lower APOB (P < 0.001) and an independent negative association between APOB and AF in both genders adjusting for confounding factors (OR 0.121, 95% CI 0.067–0.220, P < 0.001), regardless of statin use. APOB was positively correlated with total cholesterol (TC) (r = 0.529, p < 0.001), low-density lipoprotein cholesterol (LDL-C) (r = 0.545, p < 0.001), apolipoprotein A1 (APOA1) (r = 0.083, p < 0.001), and albumin (ALB) (r = 0.134, p < 0.001). ROC curve analysis showed that APOB level = 0.895 g/L was the most optimal cut-off value, the area under the ROC curve was 0.722. This study shows a protective association of APOB with AF in men and women. It implies APOB may be a potential biomarker for AF with a promising cut-off point of 0.895 g/L and may involve initiating and maintaining AF along with several metabolic factors.

QRS transitional zone rotations and the risk of atrial fibrillation: the Suita Study.

ECG screening can detect people at risk of developing atrial fibrillation (AF). Recent literature indicated that QRS transitional zone rotations could predict several cardiovascular events. Herein, we investigated the association between QRS transitional zone rotations and the future risk of AF. This prospective cohort study included 6794 participants (3178 men and 3616 women), aged 30-84years, from the urban Japanese city of Suita. QRS transitional zone rotations were diagnosed by ECG during baseline, while AF was diagnosed by ECG, hospital records, and checkups during follow-up. The Cox regression was used to compute the sex-specified hazard ratios (HRs) and 95% confidence intervals (CIs) of incident AF for participants with counterclockwise and clockwise QRS transitional zone rotations compared to those with normal rotation. Within a median follow-up period of 14.6years, 311 participants (206 men and 105 women) developed AF. Counterclockwise rotation was associated with the reduced risk of AF among men, but not women, in the age-adjusted model: HR (95% CI) = 0.66 (0.44, 0.98) and the multivariable-adjusted model: HR (95% CI) = 0.65 (0.43, 0.97). Clockwise rotation was not associated with AF risk in either sex. To the best of our knowledge, this is the first study to indicate that counterclockwise rotation could be associated with the reduced risk of AF in men. More studies are needed to confirm our findings and elucidate possible mechanisms.

Gender gap in study inclusion: Insights from the STAR-FIB cohort study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation Swiss Heart Foundation Background The underrepresentation of women in cardiovascular clinical trials is well described but cannot be fully explained by sex-specific differences in the prevalence of cardiovascular diseases. Data on potential sex- and gender-related differences in study exclusion reasons are scarce. The STAR-FIB cohort study aimed to estimate the age and sex-specific prevalence of screening-detected atrial fibrillation (AF) in 800 hospitalized patients aged 65-84 years using serial seven-day ECGs. Recruitment for study inclusion was stratified by sex (female/male, as stated in the patient’s records) and age (four age bands, ≥65 to &amp;lt;70, ≥70 to &amp;lt;75, ≥75 to &amp;lt;80, and ≥80 to &amp;lt;85 years), and was truncated for each subgroup after the inclusion of 100 participants. Purpose To assess sex and gender differences in patient recruitment for inclusion in the STAR-FIB cohort study. Methods A screening log containing sex-category, age, and reasons for exclusion was maintained. Exclusion criteria are shown in the figure. For the purpose of the present study, an explorative analysis of all exclusion criteria with respect to sex category was done. Results Overall, 11’470 patients were identified for eligibility, 795 patients (49% women; mean age 75 years) were enrolled, and 10’675 patients (52% women vs. 48% men, p =0.13) were not enrolled. The two major exclusion reasons were unwillingness to participate, which was more frequent in women (27.9% of women vs. 18.4% of men, p &amp;lt; 0.01), and the presence of clinical AF, which was more prevalent in men (27.1% of men vs. 20.5 % of women, p &amp;lt; 0.01). A detailed analysis of all exclusion criteria analysed by sex category is provided in the figure. Conclusions Clinical AF was more frequent in men, in accordance with the well described sex-driven (biological) higher prevalence of AF in men. In contrast, we found a higher percentage of women unwilling to participate in this study, which may represent a more gender-based (sociocultural) phenomenon. A further exploration of these findings should be performed and may help to identify and potentially overcome modifiable obstacles for study participation.

Lipid levels, apolipoproteins, and risk of incident atrial fibrillation in men: A report from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD)

Apolipoproteins are associated with risk of coronary heart disease but the association with risk of incident atrial fibrillation (AF) has been inconsistent. This study investigated the association of apolipoproteins A-1 (apoA-1) and B (apoB), and lipid levels including triglyceride (TG), total cholesterol (TC), very low-density lipoprotein cholesterol (VLDL-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), with the risk of new-onset AF. A total of 2533 men from the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42-60 years, were studied. Cox proportional hazards adjusted for potential confounders was used to estimate hazard ratio (HR) of incident events across serum lipid, lipoprotein, and apoA-1 and apoB concentrations. During the mean follow-up of 22.4 years, 594 AF cases occurred. Cox proportional hazards regression indicated that higher serum HDL-C and apoA-1 concentrations were associated with lower risk of AF [the extreme-quartile multivariable-adjusted HR 0.72 (95% CI 0.57-0.92, P=0.02) for HDL-C, and 0.72 (95% CI 0.52-1.00, P=0.05)] for apoA-1]. No significant associations were observed for apoB and other lipids (TC, VLDL-C, LDL-C, non-HDL-C, and TG) with risk of incident AF. Over the time of follow-up in this study lower new-onset incident AF was in association with higher HDL-C and apo-A1 levels. Future studies should investigate mechanisms underlying the association of low HDL-C and low apoA1 with higher risk of incident AF.

A Retrospective Study to Determine the Association Between Serum Albumin Levels and Atrial Fibrillation by Sex in 950 Patients from a Single Center in China.

BackgroundIt remains unclear whether there is a sex difference in the association between serum albumin (ALB) and atrial fibrillation (AF). This retrospective case-control study from a single center in China aimed to determine the association between serum ALB levels and AF by sex in 950 patients.Material/MethodsData of 950 AF patients and 963 age- and sex-matched non-AF patients with sinus rhythm were collected and analyzed retrospectively. Clinical baseline data were analyzed using the t test or Mann-Whitney U test, analysis of variance (ANOVA), and chi-square test. The interrelationships were determined by Pearson correlation analysis, and multivariate logistic regression analysis was performed to adjust for covariables.ResultsALB levels of AF patients were significantly lower in both sexes (P<0.05), especially paroxysmal AF. ALB was positively correlated with total cholesterol (TC) (r=0.359, P<0.05), low-density lipoprotein cholesterol (LDL-C) (r=0.283, P<0.05), and serum apolipoprotein A1 (APOA1) (r=0.429, P<0.05) and was negatively correlated with serum creatinine (SCr) (r=0.129, P<0.05) in patients with AF. We found an independent negative association between ALB levels and AF in men after adjusting for confounding factors (OR=0.889, 95% CI: 0.845–0.934, P<0.05).ConclusionsIn patients at a single center in China, low serum ALB levels in male patients were significantly associated with AF. These findings support those from previous studies in other populations and highlight the importance of monitoring and treating the cause of hypoalbuminemia in cardiac patients.

Independent effects of adiposity measures on risk of atrial fibrillation in men and women: a study of 0.5million individuals.

BackgroundAtrial fibrillation (AF) has a higher prevalence in men than in women and is associated with measures of adiposity and lean mass (LM). However, it remains uncertain whether the risks of AF associated with these measures vary by sex.MethodsAmong 477 904 UK Biobank participants aged 40–69 without prior AF, 23 134 incident AF cases were identified (14 400 men, 8734 women; median follow-up 11.1 years). Cox proportional hazards models were used to estimate the covariate adjusted hazard ratios (HRs) describing the association of AF with weight, measures of adiposity [fat mass (FM), waist circumference (WC)] and LM, and their independent relevance, by sex.ResultsWeight and WC were independently associated with risk of AF [HR: 1.25 (1.23–1.27) per 10 kg, HR: 1.11 (1.09–1.14) per 10 cm, respectively], with comparable effects in both sexes. The association with weight was principally driven by LM, which, per 5 kg, conferred double the risk of AF compared with FM when mutually adjusted [HR: 1.20 (1.19–1.21), HR: 1.10 (1.09–1.11), respectively]; however, the effect of LM was weaker in men than in women (p-interaction = 4.3 x 10−9). Comparing the relative effects of LM, FM and WC identified different patterns within each sex; LM was the strongest predictor for both, whereas WC was stronger than FM in men but not in women.ConclusionsLM and FM (as constituents of weight) and WC are risk factors for AF. However, the independent relevance of general adiposity for AF was more limited in men than in women. The relevance of both WC and LM suggests a potentially important role for visceral adiposity and muscle mass in AF development.

Bone mineral density and risk of cardiovascular disease in men and women: the HUNT study

The association between bone mineral density (BMD) and cardiovascular disease (CVD) is not fully understood. We evaluated BMD as a risk factor for cardiovascular disease and specifically atrial fibrillation (AF), acute myocardial infarction (AMI), ischemic (IS) and hemorrhagic stroke (HS) and heart failure (HF) in men and women. This prospective population cohort utilized data on 22 857 adults from the second and third surveys of the HUNT Study in Norway free from CVD at baseline. BMD was measured using single and dual-energy X-ray absorptiometry in the non-dominant distal forearm and T-score was calculated. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from adjusted cox proportional hazards models. The analyses were sex-stratified, and models were adjusted for age, age-squared, BMI, physical activity, smoking status, alcohol use, and education level. Additionally, in women, we adjusted for estrogen use and postmenopause. During a mean follow-up of 13.6 ± 5.7 years, 2 928 individuals (12.8%) developed fatal or non-fatal CVD, 1 020 AF (4.5%), 1 172 AMI (5.1%), 1 389 IS (6.1%), 264 HS (1.1%), and 464 HF (2.0%). For every 1 unit decrease in BMD T-score the HR for any CVD was 1.01 (95% CI 0.98 to 1.04) in women and 0.99 (95% CI 0.94 to 1.03) in men. Point estimates for the four cardiovascular outcomes ranged from slightly protective (HR 0.95 for AF in men) to slightly deleterious (HR 1.12 for HS in men). We found no evidence of association of lower distal forearm BMD with CVD, AF, AMI, IS, HS, and HF.

Sex-specific relationship between abdominal obesity and new-onset atrial fibrillation in the general Japanese population.

The incidence of atrial fibrillation (AF) is expected to increase with increasing obesity and number of geriatric patients in Japan. Although higher body mass index and abdominal obesity are associated with an increased risk of AF, the sex-specific relationship between abdominal obesity and new-onset AF is unclear. This study aimed to investigate the sex-specific relationship between abdominal obesity and new-onset AF. This retrospective study evaluated the annual health checkup data of 67,379 adults (33,562 males; age, 54 ± 10years) without baseline AF from April 2008 to March 2016. Participants were grouped according to waist circumference (WC): large-WC group (males, ≥ 85cm; females, ≥ 90cm) and normal-WC group. Logistic regression analyses were performed to determine the strength of the association between abdominal obesity and new-onset AF, overall and separately for males and females. During a median follow-up of 5years, 280 (0.4%) new cases of AF were recorded. Univariate analysis revealed a significant increase in new-onset AF in males (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.49-2.60; p < 0.001) but not in females (OR, 1.69; 95% CI, 0.96-2.97; p = 0.068) in the large-WC group. After adjusting for clinical variables, multivariate analysis revealed that a large WC was significantly associated with new-onset AF in males (OR, 1.76; 95% CI, 1.31-2.36; p < 0.001) but not in females (OR, 1.22; 95% CI, 0.68-2.18; p = 0.514). Abdominal obesity is associated with an increased risk of new-onset AF in men.

The onset of paroxysmal non-valvular atrial fibrillation in men with hypertension is associated with an increase in blood levels of transforming growth factor beta 1

Abstract Funding Acknowledgements Type of funding sources: None. Background. Patients with essential hypertension (H), primarily men, are characterized by early formation of left ventricular hypertrophy (LVH) followed by left atrial (LA) enlargement, which significantly increases the risk of development non-valvular atrial fibrillation (nAF). The most important pathogenic factor in the development of nAF is fibrosis of the LA myocardium. One of the key profibrogenic factors is transforming growth factor beta 1(TGF-beta1). Purpose. To evaluate the blood levels of TGF-beta1 in hypertensive men with paroxysmal nAF and without AF. Methods.The study included 57 men with H grade 2–3 and with LVH (age 48 ± 4 years), of those 26 with paroxysmal nAF and 31 without AF. Controls were 26 practically healthy men. All patients with paroxysmal nAF had an at least one episode of paroxysmal AF attack with spontaneous return to normal sinus rhythm and were in sinus rhythm at the time of the assessment. Patients with valvular heart disease, heart failure, ischemic heart disease, cardiomyopathy, cardiac surgery, thyroid disease, diabetes mellitus, obesity, anemia, infectious or pulmonary diseases were not included. The examination of patients include standard methods as well as echocardiography. Levels of TGF-beta1 in blood serum were measured by immune enzyme assay. All patients included in the study received standard antihypertensive therapy. Results. It was found that the blood levels of TGF-beta1 in whole group of men with H were significantly higher (13,2 [5,3;22,5] ng/mL, р=0,034 ) than in practically healthy men (7,3 [2,3;16,5] ng/mL ). The highest blood levels of TGF-beta1 were found in hypertensive men with paroxysmal nAF (18,4 [9,2;31,8] ng/mL ) and significantly exceeded (р=0,018) those in hypertensive men without AF ( 11,6 [ 4,5;19,7] ng/mL ). The following positive correlations were found in whole group of men with H between TGF-beta1 blood levels and a number of echocardiographic parameters: LA size (LA volume/height2 ) (r = 0,510, р=0,012), LV mass index ( LV mass/BSA (g/m2) ( r = 0,411, р=0,027) and E/e′ (averaged) ratio (r = 0,357, р=0,036). Conclusion. The data obtained indicate that TGF-beta1 can play an important role, both in the pathogenesis of pathological remodeling of the LV and LA in men with H, and in the development of AF in these patients.

Joint Associations Between Body Mass Index and Waist Circumference With Atrial Fibrillation in Men and Women.

BackgroundAssociations between adiposity and atrial fibrillation (AF) might differ between sexes. We aimed to determine precise estimates of the risk of AF by body mass index (BMI) and waist circumference (WC) in men and women.Methods and ResultsBetween 2008 and 2013, over 3.2 million adults attended commercial screening clinics. Participants completed health questionnaires and underwent physical examination along with cardiovascular investigations, including an ECG. We excluded those with cardiovascular and cardiac disease. We used multivariable logistic regression and determined joint associations of BMI and WC and the risk of AF in men and women by comparing likelihood ratio χ2 statistics. Among 2.1 million included participants 12 067 (0.6%) had AF. A positive association between BMI per 5 kg/m2 increment and AF was observed, with an odds ratio of 1.65 (95% CI, 1.57–1.73) for men and 1.36 (95% CI, 1.30–1.42) for women among those with a BMI above 20 kg/m2. We found a positive association between AF and WC per 10 cm increment, with an odds ratio of 1.47 (95% CI, 1.36–1.60) for men and 1.37 (95% CI, 1.26–1.49) for women. Improvement of likelihood ratio χ2 was equal after adding BMI and WC to models with all participants. In men, WC showed stronger improvement of likelihood ratio χ2 than BMI (30% versus 23%). In women, BMI showed stronger improvement of likelihood ratio χ2 than WC (23% versus 12%).ConclusionsWe found a positive association between BMI (above 20 kg/m2) and AF and between WC and AF in both men and women. BMI seems a more informative measure about risk of AF in women and WC seems more informative in men.

Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study.

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.

A Stronger Association of Epicardial Fat Volume with Non-Valvular Atrial Fibrillation Than Measures of General Obesity in Chinese Patients Undergoing Computed Tomography Coronary Angiography

ObjectiveAn association of atrial fibrillation (AF) with epicardial fat volume (EFV) varied in different ethnic groups. We evaluated the AF-related risk factors and its association with pericardial fat in Chinese patients.MethodsPatients referred for coronary computed tomography angiography (CCTA) in Shanghai East Hospital during 2012 to 2014 (n=2042, 43.8% women, mean age 65.0 years) had AF and cardiovascular risk assessment. Pericardial fat depots were measured from CT and the association of EFV with non-valvular AF risk factors was evaluated by multivariate logistic regression models.ResultsAF was present in 8.5% of patients with 11.6% of AF patients having rheumatic heart disease (RHD) and 8.7% having other valvular diseases. With increasing age, the proportion of RHD-related AF decreased and the risk factors for non-valvular AF increased. There was a significantly higher proportion of risk factors for non-valvular AF in men than in women (p=0.008), but RHD-related AF was more prevalent in women than men (p=0.013). The patients with non-valvular AF had significantly higher BMI and EFV with more pronounced elevation of EFV (p<0.001). Multivariate logistic regression showed a significant association of EFV with AF after adjustment for BMI and clinical risk factors, and the highest EFV quartile was associated with AF independent of left atrial size and obstructive coronary artery disease.ConclusionThe association of EFV with non-valvular AF in Chinese patients was independent of generalized adiposity and clinical risk factors especially in highest EFV quartile. These findings support the growing appreciation of the association of EFV with AF.

Prediction of atrial fibrillation in men with coronary artery disease by artificial neural network

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is quite common in patients with coronary artery disease (CАD). However, there is no data whether AF is associated with coronary lesion of specific localization. Purpose To select the most sensitive parameters for creating artificial neural networks (ANN) model to predict AF in men with CАD using ANN. Methods We selected the data of men of comparable age with angiographically proven CAD from the Register of coronary angiography: the main group - 180 men with AF, the comparison group - 713 men without AF. To assess the risk of AF the ANN mathematical model was applied - a multilayer perceptron with one hidden layer. The initial number of patients was divided into 3 samples: training, test and control. Results Patients with AF were significantly less frequently employed in budget organizations (55.0% vs 63.7%, p = 0.040), more often demonstrated higher (III-IV) heart failure NYHA classes (49.2% vs 21.1% , p &amp;lt; 0.001), had higher body mass index (BMI) (30.2 [27.4; 33.2] kg/m² vs 29.0 [26.1; 32.3] kg/m², p = 0.002), echocardiographic indices of increased left ventricular (LV) myocardial mass (163.7 [144.5; 192.4] g/m² vs 143.9 [126.1; 169.0] g/m², p &amp;lt; 0.001), LV (25.8 [24.1; 29.1] mm/m² vs 25.6 [23.9; 27.5] mm/m², p = 0.020) and right ventricular dimensions, enlarged left atrium (23.6 [21.7; 25.7] mm/m² vs 21.1 [19.7; 22.7] mm/m², p &amp;lt; 0.001). Rate of hemodynamically significant mitral regurgitation in AF patients was higher (48.2% vs 14.1%, p &amp;lt; 0.001), index of aortic root dimensions (7.7 [16.4; 19.0] mm/m² vs 18.3 [17.8; 20.0] mm/m², р=0.002) and LV ejection fraction (EF) in this group was lower (49 [42; 56]% vs 56 [47; 60]%, p &amp;lt; 0.001), coronary calcification (23.2% vs 15.7%, p = 0.024 ) and proximal lesions of the right coronary artery (RCA) (28.3% vs 22.7%, p = 0.025) were detected more often. Sensitivity of the final model which included 10 parameters was 85%, specificity 86%. Conclusion In CAD men AF can be predicted by ANN model that takes into account the presence of significant mitral regurgitation, non-budgetary employment, severity of heart failure, coronary calcification and proximal lesion of RCA, BMI, echocardiographic indices of the left heart and aortic root dimensions, LVEF.

Artificial neural networks in prediction of atrial fibrillation in men with coronary artery disease

Aim. The aim of the study was to select, based on mathematical apparatus of artificial neural networks (ANN), the most sen- sitive parameters for creating an ANN model aimed at prediction of atrial fibrillation (AF) in men with coronary artery disease (CАD).Material and Methods. The study focused on data of men from the register of coronary angiography with angiographically proven coronary artery disease: the main group comprised 180 men with AF; the comparison group comprised 713 men of comparable age without AF. The ANN mathematical model, a multilayer perceptron with one hidden layer, was used to assess the risk of AF. The initial group of patients was divided into three samples: the training, test, and control samples.Results. Patients with AF were significantly less likely to be employed in budget organizations (55.0% vs 63.7%, p = 0.040) and more often showed higher (III–IV) heart failure NYHA classes (49.2% vs 21.1%, p &lt; 0.001), higher body mass index (BMI) (30.2 [27.4; 33.2] kg/m2 vs 29.0 [26.1; 32.3] kg/m2, p = 0.002), and higher echocardiographic indices of the left ventricular (LV) myocardial mass (163.7 [144.5; 192.4] g/m2 vs 143.9 [126.1; 169.0] g/m2, p &lt; 0.001), left (25.8 [24.1; 29.1] mm/m2 vs 25.6 [23.9; 27.5] mm/m2, p = 0.020) and right ventricular dimensions, and the left atrial diameter (23.6 [21.7; 25.7] mm/m2 vs 21.1 [19.7; 22.7] mm/m2, p &lt; 0.001). The group of AF patients had higher rate of hemodynamically significant mitral regurgitation (48.2% vs 14.1%, p &lt; 0.001). In this group of patients, the index of aortic root dimensions (7.7 [16.4; 19.0] mm/m2 vs 18.3 [17.8; 20.0] mm/m2, р = 0.002) and LV ejection fraction (EF) were lower (49 [42; 56]% vs 56 [47; 60]%, p &lt; 0.001); coronary calcification (23.2% vs 15.7%, p = 0.024 ) and proximal lesions of the right coronary artery (RCA) (28.3% vs 22.7%, p = 0.025) were detected more often. The final model, which included 10 parameters, had the diagnostic accuracy of 85%, sensitivity of 85%, and specificity of 86%.Conclusion. Atrial fibrillation in men with coronary artery disease can be predicted by ANN model that takes into account the presence of significant mitral regurgitation, extra-budgetary employment, severity of heart failure, coronary calcification, proximal lesion of RCA, BMI, echocardiographic indexes of left heart, aortic root dimensions, and LV EF.