Backgrounds: Several studies have shown the serum high sensitive cardiac troponin I (hs-TnI) a biomarker of myocardium injury, and C-reactive protein (CRP), a biomarker of inflammation, are associated with worse cardiovascular outcomes. We evaluated the relationship between the hs-TnI level in patients with paroxysmal atrial fibrillation (PAF) after pulmonary vein isolation (PVI) and atrial fibrillation (AF) recurrence.
Methods and Results:We enrolled 263 consecutive PAF patients who underwent PVI from May 2017 to April 2018. We investigated the difference in the relationship between the myocardial injury marker (serum hs-TnI), inflammatory marker (CRP, white blood cell) at 36 to 48 hours after the PVI, and early or late recurrence of AF (ERAF; <3 months and LRAF; from 3 months to 1 year) between the radiofrequency ablation group (R group) and cryoballoon ablation group (C group). The R group consisted of 147 patients and the C groups consisted of 116 patients. The serum hs-TnI level in R group was significantly lower than in the C group (2.33 vs 5.08 ng/mL; P < .001), while the CRP was significantly higher in the R group than C group (2.02 vs 1.10 mg/dL; P < .001). The incidences of an ERAF/LRAF were similar between the two groups.Conclusion: Cryoballoon ablation may cause more myocardial injury than radiofrequency catheter ablation, on the contrary, radiofrequency catheter ablation, may cause more inflammation than cryoballoon ablation. However, these phenomena may not affect the recurrence of AF after the PVI in patient with PAF.
K E Y W O R D Shigh-sensitive cardiac troponin-T, inflammation, myocardial injury, paroxysmal atrial fibrillation, pulmonary vein isolation, recurrence of AF
Patient Population We included all consecutive patients with ISR who underwent diagnostic OCT imaging between March 2009 and November 2016. In this study, ISR was defined as an in-stent lesion with both a stenosis diameter of 50-99% by visual assessment and objective signs of myocardial ischemia or symptoms of angina pectoris. The study exclusion criteria were a recurrence of ISR, hemodynamic instability, age less than 18 years, and life expectancy of less than 6 months from a non-cardiac condition (Figure 1). Written informed consent was given by all participating patients and the protocol was approved by the local ethics committees.
Aim
In heart failure with preserved ejection fraction (HFpEF), it is unclear which factors on admission are correlated with long stays. In contrast, acute decompensated heart failure (ADHF) in older patients is associated with a high risk of a long stay. To manage older ADHF patients with HFpEF, it is important to reveal the risk factors for a long stay on admission.
Methods
We enrolled consecutive older patients (aged >75 years) with HFpEF (ejection fraction ≥50%) who were admitted to control ADHF from May 2014 to April 2016 using the acute heart failure registry in Osaka Rosai Hospital. We compared various factors, including age; sex; body mass index; heart rate; systolic blood pressure (SBP); atrial fibrillation; atherosclerotic risk factors, including dyslipidemia, diabetes mellitus, hypertension, smoking and chronic kidney disease; laboratory data, including brain natriuretic peptide and albumin; and medications, including loop diuretics, on pre‐admission between short‐stay (<14 days) and long‐stay groups.
Results
The long‐stay group consisted of 122 patients (59.5%). Multivariate analysis showed that male sex, SBP and albumin were independent predictors for long stays. According to the classification and regression tree and receiving operating characteristic curve analysis, all three factors on admission, including male sex, relatively low SBP (<155 mmHg) and hypoalbuminemia (<3.4 g/dL) could well predict the patients that would require long stays (area under curve 0.738).
Conclusions
Among older ADHF patients with HFpEF, male patients with relatively low SBP and hypoalbuminemia on admission should initially undergo more intensive management to reduce the length of stay. Geriatr Gerontol Int 2019; 19: 1084–1087.
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