Impact of concentration of apelin-13 and chosen proangiogenic factors on the left ventricle function in echocardiographic assessment after myocardial infarction

Abstract Introduction Myocardial infarction (MI) is one of the main factors of heart failure (HF) development, therefore it is essential to search possibilities of prevention of its occurance in that condition. Purpose The study aimed to determine the association between serum concentrations of apelin-13, vascular endothelial growth factor-A (VEGF-A), angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2) and systolic function of the left ventricle after MI. Methods Study group included 67 consecutive patients with acute MI (STEMI and NSTEMI) and lack of previous diagnosis of systolic HF. Venous blood samples were drawn prior to coronary intervention, on the third and fifth day of MI. The blood samples were centrifuged (3000g /15 minutes), serum was frozen and stored at −80°C before further analysis. Concentrations of the studied substances were determined by ELISA tests. Ejection fraction (Simpson's method) and mass (linear method) of the left ventricle were calculated in echocardiographic examination on the fifth day of MI. Cut off values for impaired left ventricular ejection fraction (LVEF) were 54% (women) and 52% (men). The concentrations of the studied factors were indexed to the left ventricle mass. In statistical analysis Mann-Whitney test and the logistic regression were used. Two models for proper LVEF occurance were tested. 1st model included time from pain onset to coronary intervention, type of MI, sex, eptifbatide use and heparin total dose; 2nd model included hypertension, diabetes mellitus, BMI, LDL concentration, smoking and age; each model included indexed concentration of one of the studied factors. Results STEMI was diagnosed in 45 (67%) patients. 53 patients (79%) did not achieve normal LVEF. Persons with normal LVEF exhibited statistically significant higher value of indexed concentrations of apelin-13 and VEGF-A on the first (respectively p=0.02 and p=0.03) and fifth (respectively p=0.004 and p=0.03) day of MI. In the logistic regression, odds ratio (OR) of indexed apelin-13 from the fifth day of MI, in the 1st model was 1.36 (95% CI: 1.04–1.78, p=0.02) and in the 2nd model was 1.43 (95% CI: 1.11–1.84, p=0.01); OR of indexed VEGF-A from the fifth day, in the 2nd model, was 13.65 (95% CI: 1.18–158.11, p=0.03). Indexed VEGF-A from the fifth day in the 1st model and indexed concentrations of both factors from the first day, notwithstanding type of model, did not obtain statistically significant OR. In the logistic regression inluded only indexed apelin-13 and VEGF-A from the fifth day of MI, OR was respctively 1.54 (95% CI: 1.15–2.06, p=0.003) and 22.39 (95% CI: 1.68–298.59, p=0.02). Ang-1 and Ang-2 did not exhibit statistically significant impact on LVEF. Conclusions Apelin-13 and VEGF-A exhibit properties, which may prevent deterioration of LVEF and thus avoid HF in patients with MI. Dose adjustment should be based on the left ventricle mass. Optimal time of administration of both substances is an issue of further studies. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia </jats:sec

Screening for atrial fibrillation in subjects aged 65 using a long-term continuous ECG telemonitoring vest: the NOninvasive Monitoring for early detection of atrial fibrillation (NOMED-AF) study

Abstract Background Atrial fibrillation (AF) confers a high healthcare burden from stroke, heart failure, dementia and hospitalisation, and one challenge is. Early detection of this arrhythmia in the community, given that it is often asymptomatic. Aim To perform population screening for atrial fibrillation and flutter (AF/AFl) using a mobile long-term continuous ECG telemonitoring vest in a representative Polish and European population aged ≥65 years (age range 65–100 years). Methods The NOMED-AF study is a cross-sectional study based on a representative sample of adults aged ≥65 years (n=3014; mean age 77.5±7.9 years; 49.1% female). All study participants were equipped with a mobile long-term continuous ECG telemonitoring vest. National and European estimations were calculated on weighted data. Results In 680 subjects AF/AFl (including 279 with SAF; 9.3%) was confirmed. In the NOMED-AF population, the prevalence of AF/AFl was 22.6%, estimated to be 19.2% for Poland [1,251,100 (95% CI: 1,158,300–1,344,000) and 480,100 (95% CI: 426,60–533,700) subjects with AF/AFl and SAF, respectively] and 20.4% for Europe [20,300,000 (95% CI 18.8–21.9 M), including 8,000,000 (95% CI: 6.9–9.3 M) subjects with AF/AFl and SAF, respectively]. The prevalence of AF/AFl was 2.56-fold higher in men than in women and the incidence of silent AF (SAF) was 4.73-fold higher in men than in women. Although the risk of either AF/AFl or SAF increased with age, the odds ratio was significantly higher in women of a particular age group than in men of the corresponding age. Based on our survey, the total number of subjects with AF/AFl in Europe is estimated to be roughly 20.3 million (95% CI 18.8–21.9M), including 8.0 million (95% CI: 6.9–9.3M) subjects with silent AF/AFl (Figure). Conclusions Approximately 1 in 5 subjects aged ≥65 years suffers from AF/AFl. The risk for AF/AFl and SAF is higher in men than that in women, but when correlated to a particular age group, the risk increases significantly in women. Continuous ECG telemonitoring allows for more credible AF/AFl and SAF detection. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The research has received funding from the National Centre for Research and Development under grant agreement (STRATEGMED2/269343/18/NCBR/2016 </jats:sec

Risk factors for silent and symptomatic atrial fibrillation in an elderly population screening programme:a report from the noninvasive monitoring for early detection of atrial fibrillation (NOMED-AF)

Abstract Background It is important to determine the risk factors that predispose elderly subjects from the general population for symptomatic atrial fibrillation and atrial flutter (AF/AFl), but population-based data for silent AF (SAF) are limited. Aim To study risk factors for symptomatic AF and SAF in a general population screen for subjects age ≥65 where continuous monitoring was performed up to 30 days with a vest-based monitor. Methods The NOMED-AF study was a cross-sectional study based on a representative population sample (n=3014; mean age 77.5±7.9 years; F=1479). In 680 subjects AF/AFl (including 279 with SAF) was diagnosed. Independent risk factors for AF/AFl and SAF were determine on weighted data using multiple logistic regression. Results The independent risk factors for AF/AFl and SAF are summarised in the Table. There are nine independent risk factors for AF/AFl and eight for SAF. Revascularization and obesity were independently associated with patients with (symptomatic) AF/AFl, and CKD was associated with SAF. Other risk factors are common for AF/AFl and SAF. Conclusions AF/AFl and SAF have slightly different associated clinical risk factors in this representative population sample aged ≥65 years. This may facilitated targeted screening programmes for high risk subgroups, particularly for SAF. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The research has received funding from the National Centre for Research and Development under grant agreement (STRATEGMED2/269343/18/NCBR/2016) </jats:sec

Predicting silent atrial fibrillation in the elderly – NOMED-AF study

Abstract Background Asymptomatic (“silent”) atrial fibrillation is common and associated with poor outcomes. It is important to determine the risk factors that predispose elderly individuals from the general population to atrial fibrillation (AF). However, population-based data for silent AF (SAF) are limited. Design First, to study the risk factors for symptomatic AF and SAF in an elderly (≥65 years) general population. Second, to develop a risk stratification model for predicting SAF. Methods Continuous ECG monitoring was performed for up to 30 days using a vest-based system in a cohort from NOMED-AF, a cross-sectional study based on a nationwide population sample. The independent risk factors for AF and SAF were determined using multiple logistic regression. ROC analysis was applied to validate developed risk stratification score. Results From the total cohort of 3014 subjects, AF was diagnosed in 680 individuals (mean age, 77.5±7.9; 50.1% men) with AF, and of these, 279 (41%) had SAF. Independent associations with an increased risk of AF were age, male gender, coronary heart disease, thyroid diseases, prior ischemic stroke or transient ischemic attack (ICS/TIA), diabetes, heart failure, chronic kidney disease (CKD), obesity (BMI&amp;gt;30) and NT-proBNP &amp;gt;125 ng/ml. Prior revascularization was negatively associated with risk of AF. The main risk factors for SAF were age, male gender, prior ICS/TIA, diabetes, heart failure, CKD and NT-proBNP &amp;gt;125 ng/ml. We developed a simple clinical risk scale (MR-DASH score) which had good prediction in the derivation cohort (AUC 0.726) and the validation cohort (AUC 0.730). Conclusions SAF is associated with various clinical risk factors in a population sample of individuals ≥65 years. Stratifying individuals from the general population according to their risk for SAF may be possible using the MR-DASH score, facilitating targeted screening programs of individuals with high risk of SAF Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Centre for Research and Development </jats:sec