Combination Of Atrial Fibrillation Research Articles

FC 069CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION: A DANGEROUS COMBINATION

Abstract Background and Aims Chronic kidney disease (CKD) and atrial fibrillation (AF) are both risk factors for bleeding, stroke and mortality. Whether the combination of CKD and AF leads to higher risks of bleeding, stroke and mortality than CKD or AF alone is not known. The aim of our study was to investigate the interaction between CKD and AF and outcomes. Method We included 12,394 subjects referred to the University Medical Center Utrecht (the Netherlands) from September 1996 to February 2018f for an out-patient visit with classical risk factors for arterial disease or with symptomatic arterial disease (Utrecht Cardiovascular Cohort Second Manifestation of Arterial disease (UCC-SMART) cohort). Hazard ratios (HRs) with 95% confidence intervals (CIs) for bleeding, ischemic stroke or mortality were calculated with Cox proportional hazards analyses. Presence of additive interaction between AF and CKD was examined by calculating the relative excess risk due to interaction (RERI), the attributable proportion (AP) due to interaction and the synergy index (S). Results Of the 12,394 patients, 699 patients had AF, 2,752 patients had CKD and 325 patients had both AF and CKD. Overall, 382 patients developed a first bleeding event, 421 patients had a first ischemic stroke and 2203 patients died. Patients with both CKD and AF had a 3.0-fold (95% CI 2.0-4.4) increased risk for bleeding, a 4.2-fold (95% CI 3.0-6.0) increased ischemic stroke risk and a 2.2-fold (95% CI 1.9-2.6) increased mortality risk after adjustment as compared with subjects without AF and CKD (Table 1). Although bleeding and mortality risks were highest for the combination of AF and CKD, we did not find interaction between AF and CKD. However, we found an interaction between AF and CKD for ischemic stroke risk (RERI 1.88 (95% CI 0.31-3.46), AP 0.45 (95% CI 0.17-0.72) and S 2.40 (95% CI 1.08-5.32)) (Table 1). Conclusion The combination of CKD and AF is associated with high risks for bleeding, ischemic stroke and mortality. There is a positive interaction between AF and CKD for ischemic stroke risk, but not for bleeding or mortality.

Effect of Left Atrial Appendage Closure in Combination With Catheter Ablation on Left Atrial Function for Persistent Atrial Fibrillation.

Background: A single procedure combining left atrial appendage closure (LAAC) plus catheter ablation (CA) has been proven to be safe and feasible for treating atrial fibrillation (AF). However, the influence of treatment modality on left atrial (LA) function is not thoroughly explained.Objective: We aimed to investigate the changes of LA function in persistent AF patients undergoing concomitant LAAC and CA.Methods: The study population comprised 65 patients who underwent combined AF ablation and Watchman LAAC (combined therapy group) in our center, and 65 participants of the AF simple ablation group who were matched based on sex, age, CHA2DS2-VASc score and HAS-BLED score using propensity score matching. During the 1-year follow-up period, two-dimensional echocardiography and speckle tracking echocardiography were performed to assess LA reservoir, conduit, and contractile function.Results: The combined therapy was associated with a significant improvement in the LA reservoir function with increased expansion index and strain indices, including strain and strain rate (SR) during ventricular systole. Conduit function with SR during early ventricular diastole was also improved, as was contractile function with active atrial emptying fraction and SR during atrial systole. Similarly, LA reservoir and contractile function indices all improved continuously during follow-up after catheter ablation alone. At 3 months follow-up LA reservoir and conduit function with strain indices had a tendency to improve only in the simple procedure group. At 1-year follow-up there was no significant difference in either LA volumes or strain indices between the two groups.Conclusion: Both the combined therapy group and the simple ablation group demonstrated significant improvement in LA function. Based upon the fact that LA function was improved in both groups it might be concluded that most of the effects appeared to result from ablation, not LAAC; furthermore the additional LAAC procedure did not affect the improvement of LA function after CA.

Additional diagnostic criteria for atrial cardiomyopathy in patients with lone atrial fibrillation

Aim . To determine additional diagnostic criteria for class I atrial cardiomyopathy (ACM) in patients with lone atrial fibrillation (AF). Material and methods . This cross sectional non-randomized clinical study included 170 stable patients <60 years of age, of which 99 patients were selected. The inclusion criteria in the first group were the presence of lone AF with increased left atrial (LAVI) or right atrial volume index according to echocardiography without cardiovascular and pulmonary diseases, hypertension, and diagnostic criteria for heart failure (HF). The inclusion criterion in the second group was combination of AF and HF. The inclusion criterion in the third group was diagnostic criteria for HF (N-terminal pro-brain natriuretic peptide >125 ng/ml) in patients with sinus rhythm. In all patients, the concentration of NT-proBNP, a soluble stimulating growth factor 2 (sST2), as well as creatinine and cystatin C with calculation of the glomerular filtration rate, tissue inhibitor of matrix metalloproteinases-1 (TIMP1), and neutrophil gelatinase associated lipocalin (NGAL) was determined. Non-invasive angiography was performed. Results . According to ROC analysis, NT-proBNP, TIMP-1, NGAL as markers of class I ACM in patients with lone AF, showed unsatisfactory clinical significance. In patients with ACM and AF, regardless of the presence/ absence of HF, direct moderate relationship between sST2 and LAVI (r=0,470, p=0,012) and direct strong correlation between sST2 and NT-proBNP (r=0,726, p=0,004). Using ROC curve, for all available sST2 values, its diagnostic significance was obtained in the range from 5 to 16 ng/ml (AUC=0,98). Conclusion . The blood concentration of sST2 in the range from 5 to 16 ng/ml can be considered as an additional diagnostic criterion for class I ACM in patients with lone AF with a sensitivity of 98% and a specificity of 80%.

Quantification of fibroblast growth factor 23 and N-terminal pro-B-type natriuretic peptide to identify patients with atrial fibrillation using a high-throughput platform: A validation study.

Large-scale screening for atrial fibrillation (AF) requires reliable methods to identify at-risk populations. Using an experimental semi-quantitative biomarker assay, B-type natriuretic peptide (BNP) and fibroblast growth factor 23 (FGF23) were recently identified as the most suitable biomarkers for detecting AF in combination with simple morphometric parameters (age, sex, and body mass index [BMI]). In this study, we validated the AF model using standardised, high-throughput, high-sensitivity biomarker assays. For this study, 1,625 consecutive patients with either (1) diagnosed AF or (2) sinus rhythm with CHA2DS2-VASc score of 2 or more were recruited from a large teaching hospital in Birmingham, West Midlands, UK, between September 2014 and February 2018. Seven-day ambulatory ECG monitoring excluded silent AF. Patients with tachyarrhythmias apart from AF and incomplete cases were excluded. AF was diagnosed according to current clinical guidelines and confirmed by ECG. We developed a high-throughput, high-sensitivity assay for FGF23, quantified plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and FGF23, and compared results to the previously used multibiomarker research assay. Data were fitted to the previously derived model, adjusting for differences in measurement platforms and known confounders (heart failure and chronic kidney disease). In 1,084 patients (46% with AF; median [Q1, Q3] age 70 [60, 78] years, median [Q1, Q3] BMI 28.8 [25.1, 32.8] kg/m2, 59% males), patients with AF had higher concentrations of NT-proBNP (median [Q1, Q3] per 100 pg/ml: with AF 12.00 [4.19, 30.15], without AF 4.25 [1.17, 15.70]; p < 0.001) and FGF23 (median [Q1, Q3] per 100 pg/ml: with AF 1.93 [1.30, 4.16], without AF 1.55 [1.04, 2.62]; p < 0.001). Univariate associations remained after adjusting for heart failure and estimated glomerular filtration rate, known confounders of NT-proBNP and FGF23. The fitted model yielded a C-statistic of 0.688 (95% CI 0.656, 0.719), almost identical to that of the derived model (C-statistic 0.691; 95% CI 0.638, 0.744). The key limitation is that this validation was performed in a cohort that is very similar demographically to the one used in model development, calling for further external validation. Age, sex, and BMI combined with elevated NT-proBNP and elevated FGF23, quantified on a high-throughput platform, reliably identify patients with AF. Registry IRAS ID 97753 Health Research Authority (HRA), United Kingdom.

Features of genetic manifestations in patients with abdominal obesity during atrial fibrillation in combination with arterial hypertension

To study the significance of the rs1378942 polymorphisms of the CSK gene and rs2200733 (chromosome 4q25) in the progression of AF in men with AH and AO. In an observational cohort study, 116 men aged 4565 years were followed. Of these, 57 patients with AF, AH and AO and a control group including 59 patients with AF, AH and without AO. Testing of polymorphism rs1378942 of the CSK gene and rs2200733 of chromosome 4q25 using polymerase chain reaction with restriction fragment length polymorphism. All statistical calculations were performed using the Rstudio program (version 0.99.879 20092016 RStudio, Inc., USA). The average age of all studied patients was 53.37.1 years. When dividing patients with AF and AH into groups based on the presence/absence of AO, it turned out that in the subgroups of carriers of different genotypes of the rs1378942 polymorphism of the CSK gene there are significant differences in BMI: in the group with BMI, there is an increase in the indicator in the series of CC, AC, AA genotypes. The highest BMI value in carriers of the CC genotype (p0.03) was in the group with AO. In the subgroups of carriers of different rs2200733 genotypes of chromosome 4q25, CC has the highest BMI (p0.05). It was proved that in the group with AO, the progression of AF occurred 2.57 times more often than in the group without AO (p0.003). In men with AF and AH, single nucleotide polymorphisms rs1378942 of the CSK gene and rs2200733 of chromosome 4q25 are associated with BMI. The heterozygous genotype AC rs1378942 in the CSK gene is significantly more common in patients, regardless of the presence of AO. In the group with AO, the progression of AF occurred 2.57 times more often than in the group without AO.

Quality of life among people with atrial fibrillation with and without diabetes: a comparison study.

Quality of life (QoL) is an essential consideration when managing the wellbeing of patients and assists in interpretation of symptoms, functional status and perceptions. Atrial fibrillation (AF) and diabetes demand significant healthcare resources. Existing data demonstrate a negative impact on QoL as individual conditions, but there is less evidence relating to the impact of these disease groups in combination. This study therefore explores QoL in patients with AF and diabetes. This cross-sectional, observational study required participants to complete the short form (SF)-36 survey via an online platform and was offered to people affected by AF alone and people with AF and diabetes in combination. The SF-36 provides a prevalidated tool with eight domains relating to physical and psychological health. A total of 306 surveys were completed (231 AF group, 75 AF and diabetes group).The mean and standard deviation (SD)were calculated for each QoL domain,after re-coding in accordance with SF-36 guidance. Multi-variate analysis of variance (MANOVA) demonstrated an overall significant difference between the groups when considered jointly across all domains.There were significant differences between AF and AF with diabetes QoL responses in physical functioning, energy fatigue,emotional wellbeing, social functioning and pain. In these domains, the mean was highest in the AF group. There were no significant differences in the role physical,role emotional and general health domains. In conclusion, this study demonstrates that diabetes and AF has a more detrimental effect on QoL than AF alone, in the majority of domains. Further research into the general AF population and where chronic conditions co-exist is important to comprehend the true impact this disease combination has on QoL.

Abstract 13613: Combination of Atrial Fibrillation and Frailty: Association With All-cause Mortality in Older Veterans

Background: Atrial fibrillation (AF), the commonest arrhythmia among older adults, is associated with increased mortality. Frailty constitutes a state of vulnerability to stressors resulting from multisystemic loss of physiological reserve. The study aim was to determine whether concurrent frailty and AF increases all-cause mortality in older Veterans. Methods: Retrospective cohort study of community-dwelling Veterans 60 years and older identified as having baseline AF (ICD codes) or frailty through a 30-item VA Frailty Index (VA-FI). The VA-FI was generated as a proportion of morbidity, function, sensory loss, cognition/mood and other variables. The VA-FI categorized Veterans into non-frail (robust FI≤.10, prefrail FI=&gt;.10,&lt;.21) and frail (FI≥.21). The combination resulted in 4 groups: Neither AF nor frailty (NoAF-F), atrial fibrillation (AF), frailty (F), and AF and frailty (AF-F). At the end of follow-up, data on mortality was aggregated and adjusted for age, gender, race, ethnicity, marital status, and BMI, the association of concurrent AF and/or frailty with all-cause mortality was determined using a Cox regression model including testing for interaction effects. Results: A total of 16391 Veterans were included, mean age 72.06 (SD=9.23) years 74.2% White, 86.7% non-Hispanic, and 97.9% male. There were 1534 (9.4%) Veterans with AF and the proportion of robust, pre-frail and frail patients was 44.3% (n=7255), 37.2% (n=6095) and 18.6% (n=3041) respectively. The 4 resulting groups were NoAF-F (12357, 75.4%), AF (993, 6.1%), F (2500, 15.3%) and AF-F (541, 3.3%). Over a median follow-up of 2025 days (IQR=245) 3917 deaths occurred. As compared with NoAF-F, AF-F, F and AF in that order had higher all-cause mortality, adjusted hazard ratio (HR)=3.24 (95%CI:2.88-3.66), p&lt;.0005; HR=2.06 (95%CI:1.90-2.22), p&lt;.0005; and HR=1.47 (95%CI:1.31-1.64), p&lt;.0005 respectively. When frailty and AF were considered jointly they did not interact. Conclusions: The combination of AF and frailty at baseline represents the group with highest risk for all-cause mortality in older Veterans. Further studies may be needed to assess the impact on mortality of clinical interventions targeting both conditions.

Subanalysis of the AUGUSTUS trial

Comorbidity is a common feature of a modern patient. The combination of atrial fibrillation (AF) and various types of coronary artery disease is widespread in actual clinical practice. In such cases, additional pathophysiological mechanisms appear that worsen the clinical course and patient’s prognosis. The management of AF patients who have undergone acute coronary syndrome and/or percutaneous coronary intervention is a challenging problem, which can be solved by large-scale clinical trials. The AUGUSTUS randomized trial with a two-by-two factorial design proved that full-dose apixaban is superior in safety to the vitamin K antagonist warfarin, while not inferior in effectiveness. This pattern has been preserved in several important subanalysis on stent thrombosis, hospitalization rates, and conservative management of acute coronary syndrome. The obtained results are included in the novel European Society of Cardiology guidelines on AF.

Features of remodeling of the right heart in comorbid patients with chronic heart failure

Objective: to identify the features of structural and functional remodeling of the right heart in patients with chronic heart failure (CHF) against the background of a combination of atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD), to assess the effect on the concentration of the heart failure marker NT-proBNP.Materials and methods: the study included 120 patients who were divided in to 4 groups depending on the presence of CHF, AF and COPD. Patients underwent an echocardiographic (EchoCG) study, and the concentration of the N-terminal fragment of the brain natriuretic peptide precursor (NT-proBNP) was determined.Results: comparison of EchoCG parameters of the right heart in patients with CHF of different groups was performed in pairs to determine the effect of diseases on the remodeling of the right atrium (RA) and right ventricle (RV) in comorbid conditions. In patients with CHF, AF and COPD, in comparison with patients with CHF and AF without COPD, lower volume parameters of RA (p=0.004), greater wall thickness of the RV (p&lt;0.001), lower values of the indexed end-diastolic area (EDA) of the RV (p=0.007) and its fractional area measurement (FAM) (p=0.011) were revealed, which allows us to judge the effect of chronic bronchoobstruction on heart remodeling in patients with CHF and AF. When compared with patients with CHF and COPD without AF in patients with CHF, AF and COPD have large size of RV (p=0.012), its indexed end-systolic area (ESA) (p&lt;0.001), lower ejection fraction (EF) of RV (p=0.002), FAM (p&lt;0.001), systolic excursion of the tricuspid valve plane (TAPSE) (p=0.012), indicating the influence of concomitant AF in EchoCG parameters in patients with CHF and COPD. A higher concentration of NT-proBNP was found in patients with CHF, AF and COPD compared to the marker level in both patients with CHF and AF without COPD (p=0.010) and in patients with CHF and COPD without AF (p&lt;0.001), due to more pronounced remodeling of the RV.Conclusions: In patients with CHF, AF and COPD were the features of the remodeling of the right heart, caused by influence of, on the one hand, AF, on the other, with COPD the structural and functional parameters of heart in patients with this combined pathology. Using the extended protocol EchoCG studies identify additional characteristics of structural-functional state of the right heart (ESA and EDA RV, RV EF, TAPSE and FAM) will optimize early diagnosis of CHF and cardiovascular and bronchopulmonary diseases.

Optimal Antithrombotic Treatment of Patients with Atrial Fibrillation Early after an Acute Coronary Syndrome-Triple Therapy, Dual Antithrombotic Therapy with an Anticoagulant… Or, Rather, Temporary Dual Antiplatelet Therapy?

The combination of atrial fibrillation (AF) and acute coronary syndrome (ACS) is a complex situation in which a three-dimensional risk—cardioembolic, coronary, and hemorrhagic—has to be carefully managed. Triple antithrombotic therapy (TAT) is burdened with a high risk of serious bleeding, while dual antithrombotic therapy with an anticoagulant (DAT) likely provides only suboptimal coronary protection early after stent implantation. Moreover, TAT precludes the advantages provided by the use of the latest and more potent P2Y12 inhibitors in ACS patients. Here, we aimed to simulate and compare the expected coronary, cardioembolic, and hemorrhagic outcomes offered by DAT, TAT, or modern dual antiplatelet therapy (DAPT) with aspirin plus one of the latest P2Y12 inhibitors in AF patients early after an ACS. The comparison of numbers needed to treat to prevent major adverse events with the various antithrombotic regimens suggests that AF–ACS patients at high ischemic and hemorrhagic risk and at moderately low embolic risk (CHA2DS2VASc score 2–4) might safely withhold anticoagulation after revascularization for one month taking advantage of a modern DAPT, with a favorable risk-to-benefit ratio. In conclusion, this strategy, not sufficiently addressed in recent European and North American guidelines or consensus documents, adds to the spectrum of treatment options in these difficult patients; it might be the best choice in a substantial number of patients; and should be prospectively tested in a randomized controlled trial.

Staged surgical treatment of patients with combination of non-paroxysmal form of atrial fibrillation and isthmus-dependent atrial flutter

Objective. To improve the results of treatment for the patients with non-paroxysmal atrial fibrillation (AF) in combination with isthmus-dependent (typical) atrial flutter (AFL) by determining the optimal surgical tactics.Material and methods. The research based on the study of treatment results for 37 patients who are consequentially underwent thoracoscopic radiofrequency fragmentation (TRF) of the left atrium (LA) in the period from April 2017 to December 2019. All of the patients suffered from a combination of 2 types of arrhythmias: non-paroxysmal AF and AFL. Depending on history of catheter ablation (CA) of cavotricuspid isthmus (CTI) before TRF, all patients divided into 2 groups: group 1 - there was anamnesis of CA of CTI before TRF (N = 16; 43%); group 2 - there was no CA of CTI before TRF of the LA (N = 21; 57%). In the postoperative period, all patients underwent examination and interviewed regarding cardiac arrhythmias. At the time of April 1, 2020, information about heart rhythm and its disorders during follow-up period was received from 100% of patients. The duration of the follow-up period after TRF was 17 (3; 35) months.Results. There was no supraventricular tachyarrhythmias (SVT) during all follow-up period after TRF among the patients of group 1. There was 8 patients (38%) of group 2 with AFL, which is developed in the period from 1 to 6 months after TRF. All these patients underwent a CA of CTI after the end of a “blanking” period. There was 2 of 8 patients with developing of SVT after CA of CTI. The source of new rhythm disorder was the ablation line formed during TRF on the roof of the LA.Conclusion. In order to achieve long-term freedom from SVT requiring surgical intervention in patients suffering from a non-paroxysmal AF in combination with a typical AFL it is reasonable to perform catheter radiofrequency ablation of CTI at the first stage before TFR of the LA.

Topical issues of dabigatran use in combination antithrombotic therapy in patients with acute coronary syndrome and nonvalvular atrial fibrillation

Atrial fibrillation is the most common heart rhythm disorder. According to various sources, a third of patients with atrial fibrillation also suffer from coronary heart disease. Both acute coronary syndrome and PCI with stable IHD require the prescription of combined antithrombotic therapy, which includes both anticoagulant drugs and disaggregants. A therapeutic dilemma arises: how to balance the extremely high risk of hemorrhagic complications in triple therapy with the risk of ischemic events in dual therapy? Consequently, the combination of atrial fibrillation and ischemic heart disease is not only a complex and widespread problem in terms of the selection of doses and antithrombotic therapy regimes, but is also associated with a significant increase in disability and mortality. Based on data from the PIONEER AF PCI, REDUAL PCI and AUGUSTUS STUDIES, triple therapy should be as short as possible. A tempting alternative seems to be to prescribe dual therapy in 1-7 days after an acute event. According to the ESC recommendations on the treatment of CCS, patients with stable coronary heart disease and atrial fibrillation after CCS are recommended to prescribe three drugs for the period of hospitalization, OAC + Clopidogrel for one year, then only OAC. however, if the risk of stent thrombosis and other ischemic events is high and the risk of bleeding is low, triple therapy can be prolonged. To date, patients requiring anticoagulants in combination with antiaggregants should prefer OAC in doses that have proven effective in preventing stroke in patients with atrial fibrillation (dabigatran 150 mg 2 times a day, apixaban 5 mg 2 times a day and rivaroxaban 20 mg/day).

Clinical characteristics of patients with atrial flutter before radiofrequency ablation

Introduction. Radiofrequency ablation (RFA) is today the method of choice for the ineffective medical treatment of atrial fibrillation (AF), but its course is often complicated by comorbid pathology. The predicted great impact of these nosologies on the effectiveness of radiofrequency ablation of the arrhythmia substrate requires additional study before RFA. Objectives – to analyze the clinical characteristics of patients with isolated atrial fibrillation and combination with of atrial fibrillation with atrial flutter (AF + AFib) that underwent radiofrequency ablation of the arrhythmia substrate. Materials and methods. 84 patients aged 65 ± 9 (82.3 % of men) were examined, who underwent RFA of the arrhythmia substrate: cavo-tricuspid isthmus (CTI) or combined with pulmonary veins isolation (CTI + PV) strategy for patients with AFib. Before radiofrequency ablation, the following clinical indicators were assessed: forms of AF + AFib, the presence of chronic heart failure (CHF) and functional classes (FC) according to NYHA classification, the forms of chronic coronary syndromes (CCS): postinfarction cardiosclerosis, syndrome-X, functional classes of stable angina (SA), stages of arterial hypertension (AH), the presence of type 2 diabetes or stroke in the anamnesis. Results. Radiofrequency ablation of isolated atrial fibrillation was more often performed for persistent arrhythmia in patients with stable angina III FC, arterial hypertension stage 2 and 3, radiofrequency ablation of combination of atrial fibrillation with atrial flutter – equally often for persistent or paroxysmal form in patients with SA I and II class, AH stage 2 and 3; in both cases patients with chronic heart failure II and III FC more often needed radiofrequency ablation of the arrhythmia substrate. Conclusions. Given the lack of correlation between clinical and demographic characteristics, it is advisable to continue studying their prognostic effect on the course of comorbid pathology and treatment of patients after radiofrequency ablation of the arrhythmia substrate of atrial fibrillation and combination of atrial fibrillation with atrial flutter.

Evaluation of diagnostic criteria of heart failure in patients with atrial fibrillation and chronic obstructive pulmonary disease

Assess the diagnostic significance of markers of heart failure, to identify the features of clinical symptoms and structural and functional remodeling of the left and right heart in patients with chronic heart failure (CHF) in combination with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD). groups of patients were formed: group 1 - patients with COPD without cardiovascular diseases (n=28), group 2 - patients with CHF and COPD without AF (n=30), group 3 - patients with CHF and AF without COPD (n=33), group 4 (main) - patients with CHF, AF and COPD (n=29). Patients were evaluated for clinical symptoms, 6-minute walk test, echocardiographic study, determined the concentration of natriuretic peptides (NUP): N-terminal fragment of the precursor of cerebral NUP (NT-proBNP) and mid-regional pro-atrial NUP (MR-proANP). In patients with CHF on the background of AF and COPD, a higher score of the severity of clinical symptoms was established in comparison with the 3rd group (p&lt;0,001). The features of heart remodeling in patients of the main group were revealed in comparison with patients with CHF and AF without COPD: lower volume indices of the left (p=0,001) and right (p=0,004) atria and values of the indexed index of the end-diastolic area of the right ventricle (RV) (p=0,007), lower contractility of the RV, the presence of RV hypertrophy. The effect of AF on the structural and functional parameters of the heart in patients with CHF, COPD and AF can be judged by comparison with patients with CHF and COPD without AF: higher values of the size of the RV (p=0,012), indexed index of the end-systolic area of the RV (p&lt;0,001), lower systolic function of the RV on the background of higher pressure in the RV cavity (p=0,001). Defined the highest level of NT-proBNP in patients with CHF, AF and COPD in comparison with its level in patients of the 2nd group (p&lt;0,001) and in patients 3rd groups (p=0,010). Higher levels of MR-proANP were found in patients with CHF and AF without COPD (p&lt;0,001). In patients with CHF, AF and COPD, more pronounced clinical symptoms are caused by chronic bronchial obstruction. Pathogenetic features of left and right heart remodeling in patients with CHF on the background of AF and COPD were revealed. For the early detection of HF in patients with AF the greatest diagnostic importance is the determination of the level of MR-proANP, however, in patients with combined AF and COPD the most informative is the determination of the concentration of NT-proBNP.

Assessment of progression of atrial fibrillation in middle-aged individuals with hypertension in combination with comorbid extracardial diseases

Purpose. To assess the progression of atrial fibrillation in middle-aged people with hypertension in combination with comorbid extracardiac diseases.Materials and methods. In an observational cohort study, 308 patients aged 45–65 years with atrial fibrillation (paroxysmal and persistent forms) with hypertension in combination with extracardiac pathology were observed: diabetes mellitus (n = 40), thyrotoxicosis (n = 42), hypothyroidism (n = 59), abdominal obesity (n = 64) and chronic obstructive pulmonary disease (n = 47). The control group consisted of 56 patients with hypertension + AF without concomitant extracardiac disease. The level of MMP-9 was determined using the Human MMP-9 (total) Immunoassay test-system (USA); NT-proBNP — using the NTproBNP-IFA-Best reagent kit; galectin-3 — with ELISA — Bender MedSystems (Austria). Echocardiography was performed using an Acuson Aspen apparatus (USA), 24-hour ECG monitoring with Schiller Medilog Holter system. All statistical calculations were carried out in the program Rstudio 0.99.879 (RStudio, USA).Results. In patients with hypertension and atrial fibrillation, the combination of diabetes mellitus (p = 0.041) and abdominal obesity (p = 0.004) is the most prognostic factor for AF progression. In groups of patients with diabetes mellitus, hypothyroidism and abdominal obesity, the most pronounced indicators of diastolic dysfunction of the left ventricle were: E/A, LVMI (men); the size of the left atrium and the end-diastolic size of the left ventricle are increased in all clinical groups. The prognostic value of biomarkers of fibrosis and remodeling of galectin-3 and MMP-9, and NT-proBNP in the progression of atrial fibrillation in patients with hypertension in combination with extracardial diseases is shown.Conclusion. There is no doubt that in case of hypertension, the decompensation of long-term hypertrophic myocardium is based on a violation of the balanced growth of its various structures and the formation of fibrosis and myocardial dystrophy, which was confirmed in the present study. The detected elevated levels of MMP-9, galectin-3 and NT-proBNP, as well as ultrasonic signs of myocardial remodeling, confirmed that they statistically significantly affect the progression of atrial fibrillation. In this regard, a personalized approach to a patient with atrial fibrillation in combination with comorbid pathology is required, especially in middle-aged people at the stage of comorbidity formation, under the conditions of received diagnostic information on the electrical function of the heart and assessment of the functional capabilities of CVS during its transition to various levels of functioning.

Current management approaches to patients with atrial fibrillation and percutaneous coronary intervention

In this review are provided relevant positions of the American and European clinical guidelines for antithrombotic therapy in the patients with a combination of atrial fibrillation and coronary heart disease with percutaneous coronary intervention. Similarities and distinctions of positions of two expert communities were discussed. In addition, the evidence-based positions concerning the choice of the optimal antithrombotic therapy are noted. Primary positions of a clopidogrel when choosing the antiagregants for double or triple antithrombotic therapy were designated.

Genetic markers of atrial fibrillation in patients with hypertension in combination with non-cardiac diseases

&lt;p&gt;&lt;strong&gt;Letter to the editor:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;The world medical community has categorised atrial fibrillation (AF) as one of the three cardiovascular ‘epidemics of the 21st century’, along with chronic heart failure and diabetes mellitus [1]. In recent years, the prevalence of AF has increasing steadily. However, the exact cause for the increase in the incidence of AF&lt;br /&gt;cannot be explained only by the increase in life expectancy, prevalence of cardiac valve disease or prevalence of myocardial infarction [2].&lt;/p&gt;&lt;p&gt;Although AF occurs in individuals with various manifestations of coronary heart disease, it is increasingly being diagnosed in patients with arterial hypertension without coronary heart disease [3]. AF causes serious cardiovascular complications; thus, a deep understanding of its pathogenetic aspects and a comprehensive study that considers comorbid pathologies for identifying the predictors of the development and progression of AF are required [4].&lt;/p&gt;&lt;p&gt;Hereditary factors can play a significant role in the development of AF and hypertension; consequently, the worldwide practice of scientific research in basic medicine pays significant attention to the molecular genetics methods of analysis.&lt;/p&gt;&lt;p&gt;This study aimed to evaluate the genetic determinants in patients with hypertension with AF progression accompanied by various extra-cardiac comorbid pathologies.&lt;/p&gt;&lt;p&gt;This prospective cohort study included 167 patients with a paroxysmal and persistent form of AF and stage III hypertonic disease without coronary heart disease. The average age of the patients was 53.3 ± 7.1 years. DNA isolation from blood leucocytes was performed using phenol–chloroform extraction. The rs1378942 polymorphism of the CSK gene, the rs220073 polymorphism and the -174G/C polymorphism (rs1800795) of the IL6 gene were assessed using polymerase chain reaction-restriction fragment length polymorphism. The statistical hypotheses were considered significant at a critical level of p = 0.05, i.e.&lt;br /&gt;the difference was considered statistically significant at p &amp;lt; 0.05. The lower limit of evidentiary power was equal to 80%.&lt;/p&gt;&lt;p&gt;This study reported associations between the rs1378942 polymorphism of the CSK gene, the rs1800795 polymorphism of the IL6 gene and the rs220073 polymorphism and the progression of AF in combination with the following associated diseases: hypertension, chronic obstructive pulmonary disease, hypothyroidism, type 2 diabetes mellitus and abdominal obesity. The relative risk of the progression of AF in carriers of the allele C was 1.94 times higher than that in carriers of the allele A [95% confidence interval (CI), 1.21–3.09]. Carriage of the AA genotype was conditionally protective against the progression of AF (relative risk, 0.41; 95% CI, 0.21–0.80; p = 0.010).&lt;/p&gt;&lt;p&gt;Associations of the rs1378942 and rs1800795 polymorphisms with the risk of recurrence of AF in combination with certain diseases were also found. In addition, associations were identified between rs1378942 and glomerular filtration rate, systolic and diastolic blood pressure, left atrial wall thickness and glucose, high-density lipoprotein (HDL) cholesterol, triglyceride and creatinine levels; between rs220073 and levels of triglycerides, atherogenic index, creatinine, fibrinogen and the number of months before the development of relapse and between rs1800795 and HDL cholesterol, creatinine and galectin-3 levels and diastolic blood pressure.&lt;/p&gt;&lt;p&gt;The secondary form of AF as a multi-factorial disease develops under the influence of many factors of both the external environment and hereditary nature. The complexity of the etio-pathogenesis of the disease makes it extremely difficult for researchers to identify the factors that play a leading role in the development of the pathological process. Currently, associative studies of AF with polymorphisms of &amp;gt;260 genes have been conducted, and genome-wide associative studies have been performed as well. The reproducibility of the results depends on several factors: age, sex, comorbidities, ethnicity, penetrance, expressiveness, pleiotropy, various epigenetic influences and many more.&lt;/p&gt;&lt;p&gt;Despite the limitations of the sample, our study adds to the data material already available that can serve in the prognostic assessment of the development and progression of AF. Further studies will allow the development of a personalised algorithm for predicting the progression of AF in hypertension combined&lt;br /&gt;with extra-cardiac diseases. In this regard, further larger studies are necessary that involve other institutions and a larger sample of patients, which will make it possible to predict the progression of AF with the definition of additional molecular criteria for evaluating the effectiveness of pathogenetic therapy and the possibilities of targeted treatment.&lt;br /&gt;&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding:&lt;/strong&gt; The study did not have sponsorship.&lt;br /&gt;&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conflict of interest:&lt;/strong&gt; Authors declare no conflict of interest.&lt;/p&gt;

Features of Atrial Fibrillation in Patients with Arterial Hypertension and Extracardial Disorders

Aim. To study the features of the progression of atrial fibrillation (AF) in patients with arterial hypertension (HT) and comorbid extracardiac diseases.Material and methods. In the observational cohort study 308 men 45-65 years old with AF and HT were observed Most patients also had the following comorbid extracardiac diseases: diabetes mellitus (DM; n=40), diffuse toxic goiter (DTG; n=42); hypothyroidism (HTH; n=59), abdominal obesity (AO; n=64), and chronic obstructive pulmonary disease (COPD; n=47). The comparison group consisted of 56 patients with AF and HT only. Clinical, anthropometric, laboratory parameters, levels of NT-proBNP and galectin-3, results of ECG, daily monitoring of ECG and blood pressure wereassessed initially and after 12 months.Results. Persistent AF (29.6-65.2%) and long-term persistent AF (16-31.3%) were more common in groups with extracardiac diseases compared with the AF+HT group (20.4% and 14.2%, respectively). Permanent form of AF was statistically significantly more common in the DM (11.1%), AO (14.8%) and HTH (6.2%) groups compared with the AF+HT group (0.6%). A comparative assessment of risk factors (smoking and alcohol) did not show significant differences in prevalence in the groups (22-44%). An assessment of the levels of fibrosis and remodeling markers found a statistically significant increase in the level of galectin-3 in groups of patients with concomitant extracardiac diseases and an increase in the NT-proBNP level, relative to reference values in all groups except DTG.Conclusion. Patients with AF in combination with HT and comorbid extracardiac diseases have a more rapid AF progression.

Predictors and Outcomes of Persistent Tricuspid Regurgitation After Transcatheter Aortic Valve Implantation

Persistent tricuspid regurgitation (TR) after transcatheter aortic valve implantation (TAVI) has been reported to increase mortality. The aim of this study was to investigate clinical and echocardiographic determinants and outcome of persistent TR after TAVI. We reviewed 1,085 patients who underwent TAVI. Among them, 100 patients who had ≥moderate TR without organic dysfunction of the tricuspid valve apparatus were studied. Preprocedural and follow-up transthoracic echocardiography after TAVI were analyzed. After TAVI, patients were divided into persistent TR group and improved TR group. Clinical event was defined as all-cause mortality and readmission for heart failure within 1,000 days. Fifty-three (53%) patients had persistent TR, whereas 47 (47%) patients had improved TR. Risk of clinical event was significantly higher in the persistent TR group compared with the improved TR group. Atrial fibrillation (AF) and tricuspid annular dimension (TAD; p <0.05 for all) were independent predictors of persistent TR. Receiver operating characteristic curve showed the optimal cut-off value of TAD for predicting persistent TR was 37 mm. The combination of AF and TAD ≥37 mm was associated with persistent TR (p <0.001). In conclusion, AF and dilated TAD before TAVI predicted persistent TR which was associated with higher all-cause mortality and readmission for heart failure.

Маркеры системного воспаления и фиброза при гипертонической болезни и фибрилляции предсердий в сочетании с коморбидной эстракардиальной патологией

Маркеры системного воспаления и фиброза при гипертонической болезни и фибрилляции предсердий в сочетании с коморбидной эстракардиальной патологией