Etiology distribution of patients with atrial fibrilation by echocardiography:
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Etiology distribution of patients with atrial fibrilation by echocardiography: results from a prospective study in 3755 adults. Enes Abdovic Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina. Purpose. Purpose.

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Etiology distribution of patients with atrial fibrilation by echocardiography: results from a prospective study in 3755 adults

Enes Abdovic

Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina


Purpose

Purpose

  • Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia 1

  • It is a disease of the elderly and it is common in patients with structural heart disease1

  • Hypertension (HA), diabetes mellitus, myocardial infarction,heart failure (with impaired or preserved left ventricular systolic function), and valvular heart disease are recognized predisposing factors to AF2,3,4

  • Objectives: To evaluate predisposing factors for development of AF in our hospital settings

1Go AS, et al. JAMA 2001;285:2370–75.

2Aidietis A, et al. Curr Pharm Des 2007;13:2545–55.

3Grigioni F, et al. J Am Coll Cardiol 2002;40:84–92.

4Olsson LG, et al. J Am Coll Cardiol 2006;47:1997–2004.


Methods

Methods

  • From June 2000 to February 2013, 3755 consecutive patients with AF were studied during echocardiographic check-up

  • According to transthoracic echo, patients were divided in groups based on dominative underlying heart diseases

  • Electrocardiographically documented AF was subdivided in two groups: transitory and chronic

    • Transitory AF fulfilled criteria for paroxysmal or persistent AF1

    • Chronic AF were cases of long-standing persistent or permanent AF1

  • Binary logistic regression was used to investigate relationship of gender, age, hypertension, diabetes and underlying heart diseases with the type of AF

Camm AJ, et al. Eur Heart J 2010;31:2369–2429.


Results

  • The median age was 72 years, age range between 16 and 96 years

  • There were 51.4% of females.

  • Chronic AF was observed in 68.3% pts.

  • Lone AF was diagnosed in only 25 patients, mostly in younger males (median age 48 years, range 29–59, men 80%)


Etiological distribution AF by echocardiography (3755 pts)

HHD=hypertensive heart disease; DCM=dilated cardiomyopathy; CAD=coronary artery disease; VHD=valvular heart disease; Lone=lone AF; HF=heart failure; AF=atrial fibrillation.


Comorbidities associated with AF

No=number; pts=patients; AF=atrial fibrillation; BMI=body mass index; HHD=hypertensive heart disease; DCM=dilated cardiomyopathy; CAD=coronary artery disease; VHD=valvular heart disease; Lone=lone AF.


Comorbidities associated with AF

No=number; pts=patients; AF=atrial fibrillation; BMI=body mass index; HHD=hypertensive heart disease; DCM=dilated cardiomyopathy; CAD=coronary artery disease; VHD=valvular heart disease; Lone=lone AF.


AF and HA pts (2854=76%)

HHD=hypertensive heart disease; DCM=dilated cardiomyopathy; CAD=coronary artery disease; VHD=valvular heart disease; Lone=lone AF; HF=heart failure; AF=atrial fibrillation.


AF and HF pts (1832=49%)

HHD=hypertensive heart disease; DCM=dilated cardiomyopathy; CAD=coronary artery disease; VHD=valvular heart disease; Lone=lone AF; HF=heart failure; AF=atrial fibrillation.


Characteristics of patients with chronic vs. transitory AF

No=number; pts=patients; AF=atrial fibrillation; SD=standard deviation, yrs=years, BMI=body mass index; LBBB=left bundle branch block; TIA=transitory ischemic attack.


Results (2)

Results (2)

  • Hypertensive heart disease (HHD) was the most common underlying heart disease (40.2%) followed by dilated cardiomyopathy (DCM), 24.9%, coronary artery disease (CAD), 13.9% and valvular heart disease (VHD), 11.1%.

  • Thyroid gland disease was found in 240:6.3% of patients of which 52.9% was hypothyroidism (127 vs 113)


Results (2)

Results (3)

  • Hypertension, diabetes and thyroid gland disease were found in 75.4%, 18.8% and 6.3% patients, respectively,

    mostly in females:

  • (HA: 1556pts/2832=55.0%)

  • (DM: 453pts/706=64.2%)

  • (Thy.gl.disease: 193pts/240=80.4%)


Risk of chronic atrial fibrillation (binary logistic regression model)

HHD, hypertensive heart disease; DCM, dilated cardiomyopathy; CHD, coronary artery disease; VHD, valvular heart disease; Lone, lone atrial fibrillation; BMI, body mass index; HA, hypertension; DM, diabetes mellitus; TH, diseases of thyroid gland; IVB, intraventricular block.


Pts with/without Paroxismal AFAged ≥65yrs and/or with LAE ≥ 25 and/or with IAB


CHA2DS2-VASc score ≥2 = 86.5%


Conclusion

Conclusion

  • Hypertension was by far the most prevalent associated medical condition in patients with AF

  • AF without underlying heart disease was present in only 0.7%, mostly in younger patients, males, with transitory AF

  • Almost 1/2 of pts with AF had HF and 59.2% had diastolic HF.

  • Chronic AF was predominant in groups with advanced cardiac remodeling such as DCM and VHD, mostly in elderly


Conclusion

Take Home Message

  • Optimal treatement of HA as well as DM

  • to prevent CAD and HF and

  • to eliminate or at least postpone AF, the most common sustained cardiac arrhythmia


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