Thrombogenic Risk in Patients With Atrial Fibrillation

Lim, H.; Schultz, C.; Alasady, M.; Rangnekar, G.; Dang, Jerry; Gan, C.; Lau, Dennis H.; Roberts‐Thomson, Kurt C.; Young, Glenn D.; Worthley, M.; Sanders, Prashanthan

doi:10.1016/j.jacep.2015.03.011

Cited by 10 publications

(11 citation statements)

References 25 publications

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“…This may be attributed to the higher proportion of CHF, HTN, female sex, higher age and DM that are proven to accompany LVH. 11) 12) 13) 14) 15) 16) Increased LV mass impairs the LV diastolic function and elevates the LV end-diastolic pressure (LVEDP) as shown in the increasing values of LVMI, LAVI and E/E′ in Table 2 and Figure 2 . These data suggest that a higher number of clinical attributes favorable of stroke collectively result in impaired diastolic function but not systolic functions.…”

Section: Discussionmentioning

confidence: 96%

Cardiac Structural or Functional Changes Associated with CHA₂DS₂-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography

Jang

Park

et al. 2018

J Cardiovasc Imaging

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BACKGROUNDCHA2DS2-VASc is the most widely accepted scoring system for atrial fibrillation (AF) to assess stroke risk, although little has been revealed regarding the accompanying cardiac functional/structural changes. This echocardiography study was undertaken to understand the changes related to CHA2DS2-VASc scores.METHODSA total of 4,795 nonvalvular AF patients were enrolled for the cohort, from which 591 were excluded as they did not meet the inclusion criteria. Based on the CHA2DS2-VASc scores, the remaining 4,204 patients included in the study were divided into 4 groups: 0 to 1 (n = 991); 2 to 3 (n = 1,642); 4 to 6 (n = 1,407); 7 to 9 (n = 164).RESULTSIncrease in the left ventricular mass index and prevalence of left ventricular hypertrophy (LVH) were observed with elevating CHA2DS2-VASc scores (p < 0.05 for all). Diastolic parameters such as left atrial volume index (LAVI) and the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/E′) also increased significantly in the higher CHA2DS2-VASc score groups (p < 0.001 for all), although two-way ANOVA analysis showed that such incremental diastolic impairment was independent of hypertension. LVH (hazard ratio [HR], 3.609; confidence interval [CI], 2.426–5.369; p < 0.001) and E/E′ (HR, 1.087; CI, 1.054–1.121; p < 0.001) were independent risk factors for CHA2DS2-VASc scores 2 or higher.CONCLUSIONSOur findings suggest that increasing CHA2DS2-VASc scores are associated with impaired diastolic function that may represent high left atrial pressure favoring thrombogenic propensity.

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Section: Discussionmentioning

confidence: 96%

Cardiac Structural or Functional Changes Associated with CHA₂DS₂-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography

Jang

Park

et al. 2018

J Cardiovasc Imaging

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“…Stamboul et al [169] reported higher ADMA levels in patients who developed AF after myocardial infarction. A stepwise increase of ADMA concentrations has been shown in controls, in patients with lone AF and in patients with AF and other comorbidities [170]. This notion fostered further investigation relating ADMA and SDMA to permanent rather than paroxysmal AF in acute ischemic stroke [171].…”

Section: Cardioembolic Stroke and Embolic Stroke Of Undetermined Sourcementioning

confidence: 93%

Arginine Derivatives in Cerebrovascular Diseases: Mechanisms and Clinical Implications

Große

Schwedhelm

Worthmann

et al. 2020

IJMS

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The amino acid L-arginine serves as substrate for the nitric oxide synthase which is crucial in vascular function and disease. Derivatives of arginine, such as asymmetric (ADMA) and symmetric dimethylarginine (SDMA), are regarded as markers of endothelial dysfunction and have been implicated in vascular disorders. While there is a variety of studies consolidating ADMA as biomarker of cerebrovascular risk, morbidity and mortality, SDMA is currently emerging as an interesting metabolite with distinct characteristics in ischemic stroke. In contrast to dimethylarginines, homoarginine is inversely associated with adverse events and mortality in cerebrovascular diseases and might constitute a modifiable protective risk factor. This review aims to provide an overview of the current evidence for the pathophysiological role of arginine derivatives in cerebrovascular ischemic diseases. We discuss the complex mechanisms of arginine metabolism in health and disease and its potential clinical implications in diverse aspects of ischemic stroke.

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“…Cardiovascular risk factors, cardiovascular comorbidities, and AF burden trigger, maintain, and accelerate hemostasis activation [32][33][34][35][36][37][38][39][40]. TF has been reported to be a central initiator and mediator of endothelial activation [36][37][38][39][40][41][42].…”

Section: Plasma Biomarkers Indicate a Prothrombotic And Hypercoagulab...mentioning

confidence: 99%

“…AF (even in the absence of structural heart disease, hypertension, diabetes mellitus, coronary artery disease, or a history of stroke), cardiovascular risk factors, and cardiovascular disease (in the absence of AF) all result in the inflammatory activation of the endothelial layer [32,33]. This phenomenon can be observed locally (LA) and systemically.…”

Section: Plasma Biomarkers Indicate a Prothrombotic And Hypercoagulab...mentioning

confidence: 99%

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Characterization of Biomarkers of Thrombo-Inflammation in Patients with First-Diagnosed Atrial Fibrillation

Friebel,

Wegner,

Blöbaum

et al. 2024

IJMS

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Patients with first-diagnosed atrial fibrillation (FDAF) exhibit major adverse cardiovascular events (MACEs) during follow-up. Preclinical models have demonstrated that thrombo-inflammation mediates adverse cardiac remodeling and atherothrombotic events. We have hypothesized that thrombin activity (FIIa) links coagulation with inflammation and cardiac fibrosis/dysfunction. Surrogate markers of the thrombo-inflammatory response in plasma have not been characterized in FDAF. In this prospective longitudinal study, patients presenting with FDAF (n = 80), and 20 matched controls, were included. FIIa generation and activity in plasma were increased in the patients with early AF compared to the patients with chronic cardiovascular disease without AF (controls; p < 0.0001). This increase was accompanied by elevated biomarkers (ELISA) of platelet and endothelial activation in plasma. Pro-inflammatory peripheral immune cells (TNF-α+ or IL-6+) that expressed FIIa-activated protease-activated receptor 1 (PAR1) (flow cytometry) circulated more frequently in patients with FDAF compared to the controls (p < 0.0001). FIIa activity correlated with cardiac fibrosis (collagen turnover) and cardiac dysfunction (NT-pro ANP/NT-pro BNP) surrogate markers. FIIa activity in plasma was higher in patients with FDAF who experienced MACE. Signaling via FIIa might be a presumed link between the coagulation system (tissue factor-FXa/FIIa-PAR1 axis), inflammation, and pro-fibrotic pathways (thrombo-inflammation) in FDAF.

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Thrombogenic Risk in Patients With Atrial Fibrillation

Abstract: Patients with lone AF and those with AF and comorbidities had a greater propensity for atrial thrombogenesis than controls. Prothrombotic risk is greatest in those with comorbid conditions, in whom enhanced thrombogenesis occurs predominantly through increase in endothelial dysfunction.

Cited by 10 publications

References 25 publications

Cardiac Structural or Functional Changes Associated with CHA₂DS₂-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography

Cardiac Structural or Functional Changes Associated with CHA₂DS₂-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography

Arginine Derivatives in Cerebrovascular Diseases: Mechanisms and Clinical Implications

Characterization of Biomarkers of Thrombo-Inflammation in Patients with First-Diagnosed Atrial Fibrillation

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Thrombogenic Risk in Patients With Atrial Fibrillation

Abstract: Patients with lone AF and those with AF and comorbidities had a greater propensity for atrial thrombogenesis than controls. Prothrombotic risk is greatest in those with comorbid conditions, in whom enhanced thrombogenesis occurs predominantly through increase in endothelial dysfunction.

Cited by 10 publications

References 25 publications

Cardiac Structural or Functional Changes Associated with CHA2DS2-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography

Cardiac Structural or Functional Changes Associated with CHA2DS2-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography

Arginine Derivatives in Cerebrovascular Diseases: Mechanisms and Clinical Implications

Characterization of Biomarkers of Thrombo-Inflammation in Patients with First-Diagnosed Atrial Fibrillation

Contact Info

Product

Resources

About

Cardiac Structural or Functional Changes Associated with CHA₂DS₂-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography

Cardiac Structural or Functional Changes Associated with CHA₂DS₂-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography