2020 Vol. 17, No. 4
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2020, 17(4): 177-183.
doi: 10.11909/j.issn.1671-5411.2020.04.002
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Objective To examine the association between hearing loss and cognitive function cross-sectionally and prospectively among older adults with atrial fibrillation (AF). Methods Patients with AF ≥ 65-year-old (n = 1244) in the SAGE (Systematic Assessment of Geriatric Elements)-AF study were recruited from five internal medicine or cardiology clinics in Massachusetts and Georgia. Hearing was assessed by a structured questionnaire at baseline. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at baseline and one year. Cognitive impairment was defined as score ≤ 23 on the MoCA. The associations between hearing loss and cognitive function were examined by multivariable adjusted logistic regression. Results Participants with hearing loss (n = 451, 36%) were older, more likely to be male, and have depressive symptoms than patients without hearing loss. At baseline, 528 (42%) participants were cognitively impaired. Individuals with hearing loss were significantly more likely to have cognitive impairment at baseline [adjusted odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.05–1.81]. Among the 662 participants who did not have cognitive impairment at baseline and attended the one-year follow-up visit, 106 (16%) developed incident cognitive impairment. Individuals with, versus those without, hearing loss were significantly more likely to develop incident cognitive impairment at one year (adjusted OR = 1.68, 95% CI: 1.07–2.64). Conclusions Hearing loss is a prevalent but under-recognized factor associated with cognitive impairment in patients with AF. Assessment for hearing loss may be indicated among these patients to identify individuals at high-risk for adverse outcomes.
Objective To examine the association between hearing loss and cognitive function cross-sectionally and prospectively among older adults with atrial fibrillation (AF). Methods Patients with AF ≥ 65-year-old (n = 1244) in the SAGE (Systematic Assessment of Geriatric Elements)-AF study were recruited from five internal medicine or cardiology clinics in Massachusetts and Georgia. Hearing was assessed by a structured questionnaire at baseline. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at baseline and one year. Cognitive impairment was defined as score ≤ 23 on the MoCA. The associations between hearing loss and cognitive function were examined by multivariable adjusted logistic regression. Results Participants with hearing loss (n = 451, 36%) were older, more likely to be male, and have depressive symptoms than patients without hearing loss. At baseline, 528 (42%) participants were cognitively impaired. Individuals with hearing loss were significantly more likely to have cognitive impairment at baseline [adjusted odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.05–1.81]. Among the 662 participants who did not have cognitive impairment at baseline and attended the one-year follow-up visit, 106 (16%) developed incident cognitive impairment. Individuals with, versus those without, hearing loss were significantly more likely to develop incident cognitive impairment at one year (adjusted OR = 1.68, 95% CI: 1.07–2.64). Conclusions Hearing loss is a prevalent but under-recognized factor associated with cognitive impairment in patients with AF. Assessment for hearing loss may be indicated among these patients to identify individuals at high-risk for adverse outcomes.
2020, 17(4): 184-192.
doi: 10.11909/j.issn.1671-5411.2020.04.001
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Objective To compare clinical outcomes between patients with and without history of major bleeding according to types of antithrombotic medications in patients with non-valvular atrial fibrillation (NVAF). Methods We conducted a multicenter registry of patients with NVAF during 2014 to 2017 in Thailand. The following data were collected: demographic data, type of NVAF, medical illness, components of CHA2DS2-VASc and HAS-BLED scores, history of bleeding and severity, investigations, and antithrombotic medications. Clinical outcomes were death, bleeding, and ischemic stroke/transient ischemic attack (TIA). Results There were a total of 3218 patients. The average age was 67.3 ± 11.3 years, and 58.3% were men. Sixty-nine patients (2.14%) had a history of major bleeding. Antithrombotic use was, as follows: 2126 patients (75.3%) received oral anticoagulant (OAC) alone, 555 (17.2%) received antiplatelet alone, 298 (9.3%) received both, and 239 (7.4%) received neither. During follow-up, 9.9% had major adverse outcomes, including death (5.9%), ischemic stroke/TIA (2.5%), and major bleeding (4.0%). There were no significant differences in the types of antithrombotic medications between patients with and without history of major bleeding. Multivariate analysis revealed old age, low body mass index, hypertension, diabetes, heart failure, and history of major bleeding to be independently associated with major adverse outcome. Adverse events significantly increased in patients with OAC plus antiplatelet. Conclusions History of major bleeding was identified as a factor that significantly affects clinical outcome. Inappropriate use of OAC plus antiplatelet should be avoided. Special caution should be made in this high-risk patients.
Objective To compare clinical outcomes between patients with and without history of major bleeding according to types of antithrombotic medications in patients with non-valvular atrial fibrillation (NVAF). Methods We conducted a multicenter registry of patients with NVAF during 2014 to 2017 in Thailand. The following data were collected: demographic data, type of NVAF, medical illness, components of CHA2DS2-VASc and HAS-BLED scores, history of bleeding and severity, investigations, and antithrombotic medications. Clinical outcomes were death, bleeding, and ischemic stroke/transient ischemic attack (TIA). Results There were a total of 3218 patients. The average age was 67.3 ± 11.3 years, and 58.3% were men. Sixty-nine patients (2.14%) had a history of major bleeding. Antithrombotic use was, as follows: 2126 patients (75.3%) received oral anticoagulant (OAC) alone, 555 (17.2%) received antiplatelet alone, 298 (9.3%) received both, and 239 (7.4%) received neither. During follow-up, 9.9% had major adverse outcomes, including death (5.9%), ischemic stroke/TIA (2.5%), and major bleeding (4.0%). There were no significant differences in the types of antithrombotic medications between patients with and without history of major bleeding. Multivariate analysis revealed old age, low body mass index, hypertension, diabetes, heart failure, and history of major bleeding to be independently associated with major adverse outcome. Adverse events significantly increased in patients with OAC plus antiplatelet. Conclusions History of major bleeding was identified as a factor that significantly affects clinical outcome. Inappropriate use of OAC plus antiplatelet should be avoided. Special caution should be made in this high-risk patients.
2020, 17(4): 193-201.
doi: 10.11909/j.issn.1671-5411.2020.04.008
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Background Uncertainty remains regarding the association between body mass index (BMI) and the risk of bleeding in patients with non-valvular atrial fibrillation (NVAF). We aimed to investigate the association between BMI and the risk of bleeding in elderly NVAF patients taking dabigatran. Methods A total of 509 elderly NVAF patients, who were being treated at twelve centers in China from February 2015 to December 2017 and taking dabigatran, were analyzed. The exposure and outcome variables were BMI at baseline and bleeding events within the subsequent six months, respectively. Cox proportional hazards regression analysis was used to evaluate the association between BMI and the risk of bleeding. Moreover, the Cox proportional hazards regression with cubic spline functions and smooth curve fitting was conducted. Results During the six-month follow-up, 50 participants experienced bleeding. Every 1 kg/m2 increase in BMI was associated with a 12% increased risk of bleeding (P = 0.021). Compared to those with BMI values in Tertile 1 (2), the adjusted hazard ratio (HR) of bleeding for participants in Tertile 2 (22.5–25.3 kg/m2) and Tertile 3 (> 25.3 kg/m2) were 2.71 (95% CI: 1.02–7.17) and 3.5 (95% CI: 1.21–8.70), respectively. The Ptrend-value was significant in all models. The adjusted smooth curve showed a linear association between BMI and bleeding. None of the stratified variables showed significant effect modification on the association between BMI and bleeding (Pinteraction > 0.05). Conclusions BMI was significantly and positively associated with the risk of bleeding in elderly NVAF patients treated with dabigatran.
Background Uncertainty remains regarding the association between body mass index (BMI) and the risk of bleeding in patients with non-valvular atrial fibrillation (NVAF). We aimed to investigate the association between BMI and the risk of bleeding in elderly NVAF patients taking dabigatran. Methods A total of 509 elderly NVAF patients, who were being treated at twelve centers in China from February 2015 to December 2017 and taking dabigatran, were analyzed. The exposure and outcome variables were BMI at baseline and bleeding events within the subsequent six months, respectively. Cox proportional hazards regression analysis was used to evaluate the association between BMI and the risk of bleeding. Moreover, the Cox proportional hazards regression with cubic spline functions and smooth curve fitting was conducted. Results During the six-month follow-up, 50 participants experienced bleeding. Every 1 kg/m2 increase in BMI was associated with a 12% increased risk of bleeding (P = 0.021). Compared to those with BMI values in Tertile 1 (2), the adjusted hazard ratio (HR) of bleeding for participants in Tertile 2 (22.5–25.3 kg/m2) and Tertile 3 (> 25.3 kg/m2) were 2.71 (95% CI: 1.02–7.17) and 3.5 (95% CI: 1.21–8.70), respectively. The Ptrend-value was significant in all models. The adjusted smooth curve showed a linear association between BMI and bleeding. None of the stratified variables showed significant effect modification on the association between BMI and bleeding (Pinteraction > 0.05). Conclusions BMI was significantly and positively associated with the risk of bleeding in elderly NVAF patients treated with dabigatran.
2020, 17(4): 202-209.
doi: 10.11909/j.issn.1671-5411.2020.04.003
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Objective To determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid stenosis. Methods Elderly patients (> 60 years) with moderate to severe carotid stenosis were recruited and categorized into good and poor collateral circulation groups, and underwent magnetic resonance imaging and computed tomography imaging. The carotid plaque features including lipid-rich necrotic core, intraplaque hemorrhage, calcification, and fibrous cap rupture (FCR) were evaluated, and maximum wall thickness, normalized wall index (NWI), and luminal stenosis were measured. The association between these variables and collateral circulation status was analyzed. Results Of the 97 patients (78 males, mean age: 69.0 ± 6.1 years), 19 (19.6%) had poor collaterals. The poor collateral group had a significantly higher NWI (93.7% ± 5.0% vs. 89.0% ± 7.9%, P = 0.011), a greater extent of stenosis (80.0% ± 11.4% vs. 75.3% ± 9.4%, P = 0.036) and FCR (84.2% vs. 55.1%, P = 0.020) compared with good collateral group. Carotid NWI (OR = 3.83, 95% CI: 1.36–10.82, P = 0.011) and more FCR (OR = 6.77, 95% CI: 1.35–33.85, P = 0.020) were associated with poor collateral circulation after adjustment for the confounding factors. The combination of NWI, FCR, systolic blood pressure, and triglycerides had the highest area-under-the-curve (AUC = 0.85) for detection of poor collaterals. Conclusions Carotid plaque features, specifically NWI and FCR, are independently associated with poor collateral circulation, and the combination of carotid plaque features and traditional risk factors has a stronger predictive value for poor collateral circulation than plaque features alone.
Objective To determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid stenosis. Methods Elderly patients (> 60 years) with moderate to severe carotid stenosis were recruited and categorized into good and poor collateral circulation groups, and underwent magnetic resonance imaging and computed tomography imaging. The carotid plaque features including lipid-rich necrotic core, intraplaque hemorrhage, calcification, and fibrous cap rupture (FCR) were evaluated, and maximum wall thickness, normalized wall index (NWI), and luminal stenosis were measured. The association between these variables and collateral circulation status was analyzed. Results Of the 97 patients (78 males, mean age: 69.0 ± 6.1 years), 19 (19.6%) had poor collaterals. The poor collateral group had a significantly higher NWI (93.7% ± 5.0% vs. 89.0% ± 7.9%, P = 0.011), a greater extent of stenosis (80.0% ± 11.4% vs. 75.3% ± 9.4%, P = 0.036) and FCR (84.2% vs. 55.1%, P = 0.020) compared with good collateral group. Carotid NWI (OR = 3.83, 95% CI: 1.36–10.82, P = 0.011) and more FCR (OR = 6.77, 95% CI: 1.35–33.85, P = 0.020) were associated with poor collateral circulation after adjustment for the confounding factors. The combination of NWI, FCR, systolic blood pressure, and triglycerides had the highest area-under-the-curve (AUC = 0.85) for detection of poor collaterals. Conclusions Carotid plaque features, specifically NWI and FCR, are independently associated with poor collateral circulation, and the combination of carotid plaque features and traditional risk factors has a stronger predictive value for poor collateral circulation than plaque features alone.
2020, 17(4): 210-216.
doi: 10.11909/j.issn.1671-5411.2020.04.004
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Background Growth differentiation factor-15 (GDF-15) is involved in multiple processes that are associated with coronary artery disease (CAD). However, little is known about the association between GDF-15 and the future ischemic events in patients with intermediate CAD. This study was conducted to investigate whether plasma GDF-15 constituted risk biomarkers for future cardiovascular events in patients with intermediate CAD. Methods A prospective study was performed based on 541 patients with intermediate CAD (20%–70%). GDF-15 of each patient was determined in a blinded manner. The primary endpoint was major adverse cardiac event (MACE), which was defined as a composite of all-cause death, nonfatal myocardial infarction, revascularization and readmission due to angina pectoris. Results After a median follow-up of 64 months, 504 patients (93.2%) completed the follow-up. Overall, the combined endpoint of MACE appeared in 134 patients (26.6%) in the overall population: 26 patients died, 11 patients suffered a nonfatal myocardial infarction, 51 patients underwent revascularization, and 46 patients were readmitted for angina pectoris. The plasma levels of GDF-15 (median: 1172.02 vs. 965.25 pg/mL, P = 0.014) were higher in patients with ischemic events than those without events. After adjusting for traditional risk factors, higher GDF-15 levels were significantly associated with higher incidence of the composite endpoint of MACE (HR = 1.244, 95% CI: 1.048–1.478, Quartile 4 vs. Quartile 1, P = 0.013). Conclusions The higher level of GDF-15 was an independent predictor of long-term adverse cardiovascular events in patients with intermediate CAD.
Background Growth differentiation factor-15 (GDF-15) is involved in multiple processes that are associated with coronary artery disease (CAD). However, little is known about the association between GDF-15 and the future ischemic events in patients with intermediate CAD. This study was conducted to investigate whether plasma GDF-15 constituted risk biomarkers for future cardiovascular events in patients with intermediate CAD. Methods A prospective study was performed based on 541 patients with intermediate CAD (20%–70%). GDF-15 of each patient was determined in a blinded manner. The primary endpoint was major adverse cardiac event (MACE), which was defined as a composite of all-cause death, nonfatal myocardial infarction, revascularization and readmission due to angina pectoris. Results After a median follow-up of 64 months, 504 patients (93.2%) completed the follow-up. Overall, the combined endpoint of MACE appeared in 134 patients (26.6%) in the overall population: 26 patients died, 11 patients suffered a nonfatal myocardial infarction, 51 patients underwent revascularization, and 46 patients were readmitted for angina pectoris. The plasma levels of GDF-15 (median: 1172.02 vs. 965.25 pg/mL, P = 0.014) were higher in patients with ischemic events than those without events. After adjusting for traditional risk factors, higher GDF-15 levels were significantly associated with higher incidence of the composite endpoint of MACE (HR = 1.244, 95% CI: 1.048–1.478, Quartile 4 vs. Quartile 1, P = 0.013). Conclusions The higher level of GDF-15 was an independent predictor of long-term adverse cardiovascular events in patients with intermediate CAD.
2020, 17(4): 217-220.
doi: 10.11909/j.issn.1671-5411.2020.04.005
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2020, 17(4): 221-223.
doi: 10.11909/j.issn.1671-5411.2020.04.010
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2020, 17(4): 224-228.
doi: 10.11909/j.issn.1671-5411.2020.04.009
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2020, 17(4): 229-233.
doi: 10.11909/j.issn.1671-5411.2020.04.007
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2020, 17(4): 234-240.
doi: 10.11909/j.issn.1671-5411.2020.04.006
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