Selected Advancements in the Management of Atrial Fibrillation from the Year 2021

Reiffel, James A.

doi:10.19102/icrm.2022.130107

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Entre todos los ACV, el 87% son isquémicos, el 10% son hemorragia intracerebral y el 3% son hemorragia subaracnoidea. Existe una fuerte asociación entre la FA y el ACV, que se ha encontrado que está relacionada con el 15%-20% de todos los ACV isquémicos (Reiffel, 2024). La FA es muy prevalente, con un riesgo de por vida de aproximadamente 1 de cada 3 a 5 personas después de los 45 años.…”

Section: Carga Global Por Enfermedades Cardiovascularesunclassified

Epidemiología de las enfermedades cardiovasculares: una revisión narrativa

Godoy-Valderrama,

Aguilar Vásquez,

Valero Cedeño

2024

UNESUM-Ciencias

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Las enfermedades cardiovasculares (ECV), principalmente la cardiopatía isquémica y los accidentes cerebrovasculares, son la principal causa de mortalidad mundial y un importante contribuyente a la discapacidad. La carga de las ECV se ve influida por determinantes genéticos, metabólicos, comportamentales, ambientales y sociales. Sin embargo, la baja actividad física y la presión arterial desempeñan un papel central como factores de riesgo para las ECV. Los casos prevalentes de ECV son de 523 millones en el 2019 y el número de muertes por estas patologías aumentó constantemente hasta alcanzar 18,6 millones en el mismo periodo, por lo que, en la actualidad, la cardiopatía y los accidentes cerebrovasculares fueron la primera y la segunda causa de muerte en América, mientras que a nivel mundial, el accidente cerebrovascular siguió siendo la segunda causa de muerte. Es evidente que monitorear la carga de las enfermedades cardiovasculares es de vital importancia, este artículo revisa la epidemiología total de estas, incluidas las causas subyacentes de muerte cardiovascular y los factores de riesgo relacionados, utilizando estimaciones mundiales y fuentes de datos disponibles a nivel de población sobre incidencia, prevalencia, letalidad, mortalidad y riesgos para la salud en los países de América Latina y el mundo en los últimos cinco años, de allí que se plantea esta actualización narrativa de diseño documental, que pretende aportar al conocimiento de este importante problema de salud pública, contribuyendo a las acciones de prevención e intervenciones efectivas para frenar la carga de las enfermedades ECV, especialmente en las regiones con índices sociodemográficos más bajos.

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Section: Carga Global Por Enfermedades Cardiovascularesunclassified

Epidemiología de las enfermedades cardiovasculares: una revisión narrativa

Godoy-Valderrama,

Aguilar Vásquez,

Valero Cedeño

2024

UNESUM-Ciencias

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“…2 The prevention of major adverse outcomes must be considered beyond simply reducing AF-associated symptoms, and such are of concern both in patients with episodes of symptomatic AF as well as in those whose AF remains asymptomatic until a major adverse outcome brings it to attention. Moreover, outcomes such as HF, TE, hospitalization, and death have been used as efficacy-defining events in recent clinical trials (as I noted in my 2021 year-end commentary 4 ) as they are easy to count, rather non-subjective, and in that respect are considered useful for U.S. Food and Drug Administration (FDA) analyses, similar to the time to first recurrence. These contrast with qualitative but not quantitative efficacy criteria, such as QoL.…”

Section: What Defines Efficacy?mentioning

confidence: 99%

Defining Anti-arrhythmic Efficacy in the Setting of Evolving Concepts About Atrial Fibrillation

Reiffel¹

2023

J Innov Cardiac Rhythm Manage.

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“…Despite the broad array of available diagnostic tools and therapeutic interventions, recurrent AF, treatment resistance, and adverse side effects of current pharmacotherapies remain pressing challenges in this setting [5]. Moreover, current therapies do not explicitly target AF's molecular and genetic contributors, leading to a one-size-fits-all approach that often overlooks the patient's individualized pathophysiology [6]. Therefore, a more complete understanding of its underlying molecular and genetic contributors has become essential [7].…”

Section: Introductionmentioning

confidence: 99%

The Transcriptional Landscape of Atrial Fibrillation: A Systematic Review and Meta-analysis

Gómez-Ochoa,

Möhn,

Malz

et al. 2023

Preprint

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Background and AimsDespite advances in understanding atrial fibrillation (AF) pathophysiology through the lens of transcriptomics, marked differences in the key AF genes between studies remain, while drugs targeting preserved dysregulated pathways are limited. This systematic review and meta-analysis aimed to provide a consensus transcriptional signature of AF and use it to identify potentially repurposable drugs.MethodsBibliographic databases and data repositories were systematically searched for studies reporting gene expression patterns in atrial heart auricle tissue from patients with AF and controls in sinus rhythm. A qualitative synthesis and a transcriptomics meta-analysis were performed. We calculated the pooled differences in individual gene expression to create a consensus signature (CS), from which we identified differentially regulated pathways and estimated transcription factors activity. We also created a protein-protein interaction network to identify drug interactions with highly interconnected genes (hub genes) from the AF-CS.ResultsThirty-four observational studies were assessed in the qualitative synthesis, while fourteen, comprising 511 samples (338 AF and 173 SR), were included in the meta-analysis. Despite the heterogeneity observed across individual studies, the AF-CS in both chambers were consistent and robust, showing a better performance in classifying AF status than individual studies. The functional analysis revealed commonality in the dysregulated cellular processes across the atria, including extracellular matrix remodeling, downregulation of cardiac conduction pathways, metabolic derangements, and innate immune system activity processes. Finally, drug-gene analyses highlighted several compounds as repurposing drug candidates for AF, highlighting lipid-lowering agents, antioxidants, and retinoids, among others.ConclusionsDespite variability in individual studies, this meta-analysis elucidated conserved molecular pathways involved in AF pathophysiology across its phenotypes, offering robust and potentially generalizable diagnostic biomarkers. From this AF-CS, we identified potential compounds targeting these dysregulated pathways, thereby addressing an extant gap in AF-specific pharmacotherapy.Key QuestionCan a meta-analytically derived consensus transcriptional signature effectively capture the core molecular mechanisms underlying AF and serve as a basis for identifying novel drug candidates targeting these conserved pathways?Key FindingsExtracellular matrix remodeling, downregulation of cardiac conduction pathways, and modulation of innate immune system activity emerged as conserved molecular hallmarks across the AF spectrum. Drug-gene interaction analyses highlighted the repurposing potential of lipid-lowering agents, antioxidants, and retinoids, among other compounds, for targeted intervention in these dysregulated pathways.Take Home MessageDespite AF’s complexity, a transcriptional signature derived through a meta-analysis can pinpoint conserved molecular pathways across AF phenotypes. These insights provide a foundation for identifying and repurposing drugs targeting the core dysregulated processes in the disease, offering new avenues for targeted, mechanism-based treatment of AF.GRAPHICAL ABSTRACT

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Selected Advancements in the Management of Atrial Fibrillation from the Year 2021

Cited by 3 publications

References 19 publications

Epidemiología de las enfermedades cardiovasculares: una revisión narrativa

Epidemiología de las enfermedades cardiovasculares: una revisión narrativa

Defining Anti-arrhythmic Efficacy in the Setting of Evolving Concepts About Atrial Fibrillation

The Transcriptional Landscape of Atrial Fibrillation: A Systematic Review and Meta-analysis

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