Prognostic analysis of emergency department patients with atrial fibrillation≥75 years old—a subgroup analysis of the Chinese Emergency Atrial Fibrillation Study / 中华急诊医学杂志

Objective:To investigate the baseline characteristics and 1-year follow-up prognosis of elderly (age ≥75 years) emergency department (ED) patients with atrial fibrillation (AF).Methods:From 2009 to 2011, patients with AF aged ≥75 years were continuously enrolled in the ED in 20 hospitals. The baseline characteristics and treatment status of the patients were collected and followed up for 1 year. The primary endpoint was all-cause death; Secondary endpoints were cardiovascular death, stroke, major bleeding and major adverse events. Uni- and multivariate Cox regression models were used to analyze the independent risk factors for the above events.Results:A total of 766 elderly ED patients with AF were enrolled, the average age was 80.76±4.66 years old, and 56.9% were female. The 1-year all-cause mortality was 24.3%, cardiovascular mortality was 12.8%, stroke rate was 10.6%, major adverse event rate was 33.6%, and the readmission rate was 32%. Multivariate Cox regression analysis showed that age ( HR1.073, 95% CI 1.042-1.105), heart rate ( HR1.008, 95% CI 1.002-1.013), history of dementia/cognitive impairment ( HR1.849, 95% CI 1.016) ~3.365), and history of chronic obstructive pulmonary disease ( HR1.824, 95% CI 1.303-2.551) were independent risk factors for death in elderly patients with AF in 1-year follow-up; female (HR1.664, 95% CI 1.036-2.675), and history of hypertension ( HR2.035, 95% CI 1.080-3.836), history of dementia/cognitive impairment ( HR2.773, 95% CI 1.220-6.302) were independent risk factors for 1-year stroke in elderly patients with AF. Conclusions:The prognosis of elderly ED patients with AF is poor. Age, heart rate, history of dementia/cognitive impairment, and history of chronic obstructive pulmonary disease are independent risk factors for 1-year all-cause death and major adverse events in elderly ED patients with AF. Female, history of hypertension, and history of dementia/ cognitive impairment are independent risk factors for stroke in elderly ED patients with AF.

Clinical Characteristics and Impact of Diabetes Mellitus on Outcomes in Patients with Nonvalvular Atrial Fibrillation

PURPOSE: Studies have shown that diabetes mellitus (DM) is a risk factor for cardiovascular disease, including atrial fibrillation (AF); however, the clinical characteristics and prognostic impact of DM in patients with nonvalvular AF have not been well understood in China. MATERIALS AND METHODS: Included were 1644 consecutive patients with nonvalvular AF. Endpoints included all-cause mortality, cardiovascular mortality, stroke, major bleeding, and combined endpoint events (CEE) during a 1-year follow-up. RESULTS: The prevalence of DM was 16.8% in nonvalvular AF patients. Compared with non-diabetic AF patients, diabetic AF patients were older and tended to coexist with other cardiovascular diseases. Most patients with DM (93.5%) were eligible for anticoagulation, as determined by CHADS2 scores. However, only 11.2% of patients received anticoagulation. During a 1-year follow-up, the all-cause mortality and CEE rate in the DM group were significantly higher than those of the non-DM group, while the incidence of stroke was comparable. After multivariate adjustments, DM was still an independent risk factor for 1-year all-cause mortality [hazard ratio (HR)=1.558; 95% confidence interval (CI) 1.126-2.156; p=0.007], cardiovascular mortality (HR=1.615; 95% CI 1.052-2.479; p=0.028), and CEE (HR=1.523; 95% CI 1.098-2.112; p=0.012), yet not for stroke (HR=1.119; 95% CI 0.724-1.728; p=0.614). CONCLUSION: DM is a common morbidity coexisting with nonvalvular AF and is associated with an increased risk of 1-year all-cause mortality, cardiovascular mortality, and CEE. However, no increased risk of stroke was found during a 1-year follow-up in patients with AF and DM.

Diabetes Reducing the Intensity of Sarcoplasmic Reticulum Ca2+-ATPase-SUMOylation of Myocardium in Experimental Rats / 中国循环杂志

Objective: To investigate the effect of diabetes on the intensity of sarcoplasmic reticulum Ca2+-ATPase (SERCA2a)-SUMOylation and SERCA2a activity of myocardium in experimental rats. Methods: The 8 weeks old SD rats were divided into 2 groups, Diabetic group, with diet-induced type 2 diabetic rats and Control group, with normal rats. The systolic and diastolic cardiac functions were evaluated by echocardiography and left ventricular pressure measurement. The intensity of SERCA2a-SUMOylation was examined by co-immunoprecipitation and SUMOylation kit. Results: Compared with Control group, Diabetic group had decreased systolic and diastolic cardiac functions, especially for diastolic function;decreased SERCA2a protein expression and intensity of SUMOylation;decreased SUMOylation E2 (Ubc9 ) protein expression. The protein levels of SUMO1, SAE1 and SAE2 were similar between 2 groups. Conclusion: The intensity of SERCA2a-SUMOylation and Ubc9 decreased in diabetic myocardium which implies that SERCA2a-SUMOylation and Ubc9 were closely related to the damage of diabetic myocardium in experimental rats.

An analysis of risk factors for stroke in atrial fibrillation and hypertension patients / 中华内科杂志

Objective To explore the independent risk factors for the 1 year stroke event in Chinese patients with atrial fibrillation (AF) and hypertension (HT).Methods Data of AF and HT patients in the Chinese Emergency Atrial Fibrillation Registry Study were retrospectively analyzed.The eligible patients were divided into the stroke group and the non-stroke group according to the result of 1 year follow-up.The predictors for the 1 year stroke event were identified by uni-and multi-variate Cox regression analysis with the baseline and therapeutic variables.Results A total of 1 118 AF and HT patients were enrolled in the study with the incidence of 1 year stroke event of 8.7％.All patients were divided into the stroke group (n =97) and the non-stroke group (n =1 021).Compared with the non-stroke group,more female patients were in the stroke group (68.0％ vs 54.5％,P ＜ 0.05) and the patients in the stroke group were older [(76.0 ± 9.4) years vs (71.9 ± 10.6) years,P ＜ 0.01] with higher proportion of previous history of stroke (38.1％ vs 23.8％,P ＜0.01).More patients were observed on the antihypertensive treatment in the non-stroke group (91.6％ vs 85.6％,P ＜ 0.05),while more patients on statins in the stroke group(45.4％vs 34.5％,P ＜ 0.05).Multi-variate Cox regression analysis showed that age (HR =1.036,95％ CI 1.010-1.062),female (HR =1.908,95％ CI 1.170-3.110),previous stroke history (HR =1.680,95％ CI 1.084-2.603),and no antihypertensive treatment (HR =1.955,95％ CI 1.008-3.791) were independent risk factors for the 1 year stroke event in patients with AF and HT.Conclusion Age,female,previous stroke history and no antihypertensive treatment are the independent risk factors for the 1 year stroke event in patients with AF and HT.