scholarly journals Comprehensive Use of Routine Clinical Parameters to Identify Patients at Risk of New-Onset Atrial Fibrillation in Acute Myocardial Infarction

2021 ◽  
Vol 10 (16) ◽  
pp. 3622
Author(s):  
Monika Raczkowska-Golanko ◽  
Grzegorz Raczak ◽  
Marcin Gruchała ◽  
Ludmiła Daniłowicz-Szymanowicz
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Clinical Parameters ◽  
Ventricular Ejection Fraction ◽  
Significant Complication ◽  
Onset Atrial Fibrillation ◽  
New Onset

(1) Background: New-onset atrial fibrillation (NOAF) is a significant complication of acute myocardial infarction (AMI). Our study aimed to investigate whether routinely checked clinical parameters aid in NOAF identification in modernly treated AMI patients. (2) Patients and methods: Patients admitted consecutively within 2017 and 2018 to the University Clinical Centre in Gdańsk (Poland) with AMI diagnosis (necrosis evidence in a clinical setting consistent with acute myocardial ischemia) were enrolled. Medical history and clinical parameters were checked during NOAF prediction. (3) Results: NOAF was diagnosed in 106 (11%) of 954 patients and was significantly associated with in-hospital mortality (OR 4.54, 95% CI 2.50–8.33, p < 0.001). Age, B-type natriuretic peptide (BNP), C-reactive protein (CRP), high-sensitivity troponin I, total cholesterol, low-density lipoprotein cholesterol, potassium, hemoglobin, leucocytes, neutrophil/lymphocyte ratio, left atrium size, and left ventricular ejection fraction (LVEF) were associated with NOAF in the univariate logistic analysis, whereas age ≥ 66 yo, BNP ≥ 340 pg/mL, CRP ≥ 7.7 mg/L, and LVEF ≤ 44% were associated with NOAF in the multivariate analysis. (4) Conclusions: NOAF is a multifactorial, significant complication of AMI, leading to a worse prognosis. Simple, routinely checked clinical parameters could be helpful indices of this arrhythmia in current invasively treated patients with AMI.

scholarly journals Simple clinical parameters could help to identify the patients with a high probability of new-onset atrial fibrillation in acute myocardial infarction

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Raczkowska-Golanko ◽  
W Puchalski ◽  
M Gruchala ◽  
G Raczak ◽  
L Danilowicz-Szymanowicz
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Significant Complication ◽  
Detailed Medical History ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Background New-onset atrial fibrillation (NOAF) is a significant complication of acute myocardial infarction (AMI) associated with a poor prognosis. The knowledge and understanding of risk factors of this arrhythmia are still the subjects of interest. Purpose: We aimed to investigate which clinical, routinely checked parameters could have the most predictive power on NOAF occurrence in AMI patients. Patients and methods This single-center, retrospective study was conducted on 954 consecutive patients admitted to our university clinical center with AMI diagnosis from January 2017 to December 2018. Patients underwent routine clinical assessment and laboratory investigations. AF detected at the time of admission or during a hospital stay, without a prior history of persistent or paroxysmal AF, was diagnosed as NOAF. Detailed medical history, routinely checked laboratory and echocardiography parameters, invasive and pharmacological treatment, as well as complications and in-hospital mortality, were taken into consideration. Results   NOAF was documented in 106 (11%) AMI patients at median age 74 (66 - 84) years old, and was significantly associated with in-hospital mortality [OR 4.53, p &lt; 0.001). There were some clinical factors significantly predicted NOAF in univariate logistic regression analysis: age ≥ 66 years old (odds ratio [OR] 3.09, p &lt; 0.001), B-type natriuretic peptide (BNP) ≥ 340 pg/ml (OR 5.28, p &lt; 0.001), C- reactive protein (CRP) ≥ 7.7 mg/l (OR 3.53, p &lt; 0.001), high-sensitivity troponin ≥ 1.85 ng/ml (OR 2.4, p &lt; 0.001), total cholesterol  ≤  195 mg/dl (OR 2.17, p &lt; 0.002), low-density lipoprotein ≤ 128.5 mg/dl (OR 2.03, p &lt; 0.007), potassium level ≤ 4.2 mmol/l (OR 1.92, p &lt; 0.002), hemoglobin ≤ 14 g/dl (OR 1.71, p &lt; 0.020), leucocytes ≥ 10.2 x10^9/l (OR 1.76, p &lt; 0.009), neutrophil to lymphocyte ratio ≥ 4.6 (OR 1.85, p &lt; 0.004), left atrium size ≥ 41 mm (OR 2.14, p &lt; 0.001), and left ventricular ejection fraction (LVEF) ≤ 44% (OR 2.99, p &lt; 0.001). Age, BNP, CRP, and LVEF at mentioned above pre-specified cut-off values turned out to be the most important independent predictors of NOAF development in multivariate analysis. Conclusions NOAF is a multifactorial, significant complication of AMI, leading to a worse prognosis. Older age, higher BNP and CRP level, and lower LVEF are independently associated with the probability of NOAF.

scholarly journals 773 Correlation between high troponin levels and left atrial strain as biomarker of incremented atrial fibrillation rate in patients with acute myocardial infarction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Emilia De Luca ◽  
Andrea Madeo ◽  
Giovanni San Pasquale ◽  
Gianluca Ponturo ◽  
Francescantonio Rosselli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Atrial Strain ◽  
Ventricular Ejection Fraction ◽  
Heart Rhythm Disorders ◽  
Atrial Strain

Abstract Aims Heart rhythm disorders, both bradyarrhythmias and tachyarrhythmias, are the most frequently observed complication in the acute phase and after primary angioplasty in patients with acute myocardial infarction (AMI). New onset atrial fibrillation (Afib) represents the most frequent arrhythmia found between 6% and 21% in patients with AMI and its onset increases the thromboembolic and mortality risk of all causes of those patients. Troponin levels measured with modern assays represent today the most specific cardiac biomarker of myocardial injury and its measurement represents the cornerstone for the diagnosis of AMI in accordance with the ESC Guidelines 2018; however, also Afib itself causes an increase in troponin values (troponinopathy). Therefore, the single biohumoral value cannot assume prognostic value in helping the clinician to recognize patients with AMI who are more predisposed to encounter Afib. So, the object of our evaluation was to support the elevated troponin values with echocardiographic biomarkers, such as the evaluation of the left atrial strain (LAS), to perform a more accurate stratification of the arrhythmic risk in patients with AMI. Methods and results A prospective multiparametric study was carried out at our Interventional Cardiology Hub Center. 240 patients with ACS-STEMI diagnosed were recruited over one year from March 2020 to March 2021. Patients included were all ≥18 (55 ± 23 y), predominantly male (88% male, 12% female). Exclusion criteria were: permanent atrial fibrillation; valvular heart disease (moderate or severe heart valve stenosis or valve replacement); implantation of a pacemaker or defibrillator; (4) poor image quality. Emergency coronary angiography (CAG) was carried out to execute primary percutaneous intervention (primary PCI with DES) on the culprit vessel. All patients underwent echocardiography by GE Vivid 80 (GE Ultrasound, Horten, Norway) in order to evaluate changes in segmental kinetics, left ventricular ejection fraction (LVEF). The ratio of peak early filling velocity of mitral inflow to early diastolic annulus velocity (E′) of the medial annulus (E/E′) was calculated. Left atrial volumes (LAVi, ml/m2) and diameter were obtained through standard apical 4 and 2 chamber views with a frame-rate range of 40–71 frames/s; then, offline analysis of images was performed using EchoPAC version 201 (GE Vingmed Ultrasound) (VSSLV) software in order to calculate LAS for each one. Patients were subjected to serial sampling to evaluate temporally troponin values and the possible Afib appearance was recognized by telemetry monitoring. Statistical analysis was performed using SPSS version 20 (IBM, Armonk, New York), continuous variables were expressed as mean ± standard deviation (SD). Pearson’s correlation coefficient was used to assess the correlation between strain value, baseline characteristics and troponin levels. All statistical tests are two-sided, and a P-value &lt; 0.05 is considered statistically significant. Two groups were recognized: high troponin levels with pathological LAS and new Afib (N = 47); medium-high troponin levels with normal LAS and no Afib (N = 143). Respectively, LAS were 8.4 ± 4.0% vs. 16 ± 4.5%, P &lt; 0.001, LAVi 44 ± 5 ml/m2 vs. 30 ± 3.2, P = 0.001, and peak of troponin levels (3.45 ± 0.46 ng/ml vs. 2.34 ± 0.22 ng/ml, P = 0.002). Multivariate analysis identified that peak troponin levels alone wasn’t a prognostic index of increased arrhythmic burden, while the correlation between high peak levels and altered LAS were independent predictors of new AFib in AMI. Conclusions The evaluation of atrial dysfunction by new echo-derived parameters and its correlation with troponin values allows a more accurate stratification of arrhythmic risk in patients with ACS. The applicability of the obtained data would allow a more careful evaluation of the clinical trend and the prognostic outcome in the subcategory analysed. Therefore, the association between biohumoral and instrumental parameters could become new biomarkers capable of predicting an increase in thromboembolic risk in AMI patients. The creation of an app that takes into account the parameters listed could be a possible future support that can help the clinician calculate the increased risk rate of new Afib in patients with ACS.

Early Versus Late New-Onset Atrial Fibrillation in Acute Myocardial Infarction: Differences in Clinical Characteristics and Predictors

Angiology ◽  
2019 ◽  
Vol 70 (10) ◽  
pp. 921-928 ◽  
Author(s):  
Arthur Shiyovich ◽  
Michal Axelrod ◽  
Harel Gilutz ◽  
Ygal Plakht
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Hospital Death ◽  
Severe Left Ventricular Dysfunction ◽  
St Elevation ◽  
Onset Atrial Fibrillation ◽  
New Onset

New-onset atrial fibrillation (NOAF) during acute myocardial infarction (AMI) has significant consequences but is often misdiagnosed. The aim of the study was to evaluate predictors of NOAF throughout different phases of AMI. Patients with AMI admitted to a tertiary medical center were analyzed. Exclusion criteria were preexisting AF, AMI onset ≥24 hours prior to admission, in-hospital death, significant valvular disease, and in-hospital coronary artery bypass graft. Study population were AMI without-NOAF, early-AF (AF terminated within 24 hours of admission), and late-AF (beyond the first 24 hours). Overall 5946 patients were included, age: 64.8 ±14.8 years; 30% women. The incidence of NOAF was 4.6%: 1.6% early-AF, and 3% late-AF. Patients with NOAF comprised greater rate of women, cardiovascular risk-factors burden, severe left ventricular-dysfunction, pulmonary hypertension, valvular disorders, and left atrial enlargement compared with patients without-NOAF. Non-ST-elevation myocardial infarction and inferior-ST-elevation myocardial infarction (STEMI) were significantly more prevalent among early-AF group, while anterior-STEMI, in late-AF. The final multivariate models showed c-statistics of 0.73 and 0.76 for the prediction of new-onset early-AF and late-AF, respectively. In conclusion, there are different clinical predictors of early- versus late-NOAF. The study points out “high risk” AMI population for more meticulous heart rate monitoring for NOAF.

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