المؤلفون: Morales-Lara AC; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Elkhatib W; Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA., Oluleye O; Essentia Health Heart and Vascular Center, Fargo, North Dakota, USA., Alhusain R; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Saad A; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Salwa N; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Siddiqui H; Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA., Wieczorek MA; Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA., Ray J; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Parikh P; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Burger C; Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida, USA., Shapiro B; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Kusumoto F; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Pillai D; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Adedinsewo D; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA.

المصدر: Cardiology [Cardiology] 2023; Vol. 148 (4), pp. 353-362. Date of Electronic Publication: 2023 Jun 05.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Karger Country of Publication: Switzerland NLM ID: 1266406 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1421-9751 (Electronic) Linking ISSN: 00086312 NLM ISO Abbreviation: Cardiology Subsets: MEDLINE

مواضيع طبية MeSH: Atrial Fibrillation*/complications , Atrial Fibrillation*/epidemiology , Atrial Fibrillation*/diagnosis , Hypertension, Pulmonary*/epidemiology , Hypertension, Pulmonary*/complications , Atrial Flutter*/complications, Humans ; Female ; Male ; Retrospective Studies ; Heart Atria ; Risk Factors ; Hemodynamics

مستخلص: Introduction: Atrial fibrillation/flutter (AF) is common among patients with pulmonary hypertension (PH) and is associated with poor clinical outcomes. AF has been shown to occur more commonly among patients with postcapillary PH, although AF also occurs among patients with precapillary PH. The goal of this study was to evaluate the independent impact of PH hemodynamic phenotype on incident AF among patients with PH.
Methods: We retrospectively identified 262 consecutive patients, without a prior diagnosis of atrial arrhythmias, seen at the PH clinic at Mayo Clinic, Florida, between 1997 and 2017, who had right heart catheterization and echocardiography performed, with follow-up for outcomes through 2021. Kaplan-Meier analysis and Cox-proportional hazards regression modeling were used to evaluate the independent effect of PH hemodynamic phenotype on incident AF.
Results: Our study population was classified into two broad PH hemodynamic groups: precapillary (64.9%) and postcapillary (35.1%). The median age was 59.5 years (Q1: 48.4, Q3: 68.4), and 72% were female. In crude models, postcapillary PH was significantly associated with incident AF (HR 2.17, 95% CI: 1.26-3.74, p = 0.005). This association was lost following multivariable adjustment, whereas left atrial volume index remained independently associated with incident AF (aHR 1.30, 95% CI: 1.09-1.54, p = 0.003).
Conclusion: We found PH hemodynamic phenotype was not significantly associated with incident AF in our patient sample; however, echocardiographic evidence of left atrial remodeling appeared to have a greater impact on AF development. Larger studies are needed to validate these findings and identify potential modifiable risk factors for AF in this population.
(© 2023 S. Karger AG, Basel.)

المؤلفون: Adedinsewo D; Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA, Adedinsewo.Demilade@mayo.edu., Salwa N; Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Sennhauser S; Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Farhat S; Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Winder J; Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Lesser E; Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA., White L; Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA., Landolfo C; Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Venkatachalam KL; Division of Cardiovascular Medicine, Electrophysiology and Pacing Service, Mayo Clinic, Jacksonville, Florida, USA., Pollak P; Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Parikh P; Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA.

المصدر: Cardiology [Cardiology] 2021; Vol. 146 (1), pp. 106-115. Date of Electronic Publication: 2020 Aug 18.

نوع المنشور: Journal Article; Observational Study

بيانات الدورية: Publisher: Karger Country of Publication: Switzerland NLM ID: 1266406 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1421-9751 (Electronic) Linking ISSN: 00086312 NLM ISO Abbreviation: Cardiology Subsets: MEDLINE

مواضيع طبية MeSH: Atrial Appendage*/diagnostic imaging , Atrial Appendage*/surgery , Stroke*/etiology , Stroke*/prevention & control, Aged ; Anticoagulants/therapeutic use ; Female ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

مستخلص: Introduction: Percutaneous left atrial appendage closure is an established alternative to anticoagulation therapy for stroke prophylaxis among patients with nonvalvular atrial fibrillation. There are currently no guidelines on the choice of antithrombotic therapy following placement of the Watchman® device, the optimal time to discontinue anticoagulation or the duration of follow-up imaging after device deployment. Our main objective was to evaluate clinical outcomes among these patients.
Methods: We conducted a retrospective review of patients who received a Watchman® device at Mayo Clinic sites between January 2010 and December 2018. We constructed Cox-proportional hazard models to evaluate the effect of specific variables on clinical outcomes.
Results: 231 patients were identified (33% female), median age was 77 years, CHA2DS2-VASc score was 5 and HASBLED score was 4. We found no difference in clinically significant bleeding based on initial antithrombotic choice. However, patients with prior gastrointestinal bleeding were more likely to have a bleeding event in the first 6 weeks following Watchman® implantation (HR 9.40, 95% CI 2.15-41.09). Device sizes of 24-27 mm were significantly associated with a decreased risk of thromboembolic events (HR 0.15, 95% CI 0.04-0.55) compared to 21-mm devices. Peridevice leak (PDL) sizes appeared to either remain the same or increase on follow-up imaging.
Discussion/conclusions: This observational study showed no statistically significant difference in bleeding risk related to initial antithrombotic choice. Smaller device sizes were associated with thromboembolic events, and longitudinal PDL assessment using transesophageal echocardiography showed these frequently do not decrease in size. Larger studies are needed.
(© 2020 S. Karger AG, Basel.)