Jurgaitytė, Julija

Abstract: (1) Background: The aim of this study was to determine clinical and genetic factors predicting the development of dyspnea in patients receiving ticagrelor. (2) Methods: A total of 277 patients with acute myocardial infarction (with and without ST-segment elevation), who underwent coronary angiography and PTCA with stent implantation and treated with antiplatelet drugs (ticagrelor and aspirin), were enrolled in this study. Platelet aggregation (induction with high-sensitivity ADP, ADP HS) testing was performed using a MULTIPLATE analyzer and reagents for the determination of P2Y12 receptor activity. Venous blood samples were collected for genotyping. (3) Results: Patients experiencing ticagrelor-related dyspnea had lower ADP HS. ROC curve analysis showed that an ADP HS cut-off of ≤19.5 U was associated with the development of dyspnea. The ADP HS value of ≤19.5 U and any dose of atorvastatin lower than 80 mg (or no atorvastatin) increased the risk of dyspnea by more than 4 and 2 times, respectively (OR = 4.07, p ≤ 0.001 and OR = 2.25; p = 0.008). (4) Conclusion: A lower ADP HS value possibly indicates greater ticagrelor activity and a higher plasma concentration of this drug. Atorvastatin might have an impact on the occurrence of ticagrelor-related dyspnea by affecting ticagrelor metabolism. No impact of any genetic variant on the development of dyspnea was determined.

Purpose: Spectral tissue Doppler-derived E/e' ratio has been proposed as the best parameter for prediction of atrial fibrillation (AF). Relaxation and contraction are equivalent parts of a continuous cardiac cycle, where systolic and diastolic abnormalities have a variable contribution to the left ventricle (LV) failure. The aim of this study was to investigate whether the E/(e'xs') ratio is a better index than E/e' to predict AF recurrence and to determine the changes of spectral tissue Doppler indices 1 month after the electrical cardioversion (ECV). Patients and methods: The study included 77 persistent AF patients with restored sinus rhythm (SR) after ECV. Only patients with normal LV ejection fraction (EF) were included. Echocardiography and NT-proBNP laboratory findings were performed. A primary outcome was the early (within 1 month) recurrence of AF. Results: After a 1 month follow-up period, 39 patients (50.6%) were in SR. E/e' (HR=1.74, P=0.001) and E/(e'×s') ratios (HR=8.17, P=0.01) were significant predictors of AF recurrence. E/(e'×s') in combination with LV end-diastolic diameter >49.3 mm and NT-proBNP >2000 ng/L demonstrated a higher contribution in the model to predict AF recurrence compared to the E/e' ratio (18.94, P=0.005 vs 1.95, P=0.001). On ROC analysis, E/(e'×s') and E/e' showed similar diagnostic accuracy (E/(e'×s'), AUC=0.71, P=0.002 and E/e', AUC=0.75, P<0.0001). Average e' value significantly decreased after 1 month in SR (from 10.76±1.24 to 8.96±1.47 cm/s, P=0.01), E wave did not change significantly and E/e' ratio tended to improve. A decrease of average e' and an increase of average s' values led to significant improvement of E/(e'xs') ratio. Conclusion: E/(e'xs') and E/e' ratios are comparable to predict early AF recurrence after ECV in patients with persistent AF. The e' value decreased significantly after 1 month follow-up period after ECV for persistent AF patients.

Background Spectral tissue Doppler-derived E/e' ratio has been proposed as the best parameter in the prediction of atrial fibrillation (AF). Although relaxation and contraction are equivalent parts of a continuous cardiac cycle, where systolic and diastolic abnormalities have a variable contribution to the left ventricle (LV) failure. A new doppler index, E/(e'×s') ratio, combining an index of diastolic function (E/e') and marker of systolic LV function (s'), has been confirmed as a good predictor of new-onset AF, although value of E/(e'×s') ratio to predict AF recurrence was not evaluated. Purpose The aim of this study was to investigate whether E/(e'×s') may be better parameter than E/e' to predict AF recurrence after the electrical cardioversion (ECV) of persistent AF in patients with normal LV function. Methods The prospective study included 77 patients with persistent AF with preserved LV ejection fraction (>50%) and successfully performed ECV. Plasma level of NT-proBNP was measured for all the patients before the ECV. Transthoracic echocardiography was performed within the first 24 hours after successful ECV. Primary outcome was the early (at 1 month) recurrence of AF. Results At 1 month follow-up, 39 patients (50.6%) were in sinus rhythm. Binary logistic regression analysis showed that LV enddiastolic diameter >50 mm (HR 3.70, 95% CI 1.29–10.58, p=0.02), NT-proBNP >2000 ng/L (HR 3.28, 95% CI 1.01–10.71, p=0.04), E/e' (HR 1.74, 95% CI 1.27–2.39, p=0.001) and E/(e'×s') ratios (HR 8.17, 95% CI 1.57–42.4, p=0.01) were significant predictors of AF early recurrence after ECV. When we developed multivariate models using these potential confounding factors. To minimize the problem of collinearity E/e'and E/(e'×s') were included in 2 separate models. Multivariate analysis identified that E/(e'×s') ratio and E/e' ratio in combination with LV enddiastolic diameter >49.3 mm and NT-proBNP >2000 ng/L ar[...].

Aim: The aim of this study was to determine the impact of genetic and nongenetic factors on treatment outcomes in patients receiving dual antiplatelet therapy after percutaneous coronary intervention and stent implantation. Materials & methods: Patients (n = 628) used clopidogrel or ticagrelor for at least 1 week before platelet aggregation test. Results: Multivariate binary regression analysis demonstrated that aspirin use and CYP4F2 T allele significantly increased odds for bleeding in clopidogrel users (OR: 2.488, 95% CI: 1.452-4.265; p = 0.001 and OR: 1.573, 95% CI: 1.066-2.320; respectively; p = 0.022). CYP4F2 T allele significantly increased odds for bleeding in ticagrelor users (OR: 8.270, 95% CI: 3.917-17.462; p < 0.001). Conclusion: Aspirin use and CYP4F2 T allele were significantly associated with bleeding during dual antiplatelet therapy.

Atrial fibrillation (AF) despite the absence of heart failure is related to increased levels of natriuretic peptides (NPs). NPs have not been widely investigated in relation to left atrium (LA) function after sinus rhythm (SR) restoration and duration of AF. The aim of the study was to determine the changes of NPs levels and to define their relation with LA phasic function after electrical cardioversion (ECV). Methods. The study included 48 persistent AF patients with restored SR after ECV. NT-proANP and NT-proBNP were measured for all patients before the ECV. LA phasic function (reservoir, conduit, and pump phases) was assessed using echocardiographic volumetric analysis within the first 24 hours after ECV. Patients were repeatedly tested after 1 month in case of SR maintenance. Results. After 1 month, SR was maintained in 26 (54%) patients. For those patients, NT-proBNP decreased significantly (p=0.0001), whereas NT-proANP tended to decrease (p=0.13). Following 1 month after SR restoration, LA indexed volume decreased (p=0.0001) and all phases of LA function improved (p=<0.01). Patients with AF duration < 3 months had lower NT-proANP compared to patients with AF duration from 6 to 12 months (p = 0.005). Higher NT-proANP concentration before ECV was associated with lower LA reservoir function during the first day after SR restoration (R=-0.456, p=0.005), whereas higher NT-proBNP concentration after 1 month in SR was significantly related to lower LA reservoir function (R=-0.429, p=0.047). Conclusions. LA indexed volume, all phases of LA function, and NT-proBNP levels improved significantly following 1 month of SR restoration. Preliminary results suggest that higher baseline NT-proANP levels and higher NT-proBNP for patients with maintained SR for 1 month are related to lower LA reservoir function. The longer duration of persistent AF is associated with higher NT-proANP concentration.

BACKGROUND: The natriuretic peptide system response is closely associated with myocardial tension and is one of the criteria for the diagnosis of heart failure. Concurrently, atrial fibrillation (AF) is related to increased levels of plasma natriuretic peptides, even in the absence of congestive heart failure. Specific natriuretic peptides NTproANP and NTproBNP, in relation to electrical cardioversion (ECV) have not been widely analysed in the past. OBJECTIVES: The aim of this study was to determine the changes in NTproANP and NTproBNP plasma levels and to define their relations with left atrium (LA) volume and function in 1 month after the ECV of persistent AF. METHODS: The study population included 49 persistent AF patients with preserved left ventricular ejection fraction (> 50%) and successfully performed ECV. Plasma levels of natriuretic peptides (NTproANP and NTproBNP) were measured for all the patients before the ECV procedure. Transthoracic echocardiography (TTE) was performed within the first 24 hours after successful ECV. The plasma levels of natriuretic peptides and TTE were repeatedly assessed after 1 month of sinus rhythm (SR) restoration.