Carotid Atherosclerosis in Patients with Atrial Fibrillation

Wang, Zhaojia; Korantzopoulos, Panagiotis; Liu, Tong

doi:10.1007/s11883-019-0808-4

Cited by 20 publications

(13 citation statements)

References 55 publications

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“…Our previous hospital-based study showed that carotid plaque was detected in more than half of patients with NVAF ( 96 ). In fact, a growing number of studies across the globe have shown that carotid plaque is more common in patients with AF than in those without AF ( 97 ). Result from ARAPACIS study showed that the combination of vascular diseases and carotid plaque was independently associated with stroke in patients with NVAF (HR = 1.78, 95% CI: 1.05–3.01, P = 0.0318) ( 98 ).…”

Section: Arterial Stiffness and Atherosclerosis-related Markersmentioning

confidence: 99%

A Review of Biomarkers for Ischemic Stroke Evaluation in Patients With Non-valvular Atrial Fibrillation

Shang

Zhang

Guo

et al. 2021

Front. Cardiovasc. Med.

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Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and results in a significantly increased ischemic stroke (IS) risk. IS risk stratification tools are widely being applied to guide anticoagulation treatment decisions and duration in patients with non-valvular AF (NVAF). The CHA2DS2-VASc score is largely validated and currently recommended by renowned guidelines. However, this score is heavily dependent on age, sex, and comorbidities, and exhibits only moderate predictive power. Finding effective and validated clinical biomarkers to assist in personalized IS risk evaluation has become one of the promising directions in the prevention and treatment of NVAF. A number of studies in recent years have explored differentially expressed biomarkers in NVAF patients with and without IS, and the potential role of various biomarkers for prediction or early diagnosis of IS in patients with NVAF. In this review, we describe the clinical application and utility of AF characteristics, cardiac imaging and electrocardiogram markers, arterial stiffness and atherosclerosis-related markers, circulating biomarkers, and novel genetic markers in IS diagnosis and management of patients with NVAF. We conclude that at present, there is no consensus understanding of a desirable biomarker for IS risk stratification in NVAF, and enrolling these biomarkers into extant models also remains challenging. Further prospective cohorts and trials are needed to integrate various clinical risk factors and biomarkers to optimize IS prediction in patients with NVAF. However, we believe that the growing insight into molecular mechanisms and in-depth understanding of existing and emerging biomarkers may further improve the IS risk identification and guide anticoagulation therapy in patients with NVAF.

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Section: Arterial Stiffness and Atherosclerosis-related Markersmentioning

confidence: 99%

A Review of Biomarkers for Ischemic Stroke Evaluation in Patients With Non-valvular Atrial Fibrillation

Shang

Zhang

Guo

et al. 2021

Front. Cardiovasc. Med.

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“…Причем CACS демонстрирует собственное прогностическое значение как фактор риска некардиоэмболического инсульта независимо от категории риска CHA 2 DS 2 -VASc (p < 0,001). Прогностическое значение каротидного атеросклероза у больных с неклапанной ФП в рамках первичной профилактики было подтверждено многими исследователями [7,9,10,16]. Показано, что при ФП его наличие, независимо от степени каротидного стеноза, ассоциируется с увеличением частоты ОНМК и общей смерти.…”

Section: результатыunclassified

“…Показано, что при ФП его наличие, независимо от степени каротидного стеноза, ассоциируется с увеличением частоты ОНМК и общей смерти. Вместе с тем наличие именно стеноза 50% и более (выявлен в цитируемом исследовании у 7,7% пациентов) уже не выступает однозначным предиктором ухудшения прогноза [10]. Так, по данным проспективного сравнительного исследования, у пациентов с ФП, имевших каротидный стеноз ≥ 50% и < 50% и получавших в обеих группах адекватное лечение варфарином, повышение риска ишемического инсульта или ТИА составило 2,05% vs 1,45% пациентов/год (ОР 1,39, 95% ДИ 0,42-4,48), смерти от всех причин -6,1% vs 3,8% пациентов в год (ОР 1,66, 95% ДИ 0,83-3,32), но не достигло уровня статистической значимости.…”

Section: результатыunclassified

“…Атеросклероз брахиоцефальных артерий (БЦА), церебральная микроангиопатия на фоне АГ и сахарного диабета (СД), нарушения системной гемодинамики, обусловленные, в частности, постинфарктными изменениями сердца, также могут выступать в качестве самостоятельной причины инсульта у больных с ФП и являются показанием для расширения медикаментозного превентивного лечения. Коморбидность пациентов ФП с другими перечисленными патологическими состояниями вызывает дискуссию о безальтернативной целесообразности и исключительной клинической эффективности ОАК [5,6,9,10]. Наиболее часто это обсуждается в случаях развития несомненного некардиоэмболического инсульта у больных с пароксизмальной ФП, включая редкие неустойчивые приступы аритмии.…”

Section: Introductionunclassified

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Recurrent ischemic stroke in patients with atrial fibrillation: frequency, heterogeneity, prevention

et al. 2020

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Introduction. For the prevention of recurrent ischemic stroke (IS) in patients with atrial fibrillation (AF), oral anticoagulants (OAC) are considered a priority. The comorbidity of AF patients raises a discussion about the non-alternative feasibility and exceptional clinical efficacy of OAC. The validity of the choice of a specific antithrombotic agent can be assessed using a dynamic assessment of the causes of the first and recurrent stroke in patients with AF.Aim. To assess the frequency recurrent IS and quality of medicament prevention therapy in patients with AF depend on heterogeneity of stroke leading pathogenetic mechanism.Materials and methods. The data from the register of 200 patients with IS and AF were analyzed. 55 (27.5%) patients suffered recurrent IS (24 (43,6%) men, 31 (56,4%) women, mean age 72,3 ± 10,2 years). The pathogenetic subtype of recurrent IS was determined, including a retrospective assessment of the pathogenetic subtype of a previous IS. We studied the presence and nature of antithrombotic therapy (ATT) preceding a second stroke.Results. The first IS was due to cardiogenic embolism in 36.4% of patients, the atherothrombotic subtype occurred in 18.2%, and the lacunar subtype in 34.5% of patients. Embolic stroke from an undetermined source (ESUS) - in 10.9% of patients. OACs were prescribed only to 31.7% of patients, antiplatelet agents - to 14.6% of patients, 53.7% of patients did not receive ATT. The leading pathogenetic subtype of recurrent stroke was cardiogenic embolism (70.7%), the frequency of lacunar stroke decreased (4.9%), and the frequency of atherothrombotic stroke remained unchanged. In 14 patients with recurrent stroke, AF was first detected, including all patients with ESUS.Conclusion. The proportion of recurrent stroke in patients with AF is 27.5%. Compared with the first stroke, recurrent stroke in patients with AF is characterized by an increase in the proportion of cardiogenic embolism up to 70.7%, which is due to the insufficient prescription of OAC, which must be recommended, including for patients with non-cardioembolic subtypes of stroke.

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“…Hier besteht das Dilemma, dass die Makroangiopathie durch eine Antikoagulation und das Vorhofflimmern durch eine Thrombozytenaggregationshemmung allein nicht ausreichend behandelt sind. Eine dauerhafte kombinierte Gabe beider Medikamentengruppen konterkariert jedoch möglicherweise den Benefit aufgrund der langfristig erhöhten Blutungsraten[25]. Prinzipiell kann bei ACS eine Monotherapie mit direkten oralen Antikoagulanzien (DOAK) angewendet werden.…”

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Therapie bei asymptomatischer Stenose der extrakraniellen A. carotis

Reiff¹,

Ringleb²

2021

Dtsch Med Wochenschr

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Carotid Atherosclerosis in Patients with Atrial Fibrillation

Cited by 20 publications

References 55 publications

A Review of Biomarkers for Ischemic Stroke Evaluation in Patients With Non-valvular Atrial Fibrillation

A Review of Biomarkers for Ischemic Stroke Evaluation in Patients With Non-valvular Atrial Fibrillation

Recurrent ischemic stroke in patients with atrial fibrillation: frequency, heterogeneity, prevention

Therapie bei asymptomatischer Stenose der extrakraniellen A. carotis

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