Cardiology News / Recent Literature Review / Third Quarter 2015
TCT Meeting 2015: San Francisco, 11-15/10/2015
HCS Congress: Thessaloniki, 29-31/10/2015
AHA Scientific Sessions: Orlando, 7-11/11/2015
Boston AF Symposium: Orlando, 14-16/1/2016
ACC 65th Annual Session: Chicago, 2-4/4/2016
HRS 37th Annual Meeting: San Francisco, 4-7/5/16
CardioStim/Europace: Nice, 8-11/6/2016
Euro PCR: Paris, 17-20/5/2016
ESC Meeting: Rome, 27-31/8/2016
Sustained chronic obesity results in chronic stretch, diffuse interstitial fibrosis, conduction abnormalities, and increased vulnerability to AF
In an animal study, 10 chronically obese sheep, compared with 10 age-matched controls, demonstrated greater total body fat, left atrial (LA) volume, LA pressure, and pulmonary artery pressures, reduced atrial conduction velocity with increased conduction heterogeneity, increased fractionated electrograms, decreased posterior LA voltage, and increased voltage heterogeneity (all p<0.001), with no change in the effective refractory period (ERP) or ERP heterogeneity. Obesity was associated with more episodes (p= 0.02), prolongation (p= 0.01), and greater cumulative duration (p= 0.02) of atrial fibrillation (AF). Epicardial fat infiltrated the posterior LA in the obese group (p< 0.001), consistent with reduced endocardial voltage in this region. Atrial fibrosis (p= 0.03) and atrial transforming growth factor (TGF)-β1 protein (p= 0.002) were increased in the obese group. The authors concluded that obesity results in global biatrial endocardial remodeling, and increased propensity for AF (Mahajan R et al, J Am Coll Cardiol 2015;66:1-11).
An Increased Percentage of PVCs on 24-h Holter Monitoring Confers a Decrease in LVEF, Increased Incident CHF, and Increased Mortality: PVCs might be an Important Cause of Occult or “Idiopathic” Cardiomyopathy and an Important Determinant of Incident CHF Among Those with Other Established CHF Risk Factors
Among 1,139 Cardiovascular Health Study (CHS) participants, with a normal LVEF and no history of CHF, randomly assigned to 24-h Holter monitoring, those in the upper quartile vs the lowest quartile of PVC frequency had a 3-fold greater odds of a 5-year decrease in LVEF (odds ratio [OR]: 3.10; p= 0.005), a 48% increased risk of incident CHF (HR: 1.48; p= 0.02), and a 31% increased risk of death (HR: 1.31; p = 0.01) during a median follow-up of >13 years. The specificity for the 15-year risk of CHF exceeded 90% when PVCs included at least 0.7% of ventricular beats. The population-level risk for incident CHF attributed to PVCs was 8.1%. The authors concluded that in a population-based sample, a higher frequency of PVCs was associated with a decrease in LVEF, an increase in incident CHF, and increased mortality (Dukes JW et al, J Am Coll Cardiol 2015;66:101-109)... (excerpt)
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