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subclinical atrial fibrillation and risk of stroke

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https://www.readbyqxmd.com/read/28842973/incidence-of-previously-undiagnosed-atrial-fibrillation-using-insertable-cardiac-monitors-in-a-high-risk-population-the-reveal-af-study
#1
James A Reiffel, Atul Verma, Peter R Kowey, Jonathan L Halperin, Bernard J Gersh, Rolf Wachter, Erika Pouliot, Paul D Ziegler
Importance: In approximately 20% of atrial fibrillation (AF)-related ischemic strokes, stroke is the first clinical manifestation of AF. Strategies are needed to identify and therapeutically address previously undetected AF. Objective: To quantify the incidence of AF in patients at high risk for but without previously known AF using an insertable cardiac monitor. Design, Setting, and Participants: This prospective, single-arm, multicenter study was conducted from November 2012 to January 2017...
August 26, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28794054/cardiovascular-event-prediction-by-machine-learning-the-multi-ethnic-study-of-atherosclerosis
#2
Bharath Ambale-Venkatesh, Xiaoying Yang, Colin O Wu, Kiang Liu, W G Hundley, Robyn L McClelland, Antoinette S Gomes, Aaron R Folsom, Steven Shea, Eliseo Guallar, David A Bluemke, João A Lima
Rationale: Machine learning may be useful to characterize cardiovascular risk, predict outcomes and identify biomarkers in population studies. Objective: To test the ability of random survival forests (RF), a machine learning technique, to predict six cardiovascular outcomes in comparison to standard cardiovascular risk scores. Methods and Results: We included participants from the Multi-Ethnic Study of Atherosclerosis (MESA). Baseline measurements were used to predict cardiovascular outcomes over 12 years of follow-up...
August 9, 2017: Circulation Research
https://www.readbyqxmd.com/read/28772106/frontal-plane-t-wave-axis-orientation-predicts-coronary-events-findings-from-the-moli-sani-study
#3
Licia Iacoviello, Marialaura Bonaccio, Augusto Di Castelnuovo, Simona Costanzo, Livia Rago, Amalia De Curtis, Deodato Assanelli, Fabio Badilini, Martino Vaglio, Mariarosaria Persichillo, Peter W Macfarlane, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano
BACKGROUND AND AIMS: The orientation of the frontal plane T-wave axis (T axis) is a reliable measure of ventricular repolarisation. We investigated the association between T-axis and the risk of coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), stroke and cardiovascular (CVD) mortality. METHODS: A sample of 21,287 Moli-sani participants randomly recruited from the general adult (≥35 y) Italian population, free of CVD disease, were followed for a median of 4...
July 22, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/28682320/management-of-atrial-high-rate-episodes-detected-by-cardiac-implanted-electronic-devices
#4
REVIEW
Ben Freedman, Giuseppe Boriani, Taya V Glotzer, Jeff S Healey, Paulus Kirchhof, Tatjana S Potpara
Cardiac implanted electronic devices (CIEDs), including pacemakers and implantable defibrillators that perform atrial sensing typically using an atrial electrode, frequently detect subclinical atrial high-rate episodes (AHREs). When the intracardiac electrograms are carefully examined, the majority of AHREs are atrial fibrillation (AF) or other atrial tachyarrhythmias, which have been shown to be associated with both an increased risk of stroke, and subsequent development of clinical AF. However, the absolute risk of stroke among patients with AHREs is less than might be expected for clinically diagnosed paroxysmal AF...
July 6, 2017: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/28625370/rationale-and-design-of-the-apixaban-for-the-reduction-of-thrombo-embolism-in-patients-with-device-detected-sub-clinical-atrial-fibrillation-artesia-trial
#5
RANDOMIZED CONTROLLED TRIAL
Renato D Lopes, Marco Alings, Stuart J Connolly, Heather Beresh, Christopher B Granger, Juan Benezet Mazuecos, Giuseppe Boriani, Jens C Nielsen, David Conen, Stefan H Hohnloser, Georges H Mairesse, Philippe Mabo, A John Camm, Jeffrey S Healey
BACKGROUND: Device-detected subclinical atrial fibrillation (AF) refers to infrequent, short-lasting, asymptomatic AF that is detected only with long-term continuous monitoring. Subclinical AF is common and associated with an increased risk of stroke; however, the risk of stroke with subclinical AF is lower than for clinical AF, and very few patients with subclinical AF alone have been included in large AF anticoagulation trials. The net benefit of anticoagulation in patients with subclinical AF is unknown...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28552551/resting-heart-rate-and-the-risk-of-cardiovascular-disease-total-cancer-and-all-cause-mortality-a-systematic-review-and-dose-response-meta-analysis-of-prospective-studies
#6
REVIEW
D Aune, A Sen, B ó'Hartaigh, I Janszky, P R Romundstad, S Tonstad, L J Vatten
BACKGROUND AND AIM: Epidemiological studies have reported increased risk of cardiovascular disease, cancer and all-cause mortality with greater resting heart rate, however, the evidence is not consistent. Differences by gender, adjustment for confounding factors, as well as the potential impact of subclinical disease are not clear. A previous meta-analysis missed a large number of studies, and data for atrial fibrillation have not been summarized before. We therefore aimed to clarify these associations in a systematic review and meta-analysis of prospective studies...
June 2017: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
https://www.readbyqxmd.com/read/28367846/impact-of-hypertension-and-subclinical-organ-damage-on-the-incidence-of-cardiovascular-disease-among-japanese-residents-at-the-population-and-individual-levels%C3%A3-the-circulatory-risk-in-communities-study-circs
#7
Akihiko Kitamura, Kazumasa Yamagishi, Hironori Imano, Masahiko Kiyama, Renzhe Cui, Tetsuya Ohira, Mitsumasa Umesawa, Isao Muraki, Tomoko Sankai, Isao Saito, Hiroyasu Iso
BACKGROUND: In Japan, a community-based screening program for cardiovascular disease (CVD) has been effective in preventing stroke and coronary artery disease (CAD). The present study aimed to clarify which risk factors assessed at the screening examinations affect the incidence of CVD and the magnitude of the association after the late 1990 s.Methods and Results:We conducted a 12.5-year prospective study of 10,612 Japanese residents aged 40-74 years between 1995 and 2000, initially free of CVD and who underwent the screening examinations...
March 29, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28352633/bay%C3%A3-s-syndrome-and-acute-cardioembolic-ischemic-stroke
#8
REVIEW
Adrià Arboix, Lucía Martí, Sebastien Dorison, María José Sánchez
Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block. Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave duration > 120 ms with biphasic morphology ± in the inferior leads. The clinical relevance of Bayés syndrome lies in the fact that is a clear arrhythmological syndrome and has a strong association with supraventricular arrhythmias, particularly atypical atrial flutter and atrial fibrillation. Likewise, Bayés syndrome has been recently identified as a novel risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia...
March 16, 2017: World Journal of Clinical Cases
https://www.readbyqxmd.com/read/28329380/subclinical-thyroid-dysfunction-and-cardiovascular-diseases-2016-update
#9
Carmen Floriani, Baris Gencer, Tinh-Hai Collet, Nicolas Rodondi
Subclinical thyroid dysfunction comprises subclinical hypothyroidism (SHypo), defined as elevated thyroid-stimulating hormone (TSH) by normal free thyroxine (FT4), and subclinical hyperthyroidism (SHyper) with decreased or undetectable TSH and normal FT4. Up to 10% of the elderly have SHypo, which is usually asymptomatic. Individual participant data (IPD) analyses of prospective cohort studies from the international Thyroid Studies Collaboration show that SHypo is associated with increased coronary heart disease (CHD) mortality [hazard ratio (HR) 1,58 for TSH ≥ 10 mIU/L, 95% CI 1...
February 27, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28329139/duration-of-device-detected-subclinical-atrial-fibrillation-and-occurrence-of-stroke-in-assert
#10
Isabelle C Van Gelder, Jeff S Healey, Harry J G M Crijns, Jia Wang, Stefan H Hohnloser, Michael R Gold, Alessandro Capucci, Chu-Pak Lau, Carlos A Morillo, Anne H Hobbelt, Michiel Rienstra, Stuart J Connolly
Background: ASSERT demonstrated that subclinical atrial fibrillation (SCAF) is common in pacemaker patients without prior AF and is associated with increased risk of ischemic stroke or systemic embolism. SCAF episodes vary in duration and little is known about the incidence of different durations of SCAF, or their prognosis. Methods and results: ASSERT followed 2580 patients receiving a pacemaker or ICD, aged >65 years with hypertension, without prior AF. The effect of SCAF duration on subsequent risk of ischemic stroke or embolism was evaluated with time-dependent covariate Cox models...
May 1, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28315199/hiv-infection-and-risk-of-cardiovascular-diseases-beyond-coronary-artery-disease
#11
REVIEW
Revery P Barnes, John Charles A Lacson, Hossein Bahrami
PURPOSE OF REVIEW: Cardiovascular disease (CVD) increasingly afflicts people living with HIV (PLWH) in the contemporary era of antiretroviral therapy (ART). Coronary artery disease (CAD) is the most widely studied cardiovascular problem in PLWH; however, less is known about other clinically relevant subtypes of CVD such as heart failure (HF), cerebrovascular disease, sudden cardiac death, pericardial diseases, and pulmonary hypertension. This paper reviews evidence of other subtypes of CVD as emerging issues in the post-ART era...
May 2017: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/28154101/cardioembolic-stroke
#12
REVIEW
Hooman Kamel, Jeff S Healey
Cardiac embolism accounts for an increasing proportion of ischemic strokes and might multiply several-fold during the next decades. However, research points to several potential strategies to stem this expected rise in cardioembolic stroke. First, although one-third of strokes are of unclear cause, it is increasingly accepted that many of these cryptogenic strokes arise from a distant embolism rather than in situ cerebrovascular disease, leading to the recent formulation of embolic stroke of undetermined source as a distinct target for investigation...
February 3, 2017: Circulation Research
https://www.readbyqxmd.com/read/28097334/the-role-of-cardiovascular-implantable-electronic-devices-in-the-detection-and-treatment-of-subclinical-atrial-fibrillation-a-review
#13
Paul L Hess, Jeff S Healey, Christopher B Granger, Stuart J Connolly, Paul D Ziegler, John H Alexander, Peter R Kowey, Christian T Ruff, Greg Flaker, Jonathan L Halperin, Robert G Hart, Renato D Lopes
Importance: Subclinical atrial fibrillation (AF) is associated with an increased risk for stroke. Observations: Subclinical AF is asymptomatic, short in duration, and usually detected with long-term, continuous monitoring. Most prior studies have explored its consequences using cardiovascular implantable electronic devices (CIEDs). Although current prevalence estimates are derived from study populations with prior CIEDs, 3 trials will assess the time to a first AF diagnosis among patients receiving a CIED for purposes of AF detection...
March 1, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/27956564/n-terminal-pro-brain-natriuretic-peptide-and-subclinical-brain-small-vessel-disease
#14
Andrea Vilar-Bergua, Iolanda Riba-Llena, Anna Penalba, Luz María Cruz, Joan Jiménez-Balado, Joan Montaner, Pilar Delgado
OBJECTIVE: To study the association of N-terminal pro-brain natriuretic peptide (NT-proBNP) with several brain MRI markers of brain vascular disease in a sample of participants free of stroke and dementia. METHODS: NT-proBNP plasma level was determined by means of a sandwich immunoassay method in a cohort study comprising 278 hypertensive patients. The presence of silent brain infarcts, brain microbleeds, enlarged perivascular spaces, and white matter hyperintensity volumes was assessed by brain MRI...
December 13, 2016: Neurology
https://www.readbyqxmd.com/read/27793994/genetic-risk-prediction-of-atrial-fibrillation
#15
Steven A Lubitz, Xiaoyan Yin, Henry J Lin, Matthew Kolek, J Gustav Smith, Stella Trompet, Michiel Rienstra, Natalia S Rost, Pedro L Teixeira, Peter Almgren, Christopher D Anderson, Lin Y Chen, Gunnar Engström, Ian Ford, Karen L Furie, Xiuqing Guo, Martin G Larson, Kathryn L Lunetta, Peter W Macfarlane, Bruce M Psaty, Elsayed Z Soliman, Nona Sotoodehnia, David J Stott, Kent D Taylor, Lu-Chen Weng, Jie Yao, Bastiaan Geelhoed, Niek Verweij, Joylene E Siland, Sekar Kathiresan, Carolina Roselli, Dan M Roden, Pim van der Harst, Dawood Darbar, J Wouter Jukema, Olle Melander, Jonathan Rosand, Jerome I Rotter, Susan R Heckbert, Patrick T Ellinor, Alvaro Alonso, Emelia J Benjamin
BACKGROUND: Atrial fibrillation (AF) has a substantial genetic basis. Identification of individuals at greatest AF risk could minimize the incidence of cardioembolic stroke. METHODS: To determine whether genetic data can stratify risk for development of AF, we examined associations between AF genetic risk scores and incident AF in 5 prospective studies comprising 18 919 individuals of European ancestry. We examined associations between AF genetic risk scores and ischemic stroke in a separate study of 509 ischemic stroke cases (202 cardioembolic [40%]) and 3028 referents...
April 4, 2017: Circulation
https://www.readbyqxmd.com/read/27702868/atrial-high-rate-episodes-and-stroke-prevention
#16
A John Camm, Emmanuel Simantirakis, Andreas Goette, Gregory Y H Lip, Panos Vardas, Melanie Calvert, Gregory Chlouverakis, Hans-Christoph Diener, Paulus Kirchhof
While the benefit of oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation (AF) is well established, it is not known whether oral anticoagulation is indicated in patients with atrial high-rate episodes (AHRE) recorded on a cardiac implantable electronic device, sometimes also called subclinical AF, and lasting for at least 6 min in the absence of clinically diagnosed AF. Clinical evidence has shown that short episodes of rapid atrial tachycarrhythmias are often detected in patients presenting with stroke and transient ischaemic attack...
October 4, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27637962/cerebrovascular-disease
#17
REVIEW
M L P Portegies, P J Koudstaal, M A Ikram
With 16.9 million people who suffered a first-ever stroke in 2010 worldwide, stroke is a very common vascular disease. Epidemiologic studies have played an essential role in assessing this burden and in detecting the risk factors for stroke. Primary prevention of these risk factors, primarily hypertension, smoking, diabetes, and atrial fibrillation, has reduced the incidence in high-income countries. However, stroke remains a major cause of death and disability, and therefore research should be continued. Subarachnoid hemorrhages are less prevalent than strokes but have an even higher risk of death...
2016: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/27554422/subclinical-atrial-fibrillation-a-new-entity-and-what-it-means
#18
Peter Ott
New device technologies allow for detection of clinically silent atrial fibrillation. This new entity has been associated with increased risk for stroke, even if detected for only relatively brief time periods. Current practice guidelines do not provide recommendations on how to approach this new clinical entity.
November 2016: Journal of Electrocardiology
https://www.readbyqxmd.com/read/27344417/prognostic-implications-of-lv-strain-risk%C3%A2-score%C3%A2-in%C3%A2-asymptomatic-patients-with%C3%A2-hypertensive-heart-disease
#19
Makoto Saito, Faisal Khan, Ted Stoklosa, Andrea Iannaccone, Kazuaki Negishi, Thomas H Marwick
OBJECTIVES: This study sought to investigate the associations of left ventricular (LV) strain and its serial change with major adverse cardiac events (MACE) in hypertensive heart disease, independent of and incremental to clinical and LV geometric parameters. BACKGROUND: In patients with hypertensive heart disease, MACE are associated with abnormal LV morphology, but their association with subclinical LV dysfunction is unclear. METHODS: We retrospectively studied 388 asymptomatic nonischemic patients with hypertension who had abnormal LV geometry at a baseline echocardiogram between 2005 and 2014...
August 2016: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27297859/atrial-fibrillation-without-comorbidities-prevalence-incidence-and-prognosis-from-the-framingham-heart-study
#20
Eun-Jeong Kim, Xiaoyan Yin, João D Fontes, Jared W Magnani, Steve A Lubitz, David D McManus, Sudha Seshadri, Ramachandran S Vasan, Patrick T Ellinor, Martin G Larson, Emelia J Benjamin, Michiel Rienstra
BACKGROUND: The epidemiology of atrial fibrillation (AF) without comorbidities, known as 'lone AF', is uncertain. Although it has been considered a benign condition, we hypothesized that it confers a worse prognosis compared with a matched sample without AF. METHODS: We described the proportion of AF without comorbidities (clinical, subclinical cardiovascular disease and triggers) among the entire AF sample in Framingham Heart Study (FHS). We compared AF without comorbidities with typical AF, and age-, sex- and cohort-matched individuals without AF, using Cox proportional hazards analysis in relation to combined cardiovascular events (stroke, heart failure, myocardial infarction), and mortality...
July 2016: American Heart Journal
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