The Prognostic Significance of Cardiac Structure and Function in Atrial Fibrillation: The ENGAGE AF–TIMI 48 Echocardiographic Substudy
Deepak K. Gupta,Robert P. Giugliano,Christian T. Ruff,Brian Claggett,Sabina A. Murphy,Elliott M. Antman,Michele Mercuri,Eugene Braunwald,Scott D. Solomon +8 more
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In a contemporary population of patients with AF at increased risk for thromboembolic events, larger LV size and higher filling pressures were significantly associated with increased risk of death, but neither left atrial nor LV measures were associated with thrombuembolic risk.Abstract:
Background Atrial fibrillation (AF) is associated with increased risk for thromboembolism and death; however, the relationships between cardiac structure and function and adverse outcomes among individuals with AF are incompletely understood. Methods The Effective Anticoagulation with Factor Xa Next Generation in AF–Thrombolysis in Myocardial Infarction 48 study tested the once-daily oral factor Xa inhibitor edoxaban in comparison with warfarin for the prevention of stroke (ischemic or hemorrhagic) or systemic embolism in 21,105 subjects with nonvalvular AF and increased risk for thromboembolic events (CHADS 2 score ≥ 2). In a prospective substudy of 971 subjects who underwent transthoracic echocardiography at baseline, Cox proportional hazards models were used to evaluate associations between cardiac structure and function and the risks for death and thromboembolism (ischemic stroke, transient ischemic attack, or systemic embolism). Results Over a median follow-up period of 2.5 years, 89 deaths (9.2%) and 48 incident thromboembolic events (4.9%) occurred in 971 subjects. In models adjusted for CHADS 2 score, aspirin use, and randomized treatment, larger left ventricular (LV) end-diastolic volume index (hazard ratio per 1 SD [12.9 mL/m 2 ], 1.49; 95% CI, 1.16–1.91) and higher LV filling pressures measured by E/e′ ratio (hazard ratio per 1 SD [4.6], 1.32; 95% CI, 1.08–1.61) were independently associated with increased risks for death. E/e′ ratio > 13 significantly improved the prediction of death beyond clinical factors alone. No features of cardiac structure and function were independently associated with thromboembolism in this population. Findings were similar when adjusted for CHA 2 DS 2 -VASc score in place of CHADS 2 score. Conclusions In a contemporary population of patients with AF at increased risk for thromboembolic events, larger LV size and higher filling pressures were significantly associated with increased risk for death, but neither left atrial nor LV measures were associated with thromboembolic risk. LV size and filling pressures may help identify patients with AF at increased risk for death.read more
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Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report
Gregory Y.H. Lip,Amitava Banerjee,Giuseppe Boriani,Chern En Chiang,Ramiz Fargo,Ben Freedman,Deirdre A. Lane,Christian T. Ruff,Mintu P. Turakhia,David J. Werring,Sheena Patel,Lisa K. Moores +11 more
TL;DR: Oral anticoagulation is the optimal choice of antithrombotic therapy for patients with AF with ≥1 non‐sex CHA2DS2‐VASc stroke risk factor(s), and stroke prevention (ie, oral antICOagulation therapy) is the next step.
Journal ArticleDOI
Predicting Thromboembolic and Bleeding Event Risk in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review
Ethan D. Borre,Adam P. Goode,Giselle Raitz,Bimal R. Shah,Angela Lowenstern,Ranee Chatterjee,Lauren Sharan,Nancy M. Allen LaPointe,Nancy M. Allen LaPointe,Roshini Yapa,J. Kelly Davis,Kathryn R Lallinger,Robyn Schmidt,Andrzej S. Kosinski,Sana M. Al-Khatib,Gillian D Sanders +15 more
TL;DR: CHADS2, CHA2DS2-VASc and ABC scores have the best prediction for stroke events, and HAS-BLED provides the best Prediction for bleeding risk.
Journal ArticleDOI
Correlation with invasive left ventricular filling pressures and prognostic relevance of the echocardiographic diastolic parameters used in the 2016 ESC heart failure guidelines and in the 2016 ASE/EACVI recommendations: a systematic review in patients with heart failure with preserved ejection fraction.
Jan F. Nauta,Yoran M. Hummel,Peter van der Meer,Carolyn S.P. Lam,Carolyn S.P. Lam,Adriaan A. Voors,Joost P. van Melle +6 more
TL;DR: In this article, the authors performed a systematic review of five echocardiographic parameters at resting conditions for their correlation with left ventricular filling pressures in patients with heart failure with preserved ejection fraction (HFpEF).
Journal ArticleDOI
Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment.
Milton Packer,Milton Packer +1 more
TL;DR: Obesity and diabetes can lead to heart failure with preserved ejection fraction (HFpEF), potentially because they both cause expansion and inflammation of epicardial adipose tissue and thus lead to microvascular dysfunction and fibrosis of the underlying left ventricle.
Journal ArticleDOI
Left atrial structure and function and the risk of death or heart failure in atrial fibrillation.
Riccardo M. Inciardi,Robert P. Giugliano,Brian Claggett,Deepak K. Gupta,Alvin Chandra,Christian T. Ruff,Elliott M. Antman,Michele Mercuri,Michael A. Grosso,Eugene Braunwald,Scott D. Solomon,Engage Af-Timi Investigators +11 more
TL;DR: The present study aimed to assess the association between left atrial (LA) structure and function and the risk for cardiovascular death or heart failure hospitalization in a population with atrial fibrillation.
References
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Roberto M. Lang,Michelle Bierig,Richard B. Devereux,Frank A. Flachskampf,Elyse Foster,Patricia A. Pellikka,Michael H. Picard,Mary J. Roman,James B. Seward,Jack S. Shanewise,Scott D. Solomon,Kirk T. Spencer,Martin St. John Sutton,William J. Stewart +13 more
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Validation of Clinical Classification Schemes for Predicting Stroke: Results From the National Registry of Atrial Fibrillation
Brian F. Gage,Amy D. Waterman,William D. Shannon,Michael Boechler,Michael W. Rich,Martha J. Radford +5 more
TL;DR: The 2 existing classification schemes and especially a new stroke risk index, CHADS, can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.
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Emelia J. Benjamin,Philip A. Wolf,Ralph B. D'Agostino,Halit Silbershatz,William B. Kannel,Daniel Levy +5 more
TL;DR: There was a significant AF-sex interaction: AF diminished the female advantage in survival and AF remained significantly associated with excess mortality, with about a doubling of mortality in both sexes in subjects free of valvular heart disease and preexisting cardiovascular disease.
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Sherif F. Nagueh,Christopher P. Appleton,Thierry C. Gillebert,Paolo Marino,Jae K. Oh,Otto A. Smiseth,Alan D. Waggoner,Frank A. Flachskampf,Patricia A. Pellikka,Arturo Evangelista +9 more
TL;DR: Recommendations for the evaluation of left ventricular diastolic function by echocardiography are made and further research is needed to determine the best method for this evaluation.
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Recommendations for chamber quantification
Roberto M. Lang,Michelle Bierig,Richard B. Devereux,Frank A. Flachskampf,Elyse Foster,Patricia A. Pellikka,Michael H. Picard,Mary J. Roman,James D. Seward,Jack S. Shanewise,Scott Robert Solomon,Kirk T. Spencer,Martin St John Sutton,William W. Stewart +13 more
TL;DR: This document reviews the technical aspects on how to perform quantitative chamber measurements of morphology and function, which is a component of every complete echocardiographic examination.
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