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| 2. |
- Bajraktari, G. Gani, et al.
(författare)
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LA diameter more than 40 mm predicts recurrence of atrial fibrillation after trans-catheter ablation : a systematic review and meta-analysis
- 2017
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Ingår i: European Journal of Heart Failure. - : European Society of Cardiology. - 1388-9842 .- 1879-0844. ; 19:S1, s. 431-432
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aim: Left atrial (LA) enlargement is associated with atrial fibrillation (AF) incidence and outcome. Trans-catheter ablation of AF has now become a conventional treatment of AF but its recurrence remains of clinical significance. The predictive role of the LA size in AF treatment is still controversial, hence the aim of this meta-analysis was to analyze the potential association between LA diameter and AF recurrence after ablation.Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to December 2016 in order to select clinical trial and observational studies, which assessed the predictive role of LA diameter in AF recurrence after catheter-ablation. 13.573 patients from 61 studies with paroxysmal AF (PAF), persistent (PeAF) or longstanding persistent AF (L-PeAF) were included.Results: The pooled analysis showed that after a follow-up period of 19± 7.74 months, patients with AF recurrence had larger LA size compared with those without AF recurrence, with a weighted mean difference (WMD) 0.49 ([95% CI 0.39 to 0.59], P < 0.001), irrespective of the type of AF. A subgroup analysis showed LA diameter to be different; WMD was 2.29 ([95% CI 1.31 to 3.26], P < 0.001) in PAF and 1.51 ([95% CI 1.10 to 1.93], P < 0.001) in PeAF/L-PeAF, the difference between these two subgroups was not significant (Chi2=2.04, I2=51.1%, p=0.15). LA diameter ≥40 mm predicted AF recurrence HR:1.08 [95% CI 1.03 to 1.14], P=0.006), but the best cut-off value, in all included patients, was ≥50mm HR:2.73 [95% CI 1.64 to 4.55], P<0.001).Conclusions: Increased LA diameter significantly predicts recurrence of AF after ablation procedure. While a diameter of 40 mm predicts recurrence, a diameter more than 50 mm is the most accurate predictor.
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| 3. |
- Bajraktari, G. Gani, et al.
(författare)
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Reduced LA strain predicts atrial fibrillation recurrence after catheter ablation : a systematic review and meta-analysis
- 2017
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Ingår i: European Journal of Heart Failure. - : European Society of Cardiology. - 1388-9842 .- 1879-0844. ; 19:S1, s. 430-431
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aim: Despite the improved outcome of patients with atrial fibrillation (AF) who undergo catheter ablation, recurrence of the arrhythmia remains a concern. The aim of this meta-analysis was to assess the potential association between left atrial (LA) strain and AF recurrence after ablation.Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to December 2016 in order to identify clinical trial and observational studies, which assessed the predictive role of LA strain in AF recurrence after catheter-ablation. The search identified 898 patients form 10 studies, with paroxysmal AF (PAF) and persistent AF (PeAF).Results: The pooled analysis showed that after a follow-up period of 11.8± 8.1 months, patients with AF recurrence had reduced LA strain compared with those without AF, with a weighted mean difference (WMD) -7.04% ([95% CI -9.62 to -4.45], P < 0.0001). A subgroup analysis showed that LA strain was reduced regardless of AF type; WMD was -5.47% ([95% CI -9.82% to -1.13%], P=0.003) in PAF and -7.88% ([95% CI -11.19% to -4.56%], P < 0.001) in PAF/PeAF, the difference between these two subgroups was not significant (Chi2=0.75, I2=0.0%, p=0.39). A cut off value of 21% [6% to 30%], was 79% [65-86%] sensitive and 77% [66% to 91%] specific for predicting AF recurrence.Conclusions: Reduced LA strain significantly predicts recurrence of AF after ablation procedure, irrespective of AF type. This emphasizes the impact of LA wall remodeling on successful ablation.
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| 6. |
- Batalli, A., et al.
(författare)
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Different predictors of exercise capacity in HFpEF compared to HFrEF
- 2017
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Ingår i: European Journal of Heart Failure. - : European Society of Cardiology. - 1388-9842 .- 1879-0844. ; 19:1, s. 314-314
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aim: Quality of life is as important as survival in heart failure (HF) patients. Controversies exist with regards to echocardiographic predictors of exercise capacity in HF, particularly in patients with preserved ejection fraction (HFpEF). The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional exercise capacity assessed by 6 min walk test (6-MWT) in patients with HFpEF.Methods: In 111 HF patients (mean age 63± 10 years, 47% female), an echo-Doppler study and a 6-MWT were performed in the same day. Patients were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: >300 m).Results: Group I were older (p=0.008), had higher prevalence of diabetes (p=0.027), higher baseline heart rate (p=0.004), larger left atrium - LA (p=0.001), longer LV filling time - FT (p=0.019), shorter isovolumic relaxation time (p=0.037), shorter pulmonary acceleration time - PAAT (p=0.006), lower left atrial lateral wall myocardial velocity (a’) (p=0.018) and lower septal systolic myocardial velocity (s’) (p=0.023), compared with Group II. Patients with HF and reduced EF (HFrEF) had lower hemoglobin (p=0.007), higher baseline heart rate (p=0.005), higher NT-ProBNP (p=0.001), larger LA (p=0.004), lower septal s’, e’, a’ waves, and septal MAPSE, shorter PAAT (p < 0.001 for all), lower lateral MAPSE, higher E/A & E/e’, and shorter LVFT (p=0.001 for all), lower lateral e’ (p=0.009), s’ (p=0.006), RV e’ and LA emptying fraction (p=0.012 for both), compared with HFpEF patients. In multivariate analysis, only LA diameter [2.676 (1.242-5.766), p=0.012], and diabetes [0.274 (0.084 - 0.898), p=0.033] independently predicted poor 6-MWT performance in the group as a whole. In HFrEF, age [1.073 (1.012 - 1.137), p=0.018] and LA diameter [3.685 (1.348 - 10.071), p=0.011], but in HFpEF, lateral s’ [0.295 (0.099 - 0.882), p=0.029], and hemoglobin level [0.497 (0.248-0.998), p=0.049] independently predicted poor 6-MWT performance.Conclusion: In HF patients predictors of exercise capacity differ according to severity of overall LV systolic function, with left atrial enlargement in HFrEF and longitudinal systolic shortening in HFpEF as the the main predictors.
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| 7. |
- Katsiki, Niki, et al.
(författare)
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Statin therapy in athletes and patients performing regular intense exercise - Position paper from the International Lipid Expert Panel (ILEP)
- 2020
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Ingår i: Pharmacological Research. - : Elsevier. - 1043-6618 .- 1096-1186. ; 155
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Tidskriftsartikel (refereegranskat)abstract
- Acute and chronic physical exercises may enhance the development of statin-related myopathy. In this context, the recent (2019) guidelines of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) for the management of dyslipidemias recommend that, although individuals with dyslipidemia should be advised to engage in regular moderate physical exercise (for at least 30 min daily), physicians should be alerted with regard to myopathy and creatine kinase (CK) elevation in statin-treated sport athletes. However it is worth emphasizing that abovementioned guidelines, previous and recent ESC/EAS consensus papers on adverse effects of statin therapy as well as other previous attempts on this issue, including the ones from the International Lipid Expert Panel (ILEP), give only general recommendations on how to manage patients requiring statin therapy on regular exercises. Therefore, these guidelines in the form of the Position Paper are the first such an attempt to summary existing, often scarce knowledge, and to present this important issue in the form of step-by-step practical recommendations. It is critically important as we might observe more and more individuals on regular exercises/athletes requiring statin therapy due to their cardiovascular risk.
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| 8. |
- Penson, Peter E., et al.
(författare)
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Step-by-step diagnosis and management of the nocebo/drucebo effect in statin-associated muscle symptoms patients : a position paper from the International Lipid Expert Panel (ILEP)
- 2022
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Ingår i: Journal of Cachexia, Sarcopenia and Muscle. - : John Wiley & Sons. - 2190-5991 .- 2190-6009. ; 13:3, s. 1596-1622
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Forskningsöversikt (refereegranskat)abstract
- Statin intolerance is a clinical syndrome whereby adverse effects (AEs) associated with statin therapy [most commonly statin-associated muscle symptoms (SAMS)] result in the discontinuation of therapy and consequently increase the risk of adverse cardiovascular outcomes. However, complete statin intolerance occurs in only a small minority of treated patients (estimated prevalence of only 3–5%). Many perceived AEs are misattributed (e.g. physical musculoskeletal injury and inflammatory myopathies), and subjective symptoms occur as a result of the fact that patients expect them to do so when taking medicines (the nocebo/drucebo effect)—what might be truth even for over 50% of all patients with muscle weakness/pain. Clear guidance is necessary to enable the optimal management of plasma in real-world clinical practice in patients who experience subjective AEs. In this Position Paper of the International Lipid Expert Panel (ILEP), we present a step-by-step patient-centred approach to the identification and management of SAMS with a particular focus on strategies to prevent and manage the nocebo/drucebo effect and to improve long-term compliance with lipid-lowering therapy.
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