Relation of C-reactive protein correlates with risk of thromboembolism in patients with atrial fibrillation

Thambidorai, Senthil; Parakh, Kapil; Martin, David O.; Shah, Tushar K.; Wazni, Oussama; Jasper, Susan E.; Wagoner, David R. Van; Chung, Mina K.; Murray, R.Daniel; Klein, Allan L.

doi:10.1016/j.amjcard.2004.06.011

Cited by 57 publications

(49 citation statements)

References 15 publications

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“…243 Although these findings do not imply a causal relationship, the association may indicate that a thromboembolic milieu in the LA may involve mechanisms linked to inflammation. 243 In patients with rheumatic mitral stenosis undergoing trans-septal catheterization for balloon valvuloplasty, levels of fibrinopeptide A, thrombin-antithrombin III complex, and prothrombin fragment F1.2 are increased in the LA compared with the RA and femoral vein, indicating regional activation of the coagulation system. 244,245 Whether such elevations are related to AF, for example, through atrial pressure overload or due to another mechanism has not been determined.…”

Section: Pathophysiology Of Thrombus Formationmentioning

confidence: 75%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,883

589

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Section: Pathophysiology Of Thrombus Formationmentioning

confidence: 75%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,883

589

View full text Add to dashboard Cite

“…[13][14][15] Hypoxemia, hypercapnia, and atrial stretching caused by higher pressure are stimulants for arrhythmias. CPAP may lower PVAI failure rates in the treated group either by decreasing frequency of hypoxemic episodes, by preventing atrial stretch and stimulation of stretch sensitive channels, or /and by raising the nadir value for nocturnal desaturation, which our study did not measure.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Pulmonary Vein Antral Isolation in Patients With Obstructive Sleep Apnea

Patel

Mohanty

Biase

et al. 2010

Circ: Arrhythmia and Electrophysiology

214

133

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Background— Obstructive sleep apnea (OSA) may be associated with pulmonary vein antrum isolation (PVAI) failure. The aim of the present study was to investigate if treatment with continuous positive airway pressure (CPAP) improved PVAI success rates. Methods and Results— From January 2004 to December 2007, 3000 consecutive patients underwent PVAI. Patients were screened for OSA and CPAP use. Six hundred forty (21.3%) patients had OSA. Patients with OSA had more procedural failures ( P =0.024) and hematomas ( P <0.001). Eight percent of the non-OSA paroxysmal atrial fibrillation patients had nonpulmonary vein antrum triggers (non-PV triggers) and posterior wall firing versus 20% of the OSA group ( P <0.001). Nineteen percent of the non-OSA nonparoxysmal atrial fibrillation population had non-PV triggers versus 31% in the OSA group ( P =0.001). At the end of the follow-up period (32±14 months), 79% of the non-CPAP and 68% of the CPAP group were free of atrial fibrillation ( P =0.003). Not using CPAP in addition to having non-PV triggers strongly predicted procedural failure (hazard ratio, 8.81; P <0.001). Conclusions— OSA was an independent predictor for PVAI failure. Treatment with CPAP improved PVAI success rates. Patients not treated with CPAP in addition to having higher prevalence of non-PV triggers were 8 times more likely to fail the procedure.

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“…35,36 While levels of CRP were similar in this larger population of AF patients, the relation between increasing risk and CRP diminishes in high-risk individuals. The reason for this disparity at high CRP concentrations is likely to relate to other acute inflammatory conditions that are associated with the development of AF, such as pericarditis.…”

Section: Lip Et Al Inflammation and Prognosis In Afmentioning

confidence: 99%

High-Sensitivity C-Reactive Protein and Soluble CD40 Ligand as Indices of Inflammation and Platelet Activation in 880 Patients With Nonvalvular Atrial Fibrillation

Lip

Patel²,

Hughes³

et al. 2007

Stroke

180

104

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Background and Purpose-There is now considerable evidence that atrial fibrillation is associated with an inflammatory state. We tested the hypothesis that plasma levels of C-reactive protein (CRP; an index of inflammation) and soluble CD40 ligand (an index of platelet activation, with links to inflammation) could be related to 3 established stroke risk stratification schema (SPAF, CHADS 2 , and NICE), recognized stroke risk factors or other cardiovascular disease, and prognosis. Methods-We studied 880 subjects with atrial fibrillation recruited from subjects receiving aspirin 325 mg/d (alone or combined with fixed inefficacious doses of warfarin) from the Stroke Prevention in Atrial Fibrillation (SPAF) III clinical trial. CRP and soluble CD40 ligand were measured by enzyme-linked immunosorbent assay. Results-With respect to the SPAF III stroke risk stratification criteria, those with moderate to high risk had the highest levels of CRP (Kruskal Wallis test, PϽ0.001), but those with the highest risk had the lowest levels of soluble CD40 ligand (Pϭ0.01). Similarly, CRP levels increased in a positive fashion with increasing stroke risk with respect to the CHADS 2 and NICE risk stratification criteria, whereas soluble CD40 ligand levels were negatively associated with stroke risk. CRP levels were higher among those patients with raised body mass index, diabetes, hypertension, ischemic heart disease, peripheral vascular disease, and recent heart failure, but not those with thromboembolism. Patients were followed-up for a mean time of 453 (standard deviation, 229) days, and all-cause mortality (log rank test, Pϭ0.001), and vascular events (Pϭ0.05), but not stroke, were more common in patients with high CRP levels. Soluble CD40 ligand levels were not related to stroke, vascular events, or all-cause mortality. Conclusion-Among atrial fibrillation patients, CRP was positively correlated to stroke risk and related to stroke risk factors and prognosis (mortality, vascular events). Soluble CD40 ligand levels were lowest in those at moderate to high risk of stroke and not related to prognosis. The use of CRP in risk stratification for atrial fibrillation merits further study.

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Relation of C-reactive protein correlates with risk of thromboembolism in patients with atrial fibrillation

Cited by 57 publications

References 15 publications

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Safety and Efficacy of Pulmonary Vein Antral Isolation in Patients With Obstructive Sleep Apnea

High-Sensitivity C-Reactive Protein and Soluble CD40 Ligand as Indices of Inflammation and Platelet Activation in 880 Patients With Nonvalvular Atrial Fibrillation

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