NT-proBNP is associated with mortality and adverse cardiac events in patients with atrial fibrillation presenting to the emergency department

Background: Extensive of atrial fibrosis has been demonstrated to significantly predict success of catheter ablation. However, impact of extensive fibrosis on other aspects of patient care and long-term prognosis is unknown. Methods: We conducted a historical cohort study to assess the hypothesis that increased degree of atrial fibrosis is independently associated with major adverse cardiac events (MACE). We reviewed 853 patients with non-valvular atrial fibrillation (NVAF) and quantified fibrosis. Logistic regression models were used to evaluate the association of percent fibrosis on experiencing a MACE. Linear splines were utilized to allow the functional form of the exposure to vary at high (>15%) and low (<15%) fibrosis scores. The outcome of interest was a composite of MACE: myocardial infarction (MI), ischemic stroke (IS), or venous thromboembolism (VTE). Results: The mean age of the cohort was 66.2±12.4 with 66% male and 79% white. During a median follow-up of 2.9 years, 69 (8.1%), 46 (5.4%), 52 (6.1%), and 156 (18.3%) of patients experienced an MI, IS, VTE, or MACE, respectively. High fibrosis patients were more likely to be older, male, and have a higher CHA2DS2-VASc score. In the unadjusted analysis, increased fibrosis was associated with increased odds of a MI (OR [95% CI] P-Value: 1.30 [1.00, 1.68] 0.05) or any MACE (1.28 [1.06, 1.56] 0.01), but not with IS or VTE. After adjusting for potential confounders, increasing fibrosis levels had significantly increased odds of MI (1.53 [1.02, 2.28] 0.04) and VTE (1.52 [1.17, 2.86] <0.01) when fibrosis levels were above 15%. There was no significant association below 15%. The odds of a MACE was significant above 15% (1.64 [1.18, 2.27] <0.01) and across all fibrosis scores (1.23 [1.01, 1.49] 0.04), but was insignificant when only fibrosis levels below 15% were examined. Conclusions: Advanced degree of atrial fibrosis in patients with NVAF is independently associated with increased risk of MI, VTE and a composite of MACE.

Download Full-text

104 Comparison of Chest Pain Risk Scoring Tools to Determine Emergent Cardiac Imaging Needs and Major Adverse Cardiac Events Occurrence in an Emergency Department Observation Unit

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2016.08.116 ◽

2016 ◽

Vol 68 (4) ◽

pp. S42 ◽

Cited By ~ 1

Author(s):

L. Hamblin

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Cardiac Imaging ◽

Major Adverse Cardiac Events ◽

Observation Unit ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Risk Scoring ◽

Scoring Tools

Download Full-text

Risk of Incident Non-Valvular Atrial Fibrillation after Dialysis-Requiring Acute Kidney Injury

Journal of Clinical Medicine ◽

10.3390/jcm7090248 ◽

2018 ◽

Vol 7 (9) ◽

pp. 248 ◽

Cited By ~ 3

Author(s):

Chih-Chung Shiao ◽

Wei-Chih Kan ◽

Jian-Jhong Wang ◽

Yu-Feng Lin ◽

Likwang Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Kidney Injury ◽

De Novo ◽

Kidney Injury ◽

Control Group ◽

Research Database ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Recovery Group ◽

Group Control Group

The influence of acute kidney injury (AKI) on subsequent incident atrial fibrillation (AF) has not yet been fully addressed. This retrospective nationwide cohort study was conducted using Taiwan’s National Health Insurance Research Database from 1 January 2000 to 31 December 2010. A total of 41,463 patients without a previous AF, mitral valve disease, and hyperthyroidism who developed de novo dialysis-requiring AKI (AKI-D) during their index hospitalization were enrolled. After propensity score matching, “non-recovery group” (n = 2895), “AKI-recovery group” (n = 2895) and “non-AKI group” (control group, n = 5790) were categorized. Within a follow-up period of 6.52 ± 3.88 years (median, 6.87 years), we found that the adjusted risks for subsequent incident AF were increased in both AKI-recovery group (adjusted hazard ratio (aHR) = 1.30; 95% confidence intervals (CI), 1.07–1.58; p ≤ 0.01) and non-recovery group (aHR = 1.62; 95% CI, 1.36–1.94) compared to the non-AKI group. Furthermore, the development of AF carried elevated risks for major adverse cardiac events (aHR = 2.11; 95% CI, 1.83–2.43), ischemic stroke (aHR = 1.33; 95% CI, 1.19–1.49), and all stroke (aHR = 1.28; 95% CI, 1.15–1.43). (all p ≤ 0.001, except otherwise expressed) The authors concluded that AKI-D, even in those who withdrew from temporary dialysis, independently increases the subsequent risk of de novo AF.

Download Full-text