| Impact of renal insufficiency on all-cause death, cardiovascular death and thromboembolism events in non-vavular atrial fibrillation patients aged over 45 yearsObjective This study aimed to investigate the effects of serum Cystatin C concentration on the risks of all-cause death,cardiovascular death and thromboembolism events in elderly non-vavular atrial fibrillation patients without chronic renal insufficiency.Methods 356 elderly non-vavular atrial fibrillation patients without chronic renal insufficiency were selected from cases in the PLA General Hospital from July 2008 to June 2010 in this retrospective study. The baseline characteristics and clinical adverse events were recorded. The patients were divided into two groups according to the median of baseline serum Cystatin C concentration(1.15mg/L). Logistic analysis and multivariate Cox regression analyses were adopted to calculate the adjusted hazard ratio (HR) of elevated serum Cystatin C concentration for clinical adverse events.Results During a mean follow-up period of 37.83 months, the baseline serum Cystatin C level was closely associated with creatinine and eGFR.Over 75 years, current smoking, heart failure and left ventricular hypertrophy were independent risk factors of elevated serum Cystatin C concentration. During the follow-up period,97 patients died of all-cause death and 27 patients died of cardiovascular deaths. A total of 74 patients had thromboembolism events (stroke or TIA or peripheral arterial thromboembolism) and 56 patients had cardiovascular events (acute myocardial infarction and/or acute heart failure). After adjust for other tranditional risk factors, elevated serum Cystatin C concentration was an independent predictor of the all-cause death (HR:1.936,95%CI:1.247-3.008, P=0.003), cardiovascular death (HR:3.695, 95%CI:1.536-8.889, P=0.004), thromboembolism event (HR:1.725,95%CI: 1.055-2.819, P=0.030) and cardiovascular event (HR:2.184,95%CI:1.197-3984, P=0.011).Conclusions After adjust for other traditional risk factors, elevated serum Cystatin C concentration was an independent risk factor for all-cause death, cardiovascular death, thromboembolism event and cardiovascular event in elderly non-vavular atrial fibrillation patients without chronic renal insufficiency.Effect of serum Cystatin C on risks of death, cardiovascular deathand thromboembolism events in elderly noii-vavular atrial fibrillation patients without chronic renal insufficiencyObjective This study aimed to investigate the recurrence rate and the burden of atrial fibrillation (including asymptomatic atrial fibrillation) and the impacts of renal insufficiency, left atrial volume index,and the atrial fibrillation burden on the risks of thromboembolism events in elderly non-vavular paroxysmal atrial fibrillation patients with implanted cardiac pacemakers.Methods 148 consecutive elderly paroxysmal atrial fibrillation patients after cardiac pacemaker implantation were selected from cases in the PLA General Hospital from January 2012 to December 2013 in this prospective observational study. The baseline characteristics, the recurrence rate, the burden of atrial fibrillation, and clinical adverse events were recorded.The patients were divided into three groups according to the burden of recurrence of atrial fibrillation. Multivariate Cox regression analysis was adopted to calculate the adjusted hazard ratio (HR) of renal insufficiency, left atrial volume index, and the burden of atrial fibrillation for thromboembolism events.The areas under the curves were compared among different scoring systems in predicting thromboembolism events.Results During an average of 22.79±7.03 months follow-up period,85 patients with recurrence of atrial fibrillation,34 patients with high intensity burden of atrial fibrillation, and 23 patients with asymptomatic atrial fibrillation were found. Logistic regression analysis showed left atrial volume index was an independent risk factor for both recurrence and high intensity burden of atrial fibrillation. After adjust for CHADS2 score system, renal insufficiency (eGFR<60ml/min/1.73m2) and left atrial enlargement (LAVI>28ml/m2) were both independent predictors of the thromboembolism events. The C statistics of R2CHADS2L score and R2CHA2DS2VAScL score in predicting thrombotic events were 0.740 and 0.749,which were both higher than that of CHADS2 score (P<0.05), but not higher than that of CHA2DS2VASc score.Conclusions Left atrial enlargement could predict the recurrence and high frequency of recurrence of the atrial fibrillation in elderly patients with paroxysmal atrial fibrillation. R2CHADS2L score and R2CHA2DS2VAScL score might be better than CHADS2 score in predict thromboembolism events in elderly patients with paroxysmal atrial fibrillation, but were not superior to CHA2DS2VASc score.Effects of renal insufficiency, left atrial volume index, and atrial fibrillation burden on thromboembolic events in elderly paroxsmal atrial fibrillation patients with implanted cardiac pacemakersObjective This study aimed to investigate whether renal insufficiency was an independent risk factor for thromboembolism events, all-cause death and cardiovascular death in patients with non-vavular atrial fibrillation aged over 45 years.Methods 825 patients with non-vavular atrial fibrillation aged over 45 years were selected from cases in the PLA General Hospital from July 2008 to June 2011 in this retrospective study. The baseline gerenal conditions, diseases, laboratory examinations, echocardiography parameters and adverse events during the observation period were recorded. The patients were divided into two groups according to the baseline glomerular filtration rate. Logistic analysis and multivariate Cox regression analyses were adopted to calculate the adjusted hazard ratio (HR) of renal insufficiency for clinical adverse events.Results The prevalence rate of renal insufficiency (eGFR<60ml/min/1.73m) was 21.09% in the 825 non-vavular atrial fibrillation patients without anticoagulation therapy. Over 75 years, female, diabetes mellitus, heart failure and left ventricular hypertrophy were independent risk factors of chronic renal insufficiency. During a total of 2279.58 man years’follow-up (mean 33.16±22.24 months),209 patients died of all-cause death and 61 patients died of cardiovascular death. A total of 139 patients had thromboembolism events (stroke or TIA or peripheral arterial thromboembolism) and 133 patients had cardiovascular events (acute myocardial infarction and/or acute heart failure). The all-cause mortality, cardiovascular mortality and rates of thromboembolism events and cardiovascular events were higher in patients with chronic renal insufficiency than those in the control group (P<0.05). After adjust for CHA2DS2VASc score, renal insufficiency was an independent predictor of the all-cause death (HR:1.794,95%CI:1.330-2.419, P<0.001), cardiovascular death (HR:2.865, 95%CI:1.706-4.811, P<0.001), thromboembolism events (HR:1.636,95%CI: 1.121-2.388, P=0.011) and cardiovascular events (HR:2.371,95%CI:1.651-3.404, P<0.001). In addition, left atrial enlargement (LAVI>40ml/m2) was an independent risk factor of all-cause death, thromboembolism events and cardiovascular events, but not for cardiovascular death.Conclusions After adjust for CHADS2 score or CHA2DS2VASc score, chronic renal insufficiency was an independent risk factor for death, cardiovascular death, thromboembolism event and cardiovascular event in non-vavular atrial fibrillation patients without anticoagulation therapy. Left atrial enlargement was independently associated with all-cause death,thromboembolism event and cardiovascular event. |
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