220 research outputs found
NewâOnset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With LongâTerm FollowâUp:A Nationwide Study
BACKGROUND: Newâonset atrial fibrillation (AF) is reported to increase the risk of death in myocardial infarction (MI) patients. However, previous studies have reported conflicting results and no data exist to explain the underlying cause of higher death rates in these patients. METHODS AND RESULTS: All patients with first acute MI between 1997 and 2009 in Denmark, without prior AF, were identified from Danish nationwide administrative registers. The impact of newâonset AF on allâcause mortality, cardiovascular death, fatal/nonfatal stroke, fatal/nonfatal reâinfarction and noncardiovascular death, were analyzed by multiple timeâdependent Cox models and additionally in propensity score matched analysis. In 89 703 patients with an average followâup of 5.0Âą3.5 years event rates were higher in patients developing AF (n=10 708) versus those staying in sinusârhythm (n=78 992): allâcause mortality 173.9 versus 69.4 per 1000 personâyears, cardiovascular death 137.2 versus 50.0 per 1000 personâyears, fatal/nonfatal stroke 19.6/19.9 versus 6.2/5.6 per 1000 personâyears, fatal/nonfatal reâinfarction 29.0/60.7 versus 14.2/37.9 per 1000 personâyears. In timeâdependent multiple Cox analyses, newâonset AF remained predictive of increased allâcause mortality (HR: 1.9 [95% CI: 1.8 to 2.0]), cardiovascular death (HR: 2.1 [2.0 to 2.2]), fatal/nonfatal stroke (HR: 2.3 [2.1 to 2.6]/HR: 2.5 [2.2 to 2.7]), fatal/nonfatal reâinfarction (HR: 1.7 [1.6 to 1.8]/HR: 1.8 [1.7 to 1.9]), and nonâ cardiovascular death (HR: 1.4 [1.3 to 1.5]) all P<0.001). Propensityâscore matched analyses yielded nearly identical results (all P<0.001). CONCLUSIONS: Newâonset AF after firstâtime MI is associated with increased mortality, which is largely explained by more cardiovascular deaths. Focus on the prognostic impact of postâinfarct AF is warranted
Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study
Aim: While it is commonly thought that left ventricular (LV) systolic function may insidiously deteriorate in hypertensive patients, few prospective data are available to support this notion.
Methods: We evaluated 680 hypertensive patients (66 ¹ 7 years; 45% women) with electrocardiographic (ECG)-LV hypertrophy (ECG-LVH) enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echo-sub-study free of prevalent cardiovascular disease and with baseline ejection fraction (EF) ⼠55%. Echocardiographic examinations were performed annually for 5 years during anti-hypertensive treatment. Development of reduced systolic function was defined as incident EF < 50%.
Results: During a mean follow-up of 4.8 Âą 1 years, 37 patients developed reduced EF without an inter-current myocardial infarction (5.4%). In analysis of covariance, patients who developed reduced EF were more often men, had greater baseline LV diameter and LV mass, lower mean EF (all P < 0.05), and similar diastolic function indices. At the last available examination before EF reduction, independently of covariates, patients with reduced EF showed a significant increase in left atrium (LA) size, LV diameter, end-systolic stress and mitral E/A ratio, as compared to those who did not develop reduced EF (all P < 0.05). In time-varying Cox regression analysis, also controlling for baseline EF, predictors of developing reduced EF were higher in-treatment LV diameter [hazard ratio (HR) = 5.19 per cm; 95% confidence interval (CI): 2.58â10.41] and higher in-treatment mitral E/A ratio (HR = 2.37 per unit; 95% CI: 1.58â3.56; both P < 0.0001).
Conclusions: In treated hypertensive patients with ECG-LVH at baseline, incident reduced EF is associated with the development of dilated LV chamber and signs of increased LV filling pressure (ClinicalTrials.gov identifier: NCT00338260)
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