Use of Transesophageal Echocardiography to Guide Cardioversion in Patients with Atrial Fibrillation

Klein, Allan L.; Grimm, Richard A.; Murray, R.Daniel; Apperson-Hansen, Carolyn; Asinger, Richard W.; Black, Ian W.; Davidoff, Ravin; Erbel, Raimund; Halperin, Jonathan L.; Orsinelli, David A.; Porter, Thomas R.; Stoddard, Marcus F.

doi:10.1056/nejm200105103441901

Cited by 844 publications

(322 citation statements)

References 33 publications

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“…In addition, the relatively lower thyroid hormone levels of patients with OVH may amplify the cardiovascular risks associated with insulin resistance, although hypothyroidism itself does not cause insulin resistance directly (21). Through these complex mechanisms, OVH is thought to accelerate the development of coronary atherosclerosis (1).…”

Section: Discussionmentioning

confidence: 99%

“…The cardiovascular system is a major target of thyroid hormone action (1,2). Changes in thyroid function result in several alterations in cardiac hemodynamics.…”

Section: Introductionmentioning

confidence: 99%

“…Small-scaled case-control and cohort studies have shown that coronary atherosclerosis in subjects with hypothyroidism is more frequent and severe than in normal subjects (3). There is substantial evidence that OVH alters the traditional risk factors for cardiovascular disease (CVD) by increasing the circulating levels of atherogenic low-density lipoprotein cholesterol (LDL-C) particles, inducing systolic/diastolic hypertension and abnormalities in coagulation and increasing plasma homocysteine and C-reactive protein levels (1)(2)(3)(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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Impact of subclinical hypothyroidism on the coronary artery disease in apparently healthy subjects

Park

Lee

Choi

et al. 2011

European Journal of Endocrinology

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Objective: Cardiovascular disease (CVD) occurs frequently and may progress more rapidly in overt hypothyroidism (OVH). However, the role of mild thyroid failure as a risk factor for CVD is not clear. This study is aimed at exploring the association between subclinical hypothyroidism (SCH) and coronary artery disease (CAD), as detected by cardiac computed tomography (CT), in apparently healthy subjects. Subjects and methods: We retrospectively enrolled 2404 asymptomatic subjects who underwent cardiac CT with an intermediate to high risk (Framingham 10-year risk R10%) of developing CAD but with no known CAD or thyroid disease. Coronary artery calcium score (CACS) was assessed by calcium scan, and the presence of the plaques (CAD), with R50% stenosis being indicative of obstructive CAD, was assessed by coronary CT angiography. Results: Of the 2404 subjects, 2355 subjects were euthyroid (Eu; 53G9 years, 83 females) and 49 had SCH (58G12 years, seven females). CAD and CACS O100 were more prevalent in SCH subjects than in Eu subjects (Eu vs SCH: CAD, 948 (40.6%) vs 31 (63.3%), PZ0.002; CACS O100, 239 (10.3%) vs 10 (20.4%), PZ0.031). SCH was also an independent risk factor for CAD after a multivariate analysis (odds ratio: 2.125, 95% confidence interval: 1.049-4.307, PZ0.036). Conclusions: SCH subjects who were at an intermediate-to-high risk of developing CAD were significantly more likely to exhibit occult CAD than Eu subjects, especially in men with SCH. These findings suggest that mild thyroid failure also independently contributes to the development of CAD.

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Section: Discussionmentioning

confidence: 99%

“…The cardiovascular system is a major target of thyroid hormone action (1,2). Changes in thyroid function result in several alterations in cardiac hemodynamics.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of subclinical hypothyroidism on the coronary artery disease in apparently healthy subjects

Park

Lee

Choi

et al. 2011

European Journal of Endocrinology

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“…Одним из подходов, по данным наблю-дательных когортных исследований, является на-значение антагонистов витамина К (АВК) с целевым МНО 2,0-3,0 в течение, по крайней мере, 3-х нед пе-ред кардиоверсией. Второй подход -непосредствен-ное исключение внутрисердечного тромбоза, включая ушко левого предсердия, с помощью чреспищеводной эхокардиографии (ЭХО-КГ) с сокращенным сроком ан-тикоагулянтной подготовки перед кардиоверсией [6]. Прием АВК должен быть продолжен в течение мини-мум 4 нед после кардиоверсии из-за риска тром-боэмболии в связи с дисфункцией левого предсердия после восстановления синусового ритма.…”

Section: Dabigatran In Electrical Cardioversionunclassified

Dabigatran Etexilate in the course of Electrical Cardioversion in Patients with Non-Valvular Atrial Fibrillation

Новикова

Воловченко

2016

Racionalʹnaâ farmakoterapiâ v kardiologii

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ВведениеОдин из важнейших аспектов лечения больных с фибрилляцией (ФП) и трепетанием предсердий (ТП) -восстановление синусового ритма. С одной стороны некоторые исследования показали, что тактика контроля ритма не имеет существенных преимуществ в улучше-нии прогноза перед тактикой контроля частоты [1][2][3], с другой стороны, электрическая кардиоверсия остается одной из самых востребованных процедур у данной ка-тегории больных.Главной проблемой при выполнении кардиоверсии является высокий риск тромбоэмболических ослож-нений (ТЭО), частота которых составляет 1-2% Фибрилляция предсердий (ФП) является наиболее частым кардиальным источником системной эмболии и кардиоэмболического инсуль-та. При выполнении электрической кардиоверсии данный риск значительно возрастает. Для подготовки к электрической кардиоверсии чаще всего используют антагонист витамина К -варфарин. Однако в течение последних лет все большее распространение получают новые перо-ральные антикоагулянты (НОАК) для профилактики тромбоэмболических осложнений у пациентов с ФП. В рамках ретроспективного ана-лиза пациентов, участвовавших в исследовании RE-LY, была показана возможность проведения плановой кардиоверсии на фоне приема да-бигатрана. Частота инсульта и системной эмболии в течение 30 дней после кардиоверсии была низкой и значимо не различалась во всех груп-пах. Таким образом, результаты исследования RE-LY позволяют проводить плановую и экстренную кардиоверсию на фоне приема дабигат-рана. В дальнейшем данные результаты были подтверждены в других ретроспективных исследованиях и мета-анализах, результаты которых представлены в данной статье. Исследование X-VERT и субанализ исследования ARISTOTLE показали эффективность и безопасность ривароксабана и апиксабана при подготовке и проведении электрической кардиоверсии у больных с неклапанной ФП. Во всех опубликованных работах у большинства пациентов были использованы длительные схемы подготовки к кардиоверсии. В настоящее время не проведено специально спланированного исследования, направленного непосредственно на оценку эффективности НОАК при подготовке и выполнении электри-ческой кардиоверсии, и, в частности дабигатрана, у пациентов с ФП. Поэтому остается ряд вопросов, таких как безопасность и эффектив-ность дабигатрана на фоне коротких схем подготовки перед электрической кардиоверсией.Ключевые слова: фибрилляция предсердий, электрическая кардиоверсия, варфарин, дабигатран. Atrial fibrillation (AF) is the most common cardiac cause of systemic embolism and cardioembolic stroke. The risk of thromboembolic complications increases significantly when performing for electrical cardioversion. Vitamin K antagonists (warfarin) more often used to prepare for electrical cardioversion. However lately new oral anticoagulants (NOAC) are becoming more common for the prevention of thromboembolic events in patients with AF. Possibility to perform planned cardioversion while receiving dabigatran has been shown in a retrospective analysis of patients from the RE-LY study. The incidence of stroke and systemic embolism within ...

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“…The cardiovascular system is a major target of thyroid hormone, which influences cardiac function both directly and indirectly via changes in peripheral vascular resistance and circulating volume (6). Noninvasive evaluation of myocardial function, both in animals and humans, has shown opposite abnormalities in systolic time intervals in primary hypothyroidism and hyperthyroidism that can be reversed by appropriate therapy (7,8,9).…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of subclinical central hypothyroidism in patients with hypothalamic–pituitary disease by Doppler echocardiography

Doin

Rosa-Borges²,

Martins³

et al. 2012

European Journal of Endocrinology

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Objective: The diagnosis of subclinical central hypothyroidism in hypothalamic-pituitary patients cannot be established by serum markers of thyroid hormone action. Myocardial function by echocardiography has been shown to reflect thyroid hormone action in primary thyroid dysfunction. We evaluated the performance of echocardiography in diagnosing subclinical central hypothyroidism. Design: Cross-sectional and before and after. Methods: Echocardiography and serum thyroid hormones were assessed in overt primary (nZ20) and central (nZ10) hypothyroidism, subclinical primary hypothyroidism (nZ10), hypothalamic-pituitary disease with normal free thyroxine (FT 4 ; nZ25), and controls (nZ28). Receiver operating characteristic (ROC) curves were generated using overt hypothyroidism patients and selected cut-off values were applied to detect both primary and central subclinical hypothyroidism. After levothyroxine (L-T 4 ) intervention, patients were echocardiographically reevaluated at predefined targets: normal thyrotropin (TSH) in primary hypothyroidism, normal FT 4 in overt central hypothyroidism, and higher than pretreatment FT 4 in echo-defined subclinical central hypothyroidism.

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Use of Transesophageal Echocardiography to Guide Cardioversion in Patients with Atrial Fibrillation

Abstract: The use of transesophageal echocardiography to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned.

Cited by 844 publications

References 33 publications

Impact of subclinical hypothyroidism on the coronary artery disease in apparently healthy subjects

Impact of subclinical hypothyroidism on the coronary artery disease in apparently healthy subjects

Dabigatran Etexilate in the course of Electrical Cardioversion in Patients with Non-Valvular Atrial Fibrillation

Diagnosis of subclinical central hypothyroidism in patients with hypothalamic–pituitary disease by Doppler echocardiography

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