Risk Of Atrial Fibrillation In Patients Research Articles

Atrial fibrillation in patients with a history of cancer and risk of bleeding complications associated with antithrombotic therapy

Abstract Background Up to one in four patients with atrial fibrillation (AF) has a cancer diagnosis. It is largely unknown to which extent a prior cancer diagnosis affects major bleeding and thromboembolic risk in AF patients. Moreover, data on major bleeding rates per antithrombotic treatment type are lacking in these patients. Purpose To examine the incidence rates of major bleeding per antithrombotic treatment in AF patients with prior cancer and to examine whether cancer type and the time-interval between AF and cancer influence major bleeding and thromboembolic risks. Methods This nationwide population-based cohort study included incident Danish AF patients aged ≥50 years between 01–01–1995 and 31–12–2016. Data on prior cancer, major bleeding and thromboembolisms (i.e. arterial and venous) were obtained from Danish health registries via International Classification of Diseases 10th Revision codes. We stratified according to prior cancer and by time between the AF and cancer diagnosis (i.e. <1 year, 1–3 years, >3 years), and cancer type. Data on antithrombotic exposure (e.g. no anticoagulant treatment, platelet inhibitors, vitamin K antagonists, direct oral anticoagulants, or combination of antithrombotic drugs) were evaluated as a time-dependent variable. We computed incidence rates per 100 patient-years and adjusted hazard ratios in a Cox regression model. Results We identified 39,178 AF patients with a prior cancer diagnosis. Bleeding risk increased with increasing number of antithrombotic drugs and was higher in AF patients with a history of cancer compared to those without, across all exposure categories (Figure 1). The increased bleeding risk was similar across different time intervals between cancer and AF diagnosis. The increased thromboembolic risk steeply declined with increasing time intervals between AF and cancer diagnosis (Figure 2). Prior gastrointestinal, intracranial, haematological, respiratory and urogenital cancers were associated with an increased bleeding risk. The two latter cancer types were also associated with increased thromboembolic risks. Conclusion We showed that patients with atrial fibrillation and a prior history of cancer experience higher rates of bleeding than those without cancer. Both respiratory and urogenital cancers had the highest rates of bleeding and thromboembolisms. Funding Acknowledgement Type of funding sources: None.

Уровень NT-рroBNP как предиктор развития фибрилляции предсердий у больных острым коронарным синдромом

Актуальность. Фибрилляция предсердий (ФП) отягощает течение инфаркта миокарда в 15,5 % случаев и ассоциирована с увеличением летальности на 40–50 %. Поэтому поиск маркеров риска развития ФП у больных острым коронарным синдромом (ОКС) является актуальным заданием. Целью исследования было определение предикторной ценности уровня NT-proBNP относительно риска развития ФП у больных ОКС. Материалы и методы. Обследованы 125 больных ОКС. Больные, у которых ФП впервые возникла во время госпитализации по поводу ОКС, составили подгруппу 1а (n = 41); больные, у которых ФП была в анамнезе, составили подгруппу 1б (n = 24). В группу 2 вошли больные без указаний на ФП (n = 60). Образцы крови для определения уровня NT-proBNP методом иммуноферментного анализа забирали в первые сутки заболевания. Результаты. Больные группы 2 были моложе больных подгрупп 1а (р = 0,019) и 1б (р = 0,002). В группе 2 было больше больных, чем в подгруппе 1б, которые курили (р = 0,029). У больных группы 2 уровень гемоглобина был выше, чем у больных подгруппы 1а (р = 0,014). Больные подгруппы 1б по сравнению с больными 2-й группы имели более высокий уровень гликемии при поступлении (р = 0,010). Уровень NT-proBNP оказался наивысшим в подгруппе 1а: 1592,00 (439,20; 3281,00) пг/мл. В подгруппе 1 б и группе 2 уровни NT-proBNP составили 1281,00 (844,45; 2012,50) пг/мл и 226,50 (54,40; 822,00) пг/мл соответственно (р1а–2 = 0,002; р1б–2 = 0,010). Выявлены корреляционные связи уровня NT-proBNP с возрастом больных (r = 0,500; р = 0,00006), женским полом (r = 0,286; р = 0,030), частотой сердечных сокращений и гликемией при поступлении (r = 0,363; р = 0,005 и r = = 0,482; р = 0,0001 соответственно), скоростью клубочковой фильтрации (r = –0,459; р = 0,0003), уровнем гемоглобина (r = –0,307; р = 0,019). Методом ROC-анализа, в который были включены больные подгруппы 1а и группы 2, установлена предикторная ценность уровня NT-proBNP относительно риска развития ФП у больных ОКС: при использовании пороговой точки > 1774 пг/мл чувствительность метода составляла 48 %, специфичность — 95,2 %, площадь под ROC-кривой составляла 0,77 (95% доверительный интервал 0,64–0,91). Выводы. В нашем исследовании уровень NT-proBNP был ассоциирован с клинико-анамнестическими показателями. Он был наивысшим в группе больных, у которых ФП развилась впервые на фоне ОКС; уровень NT-proBNP > 1774 пг/мл был ассоциирован с риском развития ФП.

Sodium-glucose cotransporter-2 inhibitors protect against atrial fibrillation in patients with heart failure.

Heart failure (HF) often complicates atrial fibrillation (AF) and conversely, AF frequently complicates HF. Furthermore, the coexistence of both conditions significantly increases the risk of cardiovascular complications. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been demonstrated to decrease hospitalizations for HF and reduce cardiovascular death. Therefore, this study evaluated the effects of SGLT-2 inhibitors on AF in patients with HF. A total of 903 patients with HF were enrolled in this study. Basic patient data including demographic characteristics, medical history, cardiovascular medications, and results of biochemical tests were collated. Logistic regression analysis was performed to examine the association between SGLT-2 inhibitors and the risk of AF. The effects of SGLT-2 inhibitors on AF were further analyzed according to subgroups. Patients treated with SGLT-2 inhibitors experienced a lower prevalence of AF (8.4% vs. 12.1%, P<0.001) compared to patients without SGLT-2 treatment. Controlling for potential confounders revealed that SGLT-2 inhibitors decreased the risk of AF by 24% [odds ratio (OR): 0.76; 95% confidence interval (CI): 0.70-0.85; P<0.001]. The effect of SGLT-2 inhibitors on AF was consistent in patients aged < 65 years and patients aged ≥65 years (OR =0.82 and 95% CI: 0.71-0.88 vs. OR =0.84 and 95% CI: 0.77-0.92, respectively; P interaction =0.501). Similarly, neither gender, body mass index (BMI), estimated glomerular filtration rate (eGFR), nor the New York Heart Association (NYHA) classification affected the protective effect of SGLT-2 inhibitors. SGLT-2 inhibitors reduced the risk of AF in patients with HF, and the effect was consistent irrespective of age, gender, BMI, eGFR, and NYHA classification.

Management of cardiovascular complications of bruton tyrosine kinase inhibitors.

Management of cardiovascular complications of bruton tyrosine kinase inhibitors.

Subclinical thyroid function and cardiovascular events in patients with atrial fibrillation.

To evaluate if subclinical thyroid dysfunction is associated with cardiovascular (CV) risk in patients with atrial fibrillation (AF). Swiss-AF is a prospective cohort of community-dwelling participants aged ≥ 65 years with AF. Primary outcome was a composite endpoint of CV events (myocardial infarctions, stroke/transitory ischemic events, systemic embolism, heart failure (HF) hospitalizations, CV deaths). Secondary outcomes were component endpoints, total mortality, and AF-progression. Exposures were thyroid dysfunction categories, TSH and fT4. Sensitivity analyses were performed for amiodarone use, thyroid hormones use, and competing events. 2415 patients were included (mean age: 73.2 years; 27% women). 196 (8.4%) had subclinical hypothyroidism and 53 (2.3%) subclinical hyperthyroidism. Subclinical thyroid dysfunction was not associated with CV events, during a median follow-up of 2.1 years (max 5 years): age- and sex-adjusted hazard ratio (adjHR) of 0.99 (95% CI: 0.69-1.41) for subclinical hypothyroidism and 0.55 (95% CI: 0.23-1.32) for subclinical hyperthyroidism. Results remained robust following multivariable adjustment and sensitivity analyses. In euthyroid patients, fT4 levels were associated with an increased risk for the composite endpoint and HF (adjHR: 1.46, 95% CI: 1.04-2.05; adjHR: 1.70, 95% CI: 1.08-2.66, respectively, for the highest quintile vs the middle quintile). Results remained similar following multivariable adjustment and remained significant for HF in sensitivity analyses. No association between subclinical thyroid dysfunction and total mortality or AF-progression was found. Subclinical hypothyroidism was not associated with increased CV risk in AF patients. Higher levels of fT4 with normal TSH were associated with a higher risk for HF.

Methodological considerations when discussing the fracture risk of atrial fibrillation patients taking different drug.

Methodological considerations when discussing the fracture risk of atrial fibrillation patients taking different drug.

Molecular mechanisms of left atrial fibrosis development in patients with atrial fibrillation and metabolic syndrome: what biomarkers should be used in clinical practice?

Aim. To determine the blood concentration of fibrosis biomarkers in patients with atrial fibrillation (AF) in combination with metabolic syndrome (MS) and to analyze the relationship with myocardial fibrosis.Material and methods. This cross-sectional case-control study included 547 patients aged 35 to 65 years: experimental group — patients with MS (n=373), of which 202 patients had AF; comparison group — AF patients without MS (n=110); healthy subjects without cardiovascular diseases and metabolic disorders (n=64). Patients with AF and MS who underwent electroanatomic mapping before pulmonary vein isolation (n=79) were assessed for left atrial (LA) fibrosis severity.Results. It was found that the blood concentration of circulating profibrogenic biomarkers in patients with AF and MS is higher than in patients with AF without MS: aldosterone (135,1 (80,7-224,1) and 90,1 (68,3-120,3) pg/ml, p&lt;0,0001), galectin-3 (10,6 (4,8-15,4) and 5,8 (4,8-8,3) pg/ml, p=0,0001), GDF15 (938,3 (678,3-1352,1) and 671,0 (515,7-879,5) pg/ml, p=0,001), TGF-beta-1 (4421,1 (2513,5-7634,5) and 2630,5 (2020,7-3785,4) pg/ml, p=0,001), CTGF (167,8 (78,9-194,3) and 124,3 (74,4-181,9) pg/ml, p&lt;0,0001), PIIINP (88,5 (58,6120,4) and 58,9 (40,7-86,1) ng/ml, p&lt;0,0001), PINP (3421,4 (1808,1-4321,7) and 2996,1 (2283,8-3894,3) pg/ml, p&lt;0,0001). Patients with paroxysmal AF have higher concentrations of TGF-beta1, CTGF and PINP than patients with persistent and permanent AF. In patients with persistent AF and MS, the concentrations of galectin-3, aldosterone, and PIIINP were higher than in patients with paroxysmal AF, while in patients with permanent AF, they were significantly lower. The plasma concentration of galectin-3 positively correlated with levels of PINP (p=0,465, p&lt;0,0001), PIIINP (p=0,409, p&lt;0,0001), GDF-15 (p=0,369, p&lt;O,O001), CTGF (p=0,405, p&lt;0,0001). According to multivariate regression, of all studied biomarkers, GDF-15 had a greater effect on PIIINP concentration (в=0,234, p=0,038), and galectin-3 — on PINP (в=0,248, p&lt;0,021). Positive correlations of the severity of left atrial fibrosis with the concentration of galectin-3 (p=0,563, p&lt;0,0001), PINP (p=0,620, p&lt;0,0001), TGF-beta-1 (p=0,390, p&lt;0,0001) and CTGF (p=0,551, p&lt;0,0001). According to linear multivariate regression, the most significant effect on LA fibrosis severity among the studied biomarkers is exerted by galectin-3 (в=0,432, p&lt;0,0001), PINP (в=0,343, p=0,001) and PIIINP (в=0,286, p=0,008).Conclusion. An increase in the blood concentration of profibrogenic biomarkers galectin-3, TGF-beta-1, CTGF, PIIINP, and PINP is associated with an increase in LA fibrosis severity and probably has a pathogenetic role in increasing the AF risk in patients with MS.

Predicting the Risk of Ischemic Stroke in Patients Treated with Novel Oral Anticoagulants: A Machine Learning Approach

Introduction: The aim of this cohort study was to estimate the predictors of ischemic stroke in patients treated with non-vitamin K antagonist oral anticoagulants (NOACs) in a large database containing data from general practitioners in Germany using machine learning methods. Methods: This retrospective cohort study included 39,652 patients with a diagnosis of atrial fibrillation (AF) and an initial prescription of NOAC in 1,278 general practices in Germany between January 2011 and December 2018. Of 39,652 patients, 2,310 (5.8%) receive the first stroke or TIA diagnosis during the follow-up time (average follow-up time 2.5 [SD: 1.8] years). Sub-Population Optimization and Modeling Solutions (SOMS) tool was used to identify subgroups at a higher risk of stroke compared to the overall population receiving NOAC based on 37 different variables. Results: Using SOMS, a total of 9 variables were considered important for the stroke prediction. Age had 59.1% of prediction importance, following by ischemic heart diseases (10.6%), urinary tract infections (4.6%), dementia (3.5%), and male sex (3.5%). Further variables with less importance were dizziness (2.2%), dorsalgia (1.5%), shoulder lesions (1.1%), and diabetes mellitus (1.1%). Discussion/Conclusions: The stroke risk in AF patients treated with NOAC could be predicted based on comorbidities like ischemic heart diseases, urinary tract infections, and dementia additionally to age and male sex. Knowing and addressing these factors may help reduce the risk of stroke in this patient population.

Presence of Left Atrial Fibrosis May Contribute to Aberrant Hemodynamics and Increased Risk of Stroke in Atrial Fibrillation Patients.

Atrial fibrillation (AF) patients are at high risk of stroke, with the left atrial appendage (LAA) found to be the most common site of clot formation. Presence of left atrial (LA) fibrosis has also been associated with higher stroke risk. However, the mechanisms for increased stroke risk in patients with atrial fibrotic remodeling are poorly understood. We sought to explore these mechanisms using fluid dynamic analysis and to test the hypothesis that the presence of LA fibrosis leads to aberrant hemodynamics in the LA, contributing to increased stroke risk in AF patients. We retrospectively collected late-gadolinium-enhanced MRI (LGE-MRI) images of eight AF patients (four persistent and four paroxysmal) and reconstructed their 3D LA surfaces. Personalized computational fluid dynamic simulations were performed, and hemodynamics at the LA wall were quantified by wall shear stress (WSS, friction of blood), oscillatory shear index (OSI, temporal directional change of WSS), endothelial cell activation potential (ECAP, ratio of OSI and WSS), and relative residence time (RRT, residence time of blood near the LA wall). For each case, these hemodynamic metrics were compared between fibrotic and non-fibrotic portions of the wall. Our results showed that WSS was lower, and OSI, ECAP, and RRT was higher in the fibrotic region as compared to the non-fibrotic region, with ECAP (p = 0.001) and RRT (p = 0.002) having significant differences. Case-wise analysis showed that these differences in hemodynamics were statistically significant for seven cases. Furthermore, patients with higher fibrotic burden were exposed to larger regions of high ECAP, which represents regions of low WSS and high OSI. Consistently, high ECAP in the vicinity of the fibrotic wall suggest that local blood flow was slow and oscillating that represents aberrant hemodynamic conditions, thus enabling prothrombotic conditions for circulating blood. AF patients with high LA fibrotic burden had more prothrombotic regions, providing more sites for potential clot formation, thus increasing their risk of stroke.

Risks of thromboembolism, mortality and bleeding in 2,435,541 atrial fibrillation patients with and without cancer: a nationwide cohort study

Abstract Funding Acknowledgements Type of funding sources: None. Background. Atrial fibrillation (AF) and cancer are frequently coexisting in clinical practice. The impact of cancer on outcomes in AF patients is unclear as well as the performance of HAS-BLED and CHA2DS2-VASc scores. Purpose. To investigate the incidence rate (IR) of all-cause and cardiovascular mortality, ischemic stroke (IS), major bleeding and intracranial haemorrhage (ICH) according to the presence of cancer and cancer types. Methods Observational retrospective cohort study including 2,435,541 AF patients. Results. Overall, 399,344 (16.4%) had cancer, the most common being metastatic, prostatic, colorectal, lung, breast, and bladder (figure). The table shows the IR of bleeding and ischemic outcomes according to the cancer type. During 2 years follow-up, the IS was higher with pancreas, uterine and breast cancers. Cancer increased major bleeding (HR 1.27, 95%CI 1.26-1.28) and ICH (HR 1.07, 95%1.05-1.10), which progressively increased by HAS-BLED score, which showed generally good predictivity (c indexes &amp;gt;0.70). The CHA2DS2-VASc score showed slightly lower predictivity in AF cancer patients. Conclusions. Cancer increased all-cause and cardiovascular mortality, major bleeding and ICH risk in AF patients. The association between cancer and IS differed among cancer types. All-cause deathCardiovascular deathISMajor bleedingICHNo Cancer10.8 (10.8-10.8)3.8 (3.8-3.8)2.4 (2.3-2.4)5.0 (5.0-5.1)1.2 (1.1-1.2)Cancer27.0 (26.8-27.1)4.4 (4.4-4.5)2.3 (2.2-2.3)8.4 (8.3-8.5)1.3 (1.3-1.4)Breast20.4 (20.1-20.8)4.2 (4.1-4.4)2.6 (2.5-2.8)5.5 (5.3-5.7)1.3 (1.2-1.4)Ovarian40.4 (38.7-42.2)3.8 (3.3-4.4)2.2 (1.8-2.6)8.6 (7.8-9.5)0.9 (0.7-1.2)Uterine27.0 (26.0-28.1)4.2 (3.8-4.7)2.6 (2.3-2.9)9.0 (8.4-9.6)1.1 (0.9-1.3)Prostatic20.4 (20.1-20.7)4.2 (4.1-4.3)2.2 (2.1-2.3)9.1 (8.9-9.3)1.4 (1.3-1.5)Renal24.2 (23.5-24.9)4.1 (3.8-4.4)2.1 (1.9-2.3)9.6 (9.1-10.1)1.5 (1.3-1.7)Bladder23.7 (23.3-24.1)3.9 (3.7-4.1)2.2 (2.1-2.4)11.7 (11.4-12.0)1.2 (1.1-1.3)Gastric41.2 (40.0-42.5)3.6 (3.3-4.0)2.2 (1.9-2.5)11.0 (10.3-11.7)0.9 (0.7-1.1)Colorectal22.5 (22.2-22.8)3.2 (3.1-3.4)2.1 (2.0-2.2)8.4 (8.2-8.6)1.1 (1.0-1.2)Liver59.8 (58.2-61.4)5.9 (5.4-6.5)1.9 (1.7-2.3)12.7 (11.9-13.5)1.5 (1.2-1.7)Pancreas72.4 (70.4-74.5)5.7 (5.2-6.3)2.8 (2.4-3.3)11.7 (10.9-12.6)1.4 (1.2-1.7)Lung60.7 (60.0-61.4)5.6 (5.4-5.9)1.9 (1.8-2.0)8.2 (7.9-8.5)1.0 (0.9-1.1)Leukaemia38.1 (37.3-38.9)6.1 (5.8-6.4)2.0 (1.8-2.2)12.4 (11.9-12.9)1.9 (1.7-2.1)Myeloma33.3 (32.4-34.1)5.1 (4.8-5.5)2.0 (1.8-2.2)11.6 (11.1-12.2)1.5 (1.4-1.7)Metastatic66.9 (66.3-67.4)6.0 (5.8-6.2)2.2 (2.1-2.3)10.4 (10.2-10.6)1.3 (1.2-1.4)Abstract Figure 1

Association of Type of Antidepressant Initiation with Bleeding Risk in Atrial Fibrillation Patients Taking Oral Anticoagulants.

BackgroundInconsistent evidence suggests that use of certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), in patients using oral anticoagulants (OACs) might be associated with an elevated risk of bleeding.ObjectiveThis study aims to investigate the risk of bleeding associated with initiation of different types of antidepressants among atrial fibrillation (AF) patients on OAC therapy.Patients and methodsA total of 30,336 AF patients (mean age 72.2 years; 54% female) on OAC therapy that started antidepressant treatment were identified from the Truven Health Analytics MarketScan Commercial and Medicare Databases for the period 2007–2015. Exposure was defined as filling a prescription for antidepressant, and categorized as SSRI, serotonin/norepinephrine reuptake inhibitors (SNRIs), serotonin reuptake inhibitors (SRIs), tricyclic antidepressants (TCAs), or other antidepressants. The primary outcome was incident hospitalized bleeding. Associations of antidepressant type with bleeding were assessed calculating hazard ratios (HRs) and 95% confidence intervals (CIs) with adjusted Cox models in pairwise propensity score-matched cohorts.ResultsDuring a mean follow-up of 21 months, we identified 1612 bleeding episodes. In pairwise comparisons, SSRI use was associated with an increased risk of bleeding when compared to most other antidepressants (HR 1.22, 95% CI 0.96–1.54 vs SNRI; HR 1.10, 95% CI 0.90–1.35 vs SRI; HR 1.03, 95% CI 0.82–1.30 vs TCA). SNRI use was associated with the lowest bleeding risk. Results did not differ by OAC type, age, and sex.ConclusionsAmong AF patients on OAC initiating antidepressants, risk of bleeding varied across antidepressant type. This information can inform treatment choices among patients receiving OAC.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-021-00258-3.

Subject-Specific Calculation of Left Atrial Appendage Blood-Borne Particle Residence Time Distribution in Atrial Fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia that leads to thrombus formation, mostly in the left atrial appendage (LAA). The current standard of stratifying stroke risk, based on the CHA2DS2-VASc score, does not consider LAA morphology, and the clinically accepted LAA morphology-based classification is highly subjective. The aim of this study was to determine whether LAA blood-borne particle residence time distribution and the proposed quantitative index of LAA 3D geometry can add independent information to the CHA2DS2-VASc score. Data were collected from 16 AF subjects. Subject-specific measurements included left atrial (LA) and LAA 3D geometry obtained by cardiac computed tomography, cardiac output, and heart rate. We quantified 3D LAA appearance in terms of a novel LAA appearance complexity index (LAA-ACI). We employed computational fluid dynamics analysis and a systems-based approach to quantify residence time distribution and associated calculated variable (LAA mean residence time, tm) in each subject. The LAA-ACI captured the subject-specific LAA 3D geometry in terms of a single number. LAA tm varied significantly within a given LAA morphology as defined by the current subjective method and it was not simply a reflection of LAA geometry/appearance. In addition, LAA-ACI and LAA tm varied significantly for a given CHA2DS2-VASc score, indicating that these two indices of stasis are not simply a reflection of the subjects' clinical status. We conclude that LAA-ACI and LAA tm add independent information to the CHA2DS2-VASc score about stasis risk and thereby can potentially enhance its ability to stratify stroke risk in AF patients.

The impact of weight loss related to risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium\u2013glucose cotransporter 2 inhibitor

BackgroundSodium–glucose cotransporter 2 inhibitor (SGLT2i) use reduces body weight (BW) in patients with type 2 diabetes mellitus (T2DM). Obesity and T2DM are strong risk factors of new-onset atrial fibrillation (AF). However, whether BW loss following SGLT2i treatment reduces AF risk in patients with T2DM remains unclear.MethodsWe used a medical database from a multicenter health care provider in Taiwan, which included 10,237 patients with T2DM, from June 1, 2016 to December 31, 2018, whose BW data at baseline and at 12 weeks of SGLT2i treatment were available. Patients were followed up from the drug index date until the occurrence of new-onset AF, discontinuation of the SGLT2i, or the end of the study period, whichever occurred first.ResultsThe patients’ baseline body mass index (BMI) was 28.08 pm 4.88 kg/m2. SGLT2i treatment was associated with a BW loss of 1.35 pm 3.28 kg (1.78%pm 4.47%). There were 37.4%, 47.0%, and 15.6% of patients experienced no-BW loss (n = 3832), BW loss 0.0–4.9% (n = 4814), and ge 5.0% (n = 1591) following SGLT2i treatment, respectively. Compared with patients with baseline BMI < 23 kg/m2, AF risk significantly increased in patients with baseline BMI ge 27.5 kg/m2 (P for trend = 0.015). Compared with those without BW loss after SGLT2i treatment, AF risk significantly decreased with a BW loss of ge 5.0% (adjusted hazard ratios [95% confidence intervals]: 0.39[0.22–0.68]). Use of diuretics, old age, high-dose SGLT2i, higher estimated glomerular filtration rate, and baseline BMI were independent factors associated with a BW loss of ge 5.0% following SGLT2i initiation. By contrast, neither baseline BMI nor BW loss after SGLT2i treatment predicted major cardiovascular adverse events or heart failure hospitalization risk (P for trend > 0.05).ConclusionBW loss of ≥ 5.0% following SGLT2i treatment was associated with a lower risk of new-onset AF in patients with T2DM in real-world practice.

Novel model-based point scoring system for predicting stroke risk in atrial fibrillation patients: Results from a nationwide cohort study with validation.

The stroke risk scoring system for atrial fibrillation (AF) patients can vary considerably based on patients' status while receiving ablation. This study aimed to demonstrate a novel scoring system for stroke risk stratification based on the status of catheter ablation. First, 787 patients with AF undergoing ablation were matched according to age, sex, and underlying diseases with the same number of patients not undergoing ablation using the propensity-score (PS)-matched cohort. Multivariate Cox model-derived coefficients were used to construct a simple point-based clinical model using the PS-matched cohort. Thereafter, the novel model (AF-CA-Stroke score) was validated in a nationwide AF cohort. The AF-CA-Stroke score was calculated based on age (point=5), ablation status (point=4), prior history of stroke (point=4), chronic kidney disease (point=2),diabetes mellitus (point=1), and congestive heart failure (point=1). Risk function to predict the 1-, 5-, 10-year absolute stroke risks was reported. The estimated area under the receive operating characteristic curve of the AF-CA-Stroke score in the PS-matched cohort was 0.845 (95% confidence interval: 0.824-0.865) to predict long-term stroke. A validation study showed that discrimination abilities in the AF-CA-Stroke scores were significantly higher than those in the CHADS2/CHA2DS2-VASc scores. The best cut-off value of the AF-CA-Stroke score to predict future strokes was≥5. This novel model-based point scoring system effectively identifies stroke risk using clinical factors and AF ablation status of patients with AF. Various age stratifications and AF ablation should be considered in AF management.

Evaluation of atrial fibrillation risk in patients with vasovagal syncope.

This study aimed to determine whether autonomic dysfunction in patients with vasovagal syncope with a positive tilt test may cause an alteration in atrial electromechanical properties and pose a risk for subsequent atrial arrhythmias, especially atrial fibrillation. The data of 27 patients with vasovagal syncope and a matched control group comprising 28 healthy individuals were compared. All patients underwent a tilt table test. Atrial electromechanical intervals (PA) were measured from the mitral lateral annulus, mitral septal annulus, and tricuspid annulus with tissue Doppler imaging. Left atrium volumes were measured with the disc method in apical four-chamber imaging. Although atrial electromechanical intervals such as lateral PA, septal PA, and tricuspid PA durations were significantly longer (p = 0.009, p = 0.002, p = 0.011, respectively), interatrial, right intra-atrial, and left intra-atrial durations were similar in the vasovagal syncope group and the control group (p = 0.298, p = 0.388, p = 0.069, respectively). Left atrial volumes (maximum, minimum, and presystolic) were significantly increased in the vasovagal syncope group when compared with the control group (p = 0.001, p = 0.001, p = 0.007, respectively). There was no difference between vasovagal syncope types in terms of atrial electromechanical intervals. Interatrial and intra-atrial intervals were similar in the vasovagal syncope group and the control group. However, an increase in atrial volumes and a prolongation of certain atrial electromechanical intervals were observed in patients with vasovagal syncope. These findings suggest an alteration in atrial electromechanics caused by autonomic dysfunction that can lead to subsequent atrial arrhythmias, especially atrial fibrillation.

Anticoagulant treatment in patients with non-valvular atrial fibrillation and chronic anemia: still a grey area

Anemia has been associated with a higher risk of major bleeding among atrial fibrillation patients on oral anticoagulation and is therefore included in most bleeding risk scores. In contrast, much less evidence exists regarding the association between anemia and stroke risk in atrial fibrillation patients. The purpose of this review was to re-evaluate the efficacy and safety of anticoagulant treatment, in particular of new oral anticoagulants, in patients with non-valvular atrial fibrillation and chronic anemia. Five observational studies were found in the literature that specifically investigated this issue; the results can be synthetized as follows: (i) the progressive decrease in hemoglobin level was associated with an increased incidence of major hemorrhages, already evident in mild anemia and very high in more severe anemia (hemoglobin level <~10 g/dl), up to >10% per year. In contrast, the association between anemia and stroke risk appears to be weak; (ii) warfarin seems to be effective in stroke prevention in patients with mild anemia, with a moderate increase in major hemorrhages, whereas it seems to be ineffective and associated with a high incidence of hemorrhagic complications in patients with more severe anemia; (iii) new oral anticoagulants, in particular apixaban, seem to induce a lower incidence of major hemorrhages in comparison with warfarin in patients with both mild and severe anemia. However, when hemoglobin level is <~10 g/dl, the incidence of major hemorrhages remains high, also in patients treated with the new anticoagulants. These data suggest that in patients with atrial fibrillation and mild anemia, anticoagulant treatment appears to be effective, but requires close monitoring during follow-up, whereas in patients with more severe anemia the choice of whether or not to prescribe an anticoagulant treatment should be made on a case by case basis, considering the thromboembolic risk, the etiology of chronic anemia and the history and general condition of the patient. New oral anticoagulants should be preferred to warfarin.

ПРОВЕРКА АССОЦИАЦИИ ПЯТИ ОНП С НЕКЛАПАННОЙ ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ У БОЛЬНЫХ ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ

Вackground. It is known that 5–21% of patients with acute coronary syndrome (ACS) develop atrial fibrillation (AF), which entails an increased risk of recurrence of myocardial infarction, heart failure, and increased mortality. The genetic predisposition to AF has been actively studied in recent years, but the data on the association of certain single nucleotide polymorphisms (SNPs) in the development of AF are contradictory, which determines the relevance of this study. Purpose of the study. To study five SNPs for associations with the development of non-valvular atrial fibrillation in patients with acute coronary syndrome Patient Characterization and Research Methods. The study included female and male patients not younger than 18 years old with ACS and AF (n = 133) and ACS without AF (n = 133) ACS was diagnosed according to the criteria of the European Society of Cardiology (2015; 2017). The study was approved by the Ethics Committee (Minutes No. 102 dated November 24, 2017). The observation period was 12 months. In addition to the standard examination, all patients underwent a SNP study: rs6795970 (Scn10a), rs2200733 (4th stage), rs11556924 (ZC3HC1), rs599839 (PSRC1), rs10824026 (10th stage). Statistical analysis was performed using Statistica 12.1 StatSoft. Results. The results of the rs599839 study showed that the GG genotype was significantly less common in the ACS + AF group compared to the ACS group without AF (OR 0.11 CI 95% 0.01; 0.86 p = 0.0163). A reliable connection was lost when divided by sex and by age (older and younger than 55). Allele G rs599839 significantly correlates with AF (p = 0.0043; OR 1.56). The T allele rs11556924 is highly reliably associated with a predisposition to atrial fibrillation (p = 0.0043; OR 1.93). Genotype GG rs10824026 is conditionally protective in terms of the risk of AF in patients with ACS. For rs6795970 (p = 0.290) and rs2200733 (p = 0.30), there were no statistically significant differences between the study groups. Conclusion. The study verified the association of rs6795970 (Scn10a), rs2200733, rs11556924, rs599839, rs10824026 with AF associated with ACS. The genotypes GG rs599839 and GG rs10824026 were found to be conditionally protective in relation to the risk of AF in patients with ACS.

Thromboembolism, mortality, and bleeding in 2,435,541 atrial fibrillation patients with and without cancer: A nationwide cohort study.

The number of patients with atrial fibrillation (AF) and cancer is rapidly increasing in clinical practice. The impact of cancer on clinical outcomes in this patient population is unclear, as is the performance of the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol) and CHA2 DS2 -VASc (Congestive Heart Failure, Hypertension, Age ≥ 75 years, Diabetes Mellitus, Stroke or Transient Ischemic Attack, Vascular Disease, Age 65 to 74 Years, Sex Category) scores. This was an observational, retrospective cohort study including 2,435,541 adults hospitalized with AF. The authors investigated the incidence rates (IRs) of all-cause and cardiovascular mortality, ischemic stroke, major bleeding, and intracranial hemorrhage (ICH) according to the presence of cancer and cancer types. Overall, 399,344 (16.4%) had cancer, with the most common cancers being metastatic, prostatic, colorectal, lung, breast, and bladder. During a mean follow-up of 2.0 years, cancer increased all-cause mortality (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.99-2.01). The IR of ischemic stroke was higher with pancreatic cancer (2.8%/y), uterine cancer (2.6%/y), and breast cancer (2.6%/y), whereas it was lower with liver/lung cancer (1.9%/y) and leukemia/myeloma (2.0%/y), in comparison with noncancer patients (2.4%/y). Cancer increased the risk of major bleeding (HR, 1.27; 95% CI, 1.26-1.28) and ICH (HR, 1.07; 95% CI, 1.05-1.10). Leukemia, liver cancer, myeloma, and metastatic cancers showed the highest IRs for major bleeding/ICH. Major bleeding and ICH rates progressively increased with the HAS-BLED score, which showed generally good predictivity with C indexes > 0.70 for all cancer types. The CHA2 DS2 -VASc score's predictivity was slightly lower in AF patients with cancer. Cancer increased all-cause mortality, major bleeding, and ICH risk in AF patients. The association between cancer and ischemic stroke differed among cancer types, and in some types, the risk of bleeding seemed to exceed the thromboembolic risk.

A predictive nomogram of bleeding risk in patients with atrial fibrillation after drug-eluting stent implantation.

BackgroundThe use of anticoagulants and antiplatelet therapies is associated with a higher risk of bleeding in atrial fibrillation (AF) patients after percutaneous coronary intervention, especially after stent implantation. However, no accurate bleeding risk prediction tool has been developed for these patients. The aim of this study was thus to establish a bleeding risk prediction model (predictive nomogram) for patients with AF after stent implantation.MethodsConstruction of the predictive nomogram was based on a retrospective study, which enrolled 943 AF patients who underwent drug-eluting stent implantation between May 2012 and September 2016. A range of factors, including demographics, comorbidities, medication strategies, arterial access, and laboratory tests, were collected as baseline data. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis were used to identify the key clinical features for construction of the predictive nomogram. The concordance index (C-index) and internal validation were used to evaluate the efficacy of the nomogram.ResultsOf the 943 AF patients that underwent stent implantation, the occurrence of bleeding events was 8.2% (77 out of 943). Key predictors included the number of antiplatelet drugs, peptic ulcer, cerebral infarction, type 2 diabetes, thrombocytopenia, anemia, prior myocardial infarction, sex (male), use of anticoagulant drugs, liver dysfunction, hypertension, and acute myocardial infarction. These predictors were used to construct the nomogram. The C-index for the prediction of bleeding risk by the nomogram was 0.841 (95% CI: 0.79–0.89), which indicated good discrimination and calibration. The C-index of internal validation was 0.795, which demonstrated good efficacy of the model.ConclusionsThis study suggests that our novel nomogram can accurately predict bleeding risk in AF patients after stent implantation during hospitalization, thereby helping to avoid complications. The nomogram may also be helpful for the creation of individualized post-discharge medication strategies.

The association of fracture risk in atrial fibrillation patients and long-term anticoagulant therapy category: a systematic review and meta-analysis.

ObjectiveOur study aimed to assess the risk of all fractures and hip fractures in patients with atrial fibrillation (AF) who took non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin.MethodsWe searched PubMed, Embase, and Cochrane Library and Clinical Trials.gov Website. Reviewed related researches up to January 31, 2020, to identify studies with more than 12 months of follow-up data. The protocol for this systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO Number: CRD42020156893).ResultsWe included five RCT studies, and five observational studies that contained a total of 326,846 patients in our meta-analysis. Our meta-analysis showed that patients taken NOACs had no significant all fracture risk (RR = 0.91, 95% CI [0.81–1.01]) and hip fracture risk (RR = 0.92, 95% CI [0.82–1.03]) compared with those taken warfarin. Subanalysis showed that the risk of all fractures and hip fractures treated by NOACs were significant lower compared with warfarin in observational studies compared with RCT studies. Also, a subanalysis across the duration of anticoagulation showed the NOACs users have lower all fracture risk than warfarin users when the duration of anticoagulation ≤2 years (RR = 0.89, 95% CI [0.80–0.99]). Further analysis, significant lower all fracture risk in the rivaroxaban therapy (RR = 0.81; 95% CI [0.76–0.86]) compared with warfarin but no statistical significance in hip fracture. There were no significant difference of all fracture risk and hip fracture risk in dabigatran, apixaban, and edoxaban therapy compared with warfarin.ConclusionThe meta-analysis demonstrated that NOACs associated with a significantly lower all fracture risk compared with warfarin when the duration of anticoagulation more than 2 years. Rivaroxaban users had lower risk of all fracture than warfarin users in AF patients. But there was no evidence to verify apixaban, edoxaban, and dabigatranin could decrease all fracture and hip fracture risk compared with warfarin.