Qingmiao Shao

Usefulness of Neutrophil/Lymphocyte Ratio as a Predictor of Atrial Fibrillation: A Meta-analysis

BACKGROUND AND AIMS Current evidence suggests that a high neutrophil/lymphocyte ratio (NLR) may increase the risk of atrial fibrillation (AF), but this association is still uncertain. The aim of the comprehensive meta-analysis was to evaluate the potential association between NLR and the risk of AF. METHODS We conducted a systematic literature search using electronic databases (PubMed, Ovid, Embase, Cochrane Database and Web of Science) to identify the studies reporting the association between NLR and risk of AF. We searched the literature published January 2015 or earlier. We used both fixed-effects and random-effects models to calculate the overall effect estimate. An I(2) > 50% indicates at least moderate statistical heterogeneity. A sensitivity analysis and subgroup analysis were performed to find the origin of heterogeneity. RESULTS We retrieved 11 studies involving a total of 2,766 participants. The combined odds ratio (OR) of incident AF for baseline NLR level was 1.25 (95% confidence interval [CI] 1.16-1.35) with significant heterogeneity across studies (I(2) = 82.7%, p < 0.01) and for the post-NLR level (following CABG, RFCA and cardioversion) was 1.518 (95% CI 1.076-2.142) with significant heterogeneity across studies (I(2) = 93.7%, p = 0.017). We also showed an association between AF recurrence following CABG, RFCA and cardioversion and baseline NLR level (OR 1.517, 95% CI 1.108-2.079) with significant heterogeneity across studies (I(2) = 86.8%, p < 0.01). CONCLUSIONS Our comprehensive meta-analysis suggests that the high level of NLR, whether baseline or postsurgery/procedure, is associated with the increased risk of AF recurrence/occurrence.

Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis.

AIMS Aldosterone has been implicated in atrial remodelling representing a potential target for upstream therapies. Accumulating evidence suggests that mineralocorticoid receptor blockade may have favourable effects on atrial fibrillation (AF) development, although some controversial results have been published. We, therefore, conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies in order to examine the protective role of mineralocorticoid receptor antagonists (MRAs) on AF. METHODS AND RESULTS Of the 1337 initially identified records, 3 RCTs and 2 observational studies with 3640 patients were finally analysed. The pooled analysis of the included studies demonstrated that patients treated with MRAs have 31% lower risk of AF compared with controls [relative ratio (RR): 0.69; 95% confidence interval (CI): 0.58-0.83] without any heterogeneity across the studies (I(2) = 0%). This effect was consistent across RCTs (RR: 0.72; 95% CI: 0.55-0.94) and observational studies (RR: 0.67; 95% CI: 0.53-0.84) without heterogeneity. Also, MRAs reduce the risk of AF in both heart failure (HF) (RR: 0.63; 95% CI: 0.50-0.80) and after cardiac surgery (RR: 0.77; 95% CI: 0.61-0.98). Analysing the relative impact of eplerenone and spironolactone, we showed that only eplerenone significantly reduces AF burden (RR: 0.64; 95% CI: 0.44-0.90). CONCLUSION Our meta-analysis suggests that MRAs may be effective in AF prevention especially in the HF setting. However, there are insufficient data for the widespread use of aldosterone antagonists solely for AF prevention. Larger RCTs with long-term follow-up in different clinical settings are needed to clarify the impact of MRAs on AF.

Meta-Analysis on Risk Stratification of Asymptomatic Individuals With the Brugada Phenotype

The prognosis of asymptomatic subjects remains the most controversial issue in Brugada syndrome (BS). A meta-analysis on the prognostic role of spontaneous type 1 electrocardiographic (ECG) pattern and programmed ventricular stimulation (PVS) in asymptomatic subjects with Brugada electrocardiogram was performed. Current databases were searched until March 2014. Fourteen prospective observational studies were included in the present meta-analysis, accumulating data on 3,536 asymptomatic subjects (2,820 men) with BS phenotype. The mean follow-up period varied from 20 and 77 months. Data regarding 1,398 asymptomatic subjects with spontaneous type 1 ECG pattern of BS were retrieved from 6 studies. During follow-up, arrhythmic events (sustained ventricular tachycardia/fibrillation, appropriate device therapies, or arrhythmic death) occurred in 42 patients (3%). The meta-analysis of these studies demonstrated that asymptomatic subjects with spontaneous type 1 ECG pattern of BS exhibit an increased risk of future arrhythmic events (odds ratio = 3.56, 95% confidence interval 1.70 to 7.47, Z = 3.37, p = 0.0008); 1,104 asymptomatic subjects with BS ECG pattern from 12 studies underwent PVS and were available for analysis. During follow-up, arrhythmic events occurred in 36 subjects (3.3%). Inducible ventricular arrhythmias at PVS were predictive of future arrhythmic events (odds ratio = 3.51, 95% confidence interval 1.60 to 7.67, Z = 3.14, p = 0.002). In conclusion, this meta-analysis showed that asymptomatic subjects with either spontaneous diagnostic ECG pattern or inducible ventricular arrhythmias at PVS are at increased risk.

Circulating serum levels of growth differentiation factor-15 and neuregulin-1 in patients with paroxysmal non-valvular atrial fibrillation

Growth differentiation factor-15 (GDF-15) is a stress-responsivememberofthetransforminggrowthfactor- βsuperfamilythatwasorig-inally cloned as a macrophage-inhibitory cytokine [1]. It rapidly in-creases following myocardial stretch, volume overload, oxidativestress and inflammatory state [2,3]. In recent years, it is emerging as anovel biomarker to predict mortality and adverse events in patientswith heart failure (HF) [4–7], acute coronary syndrome (ACS) [8–10]and acute pulmonary embolism [11]. Neuregulin-1 (NRG-1) is a mem-beroftheepidermalgrowthfactor(EGF)family[12]andplaysacriticalrole in cardiovascular development, cell survival, growth, and metabo-lism [13,14]. Recently, NRG-1 was shown to be a stress-related cardiacgrowth and angiogenic biomarker [15,16].Atrialfibrillation(AF)isthemostcommoncardiacarrhythmiaandisassociated with an increased risk of morbidity and mortality [17]. Therole of GDF-15 and NRG-1 in the setting of AF has not been studied.We soughttoinvestigate thepotentialrelationshipbetweencirculatingserum levels of GDF-15, NRG-1 and non-valvular AF.We enrolled 67 consecutive patients with paroxysmal AF and 67patientswithoutAFmatchedforsex,ageandatheroscleroticriskfactorspresenting to our institution between August 2012 and June 2013.Exclusioncriteriawerehistoryofmyocardialinfarction,ACS,congestiveHF, history of cardiac surgery, valvular heart disease, congenital heartdisease, cardiomyopathy, liver and kidney dysfunction, recent strokeor transient ischemic attack, inflammatory or neoplastic diseases, thy-roid disorder and anemia. The ethics committee of Second Hospital ofTianjin Medical University approved this study and written informedconsent was obtained from all patients enrolled.Baseline demographic and clinical characteristics were collected.Serumcreatinine(Cr),fastingblood-glucose(FBG),alanineaminotrans-ferase (ALT), and aspartate aminotransferase (AST) were measuredafter overnight fasting of 12 h with an automatic analyzer (TBA-120FR, Toshiba, Shenzhen, China). Blood samples were collected after supinerest for at least 10 min and overnight fasting of 12 h. The blood sampleswere then centrifuged for 15 min at 3500 r/min to obtain superna-tants which were stored at −80 °C until use. Serum levels of SOD andCAT were measured by colorimetry (Nanjing Jiancheng BioengineeringInstitute, China). Serum high-sensitivity C-reactive protein (hs-CRP)was measured using a high-sensitivity immmunonephelometric assay.Serum levels of NRG-1 and GDF-15 were assayed using commerciallyavailable ELISA kit (Cusabio Biotech Corporation, China). The kit has adetection range of 31.25 to 2000 pg/ml for GDF-15 with intra-assayand inter-assay variability of b8% and b10% respectively. The detectionrange for NRG-1 was 7.8 to 500 ng/ml with intra-assay and inter-assayvariability of b8% and b10% respectively. Transthoracic echocardio-graphicexaminationwasperformedusingtheVivid-7systemequippedwitha2.4 MHztransducer (GE Medical Systems, Milwaukee, WI,USA).Leftatrialdiameter(LAD), interventricularseptalwallthickness(IVST),left ventricular posterior wall thickness (LVPWT) and left ventricularend-diastolic diameter (LVEDD) were measured. Left ventricular ejec-tion fraction (LVEF) was determined from apical four-chamber andtwo-chamber views using Simpsons biplane formula.Categorical variables were reported as percentage and continuousvariables as means ± SD or median (interquartile range). Statisticalanalysis was performed using t-test or Kolmogorov–Smirnov test forcontinuousvariableswhiletheChisquaretestwasusedtocomparecat-egorical variables. Multivariable regressionanalyses were performed toinvestigate the relationship between GDF-15, NRG-1 and AF. A P valueof b0.05 was regarded as statistically significant. All tests were two-tailed and analyses were performed using SPSS 17.0 Statistical PackageProgram (SPSS Inc., Chicago, IL, USA).Clinical characteristics of study population are shown in Table 1.Patients with paroxysmal AF and controls had a similar distribution incardiovascular risk factors and medications. Baseline laboratory andechocardiographic characteristics of study population are shown inTable2.PatientswithAFhadhigherLAD, NRG-1andGDF-15comparedto non-AF patients. No significant difference in hs-CRP, SOD and CAT

Meta-analysis of Fragmented QRS as an Electrocardiographic Predictor for Arrhythmic Events in Patients with Brugada Syndrome

Fragmented QRS (fQRS) is an electrocardiographic marker related to ventricular fibrillation (VF) and sudden cardiac death (SCD) in various clinical settings. Current data regarding the prognostic significance of fQRS in Brugada syndrome (BrS) are contradictory. This meta-analysis aimed to evaluate the presence of fQRS as a risk stratification tool in BrS. Electronic databases (PubMed, EMBASE, and Cochrane Library) were searched until May 2016. Eight observational studies accumulating data on 1,637 BrS patients (mean age: 47 ± 11 years) were included in this meta-analysis. The mean follow-up duration ranged from 21 to 96 months. fQRS was found to be an independent predictor of future arrhythmic events in BrS (RR:3.88, 95% CI 2.26 to 6.65, p < 0.00001) with moderate heterogeneity (I2 = 54%, P = 0.03). When analyzing VF as independent end-point, the RR for VF was 3.61, and its 95% CI was 2.11 to 6.18, p < 0.00001. This meta-analysis showed that BrS patients with fQRS are at high risk for future arrhythmic events. The presence of fQRS warrants prospective evaluation as valid arrhythmogenic risk marker in BrS.

Association between air pollution and development of atrial fibrillation: A meta-analysis of observational studies

BACKGROUND Current evidence suggests that gaseous or particulate pollutants may increase the risk of atrial fibrillation (AF), although this association is still uncertain. METHODS We conducted a systematic review of literature using PubMed, Ovid, Embase and Web of Science to identify studies reporting on the association between gaseous (ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide) or particulate matter 2.5 (PM2.5) and AF risk published until March 2015. The overall effect estimate was presented as the population-attributable risks with 95% CI. We used both fix-effects and random effects models to calculate the overall effect estimate. RESULTS We retrieved 4 studies, involving 461,441 participants. There was a statistically significant association between AF development and all gaseous pollutant as well as PM2.5 [NO: 1.19% (0.70-1.67%), CO: 0.60 (0.20-1.09), SO2: 0.90 (0.60-1.28), O3: 1.09 (0.20-1.86), PM2.5: 0.89 (0.20-1.57)]. CONCLUSIONS Our comprehensive meta-analysis suggests that gaseous or particulate pollutants are associated with the increased risk of AF.

Red blood cell distribution width as a predictor of atrial fibrillation

Current evidence suggests that a higher red blood cell distribution width (RDW) may be associated with increased risk of atrial fibrillation (AF) development. Given that some controversial results have been published, we conducted a systematic review of the current literature along with a comprehensive meta‐analysis to evaluate the association between RDW and AF development.

Relation of red blood cell distribution width with CHADS2 and CHA2DS2-VASc score in Chinese patients with non-valvular atrial fibrillation

BACKGROUND Higher red cell distribution width (RDW) predicts adverse events in patients with cardiovascular diseases. However, there are limited data regarding the relationship between RDW and thromboembolism risk in the patients with atrial fibrillation (AF). We aimed to investigate the association between RDW and CHADS2, CHA2DS2-VASc scores used for the evaluation of thromboembolic risk in patients with non-valvular atrial fibrillation (AF). METHODS Our study included 99 patients with AF (68 paroxysmal AF; 31 persistent AF). We calculated CHADS2 and CHA2DS2-VASc risk scores for each patient, and we carefully recorded clinical characteristics as well as laboratory and echocardiographic parameters. According to CHADS2 and CHA2DS2-VASc scores, we divided the AF patients into 2 groups (low-intermediate risk and high risk group). Subsequently, we compared the aforementioned parameters between the 2 groups, and we evaluated the relationship between RDW and CHADS2/CHA2DS2-VASc score. Finally, multivariate logistic regression analysis was performed to find independent predictors of high CHADS2, CHA2DS2-VASc scores. RESULTS Patients with high CHADS2, CHA2DS2-VASc scores had older age, higher RDW, and creatinine levels, increased left atrial diameter and lower left ventricular ejection fraction, compared to the low CHADS2, CHA2DS2-VASc score group. Multivariate logistic regression analysis showed that RDW was an independent predictor for high CHADS2, CHA2DS2-VASc scores(OR: 2.184 and OR: 5.748; all P<0.05). CONCLUSION RDW is significantly correlated with CHADS2 and CHA2DS2-VASc score in the patients with AF, while is an independent predictor for high CHADS2 and CHA2DS2-VASc score.

Newly proposed electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in a Chinese population

The electrocardiographic criteria currently available for the diagnosis of left ventricular hypertrophy (LVH) are low in sensitivity. Thus, we compared the diagnostic performance of newly proposed electrocardiographic criteria to the existing criteria in a Chinese population.