C-reactive protein and left atrial appendage velocity are independent determinants of the risk of thrombogenesis in patients with atrial fibrillation

Cianfrocca, Cinzia; Loricchio, Maria Luisa; Pelliccia, Francesco; Pasceri, Vincenzo; Auriti, Antonio; Bianconi, Leopoldo; Guido, Vincenzo; Rosano, Giuseppe; Mercuro, Giuseppe; Santini, Massimo

doi:10.1016/j.ijcard.2008.12.052

Cited by 44 publications

(34 citation statements)

References 29 publications

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“…66 In AF patients, increased CRP levels are associated with left atrial thrombus formation and/ or dense spontaneous echo contrast. 67 Inflammation has been implicated in multiple components leading to AF-related thrombogenesis: (1) endothelial damage/dysfunction, (2) platelet/ endothelial cell activation, and (3) coagulation cascade activation.…”

Section: Inflammation and Af-related Thrombogenesismentioning

confidence: 99%

Role of Inflammation in Atrial Fibrillation Pathophysiology and Management

Harada

Wagoner

Nattel

2015

Circ J

385

290

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Atrial fibrillation (AF) is the most common clinically relevant arrhythmia, but the methods available for treating AF and its complications (of which the most important is thrombogenesis), as well as for assessing AF risk and underlying pathophysiology, are largely limited. Emerging evidence suggests a significant role of inflammation in the pathogenesis of AF. That evidence includes elevated serum levels of inflammatory biomarkers in AF subjects, the expression of inflammatory markers in cardiac tissues of AF patients and animal models of AF, and beneficial effects of anti-inflammatory drugs in experimental AF paradigms. Inflammation is suggested to be linked to various pathological processes, such as oxidative stress, apoptosis, and fibrosis, that promote AF substrate formation. Inflammation has also been associated with endothelial dysfunction, platelet activation, and coagulation cascade activation, leading to thrombogenesis. Thus, inflammation may contribute to both the occurrence/maintenance of AF and its thromboembolic complications. Here, we review the evidence for a role of inflammation and inflammatory biomarkers in the risk management and treatment of AF. We also summarize the current knowledge of inflammation-dependent cellular and molecular mechanisms in AF pathophysiology and their potential as therapeutic targets.

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Section: Inflammation and Af-related Thrombogenesismentioning

confidence: 99%

Role of Inflammation in Atrial Fibrillation Pathophysiology and Management

Harada

Wagoner

Nattel

2015

Circ J

385

290

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“…Dense SEC is described with a frequency of 8–35 % in patients with AF, depending on the patient population, type and effectiveness of anticoagulation, and CHADS 2 -/CHA 2 DS 2 -VASc Score [19, 34–36]. Our results showed a relatively lower frequency of dense SEC (VKA: 1 %, dabigatran 1 %, rivaroxaban 2 %).…”

Section: Discussionmentioning

confidence: 51%

“…Reduction of the LAAV below 20 cm/s exhibited the highest association with stroke [38]. A LAAV less than 20 cm/s is found in 1 to 13 % of patients with AF [21, 34]. We observed an incidence of LAAV <20 cm/s that were numerically higher in patients receiving VKA (4 %) compared to patients receiving a NOAC (1 % for dabigatran and rivaroxaban).…”

Section: Discussionmentioning

confidence: 74%

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Incidence of left atrial abnormalities under treatment with dabigatran, rivaroxaban, and vitamin K antagonists

et al. 2016

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BackgroundNon-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran or rivaroxaban are alternatives to vitamin K antagonists (VKAs) for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) and atrial flutter (AFL). Incidences of risk factors for left atrium (LA) and left atrial appendage (LAA) thrombus formation, such as dense spontaneous echo contrast (SEC), low LAA velocity (LAAV) <20 cm/s under treatment with dabigatran and rivaroxaban in comparison with VKAs are unknown.MethodsWe studied 306 patients with AF (94 %) and AFL (6 %) undergoing transesophageal echocardiography. Patients received VKAs (n = 138), dabigatran (n = 68), or rivaroxaban (n = 100) for at least 3 weeks prior to investigation. Time in therapeutic range was 67 % for VKA. Mean CHADS2 score and CHA2DS2-VASc score were 1.3 and 2.5, respectively. Left atrial abnormality was defined as either dense SEC, low LAAV <20 cm/s, or thrombus.ResultsAny LA abnormality occurred in 9, 3, and 5 % of patients receiving VKA, dabigatran, and rivaroxaban, respectively. The most frequent abnormality was LAA thrombus (VKA: 4 %, dabigatran: 0 %, rivaroxaban: 2 %) and low LAAV of less than 20 cm/s (VKA: 4 %, dabigatran: 1 %, rivaroxaban: 1 %), followed by dense SEC (VKA: 2 %, dabigatran: 1 %, rivaroxaban: 2 %). Results of uni- and multivariate analyses revealed a numerically lower but not significantly different frequency of any LA abnormality under dabigatran (OR 0.4, 95 % Cl 0.08 − 1.88, p = 0.25) and rivaroxaban (OR 0.65, 95 % Cl 0.22 − 1.98, p = 0.45) compared to VKA.ConclusionWith respect to the incidence of LA abnormalities, dabigatran and rivaroxaban are not inferior to VKA.

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“…Peak velocity of the LA appendage on TEE 48 LA fibrosis detected by DE-MRI 49 Atrial electromechanical interval on TTE 50 Chicken wing LA appendage morphology (protective effect) 51 LA appendage dimension The risk of AF-related stroke was higher in Caucasian populations than in Asians populations. [9][10][11][12][13][14][15] enhanced magnetic resonance imaging, in predicting TE events in AF.…”

Section: Imaging Toolsmentioning

confidence: 99%

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

Chao

Chiang

Chen

2013

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice, accounting for approximately one-third of hospitalisations for cardiac rhythm disturbances.1 Between 1980 and 2000, the age-adjusted incidence of AF significantly increased from 3.04 to 3.68 per 1,000 person-years in the US. 2 The prevalence of AF was lower among African Americans than among Caucasians, 3 and it also seemed to be lower in the Asian population. 4,5 In a nationwide cohort of 702,502 participants in Taiwan, the AF incidence was around 1.5 per 1,000 person-years. 6 Since a considerable number of AF patients was paroxysmal in nature, the incidence and prevalence of AF could be significantly underestimated.Systemic thromboembolism is the most severe complication of AF. It accounts for about 15-20 % of ischaemic strokes.7 AF-related strokes were associated with a poor prognosis as more than 50 % of the survivors remain with a severe deficit, and recurrence may be as high as 12 % per year. 8 The risk of AF-related stroke was higher in Caucasian populations than in Asians populations (see Figure 1). 4,[9][10][11][12][13][14][15] AF could in fact drive a prothrombotic or hypercoagulable state, by virtue of its fulfilment of Virchow's triad for thrombogenesis (blood stasis, endocardial dysfunction/damage, and abnormal haemostasis). The most important point in determining the strategy of stroke prevention for AF is how to estimate the thromboembolic (TE) risk accurately. The CHADS 2 score is the most commonly used scheme in stroke risk stratifications for AF patients, 17 despite the fact that it classifies a large proportion of patients as being at 'intermediate risk', and several important TE risk factors were omitted in the scoring system. 18 Recently, a newly developed scoring system, CHA 2 DS 2 -VASc score, which extends the CHADS 2 scheme by considering additional stroke risk factors (vascular diseases and female gender) was recommended to be used to guide the antithrombotic therapies for AF patients. 19,20 The CHA 2 DS 2 -VASc score is most useful in identifying truly low-risk patients, and no antithrombotic therapy is necessary for patients with a CHA 2 DS 2 -VASc score of 0. [21][22][23] In the study performed by Taillandier et al., which enrolled a total of 616 AF patients with a CHA 2 DS 2 -VASc score of 0, an OAC was prescribed on an individual basis in 273 patients (44 %), antiplatelet therapy alone in 145 patients (24 %), and no antithrombotic therapy in 198 patients (32 %).22 During a follow-up of 876 ± 1,135 days, 38 patients experienced adverse events (10 stroke/thromboembolism, 19 major bleeding, 17 deaths). Prescription of OACs and/or antiplatelet therapy was not associated with an improved prognosis for stroke/thromboembolism (relative risk: 0.99, 95 % confidence interval: 0.25-3.99, p-value: 0.99), nor improved survival or net clinical benefit (combination of stroke/ thromboembolism, bleeding and death). More recently, a nationwide cohort study in Taiwan further demonstrated that AF males with a CHA 2 ...

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C-reactive protein and left atrial appendage velocity are independent determinants of the risk of thrombogenesis in patients with atrial fibrillation

Cited by 44 publications

References 29 publications

Role of Inflammation in Atrial Fibrillation Pathophysiology and Management

Role of Inflammation in Atrial Fibrillation Pathophysiology and Management

Incidence of left atrial abnormalities under treatment with dabigatran, rivaroxaban, and vitamin K antagonists

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

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