Inflammation in Atrial Fibrillation

Guo, Yutao; Lip, Gregory Y.H.; Apostolakis, Stavros

doi:10.1016/j.jacc.2012.04.063

Cited by 713 publications

(596 citation statements)

References 42 publications

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“…Fifth, inflammatory reaction and prothrombotic state may produce LA thrombus. 23,24) However, inflammatory changes of LA endothelium and markers of coagulation were not evaluated in this study.…”

Section: Discussionmentioning

confidence: 98%

Blood Stasis Secondary to Heart Failure Forms Warfarin-Resistant Left Atrial Thrombus

Watanabe

Yamashita

2014

Int. Heart J.

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SummaryAnticoagulants such as warfarin are recommended for patients with atrial fibrillation (AF) to decrease stroke risk associated with thrombus formation in the left atrium (LA). In a subgroup of patients, however, warfarin is unable to prevent LA thrombus formation at therapeutic doses. This study characterized the clinical and echocardiographic features of patients having warfarin-resistant LA thrombus.Of the 1364 nonvalvular AF patients examined by transesophageal echocardiography, 431 received warfarin. A total of 10 patients (2.3% of warfarin-treated patients) exhibited LA thrombus formation even during warfarin treatment at a dose and duration sufficient for increasing the prothrombin time-international normalized ratio (PT-INR) to the therapeutic range for ≥ 30 days. Categorical regression analysis revealed that decreased LA appendage (LAA) flow velocity, greater LA spontaneous echocardiographic contrast (LASEC), and lower left ventricular ejection fraction (LVEF) significantly contributed to residual LA thrombus (P < 0.05 for all). Receiver operating characteristic (ROC) curve analysis indicated that higher right ventricular systolic pressure, which suggests LA pressure (area under curve, 0.85), LV mass index (0.81), and LA dimension (0.68), as well as lower LAA flow velocity (0.92) and LVEF (0.91) predicted warfarinresistant LA thrombus formation (all P < 0.05).These results suggest that blood stasis secondary to heart failure contributes to the formation of warfarin-resistant LA thrombus. We propose that therapies to increase LVEF should be administered together with warfarin for AF patients with heart failure to decrease stroke risk. (Int Heart J 2014; 55: 506-511)

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Section: Discussionmentioning

confidence: 98%

Blood Stasis Secondary to Heart Failure Forms Warfarin-Resistant Left Atrial Thrombus

Watanabe

Yamashita

2014

Int. Heart J.

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“…Height, weight, and body fat predispose to LA enlargement, which in turn predisposes to AF 35, 36. Higher BMI is associated with inflammation, which is reflected in higher concentrations of C‐reactive protein 37. In addition, general obesity is a major risk factor for obstructive sleep apnea; sleep apnea predisposes to AF 30.…”

Section: Discussionmentioning

confidence: 99%

Associations of Abdominal Obesity and New‐Onset Atrial Fibrillation in the General Population

Baek

Yang

Kim

et al. 2017

JAHA

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BackgroundHigher height and weight are known to be associated with higher risk of atrial fibrillation (AF); however, whether the risk of AF is related to abdominal obesity is unclear.Methods and ResultsWe studied 501 690 adults (mean age: 47.6±14.3 years; 250 664 women [50.0%]) without baseline AF in the National Sample Cohort released by the National Health Insurance Service in Korea. Body mass index (underweight defined as <18.5; normal, 18.5 to <25.0; overweight, 25.0 to <30.0; and obese, ≥30.0) and waist circumference (abdominal obesity defined as ≥90 cm for men and ≥80 cm for women) were evaluated. During a mean follow‐up of 3.9±1.3 years, 3443 participants (1432 women [41.6%]) developed AF. In multivariable models adjusted for clinical variables, the AF risk of underweight, overweight, and obese individuals increased by 21% (95% confidence interval, 1.01–1.45, P=0.043), 14% (95% confidence interval, 1.06–1.23, P<0.001), and 52% (95% confidence interval, 1.30–1.78, P<0.001), respectively, compared with those with normal body mass index. AF risk with confounder‐adjusted hazards for abdominal obesity was 18% (95% confidence interval, 1.10–1.27, P<0.001). The increased AF risk was present in abdominally obese individuals regardless of body mass index except for the obese group. In subgroup analysis, abdominal obesity by waist circumference conferred increased risk of new‐onset AF, particularly in participants without comorbidities.ConclusionsAbdominal obesity is an important, potentially modifiable risk factor for AF in nonobese Asian persons. These data suggest that interventions to decrease abdominal obesity may reduce the population burden of AF.

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“…Our data showed that the joint association of elevated GGT and CRP levels was associated with a stronger risk of SCD, but the estimate was imprecise and was not statistically significant because of the small number of SCDs in each category (data not shown). Other likely pathways include the involvement of GGT in impairing antioxidant defense systems and promoting oxidative stress16 and underlying fatty liver,16 which is also associated with insulin resistance and oxidative stress,33, 34 all known to be associated with increased risk of CVD 35, 36, 37. Through its involvement in atheromatous plaque formation,29, 30 GGT may also cause acute myocardial ischemia, which is the most common trigger for fatal arrhythmias 38.…”

Section: Discussionmentioning

confidence: 99%

γ‐Glutamyltransferase and Risk of Sudden Cardiac Death in Middle‐Aged Finnish Men: A New Prospective Cohort Study

Kunutsor

Khan

Laukkanen

2016

JAHA

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Backgroundγ‐Glutamyltransferase (GGT) has been linked to an increased risk of several cardiovascular outcomes; however, the relationship of GGT with sudden cardiac death (SCD) has not been investigated previously. We aimed to assess the association of GGT with risk of SCD.Methods and ResultsSerum GGT activity was assessed at baseline in the Kuopio Ischemic Heart Disease prospective cohort of 1780 men, and 136 SCDs were recorded during 22 years of follow‐up. Correction for within‐person variability was made using data from repeated measurements taken several years apart. The regression dilution ratio of loge GGT adjusted for age was 0.68 (95% CI 0.61–0.74). Serum GGT was log‐linearly associated with risk of SCD. The hazard ratio for SCD per 1 SD higher baseline loge GGT values (2‐fold higher) was 1.30 (95% CI 1.10–1.54; P=0.002) after adjustment for several established risk factors and remained consistent with further adjustment for alcohol consumption, resting heart rate, lipids, and C‐reactive protein (hazard ratio 1.26, 95% CI 1.05–1.50; P=0.014). The corresponding hazard ratios were 1.48 (95% CI 1.15–1.89; P=0.002) and 1.40 (95% CI 1.07–1.82; P=0.014) after correction for within‐person variability. Hazard ratios remained unchanged after accounting for incident coronary events and did not vary importantly by levels or categories of prespecified conventional risk factors.Conclusions GGT is positively, log‐linearly, and independently associated with future risk of SCD in the general male population. Further research is needed to replicate these findings.

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Inflammation in Atrial Fibrillation

Cited by 713 publications

References 42 publications

Blood Stasis Secondary to Heart Failure Forms Warfarin-Resistant Left Atrial Thrombus

Blood Stasis Secondary to Heart Failure Forms Warfarin-Resistant Left Atrial Thrombus

Associations of Abdominal Obesity and New‐Onset Atrial Fibrillation in the General Population

γ‐Glutamyltransferase and Risk of Sudden Cardiac Death in Middle‐Aged Finnish Men: A New Prospective Cohort Study

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