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Pharmaceuticals (Basel, Switzerland) May 2024Amiodarone is an anti-arrhythmic drug that has extensive tissue distribution and substantial storage in the fat tissue. Different studies have described some...
BACKGROUND
Amiodarone is an anti-arrhythmic drug that has extensive tissue distribution and substantial storage in the fat tissue. Different studies have described some implications of body fat composition in its pharmacokinetics and pharmacodynamics. However, no clinical studies have described its implications for clinical efficacy.
METHODS
We studied 878 patients with persistent atrial fibrillation (AF) treated with a regimen of amiodarone and referred to electrical cardioversion (ECV), included prospectively in two Spanish registries. We analyzed the influence of body mass index (BMI), as well as overweight and obesity, in the efficacy of amiodarone for achieving pharmacologic cardioversion to sinus rhythm (SR) before ECV.
RESULTS
A total of 185 patients (21.1%) reverted to SR before ECV. Patients who reverted to SR had a lower BMI than those who did not revert (27.45 ± 4.36 kg/m vs. 29.11 ± 4.09 kg/m; < 0.001). We observed a progressively lower probability of reverting to SR in overweight and obese patients (normal weight 28.3%, overweight 21.3%, obesity 13.1%; < 0.001). In the logistic regression, BMI (kg/m) adjusted for other related variables remained as the main factor inversely related to reversion to SR (OR = 0.904 × kg/m); CI 75% 0.864-0.946).
CONCLUSIONS
We observed a negative relationship between an increased BMI and the efficacy of amiodarone for reversion to SR, suggesting a negative clinical impact of excess body fat in its efficacy.
PubMed: 38931360
DOI: 10.3390/ph17060693 -
Journal of Clinical Medicine Jun 2024Atrial fibrillation (AF) has been associated with higher morbidity and mortality rates, especially in older patients. Subclinical atrial fibrillation (SCAF) is defined... (Review)
Review
Atrial fibrillation (AF) has been associated with higher morbidity and mortality rates, especially in older patients. Subclinical atrial fibrillation (SCAF) is defined as the presence of atrial high-rate episodes (AHREs) > 190 bpm for 10 consecutive beats > 6 min and <24 h, as detected by cardiac implanted electronic devices (CIEDs). The selection of eligible patients for anticoagulation therapy among elderly individuals with AHREs detected through CIEDs remains a contentious issue. The meta-analysis of ARTESiA and NOAH-AFNET 6 clinical trials revealed that taking Edoxaban or Apixaban as oral anticoagulation therapy can reduce the risk of stroke by approximately 32% while increasing the risk of major bleeding by approximately 62%. However, it is still unclear which are, among patients with SCAF, those who can take the highest net clinical benefit from anticoagulant therapy. The present review summarizes the current evidence on this intriguing issue and suggests strategies to try to better stratify the risk of stroke and systemic embolism in patients with AHREs. We propose incorporating some parameters including chronic kidney disease (CKD), obesity, enlarged left atrial volume, the efficacy in blood pressure management, and frailty into the traditional CHADS-VASc score. Future trials will be needed to verify the clinical usefulness of the proposed prognostic score mainly in the view of a personalized therapeutic approach in patients with SCAF.
PubMed: 38930095
DOI: 10.3390/jcm13123566 -
Journal of Clinical Medicine Jun 2024Patent foramen ovale (PFO) is often diagnosed in patients with cryptogenic stroke, aged > 60-65 years, but few data report the outcomes of PFO closure in elderly...
Patent foramen ovale (PFO) is often diagnosed in patients with cryptogenic stroke, aged > 60-65 years, but few data report the outcomes of PFO closure in elderly patients. Consecutive patients undergoing PFO closure at a single institution between January 2006 and December 2011 were included. Baseline clinical features and cerebral imaging data were collected, and a RoPE score was calculated for each patient. Procedural data were recorded as well as medical therapy upon discharge. All-cause death, ischemic stroke, TIA and systemic embolism recurrence at long-term follow-up were investigated, as well as new atrial fibrillation onset. : Overall, 462 patients were included, of whom 64 (13.8%) were aged ≥ 65 years. Female gender was slightly more prevalent in the younger group while hypertension was more frequent among elderly patients. Previous stroke/TIA was the indication for PFO closure in 95.3% of older patients and 80.4% of younger patients, whereas other indications were more frequent among younger patients. RoPE scores were lower in older patients (median RoPE score of 5 vs. 7), and atrial septal aneurysm was more frequently detected among elderly patients. All procedures were technically successful. Procedural or in-hospital complications equally occurred in 5 (7.8%) older patients (4 AF and 1 device embolization) and 30 (7.5%) young patients (29 AF or other supraventricular arrhythmias and 1 device embolization). The follow-up duration was longer among younger patients. All-cause mortality was higher in older patients (16 deaths vs. 4 at follow-up, log-rank < 0.001), no recurrent strokes occurred, and 2 TIAs were reported among non-elderly patients. New-onset atrial fibrillation occurred in three elderly and eight young patients. : PFO closure is a safe procedure in patients aged ≥ 65 years, associated with favorable long-term follow-up and the prevention of ischemic neurologic recurrences.
PubMed: 38930044
DOI: 10.3390/jcm13123514 -
Journal of Clinical Medicine Jun 2024Modern treatments for transfusion-dependent β-thalassemia (TDβT) have allowed patients to reach high life expectancy with no iron overload. Despite survival...
Modern treatments for transfusion-dependent β-thalassemia (TDβT) have allowed patients to reach high life expectancy with no iron overload. Despite survival improvement, atrial fibrillation (AF) has emerged as a relevant issue. AF pathophysiology and characteristics in TDβT are different than in the general population. Epicardial adipose tissue (EAT) may play a role but its relationship with AF in patients with TDβT has not been explored. A monocentric, cross-sectional study, enrolling consecutive patients with TDβT. Epicardial adipose tissue (EAT) was evaluated at magnetic resonance. Characteristics of patients with and without history of AF were investigated. Factors independently associated with AF prevalence were analyzed. A total of 116 patients were enrolled. All patients were treated with regular chelation therapy. The prevalence of AF was 29.3% (34/116). Cardiac T2* and liver iron concentration were no different between patients with and without AF. EAT thickness was significantly higher in patients with AF at left atrium, right atrium and right ventricle (5.0 vs. 4.0 mm, < 0.01, 4.4 vs. 4.0, = 0.02 and 5.0 vs. 4.3, = 0.04). Patients with AF presented with older age, (53 vs. 49 years, < 0.01), more hypothyroidism (44.1 vs. 20.7%, = 0.01), pulmonary hypertension (23.5 vs. 2.4% < 0.01), splenectomy (88.2 vs. 64.6%, = 0.01), higher right and left atrial volume (61 vs. 40 and 74 vs. 43 mL, both < 0.01). At multivariable analysis, hypothyroidism, left atrial volume and left atrial EAT were independently associated with AF (odds ratio 9.95, 1.09 and 1.91, respectively). In a contemporary cohort of patients with TDβT, treated with regular chelation therapy, prevalence of AF was unrelated to iron overload. EAT was independently associated with AF.
PubMed: 38930000
DOI: 10.3390/jcm13123471 -
Journal of Personalized Medicine Jun 2024Obstructive sleep apnea (OSA) is associated with an increased risk of hypertension, coronary artery disease, heart failure (HF), and atrial fibrillation (AF).
INTRODUCTION
Obstructive sleep apnea (OSA) is associated with an increased risk of hypertension, coronary artery disease, heart failure (HF), and atrial fibrillation (AF).
MATERIALS AND METHODS
A total of 179 patients aged 34-81 years were included in the study. The median age was 63 years (interquartile range: 56-69 years). Of these patients, 105 (58.7%) were men, and 74 (41.3%) were women; there were cases of paroxysmal ( = 99), persistent (n = 64), and permanent AF ( = 16). All patients underwent investigations including respiratory sleep monitoring, echocardiography, and 24 h Holter electrocardiography monitoring. Statistical analyses were performed using IBM SPSS Statistics 26.0.
RESULTS
OSA was detected in 131 (73.2%) patients. In patients with OSA, paroxysmal AF was commonest ( = 65), followed by persistent AF ( = 51) and permanent AF ( = 15). The patients with sleep apnea had increased body mass index (33.6 kg/m2; = 0.02), waist circumference (114 cm; < 0.001), and neck circumference (42 cm; < 0.001) values. HF (OR 2.9; 95% CI: 1.4-5.9; = 0.004) and type 2 diabetes (OR 3.6; 95% CI: 1.5-8.3; = 0.001) were more common in patients with AF and OSA. The STOP-BANG scale (AUC = 0.706 ± 0.044; 95% CI: 0.619-0.792; < 0.001) and the Berlin questionnaire (AUC = 0.699 ± 0.044; 95% CI: 0.614-0.785) had a higher predictive ability for identifying sleep apnea.
CONCLUSIONS
Patients with AF demonstrate a high prevalence of OSA and an increased association with cardiovascular comorbidities. The STOP-BANG scale and the Berlin questionnaire can be used to screen for OSA in patients with AF.
PubMed: 38929839
DOI: 10.3390/jpm14060618 -
Journal of Personalized Medicine May 2024Heart failure, stroke and death are major dangers associated with atrial fibrillation (AF), a common abnormal heart rhythm. Having a gastrointestinal (GI) procedure puts... (Review)
Review
BACKGROUND
Heart failure, stroke and death are major dangers associated with atrial fibrillation (AF), a common abnormal heart rhythm. Having a gastrointestinal (GI) procedure puts patients at risk for developing AF, especially after large abdominal surgery. Although earlier research has shown a possible connection between postoperative AF and higher mortality, the exact nature of this interaction is yet uncertain.
METHODS
To investigate the relationship between AF and death after GI procedures, this research carried out a thorough meta-analysis and systematic review of randomized controlled studies or clinical trials. Finding relevant randomized controlled trials (RCTs) required a comprehensive search across many databases. Studies involving GI surgery patients with postoperative AF and mortality outcomes were the main focus of the inclusion criteria. We followed PRISMA and Cochrane Collaboration protocols for data extraction and quality assessment, respectively.
RESULTS
After GI surgery, there was no statistically significant difference in mortality between the AF and non-AF groups, according to an analysis of the available trials ( = 0.97). The mortality odds ratio (OR) was 1.03 (95% CI [0.24, 4.41]), suggesting that there was no significant correlation. Nevertheless, there was significant heterogeneity throughout the trials, which calls for careful interpretation.
CONCLUSION
Despite the lack of a significant link between AF and death after GI surgery in our study, contradictory data from other research highlight the intricacy of this relationship. Discrepancies may arise from variations in patient demographics, research methodology and procedural problems. These results emphasize the necessity for additional extensive and varied studies to fully clarify the role of AF in postoperative mortality in relation to GI procedures. Comprehending the subtleties of this correlation might enhance future patient outcomes and contribute to evidence-based therapeutic decision making.
PubMed: 38929792
DOI: 10.3390/jpm14060571 -
Journal of Personalized Medicine May 2024Direct oral anticoagulants (DOACs) are the standard treatment for thromboembolic protection in atrial fibrillation (AF) patients. Epigenetic modifications, such as DNA...
Circulating microRNAs and DNA Methylation as Regulators of Direct Oral Anticoagulant Response in Atrial Fibrillation and Key Elements for the Identification of the Mechanism of Action (miR-CRAFT): Study Design and Patient Enrolment.
Direct oral anticoagulants (DOACs) are the standard treatment for thromboembolic protection in atrial fibrillation (AF) patients. Epigenetic modifications, such as DNA methylation and microRNAs, have emerged as potential biomarkers of AF. The epigenetics of DOACs is still an understudied field. It is largely unknown whether epigenetic modifications interfere with DOAC response or whether DOAC treatment induces epigenetic modifications. To fill this gap, we started the miR-CRAFT (Circulating microRNAs and DNA methylation as regulators of Direct Oral Anticoagulant Response in Atrial Fibrillation) research study. In miR-CRAFT, we follow, over time, changes in DNA methylation and microRNAs expression in naïve AF patients starting DOAC treatment. The ultimate goal of miR-CRAFT is to identify the molecular pathways epigenetically affected by DOACs, beyond the coagulation cascade, that are potentially mediating DOAC pleiotropic actions and to propose specific microRNAs as novel circulating biomarkers for DOAC therapy monitoring. We herein describe the study design and briefly present the progress in participant enrolment.
PubMed: 38929783
DOI: 10.3390/jpm14060562 -
Journal of Personalized Medicine May 2024A 69-year-old female presented with symptomatic atrial fibrillation. Cardiac amyloidosis was suspected due to an artificial intelligence clinical tool applied to the...
A 69-year-old female presented with symptomatic atrial fibrillation. Cardiac amyloidosis was suspected due to an artificial intelligence clinical tool applied to the presenting electrocardiogram predicting a high probability for amyloidosis, and the subsequent unexpected finding of left atrial appendage thrombus reinforced this clinical suspicion. This facilitated an early diagnosis by the biopsy of AL cardiac amyloidosis and the prompt initiation of targeted therapy. This case highlights the utilization of an AI clinical tool and its impact on clinical care, particularly for the early detection of a rare and difficult to diagnose condition where early therapy is critical.
PubMed: 38929780
DOI: 10.3390/jpm14060559 -
Antioxidants (Basel, Switzerland) Jun 2024Cardiovascular diseases stand as the predominant global cause of mortality, exerting a profound impact on both life expectancy and its quality. Given their immense... (Review)
Review
Cardiovascular diseases stand as the predominant global cause of mortality, exerting a profound impact on both life expectancy and its quality. Given their immense public health burden, extensive efforts have been dedicated to comprehending the underlying mechanisms and developing strategies for prevention and treatment. Selenium, a crucial participant in redox reactions, emerges as a notable factor in maintaining myocardial cell homeostasis and influencing the progression of cardiovascular disorders. Some disorders, such as Keshan disease, are directly linked with its environmental deficiency. Nevertheless, the precise extent of its impact on the cardiovascular system remains unclear, marked by contradictory findings in the existing literature. High selenium levels have been associated with an increased risk of developing hypertension, while lower concentrations have been linked to heart failure and atrial fibrillation. Although some trials have shown its potential effectiveness in specific groups of patients, large cohort supplementation attempts have generally yielded unsatisfactory outcomes. Consequently, there persists a significant need for further research aimed at delineating specific patient cohorts and groups of diseases that would benefit from selenium supplementation.
PubMed: 38929127
DOI: 10.3390/antiox13060688 -
International Journal of Environmental... May 2024Dementia is a major neurologic syndrome characterized by severe cognitive decline, and it has a detrimental impact on overall physical health, leading to conditions such...
Dementia is a major neurologic syndrome characterized by severe cognitive decline, and it has a detrimental impact on overall physical health, leading to conditions such as frailty, changes in gait, and fall risk. Depending on whether symptoms occur before or after the age of 65, it can be classified as early-onset (EOD) or late-onset (LOD) dementia. The present study is aimed at investigating the role of cardiovascular factors on EOD and LOD risk in an Italian population. Using a case-control study design, EOD and LOD cases were recruited at the Modena Cognitive Neurology Centers in 2016-2019. Controls were recruited among caregivers of all the dementia cases. Information about their demographics, lifestyles, and medical history were collected through a tailored questionnaire. We used the odds ratio (OR) and 95% confidence interval (CI) to estimate the EOD and LOD risk associated with the investigated factors after adjusting for potential confounders. Of the final 146 participants, 58 were diagnosed with EOD, 34 with LOD, and 54 were controls. According to their medical history, atrial fibrillation was associated with increased disease risk (ORs 1.90; 95% CI 0.32-11.28, and 3.64; 95% CI 0.32-41.39 for EOD and LOD, respectively). Dyslipidemia and diabetes showed a positive association with EOD, while the association was negative for LOD. We could not evaluate the association between myocardial infarction and EOD, while increased risk was observed for LOD. No clear association emerged for carotid artery stenosis or valvular heart disease. In this study, despite the limited number of exposed subjects and the high imprecision of the estimates, we found positive associations between cardiovascular disease, particularly dyslipidemia, diabetes, and atrial fibrillation, and EOD.
Topics: Humans; Case-Control Studies; Italy; Male; Female; Atrial Fibrillation; Dementia; Aged; Risk Factors; Middle Aged; Aged, 80 and over; Cardiovascular Diseases
PubMed: 38928935
DOI: 10.3390/ijerph21060688