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Anticoagulation for atrial fibrillation in heart failure patients:balancing between Scylla and Charybdis

Journal of Geriatric Cardiology 2021年第5期18卷 352-361页

作者： Grigorios Tsigkas Anastasiοs Apostolos Stefanos Despotopoulos Georgios Vasilagkos Angeliki Papageorgiou Eleftherios Kallergis Georgios Leventopoulos Virginia Mplani Ioanna Koniari Dimitrios Velissaris john parissis Department of Cardiology University Hospital of PatrasPatrasGreece Department of Cardiology University Hospital of HeraklionHeraklionGreece Department of Cardiology University Hospital of South ManchesterNHS Foundation TrustManchesterUnited Kingdom Department of Internal Medicine University Hospital of PatrasPatrasGreece Second Department of Cardiology National and Kapodistrian University of AthensAttikon University HospitalAthensGreece

The management of heart failure(HF)and atrial fibrillation(AF)in realworld practice remains a debating issue,while the number of HF patients with AF increase *** it is unclear if rhythm or rate control therapy is more beneficial and under which circumstances,anticoagulation therapy is the cornerstone of the AFHF patients’*** antagonists were the goldstandard during the past,but currently their usage is limited in specific *** K oral anticoagulants(NOACs)have gained ground during the last ten years and considered as goldstandard of a wide spectrum of HF *** current manuscript aims to review the current literature regarding the indications and the optimal choice and usage of NOACs in HF patients with AF.

关键词： patients fibrillation vitamin

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Association of arterial stiffness with coronary flow reserve in revascularized coronary artery disease patients

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World Journal of Cardiology 2016年第2期8卷 231-239页

作者： Vlassis Tritakis Stavros Tzortzis Ignatios Ikonomidis Kleanthi Dima Georgios Pavlidis Paraskevi Trivilou Ioannis Paraskevaidis Giorgos Katsimaglis john parissis john Lekakis Second Department of Cardiology Athens University Medical SchoolAttikon Hospital

AIM: To investigate the association of arterial wave reflection with coronary flow reserve(CFR) in coronary artery disease(CAD) patients after successful ***: We assessed 70 patients with angiographically documented CAD who had undergone recent successful revascularization. We measured(1) reactive hyperemia index(RHI) using fingertip peripheral arterial tonometry(RH-PAT Endo-PAT);(2) carotid to femoral pulse wave velocity(PWVc-Complior);(3) augmentation index(AIx), the diastolic area(DAI%) and diastolic reflection area(DRA) of the central aortic pulse wave(Arteriograph);(4) CFR using Doppler echocardiography; and(5) blood levels of lipoprotein-phospholipase A2(LpPLA2).RESULTS: After adjustment for age, sex, blood pressure parameter, lipidemic, diabetic and smoking status, we found that coronary flow reserve was independently related to AIx(b =-0.38, r = 0.009), DAI(b = 0.36, P = 0.014), DRA(b = 0.39, P = 0.005) and RT(b =-0.29,P = 0.026). Additionally, patients with CFR < 2.5 had higher PWVc(11.6 ± 2.3 vs 10.2 ± 1.4 m/s, P = 0.019), SBPc(139.1 ± 17.8 vs 125.2 ± 19.1 mm Hg, P = 0.026), AIx(38.2% ± 14.8% vs 29.4% ± 15.1%, P = 0.011) and lower RHI(1.26 ± 0.28 vs 1.50 ± 0.46, P = 0.012), DAI(44.3% ± 7.9% vs 53.9% ± 6.7%, P = 0.008), DRA(42.2 ± 9.6 vs 51.6 ± 11.4, P = 0.012) and Lp PLA2(268.1 ± 91.9 vs 199.5 ± 78.4 ng/m L, P = 0.002) compared with those with CFR ≥ 2.5. Elevated Lp PLA2 was related with reduced CFR(r =-0.33, P = 0.001), RHI(r =-0.37, P < 0.001) and DRA(r =-0.35, P = 0.001) as well as increased PWVc(r = 0.34, P = 0.012) and AIx(r = 0.34, P = 0.001). CONCLUSION: Abnormal arterial wave reflections are related with impaired coronary flow reserve despite successful revascularization in CAD patients. There is a common inflammatory link between impaired aortic wall properties, endothelial dysfunction and coronary flow impairment in CAD.

关键词： LpPLA2 Coronary artery disease Arterial stiffness Coronary flow reserve Reactive hyperemia index

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