Comparison of Echocardiography and Electron Beam Tomography in Differentiating the Etiology of Heart Failure. Tachycardia-Related Cardiomyopathy: A Common Cause of Ventricular Dysfunction in Patients With Atrial Fibrillation Referred for Atrioventricular Ablation

Background: Heart failure is a leading health problem with over 500,000 new cases and 275,000 deaths annually in the United States. Recent reports indicate that atrial fibrillation (AF) is linked to various forms of ventricular dysfunction (VD). Over 2 million Americans have AF, which is more prevalent in people over 65 years of age. However, the molecular “cause and effect” relationship between AF and VD has not been elucidated. We hypothesize that abrogation of nuclear erythroid-2 like factor-2 (Nrf2), a master antioxidant transcriptional regulator, induces atrial remodeling and fibrillation on aging. Methods: Age and sex matched WT and Nrf2-/- mice were used in this study. Atrial mass, remodeling, antioxidants and molecular redox signaling were studied at 2 and >20 months of age. Echocardiography, immunoblotting, quantitative real-time PCR and immunofluorescence (fibrosis) analyses were performed in the atrial tissue. Results: At 2 months of age, WT and Nrf2-/- mice had comparable levels of ROS in the atrium. On aging, the ROS levels were significantly increased in atria of Nrf2- null when compared to wild-type (WT) mice at 20 months of age. While decreased Nrf2-antioxidant signaling in response to increased ROS generation in atria of Nrf2- null mice was observed, ventricular function appeared to be normal at 20 months of age. However, upon endurance exercise stress (EES), hypertrophy markers including ANF, BNF, PLN and SERCA2A were significantly (p<0.05) altered in Nrf2- null when compared to age-matched WT mice. Further, activation of fibrotic process was evident in the Nrf2- null mouse atrium as indicated by significantly (p<0.05) increased markers of tissue remodeling (i.e. MMP2/9) on aging. These results indicating an early onset of atrial hypertrophy/remodeling due to age-induced oxidative stress, which cause AF in Nrf2- null mice. Age-dependent decline in Nrf2 and sustained progression of AF could lead to ventricular dysfunction and heart failure. Conclusion: Our findings indicate that atria are primary targets to age-associated oxidative stress and exhibit fibrosis, which promotes atrial fibrillation and remodeling. Thus, activation of Nrf2 signaling to prevent oxidative stress could be a potential therapeutic target for AF.

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Impact of Left Ventricular Function and Heart Failure Symptoms on Outcomes Post Ablation of Atrial Fibrillation in Heart Failure

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.120.008461 ◽

2020 ◽

Vol 13 (10) ◽

Cited By ~ 2

Author(s):

Christian Sohns ◽

Konstantin Zintl ◽

Yan Zhao ◽

Lilas Dagher ◽

Dietrich Andresen ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

New York ◽

Ventricular Dysfunction ◽

Heart Association ◽

Left Ventricular ◽

Pharmacological Therapy ◽

York Heart Association Class ◽

Association Class ◽

New York Heart Association

Background: Recent data demonstrate promising effects on left ventricular dysfunction and left ventricular ejection fraction (LVEF) improvement following ablation for atrial fibrillation (AF) in patients with heart failure. We sought to study the relationship between LVEF, New York Heart Association class on presentation, and the end points of mortality and heart failure admissions in the CASTLE-AF study (Catheter Ablation for Atrial Fibrillation With Heart Failure) population. Furthermore, predictors for LVEF improvement were examined. Methods: The CASTLE-AF patients with coexisting heart failure and AF (n=363) were randomized in a multicenter prospective controlled fashion to ablation (n=179) versus pharmacological therapy (n=184). Left ventricular function and New York Heart Association class were assessed at baseline (after randomization) and at each follow-up visit. Results: In the ablation arm, a significantly higher number of patients experienced an improvement in their LVEF to >35% at the end of the study (odds ratio, 2.17; P <0.001). Compared with the pharmacological therapy arm, both ablation patient groups with severe (<20%) or moderate/severe (≥20% and <35%) baseline LVEF had a significantly lower number of composite end points (hazard ratio [HR], 0.60; P =0.006), all-cause mortality (HR, 0.54; P =0.019), and cardiovascular hospitalizations (HR, 0.66; P =0.017). In the ablation group, New York Heart Association I/II patients at the time of treatment had the strongest improvement in clinical outcomes (primary end point: HR, 0.43; P <0.001; mortality: HR, 0.30; P =0.001). Conclusions: Compared with pharmacological treatment, AF ablation was associated with a significant improvement in LVEF, independent from the severity of left ventricular dysfunction. AF ablation should be performed at early stages of the patient’s heart failure symptoms.

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Left ventricular dysfunction in atrial fibrillation and heart failure risk

ESC Heart Failure ◽

10.1002/ehf2.12920 ◽

2020 ◽

Vol 7 (6) ◽

pp. 3694-3706

Author(s):

Jen‐Yuan Kuo ◽

Sheng‐Hsiung Chang ◽

Kuo‐Tzu Sung ◽

Po‐Ching Chi ◽

Jo‐Nan Liao ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Failure Risk

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Relationship Between Degree of Left Ventricular Dysfunction, Symptom Status, and Risk of Embolic Events in Patients With Atrial Fibrillation and Heart Failure

Stroke ◽

10.1161/strokeaha.114.007140 ◽

2015 ◽

Vol 46 (3) ◽

pp. 667-672 ◽

Cited By ~ 30

Author(s):

Roopinder K. Sandhu ◽

Stefan H. Hohnloser ◽

Marc A. Pfeffer ◽

Fei Yuan ◽

Robert G. Hart ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Symptom Status

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Usefulness of Electron Beam Tomography in the Prone Position for Detecting Atrial Thrombi in Chronic Atrial Fibrillation

Journal of Computer Assisted Tomography ◽

10.1097/00004728-200301000-00014 ◽

2003 ◽

Vol 27 (1) ◽

pp. 78-84 ◽

Cited By ~ 20

Author(s):

Tomomitsu Tani ◽

Shoji Yamakami ◽

Toyoaki Matsushita ◽

Mitsuhiro Okamoto ◽

Junji Toyama ◽

...

Keyword(s):

Atrial Fibrillation ◽

Electron Beam ◽

Prone Position ◽

Chronic Atrial Fibrillation ◽

Electron Beam Tomography ◽

Atrial Thrombi

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The Elderly and Thyrotoxicosis

AACN Advanced Critical Care ◽

10.4037/15597768-1992-1014 ◽

1992 ◽

Vol 3 (1) ◽

pp. 114-119 ◽

Cited By ~ 1

Author(s):

Mary Ellen McMorrow

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Congestive Heart Failure ◽

Respiratory Infections ◽

Beta Blockers ◽

Clinical Manifestations ◽

The Elderly ◽

Thyroid Storm ◽

Common Cause ◽

Toxic Goiter

Thyrotoxicosis is gaining recognition as a significant clinical problem in the elderly. However, distinguishing thyrotoxicosis is difficult because the elderly usually present with nonspecific and atypical clinical manifestations. The most common cause of hyperthyroidism in the elderly is toxic multinodular goiter. The second most common cause is diffuse toxic goiter (Graves’ disease). With the elderly thyrotoxic patient, cardiovascular clinical manifestations usually predominate. The elderly frequently have palpitations, tachycardia, atrial fibrillation, and congestive heart failure. Atrial fibrillation and congestive heart failure are resistant to conventional cardiac glycoside therapy. The elderly may be treated with thioureas, beta-blockers, and when they are euthyroid, radioactive iodine. At risk for thyroid storm, the elderly thyrotoxic patient must be monitored carefully for predisposing factors; especially respiratory infections. Treatment for thyroid storm includes recognition and elimination of the precipitating factor(s); control of fever, if present; thioureas (antithyroid medications); beta-blockers, and sodium iodine

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Persistent atrial fibrillation is associated with appropriate shocks and heart failure in patients with left ventricular dysfunction treated with an implantable cardioverter defibrillator

American Heart Journal ◽

10.1016/j.ahj.2006.09.010 ◽

2007 ◽

Vol 153 (1) ◽

pp. 120-126 ◽

Cited By ~ 29

Author(s):

Michiel Rienstra ◽

Marcelle D. Smit ◽

Wybe Nieuwland ◽

Eng S. Tan ◽

Ans C.P. Wiesfeld ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Implantable Cardioverter Defibrillator ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Persistent Atrial Fibrillation ◽

Left Ventricular ◽

Cardioverter Defibrillator ◽

Appropriate Shocks

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Use of Sacubitril/Valsartan in a Chronic Heart Failure Patient with Reduced Ejection Fraction Accompany Dilated Cardiomyopathy and Myocardial Indensification: A Case Report

10.21203/rs.3.rs-108070/v1 ◽

2020 ◽

Author(s):

Hengfen Dai ◽

Yan Zhang ◽

Jingwen Xiao

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Chronic Heart Failure ◽

Ejection Fraction ◽

Heart Transplantation ◽

Dilated Cardiomyopathy ◽

Clinical Prognosis ◽

Common Cause ◽

Reduced Ejection Fraction ◽

Neuroendocrine Response

Abstract Rationale: Dilated cardiomyopathy (DCM) is a progressive cardiac disease characterized by ventricular dilation and contractile dysfunction and is the third most common cause of heart failure and the most common cause of heart transplantation. Heart failure (HF) and atrial fibrillation (AF) often coexist and share a mutually beneficial relationship. The presence of atrial fibrillation increases the tendency for heart failure, which can worsen its severity and increase the risk of stroke. DCM、AF and HF are causal to each other in pathophysiological view. However, how these pathogens translates upon acute decompensation heart failure(ADHF) is unknown. Control acute attack of chronic heart failure is the first step of treatment.Case summary: Herein, we described a 68-year-old man with acute decompensated heart failure (ADHF) with severe DCM and atrial fibrillation who was treated with Sacubitril/Valsartan and had a reduced ejection fraction. The patient’s echocardiography features had a significant improvement under taking Sacubitril/Valsartan. Sacubitril/Valsartan may act as an intermediary that balancing of the good and the bad neuroendocrine response.Discussion: DCM is a major cardiomyopathy and a major cause of heart transplantation. DCM’s clinical prognosis is poor, additionally, along with myocardial indensification, early diagnosis and treatment is helpful to prolong the patients' life. The emergence of Sacubitril/Valsartan represents the advent of a new strategy for treating HFrEF. Its beneficial effects are related in part, at least, to an improvement of echocardiographic features and positive modulation of the neuroendocrine response to HF.

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