Novel Echocardiographic Biomarkers in the Management of Atrial Fibrillation

Purpose of Review: Atrial fibrillation (AF) is the most common arrhythmia in adults. The number of patients with AF is anticipated to increase annually, mainly due to the aging population alongside improved arrhythmia detection. AF is associated with a significantly elevated risk of hospitalization, stroke, thromboembolism, heart failure, and all-cause mortality. Echocardiography is one of the key components of routine assessment and management of AF. Therefore, the aim of this review is to briefly summarize current knowledge on “novel” echocardiographic parameters that may be of value in the management of AF patients. Recent Findings: Novel echocardiographic biomarkers and their clinical application related to the management of AF have been taken into consideration. Both standard parameters such as atrial size and volume but also novels like atrial strain and tissue Doppler techniques have been analyzed. Summary: A number of novel echocardiographic parameters have been proven to enable early detection of left atrial dysfunction along with increased diagnosis accuracy. This concerns particularly experienced echocardiographers. Hence, these techniques might improve the prediction of stroke and thromboembolic events among AF patients and need to be further developed and disseminated. Nonetheless, even the standard imaging parameters could be of significant value and should not be discontinued in everyday clinical practice. © 2019, The Author(s)

АНТИКОАГУЛЯНТНАЯ ТЕРАПИЯ ПРИ ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕК И ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ: ОСЬ ВРАЩЕНИЯ МЕЖДУ ПОЛЮСАМИ РИСКА

The frequent comorbidity of atrial fibrillation (AF) and chronic kidney disease (CKD) in the general population is demonstrated in many epidemiological studies. Most patients with an established diagnosis of AF are recommended to use constant anticoagulant therapy (ACT) to prevent ischemic stroke and thromboembolic complications (TEC). With renal dysfunction, changes in the hemostatic system are observed at all stages of CKD, both related to an increase in prothrombogenic activity as well as to development of coagulopathy, which increases the threat of bleeding. Therefore, in patients with CKD and AF, an important aspect of ACT is the choice of the optimal anticoagulant, that will provide a balance between the risks of stroke and hemorrhagic complications, to which this article is dedicated.Частая коморбидность фибрилляции предсердий (ФП) и хронической болезни почек (ХБП) в общей популяции продемонстрирована во многих эпидемиологических исследованиях. Большинству пациентов c установленным диагнозом ФП рекомендована постоянная антикоагулянтная терапии (АКТ) с целью профилактики ишемического инсульта и тромбоэмболических осложнений (ТЭО). При дисфункции почек на всех стадиях ХБП наблюдаются изменения в системе гемостаза, связанные как с повышением протромбогенной активности, так и развитием коагулопатии, увеличивающей угрозу кровотечения. Поэтому у пациентов с ХБП и ФП важным аспектом АКТ является выбор оптимального антикоагулянта, обеспечивающего баланс между рисками инсульта и геморрагических осложнений, чему и посвящена данная статья

PRACTICAL ASPECTS OF ANTICOAGULANT THERAPY IN PATIENTS WITH ATRIAL FIBRILLATION AND ARTERIAL HYPERTENSION

Atrial fibrillation (AF) represents the most frequent sustained cardiac arrhythmia, the prevalence of AF is 1-2% in the general population and up to 6% for population over 80 years. Arterial hypertension (AH) is the commonest background comorbidity in patients with AF. Patients with AF have 3-6-fold increased risk of ischemic stroke in comparison to that in general population, additionally the presence of AH leads an 2-3-fold increase in risk of subsequent stroke. Current clinical guidelines recommend long-time anticoagulant treatment for prevention of stroke and thromboembolic complications in majority of patients with confirmed AF. Not only does uncontrolled high blood pressure contribute to developing new-onset AF or AF progression but also can increase a bleeding risk related to oral anticoagulants. Patients with AF and concomitant AH resulting in target organ damage need for more favorable safety profile of oral anticoagulants. Instruction label dabigatran treatment in two doses can individualize approach to choice of long-term anticoagulation with lower risk of major bleeding in AF patients

PRACTICAL ASPECTS OF ANTICOAGULANT THERAPY IN PATIENTS WITH ATRIAL FIBRILLATION AND ARTERIAL HYPERTENSION

Atrial fibrillation (AF) represents the most frequent sustained cardiac arrhythmia, the prevalence of AF is 1-2% in the general population and up to 6% for population over 80 years. Arterial hypertension (AH) is the commonest background comorbidity in patients with AF. Patients with AF have 3-6-fold increased risk of ischemic stroke in comparison to that in general population, additionally the presence of AH leads an 2-3-fold increase in risk of subsequent stroke. Current clinical guidelines recommend long-time anticoagulant treatment for prevention of stroke and thromboembolic complications in majority of patients with confirmed AF. Not only does uncontrolled high blood pressure contribute to developing new-onset AF or AF progression but also can increase a bleeding risk related to oral anticoagulants. Patients with AF and concomitant AH resulting in target organ damage need for more favorable safety profile of oral anticoagulants. Instruction label dabigatran treatment in two doses can individualize approach to choice of long-term anticoagulation with lower risk of major bleeding in AF patients

АНТИКОАГУЛЯНТНАЯ ТЕРАПИЯ ПРИ ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕК И ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ: ОСЬ ВРАЩЕНИЯ МЕЖДУ ПОЛЮСАМИ РИСКА

The frequent comorbidity of atrial fibrillation (AF) and chronic kidney disease (CKD) in the general population is demonstrated in many epidemiological studies. Most patients with an established diagnosis of AF are recommended to use constant anticoagulant therapy (ACT) to prevent ischemic stroke and thromboembolic complications (TEC). With renal dysfunction, changes in the hemostatic system are observed at all stages of CKD, both related to an increase in prothrombogenic activity as well as to development of coagulopathy, which increases the threat of bleeding. Therefore, in patients with CKD and AF, an important aspect of ACT is the choice of the optimal anticoagulant, that will provide a balance between the risks of stroke and hemorrhagic complications, to which this article is dedicated.Частая коморбидность фибрилляции предсердий (ФП) и хронической болезни почек (ХБП) в общей популяции продемонстрирована во многих эпидемиологических исследованиях. Большинству пациентов c установленным диагнозом ФП рекомендована постоянная антикоагулянтная терапии (АКТ) с целью профилактики ишемического инсульта и тромбоэмболических осложнений (ТЭО). При дисфункции почек на всех стадиях ХБП наблюдаются изменения в системе гемостаза, связанные как с повышением протромбогенной активности, так и развитием коагулопатии, увеличивающей угрозу кровотечения. Поэтому у пациентов с ХБП и ФП важным аспектом АКТ является выбор оптимального антикоагулянта, обеспечивающего баланс между рисками инсульта и геморрагических осложнений, чему и посвящена данная статья

New insight on anti-ischemic action of ivabradine in patients with stable angina

Increase in heart rate triggers most ischemic episodes due to disbalance between myocardial oxygen delivery and consumption. Furthermore, increased heart rate is a modifiable risk factor in patients with chronic heart failure. Ivabradine reduces heart rate by selectively inhibiting the If current of sinoatrial node cells. Recent studies have shown that ivabradine may reduce myocardial ischaemia and its consequences not only through heart rate reduction, but also because of additional pleiotropic effects. This review summarizes last findings that demonstrate variety of ivabradine actions on coronary blood flow and left ventricular function in patients with ischemic heart disease