Atrial Fibrillation: Inflammation in Disguise?

Lappegård, Knut Tore; Hovland, Anders; Pop, Gheorghe; Mollnes, Tom Eirik

doi:10.1111/sji.12061

Cited by 17 publications

(11 citation statements)

References 112 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…29 Finally, AF might additionally impact stroke severity and thus post-stroke outcome via concomitant or resultant endothelial dysfunction, oxidative stress, and inflammation. 4,20,30 …”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation Is Associated With a Worse 90-Day Outcome Than Other Cardioembolic Stroke Subtypes

Henninger

Goddeau

Karmarkar

et al. 2016

Stroke

View full text Add to dashboard Cite

Background and Purpose Patients with a cardioembolic stroke (CES) have worse outcomes than stroke patients with other causes of stroke. Among patients with CES, atrial fibrillation (AF) is a common comorbidity. Mounting data indicates that AF may relate to stroke pathogenesis beyond acute cerebral thromboembolism. We sought to determine whether AF represents an independent risk factor for stroke severity and outcome among patients with CES. Methods We retrospectively analyzed patients with acute hemispheric CES included in an academic medical center’s stroke registry. CES was determined using the Causative Classification System of ischemic stroke. Multivariable logistic regression was used to determine whether AF was associated with 90-day outcome functional status. Results Our cohort included 140 patients. Of these, 52 had prevalent AF and 28 had incident AF diagnosed during their index hospitalization or within 90-days of hospital discharge. After adjustment for potential confounders or mediators, any AF (OR 2.51; 95%-CI 1.03–6.33; p=0.049), infarct volume (OR 1.03; 95%-CI 1.01–1.06; p=0.005), pre-admission mRS (OR 2.58; 95%-CI 1.66–4.01; p<0.001), and admission National Institutes of Health Stroke Scale score (OR 1.17; 95%-CI 1.08–1.28; p<0.001) remained associated with an unfavorable 90-day outcome (modified Rankin Scale 2–6). Conclusions AF is associated with an unfavorable 90-day outcome among patients with a CES independent of established risk factors and initial stroke severity. This suggests that AF-specific mechanisms impact CES severity and functional status after CES. If confirmed in future studies, further investigation into the underlying pathophysiological mechanisms may provide novel avenues to AF detection and treatment.

show abstract

“…29 Finally, AF might additionally impact stroke severity and thus post-stroke outcome via concomitant or resultant endothelial dysfunction, oxidative stress, and inflammation. 4,20,30 …”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation Is Associated With a Worse 90-Day Outcome Than Other Cardioembolic Stroke Subtypes

Henninger

Goddeau

Karmarkar

et al. 2016

Stroke

View full text Add to dashboard Cite

show abstract

“…It is established that atrial fibrillation is associated with increased inflammatory activity, reviewed in (Lappegård et al, 2013), and also that inflammation is a key player in the development of thrombo-embolic complications (Hijazi et al, 2013). Paradoxically, due to increased survival in coronary heart disease and congestive heart failure, along with an ageing population, the prevalence of atrial fibrillation is increasing.…”

Section: Arrhythmias and The Complement Systemmentioning

confidence: 99%

A vital role for complement in heart disease

Lappegård

Garred

Jonasson

et al. 2014

Molecular Immunology

View full text Add to dashboard Cite

Heart diseases are common and significant contributors to worldwide mortality and morbidity. During recent years complement mediated inflammation has been shown to be an important player in a variety of heart diseases. Despite some negative results from clinical trials using complement inhibitors, emerging evidence points to an association between the complement system and heart diseases. Thus, complement seems to be important in coronary heart disease as well as in heart failure, where several studies underscore the prognostic importance of complement activation. Furthermore, patients with atrial fibrillation often share risk factors both with coronary heart disease and heart failure, and there is some evidence implicating complement activation in atrial fibrillation. Moreover, Chagas heart disease, a protozoal infection, is an important cause of heart failure in Latin America, and the complement system is crucial for the protozoa-host interaction. Thus, complement activation appears to be involved in the pathophysiology of a diverse range of cardiac conditions. Determination of the exact role of complement in the various heart diseases will hopefully help to identify patients that might benefit from therapeutic complement intervention.

show abstract

“…22,23 Ischemic stroke is followed by a shortlasting inflammatory response in which cytokines (i.e., IL-1 receptor antagonist and IL-6), adhesion molecules (i.e., intercellular adhesion molecule-1 and E/P-selectins), and some chemokines (i.e., CXCL16) are released to the bloodstream in the acute phase. 27 Based on this evidence, inflammatory mediators whose plasma concentrations are increased in the acute phase of ischemic stroke may affect the intrinsic system, leading to focal firing and subsequent development of AF in acute stroke patients. 26 Of note, AF and acute ischemic stroke share some of these inflammatory markers, since IL-6, IL-1, TNFa, and CRP have been implicated in the genesis of AF as well.…”

mentioning

confidence: 99%

Poststroke atrial fibrillation: Cause or consequence?

2014

View full text Add to dashboard Cite

Poststroke atrial fibrillation (AF) represents up to 1 of 4 overall AF cases in acute ischemic stroke. Current guidelines recommend oral anticoagulation for every ischemic stroke patient in whom AF is diagnosed. However, in some cases, AF detected after acute ischemic stroke may be short-lasting and perhaps a nonrecurrent autonomic and inflammatory epiphenomena of stroke. The autonomic regulation of cardiac rhythm constitutes an integrated relay system. The highest level of control is exerted by the cerebral cortex, particularly the insula. The onset of AF may be associated with an imbalance of sympathetic and parasympathetic activity, a common consequence of insular infarctions. This autonomic imbalance and an interruption in the cerebral regulation of the intrinsic cardiac autonomic system constitute the most likely mechanisms responsible for the autonomic pathway. The role of inflammation in the genesis of AF within the first few days after ischemic stroke may occur through inflammatory mediators stimulating the intrinsic autonomic system and by direct damage to atrial myocardium. To what extent poststroke AF is the cause or a consequence remains uncertain.

show abstract

Atrial Fibrillation: Inflammation in Disguise?

Cited by 17 publications

References 112 publications

Atrial Fibrillation Is Associated With a Worse 90-Day Outcome Than Other Cardioembolic Stroke Subtypes

Atrial Fibrillation Is Associated With a Worse 90-Day Outcome Than Other Cardioembolic Stroke Subtypes

A vital role for complement in heart disease

Poststroke atrial fibrillation: Cause or consequence?

Contact Info

Product

Resources

About