Liver Disease as a Predictor of New‐Onset Atrial Fibrillation

Huang, William A.; Dunipace, Eric A.; Sorg, Julie M.; Vaseghi, Marmar

doi:10.1161/jaha.118.008703

Cited by 52 publications

(53 citation statements)

References 43 publications

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“…Unlike the situation in patients without cirrhosis, prolonged QTc is not considered a risk factor for torsade de pointes ventricular tachycardia in cirrhosis. Atrial fibrillation is common in ESLD and increases with increasing Model for End‐Stage Liver Disease score . Atrial fibrillation and other dysrhythmias have been associated with increased cardiovascular events in the perioperative period and worse long‐term outcomes …”

Section: Potential Additional Markers Of Ccmmentioning

confidence: 99%

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Redefining Cirrhotic Cardiomyopathy for the Modern Era

et al. 2019

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Cirrhotic cardiomyopathy (CCM) is cardiac dysfunction in patients with end‐stage liver disease in the absence of prior heart disease. First defined in 2005 during the World Congress of Gastroenterology, CCM criteria consisted of echocardiographic parameters to identify subclinical cardiac dysfunction in the absence of overt structural abnormalities. Significant advancements in cardiovascular imaging over the past 14 years, including the integration of myocardial deformation imaging into routine clinical practice to identify subclinical cardiovascular dysfunction, have rendered the 2005 CCM criteria obsolete. Therefore, new criteria based on contemporary cardiovascular imaging parameters are needed. In this guidance document, assembled by a group of multidisciplinary experts in the field, new core criteria based on contemporary cardiovascular imaging parameters are proposed for the assessment of CCM. This document provides a critical assessment of the diagnosis of CCM and ongoing assessment aimed at improving clinical outcomes, particularly surrounding liver transplantation. Key points and practice‐based recommendations for the diagnosis of CCM are provided to offer guidance for clinicians and identify gaps in knowledge for future investigations.

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Section: Potential Additional Markers Of Ccmmentioning

confidence: 99%

“…Atrial fibrillation is common in ESLD and increases with increasing Model for End-Stage Liver Disease score. (58) Atrial fibrillation and other dysrhythmias have been associated with increased cardiovascular events in the perioperative period and worse long-term outcomes. (59,60)…”

Section: Biomarkersmentioning

confidence: 99%

Redefining Cirrhotic Cardiomyopathy for the Modern Era

et al. 2019

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“…After excluding duplicates, based on the titles and abstracts of 89 citations (in accordance with the aforementioned exclusion criteria of the meta‐analysis), we initially identified 11 potentially relevant studies from PubMed, Web of Science and Scopus databases prior to December 14, 2018 (date last searched). After examining the full text of these 11 publications, we further excluded 2 studies, because of unsatisfactory inclusion criteria ( n = 1) or unsatisfactory outcome measures ( n = 1), as specified in the PRISMA flow diagram.…”

Section: Resultsmentioning

confidence: 99%

“…We used STATA® 14.2 (StataCorp, College Station, Texas) for all statistical analyses. the full text of these 11 publications, [11][12][13][14][15][16][17][18]24,25 we further excluded 2 studies, 24,25 because of unsatisfactory inclusion criteria (n = 1) or unsatisfactory outcome measures (n = 1), as specified in the PRISMA flow diagram.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Association between non‐alcoholic fatty liver disease and risk of atrial fibrillation in adult individuals: An updated meta‐analysis

Mantovani

Dauriz

Sandri

et al. 2019

Liver International

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Background & Aims Recent studies examined the association between non‐alcoholic fatty liver disease (NAFLD) and risk of atrial fibrillation (AF) in adults, but the findings have been inconsistent. We provided a quantitative estimate of the magnitude of the association between NAFLD and risk of AF. Methods We searched publication databases using predefined keywords to identify observational studies (published up to December 14, 2018), in which NAFLD was diagnosed by biopsy, imaging or biochemistry and AF was diagnosed by medical history and electrocardiograms. Data from selected studies were extracted and meta‐analysis was performed using random‐effects modelling. Results Nine cross‐sectional and longitudinal studies were included in the final analysis (n = 364 919 individuals). Meta‐analysis of data from 5 cross‐sectional studies showed that NAFLD was associated with an increased risk of prevalent AF (random‐effects odds ratio 2.07, 95% CI 1.38‐3.10; I2 = 54.7%), independent of age, sex, body mass index, hypertension and other common AF risk factors. This risk was particularly high among patients with established diabetes (n = 1 study; random‐effects odds ratio 5.17, 95% CI 2.05‐13.02). Meta‐analysis of data from 4 longitudinal studies showed that NAFLD was independently associated with a 10‐year increased risk of incident AF only in type 2 diabetic patients (n = 1 study; random‐effects hazard ratio 4.96, 95% CI 1.42‐17.28). Sensitivity analyses did not modify these findings. Funnel plots did not reveal significant publication bias. Conclusions NAFLD is associated with an increased risk of AF in middle‐aged and elderly individuals (especially in those with type 2 diabetes). However, the observational design of the eligible studies does not allow for proving causality.

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“…Prevalence of AF in the general population is approximately 1%-2% in the US 14 . However, regarding the incidence and prevalence of AF in patients with liver cirrhosis, existing publications yielded inconsistent results [15][16][17][18][19][20][21][22] . Some data suggested that cirrhosis might confer a protective effect against the occurrence of AF 15,23 .…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation in hospitalized patients with end‐stage liver disease: temporal trends in prevalence and outcomes

Han

Qin

et al. 2019

Liver International

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Background & Aims End‐stage liver disease (ESLD) happens due to the development and progression of chronic liver disease. This study aims to investigate the temporal trend, patient characteristics and outcomes of atrial fibrillation (AF) in hospitalized ESLD patients across the United States. Methods Nationwide Inpatient Sample from 2003 to 2014 was utilized to retrospectively study the weighted prevalence of AF in hospitalized ESLD patients. Multivariable regression models were used to assess the association between AF with clinical factors, in‐hospital mortality, length of stay (LOS) and cost. Results 639 345 hospitalizations associated with ESLD were identified, of which 47 710 (7.48%) were diagnosed with AF. The prevalence of AF increased from 5.73% in 2003 to 9.75% in 2014 in ESLD and varied by age, race, income, insurance type and hospital characteristics. Factors associated with AF included advancing age, male, white race, high income and urban teaching hospital. AF presence was associated with significant higher in‐hospital mortality (odds ratio, 1.40; 95% confidence interval, 1.35‐1.45), 21% longer LOS and 22% higher cost. In addition, a significant decreasing trend in in‐hospital mortality was observed (from 16.70% to 10.63% in patients with AF and from 10.74% to 7.50% in patients without AF). Conclusions The prevalence of AF in hospitalized ESLD patients has continued to increase from 2003 through 2014. AF is associated with poor prognosis and higher health resource utilization. Innovative anticoagulation strategies through improved collaboration between cardiologists and hepatologists are required for better management of hospitalized ESLD patients comorbid with AF.

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Liver Disease as a Predictor of New‐Onset Atrial Fibrillation

Cited by 52 publications

References 43 publications

Redefining Cirrhotic Cardiomyopathy for the Modern Era

Redefining Cirrhotic Cardiomyopathy for the Modern Era

Association between non‐alcoholic fatty liver disease and risk of atrial fibrillation in adult individuals: An updated meta‐analysis

Atrial fibrillation in hospitalized patients with end‐stage liver disease: temporal trends in prevalence and outcomes

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