scholarly journals Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction

2020 ◽  
Vol 9 (5) ◽  
pp. 1481 ◽  
Author(s):  
Audrey Sagnard ◽  
Charles Guenancia ◽  
Basile Mouhat ◽  
Maud Maza ◽  
Marie Fichot ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Sinus Rhythm ◽  
Left Ventricular Ejection ◽  
Holter Ecg ◽  
Autonomic Nervous ◽  
New Onset

Background: Atrial fibrillation (AF) is common after acute myocardial infarction (AMI) and associated with in-hospital and long-term mortality. However, the pathophysiology of AF in AMI is poorly understood. Heart rate variability (HRV), measured by Holter-ECG, reflects cardiovascular response to the autonomic nervous system and altered (reduced or enhanced) HRV may have a major role in the onset of AF in AMI patients. Objective: We investigated the relationship between autonomic dysregulation and new-onset AF during AMI. Methods: As part of the RICO survey, all consecutive patients hospitalized for AMI at Dijon (France) university hospital between June 2001 and November 2014 were analyzed by Holter-ECG <24 h following admission. HRV was measured using temporal and spectral analysis. Results: Among the 2040 included patients, 168 (8.2%) developed AF during AMI. Compared to the sinus-rhythm (SR) group, AF patients were older, had more frequent hypertension and lower left ventricular ejection fraction LVEF. On the Holter parameters, AF patients had higher pNN50 values (11% vs. 4%, p < 0.001) and median LH/HF ratio, a reflection of sympathovagal balance, was significantly lower in the AF group (0.88 vs 2.75 p < 0.001). The optimal LF/HF cut-off for AF prediction was 1.735. In multivariate analyses, low LF/HF <1.735 (OR(95%CI) = 3.377 (2.047–5.572)) was strongly associated with AF, ahead of age (OR(95%CI) = 1.04(1.01–1.06)), mean sinus-rhythm rate (OR(95%CI) = 1.03(1.02–1.05)) and log NT-proBNP (OR(95%CI) = 1.38(1.01–1.90). Conclusion: Our study strongly suggests that new-onset AF in AMI mainly occurs in a dysregulated autonomic nervous system, as suggested by low LF/HF, and higher PNN50 and RMSSD values.

scholarly journals Acute myocardial infarction as the first manifestation of paraganglioma

2019 ◽  
Vol 13 (2) ◽  
pp. 124-127
Author(s):  
Sara Pinto ◽  
Raquel Ferreira ◽  
Anabela Gonzaga ◽  
José Mesquita Bastos
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Neuroendocrine Tumors ◽  
Postpartum Woman ◽  
Autonomic Nervous

Paragangliomas (PGLs) are extra-adrenal neuroendocrine tumors, classified as sympathetic or parasympathetic according to their origin in the paraganglia of the autonomic nervous system. Sympathetic PGLs are mostly functional, presenting in a variable and non-specific way. We report a case of PGL, which was diagnosed further to an investigation of acute myocardial infarction in a postpartum woman, highlighting that the absence of typical symptoms may delay the diagnosis.

Autonomic Nervous System Responses to Personal Stressful Events in Patients with Acute Myocardial Infarction

1998 ◽  
Vol 67 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Evie D. Tsouna-Hadjis ◽  
Dimitris N. Mitsibounas ◽  
George E. Kallergis ◽  
Dimitris A. Sideris
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Stressful Events ◽  
Autonomic Nervous

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.

P3610Prognostic implication of new-onset atrial fibrillation burden in patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J C Luo ◽  
H Q Li ◽  
Z Q Li ◽  
B X Liu ◽  
M M Gong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Sinus Rhythm ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
High Burden ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) can be associated with adverse cardiovascular events. The prognostic implication of the burden of atrial fibrillation has been investigated in various settings. Purpose We aimed to explore the association of the burden of post-MI NOAF with the risk of adverse cardiovascular events during hospitalization. Methods All consecutive patients admitted forAMI between February 2014 and February 2018 were analyzed by continuous electronic monitoring (CEM) through hospitalization. AF burden was calculated by dividing the total AF duration by the total CEM duration. Patients were divided into 3 groups: sinus rhythm group, low burden (AF burden≤8.5%) group, and high burden (AF burden>8.5%) group. The primary outcome was a composite of in-hospital all-cause death, recurrent MI, acute heart failure, or cardiogenic shock. Results Overall, 2405 patients (mean age: 65.8 years; male: 76.6%) were included. NOAF was documented in 11.6% of patients, and the primary outcome was recorded in 288 patients (13.6%) of the sinus rhythm group, 42 (30.0%) in the low burden group, and 71 (50.7%) in the high burden group. Compared with patients with sinus rhythm, a greater burden of NOAF was associated with a higher risk of the primary outcome after multivariable analysis (low burden: hazard ratio, 1.22; 95% confidence interval [CI]: 0.87–1.70; high burden: hazard ratio, 1.90; 95% CI: 1.43–2.51; p for trend<0.001). In-hospital cardiovascular events MACE Patients/Events, n Unadjusted HR (95% CI) Adjusted HR (95% CI)a Sinus rhythm 2125/288 1.00 (reference) 1.00 (reference) Low burden 140/42 2.05 (1.48–2.84) 1.22 (0.87–1.70) High burden 140/71 3.93 (3.03–5.10) 1.90 (1.43–2.51) P for trend – <0.001 <0.001 All-cause death Patients, n Unadjusted HR (95% CI) Adjusted HR (95% CI)a Sinus rhythm 2125/106 1.00 (reference) 1.00 (reference) Low burden 140/10 1.02 (0.53–1.97) 0.52 (0.27–1.02) High burden 140/32 3.62 (2.41–5.42) 1.37 (0.89–2.09) P for trend – <0.001 0.081 aAdjusted for age, sex, current smoking, hypertension, diabetes mellitus, dyslipidemia, CKD, previous MI, previous stroke, previous heart failure, symptom onset to emergency department duration, STEMI, pre-hospital cardiac arrest, LVEF, and on-admission HR, SBP and CS, peak TnT, reperfusion therapy and GPIIb/IIIa inhibitor. Kaplan-Meier plots of in-hospital events Conclusion A greater burden of NOAF complicatingAMI was associated withan increased risks of in-hospital adverse events. Acknowledgement/Funding National Natural Science Foundation of China grant 81270193 and Natural Science Foundation of Shanghai grant 18ZR1429700

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 Predictive value of CHA2DS2-VASc score combined with hs-CRP for new-onset atrial fibrillation in elderly patients with acute myocardial infarction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuan Fu ◽  
Yuxia Pan ◽  
Yuanfeng Gao ◽  
Xinchun Yang ◽  
Mulei Chen
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Discrimination Performance ◽  
Regression Analyses ◽  
Combined Model ◽  
Chads2 Score ◽  
Hs Crp ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background New-onset atrial fibrillation (NOAF) is common during acute myocardial infarction (AMI) and independently associated with worse prognosis. We aimed to validate the discrimination performance of CHA2DS2-VASc score combined with hs-CRP in the prediction of NOAF after AMI in elderly Chinese population. Methods 311 consecutive elderly patients (age ≥ 65 years old) with AMI from 1 January 2018 to 1 January 2019 without atrial fibrillation history were enrolled in our study. Univariable and multivariable logistic regression analyses were used to identify risk factors of NOAF. The discrimination performance of different score models were evaluated using ROC curve analysis and AUCs were compared using the Z test. Results 30 (9.65%) patients developed NOAF during hospitalization. The NOAF group were older and had higher hs-CRP, initial Killip class, BNP, LAD, CHADS2 score, CHA2DS2-VASc score, in-hospital mortality and lower LVEF and ACEI/ARB use (P < 0.05 vs group without NOAF for all measures). In multivariate regression analyses, age (OR = 1.127, 95% CI 1.063–1.196, P < 0.001) and hs-CRP (OR = 1.034, 95% CI 1.018–1.05, P < 0.001) were independent predictors of NOAF. In ROC curve analyses, both CHADS2 score (AUC = 0.624, 95% CI 0.516–0.733, P = 0.026) and CHA2DS2-VASc score (AUC = 0.687, 95% CI 0.584–0.79, P = 0.001) had acceptable but unsatisfactory discrimination performance in predicting NOAF after AMI. The combined model with CHA2DS2-VASc score and hs-CRP showed a significant better predictive value (AUC = 0.791, 95% CI 0.692–0.891, P < 0.001) compared to that of the CHA2DS2-VASc score alone (Z test, P = 0.008). Conclusion The combined model with CHA2DS2-VASc score and hs-CRP had high accuracy in predicting post-AMI NOAF.

Sign in / Sign up

Export Citation Format

Share Document