RESUMEN
BACKGROUND AND OBJECTIVES: The hypothesis of the study was the assumption that the serum levels of soluble ST2 (sST2) and growth differentiation factor (GDF-15) can be predictors of atrial fibrillation (AF) recurrence in long-term period after primary radiofrequency catheter ablation (RFA). METHODS: Of the 165 patients included in the prospective follow-up, the final analysis included 131 patients whose follow-up duration reached 18 months after the end of the blanking period (3 months after RFA). The median age of patients was 59.0 (50.0; 64.0) years, and 80 (61%) were men. Paroxysmal AF was present in 103 (79%) and persistent AF in 28 (21%) patients. All patients underwent transthoracic and transesophageal echocardiography, and electroanatomic mapping was used to assess the area of low-voltage zones (LVZ). sST2 and GDF-15 levels were determined by ELISA using GDF-15/MIC-1 analytical kits (BioVender, Czech Republic) and Presage ST2 (Critical Diagnostics, USA) before RFA. After RFA, patients had regular follow-up visits at 3-6-9-12-18 months with 12-lead ECG or Holter ECG monitoring and with clinical evaluation. The primary endpoint was the occurrence of the first symptomatic AF recurrence (AFr) lasting > 30 s, recorded on an ECG or during daily ECG monitoring, after a blanking period. RESULTS: At the 18-month follow-up, 47 patients (35.9%) had AFr. The groups with and without AFr didn`t differ in the LVZ area. The medians of NT-proBNP, GDF-15 and sST2 also didn`t differ significantly between the groups, but in patients with AFr, the proportion of those with sST2 ≥ 36 ng/ml (the border of the lower and middle terziles) was higher (p = 0.03). According to the one-factor Cox regression analysis, AFr were associated with four factors: AF history ≥ 1 year, early AFr (during the blanking period), left atrial appendage flow velocity (LAAFV) < 54 cm/sec and sST2 ≥ 36 ng/ml. In the multivariate Cox analysis two independent predictors of AFr were obtained: sST2 ≥ 36 ng/ml (HR = 3.8; 95% CI 1.5-9.8, p = 0.006) and LAAFV < 54 Ñm/sec (HR = 1.96; 95% CI 1.01-3.82, p = 0.048). CONCLUSIONS: Serum sST2 level with a cut-off value of 36 ng/ml or more can be used as a predictor of AF recurrence in the long-term period after primary RFA.
Asunto(s)
Fibrilación Atrial , Biomarcadores , Ablación por Catéter , Factor 15 de Diferenciación de Crecimiento , Proteína 1 Similar al Receptor de Interleucina-1 , Valor Predictivo de las Pruebas , Recurrencia , Humanos , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/sangre , Fibrilación Atrial/etiología , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/cirugía , Masculino , Proteína 1 Similar al Receptor de Interleucina-1/sangre , Femenino , Persona de Mediana Edad , Ablación por Catéter/efectos adversos , Biomarcadores/sangre , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo , Factor 15 de Diferenciación de Crecimiento/sangre , Resultado del Tratamiento , Medición de Riesgo , Anciano , Electrocardiografía AmbulatoriaRESUMEN
OBJECTIVE: To compare the prevalence of cardiovascular risk factors and clinical manifestations of coronary artery disease (CAD) between patients with type 2 diabetes mellitus (DM) and CAD who lived at northern latitudes vs. those who resided at southern latitudes in the Tyumen region, western Siberia. STUDY DESIGN: This retrospective study involved 382 patients with type 2 DM selected from 8,573 patients with angiographic CAD (>50% stenosis). Out of the total, 243 patients were permanent residents at the high latitudes of the Tyumen region ("northern patients"), and 139 patients were permanent residents in areas south of the Tyumen region ("southern patients"). RESULTS: On average, northern patients were younger than southern patients (53 vs. 57 years, respectively). The odds ratio (OR) for living in the north was 2.1 (95% CI 0.99-4.53) for obesity (BMI>or=30 kg/m2), 1.87 (95% CI 1.05-3.31) for smoking, 0.93 (95% CI 0.89-0.96) per 1 year increase in age, 0.84 (95% CI 0.76-0.94) per 1 mmol/L increase of fasting plasma glucose, and 1.15 (95% CI 1.04-1.28) per 1 mm increase of right ventricular end-diastolic diameter. The proportion of patients with 3 or more CAD risk factors was higher in the north. Most patients in both groups had a history of myocardial infarction, severe angina in class III/IV as defined by the Canadian Cardiovascular System (CCS), heart failure in class II/IV as defined by the New York Heart Association (NYHA) and hypertension. CONCLUSIONS: A north-south gradient was observed in cardiovascular risk factors among patients with DM and CAD in the Tyumen region. The clinical manifestations of CAD in DM patients at high latitudes were comparable with those of patients who reside south of the Tyumen region of western Siberia, despite the younger age of northern patients.
Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico , Diabetes Mellitus Tipo 2/complicaciones , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Siberia/epidemiologíaRESUMEN
AIMS: To assess the relationship between asymmetric septal hypertrophy (ASH) and manifestations of coronary artery disease (CAD). METHODS AND RESULTS: A total of 5128 consecutive patients with proven diagnosis of CAD were examined. There were 2469 patients with left ventricular (LV) hypertrophy (LVH) (48.2%), among whom 297 (5.8%) had ASH (echocardiographic ventricular septum thickness to LV posterior wall thickness ratio > or =1.3). There were more male patients with ASH than patients with symmetric LVH (SLVH). ASH patients were significantly older and more obese, more of them were in NYHA class III/IV compared with SLVH patients. The prevalence of prior myocardial infarction (MI), systemic hypertension, heart rhythm disorders were higher in patients with ASH compared with SLVH patients. The groups differed significantly in echocardiographic parameters: LV and right ventricular (RV) end-diastolic dimensions, LV ejection fraction, left atrial dimension, extent of LV wall motion abnormalities, wall motion score index, LV mass/body surface area, signs of prior MI, and frequency of moderate mitral regurgitation. The frequency of stenosis and more severe (>90% stenosis) lesion of right coronary artery (RCA) and left circumflex artery (LCA) were higher in patients with ASH. Multivariate analysis identified that heart rhythm disorder, LV and RV end-diastolic dimensions, aortic root diameter, impaired LV ejection fraction, echocardiographic signs of previous MI, LV mass, and severe lesions of RCA were independently associated with ASH. CONCLUSION: In patients with CAD, ASH is associated with significant atherosclerosis of RCA and LCA, and more severe clinical manifestations of CAD and impaired LV function.