Omega-3 polyunsaturated fatty acids in the prevention of postoperative atrial fibrillation in open heart surgery: a systematic review and meta-analysis

Aim. To evaluate the literature data on the efficacy of omega-3 polyunsaturated fatty acids (PUFAs) in the prevention of postoperative atrial fibrillation (POAF) in elective cardiac surgery, including onor off-pump coronary artery bypass grafting and/or valve replacement and/or repair.Material and methods. The search for studies was carried out using the PubMed database and Google Scholar from 2005 to January 31, 2022. From the initially identified search results, 19 articles were analyzed. The design of articles corresponded to randomized clinical trials. Omega-3 PUFAs was selected as an interventional effect. The studies were to include, as an end point, the assessment of new POAF cases in the early period after open heart surgery.Results. The meta-analysis included 15 studies with 3980 patients, of which 1992 (50,0%) patients took omega-3 PUFAs. POAF occurred in 587 (29,5%) patients receiving omega-3 PUFAs and 679 (34,2%) patients on standard therapy (hazard ratio, 0,8, 0,68-0,93, p=0,004). There is a variation in effect size for POAF patients in the presented randomized clinical trials relative to the axis of the central trend and heterogeneity of studies with a significant number of patients included (I2=51%, p=0,01).Conclusion. Our systematic review and meta-analysis showed the effectiveness of omega-3 PUFAs in the prevention of POAF during open heart surgery

Omega-3 Polyunsaturated Fatty Acids: the Role in Prevention of Atrial Fibrillation in Patients with Coronary Artery Disease after Coronary Artery Bypass Graft Surgery

Aim. To estimate the role of omega-3 polyunsaturated fatty acids (PUFAs) administration in atrial fibrillation (AF) prevention after planned coronary artery bypass graft (CABG) surgery.Material and Methods. Studied were 306 patients divided into two groups: patients of group I didn’t receive PUFAs (158 patients, 82.7% males) and patients of group II received PUFAs (148 patients, 89.3% males). PUFAs were prescribed in daily dose 2000 mg 5 days before surgery and in daily dose 1000 mg in postoperative period during 21 days.Results. Postoperative AF (POAF) occurred in 29.7% patients in group I and in 16.9% patients in group II (р=0.009). We found that after CABG in patients of the I group median IL-6 level was 39.3% higher (p=0.001), interleukin-10 – 20.2% higher (p=0.01), superoxide dismutase – 78.9% higher (р<0.001), malondialdehyde – 33.8% higher (p=0.03), docosahexaenoic acid – 31.8% lower (p=0.01) and omega-3 index – 43.4%    lower (p=0.04) than in patients of the II group.According to multivariate regression analysis we found significant association between the factors of inflammation, oxidative stress and the risk POAF development.Conclusions. In patients who took PUFAs, we found less activation of inflammation, oxidative stress, the increasing of docosahexaenoic acid and omega-3 index accompanied by the decreasing of POAF development rates up to 12.8%

Factors associated with the risk of developing diabetes mellitus in patients with coronary artery disease

Aim to determine the factors associated with the risk of developing type 2 diabetes in patients with coronary artery disease (CAD). Material and methods.The retrospective data sample included 181 patients hospitalized in the cardiology department of the SamSMU clinics. The patients were divided into two groups: group 1 122 patients without type 2 diabetes (77 (63.1%) men, median age 66.0 (59.0;75.0) years) and group 2 59 patients with type 2 diabetes (29 (49.2%) men, median age 69.0 (63.0;73.5) years). Results.The statistically significant difference (p0.05) was registered in glomerular filtration rate (GFR); no significant differences were demonstrated in other clinical indicators, including age and gender. Expectedly, the patients with type 2 diabetes had higher glucose levels. The parameters of the lipid spectrum and creatinine did not differ between the groups. Conclusion.The factors associated with the risk of developing type 2 diabetes are high glucose concentration and reduced GFR. The application of the developed discriminant analysis model will allow to determine the risk group of type 2 diabetes in patients with coronary heart disease, which will ensure a timely control of the presented indicators

Martian Eolian Science: Recent Advances, Remaining Questions, and Roadmap for Future In Situ Investigations

We review remaining critical questions in Mars eolian science, summarize needed in situ measurements, and offer a roadmap for future in situ investigations

Science Opportunities offered by Mercury's Ice-Bearing Polar Deposits

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The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Genetic polymorphisms of matrix metalloproteinase-9, tissue inhibitor of matrix metalloproteinase-1 and development of postoperative atrial fibrillation in elderly patients

Aim. The aim of the study was to assess the association of genetic polymorphisms of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) with atrial fibrillation development in elderly patients with coronary artery disease (CAD), undergoing coronary artery bypass graft (CABG) surgery.Material and methods. Studied were 80 patients who underwent CABG in 2015-2016 years. In all the patients routine laboratory and instrumental tests were performed. Patients also underwent genetic polymorphisms of ММР-9 А8202G and TIMP-1 C536T estimation with polymerase chain reaction. According to occurrence of postoperative atrial fibrillation (POAF) all the patients were divided into two groups: 1 group comprised 56 patients without POAF (81,8% males, mean age 65,9±4,0 years), 2 group — 24 patients with first detected episode of AF after CABG (875% males, mean age 67,7±5,4).Results. According to results of multivariate regression analysis the odds ratio of POAF development in patients with stable angina grade III was 1,8 (95% CI 0,5-75, p=0,4), NYHA III — 0,85 (95% CI 0,2-3,5, p=0,55), history of CAD more than 20 months — 1,8 (95% CI 1,2-8,1, p=0,03), LA diameter more than 39 mm — 4,2 (95% CI 1,6-9,5, p<0,0001), allele G MMP-9 A8202G — 2,6 (95% CI 1,2-75, p=0,03). Conclusion. In elderly patients undergoing coronary artery bypass graft surgery left atrial diameter more than 39 mm, history of coronary artery disease more than 20 months and the presence of G allele of MMP-9 A820G are significantly associated with postoperative atrial fibrillation occurrence

Clinical, echocardiographic parameters and markers of oxidative stress associated with atrial fibrillation in patients undergoing coronary artery bypass graft surgery

Aim. To estimate the association of clinical, echocardiographic parameters and markers of oxidative stress with postoperative atrial fibrillation (POAF) in patients with coronary artery disease (CAD) undergoing coronary artery bypass graft (CABG) surgery.Material and methods. This case-control study included 158 patients with CAD who were scheduled for CABG surgery. Patients were divided into two groups: group 1 (n=111) — patients without POAF (men — 82%, median age — 62,0 [56,0;66,0] years); group 2 (n=47) — patients with POAF (men — 84,4%, median age — 65,0 [61,0;70,0] years). The median of POAF development was 5,2 [2,0;7,0] days after CABG. We studied plasma and erythrocyte superoxide dismutase (SOD) levels, plasma nitrogen oxide and myeloperoxidase levels, erythrocyte levels of catalase, malondialdehyde, reduced glutathione, glutathione reductase and glutathione peroxidase, and advanced oxidation protein products. The determination was carried out before and on average 3-4 days after CABG. All the patients also underwent echocardiography.Results. Multivariate regression revealed following parameters associated with POAF: left atrial diameter >41 mm (odds ratio (OR) 4,1,95% confidence interval (CI) 1,7-8,9, р=0,001), postoperative plasma levels of SOD >1100,5 U/g (OR 3,0, 95% CI 1,3-9,7, р=0,04), postoperative levels of reduced glutathione <0,194 Mmol/g Hb (OR 1,6, 95% CI 1,1-6,8, р=0,002), postoperative levels of glutathione peroxidase <17,36 mmol/g Hb (OR 1,9, 95% CI 1,1-7,8, р=0,0005), postoperative levels of glutathione reductase <2,99 mmol/g Hb (OR 2,1, 95% CI, 1,1-5,9, р=0,004), postoperative levels of malondialdehyde >1,25 Mmol/g Hb (OR 1,9, 95% CI 1,1-7,2, р<0,0001), postoperative plasma levels of nitrogen oxide >36,4 Mmol/l (OR 1,4, 95% CI 1,03-4,8, р=0,001).Conclusion. Our study showed significant association of increased left atrial diameter, high activity of oxidative stress and low activity of antioxidant system with POAF in patients with CAD undergoing CABG surgery

A ROLE OF SUPEROXIDE DISMUTASE IN DEVELOPMENT OF POST-OPERATION ATRIAL FIBRILLATION IN CORONARY HEART DISEASE PATIENTS

Aim. To evaluate the level of superoxide dismutase (SOD) in coronary heart disease (CHD) patients underwent coronary bypass  (CBG), and to estimate  its importance in development of post-surgery atrial fibrillation (PSAF).Material and methods. Totally, 96 patients studied,  with CHD, admitted for CBG. Patients were selected to 2 groups: 1 group — non-PSAF (67 patients, 80,6% males, mean age 57,9±7,3  y.o.), 2 group — with first time AF in early period of CBG (29 patients,  86% males, mean age 64,0±8,4 y.o.).Results. During study period PSAF developed  in 30,2% cases, mean on 4,9±3,8 day after surgery.  Comparing  with group  1, level of SOD was higher in group  2 patients (2589,8±1999,3 U/g vs 1572,8±1275,2 U/g, р=0,034). Patients of group 2 were  older  4 years  in average  (64,0±8,4  vs 57,9±7,3  y., р=0,048),  had  longer duration of cardiovascular pathology (86,9±76,1 months vs 44,3±38,4 m., р=0,002). Patients with PSAF had III functional class of angina (72,4% vs 47,8%, р=0,028) and III functional class of congestive  heart failure (38,0% vs 7,5%, р=0,006), they had larger left atrium (43,5±4,1 mm vs 37,9±3,4 mm, р<0,001).After multifactorial analysis, predictive value remained  for the following: left atrium larger than 41 mm — 5,1 (95% CI, 2,1-9,8, р=0,0005), SOD more than 2948 U/g — 4,4 (95% CI, 1,1-8,9, р=0,04).Conclusion. The study  showed  that  CBG operation  is followed by activation of oxidation stress which is followed by the decrease of SOD concentration, probably due to its consumption.  However, among patients with PSAF there is higher activity of this enzyme