Associations and outcomes of cardiovascular calcifications by computed tomography in atrial fibrillation patients

Abstract Background Coronary (CAC), mitral annular (MAC), aortic valve (AVC) and thoracic aortic (TAC) calcifications are known imaging biomarkers for cardiovascular risk in the general population. Despite this, their prognostic value are not well established in atrial fibrillation (AF) patients who have elevated risk for cardiovascular events. Purpose We assessed the associated factors and outcomes of cardiovascular calcifications detected by computed tomography (CT) in AF patients undergoing pulmonary vein isolation (PVI). Methods Consecutive AF patients enrolled in a prospective PVI registry during 2014–2018 with CT performed within 1-year of their procedure were reviewed for the presence of cardiovascular calcifications on CT. Risk factors and outcomes for each type of cardiovascular calcifications were analyzed in univariable and multivariable regression models. Results Amongst 3604 AF patients, there were 2238 (62.1%), 308 (8.6%), 572 (15.9%) and 1048 (29.1%) patients with CAC, MAC, AVC and TAC respectively. Factors independently associated with these cardiovascular calcifications are listed in Table 1. During mean follow-up of 2.8±1.6 years, there were 97 (2.7%) all-cause deaths, and 158 (4.4%) major adverse cardiovascular events (MACE). Forest plots of unadjusted and adjusted hazards ratios of cardiovascular calcifications at predicting these outcomes are shown in Figure 1. Conclusion Cardiovascular calcifications especially CAC are prevalent in AF patients, and share common risk factors with cardiovascular events, except for female being protective for CAC and AVC but having higher risk of MAC and TAC. Although all cardiovascular calcifications were associated with death and MACE in unadjusted analyses, only CAC remained so for both outcomes in adjusted analyses. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): National Heart Foundation of New Zealand Table 1 Figure 1

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Atrial fibrillation progression and prevention

ESC CardioMed ◽

10.1093/med/9780198784906.003.0501 ◽

2018 ◽

pp. 2135-2139

Author(s):

Justin G. L. M. Luermans ◽

Jordi Heijman ◽

Isabelle C. Van Gelder ◽

Harry J. G. M. Crijns

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Sinus Rhythm ◽

Clinical Significance ◽

Cardiovascular Events ◽

Therapeutic Options ◽

Major Adverse Cardiovascular Events ◽

Pathophysiological Mechanisms ◽

Underlying Mechanisms ◽

Sinus Rhythm Maintenance

Atrial fibrillation (AF) patients are commonly classified into five groups, first-diagnosed, paroxysmal, persistent, long-standing persistent, or permanent AF, based on the duration of AF and clinical conventions. Progression of AF to longer-lasting forms is common and has important clinical significance, affecting both the success of sinus rhythm maintenance and the occurrence of major adverse cardiovascular events. As such, there is considerable interest in the underlying mechanisms and therapeutic options to prevent AF progression. This chapter discusses the epidemiology, risk factors, and clinical significance of AF progression. It also provides background on the pathophysiological mechanisms of AF progression and highlights options for its management and prevention.

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POS1015 ANTI-TNF DRUGS AND CARDIOVASCULAR EVENTS IN PATIENTS WITH SPONDYLOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4133 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 775.2-776

Author(s):

C. W. S. Chan ◽

P. H. LI ◽

C. S. Lau ◽

H. Y. Chung

Keyword(s):

Risk Factors ◽

Psoriatic Arthritis ◽

Cardiovascular Events ◽

Clinical Information ◽

Incidence Rates ◽

Major Adverse Cardiovascular Events ◽

Cross Sectional ◽

Cerebrovascular Events ◽

Cardiovascular Morbidity And Mortality

Background:Cardiovascular (CVS) diseases are the leading cause of death worldwide and patients with rheumatic diseases have an increased CVS risk including stroke and myocardial infarction (MI) (1-3). CVS risk factors and CVS events are common in SpA (4). Delineating the CVS risk and the association with medications in patients with SpA would be useful.Objectives:The objective of this study was to delineate the CVS risk and the association with medications in patients with SpA.Methods:Patients with SpA and patients with non-specific back pain (NSBP) were identified in rheumatology and orthopedics clinics respectively. Clinical information and CVS events were retrieved. Incidence rates were calculated. Association analysis was performed to determine the CVS risk of SpA and other modifiable risk factors.Results:A total of 5046 patients (SpA 2616 and NSBP 2430) were included from eight centers. Over 56 484 person-years of follow-up, 160 strokes, 84 MI and 262 major adverse cardiovascular events (MACE) were identified. Hypercholesterolemia was more prevalent in SpA (SpA 34.2%, NSBP 28.7%, P<0.01). Crude incidence rates of stroke and MI were higher in SpA patients. SpA was associated with a higher risk of MACE (HR 1.66, 95%CI 1.22-2.27, P<0.01) and cerebrovascular events (HR 1.42, 95%CI 1.01-2.00, p=0.04). The use of anti-tumor necrosis factor (TNF) drugs was associated with a reduced risk of MACE (HR 0.37, 95%CI 0.17-0.80, P=0.01) and cerebrovascular events (HR 0.21, 95%CI 0.06-0.78, P=0.02).Conclusion:SpA is an independent CVS risk factor. Anti-TNF drugs were associated with a reduced CVS risk in these patients.References:[1]Crowson CS, Liao KP, Davis JM, 3rd, Solomon DH, Matteson EL, Knutson KL, et al. Rheumatoid arthritis and cardiovascular disease. Am Heart J. 2013;166(4):622-8 e1.[2]Verhoeven F, Prati C, Demougeot C, Wendling D. Cardiovascular risk in psoriatic arthritis, a narrative review. Joint Bone Spine. 2020;87(5):413-8.[3]Liew JW, Ramiro S, Gensler LS. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis. Best Pract Res Clin Rheumatol. 2018;32(3):369-89.[4]Molto A, Etcheto A, van der Heijde D, Landewe R, van den Bosch F, Bautista Molano W, et al. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016;75(6):1016-23.Disclosure of Interests:None declared.

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Risk factors for major adverse cardiovascular events after the first acute coronary syndrome

Annals of Medicine ◽

10.1080/07853890.2021.1924395 ◽

2021 ◽

Vol 53 (1) ◽

pp. 817-823

Author(s):

Marjo Okkonen ◽

Aki S. Havulinna ◽

Olavi Ukkola ◽

Heikki Huikuri ◽

Arto Pietilä ◽

...

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Coronary Syndrome

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Correction to: Major adverse cardiovascular events in non-valvular atrial fibrillation with chronic obstructive pulmonary disease: the ARAPACIS study

Internal and Emergency Medicine ◽

10.1007/s11739-018-1922-y ◽

2018 ◽

Vol 13 (8) ◽

pp. 1349-1349 ◽

Cited By ~ 1

Author(s):

Valeria Raparelli ◽

◽

Daniele Pastori ◽

Serena Francesca Pignataro ◽

Anna Rita Vestri ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

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Antiarrhythmic drug therapy after catheter ablation for atrial fibrillation has no impact on recurrences, cardiovascular events and mortality – insights from the German Ablation Registry

European Heart Journal ◽

10.1093/eurheartj/ehab724.0357 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Schleberger ◽

A Metzner ◽

K H Kuck ◽

D Andresen ◽

S Willems ◽

...

Keyword(s):

Atrial Fibrillation ◽

Drug Therapy ◽

Catheter Ablation ◽

Antiarrhythmic Drug ◽

Treatment Satisfaction ◽

Cardiovascular Events ◽

Patient Reported Outcome ◽

Antiarrhythmic Drug Therapy ◽

Funding Sources ◽

Patient Reported

Abstract Background Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after atrial fibrillation (AF) catheter ablation are inconsistent. While AAD potentially stabilizes sinus rhythm, it also increases the patients' treatment burden. Methods Patients from the prospective German Ablation Registry (n=3275) discharged with or without AAD after AF catheter ablation were compared regarding long-term success, cardiovascular events and patient reported outcome. Results In patients with paroxysmal AF (n=2138) recurrence and rehospitalization rates did not differ when discharged with (n=1051) or without (n=1087) AAD (recurrence: adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95–1.35]; rehospitalization: OR 1.08, 95% CI [0.90–1.30]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05–1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20–2.58]). Similar rates of recurrences, rehospitalisations, reablations and treatment satisfaction were found in patients with persistent AF (n=1137) discharged with (n=641) or without (n=496) AAD (recurrence: OR 1.22, 95% CI [0.95–1.56]; rehospitalization: OR 1.16, 95% CI [0.90–1.50]; reablation: OR 1.21, 95% CI [0.91–1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74–2.08]). The incidence of cardiovascular events and mortality did not differ at follow-up in paroxysmal and persistent AF patients discharged with or without AAD. Conclusion The rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction. FUNDunding Acknowledgement Type of funding sources: None.

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