Left Atrial Fibrosis and Risk of Cerebrovascular and Cardiovascular Events in Patients With Atrial Fibrillation

King, Jordan B.; Azadani, Peyman N.; Suksaranjit, Promporn; Bress, Adam P.; Witt, Daniel M.; Han, Frederick T.; Chelu, Mihail G.; Silver, Michelle; Biskupiak, Joseph; Wilson, Brent D.; Morris, Alan; Kholmovski, Eugene; Marrouche, Nassir F.

doi:10.1016/j.jacc.2017.07.758

Cited by 156 publications

(118 citation statements)

References 24 publications

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“…The left atrium is considered a biomarker for adverse cardiovascular outcomes . Left atrial (LA) fibrosis plays an important role in the pathological process of AF .…”

Section: Introductionmentioning

confidence: 99%

Matrine reduces susceptibility to postinfarct atrial fibrillation in rats due to antifibrotic properties

Yin

et al. 2018

Cardiovasc electrophysiol

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This study aimed to investigate whether matrine could prevent atrial fibrillation (AF) after myocardial infarction by reducing left atrial fibrosis, and to determine the underlying mechanisms in isolated cardiac fibroblasts (CFs). Five weeks after MI, matrine-treated rats had lower rates of AF inducibility and shorter AF duration than MI rats. Matrine improved the left atrial conduction velocity and homogeneity. Matrine decreased the fibrosis positive areas and the protein levels of type I collagen and type III collagen in the left atrium. Matrine inhibited CFs differentiation to myofibroblasts and the expression of transforming growth factor-beta 1 and matrix metalloproteinase 9. In vitro, matrine inhibited the CFs proliferation, migration, differentiation, and secretion ability. These in vitro and in vivo data demonstrated that matrine has the potential to reduce susceptibility to AF after MI due, at least in part, to reduced atrial fibrosis via inhibiting CFs proliferation, migration, differentiation, and secretion ability.

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“…The left atrium is considered a biomarker for adverse cardiovascular outcomes . Left atrial (LA) fibrosis plays an important role in the pathological process of AF .…”

Section: Introductionmentioning

confidence: 99%

Matrine reduces susceptibility to postinfarct atrial fibrillation in rats due to antifibrotic properties

Yin

et al. 2018

Cardiovasc electrophysiol

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“…It might explain the reason why neither total EAT or BMI was not associated with the ES in the present study. Of note, LA fibrosis has been associated with a higher incidence of stroke or TIA in patients with AF regardless of CA . The mechanism of correlation between EAT and ES might be explained by EAT‐mediated atrial cardiomyopathy, which features LA enlargement, increased wall stiffness, hypercontractility, endothelial dysfunction, or impaired reservoir function, and contributes to atrial prothrombotic milieu …”

Section: Discussionmentioning

confidence: 99%

Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

Ahn

Shin

Shim

et al. 2019

Cardiovasc electrophysiol

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Introduction Risk factors of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated especially among the Asian subjects, particularly regarding epicardial adipose tissue (EAT) in cardiac imaging. We aimed to assess the incidence of ES during a long‐term follow‐up period after AF ablation and to identify the risk factors associated with postablation ES, specifically focusing on EAT. Methods and Results We enrolled patients who experienced postablation ES and control subjects from a consortium of AF ablation registries from three institutes in Korea. EAT was assessed using multislice computed tomography before AF ablation. A total of 3464 patients who underwent AF ablation were recruited and followed‐up. During a follow‐up of 47.2 ± 36.4 months, ES occurred in 47 patients (1.36%) with a CHA2DS2‐VASc score of 1.48 ± 1.39 and the overall annual incidence of ES was 0.34%. Compared with the control group (n = 190), the ES group showed significantly higher prior thromboembolism (TE) and AF recurrence rates, larger left atrium size, lower creatinine clearance rate (CCr), and greater total and peri‐atrial EAT volume. Multivariate regression analysis demonstrated larger peri‐atrial EAT volume (hazards ratio, 1.065; 95% confidence interval, 1.005‐1.128), in addition to a prior history of TE and lower CCr, was independently associated with postablation ES. When a cut‐off value of peri‐atrial EAT volume of ≥20.15 mL was applied, patients with smaller peri‐atrial EAT volume showed significantly higher ES‐free survival. Conclusion Larger peri‐atrial EAT volume, in addition to prior TE and lower CCr, was independently associated with postablation ES regardless of AF recurrence and CHA2DS2‐VASc score. (ClinicalTrials.gov number, NCT03479073).

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“…A presença de fibrose atrial diagnosticada por técnica de realce tardio na ressonância magnética em alguns estudos foi relacionada a uma história pregressa de AVCi, presença de trombo em apêndice atrial esquerdo e contraste espontâneo em átrio esquerdo diagnosticados por ecocardiograma transesofágico [18][19][20] . O diagnóstico de fibrose atrial por mapa de voltagem em procedimentos de ablação para tratamento de fibrilação atrial foi relacionado a uma maior probabilidade pregressa à ablação, da ocorrência de AVCi e lesão cerebral silenciosa diagnosticada por ressonância magnética 21 .…”

Section: Ano Acidente Vascular Cerebral Isquêmico (N) Fibrilação Atriunclassified

Fibrilação Atrial e Tromboembolismo Sistêmico – Relação Causal ou uma Mensagem de Doença Atrial?

Vasconcelos¹,

Duarte²,

Filho³

2020

J Cardiac Arrhtythmias

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A relação entre fibrilação atrial (FA) e tromboembolismo é conhecida de longa data. Em 1951, Raymond Daley et al. associaram com informações consistentes a ocorrência dessa arritmia a eventos embólicos sistêmicos em pacientes portadores de cardiopatia reumática crônica 1 . Nesse estudo envolvendo 194 portadores de cardiopatia reumática vítimas de tromboembolismo, contando com informações de autópsia em 39 pacientes, ficou demonstrada a presença de FA em cerca de 90% dos casos. O clássico estudo de Framingham, publicado em 1978, foi o primeiro grande estudo que estabeleceu essa mesma relação em indivíduos não reumáticos, demonstrando que os portadores de FA têm perto de seis vezes mais chances de apresentar um acidente vascular cerebral do que aqueles indivíduos livres de FA com características ajustadas para sexo, idade e pressão arterial 2 . A inclusão de indivíduos reumáticos elevou esse risco para algo em torno de 18 vezes. Desde essa importante publicação, diversos estudos corroboraram esses achados 3-7 .Na Tabela 1 são apresentados os resultados de cinco estudos envolvendo mais de 100 mil pacientes, que situam a prevalência de FA em pacientes vítimas de um acidente vascular cerebral isquêmico (AVCi) em torno de 15 a 40%. É bastante razoável contudo deduzir que, mesmo nos 60 a 85% dos pacientes que apresentam um AVCi sem o diagnóstico pregresso de FA, a prevalência da arritmia seja maior, considerando a possibilidade de arritmia assintomática não diagnosticada. Em revisão sistemática e metanálise de 32 estudos envolvendo cerca de 5.000 pacientes sem antecedentes de FA que sofreram um AVCi submetidos a monitoramento agressivo do ritmo cardíaco, por Holter de 24 h, Holter de 7 dias ou monitor de eventos implantável, demonstrou-se o diagnóstico de FA em cerca de 11% dos pacientes 8 . Portanto, a partir das informações obtidas nesses grandes estudos ao longo das últimas seis décadas, com resultados incorporados de significativa força e consistência de associação, o seguinte paradigma foi construído: "fibrilação atrial causa AVCi tromboembólico".

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Left Atrial Fibrosis and Risk of Cerebrovascular and Cardiovascular Events in Patients With Atrial Fibrillation

Abstract: This retrospective analysis demonstrated that more severe LA LGE is associated with increased MACCE risk, driven primarily by increased risk of stroke or TIA.

Cited by 156 publications

References 24 publications

Matrine reduces susceptibility to postinfarct atrial fibrillation in rats due to antifibrotic properties

Matrine reduces susceptibility to postinfarct atrial fibrillation in rats due to antifibrotic properties

Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

Fibrilação Atrial e Tromboembolismo Sistêmico – Relação Causal ou uma Mensagem de Doença Atrial?

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