SummaryAs for nonvalvular atrial fibrillation (NVAF) patients with left atrial thrombus or spontaneous echo contrast (LAT/SEC), we evaluated the additional predictive value of serum uric acid (SUA) and Left atrial diameter (LAD) for CHADS2 and CHA2DS2-VASc, and explored the influence from the level of SUA and LAD to LAT/ SEC in moderate risk group. Thus, we put forward the concept of a borderline high risk group to guide clinical anticoagulant therapy in patients with NVAF.A total of 284 NVAF patients without the history of anticoagulant prior to hospitalization were enrolled. They were divided into LAT/SEC group or No LAT/SEC group according to transesophageal echocardiography (TEE). Then, we explored and compared the additional predictive value of serological and ultrasonic indexes after combining them to CHADS2/CHA2DS2-VASc.61 patients (21.48%) had LAT/SEC. SUA and LAD were the independent risk factors of LAT/SEC. After being added with LAD and SUA, the predictive value of CHADS2 and CHA2DS2-VASc were increased much more than others. In the moderate risk group, the incidence of LAT/SEC rose significantly when SUA or LAD was higher than cut-off values.SUA and LAD enhanced the predictive ability of CHADS2 and CHA2DS2-VASc for LAT/SEC as additional factors. For patients in moderate risk group, if SUA or LAD was higher than cut-off values, the risk of thromboembolism events would rise accompanied by the elevated risk of LAT/SEC.(Int Heart J 2017; 58: 885-893) Key words: Predictive value, Left atrial thrombus, Borderline high risk group A trial fibrillation (AF) is the most common arrhythmia, affecting approximately 8 million patients in China.1) Meanwhile, its morbidity is increasing with the aging population as well as the morbidity of cardiovascular disease year by year. Cardiac stroke accounted for about a quarter of all patients with stroke, and more than half of them were caused by AF.2) AF increased the risk of stroke by five times. Among them, more than 90% of embolism comes from left atrial appendage (LAA). Therefore, preventing thrombus in LAA can reduce the morbidity of stroke, and it can be used as a substitute to prevent patients with AF from stroke in earlier stage.At present, CHADS2 scores and CHA2DS2-VASc scores are widely accepted and practical clinical stroke risk stratifications. Recently, some researches have shown that CHADS2 and CHA2DS2-VASc scores not only predict stroke risk, but also have an obvious relationship with LAT and can be used to predict the formation of LAT. [3][4][5][6] However, Yarmohammadi, et al. 4) found that patients with a score of 0 or 1 point in CHADS2 accounted for almost a third of the total with atrial thrombus. In addition, a prospective study including 295 NVAF patients with 0 or 1 point CHADS2 score were followed up, onaverage for 5 years. The results showed that 3% of the patients had LAT and 8% of patients had SEC. 7) By adding some additional risk factors to CHADS2 and CHA2DS2-VASc score, especially in patients who should have anticoagulant therapy but were i...
Background: Heart failure (HF) is a complex and multifactorial syndrome caused by impaired heart function. The high morbidity and mortality of HF cause a heavy burden of illness worldwide. Non-thyroidal illness syndrome (NTIS) refers to aberrant serum thyroid parameters in patients without past thyroid disease. Observational studies have indicated that NTIS is associated with a higher risk of all-cause mortality in HF. This meta-analysis aimed to investigate the association between NTIS and HF prognosis. Methods: Medline, Embase, Web of Science, and the Cochrane database were searched for any studies reporting an association between NTIS and HF prognosis from inception to July 1st 2022. A meta-analysis was then performed. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS). The heterogeneity of the results was assessed with I2 and Cochran's Q statistics. Sensitivity analysis and publication bias analysis were also conducted. Results: A total of 626 studies were retrieved, and 18 studies were finally included in the meta-analysis. The results showed that NTIS in HF patients was significantly associated with an increased risk of all-cause mortality and major cardiovascular events (MACE), but not with in-hospital mortality. The stability of the data was validated by the sensitivity analysis. There was no indication of a publication bias in the pooled results for all-cause mortality and MACE. Conclusions: This meta-analysis showed that NTIS was associated with a worse outcome in HF patients. However, the association between NTIS and in-hospital mortality of HF patients requires further investigation.
Objective: Myonectin, a recently found myokine, has a role of inhibiting inflammation. The aim of this research is to see if myonectin levels are linked to the occurrence of atrial fibrillation (AF).Methods: We examined serum myonectin in a population of 194 patients with AF who were then classified into three subgroups: paroxysmal AF, persistent AF, and permanent AF. Atrial remolding was assessed using left atrial diameter (LAD). Results: Serum myonectin was significantly lower in AF group compared with healthy controls. Logistic regression analysis demonstrated that serum myonectin concentrations were correlated with a decreased risk of AF. Patients with permanent AF displayed decreased serum myonectin than in persistent and paroxysmal AF groups. Serum myonectin was lower in persistent AF group than in paroxysmal AF group. Serum myonectin concentrations in AF patients were negatively associated with body mass index (BMI), systolic blood pressure, diastolic blood pressure, and LAD. BMI and LAD stayed to be correlated with serum myonectin according to multiple stepwise regression analysis. Conclusion: Our study demonstrated a correlation between serum myonectin and AF.
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