Impaired endothelial function in lone atrial fibrillation

Polovina, Marija; Potpara, Tatjana; Stepanović, Jelena; Ostojić, Miodrag

doi:10.2298/vsp110429016p

Cited by 16 publications

(17 citation statements)

References 37 publications

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“…Despite evidence of inflammatory atrial lesions [ 16 ] and increased levels of various biomarkers in lone AF [ 17 ], there is no unequivocal link between inflammation, oxidative burden, AF, and vascular disease. In the present study, we have demonstrated higher CRP levels in AF patients compared to healthy controls, which is in line with our previous findings of impaired endothelial function and increased CRP concentrations in subjects with persistent lone AF compared to healthy individuals [ 18 ]. Similarly, increased levels of CRP [ 13 ] and other mediators of inflammation [ 19 ] have been reported in other studies of lone AF patients, with a stepwise CRP elevation associated with increased AF burden [ 13 ].…”

Section: Discussionsupporting

confidence: 93%

Relation of Biomarkers of Inflammation and Oxidative Stress with Hypertension Occurrence in Lone Atrial Fibrillation

Polovina

Ostojić

Potpara

2015

Mediators of Inflammation

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We compared plasma levels of biomarkers of inflammation (CRP) and oxidation (oxLDL), determined at study inclusion in lone atrial fibrillation (LAF) patients (48.6 ± 11.5 years; 74.0% men) and sinus rhythm controls (49.7 ± 9.3 years; 72.7% men, P > 0.05), and investigated the association of baseline CRP and oxLDL levels with the risk for vascular disease (VD) development (hypertension, cerebrovascular disease, coronary/peripheral artery disease, and pulmonary embolism) during prospective follow-up. Baseline CRP (1.2 [0.7–1.9] mg/L versus 1.1 [0.7–1.6] mg/L) and oxLDL levels (66.3 ± 21.2 U/L versus 57.1 ± 14.6 U/L) were higher in LAF patients (both P < 0.05). Following a median of 36 months, incident VD occurred in 14 (28.0%) LAF patients, all of whom developed arterial hypertension, and in 5 (11.4%) controls (hypertension, n = 4; coronary artery disease, n = 1), P < 0.05. LAF patients developed VD more frequently and at a younger age. Both CRP (HR, 2.54; 95% CI, 1.26–5.12; P = 0.009) and oxLDL (HR, 2.24; 95% CI, 1.14–4.40; P = 0.019) were multivariate predictors of incident hypertension in LAF patients, but not in the controls. Further research should clarify clinical relevance of investigated biomarkers for risk stratification and treatment of LAF patients.

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Section: Discussionsupporting

confidence: 93%

Relation of Biomarkers of Inflammation and Oxidative Stress with Hypertension Occurrence in Lone Atrial Fibrillation

Polovina

Ostojić

Potpara

2015

Mediators of Inflammation

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“…There is a constant, gradual, and consistent relationship between blood pressure and stroke risk. As blood pressure increases, the risk of stroke increases, even if it is not in the hypertensive range (10). In our study, hypertension was the most common comorbid disease, like other studies.…”

Section: Discussionsupporting

confidence: 78%

Acil Serviste İnme Tanısı Alan Hastalarda Tam Kan Sayımı Parametreleri ve Erken Dönem Mortalite İlişkisi

Demir¹,

Bildik²,

Gesoğlu³

et al. 2020

Mustafa Kemal Üniversitesi Tıp Dergisi

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Akut iskemik inme, kalp hastalığı ve kanserden sonra en yaygın ölüm nedenidir. İskemik inmenin erken dönemindeki tam kan sayımı parametreleri arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntem: Çalışma geriye dönük arşiv çalışması şeklinde düzenlenmiştir. Acil servise başvuran ve iskemik inme tanısı alan hastalar dahil edilmiştir. Demografik bulgular, tam kan sayımı parametreleri, görüntüleme testleri, acilde kalış süresi, hastanede kalış süresi not edilmiştir. Bulgular: Dört yüz yirmi iki hastanın ortalama yaşı 69,95 ± 12,26 yıldı. Hipertansiyon %68,5 oranıyla en sık görülen ek hastalıktı. İlk 7 günde ölüm oranı %2,1 iken ilk 30 günde %5,2 oldu. Nötrofil Lenfosit Oranının (NLO) ortalama değeri ilk 7 gün içinde ölen hastalarda anlamlı olarak daha yüksekti (p = 0,013). İlk 7 günde ölüm için 4,12 olarak belirlenen NLO cut-off değerinin duyarlılığı %77,8; özgüllüğü %68,5 idi. 30 gün içinde ölen hastaların Kırmızı Hücre Dağılım Genişliği (RDW) değerleri yaşayan hastalara göre istatistiksel olarak anlamlı düzeyde yüksek bulundu. Artan yaş, kalp yetmezliği ve atriyal fibrilasyon, erken ölüm için önemli risk faktörleri olarak bulundu. Sonuç: Sonuç olarak, NLO ilk 7 gün içindeki mortalite ve RDW ilk 30 gün içindeki mortalite için prediktif olabilir. Kalp yetmezliği ve / veya atriyal fibrilasyon varlığı ve 65 yaş ve üstü, erken ölüm riskini arttırmaktadır.

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“…Although heterogeneity in T2DM‐related risk in relation to background left ventricular function has not been explored in AF, it has been demonstrated in HF, where the association between T2DM and mortality or hospitalisation for HF was greater in magnitude in individuals with LVEF ≥40% than in patients with LVEF <40% . Available data suggest that both AF and HFpEF may be considered as systemic disorders that commonly share an association with increased markers of inflammation, fibrosis, and systemic and microvascular endothelial dysfunction . The presence of T2DM may aggravate these pathological processes leading to the more prominent left ventricular diastolic dysfunction and hypertrophy and more pronounced left atrial remodelling, and in turn, to the greater propensity to manifest HFpEF.…”

Section: Discussionmentioning

confidence: 99%

“…40,41 Available data suggest that both AF and HFpEF may be considered as systemic disorders that commonly share an association with increased markers of inflammation, fibrosis, and systemic and microvascular endothelial dysfunction. 39,42,43 The presence of T2DM may aggravate these pathological processes leading to the more prominent preceding HF occurrence at follow-up. ACS, acute coronary syndrome; AF, atrial fibrillation; HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; T2DM, type 2 diabetes mellitus.…”

Section: The Association Between Type 2 Diabetes and Outcomesmentioning

confidence: 99%

Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

Polovina

Lund

Đikić³

et al. 2019

European J of Heart Fail

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Aims Impact of type 2 diabetes mellitus (T2DM) on non‐thromboembolic outcomes in atrial fibrillation (AF) is insufficiently explored. This prospective cohort study of AF patients aimed (i) to analyse the association between T2DM and heart failure (HF) events (including new‐onset HF), and all‐cause and cardiovascular mortality, (ii) to assess the impact of baseline T2DM treatment on outcomes, and (iii) to explore characteristics of new‐onset HF phenotypes in relation to T2DM status. Methods and results Of 1803 AF patients (515/1288, with/without prior HF), 389 (22%) had T2DM at baseline. After 5 years of median follow‐up, T2DM patients had an 85% greater risk of HF events [adjusted hazard ratio (aHR) 1.85; 95% confidence interval (CI) 1.51–2.28; P < 0.001], including a 45% increased risk for new‐onset HF (1.45; 1.17–2.28; P = 0.015). T2DM conferred a 56% higher all‐cause (1.56, 1.22–2.01; P = 0.003) and a 48% higher cardiovascular mortality (1.48; 1.34–1.93; P = 0.007). Fine–Gray analysis, with mortality as a competing risk, confirmed greater HF risk among T2DM patients. All risks were highest among insulin‐treated patients. The prevalence of new‐onset HF phenotypes was as follows: 67% preserved ejection fraction (HFpEF), 20% mid‐range ejection fraction (HFmrEF) and 13% reduced ejection fraction (HFrEF). On time‐dependent Cox regression, adjusted for baseline characteristics and an interim acute coronary event, T2DM increased aHRs for new‐onset HFpEF (2.38; 1.30–4.58; P <0.001) and the combined HFmrEF/HFrEF (1.77; 1.11–3.62; P = 0.017). Conclusions Atrial fibrillation patients with T2DM have independently increased risk of new‐onset/recurrent HF events, cardiovascular and all‐cause mortality, particularly when insulin‐treated. The prevailing phenotype of new‐onset HF was HFpEF; T2DM conferred higher risk of both HFpEF and HFmrEF/HFrEF.

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Impaired endothelial function in lone atrial fibrillation

Cited by 16 publications

References 37 publications

Relation of Biomarkers of Inflammation and Oxidative Stress with Hypertension Occurrence in Lone Atrial Fibrillation

Relation of Biomarkers of Inflammation and Oxidative Stress with Hypertension Occurrence in Lone Atrial Fibrillation

Acil Serviste İnme Tanısı Alan Hastalarda Tam Kan Sayımı Parametreleri ve Erken Dönem Mortalite İlişkisi

Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

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