Atrial Fibrillation: Pathogenesis, Predisposing Factors, and Genetics

Sagris, Μarios; Vardas, Emmanuel P; Theofilis, Panagiotis; Antonopoulos, Alexios S; Oikonomou, Evangelos; Tousoulis, Dimitris

doi:10.3390/ijms23010006

Cited by 159 publications

(147 citation statements)

References 112 publications

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“…In this context, reports of cardiac arrhythmias have been made. As a result of myocardial inflammation and potential extensive necrosis, re-entry points in the electrical circuit may occur, leading to ventricular tachycardia and ventricular fibrillation [ 12 , 13 , 14 ]. Troponin levels have been associated with the worst outcomes, while other independent factors such as higher levels of leukocytes, D-dimer, CRP, ferritin, and IL-6 have been recognized in patients with severe COVID-19 disease.…”

Section: Inflammatory Mechanisms In Covid-19-related Cardiovascular D...mentioning

confidence: 99%

“…Many researchers support the position that cytokine storm in COVID-19 is related to individual genetic predisposition and vulnerability. This theory was strengthened by the evidence of genetic vulnerability in patients marked by primary HLH or cytokine storm in Still disease [ 14 ]. Failure of perforin and the activation of NK and cytotoxic T lymphocytes have been demonstrated as the main components of these pathologic entities.…”

Section: Genetic Predispositionmentioning

confidence: 99%

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Genetic Predisposition and Inflammatory Inhibitors in COVID-19: Where Do We Stand?

et al. 2022

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Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) and the resulting coronavirus disease-19 (COVID-19) have led to a global pandemic associated with high fatality rates. COVID-19 primarily manifests in the respiratory system as an acute respiratory distress syndrome following viral entry through the angiotensin-converting enzyme-2 (ACE2) that is present in pulmonary epithelial cells. Central in COVID-19 is the burst of cytokines, known as a “cytokine storm”, and the subsequent widespread endothelial activation, leading to cardiovascular complications such as myocarditis, arrhythmias, and adverse vascular events, among others. Genetic alterations may play an additive, detrimental role in the clinical course of patients with COVID-19, since gene alterations concerning ACE2, major histocompatibility complex class I, and toll-like receptors may predispose patients to a worse clinical outcome. Since the role of inflammation is quintessential in COVID-19, pharmacologic inhibition of various signaling pathways such as the interleukin-1 and -6, tumor necrosis factor-alpha, interferon gamma, Janus kinase-signal transducer and activator of transcription, and granulocyte–macrophage colony-stimulating factor may ameliorate the prognosis following timely administration. Finally, frequently used, non-specific anti-inflammatory agents such as corticosteroids, statins, colchicine, and macrolides represent additional therapeutic considerations.

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Section: Inflammatory Mechanisms In Covid-19-related Cardiovascular D...mentioning

confidence: 99%

Section: Genetic Predispositionmentioning

confidence: 99%

Genetic Predisposition and Inflammatory Inhibitors in COVID-19: Where Do We Stand?

et al. 2022

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“…Atrial fibrillation is a common cardiac rhythm disorder, associated with increased risk of stroke (Sagris et al, 2021). Risk factors associated with the occurrence of stroke include older age, various comorbidities (in particular, hypertension, diabetes, and renal disease) and smoking (Singer et al, 2013).…”

Section: Clinical Backgroundmentioning

confidence: 99%

Estimating Model Performance on External Samples from Their Limited Statistical Characteristics

El-Hay¹,

Yanover²

2022

Preprint

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Methods that address data shifts usually assume full access to multiple datasets. In the healthcare domain, however, privacy-preserving regulations as well as commercial interests limit data availability and, as a result, researchers can typically study only a small number of datasets. In contrast, limited statistical characteristics of specific patient samples are much easier to share and may be available from previously published literature or focused collaborative efforts.Here, we propose a method that estimates model performance in external samples from their limited statistical characteristics. We search for weights that induce internal statistics that are similar to the external ones; and that are closest to uniform. We then use model performance on the weighted internal sample as an estimation for the external counterpart.We evaluate the proposed algorithm on simulated data as well as electronic medical record data for two risk models, predicting complications in ulcerative colitis patients and stroke in women diagnosed with atrial fibrillation. In the vast majority of cases, the estimated external performance is much closer to the actual one than the internal performance. Our proposed method may be an important building block in training robust models and detecting potential model failures in external environments.

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“…Myocardial fibrosis is frequent in those patients, offering a structural foundation that promotes atrial re-entrant excitation. Likewise, studies in individuals without CKD have discovered a link between inflammation markers and AF load [9], as well as an inverse connection between inflammation levels and the persistence of sinus rhythm after cardioversion [4]. Inflammatory indicators are also enhanced in patients with CKD, and the frequency of AF in individuals with CKD is greater when C-reactive protein is persistently elevated.…”

Section: Introductionmentioning

confidence: 99%

“…Atrial fibrillation (AF) [1][2][3][4] is the most common condition of abnormal heart rhythm treated, affecting millions of people worldwide. Thus, as was published by Williams et al in 2017 [5], it is the source of a substantial rising burden for patients, physicians, and, of course, each country's healthcare system.…”

Section: Introductionmentioning

confidence: 99%

Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse

Ktenopoulos¹,

Sagris²,

Theofilis³

et al. 2022

Front. Biosci. (Schol Ed)

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The most frequent arrhythmia treated is atrial fibrillation (AF), which necessitates the use of oral anticoagulants (OACs) to reduce the risk of thromboembolism and stroke. Patients with chronic kidney disease are more likely to develop AF, with a 10% frequency among those on chronic dialysis. Warfarin is the most widely prescribed OAC for individuals with end-stage kidney disease (ESKD). On the other hand, direct OACs (DOACs) are generally safer than warfarin, with fewer fatal bleeding events and a fixed dose that does not require close international normalized ratio (INR) monitoring. For those patients, warfarin and apixaban appear to be FDA-approved, whereas dabigatran, rivaroxaban, and edoxaban are not recommended yet. Due to a lack of large randomized studies, data from major trials cannot be extended to dialysis patients. In this review, we summarize the available data and literature referring to patients on chronic hemodialysis with concomitant AF. Due to the scarcity of data, we try to assist clinicians in selecting the appropriate therapy according to the specific characteristics of each patient. Finally, future directions are provided in two key areas of focus: left atrial appendage closure therapies and genetic research.

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Atrial Fibrillation: Pathogenesis, Predisposing Factors, and Genetics

Cited by 159 publications

References 112 publications

Genetic Predisposition and Inflammatory Inhibitors in COVID-19: Where Do We Stand?

Genetic Predisposition and Inflammatory Inhibitors in COVID-19: Where Do We Stand?

Estimating Model Performance on External Samples from Their Limited Statistical Characteristics

Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse

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