Prevalence of recommended anticoagulation by guidelines preadmission and its impact on the incidence of acute myocardial infarction (AMI) and in-hospital outcomes after AMI in atrial fibrillation patients.

This study was designed to explore the prevalence of recommended anticoagulation by guidelines before admission and its impact on the incidence of acute myocardial infarction (AMI) and the AMI associated in-hospital outcomes in patients with atrial fibrillation (AF). 10,725 patients with AF at their first hospitalizations in our hospitals were retrospectively reviewed, with a prevalence of recommended anticoagulation preadmission 24.41% (Number = 2618). They had lower risk of AMI incidence (Adjusted OR 0.66, 95%CI 0.54-0.81, p < 0.001) compared to those without recommended anticoagulation after multivariate logistic regression. Furthermore, recommended anticoagulation preadmission reduced in-hospital all-cause death associated with AMI in univariate logistic analysis, but had no impact on the risk of in-hospital bleeding and stroke after AMI both in univariate and multivariate logistic analysis. The prevalence of recommended anticoagulation before admission was 24.41% in China. Recommended anticoagulation reduced incidence of hospitalized AMI, but had no impact on the associated in-hospital bleeding and stroke risk after AMI.

Validating scores predicting atrial fibrillation recurrence post catheter ablation in patients with concurrent atrial fibrillation and pulmonary diseases.

BACKGROUND: Several scores were available for predicting atrial fibrillation (AF) recurrence post radiofrequency ablation. However, the role of different scores predicting AF recurrence after ablation in patients with concurrent AF and pulmonary diseases (PDs) remained obscure. Herein, we aimed to investigate their predicting values and differences in patients with concurrent AF and PDs. METHODS: From January 2008 to April 2015, 304 patients with concurrent AF and PDs treated with catheter ablation were divided into 2 groups according to whether they experienced AF recurrence in our centers. Factors related with AF recurrence were explored using Cox regression and scores predicting recurrent AF were compared in these patients using ROC curves. RESULTS: During a median of 6-month of follow-up, factors correlating with late AF recurrence included heart failure (HF) history [hazard ratio (HR): 2.79; 95% confidence interval (CI): 1.49-5.22, P=0.001], current smoking (1.73; 1.13-2.68, P=0.01) and early AF recurrence (3.85; 95% CI: 2.62-5.66, P<0.001) according to univariate Cox regression analysis. When analyzed using multivariate Cox model, HF history (2.21; 1.12-4.37, P=0.02), hypertension history (1.54; 1.02-2.33, P=0.04) and early AF recurrence (3.90; 2.60-5.85, P<0.001) were related to late AF recurrence. The BASE-AF2 score had higher c-index than the MB-LATER, APPLE, CHADS2, CHA2DS2-VASc, CAAP-AF and HATCH scores when compared using ROC curves analysis (all P<0.05). The optimal point for predicting AF recurrence of the BASE-AF2 score in the ROC analysis was 1 point with sensitivity of 69.03% and specificity of 60.21%. CONCLUSIONS: The predicting AF recurrence value of BASE-AF2 score was superior to MB-LATER, APPLE, CHADS2, CHA2DS2-VASc, CAAP-AF and HATCH scores in patients with concurrent AF and PDs, which can be an effective and helpful score for making AF treatment decisions.

Patients with acute myocardial infarction and atrial fibrillation: association of anaemia with risk of in-hospital bleeding, stroke and other death causes.

PURPOSES: To explore the association of anaemia with risk of outcomes of in-hospital patients with acute myocardial infarction (AMI) and atrial fibrillation (AF). METHODS: Patients with AF and AMI at their first hospitalizations in three hospitals (Beijing Tongren Hospital, Beijing Friendship Hospital, Capital Medical University and China-Japan Friendship Hospital) were retrospectively reviewed and divided into two groups (with vs. without anaemia) according to haemoglobin within one day before or after admission. RESULTS: 864 patients with AF and AMI (mean age:74.22 years; 39.9% female) were included in the current study. Patients with anaemia had increased risk of any bleeding (adjusted OR: 2.29, 95% CI: 1.43-3.68, p = 0.001), minor bleeding (adjusted OR: 2.37, 95% CI:1.40-4.01, p = 0.001), gastrointestinal bleeding (adjusted OR: 2.53, 95% CI:1.51-4.25, p < 0.001) and other death causes (adjusted OR: 1.71, 95% CI: 1.07-2.72, p = 0.02) compared to those without anaemia according to logistic regression. However, there was no difference in the risk of stroke or/and systematic embolism (SE) between patients with and without anaemia. CONCLUSIONS: In the Chinese in-hospital AMI and AF cohort, anaemia was shown to be associated with increased risk of any bleeding, minor bleeding, gastrointestinal bleeding and other death causes, but not the risk of stroke or/and SE.

HDAC6 promotes sepsis development by impairing PHB1-mediated mitochondrial respiratory chain function.

OBJECTIVE: This study was aimed at investigating the regulation of mitochondrial function by histone deacetylase 6 (HDAC6) and the role of HDAC6 in the development and progression of sepsis. RESULTS: HDAC6 downregulated PHB1 and subsequently promoted the development of CLP-induced sepsis. Inhibition of HDAC6 significantly attenuated CLP-induced sepsis through inhibition of mitochondrial dysfunction and reduced oxidant production, thus protecting the rats from oxidative injury. CONCLUSIONS: In this sepsis model, HDAC6 inhibits the expression and function of PHB1 and alters the function of the mitochondrial respiratory chain mediated by PHB1, thus enhancing the production of oxidants and increasing oxidative stress and thereby leading to severe oxidative injury in multiple organs. METHODS: The expression of HDAC6 and prohibitin 1 (PHB1) in humans and in a rat model of sepsis was measured by quantitative reverse-transcription PCR and western blotting. Sepsis induction by cecal ligation and puncture (CLP) was confirmed by histological analysis. Concentrations of different sepsis markers were measured by an enzyme-linked immunosorbent assay, and mitochondrial function was assessed via the mitochondrial respiratory control rate.

Prevalence and sex- and age-related risk of pulmonary embolism in in-hospital patients with atrial fibrillation: a multicenter retrospective study from China.

BACKGROUND: This study was designed to explore the prevalence of pulmonary embolism (PE) and sex and age-related risk of incident PE in in-hospital patients with atrial fibrillation (AF) in China. METHODS: A retrospective cohort of 15,688 AF patients (mean age: 72.56 years; 55.7% male) was identified from 2008 to 2018 in our hospitals. The prevalence and incidence of PE over a 2.28-year follow-up were studied. Unadjusted, age or sex-adjusted, and multivariate Cox regression were used to explore the risk of PE in the studied patients. RESULTS: One hundred eighty-two AF patients (1.2%) had PE at their first hospitalizations. Over a mean follow-up of 2.28 years, 85 patients developed PE, with an incidence of 0.24% per person-year. PE was more likely to occur in female and older patients with AF according to the unadjusted, age or sex-adjusted, and multivariate Cox regression analysis (all P<0.05). Moreover, a significant higher risk of PE was seen in female and older patients in AF using Kaplan-Meier analysis, respectively (log-rank: both P<0.001). CONCLUSIONS: In the current AF cohort, the prevalence of PE was 1.2% and the incidence of PE was 0.24% per person-year during a mean follow-up of 2.28 years. Female and older patients were more likely to experience PE compared to male and younger patients.

Relationship of troponin to incident atrial fibrillation occurrence, recurrence after radiofrequency ablation and prognosis: a systematic review, meta-analysis and meta-regression.

OBJECTIVE: To explore the association between the levels of troponin (Tn) and incident atrial fibrillation (AF) occurrence, AF recurrence after radiofrequency ablation (RFA), and the risk trend of AF related prognosis (stroke, major bleeding and mortality). METHODS: Twenty-seven studies were included after a systematic search in PubMed from 2005 to 2017, including 13 associated with incident AF occurrence, 8 associated with AF recurrence after RFA and 6 studies evaluating the risk trend of AF-related prognosis with increased Tn levels. RESULTS: Compared with 'no incident AF occurrence' patients, the incident AF occurrence group had similar baseline troponin I (TnI) levels (standardized mean differences [SMD] = 0.42, 95% CI: -0.02-0.86, p = 0.06; I2 = 87.0%, N = 6), but higher troponin T (TnT) levels (SMD = 3.77, 2.13-5.42, p <0.001; I2=99.7%, N = 8). AF recurrence patients had similar peri-ablation TnI levels, but higher peri-ablation TnT levels compared to the 'no AF recurrence' group with pooled SMD. (TnI: SMD: -0.61, -1.22to 0, p = 0.049; I2 = 87.1%; TnT: 0.38, 0.14-0.62, p = 0.002; I2 = 64.7%). On meta-regression, there was an increased risk trend for stroke/systemic embolism (SE) (r2 = 0.93, p = 0.04) or major bleeding (r2 = 0.99, p < .0001) with the increasing TnT levels. Mortality was not significantly related to TnI (r2 = 0.09, p = 0.25) or TnT (r2 = 0.20, p = 0.31), and stroke/SE (r2 = 0.02, p = 0.74) or major bleeding (r2 = 0.002, p = 0.92) was non-significantly related to increasing TnI levels. CONCLUSIONS: In our systematic review, meta-analysis and meta-regression, TnT was associated with both incident AF occurrence and AF recurrence after RFA, as well as stroke/SE and major bleeding. In contrast, TnI was not associated with incident AF occurrence, AF recurrence after RFA or prognosis (stroke/SE, major bleeding).

Effectiveness and safety of oral anticoagulants in older patients with atrial fibrillation: a systematic review and meta-regression analysis.

Background and objective: the study analysed the effectiveness and safety of warfarin use compared with warfarin non-use and non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients aged ≥65 years. Methods: after searching PubMed and the Cochrane Library, 26 studies were included, with 10 comparing warfarin with warfarin non-use and 16 comparing warfarin with NOACs, in older AF patients (≥65 years). Results: warfarin use was superior to no antithrombotic therapy [relative risk (RR) 0.59, 95% confidence interval (CI) 0.51-0.76, I2 = 12.3%, n = 8] and aspirin (RR 0.44, 95% CI 0.24-0.64, I2 = 0.0%, n = 5) for stroke/thromboembolism (TE) prevention. Warfarin use was associated with a non-significant increase in risk of major bleeding compared with no antithrombotic therapy (RR 1.26, 95% CI 0.99-1.52, I2 = 0.0%, n = 7) and aspirin (RR 1.20, 95% CI 0.91-1.50, I2 = 0.0%, n = 5). NOACs were superior to warfarin for stroke/TE prevention [hazard ratio (HR) 0.81, 95% CI 0.73-0.89, I2 = 56.6%, n = 9], and also were associated with reduced risk of major bleeding compared to warfarin (HR 0.87, 0.77-0.97, I2 = 86.1%, n = 9). Conclusions: warfarin use was superior to warfarin non-use, aspirin and no antithrombotic therapy in reducing the risk of stroke/TE in older AF patients, but with a possible increase in major bleeding. NOACs were superior to warfarin for stroke/TE prevention, with reduced risk of major bleeding.

Modelling projections for the risks related with atrial fibrillation in East Asia: a focus on ischaemic stroke and death.

Aims: In the Far East, there has generally been low uptake of oral anticoagulants (OACs) using vitamin K antagonists (VKA, e.g. warfarin) for stroke prevention in atrial fibrillation (AF), but OAC use has been increasing more recently, with the introduction of the non-vitamin K antagonist oral anticoagulants (NOACs). To explore the risks of ischaemic stroke (IS) and death related to AF in East Asia using modelling projections. Methods and results: We performed a modelling analysis of possible trends of IS and death rates in AF patients from the time period of only VKA use to current increasing trends of NOAC use projecting until 2050 in East Asia. Data from published articles on the prevalence of AF, IS, and death were used to model estimated event rates. In 2030, the estimated AF population in East Asia will be 608 100, with the use of NOACs leading to a reduction of 82 259 ISs and 16 917 deaths. There was an estimated annual risk reduction of 5484 ISs and 1128 deaths from 2016 to 2030, respectively. The AF population is estimated to reach 861 900 in 2050, with a reduction of 206 315 ISs and 139 353 deaths. Conclusion: This modelling analysis suggests that the transition from VKA to NOACs may greatly help in reducing the burden of IS and death caused by AF in the East Asian region.

Protective effect of acacetin on sepsis-induced acute lung injury via its anti-inflammatory and antioxidative activity.

Sepsis is a clinical syndrome with no effective protective or therapeutic treatments. Acacetin, a natural flavonoid compound, has anti-oxidative and anti-inflammatory effects which can potentially work to reduce sepsis. We investigated the potential protective effect of acacetin on sepsis-induced acute lung injury (ALI) ALI and dissect out the underlying mechanisms. Mice were divided into five groups: a sham group, a sepsis-induced ALI group, and three sepsis groups pre-treated with 20, 40, and 80 mg/kg body weight of acacetin. We found that acacetin significantly attenuated sepsis-induced ALI, in histological examinations and lung edema. Additionally, acacetin treatment decreased protein and inflammatory cytokine concentration and the number of infiltrated inflammatory cells in BALF compared with that in the non-treated sepsis mice. Pulmonary myeloperoxidase (MPO) activity was lower in the acacetin-pre-treated sepsis groups than in the sepsis group. The mechanism underlying the protective effect of acacetin on sepsis is related to the regulation of certain antioxidation genes, including inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), superoxide dismutases (SODs), and heme oxygenase 1 (HO-1).Taken together, our results indicate that acacetin pre-treatment inhibits sepsis-induced ALI through its anti-inflammatory and antioxidative activity, suggesting that acacetin may be a potential protective agent for sepsis-induced ALI.