检索结果-内蒙古大学图书馆

Postoperative atrial fibrillation after heart surgery: What are the goals of prevention?

AMERICAN HEART JOURNAL 2001年第5期141卷 691-693页

作者： Kim, MH Eagle, KA Washington Univ Div Cardiovasc St Louis MO 63110 USA Univ Michigan Div Cardiovasc Ann Arbor MI 48109 USA

Postoperative atrial fibrillation (AF) is the most common complication after heart surgery with a reported incidence of, on average, about 35%.1-5 Despite improvements in the overall cardiac surgical process, the incidence of postoperative AF has remained unchanged. Although there has been no clear causal link to increased morbidity, postoperative AF has been temporally associated with an increased risk of stroke, ventricular arrhythmias, worsened cardiac function, and the need for a permanent pacemaker.3,6 In addition to the potential excess morbidity, postoperative AF has generally been associated with increased cost and resource utilization predominantly through an increased hospital length of stay.3-5

关键词：抗心律失常药/治疗应用心房颤动/流行病学心房颤动/病因学心房颤动/预防和控制心脏病/外科学心率/药物作用医院死亡率住院时间预后人类

来源：评论

学校读者我要写书评

暂无评论

Association of left ventricular hypertrophy and chronic atrial fibrillation with the incidence of new thromboembolic stroke in 2,384 older persons

引用

AMERICAN JOURNAL OF CARDIOLOGY 1999年第4期84卷 468-+页

作者： Aronow, WS Ahn, C Kronzon, I Gutsein, H Hebrew Hosp Home Bronx NY 10475 USA Mt Sinai Sch Med Dept Geriatr & Adult Dev New York NY USA Univ Texas Sch Med Div Clin Epidemiol Houston TX USA NYU Sch Med Dept Med New York NY USA

The prevalence of chronic atrial fibrillation increases with age.(1,2) Chronic atrial fibrillation is an independent risk factor for new thromboembolic stroke in older persons.' 2 Left ventricular (LV) hypertrophy is an independent risk factor for new thromboembolic stroke in older persons.(3,4) This study reports the independent association of chronic atrial fibrillation and of echocardiographic LV hypertrophy with the incidence of new thromboembolic stroke at 44-month follow-up in a prospective study of 2,384 older persons.

关键词：心房颤动/并发症心房颤动/流行病学慢性病超声心动描记术随访研究肥大左心室/并发症肥大左心室/流行病学肥大左心室/超声检查发病率颅内栓塞和血栓形成/流行病学颅内栓塞和血栓形成/病因学患病率前瞻性研究危险因素老年人老年人 80以上女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Observations on the transition from intermittent to permanent atrial fibrillation

引用

AMERICAN HEART JOURNAL 2000年第1期140卷 142-145页

作者： Al-Khatib, SM Wilkinson, WE Sanders, LL McCarthy, EA Pritchett, ELC Duke Univ Med Ctr Dept Med Div Clin Pharmacol Durham NC 27710 USA Duke Univ Med Ctr Dept Med Div Cardiol Durham NC 27710 USA Duke Univ Med Ctr Dept Community & Family Med Div Biometry Durham NC 27710 USA

Background Quantitative data on the frequency with which transition from intermittent to permanent atrial fibrillation occurs are lacking. We conducted this study to determine the proportion of patients with intermittent atrial fibrillation who progress to permanent atrial fibrillation and to investigate baseline clinical characteristics that might predict such a progression. Methods This retrospective cohort study included 231 patients who were seen with intermittent atrial fibrillation at a university hospital-based clinic from January 1978 through December 1997. Patients' medical records and electrocardiograms were reviewed and data were collected for all clinic visits through May 1998. The proportion of patients who remained free of transition from intermittent to permanent atrial fibrillation was calculated by the Kaplan-Meier method. A Cox proportional hazards model was used to determine the effect of some baseline characteristics on this transition. Results The number of patients who remained Free of transition from intermittent to permanent atrial fibrillation was 92% (95% confidence interval 88%-96%) at 1 year and 82% (95% confidence interval 75%-88%) at 4 years. Among 5 baseline characteristics (age, sex, structural heart disease, atrial fibrillation at presentation, and use of an antiarrhythmic medicine before presentation), the 2 significant predictors of progression from intermittent to permanent atrial fibrillation were age (P = .0003) and being in atrial fibrillation at presentation (P = .0006). The hazard ratio associated with 10 years of advancing age was 1.82 (95% confidence interval 1.31-2.51), and the hazard ratio associated with atrial fibrillation at presentation was 3.56 (95% confidence interval 1.73-7.34). Conclusions Approximately 18% of patients who had intermittent atrial fibrillation were permanently in atrial fibrillation after 4 years of follow-up. Age and being in atrial fibrillation at presentation were the only 2 important clinical v

关键词：心房颤动/诊断心房颤动/流行病学心房颤动/病理生理学队列研究置信区间疾病恶化心电描记术发病率多元分析预后比例危险度模型回顾性研究危险性评估老年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Atrial fibrillation after beating heart surgery

引用

AMERICAN JOURNAL OF CARDIOLOGY 2000年第1期86卷 64-67页

作者： Stamou, SC Dangas, G Hill, PC Pfister, AJ Dullum, MKC Boyce, SW Bafi, AS Garcia, JM Corso, PJ Washington Hosp Ctr Dept Surg Div Cardiac Surg Washington DC 20010 USA Washington Hosp Ctr MedStar Res Inst Washington DC 20010 USA

Postoperative atrial fibrillation (AF) is a frequent adverse event after coronary artery bypass grafting (CABG) and may negatively affect the early clinical outcome. We sought to investigate the risk factors, prevalence, and prognostic implications of postoperative AF in patients submitted to CABG without cardiopulmonary bypass (off-pump). The study population comprised 969 patients, 645 men (67%) and 324 women (33%) who had off-pump CABG at the Washington Hospital Center from January 1987 to May 1999. Preoperative AF patients were excluded (n = 15). Two hundred six patients (age 69 +/- 10 years, 137 men [66%]) developed AF, whereas 763 patients (age 61 +/- 12 years, 508 men [67%]) did not. predictors of AF included age >75 years (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.9 to 4.5;p <0.001), history of stroke (OR 2.1, CI 1.2 to 3.7;p 0.007), postoperative pleural effusion requiring thoracentesis (OR 3.2, CI 1.0 to 9.4;p 0.03), and postoperative pulmonary edema (OR 5.1, CI 1.2 to 21;p = 0.02). Minimally invasive direct CABG was associated with a lower incidence of AF (OR 0.4, CI 0.3 to 0.7;p <0.001). AF was associated with a prolonged postoperative hospital stay (9 +/- 6 days AF vs 6 +/- 5 days no AF, p <0.001). In-hospital mortality was significantly higher in AF patients (3% AF vs 1% no AF, p = 0.009). patients with persistent AF had a higher postoperative in-hospital stroke rate than patients without persistent AF (9% vs 0.6%, p <0.001). AF after beating heart surgery is associated with a higher in-hospital morbidity, mortality, and prolonged hospital stay. A minimally invasive surgical approach (minimally invasive direct CABG) is associated with a lower risk of AF. (C) 2000 by Excerpta Medica, Inc.

关键词：心房颤动/流行病学心房颤动/病因学心房颤动/预防和控制冠状动脉分流术/死亡率医院死亡率住院时间胸腔积液/流行病学胸腔积液/病因学患病率预后肺水肿/流行病学肺水肿/病因学回顾性研究危险因素外科手术微创性存活率老年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Recent trends in the incidence rates of and death rates from atrial fibrillation complicating initial acute myocardial infarction: A community-wide perspective

引用

AMERICAN HEART JOURNAL 2002年第3期143卷 519-527页

作者： Goldberg, RJ Yarzebski, J Lessard, D Wu, J Gore, JM Univ Massachusetts Sch Med Div Cardiovasc Med Dept Med Worcester MA 01655 USA

Background Limited information is available about recent trends in the incidence and death rates from atria] fibrillation (AF) complicating acute myocardial infarction (AMI). The purpose of this study was to examine the impact and trends over time of AF complicating initial AMI Methods We conducted a longitudinal study of 2596 residents of the Worcester, Massachusetts, metropolitan area with initial AMI and without previous AF who were hospitalized at all area hospitals in 5 annual periods between 1990 and 1997. Results A total of 13% of hospitalized patients developed AF, There was a marked decrease in the proportion of patients who developed AF over time (18% in 1990;11% in 1997). Patients hospitalized during the most recent study years remained at significantly lower risk for developing AF than patients hospitalized in 1990 after controlling for factors that might affect the risk of AF. Patients with AF were more likely to die during hospitalization than those without AF even after controlling for other prognostic factors. Despite the adverse impact of AF, we observed trends toward improved hospital survival during the most recent study years in patients developing AF. Patients discharged after developing AF had higher long-term death rates than patients who did not develop AF, although these differences were attenuated after adjusting for other factors. Conclusions The results of this community-wide study suggest a significant decline in the incidence of AF complicating AMI Although patients with AF had higher hospital death rates, we observed trends of improved survival for these patients. AF remains a common complication of AMI to which targeted treatment efforts appear warranted.

关键词：心房颤动/流行病学心房颤动/病因学心房颤动/死亡率医院死亡率住院发病率纵向研究马萨诸塞/流行病学多元分析心肌梗死/并发症心肌梗死/流行病学心肌梗死/死亡率比值比成年人老年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Influence of atrial fibrillation on the morbido-mortality of patients on hemodialysis

引用

AMERICAN HEART JOURNAL 2000年第6期140卷 886-890页

作者： Vázquez, E Sánchez-Perales, C Borrego, F Garcia-Cortés, J Lozano, C Guzmán, M Gil, JM Borrego, MJ Perez, V Unidad Cardiol Jaen Spain Hosp Gen Especialidades Serv Nefrol Jaen Spain

Background The consequences of atrial fibrillation (AF) on morbido-mortality of patients on hemodialysis have not been fully explored. The objective of this study was to determine the prevalence of AF in patients on hemodialysis and to evaluate its influence on the development of thromboembolic phenomena (TEP). Methods The incidence of AF in 190 patients in our hemodialysis program was assessed, and the patients were followed up for 1 year. Pertinent demographic and biochemical parameters were entered into univariate and multivariate statistical analyses to evaluate associations with overall mortality and TEP such as cerebrovascular accident, transitory ischemic accident, or peripheral embolism. Results In 13.6% of patients, AF was found;9.4% of these were of the permanent type. In the multivariate analysis, only increased age was associated with a higher probability of having arrhythmia (odds ratio, 1.10;95% confidence interval, 1.03-1.17;P =.003). During follow-vp, 23% of the patients with AF died compared with 6% of those in sinus rhythm (P <.05), although AF did not appear to be an independent predictive factor for death. Thirty-five percent of the patients with AF and 4% with sinus rhythm had TEP (P<.01). In the multivariate analysis, AF was identified as the only independent predictor for TEP (odds ratio, 8;95% CI, 2.3-27;P=.0008). Conclusions AF is a frequent arrhythmia in patients on hemodialysis, and approximately 1 in 3 hemodialysis patients with AF had thromboembolic complications within 1 year of Follow-up. These findings suggest that the consensus contraindication of prophylactic anticoagulation therapy for this group of patients may need to be redefined.

关键词：抗凝药/治疗应用心房颤动/并发症心房颤动/流行病学心房颤动/预防和控制脑缺血/病因学脑缺血/死亡率脑缺血/预防和控制横断面研究发病率肾功能衰竭慢性/治疗患病率预后复发肾透析/死亡率危险因素存活率血栓栓塞/病因学血栓栓塞/死亡率血栓栓塞/预防和控制成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Predicting post-coronary bypass surgery atrial arrhythmias from the preoperative electrocardiogram

引用

AMERICAN HEART JOURNAL 2001年第5期142卷 806-810页

作者： Passman, R Beshai, J Pavri, B Kimmel, S Northwestern Univ Sch Med Feinberg Cardiovasc Res Inst Chicago IL 60611 USA Northwestern Univ Sch Med Dept Med Div Cardiol Chicago IL 60611 USA Northwestern Univ Sch Med Dept Prevent Med Div Cardiol Chicago IL 60611 USA Tufts Univ New England Med Ctr Div Cardiol Dept Med Boston MA 02111 USA Hosp Univ Penn Ctr Clin Epidemiol & Biostat Philadelphia PA 19104 USA Univ Penn Sch Med Philadelphia PA 19104 USA

Background Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is a common occurrence and adds to the morbidity and cost associated with the procedure. Various therapies have been demonstrated to reduce the risk of post-CABG AF, but their use should be targeted to high-risk patients. The purpose of this study was to develop a prediction rule for post-CABG AF on the basis of patient age and the preoperative electrocardiogram (ECG). Methods The charts of 152 consecutive patients undergoing isolated CABG at one institution were reviewed and the preoperative ECG was analyzed with use of commercially available software. Logistic regression was performed and agead-justed predictors of the primary end point, any post-CABG AF, were derived. The discriminatory values of the various models were compared by receiver-operating characteristic curves. Results Sixty-four patients (42.1%) had AF. Multivariable predictors were dichotomized on the basis of variable distribution, and a high-risk patient population was identified by age > 65 years, PR interval greater than or equal to 180 milliseconds (age-adjusted odds ratio [OR] 2.12, P = .05), and a P-wave duration in lead V1 greater than or equal to 110 milliseconds (age-adjusted OR 2.30, P = .02). Conclusions This study demonstrates that post-CABG AF can be predicted preoperatively from patient age and evidence of intra-atrial conduction delay on ECG. Such information can be used to guide prophylactic therapy.

关键词：心房颤动/流行病学心房颤动/病因学心房扑动/流行病学心房扑动/病因学冠心病/外科学心电描记术/统计学和数值数据手术后并发症/流行病学手术后并发症/病因学概率人类

来源：评论

学校读者我要写书评

暂无评论

Incidence and predictors of myocardial infarction among patients with atrial fibrillation

引用

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第4期36卷 1223-1227页

作者： Zimetbaum, PJ Josephson, ME McDonald, MJ McClennen, S Korley, V Ho, KFL Papageorgiou, P Cohen, DJ Harvard Univ Sch Med Beth Israel Deaconess Med Ctr Dept MedCardiovasc Div GZ435 Boston MA 02115 USA

OBJECTIVES We sought to evaluate the utility of excluding myocardial infarction (MI) in patients presenting to the emergency department (ED) with atrial fibrillation (AF) and to identify predictors of MI in this group. BACKGROUND Patients with AF are frequently admitted to the hospital, in part, to exclude an associated MI. There are no prospective data on unselected patients to support this common practice. METHODS We conducted a prospective cohort study of all patients who presented to a single-center ED with the primary diagnosis of AF. RESULTS Of a total of 255 patients, 190 (75%) were admitted to the hospital, and 109 of them underwent a standard "rule-out MI" protocol. Of these 109 patients, six (5.5%) were identified as having an acute MI at the time of admission. Chest pain was present in 39% of patients, with a sensitivity and specificity for the occurrence of MI of 100% and 65%, respectively. ST segment elevation or depression was present in 43% of patients, with a sensitivity and specificity of 100% and 51%. The presence of either major ST segment depression (>2 mm) or elevation on the admission electrocardiogram (ECG) was present in 6%, with a sensitivity of 100% and a specificity of 99%. The resulting positive and negative predictive values were 86% (95% confidence interval [CI] 42% to 99%) and 100% (95% CI 96% to 100%), respectively. Use of this criterion would have reduced the number of rule-out MIs in our study group by 94%, with no loss of sensitivity. CONCLUSIONS Chest pain and ST segment depression are extremely common findings in patients presenting to the ED with AF and have limited power to predict MI. In contrast, ECG evidence of ST segment elevation or depression >2 mm appears to be a reliable discriminator of which patients are at risk for MI. Patients without significant ST segment changes are at very low risk for MI and may not require performance of the rule-out MI protocol or hospital admission ii clinically stable. CT Am Coil Cardiol 20

关键词：心房颤动/并发症心房颤动/诊断心房颤动/流行病学胸痛/诊断胸痛/流行病学胸痛/病因学诊断鉴别心电描记术发病率心肌梗死/诊断心肌梗死/流行病学心肌梗死/病因学预后前瞻性研究危险因素敏感性与特异性老年人女(雌)性人类男(雄)性

来源：评论

学校读者我要写书评

暂无评论

Risk factors for thromboembolism in patients with paroxysmal atrial fibrillation

引用

AMERICAN JOURNAL OF CARDIOLOGY 2000年第8期86卷 852-855页

作者： Inoue, H Atarashi, H Toyama Med & Pharmaceut Univ Dept Internal Med 2 Toyama 9300194 Japan Nippon Med Sch Dept Internal Med 1 Tokyo 113 Japan

There is some controversy concerning which clinical characteristics predict thromboembolism and whether treatment with class I antiarrhythmic drugs reduces thromboembolim in patients with paroxysmal atrial fibrillation (AF), This retrospective, multicenter study was undertaken to determine risk factor or factors for thromboembolism in patients with paroxysmal AF. Seven hundred forty patients with paroxysmal AF (mean age 56 years) without prior thromboembolic events were followed retrospectively. Cerebral thromboembolism, including transient ischemic attack and embolism of peripheral arteries, were selected as primary end points, Independent risk factors were determined with multivariate analysis, and event-free survival curves were estimated. During 3.4-year follow-up period, primary end points occurred in 55 patients (2.2% per year). Patients with thromboembolism had a higher prevalence of underlying heart disease (p <0.01), less frequent treatment with antiarrhythmic drugs (p <0.01), and received diuretics more often (p <0.01) compared with patients without thromboembolism, Age (greater than or equal to 65 years, RR 3.33, p = 0.0001) and gender (male, RR = 2, p = 0.0291) emerged as predictors of thromboembolism by multivariate analysis with Cox's proportional hazard model. Treatment with antiarrhythmic drugs (RR = 0.57, p = 0.0578) and aspirin (RR = 0.52, p = 0.1094) showed trends coward reducing thromboembolic risks. It is suggested that elderly men (greater than or equal to 65 years) with paroxysmal AF are at risk for thromboembolism, but the risk tended to be reduced by treatment with antiarrhythmic drugs and aspirin. (C) 2000 by Excerpta Medica, Inc.

关键词：心房颤动/流行病学比例危险度模型回顾性研究危险因素血栓栓塞/流行病学女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Subclinical hyperthyroidism as a risk factor for atrial fibrillation

引用

AMERICAN HEART JOURNAL 2001年第5期142卷 838-842页

作者： Auer, J Scheibner, P Mische, T Langsteger, W Eber, O Eber, B Gen Hosp Wels Dept Internal Med 2 Div Cardiol & Intens Care A-4600 Wels Austria Polyclin Barmherzige Bruder Dept Internal Med Graz Austria

Objectives Atrial fibrillation is a well-known manifestation of hyperthyroidism. We studied whether subclinical hyperthyroidism with low serum thyrotropin concentrations and free thyroid hormone concentrations within the normal range in clinically euthyroid persons is a risk factor for subsequent atrial fibrillation. Methods We studied 23,638 persons. The subjects were classified according to their serum thyrotropin concentrations: group 1 comprised those with normal values of serum thyrotropin concentration (>0.4-5.0 mU/L) and free tri-iodothyronine and free thyroxine concentrations were within the normal range (22,300 subjects), group 2 comprised those with both low serum thyrotropin values (less than or equal to0.03 mU/L) and elevated free tri-iodothyronine and free thyroxine concentrations (725 subjects), and group 3 comprised those with low values of serum thyrotropin (<0.4 mU/L) and free triiodothyronine and free thyroxine concentrations were within the normal range (613 subjects). Results Atrial fibrillation was present in 513 persons (2.3%) in group 1 with normal values for serum thyrotropin, 100 (13.8%) in group 2 with overt hyperthyroidism, and 78 (12.7%) in group 3 with subclinical hyperthyroidism. The prevalence of atrial fibrillation in patients with low serum thyrotropin concentrations (<0.4 mU/L) was 13.3% compared with 2.3% in patients with normal values for serum thyrotropin (P < .01). The relative risk of atrial fibrillation in subjects with low serum thyrotropin and normal free tri-iodothyronine and free thyroxine concentrations, compared with those with normal concentrations of serum thyrotropin, was 5.2 (95% CI 2.1-8.7, P < .01). Conclusion A low serum thyrotropin concentration is associated with a >5-fold higher likelihood for the presence of atrial fibrillation with no significant difference between subclinical and overt hyperthyroidism.

关键词：心房颤动/血液心房颤动/流行病学共病现象甲状腺功能亢进症/血液甲状腺功能亢进症/流行病学危险因素促甲状腺素/血液甲状腺素/血液三碘甲状腺原氨酸/血液人类中年人

来源：评论

学校读者我要写书评

暂无评论

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案：

请选择收藏分类：

通借通还

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：