Daniele Pastori1, Pasquale Pignatelli1, Alessio Farcomeni2, Roberto Cangemi1, William R Hiatt3, Simona Bartimoccia1, Cristina Nocella1, Tommasa Vicario1, Tommaso Bucci1, Roberto Carnevale4, Gregory Y H Lip5, Francesco Violi6. 1. I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinico of Rome, Rome, Italy. 2. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. 3. Division of Cardiology and CPC Clinical Research, University of Colorado School of Medicine, Aurora, CO. 4. I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinico of Rome, Rome, Italy; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. 5. Centre for Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, United Kingdom. 6. I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinico of Rome, Rome, Italy. Electronic address: francesco.violi@uniroma1.it.
Abstract
BACKGROUND: Patients with nonvalvular atrial fibrillation (AF) show high residual cardiovascular (CV) risk despite oral anticoagulants. Urinary 11-dehydro-thromboxane B2 (TxB2) is associated with an increased risk of CV events (CVEs), but its predictive value in patients with anticoagulated AF is unknown. METHODS: A prospective single-center cohort study, including 837 patients with AF, was conducted. Mean time of follow-up was 30.0 months, yielding 2,062 person-years of observation. Urinary 11-dehydro-TxB2 was measured at baseline. The primary end point was the occurrence of a CVE including fatal/nonfatal myocardial infarction and ischemic stroke, transient ischemic attack, cardiac revascularization, and CV death. RESULTS: Mean age of patients was 73.1 years, and 43.6% were women. Median 11-dehydro-TxB2 levels were 100 (interquartile range 50-187) ng/mg of urinary creatinine. Overall, the anticoagulation control was adequate (63.9% of mean time in therapeutic range). A CVE occurred in 99 (11.8%) patients, and 55 were CV deaths. At baseline, 11-dehydro-TxB2 levels were higher in patients with a CVE compared with those without (186 [107-400] vs 98 [52-170], P < .001). An increased rate of CVEs (log-rank test, P < .001) and CV deaths (P < .001) was observed across tertiles of 11-dehydro-TxB2. Cardiovascular events were associated with age (hazard ratios [HR] 1.72 per 1 SD, 95% CI 1.33-2.21, P < .001), diabetes mellitus (HR 1.89, 95% CI 1.20-2.96, P = .005), heart failure (HR 1.60, 95% CI 1.01-2.54, P = .044), history of stroke/transient ischemic attack (HR 1.96, 95% CI 1.25-3.06, P = .003), and 11-dehydro-TxB2 (HR 1.64 per 1 SD, 95% CI 1.42-1.89, P < .001). CONCLUSIONS: Urinary 11-dehydro-TxB2 levels are associated with a residual risk of CVEs and CV mortality in patients with AF despite anticoagulant treatment.
BACKGROUND:Patients with nonvalvular atrial fibrillation (AF) show high residual cardiovascular (CV) risk despite oral anticoagulants. Urinary 11-dehydro-thromboxane B2 (TxB2) is associated with an increased risk of CV events (CVEs), but its predictive value in patients with anticoagulated AF is unknown. METHODS: A prospective single-center cohort study, including 837 patients with AF, was conducted. Mean time of follow-up was 30.0 months, yielding 2,062 person-years of observation. Urinary 11-dehydro-TxB2 was measured at baseline. The primary end point was the occurrence of a CVE including fatal/nonfatal myocardial infarction and ischemic stroke, transient ischemic attack, cardiac revascularization, and CV death. RESULTS: Mean age of patients was 73.1 years, and 43.6% were women. Median 11-dehydro-TxB2 levels were 100 (interquartile range 50-187) ng/mg of urinary creatinine. Overall, the anticoagulation control was adequate (63.9% of mean time in therapeutic range). A CVE occurred in 99 (11.8%) patients, and 55 were CV deaths. At baseline, 11-dehydro-TxB2 levels were higher in patients with a CVE compared with those without (186 [107-400] vs 98 [52-170], P < .001). An increased rate of CVEs (log-rank test, P < .001) and CV deaths (P < .001) was observed across tertiles of 11-dehydro-TxB2. Cardiovascular events were associated with age (hazard ratios [HR] 1.72 per 1 SD, 95% CI 1.33-2.21, P < .001), diabetes mellitus (HR 1.89, 95% CI 1.20-2.96, P = .005), heart failure (HR 1.60, 95% CI 1.01-2.54, P = .044), history of stroke/transient ischemic attack (HR 1.96, 95% CI 1.25-3.06, P = .003), and 11-dehydro-TxB2 (HR 1.64 per 1 SD, 95% CI 1.42-1.89, P < .001). CONCLUSIONS: Urinary 11-dehydro-TxB2 levels are associated with a residual risk of CVEs and CV mortality in patients with AF despite anticoagulant treatment.
Authors: Valeria Raparelli; Daniele Pastori; Serena Francesca Pignataro; Anna Rita Vestri; Pasquale Pignatelli; Roberto Cangemi; Marco Proietti; Giovanni Davì; William Robert Hiatt; Gregory Yoke Hong Lip; Gino Roberto Corazza; Francesco Perticone; Francesco Violi; Stefania Basili Journal: Intern Emerg Med Date: 2018-03-26 Impact factor: 3.397
Authors: Maria Peleli; Peter Flacker; Zhengbing Zhuge; Cristina Gomez; Craig E Wheelock; A Erik G Persson; Mattias Carlstrom Journal: Redox Biol Date: 2017-07-05 Impact factor: 11.799
Authors: Meagan P O'Brien; Peter W Hunt; Douglas W Kitch; Karin Klingman; James H Stein; Nicholas T Funderburg; Jeffrey S Berger; Pablo Tebas; Brian Clagett; Daniela Moisi; Netanya S Utay; Fran Aweeka; Judith A Aberg Journal: Open Forum Infect Dis Date: 2017-01-19 Impact factor: 3.835